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 6 / 12 Knowledge and attitude scores The median composite scale assessing the respondent’s knowledge was 9 out of 14 (64.3%), with an IQR of 7–10, suggest- ing moderate levels of knowledge. Only 77 students (24.76%) knew what their university or hospital was doing to address its carbon footprint or were familiar with the Planetary Health Pledge (n = 88, 28.30%). The mean attitude score was 50 out of 70 (71.4%), with an IQR of 44–54, suggesting generally positive attitudes. Most students agreed or strongly agreed that med- ical schools should include mandatory coursework on climate change and its impact on health in their curriculum (n = 248, 79.74%), felt responsible for advocating for policies that address climate change to protect public health (n = 229, 73.63%), and believed that addressing climate change should be a core competency for all healthcare professionals, regardless of specialty (n = 224; 72.03%). Respondents were also optimistic about pursuing additional training to learn more about the association between climate change and health and participating in research projects related to climate change and health (65.27% and 68.81%, respectively). Most respondents denied willingness to personally engage in behaviors to combat climate change; only 24.76% (n = 77) were willing to receive a lower salary as residents to support sustainability initiatives within their hospitals (Fig 1). Respondents who graduated from medical schools in Europe had significantly higher attitude

scores than those from the MENA region (β = 4.28, p = .02). Also, those who chose surgery/surgical specialty as a residency specialty had significantly higher attitude composite scores than medical specialties (β = 3.05, p = .02) (S1 Table). Factors associated with knowledge and attitudes toward climate-related health issues Chi-squared analysis was done to study the association between education level, age, gender, region of study, and res- idency choice (Table 3). Receiving climate change-related education was shown to be significantly associated with the study region, with medical students from Asia reporting the highest rates of receiving formal education on climate change (46.94%) while the MENA region students reported the lowest (16.75%) (p < .001). Linear regression analyzing the knowledge score predictors revealed that receiving formal education on climate change was significantly associated with a higher knowledge composite score (β = 1.23, p < .001) (S2 Table). Having a higher knowledge composite score was positively associated with a higher composite attitude score (β = .71, p = .002), suggesting that increased knowledge may contribute to shaping more positive attitudes toward the subject (S1 Table). Table 2. Climate change topics taught in medical school and teaching formats (N = 78). Topic n (%N) Impact of climate change on public health 73 (93.59) Basic principles of climate change 65 (83.33) Environmental health and climate change 63 (80.77) Effects of climate change on infectious diseases 62 (79.49)

Effects of climate change on chronic diseases 51 (65.38) Strategies to prepare the healthcare sector to deal with the impacts of climate change on health 44 (56.41) Policy implications and advocacy related to climate change and health 42 (53.85) Teaching format Formal lectures 70 (89.74) Small group discussions 44 (56.41) Case based learning 42 (53.85) Problem based learning 38 (48.72) Computer based learning 27 (34.62) Clerkships or clinical rotations 23 (29.49) Simulation or Standardized Professional patients 17 (21.79) https://doi.org/10.1371/journal.pone.0330875.t002