Requirements for occupational medicine training in Europe: a Delphi study

Development of a tool for assessing the clinical competency of Chinese master's nursing students based on the mini-CEX: a Delphi method study

OBJECTIVE

To construct a scientific and systematic competency evaluation tool for master of nursing specialists (MNS) and to provide a reference for the training, assessment and competency evaluation of MNS.

METHODS

A first draft of the indicators for assessing MNS core competencies was developed on the basis of published research and group discussions. Between June and December 2020, the indicators were revised using two rounds of the Delphi expert consultation method, with questionnaires completed by 16 experts from five provinces in China.

RESULTS

The valid retrieval rate of the two questionnaires was 100.00%, and the coefficient of expert authority was 0.931. The Kendall's concordance coefficients of the two rounds of questionnaires were 0.136 (p<0.05) and 0.147 (p<0.05), respectively. Consensus was reached on the seven dimensions and 52 items of the MNS competency assessment instrument. The instrument dimensions included nurse‒patient communication (9 items), health assessment (7 items), clinical decision-making (8 items), operational skills (7 items), health promotion (6 items), humanistic care (9 items) and organisational effectiveness (6 items).

CONCLUSIONS

The MNS competency assessment tool constructed in this study is focused and highly credible. The findings can be used as a guide for the training, assessment and competence evaluation of MNS in the future.

Development of a breast cancer case management information platform (BC-CMIP) module based on patient-perceived value

Objective

To construct a content module for a breast cancer case management information platform (BC-CMIP) based on patient-perceived value (PPV).

Methods

A questionnaire was used to investigate the service needs of breast cancer patients and their families for the information platform. Based on the value dimensions of PPV, the module content of the BC-CMIP was initially constructed, and the Delphi method was used to justify and revise the module content. Excel 2019 and SPSS 26.0 were used for statistical analysis.

Results

The information platform includes the patient side and the medical side. The index content includes four primary indicators: functional value, emotional value, efficiency value and social value; it can realize all patient case management needs, such as diagnosis and treatment services, health education, telemedicine, treatment tracking, psychological support, case assessment and positive warning.

Conclusion

Based on the PPV, the module design of the BC-CMIP is reasonable and comprehensive, and it can scientifically and effectively meet the health needs of patients and provide a theoretical basis for subsequent platform development and application.

Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage

Background

The high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage.

Methods

The research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30).

Results

The literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index (I-CVI) was 0.53–1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation.

Conclusion

The research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.

The Occupational Medicine Pipeline: Report on the Results of a Survey of International Occupational Medicine Society Collaborative (IOMSC) Member Countries

OBJECTIVE

To learn how occupational and environmental medicine (OEM) expertise is developed and maintained around the world and to inform strategies for further international development of OEM.

METHODS

An anonymous survey was conducted of leaders of the 48 member societies (from 43 countries) of the International Occupational Medicine Society Collaborative (IOMSC) to evaluate OEM training, certification, maintenance, and recertification requirements.

RESULTS

OEM physician leaders representing 46 of the 48 IOMSC member societies (95.8%) completed the survey between December 2019 and February 2020. Academic post-graduate and on-the-job training were the most frequent methods for developing OEM expertise, with little use of online coursework and minimal OEM content in medical school in most countries. Occupational medicine board certification usually required graduate specialty training and passing a certification examination, while occupational medicine recertification requirements were uncommon.

CONCLUSION

The IOMSC is positioned to support the international development of OEM expertise by sharing information on competencies, best practices in medical education curriculum content and examples of OEM specialty certification pathways from different countries.

Developing a Competency Framework of Interprofessional Occupational Health Team: A First Step to Interprofessional Education in Occupational Health Field

OBJECTIVE

The present study aimed to develop a competency framework for interprofessional collaboration in an occupational health team.

METHODS

This study was carried out in three stages. In the first stage, the viewpoints of different stakeholders on the essential competencies of interprofessional team members in occupational health services (OHS) were assessed. In the second stage, extracted codes were converted into competencies in expert panels. After that, the extracted items were categorized by inductive content analysis approach into competency framework. In the third stage, the content validity of interprofessional competencies in OHS was evaluated.

RESULTS

The competency framework was finalized in six competency domains including prevention, occupational disease management, occupational health assessments, inter-disciplinary and interprofessional collaboration, education, and evidence-based practice and professionalism.

CONCLUSION

The framework could be developed in interprofessional education in OHS based on competency-based education approach.

Factors that influence occupational physicians' decision to issue an employer warning in Japan

Objectives

To elucidate the factors that influence occupational physicians’ decision to issue an employer warning.

Methods

The interview was conducted with 10 Japan Society for Occupational Health certified occupational physicians (COPs) and certified senior occupational physicians (CSOPs) to create nine fictive scenarios in which an occupational physician may need to consider issuing a warning. Sixteen CSOPs assessed the seriousness of the problem in each of nine scenarios where they may need to consider issuing an employer warning. Next, using a survey questionnaire, 597 COPs and CSOPs were asked to rate how likely they were to issue a warning in each of the nine scenarios, and answer items on their characteristics and number of previously issued warnings. A multilevel logistic regression analysis nested for various scenarios was used to assess the odds ratio (OR) of being likely to issue a warning.

Results

Valid questionnaires were obtained from 117 participants (19.6%). The ORs and 95% confidence intervals (CIs) were as follows: mean score of seriousness of the problem, 5.90 (4.50‐7.75); years of experience as occupational physician, 1.04 (1.02‐1.06); women, 1.75 (1.20‐2.54); being a part‐time occupational physician without in‐house experience, 2.08 (1.31‐3.29); and having previously issued two or more times warnings, 1.99 (1.29‐3.06), compared with those who had never issued a warning.

Conclusions

Occupational physicians’ likelihood to issue a warning was associated with the seriousness of the problem as assessed in various scenarios, years of experience as occupational physician, gender, employment type, experience as in‐house occupational physician, and number of past warnings.

Current research priorities for UK occupational physicians and occupational health researchers: a modified Delphi study

OBJECTIVES

Studies identifying national occupational health (OH) research priorities have been conducted in several countries to establish where OH research should be focused and where funding should be targeted. However, the UK findings are now over 20 years old, and OH practice is continuously evolving. The aim of this study was to identify current research priorities for UK occupational physicians (OPs) and occupational health researchers (OHRs).

METHODS

Current research priorities in OH were identified using a modified Delphi technique. This was conducted in two rounds to achieve consensus. Research priorities were rated, and then ranked using questionnaires developed from expert panel discussions, key research topics identified from the medical literature and participant feedback. Overall and intergroup comparisons were completed for the ranking scores.

RESULTS

Consensus among OPs and OHRs was high with almost all (9/10) primary domains rated as 'very important' or 'absolutely necessary' by more than 54% of respondents. The research priority areas ranked highest were jointly economic evaluation/cost effectiveness studies and disability management followed by occupational disease/injury/illness. Occupational health policy was ranked lowest after sickness absence management and health promotion. The secondary domain analysis identified priority emphasis on mental health and psychosocial hazards within the workplace and the need to further develop evidence-based guidance for clinical OH practice.

CONCLUSIONS

We identified the current research priorities for UK OPs and OHRs. The findings will inform future national OH research strategy and support research that addresses important knowledge gaps within OH and other interdisciplinary specialties.

Developing educators of European undergraduate dental students: Towards an agreed curriculum

INTRODUCTION

Recent developments in European dental education are student-focused, concerned with competency-based and problem-based learning. The development of dental educators has so far received little consideration. This study aimed to agree curriculum content for developing dental educators so that they are better able to support changing undergraduate dental education.

METHODS

Adopting consensus methodology, a 2-round Delphi was conducted in 2012. Fifty-three dental educators and 39 dental students across Europe volunteered to take part. The Delphi questionnaire was developed based on literature, piloted and sent to participants to gather opinions and seek consensus on educational content using rating scales and open-ended questions. Numeric data were analysed using descriptive statistics, and qualitative data were analysed thematically.

RESULTS AND DISCUSSION

This study revealed 7 domains of curriculum content for dental educators. Four of these domains were considered essential: educational principles; educational practice in dentistry; curriculum, quality and improvement; and educational professionalism. Three domains were viewed as optional and could be tailored to local needs: educational principles in relation to specific contexts, educational research, and educational and healthcare management. When developing training for dental educators, factors which need consideration were identified as the academic position and teaching experience of educators, and the nature of clinical dental education.

CONCLUSION

The results are beneficial for individual educators to inform professional development plans; institutions to devise faculty developments; ADEE to inform policies on developing European dental educators; and other disciplines to inform training for their educators.

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

BACKGROUND

The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey.

METHODS

An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work.

RESULTS

There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups.

CONCLUSION

This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles.

Developing Common Competencies for Southeast Asian General Dental Practitioners

Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils have proposed the "Common Major Competencies for ASEAN General Dental Practitioners" to harmonize undergraduate dental education. This article discusses how the ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills, and attitudes across ASEAN. The competencies were developed through four processes: a questionnaire about current national oral health problems, a two-round Delphi process that sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Key themes of the ASEAN competencies were compared with the competencies from the U.S., Canada, Europe, Australia, and Japan. A total of 33 competency statements, consistent with other regions, were agreed upon and approved. Factors influencing the ASEAN competencies and their implementation include oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. The ASEAN competencies will serve as the foundation for further developments in ASEAN dental education including policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for successful harmonization of ASEAN dental education.

Perception of and attitude toward ethical issues among Korean occupational physicians

Background

Occupational physicians (OPs) have complex relationships with employees, employers, and the general public. OPs may have simultaneous obligations towards third parties, which can lead to variable conflicts of interests. Among the various studies of ethical issues related to OPs, few have focused on the Korean OPs. The aim of the present survey was to investigate the ethical contexts, the practical resolutions, and the ethical principles for the Korean OPs.

Methods

An email with a self-administered questionnaire was sent to members of the Korean Society of Occupational and Environmental Medicine, comprising 150 specialists and 130 residents. The questionnaire was also distributed to 52 specialists and 46 residents who attended the annual meeting of the Korean Association of Occupational and Environmental Clinics in October 2015, and to 240 specialists by uploading the questionnaire to the online community ‘oem-doctors’ in February 2016. The responses to each question (perception of general ethical conflicts, recognition of various ethical codes for OPs, core professional values in ethics of occupational medicine, and a mock case study) were compared between specialists and residents by the chi-squared test and Fisher’s exact test.

Results

Responses were received from 80 specialists and 71 residents. Most participants had experienced ethical conflicts at work and felt the need for systematic education and training. OPs suffered the most ethical conflicts in decisions regarding occupational health examination and evaluation for work relatedness. Over 60% of total participants were unaware of the ethical codes of other countries. Participants thought ‘consideration of worker’s health and safety’ (26.0%) and ‘neutrality’ (24.7%) as the prominent ethical values in professionality ofoccupational medicine. In mock cases, participants chose beneficence and justice for fitness for work and confidential information acquired while on duty, and beneficence and respect for autonomy in pre-placement examinations.

Conclusions

This study evaluated the current perception of and attitude toward ethical issues among the Korean OPs. These findings will facilitate the development of a code of ethics and the ethical decision-making program forthe Korean OPs.

Electronic supplementary material

The online version of this article (doi:10.1186/s40557-017-0182-z) contains supplementary material, which is available to authorized users.

Comparison of competency priorities between UK occupational physicians and occupational health nurses

Objectives

The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs.

Methods

A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1—‘rating’, round 2—‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions.

Results

In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman’s r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups.

Conclusions

This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities.

International perspective on common core competencies for occupational physicians: a modified Delphi study

OBJECTIVES

The competencies required of occupational physicians (OPs) have been the subject of peer-reviewed research in Europe and individual countries around the world. In the European Union (EU), there has been development of guidance on training and common competencies, but little research has extended beyond this. The aim of this study was to obtain consensus on and identify the common core competencies required of OPs around the world.

METHODS

A modified Delphi study was carried out among representative organisations and networks of OPs in a range of countries around the world. It was conducted in 2 rounds using a questionnaire based on the specialist training syllabus of a number of countries, expert panel reviews and conference discussions.

RESULTS

Responses were received from 51 countries around the world, with the majority from Europe (60%; 59%) and North and South America (24%; 32%) in rounds 1 and 2, respectively. General principles of assessment and management of occupational hazards to health and good clinical care were jointly considered most important in ranking when compared with the other topic areas. Assessment of disability and fitness for work, communication skills and legal and ethical issues completed the top five. In both rounds, research methods and teaching and educational supervision were considered least important.

CONCLUSIONS

This study has established the current priorities among OPs across 51 countries of the common competencies required for occupational health (OH) practice. These findings can serve as a platform for the development of common core competencies/qualifications within specific geographical regions or internationally. This is particularly pertinent with globalisation of commerce and free movement within the EU.

Use of an audience response system to maximise response rates and expedite a modified Delphi process for consensus on occupational health

Background

Different methods have attempted to obtain consensus on occupational health issues. The objective of this paper is to describe a modified three-stage Delphi process that uses a wireless audience response system to enable consensus to be attained in a single day and to maximise response rates. The modified Delphi approach required: a) agreeing the topic/s of interest for which consensus is sought, b) identifying key stakeholders whose opinions are required; c) assembling the stakeholders for a one-day event. Participants’ opinions were recorded primarily through use of a system of individual wireless audience response devices (‘clickers’) linked to a computer. Providing immediate feedback enabled the audience to consider the group’s views before proceeding to the next stage. From an initial round of responses, participants were asked to narrow their choices to any five preferred options. A third round was conducted, using the ‘clickers’ to rank 5 of the most popular group options. Through this iterative exercise, stakeholder consensus was achieved after three decision rounds.

Results

The use of the modifications and the wireless audience response system described enabled stakeholders to provide a group view on specific occupational health issues e.g. priorities or barriers or resources needed. Completing the three-stage iterative exercise in a day maximised the response rate with advantages for both the participants and the researchers. Careful design of the protocol is essential, with a team familiar with information technology to ensure smooth execution of the various stages.

Conclusions

Modification of the Delphi method with the use of a wireless audience participation system facilitates rapid consensus.

Evaluation of the patient with an exposure-related disease: the occupational and environmental history

PURPOSE OF REVIEW

Although the process of taking an occupational and environmental history has remained largely the same, the context in which it is done has changed dramatically over recent years. This review examines the role of the occupational and environmental history in the context of the changing nature of medical practice and discusses methods for evaluating patients with contemporary exposure-related respiratory illnesses.

RECENT FINDINGS

Surveillance for occupational lung disease using mnemonic devices, screening questions and the use of structured questionnaires can significantly increase the likelihood and accuracy of detection. Electronic health records likewise can be adapted to include the most important elements of the occupational and environmental history.

SUMMARY

The emergence of new technologies and industries will lead to respiratory diseases in novel occupational and environmental contexts. Using the methods described herein can make detecting these diseases easier and less time-consuming.

Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan

OBJECTIVES

The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them.

METHODS

A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occupational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the necessary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods.

RESULTS

All 61 competencies in the questionnaires were evaluated as "necessary". Some of the competencies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a "practical group", the members of which mainly provided occupational health services, an "academic group", the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies significantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-job training (OJT) for 30 items, and case-based learning (CBL) for 29 items.

CONCLUSIONS

Some competencies should be added to the JSOH list. CBL should be introduced in training programs for specialist occupational physicians.

European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence

OBJECTIVE

To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians.

DESIGN

A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria.

SETTING

Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included.

PARTICIPANTS

The total number of participants was 14 338.

PRIMARY AND SECONDARY OUTCOME MEASURES

Health effects classified under the International Classification of Diseases (ICD-10).

RESULTS

Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified.

CONCLUSIONS

LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or 'dose-response' relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors.

A European survey of professional bodies representing occupational medicine specialists

BACKGROUND

Professional societies and associations of occupational medicine (OM) play a key role in the development and cohesion of the speciality including its interaction with other disciplines.

AIMS

To understand the way the speciality operates across Europe, a survey of the current European professional bodies of OM specialists was conducted on behalf of the European Union of Medical Specialists (UEMS) section of OM.

METHODS

A cross-sectional survey was conducted asking country delegates of the UEMS section of OM to complete a questionnaire exploring the characteristics and activities of their professional associations/societies.

RESULTS

Twenty-four countries in total were contacted, with a response rate of 92%. In all, 78% of organizations were open to non-occupational physicians, nurses or other occupational health professionals; all except two had a fee under €200 per year, and 65% provided services with no dedicated administrative support. All organizations provided educational events, in addition to other services including website support, production of position documents, practice guidelines and quality assurance of professional practice.

CONCLUSIONS

The European associations of OM specialists deliver a wide range of services and educational activities despite limited resources. Further research is needed to explore the potential strategic and political effects associated with differing membership models, assess the nature and standard of medical education provided by the different organizations, and identify areas for collaboration within Europe. Future actions within OM associations would support the development of the speciality within Europe.

What factors are most relevant to the assessment of work ability of employees on long-term sick leave? The physicians' perspective

Purpose

To reach insurance physician (IPs) consensus on factors that must be taken into account in the assessment of the work ability of employees who are sick-listed for 2 years.

Methods

A Delphi study using online questionnaires was conducted from October 2010 to March 2011.

Results

One hundred and two insurance physicians reached a consensus on important factors for return to work (RTW) of employees on long-term sick leave; from those factors, the most relevant for the assessment of work ability was determined. From a total of 22 relevant factors considered for the return to work of long-term sick-listed employees, consensus was reached on nine relevant factors that need to be taken into account in the assessment of the work ability of employees on long-term sick leave. Relevant factors that support return to work are motivation, attitude towards RTW, assessment of cognitions and behaviour, vocational rehabilitation in an early stage and instruction for the sick-listed employee to cope with his disabilities. Relevant factors that hinder RTW are secondary gain from illness, negative perceptions of illness, inefficient coping style and incorrect advice of treating physicians regarding RTW.

Conclusions

Non-medical personal and environmental factors may either hinder or promote RTW and must be considered in the assessment of the work ability of long-term sick-listed employees. Assessment of work ability should start early during the sick leave period. These factors may be used by IPs to improve the quality of the assessment of the work ability of employees on long-term sick leave.

Occupational health crossing borders part 2: Comparison of 18 occupational health systems across the globe

BACKGROUND

Occupational health and safety (OHS) is considered one of the most important factors for a sustainable development; however, it is often considered a luxury by decision-makers. This article compares OHS systems of 18 countries at different stages of development.

METHODS

In an international summer school, structure of the national OHS system, definition of occupational accidents and diseases, procedures for compensation claims, outcome (expressed as incidence of occupational accidents) and training opportunities were presented.

RESULTS

National OHS systems ranged from non-existent to systems implemented almost 200 years ago. Priorities, incidence of occupational accidents and training opportunities varied. Common problems included the lack of OHS service for small enterprises and in rural areas.

CONCLUSIONS

International training programs like this summer school might enhance the exchange about OHS opportunities around the globe and contribute to improved workers health.

Transition from pediatric to adult care: internists' perspectives

OBJECTIVE

The goal was to understand the concerns of adult health care providers regarding transition for young adult patients with childhood-onset conditions.

METHODS

Internists from the 2000 American Board of Medical Specialties directory were selected randomly. A 2-stage mail survey was conducted from August 2001 to November 2004. In stage 1, providers stated their concerns regarding accepting care of transitioning young adult patients. In stage 2, providers ranked their concerns.

RESULTS

A total of 241 internal medicine providers were selected for participation. In stage 1, 134 of 241 physicians were eligible to participate, and 67 (50%) of 134 completed stage 1 surveys. In stage 2, 112 physicians were eligible, and 65 (58%) of 112 responded. Concerns elicited in stage 1 were clustered into 6 categories: patient maturity, patient psychosocial needs, family involvement, providers' medical competency, transition coordination, and health system issues. In stage 2, concerns rated highest were lack of training in congenital and childhood-onset conditions, lack of family involvement, difficulty meeting patients' psychosocial needs, needing a superspecialist, lack of adolescent training, facing disability/end-of-life issues during youth and early in the relationship, financial pressures limiting visit time, and families' high expectations.

CONCLUSIONS

Internists clearly stated the need for better training in congenital and childhood-onset conditions, training of more adult subspecialists, and continued family involvement. They also identified concerns about patients' psychosocial issues and maturity, as well as financial support to care for patients with complex conditions.

Exposure or expert? Setting standards for postgraduate education through a Delphi technique

OBJECTIVES

The aim of this study was to determine if a syllabus of upper limb anatomy for emergency clinicians composed by an expert panel reflected clinical practice as experienced by those at whom the syllabus would be directed.

METHODS

A three round Delphi study was performed using an expert group. We compared this with a measure of the exposure to anatomical concepts in the day to day practice of trainees in emergency medicine.

RESULTS

In total, 404 separate anatomical facts relating to the upper limb were reviewed by both groups. There was poor agreement (kappa = 0.348) between the expert group and the trainees.

CONCLUSION

We have shown disparity between what an expert group believes trainees should know and what trainees are actually exposed to in clinical practice. We believe this demonstrates that curriculum development must strike a balance between important (expert) and common (exposure) information. We have shown how an expert:exposure matrix may be used to inform curriculum development.

Specialist competencies in occupational medicine: appraisal of the peer-reviewed literature

BACKGROUND

A re-assessment of competencies and therefore learning outcomes for higher specialist training in occupational medicine (OM) is being undertaken. Although peer-reviewed literature on the subject exists, it is limited and needs appraisal.

AIMS

To search, and critically appraise the peer-reviewed literature on specialist competencies in OM.

METHODS

Systematic search of a range of databases of peer-reviewed literature, followed by criterion based appraisal and categorization of the findings.

RESULTS

Two hundred and thirty five papers were found of which only 20 were left after application of the grading and exclusion criteria. These addressed competencies from four perspectives: peer consensus, client, educational and legal.

CONCLUSIONS

Limited evidence can be obtained from the peer-reviewed literature on specialist competencies in OM. However, it suggests the main paradigms for deriving these competencies as well as indicating gaps and the manner in which these might be filled.

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.

European dissemination of a web- and case-based learning system for occupational medicine: NetWoRM Europe

OBJECTIVE

Occupation has a large impact on health in Europe. In order to prevent and recognize occupational diseases, medical students and physicians should know about the potentially causal relationship between profession and diseases as well as the basic legal aspects of occupational medicine (OM). However, the opportunity of bedside teaching, the students' most favoured way of teaching, is limited.

METHODS

One possibility to complete and improve traditional training in OM is computer-oriented case-based learning. Using the authoring system "CASUS" (INSTRUCT AG) cases can be created and handled without knowledge in computer sciences.

RESULTS

So far, 19 cases have been created and evaluated by students of German universities. Due to the great efforts arising from the creation of such multimedia cases it is desirable and cost-effective to use the existing cases at several medical universities. Therefore, the Net-based Training in Work-Related Medicine (NetWoRM) project shares cases on an international base. In February and April 2005, 13 case-authors from 12 centres were trained in the basics of case creation during a 3 week programme in Munich. The overall evaluation of the participants indicated that this way of teaching case creation is very efficient. Up to now, nine cases were translated into English and five into Spanish. First implementation of the cases in Spain and Finland showed a good acceptance by the students but more evaluation has still to be done.

CONCLUSION

Based on these results we conclude that exchange of case-based e-learning in OM is feasible and rewarding on an international base.

Developing a competence-based core curriculum in biomedical laboratory science: a Delphi study

In this study the Delphi technique has been used to develop a core curriculum for education of the biomedical scientist. The rapid development in biomedicine and the corresponding changes in methodology in biomedical laboratories demand careful planning of the education of biomedical scientists. The Delphi technique uses an anonymous panel of experts for suggestions and assessments aiming at consensus. Twenty-six experts from different kinds of hospital and university laboratories took part in the investigation. They suggested and assessed necessary competences for a recently graduated biomedical scientist, and if 75% or more of the participants agreed on a competence, it was included in the core curriculum. The final list consisted of 66 competences of varying depth, in three categories. This list contained several generic competences, concerning for example basic laboratory methods, handling of samples, dealing with apparatus and applying relevant rules and laws; basic knowledge in chemistry, preclinical medicine and laboratory methods; and finally attitudes that the panel expected in the recently graduated person. The core was sufficiently restricted to be used in a three-year programme and still leave space for about one year of electives/special study modules. It became rather traditional, e.g. it did not include competences that many recent reports consider important for the future professional.

Development of core competencies for an international training programme in intensive care medicine

OBJECTIVE

The aim of this study was to define the core (minimum) competencies required of a specialist in adult intensive care medicine (ICM). This is the second phase of a 3-year project to develop an internationally acceptable competency-based training programme in ICM for Europe (CoBaTrICE).

METHODOLOGY

Consensus techniques (modified Delphi and nominal group) were used to enable interested stakeholders (health care professionals, educators, patients and their relatives) to identify and prioritise core competencies. Online and postal surveys were used to generate ideas. A nominal group of 12 clinicians met in plenary session to rate the importance of the competence statements constructed from these suggestions. All materials were presented online for a second round Delphi prior to iterative editorial review.

RESULTS

The initial surveys generated over 5,250 suggestions for competencies from 57 countries. Preliminary editing permitted us to encapsulate these suggestions within 164 competence stems and 5 behavioural themes. For each of these items the nominal group selected the minimum level of expertise required of a safe practitioner at the end of their specialist training, before rating them for importance. Individuals and groups from 29 countries commented on the nominal group output; this informed the editorial review. These combined processes resulted in 102 competence statements, divided into 12 domains.

CONCLUSION

Using consensus techniques we have generated core competencies which are internationally applicable but still able to accommodate local requirements. This provides the foundation upon which an international competency based training programme for intensive care medicine can be built.

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.

Agreement of medical decisions in occupational health as a quality requirement

OBJECTIVE

Workers' medical examination by the occupational physician (OPs) is a decision-making process whose output consists of a variety of evaluations, including assessment of fitness for work. The medical literature reports that there is no complete agreement among OPs assessing the same workers, evidencing a critical aspect of professional performance. This study aims at evaluating the inter-individual variability of medical decisions by different occupational physicians.

METHODS

Four specialists in occupational medicine participated in the study. Each specialist examined 100 records of subjects with different medical conditions selected from about 2,500 health care workers. Each physician completed a form including the following items: assessment of fitness for work, advice to workers, need of further investigations, report of occupational disease, recommendation for the general practitioner. To assess the inter-individual variability the percent agreement and the agreement strength or Cohen's kappa were measured.

RESULTS

The study shows a variable agreement in the assessment of fitness for work among different professionals, with percent agreement ranging from 58% for the whole group to an average of 77% for physicians' pairs. By taking into account the variability expected by chance, the agreement ranged from fair to substantial. The agreement of other decisions (workers' advice, referral to other specialists, request of further investigation, report of occupational disease, recommendation for the general practitioner) was more variable.

CONCLUSION

The study shows that an inter-individual variability exists for some decisions taken by OPs. According to the need to continuously improve professional practice, in the absence of qualitative standards based on the outcome, reduction of inter-individual variability that should be considered as a quality requirement of the performance of the occupational physician.

Prevention of injuries at work: the role of the occupational physician

OBJECTIVES

To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP.

METHODS AND RESULTS

Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions.

CONCLUSIONS

OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.

Required competencies of occupational physicians: a Delphi survey of UK customers

BACKGROUND

Occupational physicians can contribute to good management in healthy enterprises. The requirement to take into account the needs of the customers when planning occupational health services is well established.

AIMS

To establish the priorities of UK employers, employees, and their representatives regarding the competencies they require from occupational physicians; to explore the reasons for variations of the priorities in different groups; and to make recommendations for occupational medicine training curricula in consideration of these findings.

METHODS

This study involved a Delphi survey of employers and employees from public and private organisations of varying business sizes, and health and safety specialists as well as trade union representatives throughout the UK. It was conducted in two rounds by a combination of computer assisted telephone interview (CATI) and postal survey techniques, using a questionnaire based on the list of competencies described by UK and European medical training bodies.

RESULTS

There was broad consensus about the required competencies of occupational physicians among the respondent subgroups. All the competencies in which occupational physicians are trained were considered important by the customers. In the order of decreasing importance, the competencies were: Law and Ethics, Occupational Hazards, Disability and Fitness for Work, Communication, Environmental Exposures, Research Methods, Health Promotion, and Management.

CONCLUSION

The priorities of customers differed from previously published occupational physicians' priorities. Existing training programmes for occupational physicians should be regularly reviewed and where necessary, modified to ensure that the emphasis of training meets customer requirements.

Influence of Residency Training on Occupational Medicine Practice Patterns

OBJECTIVES

A relatively high proportion of occupational medicine (OM) specialists have not had formal residency training in OM. Members of the Western Occupational and Environmental Medicine Association, a professional organization of OM specialists, completed a postal questionnaire (160 of 561 members).

METHODS

Educational background, practice setting, practice activities, and skills considered relevant were compared between those with and without formal training.

RESULTS

Both groups had considerable focus in clinical care, musculoskeletal medicine, and workers' compensation. However, those with formal training practice in a broader variety of settings were less likely to have practiced another specialty, and used additional skills (toxicology, industrial hygiene, and epidemiology) in their practices. Formal education appears to create a greater diversity of skills and opportunities, but it does not appear to create a group of physicians disinterested in "front-line" occupational medicine practice.

CONCLUSIONS

The data support the need for formal residency programs but also highlight the importance of access to formal training for midcareer physicians.

The ideal attributes of chief nurses in Europe: a Delphi study

BACKGROUND

Policy decisions to advance the role of Chief Nurse in member countries of the World Health Organization European Region will necessitate the systematic selection and recruitment of suitable postholders who can develop the role and status of nursing within a wide range of political frameworks and structures. Such posts are clearly of great importance for providing appropriate care through strategic and policy decisions, both nationally and internationally. The appointment and development of suitable personnel are, therefore, essential elements in the success of these roles. To date, no information exists about the qualities and attributes required for effective delivery of the Chief Nurse role.

AIM

To identify the characteristics considered to be most relevant in a Chief Nurse, in order to inform and systematize recruitment.

METHOD

A Delphi study was undertaken of 22 European member states. Consensus was reached by the second round, in which 12 countries participated.

RESULTS

Sixteen relevant qualities were identified and listed in order of importance. Of the eight countries for which statistical analysis was possible, seven demonstrated a significant level of accord [Belgium, Denmark, the Netherlands, the United Kingdom (UK), Iceland, Sweden, Hungary and Switzerland], with only Finland showing no intra-country agreement.

CONCLUSIONS

To the extent that there is a high level of inter and intra-country consensus on the desirable qualities of Chief Nurses, these could be used to inform the future systematic selection and operational development of this role in European member states.

Frequency of occupational health concerns in general clinics

Studies have suggested that occupational disease and injury are under-recognized by clinicians. To estimate the frequency of occupational factors in disease and injury, 108 patients in a general (not occupational) health care facility were interviewed about the frequency and types of workplace-health interactions. Thirty-nine percent reported possible causation by work, and 66% reported a possible increase in symptoms by work, even if not caused by work. Twenty-seven percent reported changing jobs and/or tasks because of work-health interactions. The majority of men and women reported that worksite changes could improve their functional ability at work. This study therefore indicates that (1) occupational health concerns are common in primary care clinics, even if not addressed by clinicians; (2) the definition of occupational health concerns should be broadened to include disease caused by work, disease symptoms worsened by work, and the need for occupational accommodation even if the disease itself is not caused by work; and (3) inquiring about patient concerns about workplace-health interactions can provide clinicians with significant opportunities for primary, secondary, and tertiary prevention.

Research priorities in occupational health in Italy

OBJECTIVE

To find a broad consensus on research priorities and strategies in the field of occupational health and safety in Italy.

METHODS

A two phase questionnaire survey was based on the Delphi technique previously described in other reports. 310 Occupational safety and health specialists (from universities and local health units) were given an open questionnaire (to identify three priority research areas). The data obtained from respondents (175, 56.4%) were then used to draw up a list of 27 priority topics grouped together into five macrosectors. Each of these was given a score ranging from 1 (of little importance) to 5 (extremely important). With the mean scores obtained from a total of 203 respondents (65.4%), it was possible to place the 27 topics in rank order according to a scale of priorities.

RESULTS

Among the macrosectors, first place was given to the question of methodological approach to research in this field, and for individual topics, occupational carcinogenesis and quality in occupational medicine were ranked first and second, respectively. The question of exposure to low doses of environmental pollutants and multiple exposures ranked third among the priorities; the development of adequate and effective approaches and methods for worker education and participation in prevention was also perceived as being an important issue (fourth place).

CONCLUSIONS

This study (the first of its kind in Italy) enabled us to achieve an adequate degree of consensus on research priorities related to the protection of occupational health and safety. Disparities in the mean scores of some of the issues identified overall as being research priorities, seem to be linked both to geographical area and to whether respondents worked in local health units or universities. This finding requires debate and further analysis.