Residency in the Era of Climate Change: A Multi-Institutional Survey of Medical Student Perceptions and Match Preferences

BackgroundClimate change is an escalating health crisis, yet its influence on medical students career decisions remains underexplored. ObjectiveThis study uses the "Six Americas" framework to assess students climate views and the impact on residency and career decisions. MethodsA survey was distributed to students at four North American medical schools from October 2024 to January 2025. The instrument assessed demographic information, climate change views utilizing the Six Americas Super Short Survey, and the impact of climate change on residency and career decisions. Respondents were classified as Alarmed, Concerned, Cautious, Disengaged, Doubtful, or Dismissive using the Six Americas framework. Associations between climate attitudes, training year, and intended specialty were analyzed using Kruskal-Wallis tests. ResultsA total of 105 medical students completed the survey. 93% agreed climate change is a major health threat, 66% valued residency program sustainability efforts, and 41% indicated commitment to sustainability influences their rank list. Most students were Alarmed (62%), Concerned (19%), or Cautious (12%). Climate attitudes did not vary by specialty interest. Training year was associated with Six Americas classification (p < 0.05), MS2s had the most Alarmed respondents. ConclusionsMedical students overwhelmingly view climate change as a serious health threat and expect residency programs to demonstrate commitment to sustainability. Nearly half consider environmental values when ranking programs. These findings suggest climate-conscious training environments may gain a competitive recruitment advantage. Given the high proportion of "Alarmed" students, embedding climate-resilient education and sustainable practices into residency programs may align with future physician priorities.