Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

BACKGROUND: The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice. METHODS: This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM. RESULTS: Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians' actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands. CONCLUSIONS: Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

Evaluation Studies on Education in Occupational Safety and Health: Inspiration for Developing Economies.

BACKGROUND: Education and training of students, workers, and professionals are essential for occupational safety and health (OSH). We noticed a lack of debate on how to advance coverage and quality of OSH education given high shortages in developing economies. OBJECTIVES: International discussion on future options might be stimulated by an overview of recent studies. METHODS: We employed a search of the Cochrane Library and PubMed/MEDLINE databases for articles from the last decade on evaluation of OSH education. FINDINGS: We selected 121 relevant studies and 6 Cochrane reviews. Most studies came from the United States, Western Europe, and Asia. Studies from low-income countries were scarce. From a global perspective, the number of evaluation studies found was disappointingly low and the quality needs improvement. Most commonly workers' education was evaluated, less often education of students, supervisors, and OSH professionals. Interactive e-cases and e-learning modules, video conferences, and distance discussion boards are inspiring educational methods, but also participatory workshops and educational plays. Ways to find access to underserved populations were presented and evaluated, such as educational campaigns, farm safety days, and OSH expert-supported initiatives of industrial branch organizations, schools, and primary, community, or hospital-based health care. Newly educated groups were immigrant workers training colleagues, workers with a disease, managers, and family physicians. CONCLUSIONS: Developing economies can take advantage of a variety of online facilities improving coverage and quality of education. Blended education including face-to-face contacts and a participatory approach might be preferred. For workers, minor isolated educational efforts are less effective than enhanced education or education as part of multifaceted preventive programs. Collaboration of OSH experts with other organizations offers opportunities to reach underserved worker populations. Increasing international collaboration is a promise for the future. National legislation and government support is necessary, placing OSH education high on the national agenda, with special attention for most needed professionals and for underserved workers in high-risk jobs such as in the informal sector. International support can be boosted by a high-level international task force on education and training, funded programming, and a global online platform.

[Every physician should know how to take an occupational history: the importance of teaching occupational medicine in medical school]. / Iedere arts moet arbeidsanamnese uitvragen: belang van 'arbeid en gezondheid' in de medische opleiding.

Working and participating in society are important for one's health and wellbeing. This also works the other way around: in order to work or participate, one has to be healthy. Every doctor should learn about this reciprocal relationship during their medical training. In a survey undertaken by the Netherlands Society of Occupational Medicine, the amount of time spent on occupational medicine in the curriculum of eight Dutch medical faculties was examined. The study showed vast differences between faculties in the amount of time spent on occupational medicine, in the learning methods employed and also in the number of students who participate in internships. The situation in the Netherlands compares favourably with that in other European countries. Sufficient specific attention to subjects related to health and work during undergraduate education is important for all doctors and a prerequisite to increase the number of medical students who subsequently choose a career in occupational health medicine.

A clinically integrated post-graduate training programme in evidence-based medicine versus 'no intervention' for improving disability evaluations: a cluster randomised clinical trial.

BACKGROUND: Although several studies have shown that teaching EBM is effective in improving knowledge, at present, there is no convincing evidence that teaching EBM also changes professional behaviour in practice. Therefore, the primary aim of this study was to evaluate the effectiveness of a clinically integrated post-graduate training programme in EBM on evidence-based disability evaluation. METHODS AND FINDINGS: In a cluster randomised controlled trial, fifty-four case-based learning groups consisting of 132 physicians and 1680 patients were randomly assigned to the intervention or control groups. A clinically integrated, post-graduate, 5-day training programme in evidence-based medicine, consisting of (home) assignments, peer teaching, interactive training in searching databases, lectures and brainstorming sessions was provided to the intervention group. The control group received no training. The primary outcome was evidence-based disability evaluation, as indicated by the frequency in use of evidence of sufficient quality in disability evaluation reports. There are no general EBM behaviour outcome measures available. Therefore, we followed general guidelines for constructing performance indicators and defined an a priori cut-off for determination of sufficient quality as recommended for evaluating EB training. Physicians trained in EBM performed more evidence-based disability evaluations compared to physicians in the control group (difference in absolute proportion 9.7%, 95% CI 3.5 to 15.9). The primary outcome differences between groups remained significant after both cluster-adjusted analysis and additional sensitivity analyses accounting for subjects lost to follow-up. CONCLUSIONS: A EBM programme successfully improved the use of evidence in a non-hospital based medical specialty. Our findings support the general recommendations to use multiple educational methods to change physician behaviour. In addition, it appeared important that the professional context of the intervention was very supportive in the sense that searches in databases, using and applying guidelines and other forms of evidence are considered standard practice and are encouraged by colleagues and management.

Annual incidence of occupational diseases in economic sectors in The Netherlands.

OBJECTIVE: To report the annual incidence of occupational diseases (ODs) in economic sectors in The Netherlands. METHODS: In a 5-year prospective cohort study (2009-2013), occupational physicians were asked to participate in a sentinel surveillance system for OD notification. The inclusion criteria for participation were (1) covering a population of employees, (2) reporting the economic sectors and the size of their employee population and (3) willingness to report all diagnosed ODs. In this study, an OD was defined as a disease with a specific clinical diagnosis that was predominantly caused by work-related factors. The economic sectors (n=21) were defined according the NACE (Nomenclature des Activités Économiques dans la Communauté Européenne) classification. RESULTS: In a total working population of 514,590 employees, 1782 ODs were reported over 12 months in 2009. The estimated annual incidence for any OD was 346 (95% CI 330 to 362) per 100,000 worker-years. Of all the ODs, mental diseases were reported most frequently (41%), followed by musculoskeletal (39%), hearing (11%), infectious (4%), skin (3%), neurological (2%) and respiratory (2%) diseases. The four economic sectors with the highest annual incidences per 100,000 workers were construction (1127; 95% CI 1002 to 1253), mining and quarrying (888; 95% CI 110 to 1667), water and waste processing (832; 95% CI 518 to 1146) and transport and storage (608; 95% CI 526 to 690). CONCLUSION: ODs are reported in all economic sectors in The Netherlands. Up to 91% of all ODs are mental, musculoskeletal and hearing diseases. Efforts to increase the effective assessment of ODs and compliance in reporting activities enhance the usability of incidence figures for the government, employers and workers.

Effectiveness of e-learning in continuing medical education for occupational physicians.

BACKGROUND: Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated. AIM: To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs. METHODS: Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning. RESULTS: In both groups, a significant gain in knowledge on mental health care was found (P < 0.05). However, there was no significant difference between the two educational approaches. CONCLUSION: The effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs.

Evaluation of a workshop on evidence-based medicine for social insurance physicians.

BACKGROUND: Evidence-based medicine (EBM), a comprehensive method to support clinical decision making by using evidence, has been instrumental in clinical specialties but not yet in insurance medicine. AIMS: We developed and evaluated a workshop on EBM for Dutch social insurance physicians who perform disability evaluations. METHODS: Sixty-six social insurance physicians followed a 1-day introductory workshop that focused on teaching two EBM core skills: to ask answerable questions and to search for the best evidence. All outcomes were measured before, immediately after and 3 months after the workshop by means of self-assessment. The primary outcomes were knowledge, skills, attitude and intention to apply EBM in practice. The secondary outcomes were social influence, self-efficacy and behaviour. RESULTS: Immediately after the workshop, a marked and significant improvement was seen in self-assessed skills (mean difference 4.2, 95% CI 3.7-4.6) and in self-efficacy to apply EBM (mean difference 0.7, 95% CI 0.6-0.8). For attitude, knowledge and intention, the improvements were small. Three months after the workshop, the improvements in skills (mean difference 2.3, 95% CI 1.8-2.9) and self-efficacy (mean difference 0.5, 95% CI 0.3-0.6) remained significant. CONCLUSIONS: The workshop improved self-assessed EBM skills and self-efficacy both in the short and long term. The workshop also resulted in limited short-term improvements in self-assessed knowledge and in the intention to apply EBM in practice. The EBM approach can be successfully taught to social insurance physicians working in the field of disability evaluation.

Problem-based learning versus lecture-based learning in postgraduate medical education.

OBJECTIVES: The objective of this study was to investigate the effectiveness of problem-based learning in comparison with lecture-based learning in a postgraduate medical training program concerning the management of mental health problems for occupational health physicians. METHODS: A randomized controlled trial in 1999, with a mean follow-up of 14 months after the educational intervention, was used involving postgraduate medical education and training for occupational health physicians in The Netherlands, with 118 physicians in training as occupational health physicians. The experimental program was based on the principles of problem-based learning; the control program used the traditional lecture-based approach. Both programs were aimed at improving knowledge of and performance in the occupational management of work-related mental health problems. As the main outcome measures, knowledge tests consisting of true-or-false and open-answer questions and performance in practice based on self-reports and performance indicators were used. Satisfaction with the course was rated by the participants. RESULTS: In both groups, knowledge had increased equally directly after the programs and decreased equally after the follow-up. The gain in knowledge remained positive. The performance indicator scores also increased in both groups, but significantly more so in the problem-based group. The problem-based group was less satisfied with the course. CONCLUSIONS: Both forms of postgraduate medical training are effective. In spite of less favorable evaluations, the problem-based program appeared to be more effective than the lecture-based program in improving performance. Both programs, however, were equally effective in improving knowledge levels.