Teaching Climate and Environmental Health: a problem- and competency-based educational approach

Background

Environmental changes such as climate change threaten human health in multidimensional ways, directly or indirectly, conditioning health determinants. A health workforce capable of acting on environmental health (EH) is fundamental to build climate-resilient health systems and services. Lifelong learning is a key instrument to develop competencies. In Italy, this is made more equitable and accessible through distance-learning (DL).

Objectives

Italy’s Complementary National Plan funded a training program of 14 DL courses to create an EH-literate workforce nationwide. Topics were determined through training-need assessment. A panel of experts was asked to identify course objectives and competencies, as suggested in competency-based education. The courses were built through a problem-based learning approach. The National Institute of Health supplied the first edition of the courses via EDUISS, its DL platform, from April to December 2025. This work investigates Kirkpatrick’s first 3 levels of training evaluation: 1) “Did learners enjoy training?”; 2) “Did learning transfer occur?”; 3) “Did the training change behavior?”.

Results

Of the 31˙696 users enrolled, 67% were women, 58% had ≥ 46 years of age and 35% were nurses. Of those who started the course, 53% completed it. On a Likert scale from 1 to 5, mean cumulative satisfaction was 4.47. The difference between pre- and post-test evaluation was 10%. In addition, a statistically significant difference in Knowledge Attitude Practice Behaviour (KAPB) questionnaires before and after the course was found with Wilcoxon signed-rank test (K: z = 79, p < 0.001; A: z = 27, p < 0.001).

Conclusions

To our knowledge, this is the first lifelong DL program on EH in Italy. Preliminary results show high satisfaction, acceptable learning transfer and good behavioural change. Nevertheless, to answer Kirkpatrick’s fourth question on performance, a 6-month post-course follow-up is necessary.

Key messages

• Building a climate-competent health workforce is essential for resilient health systems; lifelong learning in environmental health is a key driver of these competencies.

• Distance learning improves equitable access to environmental health training in Italy, showing high satisfaction, good knowledge transfer, and positive behavioural change.