The WSIB Workplace Champions Program: a model for physician engagement D Linn Holness
Disclosures No relationships with commercial interests Research and program grants from Ontario Ministry of Labour, CHIR, SSHRC, WorksafeBC, WSIB
Objectives Review why it is important for occupational health to be incorporated into the medical curriculum Become familiar with the WSIB Workplace Champions Program Reflect on how to support occupational health in the medical curriculum
Background Why should doctors be competent in occupational health If occupational association is not made Impact on worker Impact on workplace Impact on healthcare system Impact on OHS system
Taking an occupational history Literature has consistently demonstrated deficits in occupational history taking Primary care Specialty practice
Taking an occupational history UK study Cornwall 2012 Study 1 Richards-Taylor et al OM 2013 2 practices notes, electronic 300 notes occ recorded 17% 50 had WR problem but 15 of these no occupation recorded 5568 EMR occ recorded 11%
Taking an occupational history UK study Cornwall 2012 Study 2 Richards-Taylor et al OM 2013 Survey 202 GPs 63 responded 65% recorded occ sometime 30% did not consider it important to record occ Barriers time limitations, lack of relevance
Taking an occupational history UK study Cornwall 2013 Study 1 Thorley et al OM 2015 3 practices notes, electronic 300 notes occ recorded 30% 104 had WR problem but 50 of these no occupation recorded EMR occ recorded 14% Additional practice EMR 1%
Taking an occupational history UK study Cornwall 2013 Study 2 Thorley et al OM 2015 Survey of 202 GPs 52 responded 65% recorded occ sometime 10% did not consider it important to record occ
Taking an occupational history Holness et al Chest 2007 and Australas J Dermatol 2007 Study of dermatologists, respirologists and family physicians in Ontario Majority report taking an occ history
Taking an occupational history Barriers to taking occ history Time constraints Lack of knowledge Barriers to further education Low volume of patients Time constraints Access to specialists
Taking an occupational history Series of studies investigating occ history in patients with lung cancer Interviews with staff Recognize that some cancers may be caused by workplace exposures Often don t take occ history
Taking an occupational history Barriers to recognition and reporting Time constraints Lack of knowledge Complexity of WC system Lack of easy referral to occ med experts Facilitators Patient completed exposure questionnaire Clear and simple referral criteria to and availability of occ med experts
Occupational health in medical school curricula Studies have generally shown little training Publications in 1980 s, 1990 s in US Need for and lack of training Various interventions 3 studies documented an ongoing decline in time allotted to occ health (Burstein AJPH 1994)
Occupational health in medical school curricula Williams et al OM 2011 Survey of UK medical schools 2009 Previous studies in 1974, 1989 and 2002 Fewer schools now provide lectures, project work or ward-based teaching No schools report workplace visits
Occupational health in medical school curricula Gehanno et al IAEOH 2014 Survey of 135/305 medicals schools in 27 European countries 2010-2011 Formal instruction - Mean hours 25.5 Large variation between and within countries 27% 10 hr or less Most covered occ disease and prevention but fewer covered disability and RTW
Occupational health in medical school curricula European initiatives to develop curriculum Kolb et al JOEM 2009 Case based e-learning Braeckman et al JOEM 2013 Development and evaluation of OM teaching module
Ontario WSIB Workplace Champions Program History External organizations advocating for change OMA section 1994 Physician Education Project in Workplace Health EFPO scholar Gary Liss WSIB - CMO (DLH) survey of medical schools in 1996 Little activity and variation amongst schools Discussion with UofT Dean - parameters Contracts with 6 medical schools 1998/9
Ontario WSIB Workplace Champions Program Program objectives: Develop and implement a workplace health curriculum to support medical training in workplace health issues Undergraduate, postgraduate (Family Medicine) Select a physician as Health and Safety Champion Assists with curriculum and links with WSIB Work with other universities to co-ordinate activities Report to WSIB
Ontario WSIB Workplace Champions Program Champions work within their own school to advocate for inclusion of occ health in curriculum and develop/deliver content Specific occ health content Infiltration of other areas of curriculum e.g. cases Constant review and renewal of curriculum
Ontario WSIB Workplace Champions Program Who is involved? Champions one from each of six medical schools in the province External advisor WSIB staff VP health services Medical Director for Occupational Disease
Ontario WSIB Workplace Champions Program Communication Champions group meets formally twice a year Once by teleconference, once in person Update on current state Share challenges Share resources Looking for way to more easily share resources
Ontario WSIB Workplace Champions Program What is happening now in the 6 medical schools Lectures, small group seminars, PBL involving occ med issues Web-based module Electives Career path in occ med Family medicine activities Evaluation
Ontario WSIB Workplace Champions Program Products created Core content - champions consensus curriculum content checklist Lectures (shared) Cases Web-based module Video occ history taking Set of questions for use in evaluation Developing OSCE s
Ontario WSIB Workplace Champions Program Evaluation Individual school level inclusion of occ health content in evaluations UofT Across the program Activities at each school
How we can influence/advocate? Publish Holness and Liss OM 2014 Share with other jurisdictions How many other provinces directly or indirectly provide funding? Advocate Continue the work
Taking an occupational history Current Ontario study Kramer & Holness - Completing the Picture funded by CCSRI and CIHR Objective: embed occupational history in EMR in community health centres