Conceptual Frameworks, Competencies, Contents and Teaching Methods in Planetary Health Education for Health Students and Professionals: A Global Systematic Scoping Review

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Urgent transdisciplinary, intersectoral, and holistic solutions adapted to local realities are needed. Designing training programs attuned to contextual needs of diverse groups and geographical areas is crucial. Planetary health programs are emerging worldwide, but little is known about their scope and learning outcomes. A systematic scoping review is needed to shed light on the state of planetary health education. Objectives: This review aims to identify existing frameworks, competencies, content, and teaching methods in planetary health education. Methods: Following PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines, we included studies targeting undergraduate and postgraduate students, focusing on skills, knowledge, and abilities related to planetary health, published in English or Spanish. No exclusions were made based on geographic area, study design, or publication period. Databases consulted were MEDLINE via PubMed, Scopus, Web of Science, and ProQuest. Selection and data extraction processes were conducted systematically. Results We included 73 articles, with 88% from high-income countries and 49% focused on health professionals. Conceptual frameworks identified include "One Health," "Sustainable Development Goals," and the "Planetary Health Education Framework." Transversal skills (complex problem-solving, systemic thinking, collaboration, interdisciplinary) and specific competencies (understanding health interactions with climate change, pollution) were outlined in 45% of studies. Half of the studies described 23 general topics and 93 specific content areas. Teaching methods included in-person (59%), virtual (12%), and hybrid models (29%). Conclusions This review highlights the heterogeneity in conceptual frameworks, competencies, content, and teaching methods in planetary health education for health professionals. Future research should focus on developing and evaluating evidence-based educational models to address the evolving challenges of planetary health. Recommendations include enhancing collaboration among stakeholders and integrating innovative teaching methods to improve planetary health education. Protocol Registration The protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024). Clinical trial number: not applicable Systematic scoping review Planetary Health education capacity building curriculum development instructional design health professionals Figures Figure 1 Figure 2 Introduction Background The Anthropocene era has brought significant global health improvements (1,2)including a doubling of life expectancy to 72.6 years by 2019. However, these gains have come at the cost of unsustainable resource consumption and environmental degradation (3)exceeding six of nine planetary boundaries (4,5) Health benefits remain unequally distributed, with life expectancy in 2021 ranging from 52.5 years in Chad to 84.8 years in Japan (6) and disparities also evident within nations. Addressing these challenges requires Planetary Health education that promotes health equity and sustainability while recognizing the urgent need to balance human development with the planet's finite resources (7) Rationale In 2015, coinciding with the launch of the Sustainable Development Goals (SDG) by the United Nations, the Rockefeller Foundation and the Lancet Commission defined Planetary Health as "the maximum achievement of health, well-being and equity through a use of the Earth's natural resources that is within limits that allow humanity to prosper, without compromising the economic, political and social systems of future generations" (1). This concept builds upon previous notions of environmental sustainability, global health, environmental epidemiology, and “One Health”, emphasizing inter- and transdisciplinary collaboration, solutions-oriented strategies, and health co-benefits. Knowledge gap Recent reports from the Intergovernmental Panel on Climate Change (IPCC)(8), the United Nations Environment Program (UNEP), and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) (9) have further underscored the urgent need for action at all levels to adapt, mitigate and reverse the impacts of the climate crisis on global health. The challenges are complex, transversal and unevenly distributed, vulnerable communities, particularly in low- and middle-income countries, facing disproportionate risks due to factors such as geographical location, political instability, population density, and resource dependency (10). The pressure on natural systems, understood as the excessive use of resources, deforestation, changes in land use, or the consumption, resource and energy needs of an increasingly "westernized" population, also increases susceptibility to zoonotic diseases and future pandemics (11). Adaptation therefore requires systematic transitions towards a more sustainable society, operating within the limits of the planet in a fair and equitable way. This implies fundamental changes, ranging from an energy transition, rethinking of food systems and habits, urban planning, and land use. For this reason, it is important to acquire new skills and abilities across various professional areas and incorporate transdisciplinary approaches. To achieve this, we need to train competent and committed people across the world, in order to drive research and transformation at a "glocal" level (both local and global). With this review we aim to map the most relevant conceptual frameworks, competencies, contents, and teaching methods in this field making it possible to improve quality of future capacity building strategies in planetary health. Objectives Universities play a pivotal role in training professionals equipped to address these complex challenges through high-quality research and transdisciplinary approaches. As highlighted in the 2019 United Nations report (12) and the São Paulo Declaration on Planetary Health, there is a growing demand for Planetary Health education across all curricular levels (13). This training is crucial for fostering a generation of leaders capable of driving research, innovation, and transformative change at both global and local levels. Search for Existing Reviews While the number of Planetary Health courses is increasing, they often remain as elective or supplementary modules, primarily available in high-income countries such as Canada, Scotland, England, Switzerland, the Netherlands, the United States or Spain. There is a pressing need to expand access to these educational opportunities, particularly in vulnerable regions. By empowering individuals with the knowledge and skills to address the specific needs of their communities, we can foster resilience and promote equitable solutions to the multifaceted challenges of Planetary Health. An international organisation of medical educators has produced a consensus on planetary health and education for sustainable healthcare (14) The consensus consists of learning outcomes, objectives, and strategies to deliver sustainable healthcare education, aiming to raise awareness of healthcare professionals. However, a more comprehensive and systematic scoping review considering broader multidisciplinary scopes beyond health professions education remains necessary. Relevance This systematic scoping review aims to identify generic existing frameworks, competencies, content, and teaching methods in Planetary Health education which could be adapted based on individual school or program needs. This information will be used to co-design a conceptual framework for community-driven training in the field. Results of this systematic scoping review will be relevant to educational practice and the development of the planetary health field. Review Question This global systematic scoping review aims to answer the following review question: What are the conceptual frameworks, competencies, contents, and teaching methods currently used in Planetary Health education for health professionals, and how are these elements applied in different educational contexts?” Methods To explore the complexities and evolving nature of Planetary Health education, a systematic scoping review is employed. This methodology is particularly suited for synthesizing and mapping existing evidence in emerging, complex, or heterogeneous fields, where conducting a precise systematic review might be premature. Systematic scoping reviews are instrumental in clarifying concepts, identifying key elements within the existing literature, and uncovering knowledge gaps that need further research. Importantly, in systematic scoping reviews, the primary focus is on breadth and comprehensiveness rather than on the critical appraisal of individual study quality, allowing for a broad overview of the landscape. This approach aligns with the objectives of this study, which seeks to comprehensively map the current state of Planetary Health education to inform the development of a robust and contextually relevant training framework. The protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024). Search Strategy In line with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) statement (15)a comprehensive search strategy was developed to ensure transparency and reproducibility. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Scopus, Web of Science, and ProQuest. The search terms were structured around three thematic blocks: [A]: Core concepts of Planetary Health (Planetary Health, One Health, environmental health, ecohealth, global health, international health, climate change) [B]: Educational aspects (Capacity Building, training, skills, education, formation, learning, teaching) [C]: Conceptual and structural elements (Framework, system, model, outline, frame). The final search strategy was adopted following an iterative refinement approach. After an initial screening of 50 articles the review team examined the results and iteratively refined the search strategy to maximize the capturing of the diversity of educational approaches in planetary health. The full search strategy for each database is available in Appendix 1 . Appendix 4 shows the previous iterations of the search strategy. Keywords within each block were identified based on prior knowledge and refined through preliminary searches. The search was executed using Boolean operators ('OR' and 'AND'), combining terms as follows: (Block A) AND (Block B) AND (Block C). Given the relatively recent emergence of Planetary Health as a field, the search terms were intentionally broad to capture relevant literature that may use related terminology (e.g., climate and health). However, only articles explicitly aligned with the core principles of Planetary Health mentioned in its definition (1) were included. The search was supplemented by a manual review of reference lists from selected articles. Study Selection The selection of the studies according to the previously described search strategy was carried out and followed considering inclusion and exclusion criteria. Population: Studies focusing on undergraduate, postgraduate, or lifelong learning populations were included, while those targeting primary or secondary education were excluded. Concept: Thematic relevance was ensured by including studies addressing skills, knowledge, content, or basic abilities related to Planetary Health, while excluding those focused on unrelated competencies. Context: The review encompassed studies from any geographic region and various designs, including systematic and narrative reviews, observational studies, and descriptive studies. However, study protocols, letters to the editor, and articles lacking peer review were excluded. Articles published in English or Spanish were considered, while those in other languages were not. The publication period was limited to the last 10 years (2014-2024) due to the fact that Planetary Health concept was officially launched in 2015 (1) Search results were downloaded and managed using Covidence, a specialized systematic review software. After removing duplicates, titles and abstracts were screened independently by two reviewers according to the pre-defined inclusion/exclusion criteria. One of the reviewers was always the same person (CC) while the second one was one of the rest of the team (COG, SOB, AM, IRM, RWR, SML, AF, MLl, DS, CDP, ED, DYF, IW). Full texts of potentially eligible articles were then retrieved and assessed independently by the same reviewers. Disagreements were resolved through discussion or, if necessary, by a third reviewer. Reasons for exclusion were documented at each stage and available in Appendix 2. As this is a scoping review, formal quality assessment of included studies was not conducted. Data Extraction A standardized data extraction form was developed and piloted on a subset of included articles to ensure consistency and comprehensiveness. The following data elements were extracted from each study: Bibliographic Information: Title, authors, publication year, journal, and language. Study Characteristics: Study design and main concept (Planetary Health, One Health, global health). Population Characteristics: Target audience (health professionals, students), professional roles, level of professional development, and sample size (if applicable). Educational Context: Educational level (undergraduate, postgraduate, lifelong learning), geographic context, and any reported conceptual frameworks. Educational Content and Methods: Specific competencies and skills addressed, content areas covered, and teaching methods employed (online, face-to-face, problem-based learning). Study Findings: Key results, conclusions, and recommendations for future research or practice. Data extraction was performed by one reviewer using the standardized form. Data Analysis: The extracted data was analysed thematically in accordance with the instructions of Nowell et al (15)This involves the following steps: 1) understanding the data; 2) creating provisional categories; 3) identifying categories and competencies; 4) revising the categories; 5) defining the categories; 6) final description of the data using the categories. Results Search Strategy and Study Selection The initial database search yielded 7,021 references. After removing 1,454 duplicates (21%), 5,567 unique references remained. These underwent title and abstract screening, resulting in 492 articles selected for full-text review. Of these, 373 were excluded for not meeting the inclusion criteria: lack of relevant intervention (28%, n=103), intervention and/or outcome mismatch (25%, n=92), ineligible population (19%, n=72), lack of relevant outcome (15%, n=57), inappropriate publication type (11%, n=40), wrong language (1%, n=3), or misalignment with the core concept of Planetary Health (1%, n=3). During the data extraction phase, an additional 46 articles were excluded for similar reasons: misalignment with the core concept of Planetary Health (26%, n=12), lack of relevant outcome (22%, n=10), inappropriate publication type (20%, n=9), intervention and/or outcome mismatch (17%, n=8), lack of relevant intervention (13%, n=6) or ineligible population (2%, n=1). A detailed list of excluded studies and reasons is provided in Appendix 2. The study selection process is visually summarized in the PRISMA flow diagram (Figure 1). Study Characteristics The detailed description of the 73 articles included in this systematic scoping review is included in Appendix 3. Only 14 of the included explicitly focused on Planetary Health. The remaining articles addressed related topics, with the most frequent being climate change (n=14), sustainable development (n=12), followed by environmental health (n=8) and the intersection of climate change and health (n=7). Other less frequent topics included One Health and global health (n=6 each), systems thinking (n=2), and public health, environmental education, and global citizenship (n=1 each). The most frequent study design (52%, n=38) involved descriptive analyses of conceptual frameworks, educational objectives, methodologies, or intended competencies. Qualitative methodologies, such as focus groups or semi-structured interviews, were employed in approximately a quarter of studies (26%, n=19). These explored student and teacher perspectives on various modules, courses, or programs, capturing opinions, motivations, feedback, and perceived impacts. A smaller proportion of studies (5%, n=4) utilized mixed methods, combining focus groups with quantitative approaches like questionnaires. Additionally, 12% of the included articles (n=9) were reviews, encompassing three scoping reviews, four narrative reviews, and two systematic reviews. The remaining articles included one cross-sectional study, one pre-post study, and one randomized controlled trial (RCT) that specifically examined the use of refutation texts to counter misinformation on controversial Planetary Health topics. Figure 1: PRISMA diagram – Selection of studies (additional file) Target population Regarding the educational level of the target audience, and considering that only university and post-university studies were included in this review, 60% (n=44) were aimed at undergraduate students, 10% (n=7) at postgraduate students, and 11% (n=8) at lifelong learners. In 15% of studies (n=11), the educational level was not specified between university and post-university level, and in three studies, it was unclear whether the target audience was undergraduate or postgraduate. The primary target audience for the included trainings was health professionals, with 49% (n=36) of studies focusing on various health disciplines: medicine (n=11), nursing (n=8), public health (n=3), pharmacy (n=1), dentistry (n=1), occupational therapy (n=2), psychology (n=1), and general health professionals (n=8). Another 44% (n=32) of studies addressed a mixed audience of health professionals without specifying disciplines. The remaining studies targeted social science professionals (n=2), veterinarians (n=1), and engineers (n=1). Geographical scope of the studies The vast majority of included studies (88%, n=64) originated from high-income countries, with the United States (n=32) being the most represented. Other high-income countries contributing to the studies included Canada (n=3), Great Britain (n=7), Australia (n=6), Japan (n=1), New Zealand (n=1), and various European countries (n=14). In contrast, only 9 studies (12%) were identified from low- and middle-income countries (LMICs), with two studies each from Uganda and Mexico, and one study each from West Africa, East Africa (multi-country), Indonesia, Grenada, and Southeast Asia (multi-country collaboration). Of the 73 studies included, one was published in Spanish, and the remaining 72 were published in English. Objective of the studies The objectives of the included studies varied widely. Some studies (n=20) focused on developing theoretical frameworks to identify the skills required for Planetary Health professionals. Others built upon existing frameworks, aiming to define competencies and learning objectives in greater detail. Several studies also described the content and methodologies used in implementing educational programs, including the development of comprehensive curricula. A subset of studies employed research-based approaches to analyse student and teacher opinions, motivations, and the perceived impact of pilot or established Planetary Health courses. Main Theoretical Frameworks Of the 73 included studies, 28 (38%) described using a total of 20 distinct conceptual frameworks for education in Planetary Health and related fields. Notably, only one framework was explicitly designed for Planetary Health training (16) while the others were adapted from related fields like One Health, Global Health, and the Sustainable Development Goals. Table 1 provides a list of the identified frameworks, the articles that referenced them, and a brief description of each. Among these, the One Health (17), Sustainable Development Goals (18) and the Planetary Health Alliance's Planetary Health Education Framework (16) emerged as the most commonly utilized. Figure 2 offers graphical representations of some of the most relevant and frequently used conceptual frameworks. Table 1 : Conceptual frameworks used in the studies included in the review. (*) Graphical representation of these studies is shown in figure 2. Framework name Articles Description Planetary Health Education (*) n=5 (19–22) Developed by the Planetary Health Alliance, it encompasses five core domains: interconnectedness with nature, equity and social justice, the Anthropocene's health implications, systems thinking and complexity, and transformative movements for systemic change. It aims to integrate local and global perspectives One Health (*) n=5 (23–27) Collaborative, multisectoral, and transdisciplinary framework. It promotes optimal health outcomes through the interconnectedness of people, animals, plants, and their shared environment at local, regional, national, and global levels. The included articles discuss the framework's local adaptation in Central and Eastern Africa (26) and its application in specific disciplines like medicine (25), nutrition (23), and veterinary medicine (27). Sustainable Development Goals (SDGs) (*) n=3 (28,29) Established by the United Nations in 2015, the 17 SDGs comprise a set of interconnected goals aimed at fostering international development. Emphasizes the interdependence of these goals, recognizing that actions in one area can impact outcomes in others, and underscores the need for development to balance social, economic, and environmental sustainability. Drivers, Pressures, State, Impact, Responses (DPSIR) (*) n=1 (30) Explores the complex interactions between society and the environment. Analyses environmental issues by identifying the drivers that generate pressures, leading to changes in the state of the environment. These changes cause impacts that trigger responses aimed at mitigating or addressing these impacts. WEACT-PLEASE (*) n=1 (31) Focuses on 5 domains of the healthcare system that contribute to pollution: waste, energy and water, agriculture and food, chemicals, and transport (WE ACT). It also identifies six key professional elements essential for addressing these issues at a global level: Professional Obligation, Leadership, Education, Responsibility, Science, and Commitment (PLEASE). 5 Ps model of global health: People, Planet, Priority, Practice, Parity (*) n=1 (32) Emphasizes five core domains: Parity (health equity), People (access to healthcare for individuals and communities), Planet (globalization and environmental health), and Priorities (values guiding decision-making), and Practices (data and tools used to address health issues). CARE-KNOW-DO n=1 (33) Emphasizes three key components: CARE (student engagement with real-world issues that resonate and motivate them to learn), KNOW (acquisition of knowledge to understand and discuss solutions), and DO (application of knowledge through actions to solve problems). Medical education needs assessment n=1 (34) Focuses on the specific educational needs of medical professionals in the context of planetary health, addressing domains such as climate change, heat-related illnesses, the impact of extreme weather events and zoonotic diseases, water-borne diseases, and the mental health consequences of natural disasters. Nursing global health competencies n=1 (35) Focuses on a single dimension: the core values and principles of nursing, complemented by seven subcategories: social justice and equity, holistic care, advocacy, health as a human right, sustainability, and collaboration. Also incorporates four key approaches: environmental, care, educational, and competence. Person-in- environment n=1 (36) Central to social work practice, considers the individual within the context of their interacting systems: family, social, political, economic, and, in the current context, the environment, with a global perspective. Socio-ecological- biological n=1 (37) Proposes integrating the human microbiota into human ecology, spanning from the micro level (genome and microbiota) to the macro level (environment) through various levels (individual, community, society). Climate, environmental change, and health (CECH) competence n=1 (38) Encompasses the following domains: climate and environmental science, drivers of climate change, evidence, projections and assessments, iterative risk management, mitigation, adaptation and joint health, benefits and collective strategies. Population health n=1 (39) Offers a unified approach to population health, encompassing public health, health systems, global health, and Planetary Health. UNESCO Education for Sustainable Development n=1 (40) Aligns with the SDGs and focuses on five key areas: advancing policies, fostering learning and collaborative environments, empowering teachers and educators, engaging youth and communities, and strengthening research and knowledge. Human-centred design (HCD) and shared-action learning (SAL) n=1 (41) Combined, these frameworks draw on user-centred design principles (problem-solving, trust-building, immersive experiences, conflict management, empathy, and the customary "design thinking" process in technological development). Community-Based Design Research (CBDR) n=1 (42) Emphasizes an iterative process of innovation, evaluation, and adaptation of the curriculum through multiple cycles. Health in All education n=1 (43) Encompasses a broad range of health determinants and related factors, including social, environmental, and economic aspects. Covers determinants of health, evidence-based interventions, population health, interprofessional relations, community collaboration, environmental and occupational health, global health, cultural diversity, health systems, healthcare financing and budgeting, and health law and policy. Graduate Leadership education for sustainability (GLES) n=1 (44) Focuses on three elements: leadership, sustainability and higher education. Critical thinking, coexistence and resistance (CCR) Education n=1 (45) Emphasizes critical thinking about the climate, environmental, and social costs of fossil fuels, as well as the importance of coexistence with nature and the "other." It also promotes resistance against neoliberalism and other forces that threaten a just transition. GreenSCENT Competence n=1 (46) Encompasses transversal, pragmatic, and applied areas, addressing key components of environmental sustainability: climate change, clean energy, circular economy, green construction, sustainable mobility, food systems, biodiversity, and pollution reduction. One included article (47) specifically reviewed conceptual frameworks, identifying 17 distinct options. However, only three of these (SDG, PHEF, and WE-ACT PLEASE) were also found in the other included studies. The remaining 14 frameworks identified in the review article were not incorporated into Table 1, as they represented a blend of frameworks, teaching methods, and content, rather than standalone conceptual frameworks. Furthermore, some of these 14 frameworks focused narrowly on specific aspects of Planetary Health, such as food or green energy, without addressing the broader, holistic concept. Figure 2: Graphical representation of the most frequently used conceptual frameworks identified in the included studies (*). SDG: Sustainable Development Goals; DPSIR: Drivers, Pressures, State, Impact, Responses; 5Ps: People, Planet, Priority, Practice, Parity (additional file) Main Skills Thirty-three (45%) studies described the skills the different teaching programs aim to develop. Table 2 lists the transversal competencies that, while not specific to Planetary Health, are instead relevant to being able to engage with it. Table 3 highlights skills which are more specific to Planetary Health Table 2: Transversal skills identified in the studies included in the review Transversal skills n articles References Use systemic thinking 10 (20,21,36,48–54) Collaborate and cooperate effectively with different sectors and organizations involved in the challenges of Planetary Health 8 (22,26,36,44,49,55–57) Ability to solve complex problems and situations 7 (21,41,44,49,51,54,58) Communicate effectively to all types of audiences 7 (25,26,34,49,54,59,60) To be proactive leaders in Planetary Health, working with local, national and international partners to defend sustainable policies 7 (20,21,26,31,44,59,61) Use critical and reflective thinking 6 (33,36,50,61–63) Ability to act ethically, equitably and socially responsible 6 (20,26,35,49,54,64) Work in interdisciplinary and interprofessional teams 5 (21,25,33,54,56) Ability to search, analyse, evaluate and use the information provided to make decisions 3 (33,54,59) Ability to influence at a political level 3 (26,35,55) Solidarity and empathy 3 (20,33,41) Negotiation ability 3 (33,56,60) Ability to learn continuously 2 (50,54) Be community oriented 1 (61) Dialogue capacity 1 (63) Conflict resolution 1 (41) As illustrated by Table 2, the transversal skills needed refer to having the ability to face complex problems, use systemic and reflective thinking, communicate effectively towards different groups, including the general public and decision makers, cooperate and collaborate in inter and transdisciplinary teams, and maintain an equity and ethics focus. Table 3 : Specific competencies of Planetary Health identified in the studies included in the review Competences n articles References Analyse the interaction between human health and natural systems and learn about its evolution. 7 (19,21,22,25,34,54,64) Be prepared to manage disasters caused by extreme weather phenomena and other public health emergencies. 3 (19,34,60) Interpret, synthesize and critically integrate the results of the analysis of research in Planetary Health. 3 (26,34,54) Design and carry out a research project to advance knowledge on the different aspects of Planetary Health. 2 (26,54) Make predictions about the evolution of health problems based on changes in natural systems. 2 (34,54) Critical thinking about the climate, environmental and social costs of fossil fuels. 2 (34,45) Understand who the most vulnerable populations are and why they are so. 2 (21,34) Identify population health patterns and global connectivity. 2 (19,34) Critically evaluate and apply innovative proposals for solutions for the prevention, promotion and management of health without damaging natural systems. 1 (54) Explore innovative ways to care for the environment in the same way we care for our patients. 1 (21) Appreciate the strength of the knowledge of the indigenous population. 1 (21) Resistance against neoliberalism and other forces that endanger the just transition. 1 (45) Support changes in attitudes in favour of Planetary Health. 1 (65) Train to evaluate and improve the environment of patients in order to take them into account when treating diseases. 1 (25) Table 3 highlights the need for specific competencies in Planetary Health, such as understanding the intricate relationship between human health and environmental factors, encompassing the impacts of climate change, pollution, extreme weather events, and land-use changes. Additionally, the identified competencies underscore the importance of conducting high-quality research to advance knowledge in Planetary Health and develop innovative, multi-level solutions that promote both human well-being and environmental sustainability. Main Contents The specific teaching content of the various training programs was outlined in 33 (45%) of the selected studies. This content was directly linked to the intended learning outcomes of the respective programs. Table 4 provides a comprehensive overview, categorizing the content into 23 general themes and 93 specific subtopics, and indicating which articles addressed each specific learning objective. Table 4: Collection of identified learning contents in the studies selected for the review Climate change emerged as the most frequently addressed content area, with five articles specifically focusing on climate change education and its health implications. Notably, a substantial number of articles also covered topics related to ethics (n=9) and complex systems (n=6). In most training programs, the content tended to concentrate on a single general topic (out of the 23 identified), with limited coverage of specific content areas within that topic. However, one article stood out by addressing a comprehensive range of specific topics (72 out of 93), thereby integrating multiple general content areas. It's important to acknowledge that many articles only provided module or subject titles without detailing the specific content covered, potentially obscuring the full breadth of topics addressed in these programs. Main teaching methods The majority of studies (67%, n=49) in this review addressed teaching methods. Among these, face-to-face methodologies were the most prevalent (n=29), followed by hybrid (n=14) and virtual (n=6) approaches. Tables 5, 6, and 7 categorize and list these methodologies, differentiating between completely virtual, face-to-face, and hybrid training. Table 5: Teaching methods in fully online training Teaching methods in 100% online training Articles Use of digital educational materials (50,62) Master sessions recorded on video (50) Self-assessed tests (before and after the course) (50,51) Digital tasks (50) Case study (50) Learning from own experiences (50) Podcast (51) Use and elaboration of conceptual diagrams and maps (51) Take and analye photographs (51) Analyze data from information sources (51) Build stories ( story telling ) (77) Asynchronous and autonomous learning (54) Table 6: Teaching methods in fully face-to-face training Teaching methods in face-to-face training n articles References Participatory actions in the community 8 (26,44,48,49,56,58,67,78) Case study 8 (25,26,37,53,71,73,78,79) Seminars taught by experts on specific topics 6 (22,26,30,49,67,80) Problem-based learning 5 (40,60,63,64,81) Field Work 5 (22,24,36,56,71) Simulations and role-playing 4 (26,67,71,82) Lecture sessions 4 (24,71,80,83) Project-based learning 2 (48,80) Discuss documentaries and films on specific topics 2 (26,49) Flipped classroom 2 (73,83) Serious games 2 (67,82) Rebuttal texts (to combat false information) 1 (66) Article discussion 1 (26) Video recording 1 (36) Photovoice 1 (36) Presentations by students 1 (80) Problem solving 1 (37) Cross learning between different disciplines 1 (28) Mapping resources and situations 1 (82) Infographics 1 (22) Laboratory projects 1 (24) Table 7: Teaching methods in hybrid online/face-to-face training Teaching methods in hybrid trainings n articles References Pre-recorded or synchronous master sessions 4 (20,42,52,72) Face-to-face and virtual simulation games 4 (29,42,84,85) Flipped classroom 4 (29,72,85,86) Case study 4 (20,29,39,72) Virtual learning resources (texts, articles...) 3 (70,72,87) Webinars with experts 2 (39,70) Practical experiences in the community 2 (39,87) Questionnaires 2 (20,72) Face-to-face or virtual role-playing dynamics 2 (29,84) Tasks and personal reflections 2 (20,88) Learning from own experiences 1 (88) Mentorships 1 (88) Face-to-face or virtual meetings with different opinion groups and experts 1 (70) Organization of public debates and dialogues (led by students or teachers) 1 (70) Data analysis based on the habits of each student 1 (72) Discussions in small groups 1 (39) Massive Open Online Courses (MOOCs) 1 (29) Service learning 1 (29) Problem-based learning 1 (29) Challenge-based learning 1 (29) Build stories 1 (42) Presentations by students 1 (87) Problem solving 1 (87) Online learning employs strategies like videos, podcasts, photo analysis, and interactive text or case study analysis to boost student motivation and engagement, which are crucial due to high online dropout rates. Hybrid courses combine these with community experiences, service-learning, problem-based learning, and other methods that blend online and in-person activities. Face-to-face training, similar to hybrid models, fosters strong student interaction and localized relevance, resulting in courses tailored to the local context. Case studies, a common strategy across all formats (mentioned in 13 articles), and community-based learning (10 articles: 8 face-to-face, 2 hybrid), are particularly effective in hybrid and in-person settings. While online courses facilitate a global perspective by connecting geographically dispersed students, hybrid and in-person formats more easily cultivate community connections. Discussion This review highlights a growing interest in Planetary Health education mainly in high-income countries, despite its relatively recent emergence. More established fields like global health and climate change education offer a greater volume of educational resources, but Planetary Health distinguishes itself through a strong emphasis on inter- and transdisciplinary. This complexity is reflected in the identified competencies, which prioritize systems thinking, problem-solving, and collaboration across diverse disciplines and stakeholders. Education is a fundamental axis for transforming society ( 89 ). In order to move towards a “Healthy Planet” it is essential to make people aware of the impacts that the environmental crisis can have on their health and on all of the Earth's systems. It is particularly important to train professionals from different fields (health, engineering, architecture, life sciences, social sciences, education itself) and society in general, emphasizing the most vulnerable populations, many of whom are already suffering the impacts of climate change, in order to define and implement resilience strategies. Educational programs can therefore be a key lever to generate real societal changes. In recent years, dedicated Planetary Health courses (postgraduate or master's level) have begun to appear, primarily in high-income countries. However, the diverse challenges of Planetary Health necessitate educational initiatives that target professionals from a broader range of fields and prioritize vulnerable populations disproportionately affected by the environmental crisis. These initiatives should also include non-professionals as well as community engagement in order to achieve a bottom-up transdisciplinary approach and to ensure that the right stakeholders define the context-specific mitigation and adaptation strategies. It is extremely necessary to support creation and implementation of planetary health courses in low and middle income countries where according to our findings there is a clear gap. These educational initiatives should not only elucidate the causes and impacts of the crisis but also foster the identification of context-specific mitigation and adaptation strategies. The implementation of capacity building strategies in LMICs can be challenging and needs to overcome specific barriers such as limited financial resources, inadequate infrastructure, lack of trained personnel, political instability, and insufficient access to technology and data. In this review we have identified some experiences that can be examples of how to develop contents and case studies adapted to the LMIC specific context such as the one in Southeast Asia ( 30 ) where the DPSIR framework was found to be suitable for bringing together a range of stakeholders from different disciplines, roles, and countries, to learn, understand and derive sustainable solutions for planetary health problems in a coastal setting. Another example is that of the network of One Health Central and Eastern Africa universities, which developed core competencies and modules in One Health that were key to delivering knowledge and skills to a multidisciplinary workforce and building a framework on which One Health curricula can be designed and implemented in central and Eastern Africa ( 26 ). Several training modalities already exist that address partial or, in some cases, more global aspects of Planetary Health. However, these programs are mostly found in high-income countries. The reference frameworks that are most used and adapted to Planetary Health are the sustainable development objectives, the conceptual framework of One Health and those defined by the Planetary Health Alliance. These frameworks all seek to train people in various aspects, among which the management of complexity and systemic thinking stands out. These concepts underpin the role of interdisciplinary and team work for collaborating and cooperating towards finding effective and feasible adaptation and resilience solutions to the ongoing effects of the environmental crisis. The contents described within the different trainings revolve around obtaining the necessary skills to transform society in a way that is healthier and more sustainable. The contents range from knowledge based aspects, such as knowing and understanding how different ecosystems work and the interactions between them and human beings from a physical, chemical and biological point of view, to decision-making aspects including knowing how to generate changes at the personal level, and the generation of policies and legislation with an equitable and ethical approach. Hybrid and face-to-face based education programs appear to be more commonly implemented, although fully online alternatives are also available. However, it has not been possible to identify which teaching methods are the more effective ones.Therefore there is a need for further research to evaluate the effectiveness of different teaching methods. Systematic scoping reviews have certain limitations. First they produce a synthesis of an existing and evolving body of literature to determine gaps in and identify areas for future work. However, as this includes studies of various types, including both primary and secondary sources, this means that a systematic and in-depth review is not performed and thus it is not possible to delve into all the selected articles in the same way and that it is not sought to arrive at a specific answer to a specific research question. One of the most relevant challenges is the selection of a search which is sufficiently broad while at the same time allowing for a meaningful analysis. Given that Planetary Health is a relatively new term, it was considered necessary to examine potentially relevant information from other, related, concepts. This required a more detailed examination of titles, summaries and full texts to identify how articles describing concepts such as Global Health, One Health, or environmental health, related (or did not relate) to Planetary Health.. All three concepts recognize the interconnectedness of human, animal, and environmental health and emphasize the need for collaborative, interdisciplinary approaches to address health challenges. Health focuses more on the direct interactions between humans, animals, and their environments, particularly in the context of zoonotic diseases. Ecohealth takes a broader view, incorporating social and ecological interactions and emphasizing sustainability and social justice. Planetary health encompasses the widest scope, addressing global environmental changes and their impacts on all life on Earth. This aspect added additional complexity and, to some extent, increased subjectivity when selecting these particular articles An additional limitation was that the title and abstract screening was performed by a single reviewer, with instead the decision being made to focus paired reviews on the full-text selection. Finally, in panoramic reviews, unlike systematic reviews, a risk of bias assessment is not carried out. Instead, the aim of this review was mainly to identify and collect competencies, conceptual frameworks, content and learning methodologies that have been used so far in Planetary Health training. We did identify a small number of experimental studies, all of which had very small sample sizes, and used instruments such as ad-hoc questionnaires when identifying their impact. We therefore did not formally evaluate these studies’ reports of satisfaction, effectiveness, or impact. This scoping review identifies existing frameworks, competencies, content, and teaching methods in Planetary Health education, providing essential insights to co-design a community-driven training framework. By aligning education with local needs, it empowers communities to address environmental and health challenges, promoting sustainable practices and enhancing health outcomes. This approach fosters a more equitable and resilient healthcare system, responsive to the global health impacts of environmental changes. Conclusion The urgency of the planetary health crisis demands a swift response from every stakeholder, including educational institutions by creating and delivering sustainable PHE. This systematic scoping review underlines the interest in Planetary Health education, evidenced by a growing body of literature on diverse educational interventions. However, it also reveals a lack of standardization in conceptual frameworks, competencies, content, and teaching methods, particularly for health professionals. This heterogeneity, while reflective of the field's nascence and interdisciplinary nature, poses challenges for curriculum development and quality assurance. This review also highlights inequities in the development and deployment of Planetary Health education, with very few studies involving LMIC. We encourage educators and policy makers to collaborate in an interdisciplinary way to integrate diverse perspectives and expertises, fostering a holistic understanding of Planetary Health and to advocate for policy support at micro, meso and macro level to promote integration of Planetary Health education into standard curricula. Future research should also prioritize the development and rigorous evaluation of evidence-based educational models that address the evolving complexities of Planetary Health, ensuring they are accessible, inclusive, and effective in empowering health professionals to become agents of change in this critical arena. Declarations Ethics approval and consent to participate “Not applicable”. Consent for publication “Not applicable” Availability of data and materials The data that supports the results and findings of this systematic review can be found in either the main paper or the additional supporting files. Any other data from the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests Funding The CATA-Earth project has received funding from the European Union’s Erasmus+ programme under Grant Agreement no. 101128952. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or Erasmus+ programme Capacity Building in Higher Education. Neither the European Union nor the granting authority can be held responsible for them. We also acknowledge support from the Eureopan Union's Horizon Europe research and innovation programme under Grant Agreement No.101084198 and from the UK Research and Innovation under Project Ref. 10082340 and from the grant CEX2023-0001290-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program Authors' contributions CC and COG conceptualized the protocol for this systematic scoping review. CC, COG, SOB, AM, IRM, RWR, SML, AF, MLl, DS, CDP, ED, DYF and IW did study screening (title, abstract and full-text). CC made data extraction. CC and COG prepared the manuscript. All authors made relevant contributions to the manuscript. 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Journal of Education [Internet]. 2022;202(1):26–33. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85088477811&doi=10.1177%2f0022057420943188&partnerID=40&md5=ede13a85ecbf55e5846624f2e3c6ab2d Field J, Martin N, Duane B, Vital S, Mulligan S, Livny A, et al. Embedding environmental sustainability within oral health professional curricula-Recommendations for teaching and assessment of learning outcomes. Eur J Dent Educ. 2023;27(3):650–61. Richardson J, Grose J, Bradbury M, Kelsey J. Developing awareness of sustainability in nursing and midwifery using a scenario-based approach: Evidence from a pre and post educational intervention study. Nurse Educ Today. 2017;54:51–5. Wróblewska D, Okraszewska R. Project-based learning as a method for interdisciplinary adaptation to climate change-Reda Valley case study. Sustainability (Switzerland) [Internet]. 2020;12(11). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85085753359&doi=10.3390%2fsu12114360&partnerID=40&md5=89a12b9007711c97cb51ef541b5d5897 Schmeltz MT, Ganesh C. Improving the capacity and diversity of local public health workforce to address climate impacts to health through community partnerships and problem-based learning. Front Public Health. 2022;10:1090129. Martindale L, Cannone C, Niet T, Hodgkins R, Alexander K, Howells M. Empowering Tomorrow’s Problem Solvers: Nexus Thinking and CLEWs Modelling as a Pedagogical Approach to Wicked Problems. Energies (Basel) [Internet]. 2023;16(14). Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166250929&doi=10.3390%2fen16145539&partnerID=40&md5=153c07566f062e0077aff9b3dd45bc4e Dambre C, G SDJ, Orhan R, Montag D, I van der Z, Gallo V. Working toward a transdisciplinary approach to teaching and learning planetary health-A collective reflection. Front Public Health. 2022;10:1039736. Creutzig F, Kapmeier F. Engage, don’t preach: Active learning triggers climate action. Energy Res Soc Sci. 2020;70:101779. Slimings C, Sisson E, Larson C, Bowles D, Hussain R. Adaptive doctors in Australia: preparing tomorrow’s doctors for practice in a world destabilised by declining planetary health. Environ Educ Res [Internet]. 2022;28(5):786–801. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85122853345&doi=10.1080%2f13504622.2021.2025343&partnerID=40&md5=2708f1c7f26b8cf1589a7f8c41cb1a97 Acosta D, Stark H, Hack G. The importance of incorporating systems thinking and One Health in global health classrooms: findings from a One Health simulation activity. Front Public Health. 2024;12:1299116. Telesford L, Nsobundu C, Lewis T, Marks A, Alamrany A, Zaim O, et al. Leveraging small island context to advance and disseminate environmental health and sustainable development knowledge through higher education. Front Educ (Lausanne) [Internet]. 2024;9. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85187903130&doi=10.3389%2ffeduc.2024.1337302&partnerID=40&md5=89404d12cd3e366e27583f141cf967d1 McNabb SJN, Magowe M, Shaw N, Berrian AM, Wilkes M, Shaikh A, et al. Delivering Modern Global Health Learning Requires New Obligations and Approaches. Ann Glob Health. 2021;87(1):68. UNESCO. Director-General 2009-2017 (Bokova, I.G.). UNESCO 2015 [Internet]. 2015. Available from: http://www.unesco.org/open-access/terms-use-ccbysa-en Asaduzzaman M, Ara R, Afrin S, Meiring JE, Saif-Ur-Rahman KM. Planetary Health Education and Capacity Building for Healthcare Professionals in a Global Context: Current Opportunities, Gaps and Future Directions. Int J Environ Res Public Health. 2022;19(18):11786. Lansbury N, Mishiro K, Son KY, Milsom O, Baston S, Buckley L. Teaching About Climate Change Impacts on Health: Capturing the Experience for Educators. Case Studies in the Environment. 2023;7(1):1925640. Maldonado-González AL. Climate Change in Educational Experiences of University Teachers. Revista Electronica Educare. 2023;27(1). Table Table 4 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Appendix3Characteristicsobjectivesandelementsincludedintheselectedarticles.additionalfile.docx Appendix.docx Table4.docx Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 04 Apr, 2025 Reviews received at journal 03 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviews received at journal 28 Mar, 2025 Reviews received at journal 28 Mar, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviewers agreed at journal 27 Mar, 2025 Reviewers invited by journal 27 Mar, 2025 Submission checks completed at journal 25 Mar, 2025 First submitted to journal 21 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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studies\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/10310f28b49399e0dc9b7f5c.jpeg"},{"id":79423569,"identity":"2f097560-6b7c-459a-a379-785d647f27b1","added_by":"auto","created_at":"2025-03-28 09:07:18","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":433892,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical representation of the most frequently used conceptual frameworks identified in the included studies (*). SDG: Sustainable Development Goals; DPSIR: Drivers, Pressures, State, Impact, Responses; 5Ps: People, Planet, Priority, Practice, Parity\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/8004273182c95cb158d13766.jpeg"},{"id":86179903,"identity":"4ecd2b5f-9bfb-4c26-97ac-ba0d5f7163a5","added_by":"auto","created_at":"2025-07-07 16:20:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2305965,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/4611ff00-928c-4ca0-91c9-28fb25869a6a.pdf"},{"id":79423572,"identity":"0905ec81-2764-4d01-92a1-d6ef4ec3ca73","added_by":"auto","created_at":"2025-03-28 09:07:18","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33402,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix3Characteristicsobjectivesandelementsincludedintheselectedarticles.additionalfile.docx","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/054f77f89bfcc23bb97266be.docx"},{"id":79424312,"identity":"bbbc719d-cffd-42db-9ad1-a1ea4d586b36","added_by":"auto","created_at":"2025-03-28 09:15:18","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21021,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/87139e76d162a3d3aef020d3.docx"},{"id":79423575,"identity":"04eba70c-bd12-4b88-ae43-2ce59a6ac0b0","added_by":"auto","created_at":"2025-03-28 09:07:18","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":167951,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-5683433/v1/dc873b1ad361fe0bbdeb8812.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Conceptual Frameworks, Competencies, Contents and Teaching Methods in Planetary Health Education for Health Students and Professionals: A Global Systematic Scoping Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eBackground\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Anthropocene era has brought significant global health improvements (1,2)including a doubling of life expectancy to 72.6 years by 2019. However, these gains have come at the cost of unsustainable resource consumption and environmental degradation (3)exceeding six of nine planetary boundaries (4,5) Health benefits remain unequally distributed, with life expectancy in 2021 ranging from 52.5 years in Chad to 84.8 years in Japan (6) and disparities also evident within nations. Addressing these challenges requires Planetary Health education that promotes health equity and sustainability while recognizing the urgent need to balance human development with the planet\u0026apos;s finite resources (7)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRationale\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn 2015, coinciding with the launch of the Sustainable Development Goals (SDG) by the United Nations, the Rockefeller Foundation and the Lancet Commission defined Planetary Health as \u0026quot;the maximum achievement of health, well-being and equity through a use of the Earth\u0026apos;s natural resources that is within limits that allow humanity to prosper, without compromising the economic, political and social systems of future generations\u0026quot; (1). This concept builds upon previous notions of environmental sustainability, global health, environmental epidemiology, and \u0026ldquo;One Health\u0026rdquo;, emphasizing inter- and transdisciplinary collaboration, solutions-oriented strategies, and health co-benefits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eKnowledge gap\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRecent reports from the Intergovernmental Panel on Climate Change (IPCC)(8), the United Nations Environment Program (UNEP), and the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) (9) have further underscored the urgent need for action at all levels to adapt, mitigate and reverse the impacts of the climate crisis on global health. The challenges are complex, transversal and unevenly distributed, vulnerable communities, particularly in low- and middle-income countries, facing disproportionate risks due to factors such as geographical location, political instability, population density, and resource dependency (10). The pressure on natural systems, understood as the excessive use of resources, deforestation, changes in land use, or the consumption, resource and energy needs of an increasingly \u0026quot;westernized\u0026quot; population, also increases susceptibility to zoonotic diseases and future pandemics (11). Adaptation therefore requires systematic transitions towards a more sustainable society, operating within the limits of the planet in a fair and equitable way. This implies fundamental changes, ranging from an energy transition, rethinking of food systems and habits, urban planning, and land use. For this reason, it is important to acquire new skills and abilities across various professional areas and incorporate transdisciplinary approaches. To achieve this, we need to train competent and committed people across the world, in order to drive research and transformation at a \u0026quot;glocal\u0026quot; level (both local and global). \u0026nbsp;With this review we aim to map the most relevant conceptual frameworks, competencies, contents, and teaching methods in this field making it possible to improve quality of future capacity building strategies in planetary health. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjectives\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eUniversities play a pivotal role in training professionals equipped to address these complex challenges through high-quality research and transdisciplinary approaches. As highlighted in the 2019 United Nations report (12) and the S\u0026atilde;o Paulo Declaration on Planetary Health, there is a growing demand for Planetary Health education across all curricular levels (13). This training is crucial for fostering a generation of leaders capable of driving research, innovation, and transformative change at both global and local levels. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSearch for Existing Reviews\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWhile the number of Planetary Health courses is increasing, they often remain as elective or supplementary modules, primarily available in high-income countries such as Canada, Scotland, England, Switzerland, the Netherlands, the United States or Spain. There is a pressing need to expand access to these educational opportunities, particularly in vulnerable regions. By empowering individuals with the knowledge and skills to address the specific needs of their communities, we can foster resilience and promote equitable solutions to the multifaceted challenges of Planetary Health. An international organisation of medical educators has produced a consensus on planetary health and education for sustainable healthcare (14) The consensus consists of learning outcomes, objectives, and strategies to deliver sustainable healthcare education, aiming to raise awareness of healthcare professionals. However, a more comprehensive and systematic scoping review considering broader multidisciplinary scopes beyond health professions education remains necessary. \u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRelevance\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic scoping review aims to identify generic existing frameworks, competencies, content, and teaching methods in Planetary Health education which could be adapted based on individual school or program needs. This information will be used to co-design a conceptual framework for community-driven training in the field. Results of this systematic scoping review will be relevant to educational practice and the development of the planetary health field.\u003cstrong\u003eReview Question\u003c/strong\u003eThis global systematic scoping review aims to answer the following review question: What are the conceptual frameworks, competencies, contents, and teaching methods currently used in Planetary Health education for health professionals, and how are these elements applied in different educational contexts?\u0026rdquo;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo explore the complexities and evolving nature of Planetary Health education, a systematic scoping review is employed. This methodology is particularly suited for synthesizing and mapping existing evidence in emerging, complex, or heterogeneous fields, where conducting a precise systematic review might be premature. Systematic scoping reviews are instrumental in clarifying concepts, identifying key elements within the existing literature, and uncovering knowledge gaps that need further research. Importantly, in systematic scoping reviews, the primary focus is on breadth and comprehensiveness rather than on the critical appraisal of individual study quality, allowing for a broad overview of the landscape. This approach aligns with the objectives of this study, which seeks to comprehensively map the current state of Planetary Health education to inform the development of a robust and contextually relevant training framework.\u003c/p\u003e\n\u003cp\u003eThe protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSearch Strategy\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn line with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) statement (15)a comprehensive search strategy was developed to ensure transparency and reproducibility. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Scopus, Web of Science, and ProQuest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe search terms were structured around three thematic blocks:\u003c/p\u003e\n\u003cp\u003e[A]: Core concepts of Planetary Health (Planetary Health, One Health, environmental health, ecohealth, global health, international health, climate change)\u003c/p\u003e\n\u003cp\u003e[B]: Educational aspects (Capacity Building, training, skills, education, formation, learning, teaching)\u003c/p\u003e\n\u003cp\u003e[C]: Conceptual and structural elements (Framework, system, model, outline, frame).\u003c/p\u003e\n\u003cp\u003eThe final search strategy was adopted following an iterative refinement approach. After an initial screening of 50 articles the review team examined the results and iteratively refined the search strategy to maximize the capturing of the diversity of educational approaches in planetary health.\u003c/p\u003e\n\u003cp\u003eThe full search strategy for each database is available in Appendix 1 . Appendix 4 shows the previous iterations of the search strategy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKeywords within each block were identified based on prior knowledge and refined through preliminary searches. The search was executed using Boolean operators (\u0026apos;OR\u0026apos; and \u0026apos;AND\u0026apos;), combining terms as follows: (Block A) AND (Block B) AND (Block C). Given the relatively recent emergence of Planetary Health as a field, the search terms were intentionally broad to capture relevant literature that may use related terminology (e.g., climate and health). However, only articles explicitly aligned with the core principles of Planetary Health mentioned in its definition\u0026nbsp;(1)\u0026nbsp;were included. The search was supplemented by a manual review of reference lists from selected articles.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy Selection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe selection of the studies according to the previously described search strategy was carried out and followed considering inclusion and exclusion criteria. Population: Studies focusing on undergraduate, postgraduate, or lifelong learning populations were included, while those targeting primary or secondary education were excluded. Concept: Thematic relevance was ensured by including studies addressing skills, knowledge, content, or basic abilities related to Planetary Health, while excluding those focused on unrelated competencies. Context: The review encompassed studies from any geographic region and various designs, including systematic and narrative reviews, observational studies, and descriptive studies. However, study protocols, letters to the editor, and articles lacking peer review were excluded. Articles published in English or Spanish were considered, while those in other languages were not. \u0026nbsp;The publication period was limited to the last 10 years (2014-2024) due to the fact that Planetary Health concept was officially launched in 2015 (1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSearch results were downloaded and managed using Covidence, a specialized systematic review software. After removing duplicates, titles and abstracts were screened independently by two reviewers according to the pre-defined inclusion/exclusion criteria. One of the reviewers was always the same person (CC) while the second one was one of the rest of the team (COG, SOB, AM, IRM, RWR, SML, AF, MLl, DS, CDP, ED, DYF, IW). Full texts of potentially eligible articles were then retrieved and assessed independently by the same reviewers. Disagreements were resolved through discussion or, if necessary, by a third reviewer. Reasons for exclusion were documented at each stage and available in Appendix 2. As this is a scoping review, formal quality assessment of included studies was not conducted. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Extraction\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA standardized data extraction form was developed and piloted on a subset of included articles to ensure consistency and comprehensiveness. The following data elements were extracted from each study:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eBibliographic Information: Title, authors, publication year, journal, and language.\u003c/li\u003e\n \u003cli\u003eStudy Characteristics: Study design and main concept (Planetary Health, One Health, global health).\u003c/li\u003e\n \u003cli\u003ePopulation Characteristics: Target audience (health professionals, students), professional roles, level of professional development, and sample size (if applicable).\u003c/li\u003e\n \u003cli\u003eEducational Context: Educational level (undergraduate, postgraduate, lifelong learning), geographic context, and any reported conceptual frameworks.\u003c/li\u003e\n \u003cli\u003eEducational Content and Methods: Specific competencies and skills addressed, content areas covered, and teaching methods employed (online, face-to-face, problem-based learning).\u003c/li\u003e\n \u003cli\u003eStudy Findings: Key results, conclusions, and recommendations for future research or practice.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eData extraction was performed by one reviewer using the standardized form. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Analysis:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe extracted data was analysed thematically in accordance with the instructions of Nowell et al (15)This involves the following steps: 1) understanding the data; 2) creating provisional categories; 3) identifying categories and competencies; 4) revising the categories; 5) defining the categories; 6) final description of the data using the categories.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSearch Strategy and Study Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe initial database search yielded 7,021 references. After removing 1,454 duplicates (21%), 5,567 unique references remained. These underwent title and abstract screening, resulting in 492 articles selected for full-text review. Of these, 373 were excluded for not meeting the inclusion criteria: lack of relevant intervention (28%, n=103), intervention and/or outcome mismatch (25%, n=92), ineligible population (19%, n=72), lack of relevant outcome (15%, n=57), inappropriate publication type (11%, n=40), wrong language (1%, n=3), or misalignment with the core concept of Planetary Health (1%, n=3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDuring the data extraction phase, an additional 46 articles were excluded for similar reasons: misalignment with the core concept of Planetary Health (26%, n=12), lack of relevant outcome (22%, n=10), inappropriate publication type (20%, n=9), intervention and/or outcome mismatch (17%, n=8), lack of relevant intervention (13%, n=6) or ineligible population (2%, n=1). A detailed list of excluded studies and reasons is provided in Appendix 2. The study selection process is visually summarized in the PRISMA flow diagram (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe detailed description of the 73 articles included in this systematic scoping review is included in Appendix 3. Only 14 of the included explicitly focused on Planetary Health. The remaining articles addressed related topics, with the most frequent being climate change (n=14), sustainable development (n=12), followed by environmental health (n=8) and the intersection of climate change and health (n=7). Other less frequent topics included One Health and global health (n=6 each), systems thinking (n=2), and public health, environmental education, and global citizenship (n=1 each).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most frequent study design (52%, n=38) involved descriptive analyses of conceptual frameworks, educational objectives, methodologies, or intended competencies. Qualitative methodologies, such as focus groups or semi-structured interviews, were employed in approximately a quarter of studies (26%, n=19). These explored student and teacher perspectives on various modules, courses, or programs, capturing opinions, motivations, feedback, and perceived impacts. A smaller proportion of studies (5%, n=4) utilized mixed methods, combining focus groups with quantitative approaches like questionnaires. Additionally, 12% of the included articles (n=9) were reviews, encompassing three scoping reviews, four narrative reviews, and two systematic reviews. The remaining articles included one cross-sectional study, one pre-post study, and one randomized controlled trial (RCT) that specifically examined the use of refutation texts to counter misinformation on controversial Planetary Health topics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 1:\u003c/strong\u003e PRISMA diagram \u0026ndash; Selection of studies\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(additional file)\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTarget population\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRegarding the educational level of the target audience, and considering that only university and post-university studies were included in this review, 60% (n=44) were aimed at undergraduate students, 10% (n=7) at postgraduate students, and 11% (n=8) at lifelong learners. In 15% of studies (n=11), the educational level was not specified between university and post-university level, and in three studies, it was unclear whether the target audience was undergraduate or postgraduate. The primary target audience for the included trainings was health professionals, with 49% (n=36) of studies focusing on various health disciplines: medicine (n=11), nursing (n=8), public health (n=3), pharmacy (n=1), dentistry (n=1), occupational therapy (n=2), psychology (n=1), and general health professionals (n=8). Another 44% (n=32) of studies addressed a mixed audience of health professionals without specifying disciplines. The remaining studies targeted social science professionals (n=2), veterinarians (n=1), and engineers (n=1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGeographical scope of the studies\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe vast majority of included studies (88%, n=64) originated from high-income countries, with the United States (n=32) being the most represented. Other high-income countries contributing to the studies included Canada (n=3), Great Britain (n=7), Australia (n=6), Japan (n=1), New Zealand (n=1), and various European countries (n=14). In contrast, only 9 studies (12%) were identified from low- and middle-income countries (LMICs), with two studies each from Uganda and Mexico, and one study each from West Africa, East Africa (multi-country), Indonesia, Grenada, and Southeast Asia (multi-country collaboration). Of the 73 studies included, one was published in Spanish, and the remaining 72 were published in English.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjective of the studies\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe objectives of the included studies varied widely. Some studies (n=20) focused on developing theoretical frameworks to identify the skills required for Planetary Health professionals. Others built upon existing frameworks, aiming to define competencies and learning objectives in greater detail. Several studies also described the content and methodologies used in implementing educational programs, including the development of comprehensive curricula. A subset of studies employed research-based approaches to analyse student and teacher opinions, motivations, and the perceived impact of pilot or established Planetary Health courses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain Theoretical Frameworks\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 73 included studies, 28 (38%) described using a total of 20 distinct conceptual frameworks for education in Planetary Health and related fields. Notably, only one framework was explicitly designed for Planetary Health training (16) while the others were adapted from related fields like One Health, Global Health, and the Sustainable Development Goals. Table 1 provides a list of the identified frameworks, the articles that referenced them, and a brief description of each. Among these, the One Health (17), Sustainable Development Goals (18) and the Planetary Health Alliance\u0026apos;s Planetary Health Education Framework (16) emerged as the most commonly utilized. Figure 2 offers graphical representations of some of the most relevant and frequently used conceptual frameworks. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Conceptual frameworks used in the studies included in the review.\u0026nbsp;(*)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eGraphical representation of these studies is shown in figure 2.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eFramework name\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eArticles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eDescription\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePlanetary Health Education (*)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=5\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(19\u0026ndash;22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eDeveloped by the Planetary Health Alliance, it encompasses five core domains: interconnectedness with nature, equity and social justice, the Anthropocene\u0026apos;s health implications, systems thinking and complexity, and transformative movements for systemic change. It aims to integrate local and global perspectives\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eOne Health (*)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=5 (23\u0026ndash;27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eCollaborative, multisectoral, and transdisciplinary framework. It promotes optimal health outcomes through the interconnectedness of people, animals, plants, and their shared environment at local, regional, national, and global levels. The included articles discuss the framework\u0026apos;s local adaptation in Central and Eastern Africa (26) and its application in specific disciplines like medicine (25), nutrition (23), and veterinary medicine (27).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eSustainable Development Goals (SDGs)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(*)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=3\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(28,29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEstablished by the United Nations in 2015, the 17 SDGs comprise a set of interconnected goals aimed at fostering international development. Emphasizes the interdependence of these goals, recognizing that actions in one area can impact outcomes in others, and underscores the need for development to balance social, economic, and environmental sustainability.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eDrivers, Pressures, State, Impact, Responses (DPSIR)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u0026nbsp;\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(30)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eExplores the complex interactions between society and the environment. Analyses environmental issues by identifying the drivers that generate pressures, leading to changes in the state of the environment. These changes cause impacts that trigger responses aimed at mitigating or addressing these impacts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eWEACT-PLEASE\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(*)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(31)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eFocuses on 5 domains of the healthcare system that contribute to pollution: waste, energy and water, agriculture and food, chemicals, and transport (WE ACT). It also identifies six key professional elements essential for addressing these issues at a global level: Professional Obligation, Leadership, Education, Responsibility, Science, and Commitment (PLEASE).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e5 Ps model of global health: People, Planet, Priority, Practice, Parity\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(*)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(32)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEmphasizes five core domains: Parity (health equity), People (access to healthcare for individuals and communities), Planet (globalization and environmental health), and Priorities (values guiding decision-making), and Practices (data and tools used to address health issues).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eCARE-KNOW-DO\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(33)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEmphasizes three key components: CARE (student engagement with real-world issues that resonate and motivate them to learn), KNOW (acquisition of knowledge to understand and discuss solutions), and DO (application of knowledge through actions to solve problems).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eMedical education needs assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(34)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eFocuses on the specific educational needs of medical professionals in the context of planetary health, addressing domains such as climate change, heat-related illnesses, the impact of extreme weather events and zoonotic diseases, water-borne diseases, and the mental health consequences of natural disasters.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eNursing global health competencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(35)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eFocuses on a single dimension: the core values and principles of nursing, complemented by seven subcategories: social justice and equity, holistic care, advocacy, health as a human right, sustainability, and collaboration. Also incorporates four key approaches: environmental, care, educational, and competence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePerson-in- environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(36)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eCentral to social work practice, considers the individual within the context of their interacting systems: family, social, political, economic, and, in the current context, the environment, with a global perspective.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eSocio-ecological- biological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eProposes integrating the human microbiota into human ecology, spanning from the micro level (genome and microbiota) to the macro level (environment) through various levels (individual, community, society).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eClimate, environmental change, and health (CECH) competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEncompasses the following domains: climate and environmental science, drivers of climate change, evidence, projections and assessments, iterative risk management, mitigation, adaptation and joint health, benefits and collective strategies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003ePopulation health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(39)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eOffers a unified approach to population health, encompassing public health, health systems, global health, and Planetary Health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eUNESCO Education for Sustainable Development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eAligns with the SDGs and focuses on five key areas: \u0026nbsp;advancing policies, fostering learning and collaborative environments, empowering teachers and educators, engaging youth and communities, and strengthening research and knowledge.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eHuman-centred design (HCD) and shared-action learning (SAL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(41)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eCombined, these frameworks draw on user-centred design principles (problem-solving, trust-building, immersive experiences, conflict management, empathy, and the customary \u0026quot;design thinking\u0026quot; process in technological development).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eCommunity-Based Design Research (CBDR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEmphasizes an iterative process of innovation, evaluation, and adaptation of the curriculum through multiple cycles.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eHealth in All education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEncompasses a broad range of health determinants and related factors, including social, environmental, and economic aspects. Covers determinants of health, evidence-based interventions, population health, interprofessional relations, community collaboration, environmental and occupational health, global health, cultural diversity, health systems, healthcare financing and budgeting, and health law and policy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eGraduate Leadership education for sustainability (GLES)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(44)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eFocuses on three elements: leadership, sustainability and higher education.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eCritical thinking, coexistence and resistance (CCR) Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(45)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEmphasizes critical thinking about the climate, environmental, and social costs of fossil fuels, as well as the importance of coexistence with nature and the \u0026quot;other.\u0026quot; It also promotes resistance against neoliberalism and other forces that threaten a just transition.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eGreenSCENT Competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003en=1\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(46)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 392px;\"\u003e\n \u003cp\u003eEncompasses transversal, pragmatic, and applied areas, addressing key components of environmental sustainability: climate change, clean energy, circular economy, green construction, sustainable mobility, food systems, biodiversity, and pollution reduction.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOne included article (47) specifically reviewed conceptual frameworks, identifying 17 distinct options. However, only three of these (SDG, PHEF, and WE-ACT PLEASE) were also found in the other included studies. The remaining 14 frameworks identified in the review article were not incorporated into Table 1, as they represented a blend of frameworks, teaching methods, and content, rather than standalone conceptual frameworks. Furthermore, some of these 14 frameworks focused narrowly on specific aspects of Planetary Health, such as food or green energy, without addressing the broader, holistic concept.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2:\u003c/strong\u003e Graphical representation of the most frequently used conceptual frameworks identified in the included studies (*). SDG: Sustainable Development Goals; DPSIR: Drivers, Pressures, State, Impact, Responses; 5Ps: People, Planet, Priority, Practice, Parity\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(additional file)\u003c/em\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMain Skills\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThirty-three (45%) studies described the skills the different teaching programs aim to develop. Table 2 lists the transversal competencies that, while not specific to Planetary Health, are instead relevant to being able to engage with it. Table 3 highlights skills which are more specific to Planetary Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eTransversal skills identified in the studies included in the review\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransversal skills\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en articles\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eUse systemic thinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(20,21,36,48\u0026ndash;54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eCollaborate and cooperate effectively with different sectors and organizations involved in the challenges of Planetary Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(22,26,36,44,49,55\u0026ndash;57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eAbility to solve complex problems and situations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(21,41,44,49,51,54,58)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eCommunicate effectively to all types of audiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(25,26,34,49,54,59,60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eTo be proactive leaders in Planetary Health, working with local, national and international partners to defend sustainable policies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(20,21,26,31,44,59,61)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eUse critical and reflective thinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(33,36,50,61\u0026ndash;63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eAbility to act ethically, equitably and socially responsible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(20,26,35,49,54,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eWork in interdisciplinary and interprofessional teams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(21,25,33,54,56)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eAbility to search, analyse, evaluate and use the information provided to make decisions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(33,54,59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eAbility to influence at a political level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(26,35,55)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eSolidarity and empathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(20,33,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eNegotiation ability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e(33,56,60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eAbility to learn continuously\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50,54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eBe community oriented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(61)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eDialogue capacity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(63)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eConflict resolution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(41)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAs illustrated by Table 2, the transversal skills needed refer to having the ability to face complex problems, use systemic and reflective thinking, communicate effectively towards different groups, including the general public and decision makers, cooperate and collaborate in inter and transdisciplinary teams, and maintain an equity and ethics focus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e: Specific competencies of Planetary Health identified in the studies included in the review\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompetences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en articles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eAnalyse the interaction between human health and natural systems and learn about its evolution.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(19,21,22,25,34,54,64)\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eBe prepared to manage disasters caused by extreme weather phenomena and other public health emergencies.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(19,34,60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eInterpret, synthesize and critically integrate the results of the analysis of research in Planetary Health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(26,34,54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eDesign and carry out a research project to advance knowledge on the different aspects of Planetary Health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(26,54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eMake predictions about the evolution of health problems based on changes in natural systems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(34,54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eCritical thinking about the climate, environmental and social costs of fossil fuels.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(34,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eUnderstand who the most vulnerable populations are and why they are so.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(21,34)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eIdentify population health patterns and global connectivity.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(19,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eCritically evaluate and apply innovative proposals for solutions for the prevention, promotion and management of health without damaging natural systems.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e(54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eExplore innovative ways to care for the environment in the same way we care for our patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(21)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eAppreciate the strength of the knowledge of the indigenous population.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(21)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eResistance against neoliberalism and other forces that endanger the just transition.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(45)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eSupport changes in attitudes in favour of Planetary Health.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(65)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 356px;\"\u003e\n \u003cp\u003eTrain to evaluate and improve the environment of patients in order to take them into account when treating diseases.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 highlights the need for specific competencies in Planetary Health, such as understanding the intricate relationship between human health and environmental factors, encompassing the impacts of climate change, pollution, extreme weather events, and land-use changes. Additionally, the identified competencies underscore the importance of conducting high-quality research to advance knowledge in Planetary Health and develop innovative, multi-level solutions that promote both human well-being and environmental sustainability.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMain Contents\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe specific teaching content of the various training programs was outlined in 33 (45%) of the selected studies. This content was directly linked to the intended learning outcomes of the respective programs. Table 4 provides a comprehensive overview, categorizing the content into 23 general themes and 93 specific subtopics, and indicating which articles addressed each specific learning objective.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eCollection of identified learning contents in the studies selected for the review\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClimate change emerged as the most frequently addressed content area, with five articles specifically focusing on climate change education and its health implications. Notably, a substantial number of articles also covered topics related to ethics (n=9) and complex systems (n=6). In most training programs, the content tended to concentrate on a single general topic (out of the 23 identified), with limited coverage of specific content areas within that topic. However, one article stood out by addressing a comprehensive range of specific topics (72 out of 93), thereby integrating multiple general content areas. It\u0026apos;s important to acknowledge that many articles only provided module or subject titles without detailing the specific content covered, potentially obscuring the full breadth of topics addressed in these programs.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMain teaching methods\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe majority of studies (67%, n=49) in this review addressed teaching methods. Among these, face-to-face methodologies were the most prevalent (n=29), followed by hybrid (n=14) and virtual (n=6) approaches. Tables 5, 6, and 7 categorize and list these methodologies, differentiating between completely virtual, face-to-face, and hybrid training.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u0026nbsp;\u003c/strong\u003eTeaching methods in fully online training\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeaching methods in 100% online training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArticles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eUse of digital educational materials\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50,62)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMaster sessions recorded on video\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSelf-assessed tests (before and after the course)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50,51)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDigital tasks\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eCase study\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLearning from own experiences\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(50)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePodcast\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(51)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eUse and elaboration of conceptual diagrams and maps\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(51)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eTake and analye photographs\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e(51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAnalyze data from information sources\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e(51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBuild stories (\u003cem\u003estory telling\u003c/em\u003e)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(77)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 455px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAsynchronous and autonomous learning\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(54)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eTeaching methods in fully face-to-face training\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeaching methods in face-to-face training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en articles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eParticipatory actions in the community\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(26,44,48,49,56,58,67,78)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eCase study\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e(25,26,37,53,71,73,78,79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSeminars taught by experts on specific topics\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(22,26,30,49,67,80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eProblem-based learning\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(40,60,63,64,81)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eField Work\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(22,24,36,56,71)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSimulations and role-playing\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(26,67,71,82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLecture sessions\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(24,71,80,83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eProject-based learning\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(48,80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDiscuss documentaries and films on specific topics\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(26,49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eFlipped \u003cem\u003eclassroom\u003c/em\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(73,83)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSerious games\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(67,82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eRebuttal texts (to combat false information)\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(66)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eArticle discussion\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(26)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eVideo recording\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(36)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePhotovoice\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(36)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePresentations by students\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(80)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eProblem solving\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eCross learning between different disciplines\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(28)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eMapping resources and situations\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eInfographics\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(22)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 360px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLaboratory projects\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(24)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eTeaching methods in hybrid online/face-to-face training\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTeaching methods in hybrid trainings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en articles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003ePre-recorded or synchronous master sessions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e(20,42,52,72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eFace-to-face and virtual simulation games\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29,42,84,85)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eFlipped \u003cem\u003eclassroom\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29,72,85,86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eCase study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(20,29,39,72)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eVirtual learning resources (texts, articles...)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(70,72,87)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eWebinars with experts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(39,70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003ePractical experiences in the community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(39,87)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eQuestionnaires\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(20,72)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eFace-to-face or virtual role-playing dynamics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29,84)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eTasks and personal reflections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(20,88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eLearning from own experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eMentorships\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eFace-to-face or virtual meetings with different opinion groups and experts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eOrganization of public debates and dialogues (led by students or teachers)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eData analysis based on the habits of each student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(72)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eDiscussions in small groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(39)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003e\u003cem\u003eMassive Open Online Courses\u0026nbsp;\u003c/em\u003e(MOOCs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eService learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eProblem-based learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eChallenge-based learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eBuild stories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003ePresentations by students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(87)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 362px;\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp class=\"MsoNormal\" align=\"center\"\u003e\u003cspan lang=\"EN-GB\"\u003e(87)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOnline learning employs strategies like videos, podcasts, photo analysis, and interactive text or case study analysis to boost student motivation and engagement, which are crucial due to high online dropout rates. Hybrid courses combine these with community experiences, service-learning, problem-based learning, and other methods that blend online and in-person activities. Face-to-face training, similar to hybrid models, fosters strong student interaction and localized relevance, resulting in courses tailored to the local context. Case studies, a common strategy across all formats (mentioned in 13 articles), and community-based learning (10 articles: 8 face-to-face, 2 hybrid), are particularly effective in hybrid and in-person settings. While online courses facilitate a global perspective by connecting geographically dispersed students, hybrid and in-person formats more easily cultivate community connections.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review highlights a growing interest in Planetary Health education mainly in high-income countries, despite its relatively recent emergence. More established fields like global health and climate change education offer a greater volume of educational resources, but Planetary Health distinguishes itself through a strong emphasis on inter- and transdisciplinary. This complexity is reflected in the identified competencies, which prioritize systems thinking, problem-solving, and collaboration across diverse disciplines and stakeholders.\u003c/p\u003e \u003cp\u003eEducation is a fundamental axis for transforming society (\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e). In order to move towards a \u0026ldquo;Healthy Planet\u0026rdquo; it is essential to make people aware of the impacts that the environmental crisis can have on their health and on all of the Earth's systems. It is particularly important to train professionals from different fields (health, engineering, architecture, life sciences, social sciences, education itself) and society in general, emphasizing the most vulnerable populations, many of whom are already suffering the impacts of climate change, in order to define and implement resilience strategies. Educational programs can therefore be a key lever to generate real societal changes. In recent years, dedicated Planetary Health courses (postgraduate or master's level) have begun to appear, primarily in high-income countries. However, the diverse challenges of Planetary Health necessitate educational initiatives that target professionals from a broader range of fields and prioritize vulnerable populations disproportionately affected by the environmental crisis. These initiatives should also include non-professionals as well as community engagement in order to achieve a bottom-up transdisciplinary approach and to ensure that the right stakeholders define the context-specific mitigation and adaptation strategies. It is extremely necessary to support creation and implementation of planetary health courses in low and middle income countries where according to our findings there is a clear gap. These educational initiatives should not only elucidate the causes and impacts of the crisis but also foster the identification of context-specific mitigation and adaptation strategies. The implementation of capacity building strategies in LMICs can be challenging and needs to overcome specific barriers such as limited financial resources, inadequate infrastructure, lack of trained personnel, political instability, and insufficient access to technology and data. In this review we have identified some experiences that can be examples of how to develop contents and case studies adapted to the LMIC specific context such as the one in Southeast Asia (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) where the DPSIR framework was found to be suitable for bringing together a range of stakeholders from different disciplines, roles, and countries, to learn, understand and derive sustainable solutions for planetary health problems in a coastal setting. Another example is that of the network of One Health Central and Eastern Africa universities, which developed core competencies and modules in One Health that were key to delivering knowledge and skills to a multidisciplinary workforce and building a framework on which One Health curricula can be designed and implemented in central and Eastern Africa (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Several training modalities already exist that address partial or, in some cases, more global aspects of Planetary Health. However, these programs are mostly found in high-income countries. The reference frameworks that are most used and adapted to Planetary Health are the sustainable development objectives, the conceptual framework of One Health and those defined by the Planetary Health Alliance. These frameworks all seek to train people in various aspects, among which the management of complexity and systemic thinking stands out. These concepts underpin the role of interdisciplinary and team work for collaborating and cooperating towards finding effective and feasible adaptation and resilience solutions to the ongoing effects of the environmental crisis. The contents described within the different trainings revolve around obtaining the necessary skills to transform society in a way that is healthier and more sustainable. The contents range from knowledge based aspects, such as knowing and understanding how different ecosystems work and the interactions between them and human beings from a physical, chemical and biological point of view, to decision-making aspects including knowing how to generate changes at the personal level, and the generation of policies and legislation with an equitable and ethical approach. Hybrid and face-to-face based education programs appear to be more commonly implemented, although fully online alternatives are also available. However, it has not been possible to identify which teaching methods are the more effective ones.Therefore there is a need for further research to evaluate the effectiveness of different teaching methods.\u003c/p\u003e \u003cp\u003eSystematic scoping reviews have certain limitations. First they produce a synthesis of an existing and evolving body of literature to determine gaps in and identify areas for future work. However, as this includes studies of various types, including both primary and secondary sources, this means that a systematic and in-depth review is not performed and thus it is not possible to delve into all the selected articles in the same way and that it is not sought to arrive at a specific answer to a specific research question. One of the most relevant challenges is the selection of a search which is sufficiently broad while at the same time allowing for a meaningful analysis. Given that Planetary Health is a relatively new term, it was considered necessary to examine potentially relevant information from other, related, concepts. This required a more detailed examination of titles, summaries and full texts to identify how articles describing concepts such as Global Health, One Health, or environmental health, related (or did not relate) to Planetary Health.. All three concepts recognize the interconnectedness of human, animal, and environmental health and emphasize the need for collaborative, interdisciplinary approaches to address health challenges. Health focuses more on the direct interactions between humans, animals, and their environments, particularly in the context of zoonotic diseases. Ecohealth takes a broader view, incorporating social and ecological interactions and emphasizing sustainability and social justice. Planetary health encompasses the widest scope, addressing global environmental changes and their impacts on all life on Earth. This aspect added additional complexity and, to some extent, increased subjectivity when selecting these particular articles\u003c/p\u003e \u003cp\u003eAn additional limitation was that the title and abstract screening was performed by a single reviewer, with instead the decision being made to focus paired reviews on the full-text selection. Finally, in panoramic reviews, unlike systematic reviews, a risk of bias assessment is not carried out. Instead, the aim of this review was mainly to identify and collect competencies, conceptual frameworks, content and learning methodologies that have been used so far in Planetary Health training. We did identify a small number of experimental studies, all of which had very small sample sizes, and used instruments such as ad-hoc questionnaires when identifying their impact. We therefore did not formally evaluate these studies\u0026rsquo; reports of satisfaction, effectiveness, or impact.\u003c/p\u003e \u003cp\u003eThis scoping review identifies existing frameworks, competencies, content, and teaching methods in Planetary Health education, providing essential insights to co-design a community-driven training framework. By aligning education with local needs, it empowers communities to address environmental and health challenges, promoting sustainable practices and enhancing health outcomes. This approach fosters a more equitable and resilient healthcare system, responsive to the global health impacts of environmental changes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe urgency of the planetary health crisis demands a swift response from every stakeholder, including educational institutions by creating and delivering sustainable PHE. This systematic scoping review underlines the interest in Planetary Health education, evidenced by a growing body of literature on diverse educational interventions. However, it also reveals a lack of standardization in conceptual frameworks, competencies, content, and teaching methods, particularly for health professionals. This heterogeneity, while reflective of the field's nascence and interdisciplinary nature, poses challenges for curriculum development and quality assurance. This review also highlights inequities in the development and deployment of Planetary Health education, with very few studies involving LMIC. We encourage educators and policy makers to collaborate in an interdisciplinary way to integrate diverse perspectives and expertises, fostering a holistic understanding of Planetary Health and to advocate for policy support at micro, meso and macro level to promote integration of Planetary Health education into standard curricula. Future research should also prioritize the development and rigorous evaluation of evidence-based educational models that address the evolving complexities of Planetary Health, ensuring they are accessible, inclusive, and effective in empowering health professionals to become agents of change in this critical arena.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch4\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003e\u0026ldquo;Not applicable\u0026rdquo;.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003e\u0026ldquo;Not applicable\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the results and findings of this systematic review can be found in either the main paper or the additional supporting files. Any other data from the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eThe CATA-Earth project has received funding from the European Union\u0026rsquo;s Erasmus+ programme under Grant Agreement no. 101128952. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or Erasmus+ programme Capacity Building in Higher Education. Neither the European Union nor the granting authority can be held responsible for them. We also acknowledge support from the Eureopan Union\u0026apos;s Horizon Europe research and innovation programme under Grant Agreement No.101084198 and from the UK Research and Innovation under Project Ref. 10082340 and from the grant CEX2023-0001290-S funded by MCIN/AEI/ 10.13039/501100011033, and support from the Generalitat de Catalunya through the CERCA Program\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eCC and COG conceptualized the protocol for this systematic scoping review. CC, COG, SOB, AM, IRM, RWR, SML, AF, MLl, DS, CDP, ED, DYF and IW did study screening (title, abstract and full-text). CC made data extraction. CC and COG prepared the manuscript. All authors made relevant contributions to the manuscript. All authors read and approved the final manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWhitmee S, Haines A, Beyrer C, Boltz F, Capon AG, De Souza Dias BF, et al. Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation-Lancet Commission on planetary health. The Lancet. 2015. \u003c/li\u003e\n\u003cli\u003eMcGinnis R, Meadows DH, Meadows DL, Randers J, Behren WW. The Limits to Growth: A Report for the Club of Rome\u0026rsquo;s Project on the Predicament of Mankind. Demography. 1973; \u003c/li\u003e\n\u003cli\u003eNations U. UN chronicle. [Cited 2023 Nov 19]. As the World\u0026rsquo;s Population Surpasses 8 Billion, What Are the Implications for Planetary Health and Sustainability? 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Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85148334566\u0026amp;doi=10.1016%2fj.jclepro.2023.136364\u0026amp;partnerID=40\u0026amp;md5=2f96685b637bef2740e90c5656af8070\u003c/li\u003e\n\u003cli\u003eSanyang E, Butler-Dawson J, Mikulski MA, Cook T, Kuye RA, Venzke K, et al. Environmental and occupational health needs assessment in West Africa: opportunities for research and training. Int J Public Health. 2017;62(2):317\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eEzezika O, Jarrah M. A Case Study on the Impact of a Web-Based Animated Storyline Module for Global Health Pedagogy: Student Perspectives. Journal of Education [Internet]. 2022;202(1):26\u0026ndash;33. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85088477811\u0026amp;doi=10.1177%2f0022057420943188\u0026amp;partnerID=40\u0026amp;md5=ede13a85ecbf55e5846624f2e3c6ab2d\u003c/li\u003e\n\u003cli\u003eField J, Martin N, Duane B, Vital S, Mulligan S, Livny A, et al. 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Planetary Health Education and Capacity Building for Healthcare Professionals in a Global Context: Current Opportunities, Gaps and Future Directions. Int J Environ Res Public Health. 2022;19(18):11786.\u003c/li\u003e\n\u003cli\u003eLansbury N, Mishiro K, Son KY, Milsom O, Baston S, Buckley L. Teaching About Climate Change Impacts on Health: Capturing the Experience for Educators. Case Studies in the Environment. 2023;7(1):1925640.\u003c/li\u003e\n\u003cli\u003eMaldonado-Gonz\u0026aacute;lez AL. Climate Change in Educational Experiences of University Teachers. Revista Electronica Educare. 2023;27(1).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable 4 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Systematic scoping review, Planetary Health, education, capacity building, curriculum development, instructional design, health professionals","lastPublishedDoi":"10.21203/rs.3.rs-5683433/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5683433/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePlanetary Health studies the impact of the global environmental crisis on health. Urgent transdisciplinary, intersectoral, and holistic solutions adapted to local realities are needed. Designing training programs attuned to contextual needs of diverse groups and geographical areas is crucial. Planetary health programs are emerging worldwide, but little is known about their scope and learning outcomes. A systematic scoping review is needed to shed light on the state of planetary health education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review aims to identify existing frameworks, competencies, content, and teaching methods in planetary health education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines, we included studies targeting undergraduate and postgraduate students, focusing on skills, knowledge, and abilities related to planetary health, published in English or Spanish. No exclusions were made based on geographic area, study design, or publication period. Databases consulted were MEDLINE via PubMed, Scopus, Web of Science, and ProQuest. Selection and data extraction processes were conducted systematically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included 73 articles, with 88% from high-income countries and 49% focused on health professionals. Conceptual frameworks identified include \"One Health,\" \"Sustainable Development Goals,\" and the \"Planetary Health Education Framework.\" Transversal skills (complex problem-solving, systemic thinking, collaboration, interdisciplinary) and specific competencies (understanding health interactions with climate change, pollution) were outlined in 45% of studies. Half of the studies described 23 general topics and 93 specific content areas. Teaching methods included in-person (59%), virtual (12%), and hybrid models (29%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review highlights the heterogeneity in conceptual frameworks, competencies, content, and teaching methods in planetary health education for health professionals. Future research should focus on developing and evaluating evidence-based educational models to address the evolving challenges of planetary health. Recommendations include enhancing collaboration among stakeholders and integrating innovative teaching methods to improve planetary health education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProtocol Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol has been registered in the Open Science Framework database (registration number: osf.io/h2b3j, March 2024).\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable\u003c/p\u003e","manuscriptTitle":"Conceptual Frameworks, Competencies, Contents and Teaching Methods in Planetary Health Education for Health Students and Professionals: A Global Systematic Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-28 09:07:13","doi":"10.21203/rs.3.rs-5683433/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-04T10:05:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T16:24:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185105410231942907188434380476196945092","date":"2025-04-01T17:30:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-28T16:51:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-28T16:19:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149900993638000195290020228847189408356","date":"2025-03-28T16:14:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306192395125446855013279605005205120309","date":"2025-03-27T18:00:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-27T17:20:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-25T14:25:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-03-21T12:20:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"611bdddc-e09e-43e1-9d7e-85095bb6913c","owner":[],"postedDate":"March 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:12:21+00:00","versionOfRecord":{"articleIdentity":"rs-5683433","link":"https://doi.org/10.1186/s12909-025-07450-x","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-07-01 15:58:18","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-03-28 09:07:13","video":"","vorDoi":"10.1186/s12909-025-07450-x","vorDoiUrl":"https://doi.org/10.1186/s12909-025-07450-x","workflowStages":[]},"version":"v1","identity":"rs-5683433","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5683433","identity":"rs-5683433","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}