Effect of clinical vignettes on senior medical students' opinions of climate change

OBJECTIVES: The consequences of climate change directly threaten human health. Some have argued that, as such, doctors have a special duty to solve climate change. Despite such recommendations, to our knowledge, there has been no previous work documenting physician attitudes on climate change, or the stability of those opinions. METHODS: We invited 523 fourth-year medical students to a survey asking their opinion on climate change and their opinion regarding one of two fictional medical vignettes. In the vignettes, which are analogous to the climate change issue, students decide whether to discontinue a drug that may be adversely affecting laboratory values. In the climate change question, students are asked whether the United States should take efforts to discontinue the use of fossil fuels. Students are randomized to the order in which they receive the questions. RESULTS: Ninety-five percent (95% CI 89.1%-100%) of students initially asked about climate change feel the United States should take steps to curb carbon dioxide emissions, while only 73% (95% CI 57.5%-89.2%) of students respond similarly if first given an analogous patient vignette. Conversely, in all cases where a fictional medical vignette follows the climate change question, students are more likely to cease using a potentially harmful agent (66% CI 53.5%-71.8% vs. 52% CI 43.3%-67.1%). CONCLUSION: Our results suggest that student physician attitudes to climate change are mutable. Priming students into "medical mode" may alter their opinions on the scientific merit of nonmedical issues, and may be a vestige of a hidden medical curriculum. Further studies should explore the interrelationship between other sociopolitical beliefs and medical decision making.