Training pathways for occupational medicine

OBJECTIVE: Consider the funding, organization, and applicant pool for occupational medicine residency training positions concerns in the United States. METHODS: Postgraduate training models are compared for responsiveness to competence and workforce needs, including traditional residency, nontraditional residency, postdoctoral fellowship, extended courses, multiple certificate preparation, continuing medical education, "executive MPH," and implicit education (learning from consultants in the course of practice). RESULTS: Educational models differ in comprehensiveness, crossdisciplinary experience, socialization to core professional values, financial requirements, accessibility to physicians currently in practice, potential number of trainees, and short- and long-term impact on training outcomes. CONCLUSION: There are tradeoffs between the benefits of comprehensive program standards and the benefit of facilitated training access by reducing barriers or requirements. Recognizing and understanding assumptions about training in our discipline may inform future choices.     

Confidentiality in occupational medicine

Confidentiality of personal medical information is a serious concern in occupational medicine. New regulations issued under the Health Insurance Portability and Accountablility Act (HIPAA) significantly alter procedures for protecting and managing confidential medical information. There are still questions about how much the new regulations will affect occupational medicine practices, but there will be significant changes in the collection, storage, and dissemination of personal medical information in the near future. The implications of increased confidentiality concerns on research are also considered.     

Dietary intervention in occupational medicine

In two groups of employees (19 offshore workers and 62 office personnel) we attempted to improve dietary habits by information and a change in the canteen supply of meals in the former and by information only in the latter group. Measurements of total plasma cholesterol and diastolic blood pressure were carried out in order to demonstrate the effect and to motivate the participants, who had volunteered. In the office group a statistically significant decrease of both parameters was found (cholesterol: 5.7 (1.3) mmol/l vs. 4.9 (1.0) mmol/l, p less than 0.01; blood pressure: 89.1 (11.1) mmHg vs. 82.3 (10.3) mmHg, p less than 0.01). This showed that such an intervention is feasible within a company. Easily demonstrable parameters, a simple intervention design, active participation of management, good communication, frequent assistance by the members of the project team and participation in a group are important factors for the success of the intervention.     

Telemedicine applications in occupational medicine

Telemedicine combines telecommunication technology and medicine to increase access to health care services for patients living in remote areas and enhance the efficiency of delivering that care. This article describes the results of a Mayo Clinic pilot study on the use of telemedicine in an occupational medicine clinic for Mayo Clinic employees and their dependents. The study involved 21 patients who came for initial evaluations for work-related problems or injuries, follow-up visits, visits for acute problems such as low-back pain, and periodic health evaluations. It found that patients and providers were comfortable with the technology after a short training session and satisfied with the outcomes of the visits. More rigorous research evaluating the applications of telemedicine in occupational health care is needed.     

Appraisal standards in occupational medicine

Following a series of serious misdemeanours by British doctors, the General Medical Council (GMC) has introduced a system of re-licensing called 'revalidation'. Annual medical appraisal forms an important cornerstone of the proposed system, but specific guidance is lacking on the content of appraisal for occupational physicians, and the kinds of evidence that they might bring to critical reviews of performance. Two educational bodies, the Revalidation Committee of the Faculty of Occupational Medicine, Royal College of Physicians and the Education Panel of the Society of Occupational Medicine, have jointly developed a set of recommendations on appraisal to further the process. In this paper we summarize the background and present the guidelines promulgated by the Faculty and the Society.     

Web-based training in occupational medicine

OBJECTIVES: The aim of our project was to develop and evaluate an interactive computer-based approach to teach medical students in occupational medicine. To enhance interest in occupational medicine the major focus was on clinical and practical aspects of occupational medicine. METHODS: The computer program was designed in HTML and JavaScript. It presents a guided tour of the patient's case history followed by information on practice and theory of occupational medicine. The program was integrated into the curriculum during the summer term of 1999 and the following winter term. To assess the effectiveness and acceptability of the program we asked students to rate the program on an 18-item questionnaire. RESULTS: Overall, 287 students participated in the evaluation of the program. The participants highly recommended the program structure and had no difficulties in handling the program. This was independent of the computer experience of the students. The evaluation showed that it was possible to enhance interest in occupational medicine by using "virtual patients". CONCLUSION: The program represents a student-orientated learning tool that points out clinical and practical aspects of occupational medicine. The availability via the Internet allows the application as a self-learning tool as well as a teaching tool for the medical curriculum.     

Problem-solving techniques in occupational medicine

The diagnosis of occupational illnesses may be considerably more difficult than is the case with occupational injuries because of a variety of factors: an intervening latency period, uncertainty in identifying the most significant chemical or physical exposures, determination of exposure levels retrospectively, and coordination of the physician with regulatory and workers' compensation bureaucracies. Such problem-solving techniques as retrospective industrial hygiene and attention to in-situ chemistry can act as means of reducing the uncertainty in making the diagnosis of occupational illness. Advance familiarity with workers' compensation and state or federal regulatory agencies can further facilitate diagnosis and patient advocacy.