The Occupational Medicine Pipeline: Report on the Results of a Survey of International Occupational Medicine Society Collaborative (IOMSC) Member Countries.

OBJECTIVE: To learn how occupational and environmental medicine (OEM) expertise is developed and maintained around the world and to inform strategies for further international development of OEM. METHODS: An anonymous survey was conducted of leaders of the 48 member societies (from 43 countries) of the International Occupational Medicine Society Collaborative (IOMSC) to evaluate OEM training, certification, maintenance, and recertification requirements. RESULTS: OEM physician leaders representing 46 of the 48 IOMSC member societies (95.8%) completed the survey between December 2019 and February 2020. Academic post-graduate and on-the-job training were the most frequent methods for developing OEM expertise, with little use of online coursework and minimal OEM content in medical school in most countries. Occupational medicine board certification usually required graduate specialty training and passing a certification examination, while occupational medicine recertification requirements were uncommon. CONCLUSION: The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical education curriculum content and examples of OEM specialty certification pathways from different countries.

The Future of Military Occupational and Environmental Medicine in the Department of Defense.

OBJECTIVE: Transfer of military medical facilities to the Defense Health Agency is transforming the Military Health System. Our objective is to inform this transformation with respect to optimum application of occupational and environmental medicine (OEM) expertise. METHODS: We defined and analyzed the external influences on military OEM practice using a structured framework to identify key drivers. RESULTS: Key drivers are political and economic factors. These may change the size or military/civilian ratio of the specialty. Limited career development pathways should prompt consideration of making OEM a second or combined residency, and military-funded training of civilian physicians may be required. OEM specialist utilization should be reassessed. CONCLUSIONS: OEM is a highly adaptable specialty defined by the needs of its stakeholders. Comprehensive analysis of external influences can ensure that OEM practice remains in step with changing needs.

Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University.

OBJECTIVE: To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program. METHODS: Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis). RESULTS: Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with U.S. Department of Defense (DoD) toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget, and personnel cuts. CONCLUSIONS: The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal, and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.

Uniformed Services University Occupational and Environmental Medicine Residency Program.

In 2019, the Uniformed Services University of the Health Sciences (USU) F. Edward Hébert School of Medicine celebrated the 30th anniversary of its Occupational and Environmental Medicine (OEM) Residency program. This unique program is among the largest preventive medicine residency programs in the United States. Residents from the US Army, Navy, Air Force, other federal institutions, and the Canadian Forces come to Bethesda, Maryland, to become OEM specialists in a unique training program encompassing both military and civilian OEM settings. This publication describes the historical development and practice of OEM in the military leading to the development of the USU OEM Residency Program, along with the program's past accomplishments and current operation. Finally, the publication explores potential future directions for this relatively small but important preventive medicine specialty in the practice of military medicine, considering the impacts of reorganization of the Military Health System along with the opportunities this reorganization presents for the USU OEM Residency program.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.

BACKGROUND: Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. OBJECTIVE: We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. METHODS: Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. RESULTS: Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. CONCLUSIONS: Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

BACKGROUND: Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army. METHODS: Records possibly related to the residency were reviewed, starting with 1954 since certification of physicians as Occupation Medicine specialists began in 1955. Interviews were conducted with selected physicians who had strong affiliations with the Army residency and the practice of Army OEM. FINDINGS: The Army OEM residency began in 1960 and closed in 1996 with the transfer of Army OEM residency training to the Uniformed Services University of the Health Sciences, Bethesda, MD. Over 36 years, 47 uniformed residency graduates were identified; 44 were from the Army. Forty graduated between 1982 and 1996. The OEM residency was part of a dynamic cycle. Uniformed OEM leaders identified the knowledge and skills required of military OEM physicians and where these people should be stationed in the global Army. Rotations at military sites to acquire the needed knowledge and skills were integrated into the residency. Residency graduates were assigned to positions where they were needed. Having uniformed residents and preceptors facilitated the development of trust with military leaders and access to areas where OEM physician skills and knowledge could have a positive impact. Early reports indicated the residency was important in recruiting and retaining OEM physicians, with emphasis placed on supporting the Army industrial base. The late 1970s into the 1990s was a more dynamic period. There was heightened interest in environmental protection and restoration of military installations, and in the threats posed by nuclear, biological and chemical weapons. Additionally, President Reagan initiated a military buildup that brought new health risks to soldiers who would use and maintain modern equipment. Army OEM physicians were required to possess competencies in many areas, to include depots in the Army industrial base, occupational health for the soldier for exposures like carbon monoxide in armored vehicles, military unique exposures like those from chemical threat agents, and environmental medicine to assess health risks on contaminated U.S. military sites and from exposures of deployed forces. These offered interesting OEM training opportunities that challenged residents in the program and helped recruit new residents. DISCUSSION: The strength of the first Army OEM residency was that it was part of a dynamic cycle that consisted of identifying and defining Army OEM needs, training physicians to meet those needs and assigning residency graduates to positions where they would have a positive impact. This paradigm can be used as the basis for contemporary assessments of the Army's need for uniformed OEM physicians and a uniformed OEM residency program.

Occupational Safety and Health in Peru.

Peru is a country located on the Pacific coast of South America with a population of more than 30 million inhabitants. In the past 10 years, Peru has had a steady economic growth. Peru is predominantly an extractive industry country, but the manufacturing and construction sectors are booming. It is in this context that regulations have been implemented to protect the safety and health of workers. One of the most important regulations is the Law on Safety and Health at Work, which has been recently promulgated. Regulations are complemented by training and education in occupational safety and health. The measures are yet to be fully implemented thus a positive effect in reducing accidents and occupational diseases at work has not yet been seen.

Developing and analysing a curriculum map in Occupational- and Environmental Medicine.

BACKGROUND: During the last 5 years a fundamental curriculum reform was realized at the medical school of the Ludwig-Maximilians-University. In contrast to those efforts, the learning objectives were not defined consistently for the curriculum and important questions concerning the curriculum could not be answered. This also applied to Occupational and Environmental Medicine where teachers of both courses were faced with additional problems such as the low number of students attending the lectures.The aims of the study were to develop and analyse a curriculum map for Occupational and Environmental Medicine based on learning objectives using a web-based database.Furthermore we aimed to evaluate student perception about the curricular structure. METHODS: Using a web-based learning objectives database, a curriculum map for Occupational and Environmental Medicine was developed and analysed. Additionally online evaluations of students for each course were conducted. RESULTS: The results show a discrepancy between the taught and the assessed curriculum. For both curricula, we identified that several learning objectives were not covered in the curriculum. There were overlaps with other content domains and redundancies within both curricula. 53% of the students in Occupational Medicine and 43% in Environmental Medicine stated that there is a lack of information regarding the learning objectives of the curriculum. CONCLUSIONS: The results of the curriculum mapping and the poor evaluation results for the courses suggest a need for re-structuring both curricula.

Engaging medical students in occupational and environmental medicine--a new approach.

BACKGROUND: For a number of reasons, engaging the interest of medical students in the discipline of occupational and environmental medicine (OEM) can be challenging. AIMS: To renew a curriculum in OEM within a graduate medical programme with an emphasis on student involvement to maximize their interest in the topic. METHODS: A second year student cohort of a 4 year graduate medical programme was surveyed as to their preferences for the content of a short course of OEM embedded in their medical course. The course was extensively rewritten as a result of the student survey, with a number of topics deleted from the old course and new topics added. In order to validate the content of the new course, local occupational physicians (OPs) were also surveyed as to their opinion of an appropriate curriculum in OEM for medical students. The new course was taught to the subsequent cohort of second year medical students. The students' ratings of the course pre- and post-revision were compared. RESULTS: The student satisfaction rates of the course significantly improved as a result of the changes. The content of the student-led curriculum was strikingly similar to the course proposed by the local OP with a few key exceptions. CONCLUSIONS: Student involvement in curriculum design in OEM is entirely feasible. It can result in a curriculum similar to that designed by expert opinion but has the advantage of strongly engaging student interest.

Perceptions of training in occupational and environmental medicine among family medicine residents.

OBJECTIVE: Although knowledge of occupational and environmental medicine (OEM) is important for effective primary health care practice, few studies have examined physicians' appraisals of training in OEM. We evaluated family medicine residents' perceptions of a 4-week rotation in OEM that combined lectures, worksite visits, and clinical placements. METHODS: Qualitative analysis of residents' rotation evaluations (n = 208) collected between 2002 and 2008. Subjective appraisals were compared with quantitative changes in resident knowledge of OEM measured by pre- and posttests. RESULTS: Residents' perceptions of the usefulness of the OEM rotation were grouped into three main categories: knowledge, experience, and skill development. Posttest scores demonstrated significantly improved knowledge in key OEM subject areas. CONCLUSIONS: Residents gained knowledge and insight regarding the possible impact of work on patients' health and considered the rotation highly relevant to their family medicine practice.

Armed Forces occupational health--a review.

BACKGROUND: The Armed Forces operate in a particularly arduous physical and psychological environment. The occupational health (OH) of all personnel is of paramount importance to sustain the service's fighting ability. AIMS: Firstly, to bring readers up to date with the current organization and delivery of OH to uniformed personnel in the Armed Forces. Secondly, to review the research that has led to an improvement in OH services and the ways in which the Armed Forces are responding to the various challenges. METHODS: A description of the type and delivery of OH to the Armed Forces is followed by a review of the relevant contemporaneous literature from both open publications and research dissertations. RESULTS: Although there are some similarities with civilian OH, the principal requirement to prepare and sustain service personnel for operations on land, sea and air adds considerable complexity to the task. Research undertaken by Armed Forces OH professionals has added to the evidence base and enabled attrition in all aspects of the Armed Forces to be reduced. CONCLUSIONS: To meet the challenges of the 21st century, Armed Forces OH practitioners must continue to provide the best evidence-based advice to enhance force preparation and sustainment. All consultations in the Armed Forces involve an OH consideration from the simplest consultations through to the input from specialist OH practitioners. While the assessment of fitness to work in home bases and on deployed operations remains the primary output of OH, the provision of support to command policy, procurement and research are also key to the ability to operate worldwide.

Occupational medicine physicians in the United States: demographics and core competencies.

OBJECTIVE: We assessed the demographic profile and opinions of current occupational medicine (OM) physicians on the importance of specific core competencies. METHODS: A random sample of 1500 OM physicians listed in the membership directory of the American College of Occupational and Environmental Medicine (ACOEM) were asked to complete a voluntary survey. RESULTS: Six hundred and ten OM physicians completed the survey. Fifty two percent worked in clinical settings, and 16% worked in corporate or industrial settings. Eighty percent were satisfied with their choice of careers. CONCLUSIONS: OM physicians appeared to be highly trained, with 60% certified in OM and 68% board certified in other specialties. The OM physicians valued staying current in the field, understanding the relationship between occupational exposure and health, and communicating with stakeholders most highly. Occupational physicians are an important source of knowledge regarding what competencies and core knowledge areas are important for OM practice.

Occupational medicine residency graduate survey: assessment of training programs and core competencies.

OBJECTIVE: This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. METHODS: A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. RESULTS: Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). CONCLUSIONS: OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.

[Degree in prevention techniques for the environment and the workplace: distribution of credits and proposal for a unified training programme]. / Laurea in tecniche della prevenzione nell'ambiente e nei luoghi di lavoro: attuale distribuzione dei CFU e proposta di un piano didattico-tipo.

A revision of the training programmes of the Degree in Prevention techniques in the environment and at the workplace was carried out in order to appraise the present distribution of the credits (CFU) and to propose a common training programme that holds account of the core curriculum, of the present situation and of the training requirements that are emerging so far. In a lot of teaching programmes emerged the deficiency of juridical and psico-social matters that appear fundamental for the training of this Technician while the bio-medical disciplines seem too much represented. General and applied hygiene (SSD MED/42), Occupational medicine (MED/44) and the Applied physics (FIS/07) are the three disciplines activated in all the 25 curricula analysed. The Hygiene is the discipline with the average higher number of CFU (mean of 9.97 with ranks from 2.5 to 21.6).

Work-related carpal tunnel syndrome: the facts and the myths.

Carpal tunnel syndrome is a medical disease, not an injury, although symptoms may occur in association with certain physical activities of the upper extremity. The concept of work-related carpal tunnel syndrome has grown to such proportion as to be problematic for society, having spawned health care industries to support a cultural concept and a largely mythical medical paradigm. Because of these social and economic forces, cultural perceptions and expectations have adjusted to this flawed medical model. Success in improving patient management and making the best use of sound medical evidence depends on the concurrent use of educational strategies addressing social influences and attitudinal changes of practicing physicians, patients, and third-party administrators. The promotion of evidence-based medicine is key. This article discusses these controversies and suggests ways of managing carpal tunnel syndrome.

Influence of residency training on occupational medicine practice patterns.

OBJECTIVES: A relatively high proportion of occupational medicine (OM) specialists have not had formal residency training in OM. Members of the Western Occupational and Environmental Medicine Association, a professional organization of OM specialists, completed a postal questionnaire (160 of 561 members). METHODS: Educational background, practice setting, practice activities, and skills considered relevant were compared between those with and without formal training. RESULTS: Both groups had considerable focus in clinical care, musculoskeletal medicine, and workers' compensation. However, those with formal training practice in a broader variety of settings were less likely to have practiced another specialty, and used additional skills (toxicology, industrial hygiene, and epidemiology) in their practices. Formal education appears to create a greater diversity of skills and opportunities, but it does not appear to create a group of physicians disinterested in "front-line" occupational medicine practice. CONCLUSIONS: The data support the need for formal residency programs but also highlight the importance of access to formal training for midcareer physicians.