Training Future Surgeon Leaders in Environmental Stewardship: A Review of a Decade of the Health Care Sustainability Fellowship

Jenny H Chang; Moustafa Moussally; Mujtaba Mubashir; Kimberly Woo; R Matthew Walsh; Ilyssa O Gordon; Jon Utech; Sofya Asfaw; Benjamin T Miller

doi:10.1016/j.jsurg.2024.03.017

Training Future Surgeon Leaders in Environmental Stewardship: A Review of a Decade of the Health Care Sustainability Fellowship

J Surg Educ. 2024 May 14:S1931-7204(24)00164-8. doi: 10.1016/j.jsurg.2024.03.017. Online ahead of print.

Authors

Jenny H Chang¹, Moustafa Moussally², Mujtaba Mubashir², Kimberly Woo², R Matthew Walsh², Ilyssa O Gordon³, Jon Utech⁴, Sofya Asfaw², Benjamin T Miller²

Affiliations

¹ Cleveland Clinic, Department of General Surgery, Cleveland, OH 9500 Euclid Avenue, A100, Cleveland, Ohio. Electronic address: Changj7@ccf.org.
² Cleveland Clinic, Department of General Surgery, Cleveland, OH 9500 Euclid Avenue, A100, Cleveland, Ohio.
³ Cleveland Clinic, Department of Pathology, Cleveland, OH, 2049 East 100th Street, Cleveland, Ohio; Cleveland Clinic, Sustainability, Cleveland, OH, 9500 Euclid Avenue, A100, Cleveland, Ohio.
⁴ Cleveland Clinic, Sustainability, Cleveland, OH, 9500 Euclid Avenue, A100, Cleveland, Ohio.

PMID: 38749811
DOI: 10.1016/j.jsurg.2024.03.017

Abstract

Objective: Since the inception of Ken Lee Memorial Fellowship (KLMF) in 2013, our institution has achieved 10 years of trainee led sustainability projects. The ability of health care organizations to drive sustainability depends on organizational and human capacity. This qualitative study presents the first decade of sustainability fellows' projects, the challenges associated with implementing them, and the environmental and cost impact of these initiatives.

Design, setting, participants: All residents in the General Surgery residency program at the Cleveland Clinic, a quaternary hospital, regardless of postgraduate year (PGY) level, are invited to apply for the KLMF program with a short project proposal. One fellow is selected per year. Each project since the program's inception was reviewed qualitatively, relying on data derived from observation, interview of prior fellows, and supervising staff, and analysis of documentation from the annual fellow presentation and abstract, Grand Rounds recording, and fellowship leadership.

Results: A targeted approach by each sustainability fellow is encouraged, with the following action cycle for change implementation throughout the 1-year fellowship: identification and discovery of an issue, collaborative planning of an intervention, implementation of the intervention, and evaluation. Projects range from water and waste reduction to education of surgical staff, with positive implications for environmental stewardship in our hospital. However, multiple barriers to completing, scaling, and maintaining sustainability initiatives remain, as demonstrated by challenges faced by our Ken Lee Fellows.

Conclusions: Our goal is that this intensive educational experience within the framework of a graduate medical education curriculum will ensure future generations of surgeons who are thoughtful leaders in environmental stewardship.

Keywords: climate change; healthcare sustainability; surgical education.