|
GENERAL
OBJECTIVES:Occupational
Medicine is a medical discipline that deals clinically and
administratively with the health needs of both individuals and groups
with respect to their working environment and includes the recognition,
evaluation, control, management and prevention of occupationally-related
diseases and injuries.
Residents must
acquire a body of knowledge of occupationally-related diseases and
injuries. In the course of training, residents must acquire a knowledge
of the sciences basic to occupational medicine, including toxicology,
epidemiology, biostatistics, occupational hygiene, accident prevention
and ergonomics. The residents must
understand diagnostic procedures essential to the evaluation of
occupationally-related diseases and injuries, and must have a thorough
knowledge of the methods of assessing the workplace and workplace
hazards. The residents will acquire expertise in history-taking,
physical examination, and a knowledge of relevant diagnostic and
laboratory procedures. The residents must be expert in the management of
occupationally-related diseases and injuries, and in particular, the
rehabilitation of diseased or injured workers. Clinical training must
provide expertise in a number of areas such as the evaluation of chest
X-rays using the ILO grading system for pneumoconiosis, a working
knowledge of detailed pulmonary function tests, knowledge of the
psychological mechanisms important in problems of job adjustment,
substance abuse and individual and group conversion reactions. The residents must
develop expertise in the recognition, evaluation, control and management
of workplace hazards. These hazards include toxic chemical and
biological agents, physical agents (noise, radiation, etc.), and
physical hazards that cause traumatic injuries. In order to acquire this
knowledge, the residents must understand the principles and methods of
occupational hygiene and safety. In addition, the residents must have a
sound understanding of administration, business organization, labour-management
relations, labour and compensation law, and the principles of how to
implement and evaluate an occupational health and safety program. Health
promotion can play an important role in occupational medicine and the
residents should develop knowledge and skills in the area of nutrition,
stress management, physical fitness, and alcohol and drug abuse. Residents must
acquire epidemiological skills including the ability to evaluate the
health of a group of workers by statistical analysis and comparison of
the health status of categories within the group and with external
comparison populations. A working knowledge of morbidity and mortality
studies is essential. The residents must
develop attitudes consistent with effective collaboration with
physicians and others including occupational health nurses, occupational
hygiene and safety experts, epidemiologists, managers, labour groups,
community and government agents. The residents will develop critical
skills in literature review and a commitment to the continued
acquisition of knowledge. Finally, the importance of the confidentiality
of both the physician/patient relationship and the medical record, and
the medical-legal implications thereto, must be thoroughly understood.
The purpose of the
training required under Section 1 of the training requirements is to
give the resident a degree of independent responsibility for clinical
decisions; an opportunity for further development of the skills required
in making effective relationships with patients; the consolidation of
competence in primary clinical and technical skills across a broad range
of medical practice; and an understanding of the nature of the
relationships between a referring physician and a consultant specialist
in Occupational Medicine. |
|
|
CONTENT
AND ORGANIZATION OF THE RESIDENCY PROGRAM:
There
must be an organized program of rotations and other educational
experiences, both mandatory and elective, designed to provide each
resident with the opportunity to fulfil the educational requirements and
achieve competence in the specialty. The content and
organization of each accredited program in occupational medicine must be
consistent with the specialty training requirements. RESOURCES:There
must be sufficient resources including teaching faculty, the number and
variety of patients, physical and technical resources, as well as the
supporting facilities and services necessary to provide the opportunity
for all residents in the program to achieve the educational objectives
and receive full training as defined by the specialty training
requirements in occupational medicine.
In those cases
where a university has sufficient resources to provide most of the
training in occupational medicine but lacks one or more essential
elements, the program may still be accredited provided that formal
arrangements have been made to send residents to another accredited
residency program for periods of appropriate prescribed training.
There
must be a sufficient number of qualified teaching staff to supervise the
residents and provide teaching in the basic, clinical and administrative
sciences related to occupational medicine. For a program to be
accredited there must be an adequate core of full-time medical staff in
participating institutions and affiliated agencies (hospitals,
government agencies, corporations, community-based clinics) available to
provide expertise in clinical occupational medicine, occupational
hygiene and safety, epidemiology and biostatistics, administration and
research.
There
must be a sufficient number of patients with the spectrum of
occupational and environmental problems for the resident to achieve
competence in clinical occupational medicine. The resident must be
exposed to an adequate volume and variety of patients with psychiatric,
respiratory, cutaneous, cardiovascular, orthopedic and toxicological
disorders as well as other occupationally related disorders. Residents
must become competent in the evaluation of workers with respect to the
matching of their physical and mental capabilities to their occupation.
There
must be an occupational medicine clinical service providing consultant
occupational medicine services. In addition, there must be access to
clinical specialties including medicine, surgery, psychiatry, orthopedic
surgery and rehabilitation medicine that are essential in order to
permit residents to gain experience in the evaluation of complicated
problems in both in-patients and out-patients.
It
is essential that residents be involved in the provision of consultative
services to other physicians.
There
must be community learning experiences which may include industrial
placements, government agencies and community-based clinics. The purpose
of resident participation in these agencies, other than affiliated
teaching hospitals, as part of the clinical teaching program is to
provide professional experience in the management of work-related
disorders outside the teaching hospital setting. Through such experience
the resident will learn how to develop practical methods of problem
solving which cannot be acquired in isolation from the practical
realities of the workplace.
There
must be an active teaching service in internal medicine. It is desirable
that there also be teaching services in cardiology, dermatology,
diagnostic radiology, emergency medicine, general surgery, neurology,
orthopedic surgery, otolaryngology, physical medicine and
rehabilitation, psychiatry, and respirology.
There
must be emergency and intensive care services available to allow
residents to consult on acute and emergency occupational medical
problems.
There
must be adequate investigative facilities to support the necessary
diagnostic procedures carried out for occupationally related problems.
There
must be access to an occupational hygiene laboratory and an active,
adequately equipped field service to allow the residents to gain
training in occupational hygiene.
Access
to computer facilities is essential so that the resident can acquire the
skills necessary to carry out epidemiological evaluations. ACADEMIC
AND SCHOLARLY ASPECTS OF THE PROGRAM:
The academic and scholarly
aspects of the program must be commensurate with the concept of a
university postgraduate education. The quality of scholarship in the
program will in part, be demonstrated by a spirit of enquiry during
clinical discussions, rounds, and conferences. Scholarship implies an
in-depth understanding of basic mechanisms of normal and abnormal states
and the application of current knowledge to practice.
A
coordinated educational program must be provided in occupational
medicine and associated fields. This must include organized teaching in
the clinical and basic sciences related to the specialty, including
toxicology, health effects of physical agents, occupational hygiene,
accident prevention, ergonomics, epidemiology and biostatistics. In
addition, teaching in occupational health and safety law, management
studies, human rights and labour relations must be provided. The program
may include lectures and seminars which may be interdisciplinary in
nature, teaching rounds, specialty conferences, laboratory work,
technical demonstrations, and journal clubs.
The following
content areas must be included.
In
addition to the basic occupational diseases and fitness to work
considerations, residents should develop knowledge and skills in the
area of stress management, alcohol and drug abuse and health promotion.
Expertise
in occupational hygiene and safety is essential in the practice of
occupational medicine. The resident must have adequate teaching,
laboratory and field experience to acquire this knowledge.
Training
in epidemiology and biostatistics must be part of the integrated
residency program. Staff members with training in epidemiology and
biostatistics must be accessible to residents in order to foster the
acquisition of epidemiological expertise in the solution of occupational
health problems.
Residents
should have experience in different field settings involving different
administrative approaches to the management of occupational health and
safety programs. The program must provide residents with an opportunity
to work in practical situations dealing with joint worker-management
health and safety committees where these exist, corporate managers,
government officials and labour representatives.
Because
of the importance of regulations in the management of occupational
health problems, a field placement in government agencies (e.g.
departments responsible for workers' health and safety) and/or a
workers' compensation authority are essential components of the program.
Instruction in laws and regulations, human rights and medical ethics, as
they relate to occupational health and safety, must be provided.
The
academic program must provide opportunities for residents to gain an
understanding of the basic principles of biomedical ethics as it relates
to occupational medicine including issues related to confidentiality,
doctor-patient relationships in the workplace setting and third party
assessments.
There
must be opportunities for residents to learn effective communication
skills for interacting with patients and their families, allied health
professionals, and colleagues. In addition to teaching communication
skills in the clinical setting, organized sessions on communication
skills should be in place. Communication skills include those in the
clinical, corporate and regulatory and medico-legal setting.
Residents
must be given opportunities to develop effective teaching skills by
teaching junior colleagues and students, as well as through conference
presentations, clinical and scientific reports and patient education.
The
residents must participate in quality assurance/improvement activities
in the clinical and corporate setting and it is desirable that they also
participate in such activity in their field placements. Organized
sessions on quality assurance/improvement should be in place.
The
milieu of scholarship should be enhanced wherever possible by close
association between residents and staff who are active in research.
Residents should have an opportunity to participate in research during
their program. Critical appraisal must form part of the organized
teaching activity. It is desirable that the spectrum of research range
from basic and clinical to population-based and health services.
The
faculty should be active in occupational medicine research and a culture
of enquiry must be evident in the core aspects of the program.
The program should provide opportunities for residents to attend conferences outside their own university. PROGRAMS (WITH TRAINING REQUIREMENTS): Diplomas(Dip):
Six
months of approved residency training.
Doctor of
Medicine(M.D):
Eighteen months of approved residency training. Doctor of
Philosophy(Ph.D):
Forty eight months(four years)of approved residency training. |