Education about planetary health and sustainable healthcare: A national Delphi panel assessment of its integration into health professions education in South Africa

Background. Education about planetary health (PH) and sustainable healthcare (SH), or education for sustainable healthcare (ESH), enables healthprofessionals to help protect public health and healthcare from climate change and environmental degradation. The Association for Medical Education in Europe Consensus (AMEE Consensus) Statement on Planetary Health and Education for Sustainable Healthcare has proposed a set of ESH learning objectives, activities and assessments for adaptation to different health professions education (HPE) contexts. The national audit phase of a mixed methods study in South Africa (SA) found that awareness of ESH and its curriculum development is emerging. The African Medical Education Directives for Specialists (AfriMEDS) is a competency framework for undergraduate medical students in SA that defines key competencies and enabling competencies related to seven roles of a health professional. Objectives. To recruit a national Delphi panel of health professions educators to assess the applicability of the AMEE Consensus learning objectives, activities and assessments to HPE in SA; to elicit panellists' perceptions of the main barriers and opportunities for ESH in faculties; and to compare learning objectives recommended by AMEE and the panel for key competencies and enabling competencies within the AfriMEDS framework. Methods. Nine educators from three different disciplines and six national faculties of health sciences participated in two rounds of a Delphi process and in follow-up discussions. In round 1, they rated the AMEE Consensus learning objectives, activities and assessments, and proposed additional ones. In round 2, they rated the score-ranked AMEE lists, as well as relevant additions from round 1. All panellists participated in further discussions regarding applicability, and highlighted the potential barriers and opportunities for integrating ESH into their faculties. The lead author then matched the panel's learning objectives with enabling competencies related to all seven health professional roles described by AfriMEDS. Results. All panellists recognised the importance of ESH in SA and the need for eco-ethical leadership by health professionals. All 13 AMEE Consensus learning objectives, as well as three additional objectives from the panel, were matched most frequently with AfriMEDS-enabling competencies related to the roles of leader and manager (n=9), communicator (n=8) and healthcare practitioner (n=7). Panellists highly ranked learning activities and assessments that are authentic, multiprofessional and require systems thinking. They perceived the lack of capable educators and curriculum overload to be the main barriers to integration of ESH, as well as the need for strong leaders, disciplinary champions and trained educators. Conclusions. Situating the selected learning objectives within the AfriMEDS competency framework provides a good basis for developing aligned learning activities and assessments of ESH. Strong leadership, capable educators and multidisciplinary collaboration are important enablers of integrating ESH into HPE in SA.