Occupational and Environmental Medicine Training Curriculum Australasian Faculty of Occupational and Environmental Medicine Australasian Faculty of Occupational and Environmental Medicine Physician Readiness for Expert Practice (PREP) Training Program Occupational and Environmental Medicine Training Curriculum ACKNOWLEDGEMENTS The Royal Australasian College of Physicians (RACP) Fellows, trainees and staff have contributed to the development of this curriculum document. The College specifically thanks those Fellows and trainees who have generously contributed to the development of this curriculum, through critical comments drawn from their knowledge and experience and the donation of their time and professional expertise. The following people, external to AFOEM, deserve specific mention for their contribution: • Dr Geza Benke, Past President, Australian Institute of Occupational Hygienists • Prof David Caple, management consultant • A/Prof Andrew Cole, Australasian Faculty of Rehabilitation Medicine, FAFRM • A/Prof Matthew Frei, Chapter of Addiction Medicine, FAChAM • A/Prof Wendy MacDonald, La Trobe University, Melbourne • Ms Pam Prior, Chair, OHS Educators Chapter, Safety Institute of Australia • Ms Christine Waring, President, Human Factors & Ergonomics Society of Australia This curriculum is drawn from the voices of many within AFOEM. It is our curriculum. Through the process of its formulation, Dr David Goddard: Education Project Officer, acted as scribe, collator and ‘accoucheur’, supported by the present and previous administrative staff of the Faculty. Much assistance with word processing came from Ruth and Moira Goddard, John Sapien and Roslyn Selby. The process was managed by the Curriculum Development Unit within the College’s Education Services, who designed the document, drafted content material, organised and facilitated writing workshops, developed resource materials, and formatted the final document. Occupational and Environmental Medicine Training Curriculum 3 CONTACT DETAILS THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS AUSTRALIA NEW ZEALAND 145 Macquarie Street 5th Floor Sydney 99 The Terrace NSW 2000 Wellington Australia New Zealand Tel: (+61) (2) 9256 5444 Tel: (+64) (4) 472 6713 Fax: (+61) (2) 9252 3310 Fax: (+64) (4) 472 6718 Email: [email protected] Email: [email protected] Website: www.racp.edu.au Website: www.racp.edu.au COPYRIGHT 1st edition 2010 (revised 2013). Please note: No Domains, Themes or Learning Objectives have been updated for this edition; design changes ONLY. Copyright © 2013. The Royal Australasian College of Physicians (RACP). All rights reserved. Published December 2013. This work is copyright. Apart from any fair use, for the purposes of study or research, it may not be reproduced in whole or in part, by any means electronic or mechanical, without written permission from The Royal Australasian College of Physicians 4 Occupational and Environmental Medicine Training Curriculum TABLE OF CONTENTS Acknowledgements .......................................................................................................................................................3 Physician and paediatrician training continuum of learning ...........................................................................................8 Overview of the specialty ...............................................................................................................................................9 Curriculum overview ....................................................................................................................................................10 Curriculum themes and learning objectives .................................................................................................................15 Learning objectives tables ............................................................................................................................................17 DOMAIN 10: CLINICAL PRACTICE ....................................................................................................33 SUB-DOMAIN 11: Clinical process ..........................................................................................................33 THEME 11.1: Clinical skills .............................................................................................................................33 THEME 11.2: Patient care and therapeutics ...................................................................................................41 THEME 11.3: Procedural skills ........................................................................................................................51 SUB-DOMAIN 12: Medical expertise .......................................................................................................54 THEME 12.1: Management of acute medical problems .................................................................................54 THEME 12.2: Management of patients with undifferentiated presentations ...................................................60 THEME 12.3: Management of patients with disorders of an organ system .....................................................63 THEME 12.4: Management of patients with defined disease processes ..........................................................88 THEME 12.5: Medicine through the lifespan – growth and development ......................................................94 THEME 12.6: Diseases affected by occupation and environment and their consequences ............................101 DOMAIN 20: WORKPLACE HAZARD ASSESSMENT ........................................................................115 THEME 20.1: Properties and mechanisms of harm of agents that can affect health ......................................115 THEME 20.2: Description of health effects of occupational hazards .............................................................118 THEME 20.3: Assessment and control of work-related hazards .....................................................................128 THEME 20.4: Investigation of situations .......................................................................................................134 THEME 20.5: Investigation of an outbreak ...................................................................................................137 DOMAIN 30: CRITICAL APPRAISAL OF INFORMATION ...................................................................141 THEME 30.1: Finding and application of information ..................................................................................141 THEME 30.2: Clinical decision making .........................................................................................................143 THEME 30.3: Diagnostic and screening tests ...............................................................................................148 THEME 30.4: Evaluation of health interventions ..........................................................................................149 THEME 30.5: Attribution of cause ................................................................................................................151 THEME 30.6: Compliance with preventive interventions and procedures .....................................................152 Occupational and Environmental Medicine Training Curriculum 5 DOMAIN 40: RESEARCH METHODS ................................................................................................153 THEME 40.1: Research procedure ................................................................................................................153 THEME 40.2: Ethical conduct of research ....................................................................................................155 THEME 40.3: Analysis, summary and depiction of data ...............................................................................156 THEME 40.4: Research presentation ............................................................................................................157 DOMAIN 50: WORKING WITH LEADERS ........................................................................................160 THEME 50.1: Nature of organisations ..........................................................................................................160 THEME 50.2: Organisational factors affecting health and safety performance ..............................................163 THEME 50.3: Quality assurance ...................................................................................................................164 THEME 50.4: Managing and marketing an independent occupational health service within an organisation ......................................................................................................................165 DOMAIN 60: PROFESSIONAL QUALITIES ........................................................................................171 SUB-DOMAIN 61: Communication .......................................................................................................171 THEME 61.1: Physician-patient communication ...........................................................................................171 THEME 61.2: Communication with a third party, including the patient’s employer or their family and/or carers ...............................................................................................................178 THEME 61.3: Communication with colleagues and the broader health care team .......................................180 THEME 61.4: Communication with the broader community .......................................................................189 THEME 61.5: The influencing of groups ......................................................................................................196 SUB-DOMAIN 62: Quality and safety ....................................................................................................203 THEME 62.1: Use of evidence and information ............................................................................................203 THEME 62.2: Safe practice ..........................................................................................................................204 THEME 62.3: Identification, prevention and management of potential harm ...............................................211 SUB-DOMAIN 63: Teaching and learning (scholar) ..............................................................................219 THEME 63.1: Ongoing learning ...................................................................................................................219 THEME 63.3: Educator ................................................................................................................................222 SUB-DOMAIN 64: Cultural competency ...............................................................................................225 THEME 64.1: Cultural competency ..............................................................................................................225 SUB-DOMAIN 65: Ethics ........................................................................................................................235 THEME 65.1: Professional ethics ..................................................................................................................235 THEME 65.2: Personal ethics .......................................................................................................................237 THEME 65.3: Ethics and health law .............................................................................................................241 SUB-DOMAIN 67: Leadership and management ..................................................................................244 THEME 67.1: Self-management ...................................................................................................................244 THEME 67.2: Leadership and management of others ..................................................................................247 6 Occupational and Environmental Medicine Training Curriculum SUB-DOMAIN 68: Health advocacy .......................................................................................................249 THEME 68.1: Advocacy for the patient ........................................................................................................249 THEME 68.2: Individual advocacy ................................................................................................................251 THEME 68.3: Group advocacy .....................................................................................................................253 SUB-DOMAIN 69: The broader context of health ................................................................................255 THEME 69.1: Burden of disease ...................................................................................................................255 THEME 69.2: Determinants of health ..........................................................................................................258 THEME 69.3: Prevention and control ...........................................................................................................260 THEME 69.4: Priority population groups ......................................................................................................262 THEME 69.5: Economics of health ...............................................................................................................263 DOMAIN 70: LAW AND MEDICINE .................................................................................................265 THEME 70.1: Relevant laws and their administration ...................................................................................265 THEME 70.2: Industrial relations ..................................................................................................................267 THEME 70.3: The legal process ...................................................................................................................268 DOMAIN 80: FITNESS AND RETURN TO WORK ..............................................................................270 THEME 80.1: Assessment of fitness for work ................................................................................................270 THEME 80.2: Development and implementation of a vocational rehabilitation policy and program ................................................................................................................................277 DOMAIN 90: ENVIRONMENTAL RISKS AND INCIDENTS ..................................................................280 THEME 90.1: Scope of environmental issues ................................................................................................280 THEME 90.2: Planning for an environmental incident ..................................................................................287 THEME 90.3: Practical handling of an environmental incident .....................................................................289 THEME 90.4: Remediation of a contaminated site .......................................................................................292 Useful references ........................................................................................................................................................296 Index of curriculum content ......................................................................................................................................298 List of acronyms and initialisms ..................................................................................................................................307 Occupational and Environmental Medicine Training Curriculum 7 RACP FELLOWSHIP TRAINING PATHWAYS AND THE CONTINUUM OF LEARNING Foundation RACP PREP Training Professional medical practice Basic Training Advanced Training Programs Qualification studies and Programs workplace Division Training Programs experience Cardiology Clinical Genetics Clinical Haematology Clinical Immunology & Allergy Clinical Pharmacology FRACP Community Child Health P Continuing Professional Dermatology (NZ only) Development Endocrinology Initial Medical Basic Training Gastroenterology Qualification in Adult General & Acute Care Medicine A Medicine General Paediatrics P Geriatric Medicine A Infectious Diseases Medical Oncology Neonatal/Perinatal Medicine P Nephrology Neurology Nuclear Medicine Palliative Medicine 1 Respiratory Medicine Rheumatology Sleep Medicine Joint Training Programs 2 RACP & The Australasian Faculty of Rehabilitation Medicine (AFRM) FRACP & • Paediatric Rehabilitation MedicineP FAFRM One or more RACP & The Royal College of Pa- Basic Training initial post- thologists of Australasia (RCPA) in Paediatrics graduate • Endocrinology & Chemical & Child years in the Pathology Health FRACP & workplace • Haematology FRCPA • Immunology & Allergy • Infectious Diseases & Microbiology RACP & The Australasian College FRACP &/OR for Emergency Medicine (ACEM) FACEM • Paediatric Emergency Medicine 3 Chapter Training Programs • Addiction Medicine 3 FAChAM • Palliative Medicine 1,3 FAChPM • Sexual Health Medicine 3 FAChSHM Faculty Training Programs • Rehabilitation Medicine 3 FAFRM • Occupational & Environmental Medicine 3 FAFOEM • Public Health Medicine 3 FAFPHM P Trainees must complete Basic Training in Paediatrics & Child Health to enter this program. A Trainees must complete Basic Training in Adult Medicine to enter this program. 1 Trainees who have entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will be awarded FRACP upon completion and may subsequently be awarded FAChPM. Trainees who have NOT entered Advanced Training in Palliative Medicine via a RACP Basic Training Program will only be awarded FAChPM upon completion. 2 The Child & Adolescent Psychiatry Joint Training Program with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is currently under review by the RACP and RANZCP and closed to new entrants at present. 3 Alternative entry requirements exist for these training programs; please see the corresponding PREP Program Requirements Handbook for further information. NB1: This diagram only depicts training programs that lead to Fellowship. Please see the RACP website for additional RACP training programs. NB2: For further information on any of the above listed training programs, please see the corresponding PREP Program Requirements Handbook. 8 Occupational and Environmental Medicine Training Curriculum OVERVIEW OF THE SPECIALTY What is an occupational physician? An occupational physician applies high-level medical skills to the interface between a person’s work and his or her health. For an individual worker-patient, this may mean seeking evidence for the work-relatedness of a disease, assisting return to work after injury, or assessing fitness for safety-critical work. For groups of workers, this may mean working to reduce known harmful exposures, research on the effects of exposures or clusters of adverse health effects, or promotion of wellness. In addition to being medically capable, an occupational physician requires understanding of harmful exposures, laws that bear on exposure control and employment opportunity, and how to gain influence within organisations to prevent work-related afflictions and to promote wellness. These abilities serve workers and can assist the work of other medical practitioners and occupational health professionals. Traditionally, the term exposure has applied to dusts, airborne toxins, radiation and noise. Trends suggest that future exposures will be very much concerned with the changing design of work – more part-time and home-based work and greater proportions of immigrant workers and workers supplied to companies by labour hire firms. A worker’s mobility, dexterity, aerobic capacity, vision, hearing, skin and reliable mental function will remain the focus of occupational medicine. What is an environmental physician? An environmental physician is likewise concerned with exposures and their effect on health. These exposures come from air, water, soil, food, and recreation or play. General practitioners and public health physicians conduct much medical activity in this area, so physicians coming from a background in occupational medicine have tended to address environmental hazards generated by industry – be they neighbourhood noise or dust, chemical spills from tankers, or contamination of sites or waterways. Environmental physicians have served teams assessing the spread and health effects of an environmental incident, or in planning to reduce the risks of fires, explosions or sabotage. The curriculum leans toward these areas but we recognise that some roles of a physician addressing environment-related health effects are as yet beyond imagination. The roles of occupational physician and environmental physician frequently coexist in the one person, but not always. In fact, for the life of this Faculty so far, the greater strength of our Fellowship typically has been in occupational medicine. Now, growing numbers in our communities recognise environmental medicine as important, so competency there is required for all trainees. Faculty overview The Australasian Faculty of Occupational and Environmental Medicine (AFOEM) provides: • a Fellowship to foster and improve the practice of medicine at the interfaces between health and work and wider environment • coordination of training and setting of standards for medical practitioners seeking to enter this field in its clinical, preventive and population-based aspects. Guidance offered by Fellows to trainees is important to training. For this reason, each trainee is linked with an educational supervisor and educational supervision is supported and coordinated in regions by Directors of Training. Nearly always, training is conducted in a community setting. Hospital-based training is the exception. Occupational and Environmental Medicine Training Curriculum 9