# Maritime Health Research and Education-NET/EDUCATION/Education module links/MSc Global Occupational Medical Research Education/MSc Module 4:Clinical education diagnostics of occupational diseases 18 months

The list below sets out the competencies the occupational medical specialist should possess on completion of education, with the emphasis on the skills and the required compulsory assessment methods. Competences and the related assessment methods are concretized by using competence cards or other specific guidance.

## Competencies to be learned during the occupational medical introduction 18 months

| 1 | Diagnostics, etiological assessment and prognosis | Should be able to make: |
| 1 | Exposure assessment | At the basic level perform an exposure assessment and risk assessment in the clinical work regarding ergonomic, physical chemical, biological and psychosocial risk factors |
| | | Under supervision carry out and in writing reports of 5-10 workplace visits |
| 2 | Basic occupational patient medical assessment | Under supervision do asessment of the most common occupational disorders: Disorders of the neck-shoulder Low back disease Shoulder disorders Elbow and wrist disorders Hips and knee disorders Vibration-induced white fingers Hand eczema Asthma/rhinitis COLD (Chronic Obstructive Lung Disease) Indoor climate-related symptoms Asbestos-related disorders Exposure related mental disorders |
| 3 | Risk assessment for pregnant women | Under supervision: carry out a risk assessment of pregnant women and breastfeeding the working environment and recommend as appropriate preventive measures or absence reports |
| 4 | Conclusion and completion of patients | In cases of well-known occupational medical issues independently formulate diagnosis, prognosis, etiological assessment, and conclusion |
| 5 | Relevant communication | Faced with patients and collaborating partners, establish contact and communicate in a form of trust, empathy, and situational sensation. Make a clarification and agreement of the patients´ expectations. Clarify the role of the doctor and the occupational medicine clinic and make sure that the patient understands the purpose of the consultation. Ensure that the patient has understood the conclusion and |
| 6 | Relevant patient consent | Make agreements with the patient, the members of the interdisciplinary teams, and the workplace about the diagnostics and the mapping of exposure conditions. Ensure that there is relevant consent or legal basis for any collection or disclosure of health and exposure information. |
| 7 | Report occupational diseases and injuries | Could report occupational diseases and injuries and advise victims in relation to notification to the relevant Authority |
| 8 | Basic work retention | Have knowledge of social medicine possibilities and provide suggestions for action on job retention |
| 9 | Workplace visits | Under supervision plan and implement 5-10 workplace visits |
| 10 | Health promotion | Could advise patients about risk factors and protective factors in work, environment and lifestyle and the interaction between these and indicate options for reducing risks |
| 11 | Education | Participate in the department's professional activities eg. by the presentation of articles and internal teaching of colleagues. |

## Lung medicine

| 1 | Diagnostics, treatment and prognosis | Conduct diagnostic investigation with focus on relevant differential diagnoses To prescribe and interpret answers to common paraclinical investigations and make preliminary diagnosis Indicate overall treatment options Specify prognosis with focus on function level for the following states: Pneumonia Asthma Chronic Obstructive Pulmonary Disease (COLD) Restrictive pulmonary diseases, Including silicosis and asbestos Allergic alveolite # Lung cancer and mesothelioma |
| 2 | Spirometry | Perform and interpret spirometry incl. test of reversibility |
| 3 | Peak-flow monitoring | Make indication and guidance for peak-flow monitoring, as well as read and interpret outcome |
| 4 | Bronchial provocation test | Make indication of and interpretation results of unspecific bronchial provocation test |
| 5 | Investigation of specific allergies | Make indication for the investigation of specific allergies (including test and specific IgE) |
| 6 | Precipitation antibodies | Interpret investigation for precipitation antibodies |
| 7 | Pulmonary function study | Give indication for pulmonary function study with diffusion capacity |
| 8 | COPD and asthma | Classify COPD and asthma with regard to function difficulties |

## Rheumatology

| 1 | Diagnostics, treatment and prognosis | Make a diagnostic with a focus on the relevant differential diagnoses and independently prescribe and interpret answers to common paraclinical studies Make a preliminary diagnosis Provide ordered treatment options and help initiate treatment Specify prognosis with focus on function level for the following modes: hip arthrosis knee cartilage palpitations shoulder disorders, including rotator cuff and periartrose neck disorders including osteoarthrosis Elbow and wrist disorders diffuse pain conditions in the musculature inflammatory arthritis Arthritis urica sarcoidosis |
| 2 | Musculoskeletal | Conduct a clinical study for strength, movement, function, and tenderness of the Neck, Back, upper and lower extremities hip arthrosis knee cartilage palpitations shoulder disorders, including rotator cuff and periartrosis neck disorders including osteoarthrosis Elbow and wrist disorders diffuse pain conditions in the musculature inflammatory arthritis Arthritis uric sarcoidosis |
| 3 | | Investigate for nervous pressure and medulla influence |
| 4 | | Distinguish between local and systemic, rheumatological disorders |

## Psychiatry

| 1 | Have knowledge of diagnostics with a focus on relevant differential diagnoses, including independently prescribe and interpret answers to common paraclinical studies. Could carry out a relevant psychiatric interview, adapted patient condition and they even circumstances so that the patient situation is being illuminated from a biomedical, Psychological and social perspective. Must have knowledge of the most important diagnostic instruments and knowledge of the content of an objective psychiatric examination and on that background Could carry out such an investigation be able to set up and revise diagnostic considerations in connection with the below diagnoses indicate parent Treatment options as well as Psychopharmacological and psychotherapeutic Treatment, as well as physical exercise and participation To initiate treatment and specify prognosis with focus on the following states: |
| 2 | Depression Anxiety Post-Traumatic Stress Disorder (PTSD) Prolonged load conditions Somatoform modes Personality Disorders |
| 3 | Have knowledge about communication principles regarding psychiatry's patient-patient relationship and ability Apply patient interviews |
| 4 | Have knowledge of the use of relevant tools and scales for assessment of the severity of the disease, e.g. Hamilton depression score. |

## Dermatology

| 1 | Have knowledge of: diagnostic investigation focusing on relevant differential diagnoses common para clinical studies overall treatment of prophylactic measures prognosis with focus on functioning for the following disorders: contact eczema urticaria The skin's benign and malignant tumors atopic skin disorders Other skin disorders that may illuminate Work-related skin disorders: eg. Seborrhoeic dermatitis, rosacea, psoriasis, dermatomycosis |
| 2 | Explain the theoretical background for Mechanisms of the occurrence of contact eczema |
| 3 | Know tools to differentiate between professional and non-business-related contact cases |
| 4 | Make indication for and interpreting patch samples |

## Neurology

| 1 | Diagnostics, treatment and prognosis | Have knowledge of diagnostic investigation focusing on relevant differential diagnoses Have knowledge of common paraclinical investigations Have knowledge of the superior treatment Knowledge of prognosis with focus on functioning for the following disorders: dementia headache peripheral neuropathies cerebrovascular diseases |
| 2 | | Perform a clinical neurological examination |
| 3 | | Make indication for and interpreting neuropsychological examination |
| 4 | | Make indication for and interpreting neurophysiological examination |
| 5 | Patientkommunication | Establish and manage calls in situations that deals with serious illnesses or crisis situations |
| 6 | | Coordinate and manage a patient meeting |

## Communication and teaching

Physicians working in the field of occupational and environmental medicine, through patient-related work, business assignments, literature studies, and research, gain significant knowledge about the environment, including the health and safety of the working environment. In order for this knowledge to be used for prevention, the specialist doctor should be able to convey it to colleagues, other professional groups, companies, and communities during teaching, meetings, and writing. The dissemination must be adapted to the target groups' academic and linguistic requirements.
After completion of specialist medical training, the specialist must be able to:
| 1 | Education | Schedule and complete teaching medical students, doctors in other specialties, and students on occupational health |
| 2 | Communication | Write articles and comments to trade magazines, staff magazines, daily press or similar in electronic media Handle inquiries from the press about occupational and environmental medicine issues |

## Clinical occupational medicine competencies – main education

| 1 | Diagnostics, etiological assessment and prognosis | Should be able to make: Diagnostic investigation and differential diagnostics in collaboration with relevant specialties Business history Exposure assessment Etiological of assessment Assessment of work ability and prognosis In the following conditions: |
| 2 | Lung Medicine and allergy: | asthma rhinitis/rhinoconjunctivitis allergic alveolitis Chronic Obstructive Lung Diseases Restrictive pulmonary disease, including Asbestos and silicosis pleural plaques Instruct and interpret Peak flow monitoring to assess working relationship |
| 3 | Neurology: | toxic encephalopathy Carpal tunnel syndrome Morbus Raynaud, Vibration including: Establish indication for and able to interpret The answer to one cold provocation study Establish indication for and able to interpret Neuropsychological examination at Investigation of toxic encephalopathy |
| 4 | Rheumatology: | Disorders of the neck-shoulder Shoulder disorders elbow and hand disorders hip and knee disorders diffuse pain conditions in musculoskeletal |
| 5 | Psychiatry: | mental stress conditions Depression and anxiety post-traumatic stress condition(PTSD) somatizing states |
| 6 | Dermatology: | mumps (irritant / allergic) urticaria |
| 7 | Other disorders: | indoor climate-related symptoms "multiple chemical sensitivity" / odor hypersensitivity cancerous diseases # infectious diseases # hearing damage # following chemical poisoning # For these modes, diagnostic is not performed but only an assessment of exposure and asessment of Work-related causation |
| 8 | Work-retaining and social medicine | Provide social medicine guidance for the patient, workplace, job center Give advice in relation to retirement, flex job, etc., cooperate with and refer to relevant public bodies |
| 9 | Assessment and advice to pregnant | Make pregnancy risk assessment for maternal injuries in the working environment |
| 10 | Health examinations according to regulations | Have knowledge of directives, announcements, etc. about night work, work with lead, etc. and handling of health surveys in this context |
| 11 | Group Study | Independent planning and implementation of group survey |
| 12 | Advice on risk reduction | Advise patients about risk factors and protective factors in work and environment, lifestyle and the interaction between these, and set options to change these |
| 13 | Initiate prevention at work | Propose relevant prevention measures for the patient Identified risk factors in working environment. Including suggesting relevant actions and guide the patient by the involvement of a safety representative, Security leader, security committee / If necessary contact the CSS in agreement with the patient. |
| 14 | Dissemination of knowledge | Communicate knowledge to both patients and relatives as well as non-medical professional instances in an easily understandable and useful manner |
| 15 | Complete certificates | Complete certificates and declarations to the Social Services, insurance companies |
| 16 | Clinical instructions | Eleborate clinical instructions |
| 17 | Project management | Have knowledge of project management, lead and organize a group-investigation or other research project |
| 18 | Ethics and confidentiality | Apply relevant administrative rules and laws in the healthcare system guidelines for clinical practice, including collection and disclosure of Information, information gathered consent, compliance with confidentiality, handling of conflicts of interest |
| 19 | Resource management | Manage your own resources and your own clinical work in relation to dissemination tasks, prevention as well research and development |
| 20 | Internationaloccupational medicine | Knowledge of international occupational medicine and developing countries including Regulation and organization of occupational health and safety conditions under different conditions and the social importance of globalization |

## Exposure description and assessment

The basis for making reason and risk assessments is a detailed knowledge of exposure in the relevant environment. The exposure description and assessment may include chemical, physical, biological, ergonomic, and psychosocial influences. Therefore, very different methods of collection and assessment of exposure information are used. The work history Is the most commonly used method of clinical work medicine to map out the effects of the working environment. The work history describes chronologically the various employment conditions, tasks, and related exposures.
| 1 | Diagnostics, etiological assessment and prognosis | Should be able to make: |
| 1 | Chemical | Gases and aerosols Dust and fibers Process assessment (chemical conversion) |
| 2 | Routes of exposure | Absorption, inhalation, oral intake passage of placenta barrier |
| 3 | Physical | The hand / arm vibration whole-body vibration Noise Temperature and draft ionizing radiation # Basic knowledge of ventilation |
| 4 | Ergonomic | Repetivity Force Posture Static load |
| 5 | Biological | Infectious microorganisms Allergens |
| 6 | Psychosocial factors | Working time Working Volume3) Qualitative requirements Influence Support Effort / reward Violence and threats Interpersonal conflicts |
| 7 | Combined | Indoor climate |
| 8 | apply methods to collect information on Influences in a work environment | Obtain and evaluate workplace instructions and Datasheets, including recipe- Information on chemical products Assess options and restrictions using Questionnaire to exposure description |
| 9 | Apply relevant databases | Medline (pubmed), Toxnet, Vibration databases, Reprotox |
| 10 | Have knowledge of and understanding of CSS work control system | Workplace Inspection, Jurisdiction and legal basis, Relevant announcements, etc. Organization of workplace inspection Workplace Inspection Practice, Supervision |
| 11 | Do company visits under supervision | Through company visits qualify exposure assessment in connection with patient investigation. |
| 12 | Local industrial working conditions | Have knowledge of working conditions within those in the current region largest industries. |

## Etiological- and Risk Assessment competencies

An assessment of the multiple etiologies is defined as an assessment of whether there is a probable correlation between the exposure and the identified disease or symptoms based on exposure and diagnosis. Risk assessment assesses the likelihood that a given exposure may result in a given health injury in the short or long term, or may affect the prognosis

## After completion of the specialist medical training, the specialist must be able to

| 1 | Diagnostics, etiological assessment and prognosis | Should be able to make: |
| 1 | Know how to use the general principles for etiological risk assessment | Assess risk objectives: Relative risk, Absolute risk, aetiological fraction Explain the fundamental mechanisms of action. Interpret and summarize results of in vitro experiments, animal experiments and human data in relation to the particular one issue Apply different acceptance criteria depending on the context, eg. for the following areas: Chemical influences Physical effects Ergonomic influences Biological influences Psychological Impact |
| 2 | Chemical Etiologicals and risk assessments | Explain fundamentally toxicology |
| 3 | Physical, risk assessment | From naturally occurring influences, eg. background radiation |
| 4 | Ergonomic etiological and risk assessment | Explain the mechanism of action, including the importance of work position, speed and power consumption at movements, and the significance of inactivity |
| 5 | Biological etiologies´ risk assessment | Know the mechanism of action incl. Infections, toxic and allergic influence Interpreting controlled biological experiments, eg. climate chamber trials |
| 6 | Psychological risk assessment | Explain the importance of known risk factors and interaction with individual resources and coping strategies |
| 7 | Cross-etiological risk assessments | Evaluate multiple effects of for example shift work Evaluate multiple influences, eg. In the indoor climate or in pregnant women |
| 8 | Individual vulnerability | Explain Individual Vulnerability: Genetics, including atopy, age, social Inequality, inactivity |
| 9 | Risk Communication | Make risk communication under different risk perceptions |
| 10 | Risk Management | Be able to make a plan for concrete risk management |

## Communication and teaching competencies

Physicians working in the field of occupational and environmental medicine, through patient-related work, business assignments, literature studies, and research, gain significant knowledge about the environment, including the health and safety of the working environment. In order for this knowledge to be used for prevention, the specialist doctor should be able to convey it to colleagues, other professional groups, companies and communities during teaching, meetings, and writing. The dissemination must be adapted to the target groups' academic and linguistic requirements.
After completion of specialist medical training, the specialist must be able to:
| 1 | Diagnostics, etiological assessment and prognosis | Should be able to make: |
| 1 | Education | Schedule and complete teaching medical students, doctors in other specialties, and students on occupational health |
| 2 | Communication | Write articles and comments to trade magazines, staff magazines, daily press or similar in electronic media Handle inquiries from the press about occupational and environmental medicine issues |