Fifty years of hope and concern for the future of occupational medicine

Development of an interprofessional task-based learning program in the field of occupational health: a content validity study

OBJECTIVE

One of the duties of the educational system is to provide situations in which students learn the tasks corresponding to their future careers in an interprofessional team. This study was designed to develop an interprofessional task-based training program.

METHODS

This was a curriculum development study conducted by content validity methodology in two stages: 1) 'framework development' which resulted in the creation of the framework items; and 2) 'evaluation of the framework' (judgment and quantification). The first stage consisted of task identification, generation of sub-tasks, and assimilation of items into a usable format. The second stage consisted of the judgment -quantification of the content validity of items and the framework. After that, the framework of the tasks of the occupational health team was finalized in the expert panel. After explaining the tasks, a matrix for task-expected roles in the occupational health team and a matrix for task-required skills to perform each task were developed. The next step determined the appropriate teaching and assessment methods for each task. Finally, an expert panel reviewed and approved the components of the interprofessional task-based training program.

RESULTS

Integrating the interprofessional education strategy with task-based learning was considered innovative in occupational health team training. In the development stage, 48 items were extracted, and then 35 tasks were generated in the step of identification of tasks. In the second step, 174 sub-tasks were developed. The tasks and sub-tasks were categorized into seven areas. After the stage of evaluation of the framework, 33 tasks were categorized into seven main areas, including "assessment and identification of workplace hazards" (n = 10), "control of occupational hazards" (n = 4), "determining the appropriate job position for each person" (n = 3), "occupational health examinations" (n = 6), "management of occupational/work-related diseases" (n = 5), "inter-organizational and inter-disciplinary relations, and legal judgment" (n = 3) and "education and scholarship in occupational health services" (n = 2).

CONCLUSION

The results of the present study can be used in developing the use of the interprofessional strategy and task-based training as two appropriate strategies for the purposeful development of learners' abilities in the fields involved in providing occupational health services in their future careers.

A century of the Archives of Environmental & Occupational Health

With this issue, the Archives of Environmental & Occupational Health celebrates 100 years of continuous publication since its foundation as the Journal of Industrial Hygiene in 1919. During its first century, the Archives established an extraordinary legacy in the development of no less than three fields of research and practice: (1) occupational medicine, (2) industrial hygiene, and (3) air pollution studies and regulation. Its contribution to American environmental protection standards in air quality was particularly important, as the journal served as a major outlet for crucial air pollution research during the early years of the new United States Environmental Protection Agency. Its pages also chart the development of occupational health as an independent field, as well as the later emergence of modern environmental health as a related co-discipline. As the Archives moves into its second century of continuous publication, the journal will continue shaping the fields of environmental and occupational health; building on the solid foundation of evidence-based research from which humankind continues to benefit.

Historical development of the Archives of Environmental & Occupational Health and its predecessor journals, 1919-2009

The Archives of Environmental & Occupational Health (AEOH) has a long and distinguished history that has so far involved a total of 7 journal titles since 1919. This article provides a detailed historical review of the AEOH, from its seminal precursors of the early 20th century, into the distinguished periodical of today. As editorial leadership is known to influence journal quality, considerable discussion focuses on the careers and professional achievements of the Editors-in-Chief, as well as key members of the editorial board who served the AEOH and its predecessor journals over the past 90 years.

Historical development of the journal impact factor and its relevance for occupational health

For better or for worse, the advent of journal impact factors last century marked a key turning point in the global development of scientific publication and referencing systems. Since that time however, the concept has attracted considerable attention from a variety of sources, and its usefulness for relatively small research fields such as occupational health, has also been debated. For these reasons, the current paper provides a descriptive history of the journal impact factor and a discussion of its relevance for occupational health. Developmental milestones, inherent shortcomings and future challenges are also described, along with techniques used for increasing the impact factor and some potential strategies for improvement of the citation indexing system. While many scholars now question its increasingly prominent role in the evaluation of scientific research, the journal impact factor continues to form an important component in the dissemination and retrieval of scientific literature in the occupational health field, as elsewhere. Due to the controversy incurred since its inception however, and the increasingly diverse manner in which it is now being used, it remains to be seen what the next 50 years of journal impact factors will bring.

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.

Outcomes From the Occupational Physicians Scholarship Fund: Private Support for Physician Residency Training

The Occupational Physicians Scholarship Fund (OPSF) was established 20 years ago with the goal of helping to address the critical shortage of qualified physicians entering occupational and environmental medicine (OEM). We examined descriptive and outcome measures to evaluate its success. Information was obtained from members of the original board of directors, the OPSF office, and the American Board of Preventive Medicine (ABPM). Most of the scholars (88%) are diplomats of the ABPM, certified in OEM. Scholars represent 6% of board-certified OEM physicians, score higher on the certifying examination than other examinees, practice in all regions of the United States, and are represented in diverse practice settings. The OPSF has achieved its objectives, producing well-trained physicians who contribute to the growth and vitality of the specialty improving worker health, business productivity, and the environment.

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.

Occupational medicine practice in the United States since the industrial revolution

OBJECTIVES

Occupational medicine lies at the interface between work and health. Not only do workplace hazards impact health, but our state of health influences our ability to get to work, to perform work, to tolerate work, and to gain a measure of satisfaction from the work we do. Comprehensive occupational medicine requires familiarity with the work that patients do; knowledge of the workplace itself and its hazards; appreciation of the social forces that shape work; and understanding of how chemical, physical, biologic, mechanical, and psychosocial agents influence health. Many practitioners who treat injured workers or provide disability assessments have no more formal training in occupational medicine than primary care physicians in general, which limits the quality, or at least the scope, of the care they give to workers.

METHODS

This history has been compiled from books, journals, letters and recollections. A subset of journal issues from each decade after 1910 has been systematically reviewed, making no attempt to read through every issue.

RESULTS

Industrial medicine as we recognize it began in the late-1800s, grew rapidly in the early and mid-1900s, and peaked toward the end of the 20th century, when American corporations began to outsource medical services, supporting the rise of free-standing industrial medicine facilities, chains of which now operate profitably throughout the country. Many of these facilities emphasize injury treatment, work hardening, and physical therapy rather than disease recognition and prevention. Occupational medicine is one of the very few medical specialties to be underserved. Board-certified specialists are relatively few, and when supply falls short of demand, the demand has tended to lower its sights.

CONCLUSIONS

Occupational medicine has always been influenced by economics, politics, and changing patterns of employment, and today these forces include managed care, weakened unions, outsourcing and contract labor, and a generally growing political and social conservatism, not to mention multinational corporations. The globalization of manufacture and economics facilitated by rapid population growth in poor nations assures an unending supply of cheap labor, allowing limited attention to hazard control, thereby impeding progress in occupational health and safety. Some corporations are meeting the challenge of protecting their international workforce. Many, probably most, have not yet achieved this.

Occupational medicine: the case for reform

The specialty of occupational medicine is in peril, in large part because of its reliance on financing by industry, which has powerful incentives to limit costs and to favor physicians who are useful to their employers. Occupational physicians generally practice within the framework of the workers' compensation system. Serious flaws in the incentive structure of workers' compensation constrain objectivity in their practice. Under present law they are unavoidably subject to perverse influences from employers and insurance companies. A fundamental reform of workers' compensation law and practice is urgently needed to separate occupational physicians from the control of employers and workers' compensation insurers, whose interests should not be allowed to override the physicians' integrity or to compromise the specialty.