Factors influencing medical students’ knowledge and attitudes toward climate change: A cross-sectional study

PLOS One | https://doi.org/10.1371/journal.pone.0330875 October 10, 2025 4 / 12 included 14 multiple-choice knowledge questions on the effects of climate change on health. A cumulative score was computed by summing each participant’s responses, with a score of 1 assigned for correct answers and 0 for incorrect answers. The maximum possible cumulative score was 14, with higher scores indicating more climate change-related knowledge. The final section consisted of 14 items measuring personal attitudes to climate change. These items used a 5-point Likert-like scale ranging from strongly disagree (1) to strongly agree (5). The maximum possible score was 70, with higher scores correlating with more positive attitudes towards climate change education and sustainability practices. Data collection A total population sampling approach was used, in which all applicants to residency training programs at two academic medical centers in the UAE for the 2024–2025 academic year were invited to participate. The sample size was not deter- mined a priori through formal power calculations as the study aimed to include the entire population of eligible appli- cants to obtain a comprehensive assessment of their knowledge, attitudes, and education related to climate change and health. The UAE was selected as the study site because it is vulnerable to the health impacts of climate change, includ- ing extreme heat, air pollution, and water scarcity [24]. The country’s structured, competency-based medical education

system attracts graduates from across the MENA region and internationally [25], making it a strategic location to assess climate change-related knowledge and attitudes among future physicians. We focused on recently graduated medical students to capture perspectives at a pivotal stage in their professional development- when they are transitioning into clinical roles and positioned to influence healthcare practice and policy. The two academic medical centers included in this study are the largest training institutions in the UAE with a large, diverse applicant pool, allowing for insights that may be transferable to other regional health systems facing similar environmental and educational challenges. After approval by each institution’s research ethics committee, email addresses of the applicants were obtained from institution education departments. Administrators who were not involved in residency recruitment or training sent each applicant an e-mail invitation and an individual link to an online survey. The email described the purpose of the study and explained that it was anonymous and confidential. Participation was voluntary, and no incentives were offered. No IP addresses were collected for this study. The first page of the questionnaire included a consent statement. Participants who provided the written consent were able to proceed to the survey questions. Data were collected between May 6 and October 21, 2024. Data analysis Data were analyzed using R (version 4.2.3). Descriptive statistics were used to measure the frequency of the variable

tabulation. Linear regression models were used to measure the predictors for knowledge and attitude. Chi-squared was used to determine the associations between formal education on climate change and demographics. The assumptions of the test were evaluated. All variables included in the chi-squared tests were categorical, and expected cell counts were examined to ensure that no more than 20% of cells had expected counts less than 5. When this assumption was violated, Fisher’s exact test was used instead. For continuous variables, normality was assessed using the Shapiro-Wilk test. Nor- mally distributed data were reported as mean ± standard deviation, while non-normally distributed data were reported as median with interquartile range (IQR). A p-value of <.05 was considered statistically significant. The datasets can be found in S3 File. Ethical approval All methods were performed in accordance with all relevant guidelines and regulations of the Declaration of Helsinki. The study was approved by the Sheikh Khalifa Medical City Research Ethics Committee (RS-854) and the Mohammed Bin Rashid University Institutional Review Board MBRU-IRB (2024−579).