OCCUPATIONAL MEDICINE TRAINING AND ASSESSMENT - SOUTH AFRICAN APPROACHES AND INTERNATIONAL INITIATIVES (ATOM PROJECT) Mohamed F Jeebhay and Rajen Naidoo 2 Occupational and Environmental Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa 2 Centre for Occupational and Environmental Health, Nelson Mandela School of Medicine, University of KwaZulu-Natal
What is Occupational Medicine? identifying and modifying the adverse effects of working environments on individuals and working populations, including establishing the association between working conditions/processes and workers health assisting in managing the health, skills and working capacity of the entire working population managing individual cases in the context of work ability
Early Definitions of Competencies for the Occupational Medicine Physician Ramazzini,, 600 - The Occupational History - What is your Occupation? Risk Assessment - The physician should visit the lowliest workshops and study the mysteries of the mechanic arts Donald Hunter, 955 - (s)he must be prepared to make himself technically minded to a degree that used to be thought quite foreign to the sphere of practical medicine be in a position to make the industrialist understand the risks to which his men are exposed
Prioritisation of of training areas for occupational medicine physicians identified by bycustomers of of occupational health Competency Ranking by Mean Scores Customer Group Occupational Physician Group 8 Law 2 Fitness 2 5 Hazards 3 Communications 4 3 Exposures 5 8 Research 6 4 Promotion 7 7 Management 8 6 Reetoo and Macdonald. OEM; 2005
Evolution of Competencies of Occupational Medicine Physicians WHO/ILO definition (950) - physical, mental and social well-being being prevention protection WHO/ILO (996) - Global Strategy for Occupational health for all - the overall promotion of health and workability for all employees Scotland (2005) healthy working lives maximising the functional capacity of the working age population
Number of physicians* working in OCCUPATIONAL MEDICINE, by number of inhabitants * Includes specialists and non specialists Finland one per 4.000 France, Belgium, Holland one per 5.000-0.000 Norway, United Kingdom one per 30.000-70.000 Sweden, Denmark one per 00.000 South Africa one per 25.000-80.000 AFRICA one per? >m Sources: UEMS OM Section. Survey 2002, 4 members. Carstensen O, Sherson D. Barcelona, 2002
There is a growing shortage of specialists in Occupational Medicine Highlighted at the ICOH conference on OH education & Training for everyone everywhere (Strasbourg, Sep 05) The need to train more doctors and ensure transferability of skills in a globalised world characterised by regionalised economic blocks is a major challenge
Development of training programmes for occupational medicine in in South Africa Occupational medicine - new specialty recognised by Health Professionals Council of South Africa (HPCSA) in 2004 Training of specialists occurs within Schools of Public Health / Community Medicine at 4 universities Pre-requisite requisite for entering training programme - undergraduate medical degree and 2 years of community service Training platform - permanent workplace-based attachments and part-time time clinical attachments at clinics based at teaching hospitals (e.g. respiratory medicine, dermatology, ENT etc.) Academic training (masters coursework in public health, Diploma in Occupational Health ± Health Management) and clinical postings concurrently over 48 month training period
Assessment of competence in in occupational medicine in in South Africa College of Public Health Medicine (CPHM) in the Colleges of Medicine of South Africa (CMSA) is the foremost assessment body in South Africa CMSA coordinates the development of MMed (Occ Med) training guidelines/ regulations for occupational medicine specialists with academic institutions CMSA also coordinates and conducts occupational medicine specialist exams together with members of the Division of Occupational Medicine (DOM) Assessment comprises both formative and summative evaluations
Assessment of competence in in occupational medicine in in South Africa Three major areas of exit competencies relate to: ) Ability to diagnose and manage all aspects of work-related related disease or disability or threats to health and well-being of individual employees 2) Ability to investigate occupational health risks in a workplace and develop an efficient and effective hazard control and management programme through workplace interventions and appropriate occupational health services 3) Ability to describe, explain and quantify occupational health risks, occupational health service needs and interventions through conducting appropriate epidemiological research and developing appropriate policy options based on study findings
Assessment of competence in in occupational medicine in in South Africa Formative assessment requires the submission of a portfolio of 6-monthly 6 reports of various attachments and supporting documents over the 4 year training period The summative component at the end of the training involves: - MMed dissertation (or long report/defence) - Short report and oral defence - Multiple choice paper - Short answers paper - Essay paper - Oral exam (questions) - Occupational medicine skills examination
Assessment of competence in in occupational medicine in in South Africa Curriculum domains assessed in the components: assessed in the summative - Basic public and occupational health sciences including epidemiology, biostatistics and health economics - Social and behavioural sciences including industrial relations and psychology - Occupational Medicine and Toxicology I (diagnosis of occupational disease, effects of chemicals on body systems) - Occupational Medicine II (lungs and skin) - Occupational Medicine III (effects of physical/biological/ ergonomic hazards, disability assessment /management) - Occupational hygiene including physical hazards, safety and injury - Occupational health services and management systems - Environmental health / Occupational health and safety law
Challenges for occupational medicine training and assessment institutions internationally ATOM Workshop (Barcelona, 2006) Improve the delivery of occupational health care worldwide - global companies want global standards Improve the quality of occupational medicine training worldwide Establish consensus on a core assessment tool Establish an international academic/ accreditation network to develop a tool Mutual recognition of competencies and qualifications internationally (initial focus on Europe) based on quality assurance
Results of of first phase of of ATOM project: Survey of of Assessment and Training Bodies (Reetoo N, N, Macdonald E, E, 2006) Respondents: 26 26 countries Country Frequency Country Frequency Australia 2 Macedonia Austria Netherlands 4 Belgium 2 New Zealand Canada Norway Czech Republic Poland Finland Romania France Serbia Germany Slovenia Greece South Africa 5 India 2 Spain 7 Ireland Switzerland Italy 2 UK 2 Japan USA
ATOM Survey Respondents: Organisation Description Type of Organisation Training Body Assessment Body Training and assessment body Supervisory body Other Total Freq 7 4 7 4 43 Percent 40% 9% 40% 2% 9% 00
ATOM Survey Respondents: Organisation Sector Sector Private Public Other Total Frequency 4 35 4 43 Percent 9.3% 8.4% 9.3% 00%
ATOM Survey Respondents: Overall trends in in training prerequisites OM training prerequisite Undergraduate Degree Postgraduate Degree Postgraduate Experience % Countries 00% 30.2% 46.5% Notes 3-7 years Diploma/MPH/ MRCP equivalent 6 months-3 years Other Criteria: Screening Exams, Associate of Faculty, Currently in a job with some OM responsibilities
ATOM Survey Respondents: Duration of training of specialists Average is 4 years UEMS OM Section. Survey 2002, 4 members. Cashman C, Slovak A. Occupational Medicine, 2005
ATOM Survey Respondents: Training components Training of specialist trainees % Countries Academic Training 00% General Clinical Posting 6% Occupational Med. Clinical Posting 00% Other components of training: Membership exams, sub-specialisations
ATOM Survey Respondents: Scope of practice and competencies 5/26 countries (58%) indicated that the competencies required of specialists trainees in occupational medicine were based on the published WHO list of competencies
ATOM Survey Respondents: Current and anticipated preferences for assessment tools in occupational medicine
ATOM Project: Conclusions Multiple assessment techniques testing all all knowledge domains and performance throughout the training period DOES SUPERVISOR - Performance (application in the workplace) SHOWS HOW - Mentor/supervisor EXAMINER - MCQ (extended) - Examination questions - OSCE KNOWS HOW KNOWS MILLER S PYRAMID
THE WAY FORWARD FOR OCCUPATIONAL MEDICINE TRAINING IN IN SOUTH AFRICA Continued participation in the working group activities of the ATOM project benchmarking/networking Ongoing review of current Occupational Medicine Regulations (2004) in the light of the UK document /international consensus documents on training and competencies Finalisation of the Scope of Practise document based on the WHO (2000) document submission to medical aid administrators Ongoing review of Exam Regulations in occupational medicine as consensus develops on appropriate assessment tools through the ATOM project Develop a databank on assessment tools (e.g. MCQ bank, logbooks)
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