Occupational Medicine Residency Research Articles

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns.

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

A Cross-Sectional Descriptive Analysis of Diversity, Equity, and Inclusion Presence Among United States Occupational and Environmental Medicine Residency Program Websites.

To evaluate the presence of diversity, equity, and inclusion (DEI) among US occupational and environmental medicine (OEM) residency program websites. In January to February 2022, two independent reviewers evaluated the websites of all 24 US accredited OEM residency programs and documented the presence of 10 predetermined DEI metrics and resident/faculty photographs and biographies. Program websites included a median of 1 (0-3) DEI element with 46% of websites containing none of the DEI metrics. Faculty photographs and biographies were included in 83% and 75% of websites, respectively. Resident photographs and biographies were included in 50% and 25% of websites, respectively. Many OEM residency program websites lack DEI presence. Programs should consider presenting information relevant to DEI on their websites to help attract more diverse applicant pools.

Training Occupational and Environmental Medicine (OEM) Residents at the Uniformed Services University.

To develop an actionable plan to sustain and improve the quality of the Uniformed Services University of the Health Sciences (USU) Occupational and Environmental Medicine (OEM) Residency Program. Program metrics were collected and analyzed to assess strengths, weaknesses, opportunities, and threats (SWOT analysis). Program strengths are stable funding, full-time faculty and large class size. Weaknesses are limited toxicology curriculum, and the lack of complex clinical cases. Opportunities include establishing an OEM referral clinic, collaborating with U.S. Department of Defense (DoD) toxicology programs, aligning OEM research priorities in DoD, and including DoD Civilian physicians in OEM residency training. Threats are Military Health System reorganization, budget, and personnel cuts. The USU OEM Residency is strong but must be flexible to adjust to personnel, fiscal, and organizational changes. Aggregating the SWOT analyses for all the OEM residency programs may help identify strategies to sustain OEM training in the United States.

Two decades’ contribution of occupational medicine training in Thailand: experience from the foundation with a view toward the future

Abstract For 2 decades, the Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, has served the Occupational Medicine Residency training program in Thailand. Graduates of this program undertake to work in occupational medicine to promote health and prevent morbidity and mortality in the workplace and provide occupational medical services for the working population in Thailand. Qualifying for a Postgraduate Diploma in Occupational Medicine in Thailand can be achieved in 2 ways: through a 3-year residency training or 5 years of working experience in the field of occupational medicine combined with an elective 2-month short course. There are currently 159 Thai board-certified occupational medicine physicians. Occupational medicine physicians in Thailand work in both public and private healthcare facilities. A number of certified occupational physicians occupy leading national health positions in various government and academic organizations. Knowledge of occupational medicine is currently essential for undergraduate medical students as specified in the medical competency assessment criteria of the Thai Medical Council. Updating content and incorporating needs of employers are keys to success for Thailand, as a country with an occupational medicine training program in its initial stages. In Thailand, the supply of occupational medicine physicians is still less than the increasing demand. Advancement of health research schemes would contribute to the curriculum. Occupational medicine development in Thailand needs to address challenges in local issues including work in the informal sector, particularly in agriculture, and incorporate standardization and international consistency into the training curriculum and qualifying management.

English

The Ebola Virus Disease (EVD) outbreak in West Africa in 2014 resulted in cases spreading to other parts of the world, such as the United States of America (USA). A survey was carried out among Meharry Medical College residents to ascertain their knowledge of Center of Disease Control and Prevention (CDC) guidelines on prevention and management of EVD. A structured questionnaire was administered to a cross-section of residents at Meharry Medical College between December 2014 and January 2015. A total of 60 residents participated in the survey. Of these, 11 (18.3%) were psychiatry residents, 5 (8.3%) each were preventive and occupational medicine residents, while 13 (21.7%) and 26 (43.4%) were family and internal medicine residents, respectively. Compared to other specialties, resident physicians in occupational medicine had higher knowledge of the first step in the management of Ebola virus (EBOV) (p=0.042). On whether use of personal protective equipment (PPE) was required for individuals driving or riding in a vehicle carrying human remains of EBOV patients, only 10 respondents (16.7%) answered correctly, with preventive medicine residents performing significantly better than other physicians (p<0.0001). In conclusion, this study identified that resident physicians have a low level of knowledge regarding the presentation, prevention and management of EVD, including handling post-mortem remains. This study highlights the importance of educational interventions to improve knowledge on EVD prevention and management. Key words: Ebola virus disease, Ebola hemorrhagic fever, infectious disease, awareness, Knowledge, attitude and perception (KAP), medical residents, knowledge, attitudes, Ebola epidemic.

The U.S. Army Occupational and Environmental Medicine Residency at Aberdeen Proving Ground, Maryland: 1960-1996.

Reorganization of the Army and critical assessment of Army Graduate Medical Education programs prompted the Occupational and Environmental Medicine (OEM) Consultant to the Army Surgeon General to initiate a review of current Army OEM residency training. Available information indicated the Army OEM residency at Aberdeen Proving Ground, MD, was the first and longest operating Army OEM residency. Describing this residency was identified as the first step in the review, with the objectives of determining why the residency was started and sustained and its relevance to the needs of the Army. Records possibly related to the residency were reviewed, starting with 1954 since certification of physicians as Occupation Medicine specialists began in 1955. Interviews were conducted with selected physicians who had strong affiliations with the Army residency and the practice of Army OEM. The Army OEM residency began in 1960 and closed in 1996 with the transfer of Army OEM residency training to the Uniformed Services University of the Health Sciences, Bethesda, MD. Over 36 years, 47 uniformed residency graduates were identified; 44 were from the Army. Forty graduated between 1982 and 1996. The OEM residency was part of a dynamic cycle. Uniformed OEM leaders identified the knowledge and skills required of military OEM physicians and where these people should be stationed in the global Army. Rotations at military sites to acquire the needed knowledge and skills were integrated into the residency. Residency graduates were assigned to positions where they were needed. Having uniformed residents and preceptors facilitated the development of trust with military leaders and access to areas where OEM physician skills and knowledge could have a positive impact. Early reports indicated the residency was important in recruiting and retaining OEM physicians, with emphasis placed on supporting the Army industrial base. The late 1970s into the 1990s was a more dynamic period. There was heightened interest in environmental protection and restoration of military installations, and in the threats posed by nuclear, biological and chemical weapons. Additionally, President Reagan initiated a military buildup that brought new health risks to soldiers who would use and maintain modern equipment. Army OEM physicians were required to possess competencies in many areas, to include depots in the Army industrial base, occupational health for the soldier for exposures like carbon monoxide in armored vehicles, military unique exposures like those from chemical threat agents, and environmental medicine to assess health risks on contaminated U.S. military sites and from exposures of deployed forces. These offered interesting OEM training opportunities that challenged residents in the program and helped recruit new residents. The strength of the first Army OEM residency was that it was part of a dynamic cycle that consisted of identifying and defining Army OEM needs, training physicians to meet those needs and assigning residency graduates to positions where they would have a positive impact. This paradigm can be used as the basis for contemporary assessments of the Army's need for uniformed OEM physicians and a uniformed OEM residency program.

Feasibility and Implementation of Musculoskeletal Ultrasound Training in Occupational Medicine Residency Education.

This article aims to present the musculoskeletal (MSK) ultrasound (US) course, the objective measures of occupational medicine (OM) resident skill, and subjective opinions of OM residents regarding the MSK US course and MSK US in general. Also, to provide other OM residency programs information to help them develop this skill for their programs. Didactic sessions based on American Institute of Ultrasound in Medicine (AIUM) guidelines were taught in modular format with subsequent practice-based workshops. A practical examination was given at the completion of the workshop and a survey of the residents experience during the workshop. The average score on the practical examination among residents was 92.5%. The survey indicated that the residents felt like they learned from this course and increased their knowledge of MSK US. The findings suggest that a course in MSK US for OM residents can feasibly be implemented in an OM residency curriculum.

Emergency responder health: what have we learned from past disasters?

As the Deepwater Horizon disaster unfolds in the Gulf of Mexico, public health practitioners are having a sinking deja vu feeling. Once again, environmental disaster has struck, and tens of thousands of emergency responders—some professionals, but many more volunteers—have swung into action, potentially risking their health as they work to clean up the worst oil spill in U.S. history. Veterans of similar disasters are wondering if historical lessons learned can help keep the damage to a bare minimum. But a paucity of hard data on emergency responder health makes it difficult even to ask the right questions. “Emergency responders have not been adequately studied,” says Gina Solomon, codirector of the occupational and environmental medicine residency and fellowship program at the University of California, San Francisco, and a senior scientist with the Natural Resources Defense Council. “They tend to be ignored.” Professional emergency responders such as firefighters may not put much emphasis on health effects studies. “They are going to do what they need to do regardless of their own safety,” says Don Donahue, executive director of the Center for Health Policy & Preparedness at the Potomac Institute for Policy Studies, who has firefighters in his extended family. “They have to be a little crazy by definition.” That heroic approach is manna for the people they save, but firefighters may pay a price with disorders such as cancer. Studies of cancers in firefighters have had mixed results, but there is evidence linking this occupation with brain, thyroid, esophageal, bladder, testicular, prostate, and cervical cancers, as well as melanoma and Hodgkin disease (Bates1 and Ma et al.2 are two such studies). Health risks tend to be even greater for the many nonprofessional emergency responders who rush to the scene of crises such as oil spills, terrorist attacks, hurricanes, train derailments, and chemical releases. Those workers often don’t have the training and advanced equipment that protect professional emergency responders to some degree. These and many other factors make it a daunting challenge to protect the health of emergency responders during disasters.

Occupational Medicine Residency Graduate Survey: Assessment of Training Programs and Core Competencies

This study provides insight into Occupational Medicine (OM) residency graduates and how residency programs are meeting their education goals. A survey of graduates from nine OM residency program was performed to evaluate the effectiveness of OM residency training in the United States and Canada. Eighty percent of the OM residency graduates were currently practicing OM. Three-quarters worked in clinical practice for a mean of 20 hr/wk. Other activities varied and included management, teaching and consulting. Ninety-five percent were satisfied with their OM residency training. The competencies acquired were mostly ranked highly as practice requisites, although preparation in clinical OM might be better emphasized in training. Recent OM residency graduates were more likely to be board-certified in OM than other American College of Occupational and Environmental Medicine physician members (73% vs 41%). OM residency graduates over the past 10 years were highly satisfied with OM residency training, with the training generally meeting practice needs.

Editorial: New Deputy Editors and Medical Editor

In January 2007, EHP was fortunate to have Steve Kleeberger and Matt Longnecker step up to serve with me as interim deputy editors in the absence of a full-time permanent editor. Steve and Matt have given generously of their time, expertise, and energy in helping to maintain EHP ’s scientific quality during a time of transition. Given EHP’s broad scope of coverage, however, we felt the need to likewise broaden the scope of our science editorial expertise. Thus, we are pleased to welcome aboard two additional interim deputy editors. Michael P. Waalkes is a senior research toxicologist with the National Cancer Institute, where he serves as chief of the Inorganic Carcinogenesis Section, which is part of the Laboratory of Comparative Carcinogenesis stationed at the NIEHS campus in Research Triangle Park, North Carolina. Mike received his PhD in pharmacology and toxicology from West Virginia University. His postdoctoral studies at the University of Kansas School of Medicine focused on the cellular and molecular mechanisms of acquired tolerance to metal toxicity. His current research involves defining the mechanisms of action of the carcinogenic inorganics, including arsenic, lead, and cadmium. Mike is currently an adjunct professor of molecular toxicology at Duke University and an active member of the Society of Toxicology. He has been the editor of Toxicology and Applied Pharmacology since 2000 and serves on the editorial boards of Toxicology, the Journal of Toxicology and Environmental Health, and Toxicology Mechanisms and Methods. Stephanie London is a senior investigator in the NIEHS Epidemiology Branch with a joint appointment in the Laboratory of Respiratory Biology. She received her MD and her DrPH degree in epidemiology from Harvard University. She completed a residency in internal medicine at the Massachusetts General Hospital and a residency in occupational and environmental medicine at Harvard, and is board certified in both fields. Stephanie was an assistant professor at the University of Southern California School of Medicine from 1989 through 1995, where she was part of a small team of investigators who founded a landmark study of health effects of air pollution in schoolchildren known as the Children’s Health Study. She came to the NIEHS in 1995. Her work focuses on genetics and interactions between genetics, diet, and environmental pollutants in relation to asthma and chronic obstructive pulmonary disease. Stephanie is an editor for Epidemiology and has served on the editorial board of the American Journal of Epidemiology. I would also like to take this opportunity to introduce our new medical editor, Russ Hauser, who succeeds Brian S. Schwartz. Russ is an associate professor of environmental and occupational epidemiology in the departments of Environmental Health and Epidemiology at the Harvard School of Public Health. He graduated from Clark University and the Albert Einstein College of Medicine, where he received his MD. He received his MPH and ScD from the Harvard School of Public Health, where he completed a residency in occupational medicine. He is board certified in occupational medicine. From 2000 to 2004, he served as deputy director of the Occupational and Environmental Medicine Residency, National Institute for Occupational Safety and Health Education and Research Center. Russ’s research focuses on the effects of environmental and occupational chemicals on fertility and pregnancy outcomes. He is on the editorial board of the Journal of Exposure Science and Environmental Epidemiology, and is chair of the Environment and Reproduction Special Interest Group of the American Society for Reproductive Medicine. Finally, we bid a fond farewell to Brian, our outgoing medical editor. Brian served in this role from July 2004 through July 2007. During this time he significantly raised the bar for EHP ’s Grand Rounds and Environmental Medicine submissions, allowing the journal to advance in its mission of delineating relationships between the environment and human health. We are most grateful for his service to the journal. Stay tuned for news of a permanent editor-in-chief for EHP. As always, we welcome your feedback.

Training Pathways for Occupational Medicine

Consider the funding, organization, and applicant pool for occupational medicine residency training positions concerns in the United States. 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). 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. 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.

Clinical Activities in an Academic Hospital-Based Occupational Medicine Program

The objectives of this article are to characterize the clinical activities encountered by a large academic hospital-based occupational medicine program and to discuss their implications for occupational medicine residency training and the training of practicing physicians. Clinical activities from July 1, 1996, to December 31, 2004, were retrieved from computerized databases and categorized. All morbidity coding was performed using the same classification scheme and resource. The largest volume of clinical activities included patients seen for physical examinations, work-related injury and illness care, and substance abuse testing. The most frequently encountered workers' compensation cases were musculoskeletal. Although medical surveillance examinations, toxic exposure assessments, and other specialty services were available, the demand for such services was relatively low.

Use of Specific Inhalation Challenge in the Evaluation of Workers at Risk for Occupational Asthma: A Survey of Pulmonary, Allergy, and Occupational Medicine Residency Training Programs in the United States and Canada

To document the current practice of occupational asthma (OA) diagnosis and use of specific inhalation challenge (SIC). A survey evaluating the current practice of SIC was mailed to 259 residency training programs in adult pulmonary diseases, allergy and immunology, and occupational medicine accredited in the United States and Canada during the year 2000. Forty-six percent (123 of 259 programs) participated. Ninety-two programs reported that patients with OA were seen during the previous year, 15 programs reported that SIC had been performed, and 10 programs reported that patients had been referred to other sites for SIC. A total of 259 patients underwent SIC. No unexpected adverse reactions were reported. Forty-one programs reported that they had been willing to undertake SIC but were unable to do so. The most common barriers cited were lack of availability of SIC within the evaluating institution, inability to locate a site for referral, concerns about reimbursement, and lack of an appropriate diagnostic reagent for use in SIC. Seventy-four programs indicated that SIC was useful, and 34 programs included training in the use of SIC was part of the residency curriculum. Although SIC is considered the "gold standard" for objective documentation of OA, the test is performed in only a few institutions in the United States and Canada. Many institutions indicate that SIC is not available, even when desired for patient management. Only a minority of participating residency training programs include SIC as a formal part of the training curriculum.

Workers Exposed to Hot Environments

Director, Occupational Medicine Residency, Uniformed Services University of Health Sciences, Bethesda, MD

Physician Training in Agricultural Safety and Health

ABSTRACT This paper describes the Emory Agromedicine Training Project, a component of Occupational Medicine residency training at Emory University since 1991. The Project places occupational medicine residents in rural settings, where they perform a range of activities: working on farms, service visits to farms, grand rounds presentations to rural hospitals, public presentations in farm communities, and clinical service in the migrant health program. In addition they complete a directed reading syllabus and a research project. The rotation has been successful in building the residents' knowledge of agricultural safety and health, instilling positive attitudes toward the field, and achieving desired behaviors and skills. In addition, strong statewide networking was accomplished through this initiative. Areas of limited success include the small number of residents trained, some resident dissatisfaction with intense travel requirements and security concerns, and inability to secure long-term funding. We conclude that agricultural safety and health is highly suitable for inclusion in occupational medicine training, and this model should be extended to primary care specialties such as family practice.

Problem-Based Learning as a Training Modality in the Occupational Medicine Curriculum

Problem-based learning has been used as a curricular modality in the academic year of the Occupational Medicine Residency Program. The method was applied to the resolution of problems presented by patients referred to a university clinic specifically for the determination of possible work-relatedness of the syndrome or symptoms presented. Following the usual development of the occupational and medical histories, physical examination, and determination of certain clinical laboratory values, the resident would then have to seek assistance through consultation with related specialists, a perusal of the pertinent toxicology, epidemiology, or other discipline literature, and ultimately prepare a university-level report, following case conferences with fellow residents and faculty members. No formal direction was given the student, the problems of diagnosis, occupational etiology and medicolegal acceptance of the resulting report having to be resolved through self-perusal of informational sources. The knowledge gained from the exercise would be longer-lasting than that attained strictly from lecture attendance.

Training the future physician manager: Assessing the results

Occupational medicine residents at the University of Arizona have received formal academic and practicum training in administration since 1983. Training introduces computer skills, fiscal control, budgeting, personnel management, political or regulatory process, program development, and planning and organization. We asked physician graduates who completed program requirements from 1983–1991 to evaluate administrative training and applicability of training to current employment, and to report on their current job duties. Former residents graded program activities as preparation for management responsibilities: community-based rotations, a one-month administration rotation, committee work, administering a program, and residency training overall. Survey results underscore the importance of management training during residency years, since current job duties show such skills are required. However, since the survey indicates our attempts to foster acquisition of specific management skills have been only partially successful, continued and improved efforts in these training areas are necessary.

Where Do Occupational Medicine Residencies Fit in the Institution?

1Director Occupational Medicine Residency The University Hospital at Boston University Medical Center Boston, Mass

Occupational Medicine Training Program Surveys

Although the quantity of Occupational Medicine (OM) residents in training programs has risen in the past 15 years, there remains a significant shortage of OM physicians in the United States. A survey of OM residency program directors and residents and fellows (trainees) was accomplished to answer questions relevant to recruiting and supplying OM trained physicians. Twenty-six of 29 program directors (89.7%) replied. One hundred forty-three of 174 (82.2%) trainees responded. Fifty percent of responding program directors were satisfied with the current quantity of program applicants. Medical students were provided a median of 3 hours (range, 0 to 20 hours; mean, 5.35 hours) of formal OM teaching by the responding programs. Almost half of trainees, 68 (48.6%), did not receive formal OM instruction in medical school. An average of 5.4 +/- 13.3 hours of OM was taught to OM trainees in medical school. Disproportionate numbers of trainees were taught OM as fourth-year medical students and in other residencies. Reasons for pursuing OM training were diverse and often related to postgraduate clinical experience with OM. Only a total of 84 primary care residents (0.32%) rotate through the OM residency programs in an average year. We conclude that an insufficient quantity of qualified applicants, combined with limited exposure to OM in medical schools and low levels of contact with residents in primary care programs, will continue to hinder efforts to reduce the shortage of OM residents and physicians. Further training specifically targeting the fourth year of medical school and the primary care residencies may have the most impact on recruitment.

Occupational Medicine Residency Training Programs

An experienced occupational health nurse with suitable academic qualifications is able to assist in providing a well-rounded education and teaching physicians to be effective members of occupational health teams. Nurses are involved in teaching occupational health to physicians in the academic and practicum phases of occupational medicine residency training programs. However, the involvement of nurses in training physicians is inconsistent among the accredited residencies. Most of the nurses involved in teaching occupational health to physicians are at least master's degree prepared. Nurses are involved in the didactic, clinical, and administrative components of the training programs. Though nurses are involved in residency training programs to an extent, the lack of consistent involvement limits the diversity of points of view and fosters an imbalance in the training of occupational medicine residents.