By implementing peer education in sustainability practices, Central Coast Local Health District is empowering junior medical officers to act as sustainability champions and help the district meet its Net Zero targets.
Central Coast Local Health District (CCLHD) has committed to Net Zero greenhouse gas emissions by 2050, with an interim target of 50% by 2030. Junior medical officers (JMOs) are well placed to act as champions for sustainable healthcare.
JMOs can have a significant impact on healthcare associated emissions through their daily clinical decision-making. Despite this, sustainability practices in healthcare are not required learning in the teaching schedule for JMOs. At the time of this project, CCLHD had nearly 70 JMOs and 156 resident medical officers (RMOs) – also referred to as postgraduates of two years or more (PGY2+) – in general rotations. In 2024, we integrated JMO-led sustainability education into their teaching programs within CCLHD.
We developed two short sustainability teaching modules for JMOs, and one longer teaching session for RMOs that provided an overview of environmental sustainability in healthcare, as well as a focus on practical strategies to improve sustainability within clinical practice.
Micro-learning modules focused on practical strategies
In 2024, we presented an overview on sustainability in healthcare alongside district-specific project examples to a cohort of approximately 70 JMOs during their orientation. In CCLHD, interns attend one hour of weekly teaching, usually based on clinical topics.
We initiated micro-learning modules focusing on practical strategies to improve sustainability in their clinical practice that could be delivered in 5-10 minutes, once per 10-week term. Topics included rationalising investigations such as pathology and imaging. Each module was presented by a JMO Environmental Sustainability Champion, as near-peer teaching was predicted to create a more conducive and positive learning environment for the interns.
RMOs generally have one day allocated as an education day per 10-week term, so we organised an annual 45-minute sustainability presentation. This was delivered by our CCLHD Environmental Sustainability Officer and a staff specialist who was also nominated as a local environmental sustainability champion. Given that RMOs likely had a deeper understanding of the healthcare system compared to JMOs, the presentation provided them with a more holistic perspective of environmental sustainability in healthcare, as well as encouragement to be agents of change within their own departments and communities. We used pre- and post-teaching surveys for both JMOs and RMOs to evaluate:
- their understanding of environmental sustainability in healthcare
- their preparedness to implement sustainability into clinical practice
- the importance of environmental sustainability to their clinical practice.
To monitor the efficacy of these sessions, we plan to continue the pre- and post-teaching surveys, as well as request feedback from the JMOs wherever available.
Improving understanding of sustainability in clinical practice
Throughout this process, we have found that short, practical modules are effective teaching methods. They allow JMOs to improve their understanding and implementation of sustainability principles within clinical practice. Pilot surveys of the JMOs teaching modules in Term 3 (rationalising pathology testing) and Term 4 (rationalising imaging investigations) showed significant improvement in understanding of environmental sustainability and preparedness to implement sustainability into clinical practice.
Term 3: Rationalising Pathology Testing (13 respondents)
- Understanding of Environmental Sustainability in Healthcare:
- pre-teaching 30% rated ‘good’ or above
- post-teaching 93% rated ‘good’ or above
- How prepared do you feel to implement sustainability within your clinical practice?
- pre-teaching 15% answered ‘prepared’ or ‘well-prepared’
- post-teaching 76% answered ‘prepared’ or ‘well-prepared’
Term 4: Rationalising Imaging Investigations (10 respondents)
- Understanding of Environmental Sustainability in Healthcare:
- pre-teaching 15% rated ‘good’ or above
- post-teaching 76% rated ‘good’ or above
- How prepared do you feel to implement sustainability within your clinical practice?
- pre-teaching 56% answered ‘prepared’ or ‘well-prepared’
- post-teaching 70% answered ‘prepared’ or ‘well-prepared’
Peer-led teaching is empowering
We found that most interns surveyed felt environmental sustainability was important or very important to their clinical practice. Given the nature of shift work and the split in term allocations across multiple hospital sites, not all interns could attend each teaching module, which was reflected in the low survey participant number. However, this highlights the need for the sessions to be delivered regularly each term to reinforce key concepts for interns.
In contrast to the interns, the RMOs cohort was diverse. Out of a total 156 RMOs in general rotations, 101 of them were international medical graduates. From a survey of 48 participants, only 20% recalled receiving environmental sustainability education during medical school.
Following the 45-minute teaching session delivered by our sustainability champion and our environmental sustainability officer, RMOs increased their understanding of environmental sustainability in healthcare, with 46% rating themselves as ‘prepared’ or ‘well-prepared’ pre-teaching compared to 91% post-teaching; and with preparedness to implement sustainability within their clinical practice, 46% rating themselves as (pre-teaching 46%, post-teaching 98%).
Similarly to the JMOs, 96% of RMOs believed that environmental sustainability was ‘important’ or ‘very important’ to their clinical practice.
In summary, teaching sessions delivered by leaders in sustainability are effective in empowering JMOs and RMOs to implement sustainability into their clinical practice. Ongoing sustainability education integrated within regular teaching schedules is paramount to reinforcing positive cultural change, applicable not only for JMOs, but also the wider healthcare community. In 2025, we plan to deliver five sustainability teaching modules, one per term for JMOs, and continue with the annual longer session for the RMOs.
References
- Australian Government. National Waste Policy Action Plan. Canberra, ACT: Australian Government; 2024 [updated 30 Sept 2025].
- Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health. 2018;2(1):e27-e35. DOI:10.1016/S2542-5196(17)30180-8
- NSW Health. NSW Health Climate Risk & Net Zero Unit: Position Statement. NSW: NSW Health; 2022 [updated July 2022].
