Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review

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Some European countries such as the UK are beginning to incorporate Planetary Health into the medical and postgraduate family doctor curriculum to equip future GPs with skills to manage impacts. However, qualified GPs who completed training may not have received any formal teaching on Planetary Health and will have missed this aspect of general practice. We explore the current integration of Planetary Health for European Family Doctors training curriculum. Methods This scoping review is based on Arksey and O'Malley's methodology, and Levac et al.'s methodological enhancement. The approach for this review will be adopted from the systematic protocol by Moloo et al.. 2022. PRISMA-ScR will be used to report this review. Inclusion Any paper relating to planetary health in general practice training and continuous professional development including comments/opinion pieces offering a perspective on the issue or studies related to pedagogy and content i.e., studies examining the why, what and how of planetary health in general practice training. Discussion We will examine current integration of planetary health into postgraduate family medicine training and continued professional development, globally. Outcomes will be categorised within the domains of the Planetary Health Education Framework, which incorporates concepts of systems thinking, social justice and interconnection within nature as they apply to education for planetary health. To our knowledge, no reviews have been published that address this research question. This review will be the first step to formally identify the current landscape of planetary health education for family medicine trainees, and will be used to inform a stakeholder consensus process in the ongoing development of a live “Planetary Health in General Practice” information catalogue and online dashboard. Results will be disseminated through a peer-reviewed publication and conference presentations. Registration OSF (https://doi.org/10.17605/OSF.IO/853Q4). 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HRB Open Res 2025, 8 :39 ( https://doi.org/10.12688/hrbopenres.14051.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] Oisin Brady Bates 1 , Natasha Freeman 2 , Paula Sala-Ivars 3 , [...] Simal Arslan Arslan https://orcid.org/0000-0002-1693-1227 4 , Zahra Abdi 4 , Adedoyin Oyekan 5 , Lorenzo Campedelli https://orcid.org/0009-0004-1894-9668 4 , Genco Gorgu 6 , Ozden Gokdemir 4 , Debbi Stanistreet 7 Oisin Brady Bates 1 , Natasha Freeman 2 , [...] Paula Sala-Ivars 3 , Simal Arslan Arslan https://orcid.org/0000-0002-1693-1227 4 , Zahra Abdi 4 , Adedoyin Oyekan 5 , Lorenzo Campedelli https://orcid.org/0009-0004-1894-9668 4 , Genco Gorgu 6 , Ozden Gokdemir 4 , Debbi Stanistreet 7 PUBLISHED 13 Mar 2025 Author details Author details 1 Royal College of Surgeons in Ireland Department of General Practice, Dublin, Leinster, Ireland 2 Independent researcher, London, UK 3 Universitat de Valencia Departament de Farmacia i Tecnologia Farmaceutica i Parasitologia, Burjassot, Valencian Community, Spain 4 Izmir University of Economics, Izmir, İzmir, Turkey 5 London School of Hygiene & Tropical Medicine, London, England, UK 6 Republic of Türkiye Ministry of Health, Ankara, Turkey 7 Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland 8 Royal College of General Practitioners, London, England, UK Oisin Brady Bates Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Natasha Freeman Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Paula Sala-Ivars Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Simal Arslan Arslan Roles: Writing – Review & Editing Zahra Abdi Roles: Writing – Review & Editing Adedoyin Oyekan Roles: Writing – Original Draft Preparation Lorenzo Campedelli Roles: Writing – Review & Editing Genco Gorgu Roles: Writing – Review & Editing Ozden Gokdemir Roles: Writing – Review & Editing Debbi Stanistreet Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Family doctors are required to address the physical and mental health impacts of climate change. Some European countries such as the UK are beginning to incorporate Planetary Health into the medical and postgraduate family doctor curriculum to equip future GPs with skills to manage impacts. However, qualified GPs who completed training may not have received any formal teaching on Planetary Health and will have missed this aspect of general practice. We explore the current integration of Planetary Health for European Family Doctors training curriculum. Methods This scoping review is based on Arksey and O'Malley's methodology, and Levac et al. 's methodological enhancement. The approach for this review will be adopted from the systematic protocol by Moloo et al. . 2022. PRISMA-ScR will be used to report this review. Inclusion Any paper relating to planetary health in general practice training and continuous professional development including comments/opinion pieces offering a perspective on the issue or studies related to pedagogy and content i.e., studies examining the why, what and how of planetary health in general practice training. Discussion We will examine current integration of planetary health into postgraduate family medicine training and continued professional development, globally. Outcomes will be categorised within the domains of the Planetary Health Education Framework, which incorporates concepts of systems thinking, social justice and interconnection within nature as they apply to education for planetary health. To our knowledge, no reviews have been published that address this research question. This review will be the first step to formally identify the current landscape of planetary health education for family medicine trainees, and will be used to inform a stakeholder consensus process in the ongoing development of a live “Planetary Health in General Practice” information catalogue and online dashboard. Results will be disseminated through a peer-reviewed publication and conference presentations. Registration OSF ( https://doi.org/10.17605/OSF.IO/853Q4 ). READ ALL READ LESS Keywords Family Medicine, General Practice, Medical Education, Medical Training, Planetary Health, Global Health, Climate Change, Sustainable Healthcare Corresponding Author(s) Oisin Brady Bates ( [email protected] ) Close Corresponding author: Oisin Brady Bates Competing interests: No competing interests were disclosed. Grant information: Health Research Board [APA-2024-002]. Copyright: © 2025 Brady Bates O et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Brady Bates O, Freeman N, Sala-Ivars P et al. Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.12688/hrbopenres.14051.1 ) First published: 13 Mar 2025, 8 :39 ( https://doi.org/10.12688/hrbopenres.14051.1 ) Latest published: 13 Mar 2025, 8 :39 ( https://doi.org/10.12688/hrbopenres.14051.1 ) Key messages 1. Our scoping review will focus on postgraduate general practice training/curricula with planetary health integration 2. When reporting the findings, the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) will be used. 3. This study will mark the inaugural phase of a multi-part research initiative with the objective of contributing to a live, evidence-based planetary health resource and information catalogue. Ethics The study does not involve any primary data collection from human or animal subjects. As such, ethical approval is not required for this study. Patient and Public Involvement Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research. Transparency statement The lead author confirms that this manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained. Background The Rockefeller Foundation-Lancet Commission first defined the term “Planetary Health” in 2015 as ‘The health of human civilization and the state of the natural systems on which it depends’ 1 . This is, and will continue to be, an essential component of the role of the General Practitioner (GP), from the move to reduce greenhouse gas emissions in healthcare to helping tailor patient care to changing climate patterns and increasing natural disasters. Nonetheless, despite the relevance of Planetary Health to General Practice, it remains a topic that is poorly integrated into postgraduate training and continuing professional development. Although the potential human health cost in relation to unsustainable practice has been acknowledged for over a decade family medicine/general practice is well situated within the healthcare specialties to address these issues 2 . Family medicine holds status within the community, has multiple strong relationships and a holistic approach to medical practice bestows it with a credible and impactful voice to advocate for positive planetary health. Whitmee et al ., 2015 describe a ‘safeguarding’ role 1 . GPs can engage in meaningful advocacy 3 and can be catalysts for impactful change in the field of planetary health, particularly with a view to influencing policymakers; “While policymakers have the major role to play, we [family medicine] can still contribute to making our community and policymakers aware of the threat to health that climate change bring.“ 4 . GPs can not only lobby politicians and policymakers but also advocate within the patient population 5 . The primary care relationship helps raise awareness on planetary health issues 6 . In order to fulfill their role as planetary health advocates and to adopt positive planetary health practice, it is therefore imperative that family medicine physicians are adequately educated in regard to planetary health issues as part of their training and continuous professional development. We seek to examine what resources are available for GPs and GP trainees that fit this brief. We envisage that this scoping review will outline a growing momentum in Planetary Health education, synthesise various opportunities to further increase their knowledge of Planetary Health and that our findings can be further utilised to inform the ongoing development and improvement of a live Planetary Health catalogue of information and resources hosted by the European Young Family Doctor’s Movement (EYFDM) 7 . Methods Scoping review framework Methods for this study were developed based on Arksey and O'Malley's scoping review methodology 8 , and Levac et al. 's methodological enhancement 9 . According to this framework, there are five different stages in undertaking a scoping review: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; (5) collating, summarising and reporting the results. The approach for this review will be adopted from the systematic protocol published by Moloo et al . 2022 10 . The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting of the scoping review 11 . As this is a scoping review it will be designed to identify the range of the evidence available and will be represented as a mapping of the identified data, without the act of synthesis or particular reference to methodological quality of relevant studies. Stage 1: Identifying the research question The purpose of this study is to identify the extent to which planetary health has been integrated into postgraduate family medicine training and continuous professional development curriculum, internationally. Research question: To what extent are planetary health topics integrated into postgraduate GP training schemes and continuous professional development curriculum, internationally? The question was framed using Population (postgraduate general practice trainees), Concept (planetary health curriculum) and Context (international) approach 12 . Stage 2: Identifying relevant studies Search strategy and information sources This scoping review will include studies that address the integration of planetary health within postgraduate general practice education. Eligible studies may explore formal curricula in addition to supplementary courses or workshops. No restrictions will be placed on study design; commentaries and expert opinions will also be included if they detail curriculum components related to planetary health, describe the implementation of such curricula, or provide recommendations for future curriculum development. To identify relevant studies, we will systematically search the following electronic databases: MEDLINE, EMBASE, and the Cochrane Review. The proposed search strategy is outlined in Supplementary Appendix 1, uploaded to the open science framework. Additionally, we will manually review reference lists of included studies to locate further relevant material. Grey literature searches will review the websites of national, and international organisations, in addition to health and scientific bodies, such as higher education institutions and national general practice colleges. We will also review the Association for Medical Education in Europe’s Consensus Statement, which outlines strategies for incorporating planetary health into health professions education for further references 13 . The search itself will be conducted by a team of international academics. Co-authors on this systematic review provide diverse international representation, with academics from Ireland, the United Kingdom, Italy and Turkey co-authoring. To ensure comprehensive coverage of relevant information, we will include a broad search of grey literature sources. This will involve querying the following databases: Grey Literature Report, OpenGrey, and Web of Science Conference Proceedings, to identify pertinent studies, reports, and conference abstracts. Search terms will be developed collaboratively with input from the entire research team. The search strategy will be designed with the help of an experienced research librarian and will be refined based on feedback from all stakeholders and co-authors. Stage 3: Study selection The review process will involve two stages of screening: (1) a review of titles and abstracts and (2) a full-text review. During the first stage, two investigators will independently screen the titles and abstracts of all retrieved citations against the inclusion criteria. These criteria will be piloted on a subset of abstracts beforehand to ensure they are sufficiently robust to identify all relevant articles. Articles deemed relevant by either reviewer will proceed to the full-text review. In the second stage, a team of six international investigators will independently evaluate assigned portions of the full-text articles to determine whether they meet the inclusion and exclusion criteria. Rationales for exclusion of studies following the full text review will be carefully recorded. In the event of a disagreement, the adjudication of Reviewer DS will be sought to arrive at a final decision with respect to final study inclusion or exclusion. The eligibility criteria that will be applied when screening can be seen in Table 1 . A comprehensive overview of the study selection protocol will be provided via the PRISMA flow diagram 11 . Table 1. Eligibility criteria. Inclusion criteria Exclusion criteria Any paper relating to the topic of planetary health in general practice training and continuous professional development including comments/opinion pieces which offered a perspective on the issue or studies related to both pedagogy and content i.e., all studies examining the why, what and how of planetary health topics in general practice training All papers that fall outside the inclusion criteria above will be excluded, including papers related to global health rather than a focus on planetary health i.e., only papers which specifically dealt with climate change and environmental issues will be included. No restriction on study design, outcome or setting Papers that discussed either family medicine or planetary health in isolation without addressing the relationship between these topics in some manner were excluded No limitation placed on study outcome, design, setting or date of publication. Not healthcare students or professionals. Stage 4: Data collection Using microsoft excel, the research team will design a data collection instrument to capture essential study characteristics. The extracted study characteristics will encompass, but not be restricted to, the year of publication, publication genre (e.g., original research), study design, geographical location, characteristics of the planetary health content taught and theme of the planetary health content taught. Prior to implementation, this instrument will undergo review by the research team and will be pre-tested by all reviewers to ensure accurate capture of information. Data abstraction will be a collaborative effort involving all reviewers independently duplicating the extraction process for all encompassed studies. Stage 5: Collating, summarising and reporting the results The data will subsequently be collated to give an overview of the breadth of literature (recommended by Levac et al ., 2010 ) with a summary of the main findings 9 . In light of the expected diversity in methodologies and study populations across the research encompassed within this scoping review, the interpretation of findings will depend upon the nature of the collected data. Discussion We envisage that the data analysis is likely to encompass a quantitative component for synthesizing the frequencies/demographics of studies, the sector of health education, the type of course, and the learning objectives/competencies addressed. In addition, a qualitative component will be used to delineate prevalent themes pertinent to planetary health within the realm of postgraduate family medicine education and training. When feasible, outcomes will be classified within the domains outlined by the Planetary Health Education Framework (PHEF), which integrates principles of systems thinking, social justice, and interconnectedness within nature as they relate to planetary health 14 . Dissemination This study will mark the inaugural phase of a multi-part research initiative with the objective of contributing to an evidence-based planetary health resource and information catalogue, currently hosted on the European Young Doctor’s Movement Website 7 . The aim of the catalogue is to organise the existing resources relating to planetary health that are pertinent to general practice (and indeed any other interested parties), and the materials collected in this review relating to mapping international curricula in postgraduate GP training and CPD would significantly add to the content of this repository. Following study completion, we plan to disseminate our results via publication in a peer-reviewed journal and/or conference presentation. Declarations Ethics Given that the scoping review methodology consists of the examination and collation of information from publicly accessible resources, ethical approval is deemed unnecessary for this study. Data availability Underlying data No data are associated with this article. Extended data Open Science Framework: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review, https://doi.org/10.17605/OSF.IO/853Q4 15 . Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Reporting guidelines Open Science Framework: PRISMA SCR checklist for ‘Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review’, https://doi.org/10.17605/OSF.IO/853Q4 15 . Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Author’s contributions Oisin Brady Bates: Conceptualisation, Methodology, Writing – Original Draft, Writing – Review & Editing Natasha Freeman: Conceptualisation, Methodology, Writing – Review & Editing, Project administration Paula Sala-Ivers: Conceptualisation, Methodology, Writing – Review & Editing, Project administration Simal Arslan: Writing – Review & Editing Zarah Abdi: Writing – Review & Editing Adedoyin Oyekan: Writing – Review & Editing Lorenzo Campedelli – Review & Editing Ozden Gokdemir: Writing – Review & Editing Debbi Stanistreet: Conceptualisation, Methodology, Writing – Review & Editing, Project administration Faculty Opinions recommended References 1. Whitmee S, Haines A, Beyrer C, et al. : Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation- Lancet Commission on planetary health. Lancet. 2015; 386 (10007): 1973–2028. PubMed Abstract | Publisher Full Text 2. Thompson T, Ballard T: Sustainable medicine: good for the environment, good for people. Br J Gen Pract. 2011; 61 (582): 3–4. PubMed Abstract | Publisher Full Text | Free Full Text 3. Klemenc Ketiš Z, Rochfort A: Sustainability for planetary health: a seventh domain of quality in primary care. Zdr Varst. 2022; 61 (4): 198–200. PubMed Abstract | Publisher Full Text | Free Full Text 4. Govender I: The role of family medicine and primary health care and its impact on the climate crisis. S Afr Fam Pract (2004). 2023; 65 (1): e1–e2. PubMed Abstract | Publisher Full Text | Free Full Text 5. Ballard T: Climate change and health: time to adopt environmental probity? Br J Gen Pract. 2011; 61 (592): 682–3. PubMed Abstract | Publisher Full Text | Free Full Text 6. Gonzalez-Holguera J, Gaille M, Del Rio Carral M, et al. : Translating Planetary Health principles into sustainable primary care services. Front Public Health. 2022; 10 : 931212. PubMed Abstract | Publisher Full Text | Free Full Text 7. Brady Bates OF, Natasha, Bentounsi, et al. : European young family doctors movement planetary health repository. 2023. Reference Source 8. Arksey H, O'Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8 (1): 19–32. Publisher Full Text 9. Levac D, Colquhoun H, O'Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5 (1): 69. PubMed Abstract | Publisher Full Text | Free Full Text 10. Husein M, Rajajee S, Nieve S, et al. : Integration of planetary health in undergraduate and postgraduate medical education: protocol for a scoping review. BMJ Open. 2022; 12 (6): e057207. PubMed Abstract | Publisher Full Text | Free Full Text 11. Liberati A, Altman DG, Tetzlaff J, et al. : The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6 (7): e1000100. PubMed Abstract | Publisher Full Text | Free Full Text 12. Peters MDJ, Marnie C, Tricco AC, et al. : Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020; 18 (10): 2119–26. PubMed Abstract | Publisher Full Text 13. Shaw E, Walpole S, McLean M, et al. : AMEE Consensus Statement: planetary health and education for sustainable healthcare. Med Teach. 2021; 43 (3): 272–86. PubMed Abstract | Publisher Full Text 14. Guzmán CAF, Aguirre AA, Astle B, et al. : A framework to guide planetary health education. Lancet Planet Health. 2021; 5 (5): e253–e5. PubMed Abstract | Publisher Full Text 15. Bates OB, et al. : Integrating Planetary Health into the Continuing Professional Development and Training in Family Medicine: Protocol for a Scoping Literature Review. OSF, (Dataset), Web. 2025. Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Mar 2025 ADD YOUR COMMENT Comment Author details Author details 1 Royal College of Surgeons in Ireland Department of General Practice, Dublin, Leinster, Ireland 2 Independent researcher, London, UK 3 Universitat de Valencia Departament de Farmacia i Tecnologia Farmaceutica i Parasitologia, Burjassot, Valencian Community, Spain 4 Izmir University of Economics, Izmir, İzmir, Turkey 5 London School of Hygiene & Tropical Medicine, London, England, UK 6 Republic of Türkiye Ministry of Health, Ankara, Turkey 7 Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland 8 Royal College of General Practitioners, London, England, UK Oisin Brady Bates Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Natasha Freeman Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Paula Sala-Ivars Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Simal Arslan Arslan Roles: Writing – Review & Editing Zahra Abdi Roles: Writing – Review & Editing Adedoyin Oyekan Roles: Writing – Original Draft Preparation Lorenzo Campedelli Roles: Writing – Review & Editing Genco Gorgu Roles: Writing – Review & Editing Ozden Gokdemir Roles: Writing – Review & Editing Debbi Stanistreet Roles: Conceptualization, Methodology, Project Administration, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information Health Research Board [APA-2024-002]. Article Versions (1) version 1 Published: 13 Mar 2025, 8:39 https://doi.org/10.12688/hrbopenres.14051.1 Copyright © 2025 Brady Bates O et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Brady Bates O, Freeman N, Sala-Ivars P et al. Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.12688/hrbopenres.14051.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 13 Mar 2025 Views 0 Cite How to cite this report: von Pressentin KB. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46873 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46873 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Jun 2025 Klaus B von Pressentin , University of Cape Town, Cape Town, South Africa Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15428.r46873 Thank you for the opportunity to review this manuscript, which describes a protocol for a planned scoping review. The authors provided sufficient background and highlighted the knowledge gap they wish to address in this scoping review. The methodology (Arksey ... Continue reading READ ALL Thank you for the opportunity to review this manuscript, which describes a protocol for a planned scoping review. The authors provided sufficient background and highlighted the knowledge gap they wish to address in this scoping review. The methodology (Arksey and O'Malley) and PRISMA-ScR reporting guidelines are suitable. A few comments to help strengthen the planned scoping review include: 1. The focus is on postgraduate GP trainees. The question and search strategy will be strengthened by including additional terminology, including broadening the population to family medicine trainees, as GP training schemes are limited from a global naming perspective. 2. While the team comprises some international academics, it would be good to exercise reflexivity and appreciate that these authors mainly represent Europe. Will this team be able to incorporate studies published in additional languages? There is mention of "stakeholders" in stage 2 - who are these stakeholders? 3. Software such as Rayyan will strengthen the data collection process. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Primary care research, family medicine, health professions education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT von Pressentin KB. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46873 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46873 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: McLean M. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46877 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46877 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Apr 2025 Michelle McLean , Bond University, Gold Coast, Australia Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15428.r46877 Thanks for inviting me to review this proposal for a scoping review into what I think is the extent to which 'planetary health' has been incorporated into the General Practice/Family Medicine PG training curriculum globally (or is it in Europe?) ... Continue reading READ ALL Thanks for inviting me to review this proposal for a scoping review into what I think is the extent to which 'planetary health' has been incorporated into the General Practice/Family Medicine PG training curriculum globally (or is it in Europe?) such as this one: Shah S, 2022 (Ref 1) . The titles say CPD so is that a second part of the review? The protocol, while undertaking valuable research, needs to be tightened in terms of what exactly is going to be undertaken. A clearly articulated research question is required that incorporates the three interrelated elements of the triple planetary crisis. The search strings need to reflect the core elements. The following should to be addressed to improve the readability and implementation of the protocol (my perspective): 1. For the authors, there is an 8 superscripted (RCGPs) but it would appear that none of the authors is associated with the organisations as they appear to be surgeons, public health physicians, etc. . There is at least one occasion in the document when the authors use 'we' in relation to "we (family medicine)" in the second paragraph in the Background and then the next paragraph uses 'their role', meaning they are not GPs (which is what their titles suggest). 2. The authors move interchangeably between family doctor, GPs (not used in full in paragraph 1) and I think family physician. There might need to be a note about what term is used where. 3. WONCA Planetary Health would be good to mention in the Background. 4. The title uses CPD and then training. Should it not be training first as the review is about the GP curriculum? CPD comes later. Additionally, the current assumption (last sentence of first full paragraph) in column 2 on p. 4 is that there is no 'planetary health' in the UG medical curriculum, which is not true. 5. The authors use planetary health and Planetary Health interchangeably. What's the difference? I have argued for Planetary Health when 'planetary health' is being referred to as a discipline as opposed to planetary health being an adjective and a noun that describes the health of the planet. McLean M, 2024 (Ref 2) 6. There seems to be non-alignment between the paragraph starting with "We seek to examine what resources are available.." and then Stage 1: Identifying the research question. The purpose of this study is to identify the extent to which .... integrated into PG Fam med curriculum. These are two different things and would require different searches. 7. In the Abstract, the last sentence of the first paragraph talks about researching what is in the European FM curriculum but p. 4 final sentence under Stage 1 says the context is international. 8. P 5. The AMEE CS is now dated. It was published in March 2021, so it is four years old. Since then, it has informed a wide range of PH inclusions in curricula. I am not sure how useful it will be. 9. Climate change is only one of three interrelated crises that impact health and well-being. The triple planetary crisis comprises a changing climate, biodiversity loss and pollution in all of its forms. Global Action Plan on Biodiversity and Health . Abbasi K, et al., 2023 (Ref 3) Pollution and climate both exacerbate biodiversity loss. 10. The keywords include sustainable healthcare (not mentioned in the text) and global health (mentioned once). Triple planetary crisis needs to be included as a term as does 'biodiversity loss' and 'pollution'. 11.This sentence does not make sense: T his is, and will continue to be, (remove the commas) an essential component of the role of ....... reduce GHG emissions in HC to helping tailor patient care to changing climate patterns and increasing natural disasters . It should like you are tailoring patient care to climate patterns... Also, GHG emissions are just one of the environmental impacts of healthcare. HC has an ecological footprint in terms of its activities, from infrastructure to the food it serves. Irwin A, et al., 2024 (Ref 4) HC also produces pollution when FF are burnt, plus it uses a lot of single-use items, most of which end up in landfills. Medical equipment requires raw materials from mining, so there is habitat destruction, plus hospitals are built on cleared land. HC thus contributes to the triple planetary crisis. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Shah S: Planetary health and sustainable primary care: what does this mean for a GP curriculum?. Br J Gen Pract . 2022; 72 (724): 532-533 PubMed Abstract | Publisher Full Text 2. McLean M: When I say …. Planetary Health. Med Educ . 2024; 58 (6): 669-670 PubMed Abstract | Publisher Full Text 3. Abbasi K, Ali P, Barbour V, Benfield T, et al.: Time to treat the climate and nature crisis as one indivisible global health emergency. BMJ . 2023. Publisher Full Text 4. Irwin A, Geschke A, Mackenbach J: The Biodiversity Impact of Health Care: Quantifying the Extinction-Risk Footprint of Health Care in The Netherlands and Other European Countries. Sustainability . 2024; 16 (3). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: I have been involved in integrating Planetary Health in health professions education since 2018 and as a Masters subject since 2020. I have been a medical educator involved in curriculum development for more than 35 years. I regularly review 'planetary health' articles, generally in education. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT McLean M. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46877 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46877 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Wabnitz K. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46479 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46479 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Mar 2025 Katharina Wabnitz , Institute for Ethics and History of Health in Society (IEHHS), University of Augsburg, Augsburg, Bavaria, Germany Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15428.r46479 Peer review report for study protocol Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review By Katharina Wabnitz MD, MSc This protocol describes the endeavour ... Continue reading READ ALL Peer review report for study protocol Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review By Katharina Wabnitz MD, MSc This protocol describes the endeavour of systematically scoping academic databases, and sources of grey literature to identify sources which support assessment of the extent to which planetary health is integrated into postgraduate general practitioners’ education internationally. Is the rationale for, and objectives of, the study clearly described? Yes. Is the study design appropriate for the research question? Yes. As this is supposed to inform a living repository, the question arises if and how regular updates of the scoping for new published material is envisioned to be carried out. Will the same team update the scoping review or is some kind of automation planned? A few more details on these aspects would be desirable but this is not decisive for my assessment of the methodological adequacy and resultant approval status of this protocol. Are sufficient details of the methods provided to allow replication by others? No. It is unclear if and how the initial broad search strategy described in Appendix 1 was updated after key terms had been identified. The initial strategy also seems to be lacking central aspects, e.g. sustainability / sustainable health care / planetary health education / transformation / pollution / biodiversity. I recommend the authors revise their operationalisation of the concept planetary health or planetary health topics as per their research question to reflect the planetary boundaries better and include related concepts such as sustainability / sustainable health care, environmental health and (transformative) planetary health education. It is also unclear to me why the Cochrane database will be searched – it is not very likely that Cochrane reviews have been carried out on this matter and I’d rather recommend searching Web of Science or Scopus and consider searching Google Scholar instead. For the grey literature search, a search strategy is missing from the protocol. I would also assume that a minority of curricula or offers for GPs in training have been reported on in scientific papers or any published text format but that a lot would only be found through searching institutional websites. This is of course a matter of capacity available but should be reflected on more clearly as a limitation. Consider complementing your literature scoping with a short survey to be distributed e.g. through the Planetary Health Alliance, WONCA or national networks dedicated to teaching and training of GPs, asking for information on courses. Some feedback on specific details in the methods section: Stage 3: It should be specified why no consensus between reviewers is being sought at the title/abstract review stage. This would potentially render the whole process more efficacious. Stage 4: It should be specified whether the themes of the planetary health content taught will be developed deductively or inductively and if deductively, which framework or source will serve as a starting point. Are the datasets clearly presented in a useable and accessible format? There are no data sets linked to this protocol. Feedback on the Background section The authors refer to the seminal definition of planetary health by the 2015 The Rockefeller-Lancet Commission on Planetary Health. In the next sentence, they only mention aspects of climate change which falls short of the notion of planetary health as this encompasses all natural systems and processes currently threatened by human activities. Furthermore, it is not clear yet what exactly the role of GPs (and all doctors) should be in regard to the environmental crisis, particularly when it comes to trade-offs between health care and sustainable practices or to political activities beyond health care. I recommend at least briefly referring to the (potential) ethical issues the notion of planetary health entails regarding the professional activities of doctors. The second paragraph starts with a sentence that is unclear to me semantically – the claim that general medicine is particularly well suited to address these issues cannot logically be supported by general awareness for costs. Also, do you refer to unsustainable medical practice here? What evidence is there for the costs that arise thereof? In the next sentence, it is unclear what strong relationships Familiy Medicine holds – to whom or what? The term positive planetary health is non-sensical as there is no negative planetary health – there’s either planetary health or planetary disaster / ill-health. You refer to a safeguarding role in the Rockefeller-Lancet Report but I cannot identify a mention of GPs in the report so the question arises whether this is a useful statement in relation to GPs here. I recommend revising the justificatory elements of the Introduction to make a stronger and more differentiated case for the role of GPs in regards to planetary health as this will also be important if this review will be indexed in bibliographic databases. Approval status Approved with reservations. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ethics of health and environmental change, co-benefits of prevention and health promotion for planetary health, medical ethos in the Anthropocene, planetary health education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Wabnitz K. Reviewer Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46479 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46479 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Mar 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 1 13 Mar 25 read read read Katharina Wabnitz , University of Augsburg, Augsburg, Germany Michelle McLean , Bond University, Gold Coast, Australia Klaus B von Pressentin , University of Cape Town, Cape Town, South Africa Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 von Pressentin K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Jun 2025 | for Version 1 Klaus B von Pressentin , University of Cape Town, Cape Town, South Africa 0 Views copyright © 2025 von Pressentin K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this manuscript, which describes a protocol for a planned scoping review. The authors provided sufficient background and highlighted the knowledge gap they wish to address in this scoping review. The methodology (Arksey and O'Malley) and PRISMA-ScR reporting guidelines are suitable. A few comments to help strengthen the planned scoping review include: 1. The focus is on postgraduate GP trainees. The question and search strategy will be strengthened by including additional terminology, including broadening the population to family medicine trainees, as GP training schemes are limited from a global naming perspective. 2. While the team comprises some international academics, it would be good to exercise reflexivity and appreciate that these authors mainly represent Europe. Will this team be able to incorporate studies published in additional languages? There is mention of "stakeholders" in stage 2 - who are these stakeholders? 3. Software such as Rayyan will strengthen the data collection process. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Primary care research, family medicine, health professions education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) von Pressentin KB. Peer Review Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46873) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46873 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 McLean M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Apr 2025 | for Version 1 Michelle McLean , Bond University, Gold Coast, Australia 0 Views copyright © 2025 McLean M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks for inviting me to review this proposal for a scoping review into what I think is the extent to which 'planetary health' has been incorporated into the General Practice/Family Medicine PG training curriculum globally (or is it in Europe?) such as this one: Shah S, 2022 (Ref 1) . The titles say CPD so is that a second part of the review? The protocol, while undertaking valuable research, needs to be tightened in terms of what exactly is going to be undertaken. A clearly articulated research question is required that incorporates the three interrelated elements of the triple planetary crisis. The search strings need to reflect the core elements. The following should to be addressed to improve the readability and implementation of the protocol (my perspective): 1. For the authors, there is an 8 superscripted (RCGPs) but it would appear that none of the authors is associated with the organisations as they appear to be surgeons, public health physicians, etc. . There is at least one occasion in the document when the authors use 'we' in relation to "we (family medicine)" in the second paragraph in the Background and then the next paragraph uses 'their role', meaning they are not GPs (which is what their titles suggest). 2. The authors move interchangeably between family doctor, GPs (not used in full in paragraph 1) and I think family physician. There might need to be a note about what term is used where. 3. WONCA Planetary Health would be good to mention in the Background. 4. The title uses CPD and then training. Should it not be training first as the review is about the GP curriculum? CPD comes later. Additionally, the current assumption (last sentence of first full paragraph) in column 2 on p. 4 is that there is no 'planetary health' in the UG medical curriculum, which is not true. 5. The authors use planetary health and Planetary Health interchangeably. What's the difference? I have argued for Planetary Health when 'planetary health' is being referred to as a discipline as opposed to planetary health being an adjective and a noun that describes the health of the planet. McLean M, 2024 (Ref 2) 6. There seems to be non-alignment between the paragraph starting with "We seek to examine what resources are available.." and then Stage 1: Identifying the research question. The purpose of this study is to identify the extent to which .... integrated into PG Fam med curriculum. These are two different things and would require different searches. 7. In the Abstract, the last sentence of the first paragraph talks about researching what is in the European FM curriculum but p. 4 final sentence under Stage 1 says the context is international. 8. P 5. The AMEE CS is now dated. It was published in March 2021, so it is four years old. Since then, it has informed a wide range of PH inclusions in curricula. I am not sure how useful it will be. 9. Climate change is only one of three interrelated crises that impact health and well-being. The triple planetary crisis comprises a changing climate, biodiversity loss and pollution in all of its forms. Global Action Plan on Biodiversity and Health . Abbasi K, et al., 2023 (Ref 3) Pollution and climate both exacerbate biodiversity loss. 10. The keywords include sustainable healthcare (not mentioned in the text) and global health (mentioned once). Triple planetary crisis needs to be included as a term as does 'biodiversity loss' and 'pollution'. 11.This sentence does not make sense: T his is, and will continue to be, (remove the commas) an essential component of the role of ....... reduce GHG emissions in HC to helping tailor patient care to changing climate patterns and increasing natural disasters . It should like you are tailoring patient care to climate patterns... Also, GHG emissions are just one of the environmental impacts of healthcare. HC has an ecological footprint in terms of its activities, from infrastructure to the food it serves. Irwin A, et al., 2024 (Ref 4) HC also produces pollution when FF are burnt, plus it uses a lot of single-use items, most of which end up in landfills. Medical equipment requires raw materials from mining, so there is habitat destruction, plus hospitals are built on cleared land. HC thus contributes to the triple planetary crisis. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Shah S: Planetary health and sustainable primary care: what does this mean for a GP curriculum?. Br J Gen Pract . 2022; 72 (724): 532-533 PubMed Abstract | Publisher Full Text 2. McLean M: When I say …. Planetary Health. Med Educ . 2024; 58 (6): 669-670 PubMed Abstract | Publisher Full Text 3. Abbasi K, Ali P, Barbour V, Benfield T, et al.: Time to treat the climate and nature crisis as one indivisible global health emergency. BMJ . 2023. Publisher Full Text 4. Irwin A, Geschke A, Mackenbach J: The Biodiversity Impact of Health Care: Quantifying the Extinction-Risk Footprint of Health Care in The Netherlands and Other European Countries. Sustainability . 2024; 16 (3). Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise I have been involved in integrating Planetary Health in health professions education since 2018 and as a Masters subject since 2020. I have been a medical educator involved in curriculum development for more than 35 years. I regularly review 'planetary health' articles, generally in education. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) McLean M. Peer Review Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46877) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-39/v1#referee-response-46877 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Wabnitz K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Mar 2025 | for Version 1 Katharina Wabnitz , Institute for Ethics and History of Health in Society (IEHHS), University of Augsburg, Augsburg, Bavaria, Germany 0 Views copyright © 2025 Wabnitz K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Peer review report for study protocol Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review By Katharina Wabnitz MD, MSc This protocol describes the endeavour of systematically scoping academic databases, and sources of grey literature to identify sources which support assessment of the extent to which planetary health is integrated into postgraduate general practitioners’ education internationally. Is the rationale for, and objectives of, the study clearly described? Yes. Is the study design appropriate for the research question? Yes. As this is supposed to inform a living repository, the question arises if and how regular updates of the scoping for new published material is envisioned to be carried out. Will the same team update the scoping review or is some kind of automation planned? A few more details on these aspects would be desirable but this is not decisive for my assessment of the methodological adequacy and resultant approval status of this protocol. Are sufficient details of the methods provided to allow replication by others? No. It is unclear if and how the initial broad search strategy described in Appendix 1 was updated after key terms had been identified. The initial strategy also seems to be lacking central aspects, e.g. sustainability / sustainable health care / planetary health education / transformation / pollution / biodiversity. I recommend the authors revise their operationalisation of the concept planetary health or planetary health topics as per their research question to reflect the planetary boundaries better and include related concepts such as sustainability / sustainable health care, environmental health and (transformative) planetary health education. It is also unclear to me why the Cochrane database will be searched – it is not very likely that Cochrane reviews have been carried out on this matter and I’d rather recommend searching Web of Science or Scopus and consider searching Google Scholar instead. For the grey literature search, a search strategy is missing from the protocol. I would also assume that a minority of curricula or offers for GPs in training have been reported on in scientific papers or any published text format but that a lot would only be found through searching institutional websites. This is of course a matter of capacity available but should be reflected on more clearly as a limitation. Consider complementing your literature scoping with a short survey to be distributed e.g. through the Planetary Health Alliance, WONCA or national networks dedicated to teaching and training of GPs, asking for information on courses. Some feedback on specific details in the methods section: Stage 3: It should be specified why no consensus between reviewers is being sought at the title/abstract review stage. This would potentially render the whole process more efficacious. Stage 4: It should be specified whether the themes of the planetary health content taught will be developed deductively or inductively and if deductively, which framework or source will serve as a starting point. Are the datasets clearly presented in a useable and accessible format? There are no data sets linked to this protocol. Feedback on the Background section The authors refer to the seminal definition of planetary health by the 2015 The Rockefeller-Lancet Commission on Planetary Health. In the next sentence, they only mention aspects of climate change which falls short of the notion of planetary health as this encompasses all natural systems and processes currently threatened by human activities. Furthermore, it is not clear yet what exactly the role of GPs (and all doctors) should be in regard to the environmental crisis, particularly when it comes to trade-offs between health care and sustainable practices or to political activities beyond health care. I recommend at least briefly referring to the (potential) ethical issues the notion of planetary health entails regarding the professional activities of doctors. The second paragraph starts with a sentence that is unclear to me semantically – the claim that general medicine is particularly well suited to address these issues cannot logically be supported by general awareness for costs. Also, do you refer to unsustainable medical practice here? What evidence is there for the costs that arise thereof? In the next sentence, it is unclear what strong relationships Familiy Medicine holds – to whom or what? The term positive planetary health is non-sensical as there is no negative planetary health – there’s either planetary health or planetary disaster / ill-health. You refer to a safeguarding role in the Rockefeller-Lancet Report but I cannot identify a mention of GPs in the report so the question arises whether this is a useful statement in relation to GPs here. I recommend revising the justificatory elements of the Introduction to make a stronger and more differentiated case for the role of GPs in regards to planetary health as this will also be important if this review will be indexed in bibliographic databases. Approval status Approved with reservations. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Ethics of health and environmental change, co-benefits of prevention and health promotion for planetary health, medical ethos in the Anthropocene, planetary health education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Wabnitz K. Peer Review Report For: Integrating planetary health into the continuing professional development and training in family medicine: Protocol for a scoping literature review [version 1; peer review: 3 approved with reservations] . HRB Open Res 2025, 8 :39 ( https://doi.org/10.21956/hrbopenres.15428.r46479) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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