{"id":"https://openalex.org/W7223883768","doi":"https://doi.org/10.1186/s12909-026-10712-x","title":"The physician as ecological gatekeeper: operationalizing planetary health competencies in medical education","display_name":"The physician as ecological gatekeeper: operationalizing planetary health competencies in medical education","publication_year":2026,"publication_date":"2026-10-28","ids":{"openalex":"https://openalex.org/W7223883768","doi":"https://doi.org/10.1186/s12909-026-10712-x"},"language":"en","primary_location":{"id":"doi:10.1186/s12909-026-10712-x","doi":"https://doi.org/10.1186/s12909-026-10712-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12909-026-10712-x","pdf_url":null,"source":{"id":"https://openalex.org/S144187503","display_name":"BMC Medical Education","issn_l":"1472-6920","issn":["1472-6920"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Medical Education","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.1186/s12909-026-10712-x","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5159811525","display_name":"Le Li","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":true,"raw_author_name":"Le Li","raw_affiliation_strings":["Center for Medical Language and Culture Studies, Xi\u2019an Medical University, Xi\u2019an, 710021, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Center for Medical Language and Culture Studies, Xi\u2019an Medical University, Xi\u2019an, 710021, China","institution_ids":["https://openalex.org/I4210107780"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159863310","display_name":"Yingli Xue","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Yingli Xue","raw_affiliation_strings":["Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China","institution_ids":["https://openalex.org/I4210107780"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159780682","display_name":"Ting Xue","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Ting Xue","raw_affiliation_strings":["Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China","institution_ids":["https://openalex.org/I4210107780"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159789427","display_name":"Na Zhao","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Na Zhao","raw_affiliation_strings":["Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China","institution_ids":["https://openalex.org/I4210107780"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5159784088","display_name":"Jingli Zuo","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Jingli Zuo","raw_affiliation_strings":["Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China","institution_ids":["https://openalex.org/I4210107780"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5123990330","display_name":"Jianan Yang","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210107780","display_name":"Xi'an Medical University","ror":"https://ror.org/01fmc2233","country_code":"CN","type":"education","lineage":["https://openalex.org/I4210107780"]}],"countries":["CN"],"is_corresponding":false,"raw_author_name":"Jianan Yang","raw_affiliation_strings":["Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Foreign Languages, Xi\u2019an Medical University, Xi\u2019an, Shaanxi, China","institution_ids":["https://openalex.org/I4210107780"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5159811525"],"corresponding_institution_ids":["https://openalex.org/I4210107780"],"apc_list":{"value":2990,"currency":"USD","value_usd":2990},"apc_paid":{"value":2990,"currency":"USD","value_usd":2990},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.8763368,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.8779000043869019,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.8779000043869019,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11835","display_name":"Sustainability in Higher Education","score":0.04699999839067459,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12413","display_name":"Health and Medical Education","score":0.045099999755620956,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/planetary-health","display_name":"planetary health","score":0.9869999885559082},{"id":"https://openalex.org/keywords/medical-curriculum","display_name":"medical curriculum","score":0.7639999985694885},{"id":"https://openalex.org/keywords/competency-based-learning-objectives","display_name":"competency-based learning objectives","score":0.6850000023841858},{"id":"https://openalex.org/keywords/primary-care","display_name":"primary care","score":0.7350000143051147},{"id":"https://openalex.org/keywords/systems-thinking","display_name":"systems thinking","score":0.8100000023841858},{"id":"https://openalex.org/keywords/intergenerational-justice","display_name":"intergenerational justice","score":0.8759999871253967},{"id":"https://openalex.org/keywords/climate-anxiety","display_name":"climate anxiety","score":0.9539999961853027},{"id":"https://openalex.org/keywords/quaternary-prevention","display_name":"quaternary prevention","score":0.6570000052452087},{"id":"https://openalex.org/keywords/professional-identity","display_name":"professional identity","score":0.5419999957084656},{"id":"https://openalex.org/keywords/anthropocentrism","display_name":"anthropocentrism","score":0.6600000262260437},{"id":"https://openalex.org/keywords/sustainable-healthcare-systems","display_name":"sustainable health systems","score":0.8090000152587891}],"concepts":[{"id":"https://openalex.org/C9354725","wikidata":"https://www.wikidata.org/wiki/Q286017","display_name":"Operationalization","level":2,"score":0.7221999764442444},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.5515999794006348},{"id":"https://openalex.org/C7807463","wikidata":"https://www.wikidata.org/wiki/Q191624","display_name":"Anthropocentrism","level":2,"score":0.5471000075340271},{"id":"https://openalex.org/C47177190","wikidata":"https://www.wikidata.org/wiki/Q207137","display_name":"Curriculum","level":2,"score":0.5297999978065491},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4632999897003174},{"id":"https://openalex.org/C14224292","wikidata":"https://www.wikidata.org/wiki/Q13600188","display_name":"Conceptual framework","level":2,"score":0.4255000054836273},{"id":"https://openalex.org/C164065428","wikidata":"https://www.wikidata.org/wiki/Q1201929","display_name":"Core competency","level":2,"score":0.4237000048160553},{"id":"https://openalex.org/C200287777","wikidata":"https://www.wikidata.org/wiki/Q830115","display_name":"Concept map","level":2,"score":0.38589999079704285},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.3785000145435333},{"id":"https://openalex.org/C55587333","wikidata":"https://www.wikidata.org/wiki/Q1133029","display_name":"Engineering ethics","level":1,"score":0.3499999940395355},{"id":"https://openalex.org/C100521375","wikidata":"https://www.wikidata.org/wiki/Q2015382","display_name":"Competence (human resources)","level":2,"score":0.34630000591278076},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.33980000019073486},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.33559998869895935},{"id":"https://openalex.org/C18903297","wikidata":"https://www.wikidata.org/wiki/Q7150","display_name":"Ecology","level":1,"score":0.30300000309944153},{"id":"https://openalex.org/C144024400","wikidata":"https://www.wikidata.org/wiki/Q21201","display_name":"Sociology","level":0,"score":0.2985999882221222},{"id":"https://openalex.org/C2778568292","wikidata":"https://www.wikidata.org/wiki/Q7727275","display_name":"The Conceptual Framework","level":3,"score":0.2888000011444092},{"id":"https://openalex.org/C126086293","wikidata":"https://www.wikidata.org/wiki/Q237151","display_name":"Medical ethics","level":2,"score":0.2849000096321106},{"id":"https://openalex.org/C169900460","wikidata":"https://www.wikidata.org/wiki/Q2200417","display_name":"Cognition","level":2,"score":0.2818000018596649},{"id":"https://openalex.org/C88610354","wikidata":"https://www.wikidata.org/wiki/Q1813494","display_name":"Teaching method","level":2,"score":0.28060001134872437},{"id":"https://openalex.org/C173366509","wikidata":"https://www.wikidata.org/wiki/Q206829","display_name":"Reductionism","level":2,"score":0.2786000072956085},{"id":"https://openalex.org/C2777921204","wikidata":"https://www.wikidata.org/wiki/Q66104672","display_name":"Knowledge translation","level":2,"score":0.27160000801086426},{"id":"https://openalex.org/C2778587949","wikidata":"https://www.wikidata.org/wiki/Q188504","display_name":"Integrative medicine","level":3,"score":0.27149999141693115},{"id":"https://openalex.org/C113807197","wikidata":"https://www.wikidata.org/wiki/Q60894","display_name":"Health education","level":3,"score":0.26409998536109924},{"id":"https://openalex.org/C48164120","wikidata":"https://www.wikidata.org/wiki/Q4491893","display_name":"Concept learning","level":2,"score":0.26080000400543213},{"id":"https://openalex.org/C55958113","wikidata":"https://www.wikidata.org/wiki/Q169480","display_name":"Indigenous","level":2,"score":0.26030001044273376},{"id":"https://openalex.org/C139621336","wikidata":"https://www.wikidata.org/wiki/Q3190382","display_name":"Economic Justice","level":2,"score":0.2578999996185303},{"id":"https://openalex.org/C66204764","wikidata":"https://www.wikidata.org/wiki/Q219416","display_name":"Sustainability","level":2,"score":0.25459998846054077},{"id":"https://openalex.org/C51067260","wikidata":"https://www.wikidata.org/wiki/Q828812","display_name":"Professional development","level":2,"score":0.2500999867916107}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1186/s12909-026-10712-x","doi":"https://doi.org/10.1186/s12909-026-10712-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12909-026-10712-x","pdf_url":null,"source":{"id":"https://openalex.org/S144187503","display_name":"BMC Medical Education","issn_l":"1472-6920","issn":["1472-6920"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Medical Education","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1186/s12909-026-10712-x","doi":"https://doi.org/10.1186/s12909-026-10712-x","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s12909-026-10712-x","pdf_url":null,"source":{"id":"https://openalex.org/S144187503","display_name":"BMC Medical Education","issn_l":"1472-6920","issn":["1472-6920"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["cwts-core","doaj","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320256","host_organization_name":"BioMed Central","host_organization_lineage":["https://openalex.org/P4310320256","https://openalex.org/P4310319965"],"host_organization_lineage_names":["BioMed Central","Springer Nature"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Medical Education","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9235000014305115,"id":"https://metadata.un.org/sdg/4","display_name":"Quality education"},{"score":0.5683000087738037,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4321088125","https://openalex.org/W4366989494","https://openalex.org/W4410064722","https://openalex.org/W4405357983","https://openalex.org/W4311054788","https://openalex.org/W3130351444","https://openalex.org/W4413815665","https://openalex.org/W7164556959","https://openalex.org/W6925489458","https://openalex.org/W7154525571"],"abstract_inverted_index":{"Abstract":[0],"Background":[1],"Planetary":[2],"health":[3,86,262],"is":[4,51,239],"increasingly":[5],"recognized":[6],"as":[7,152,210,227],"a":[8,52,99,175,214,233,257,271],"critical":[9],"component":[10],"of":[11,65,70,105,189,229],"medical":[12,89,230],"education":[13],"curricula":[14],"globally.":[15],"However,":[16],"implementation":[17],"remains":[18],"fragmented,":[19],"often":[20],"limited":[21],"to":[22,38,74,146,165,180,201,219,241],"elective":[23],"courses":[24],"or":[25],"abstract":[26],"principles":[27],"that":[28,58,259],"lack":[29],"translation":[30],"into":[31,87],"routine":[32,250],"clinical":[33,48,236,282],"practice.":[34],"Consequently,":[35],"students":[36],"struggle":[37],"bridge":[39],"the":[40,63,125],"gap":[41],"between":[42],"macro-level":[43],"ecological":[44,187],"ethics":[45],"and":[46,128,137,150,191,208,213,224,281],"micro-level":[47],"decision-making.":[49],"There":[50],"pressing":[53],"need":[54],"for":[55,62,83,115,274],"pedagogical":[56],"approaches":[57],"operationalize":[59],"these":[60,247],"concepts":[61,263],"reality":[64],"daily":[66],"care.":[67],"The":[68,141],"aim":[69],"this":[71],"study":[72,255],"was":[73,162],"organize":[75],"existing":[76,142,265],"competencies":[77,248],"within":[78],"an":[79,196],"\u201cEcological":[80,158],"Gatekeeper\u201d":[81,159],"framework":[82,103,161,258],"integrating":[84],"planetary":[85,261],"core":[88],"curricula,":[90],"specifically":[91],"in":[92,249],"primary":[93],"care":[94],"settings.":[95],"Methods":[96],"We":[97],"conducted":[98],"hybrid":[100],"inductive-deductive":[101],"conceptual":[102,160],"analysis":[104],"nine":[106],"objectives":[107,143],"from":[108,124,178,199,217],"Germany\u2019s":[109],"National":[110],"Competency-Based":[111],"Learning":[112],"Objectives":[113],"Catalog":[114],"Medicine":[116],"2.0":[117,267],"(NKLM":[118],"2.0).":[119],"Descriptive":[120],"themes":[121],"were":[122,144],"developed":[123],"policy":[126],"text":[127],"then":[129],"interpreted":[130],"through":[131,169],"Systems":[132],"Thinking,":[133],"Indigenous":[134],"Relational":[135,202],"Ethics,":[136],"Sustainable":[138],"Health":[139],"Systems.":[140],"mapped":[145],"three":[147,170],"analytic":[148],"dimensions":[149],"reformatted":[151],"assessable":[153],"statements.":[154],"Results":[155],"A":[156],"three-dimensional":[157],"constructed,":[163],"designed":[164],"transform":[166],"professional":[167,211],"identity":[168],"operational":[171],"shifts.":[172],"These":[173],"include":[174],"cognitive":[176],"shift":[177,198,216],"reductionism":[179],"Ecological":[181],"Diagnosis,":[182],"which":[183,204,221],"involves":[184],"identifying":[185],"non-linear":[186],"drivers":[188],"disease":[190],"psychological":[192],"burdens":[193],"like":[194],"eco-anxiety;":[195],"ethical":[197],"anthropocentrism":[200],"Identity,":[203],"recognizes":[205],"intergenerational":[206],"justice":[207],"interconnectedness":[209],"duties;":[212],"practical":[215],"interventionism":[218],"Eco-Stewardship,":[220],"applies":[222],"Pharma-Ecology":[223],"Quaternary":[225],"Prevention":[226],"forms":[228],"urgency.":[231],"Additionally,":[232],"\u201cClimate":[234],"Clinic\u201d":[235],"decision":[237],"pathway":[238],"presented":[240],"illustrate":[242],"how":[243],"physicians":[244],"can":[245],"demonstrate":[246],"patient":[251],"consultations.":[252],"Conclusions":[253],"This":[254],"proposes":[256],"aligns":[260],"with":[264],"NKLM":[266],"objectives.":[268],"It":[269],"offers":[270],"structured":[272],"basis":[273],"curriculum":[275],"development,":[276],"but":[277],"its":[278],"educational":[279],"effectiveness":[280],"feasibility":[283],"require":[284],"empirical":[285],"validation.":[286]},"counts_by_year":[],"updated_date":"2026-10-29T09:56:32.521200","created_date":"2026-10-28T00:00:00"}
