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Journal of Occupational & Environmental Medicine:
Committee Report

Occupational and Environmental Medicine Competencies-v1.0

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Preamble

Both a clinical and a population-based medical specialty, occupational and environmental medicine (OEM) is devoted to the prevention and management of occupational and environmental injury, illness, and disability, and the promotion of the health and productivity of workers, their families, and communities. Through training and experience, the OEM physician brings to employers, employees, and society specific competencies to achieve this mission. With a focus on prevention, the OEM physician intervenes to mitigate occupational and environmental risks and promote the health and safety of the individual, the workplace, and the community. When injury or illness does occur, the OEM physician restores health and productivity expeditiously, efficiently, and effectively, helping individuals achieve their maximum human potential as valued workers and citizens. All OEM physicians are first and foremost medical doctors with training in the provision of clinical care to patients. Additionally, OEM physicians have special expertise in the prevention, evaluation, and management of conditions that are either commonly or uniquely experienced by workers or persons exposed to hazardous environmental agents.

OEM comprises a spectrum of competencies ranging from those of the general practitioner to those of a highly trained specialist. Occupational and environmental physicians vary in the nature of their practices and their practice settings. While a gastroenterologist in Paris and one in Detroit may perform very similar tasks on a routine basis, the practices of two OEM physicians in Detroit may be completely different. As a result, it is not practical to define a "core" set of competencies for this field of medicine. Those competencies that are considered core for the OEM generalist who primarily manages occupational injuries and fitness for duty issues may be very different from those considered to be core for the OEM specialist who serves as a consultant on health issues of populations of workers or communities with environmental concerns. Thus the approach of the American College of Occupational and Environmental Medicine's (ACOEM's) Panel to Define the Competencies of Occupational and Environmental Medicine has been to define a more comprehensive "menu" of competencies rather than the core.

It is anticipated that no one will be expert in all of the listed competencies; each practitioner will have a unique spectrum of competencies. Generalist OEM physicians will have a strong clinical emphasis and will be familiar with issues of worker placement and accommodation. In addition to this grounding in clinical practice, specialist OEM physicians will have competencies in public health, prevention, population medicine, epidemiology, toxicology, and research methods, as well as other competencies on this list. Of note, many generalist OEM physicians may have developed a subset of the competencies that are designated as specialist level. Whether a generalist or specialist, all OEM physicians must be able to both apply the fundamental principles of prevention and public health to clinical practice, and vice versa.

Building upon a foundation of general clinical competence, OEM residency education is designed to provide an appropriate complement of additional competencies through active participation in a wide range of activities. Training is expected to have begun well before one's residency and to continue throughout one's career. OEM specialists in the United States are usually distinguished by residency training in the field and/or certification by the American Board of Preventive Medicine (ABPM). However, because the number of such physicians may be inadequate to serve the nation's need for OEM services, many generalists have acquired specific specialty level competencies in order to address specific medical concerns facing them.

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Linkage with Preventive Medicine and Medical Management

Occupational and environmental medicine, along with aerospace medicine and general preventive medicine/public health, make up the broad field of preventive medicine. Because of its traditional strong grounding in prevention, board certification in the field of OEM is provided by the ABPM. Under the direction of Drs Dorothy Lane and D.W. Chen, the American College of Preventive Medicine (ACPM) and the US Department of Health and Human Services (DHHS) Health Resources and Services Administration (HRSA) have developed competencies for preventive medicine and have also drafted an initial set of competencies for the field of managerial medicine. These two documents (see Appendix B) and the ACOEM competencies list may be seen as complementary efforts that should be cross-referenced.

Differences that should be noted are that the HRSA/ACPM efforts are directed specifically at defining the essential "core" competencies which should be taught in all preventive residency programs, as well as those for managerial medicine training programs. HRSA/ACPM and representatives of ACOEM worked collaboratively on OEM competencies for preventive medicine residents, with a goal of bridging these with the ACOEM competencies. The OEM competencies comprise a comprehensive list that expands beyond the common denominator of what should be taught in residency programs. OEM residency program directors may seek to extract from this expansive list a similar"core" training set of competencies.

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Potential Applications of This List

The purpose of this competencies list is to clarify the identity of the field of OEM in the face of a rapidly changing medical model and to enhance the understanding of what an OEM physician does and what an OEM physician has to offer society. Through further adaptation of the entire list or subsets of this list, many applications may become apparent. The competencies could be viewed as a starting point to aid the development of many possible applications, such as those that follow.

* Self-assessment

* Career planning for students, residents, fellows, and practicing physicians

* Curriculum development for residents/fellows

* Curriculum development for continuing medical education

* Curriculum development for independent learning

* Evaluation of training programs and learning progress

* Certification of competence

* Accreditation of teaching programs

* Planning of OEM services

* Marketing of OEM services and establishing realistic customer expectations

* Recruitment of physicians

* Evaluation of physician performance

* Evaluation of OEM services/quality assurance

* Linkage with other organizations' competencies, where scope of practice may overlap (eg, other countries' efforts to define OEM competencies, preventive medicine, managerial medicine)

* Public policy regarding medical services

A customized approach to selecting, weighing, and ordering subsets of the competencies may be useful in using this list for certain purposes. For some applications, it may be useful to supplement this list with specific performance measures. The competencies are behaviorally focused and adequately concise so that they can be linked to specific training activities and measurable practice outcomes.

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How This List Is Organized

Competencies are grouped by subject category, each of which has a brief commentary, followed by the competencies, and in some cases, subcompetencies of that category. Each competency is followed by a designator denoting whether the competency is characteristic of all OEM physicians (G -"generalist"), the OEM specialist (S), or among those with specific additional training (O - "other"). The "G" competencies reflect expectations of most physicians providing clinical services to occupational clients, whether residency-trained, board-certified, or trained through personal experience. The "S" category reflects the expectations of occupational medicine specialists. The "O" category reflects competencies that one could not assume to be characteristic of either group unless the physician underwent additional training beyond residency to develop this skill: for example, medical review officer (MRO) and B-Reader Certification."Generalist," "Specialist," and "Other" (GSO) designations are provided for competencies in upper case and sub-competencies in lower case. It is important to recognize that the GSO designations are not designed to draw sharp distinctions between practitioners and must only be considered general guidelines. OEM physicians do not fall neatly into these categories; rather, they comprise a broad spectrum of skill.

The following outline lists the subject categories of competencies:

* Disability Management and Work Fitness

* Public Health and Surveillance

* Hazard Recognition, Evaluation, and control

* Clinical

* General

* Cardiology

* Dermatology

* Emergency Medicine and Surgery

* Ear, Nose and Throat

* Hematology/Oncology

* Infectious Disease

* Musculoskeletal

* Neurology

* Ophthalmology

* Psychiatry

* Pulmonary

* Reproductive medicine

* Toxicology

* Regulations and Government Agencies

* Environmental Health and Risk Assessment

* Clinical Preventive Services

* Management and Administration

* Medical/Legal

* Research and Education

* Social Sciences

* Professionalism

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Disability Management and Work Fitness

The OEM physician has the clinical and administrative knowledge and skills to assist employees and employers to ensure that recovery from illness or injury is as rapid and complete as possible. With broad knowledge of the workplace, placement administrative requirements, and the legal, rehabilitative, and financial aspects of disability, the OEM physician facilitates the restoration of productivity for the injured or ill employee at the therapeutically indicated stage of recovery. The OEM physician assesses safe work capacities in order to permit work placements that safeguard employees and others.

1. Design and implement integrated systems of disability prevention and management. (S)

* Develop protocols for early identification of the disabled employee and the risk factors for delayed recovery. (s)

* Assure quality in the diagnostic process. (s)

* Design systems to identify and manage the impact of psychological conditions, substance abuse, and family stresses on the natural history of illness and injury. (s)

* Establish and apply protocols for the implementation of appropriate therapeutic plans. (s)

* Track progress against prognostic indicators. (s)

* Identify and manage delayed recovery. (s)

* Communicate recommendations for temporary (transitional work) or permanent accommodations for disabled workers. (s)

* Prescribe preventive maintenance plans for recovered employees and track compliance. (s)

2. Design protocols to evaluate employees for conditions creating an undue risk to self or others in the workplace, in compliance with the Americans with Disabilities Act (ADA). (S)

* Design plant specific programs for pre-placement and return-to-work evaluations. (s)

* Explain and make clinical decisions as well as placement/accommodation recommendations relating to the concept of "direct threat" as defined under the ADA. (s)

3. In compliance with regulations, including the ADA, conduct clinical evaluations to assess level of impairment and fitness for duty.(G)

Translate impairment assessments into safe work functional capacity statements for the use of employers in placing employees in jobs. (g)

* Express impairment in terms required by relevant legal or benefit systems. (g)

* Perform Department of Transportation (DOT) examinations. (g)

* Perform Federal Aviation Administration (FAA) examinations.(o)

Perform fitness for duty examinations and baseline clinical assessments for workers who perform heavy exertional work or work that stresses the musculoskeletal system. (g)

* Perform fitness for duty examinations and baseline clinical assessments for workers potentially exposed to chemicals on the job.(s)

* Perform fitness for duty examinations and baseline clinical assessments for hazardous waste workers. (s)

* Perform fitness for duty examinations and baseline clinical assessments for pregnant workers. (s)

* Perform fitness for duty examinations and baseline clinical assessments for persons with disabilities or medical conditions which may require special accommodations. (g)

* Perform fitness for duty evaluations for employees who have recently undergone surgery, been hospitalized, or otherwise have recovered or are recovering from a significant medical condition. (g)

* Establish physical and psychological fitness for travel, and recommend accommodations as indicated. (s)

* Perform fitness for duty examinations for employees working in any other environment or capacity. (g)

* Perform specialized evaluations to assess functional capacity.(o)

* Assess impairment ratings in accordance with the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.(o)

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Public Health and Surveillance

The OEM physician has the knowledge and skills to recognize and address conditions of public health importance with an emphasis on prevention, as well as to monitor populations for indicators of occupational/environmental health effects.

1. Develop, implement, evaluate, and refine screening programs for groups to identify risks for disease or injury and opportunities to promote wellness. (S)

* Characterize the population to identify target exposures, risk factors, and/or conditions of concern. (s)

* Assess the utility of screening tools. (s)

* Assess the screening programs using standard criteria. (s)

* Assess resources. (s)

* Create structures (clinic staffing, etc) (s)

* Report results. (s)

2. Design and implement proactive systems of care that effectively reach all members of a population, including those at high risk and those who do not normally seek care. (S)

3. Design and conduct surveillance programs in workplace and/or community settings. (S)

* Develop and implement medical surveillance programs in the workplace and/or in communities exposed to environmental contamination.(s)

* Utilize biomarkers to identify exposure, within limitations of the methodology, and interpret results in both clinical and public health contexts. (s)

* Intervene in response to positive findings when indicated, in order to measurably improve health outcomes. (s)

* Evaluate the effectiveness of surveillance and screening programs.(s)

4. Recognize and investigate potential sentinel events. (S)

5. Apply validated epidemiologic and biostatistical principles and techniques to analyze injury/illness data in a defined worker and community populations. (S)

6. Design and/or conduct an outbreak and/or cluster investigation.(S)

7. Apply individual or community-based interventions to prevent or mitigate exposure and/or resultant health effects. (S)

* Characterize the population to identify target conditions or exposures. (s)

* Prioritize areas for prevention and mitigation. (s)

* Identify efficient and effective interventions. (s)

* Develop a strategy or plan for intervention. (s)

* Implement the interventions. (s)

* Evaluate the effectiveness of prescribed interventions. (s)

8. Design and implement a medical response plan for mass casualty events in industry or in the general environment. (S)

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Hazard Recognition, Evaluation, and Control

The OEM physician has the knowledge and skills to: (1) recognize and evaluate, or assist in evaluating, potentially hazardous workplace and environmental conditions; (2) recommend or implement controls or programs to reduce such exposures; and (3) evaluate the impact of such exposures on the health of individual workers, patients, and the public. The physician collaborates with other professionals, such as industrial hygienists, safety engineers, ergonomists, and occupational health nurses, on such efforts.

1. Characterize existing and potential occupational and environmental hazards within a defined populations. (S)

* Perform a workplace walkthrough assessment of occupational health and safety concerns. (s)

* Perform an environmental site visit. (s)

2. Evaluate and interpret the results of industrial hygiene surveys.(S)

3. Evaluate the health effects of toxic chemical exposures, including mixtures. (S)

4. Interpret and apply Occupational Safety and Health Administration(OSHA) permissible exposure limits (PELs), the American Conference of Governmental Industrial hygienists (ACGIH) threshold limit values (TLVs) and biologic exposure indices (BEIs), Environmental Protection Agency standards, and other criteria in the assessment of chemical and physical hazard exposures. (S)

5. Apply ergonomic principles to optimize comfort and reduce risk at work, including evaluation and redesign of hazardous lifting jobs, repetitive motion work, and jobs with special visual demands. (S)

6. Recognize and reduce exposures to certain physical hazards.(S)

* Identify and minimize exposure to ionizing radiation (eg, radon, x-ray, radioisotopes). (s)

* Identify and minimize exposure to non-ionizing radiation (eg, ultraviolet, infrared, microwave, radiofrequency, electromagnetic).(s)

* Appropriately engage the services of a radiation protection officer and health physicist. (s)

* Prevent, diagnose, and manage health effects associated with high-altitude living and working. (s)

* Explain the hazards of barotrauma and decompression sickness.(s)

7. Explain health-related information on a material safety data sheet (MSDS) to workers and patients. (S)

8. Advise patients regarding industrial hygiene controls, such as work practices, respirator use, and engineering controls. (S)

9. Recommend and implement policies and control measures to reduce or mitigate safety and health hazards. (S)

10. Design and manage a hearing conservation program for workers exposed to loud noise. (S)

* Advise employees and employers regarding the use of hearing protection. (g)

* Design programs to comply with the OSHA noise standard. (s)

11. Recommend appropriate environmental monitoring studies. (S)

12. Describe the key elements of a good respirator program. (S)

13. Assist employees and employers with the management of the effects of shift work, jet lag, and other chronobiological stressors. (S)

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Clinical-General

The OEM physician has the clinical knowledge and skills to provide high quality, cost-effective medical care in diagnosing and treating occupational and environmental injuries and illnesses. The physician provides care with an understanding of the workplace, work exposures, and relevant statutes, such as workers' compensation. Throughout the course of care, the physician seeks to maximize the patient's functional recovery. The physician also seeks to identify and reduce workplace and environmental hazards to reduce the risk of future injury or illness to the patient.

1. Obtain brief, as well as comprehensive, patient histories, with an emphasis on occupation and exposure. (G)

2. Perform complete or focused physical examinations as indicated.(G)

3. Select appropriate diagnostic studies in the evaluation of patients.(G)

4. Identify the potential relationship between patient symptoms and occupational/environmental exposures. (G)

5. Diagnose and manage occupational/environmental illnesses and injuries with the use of consultants in related disciplines when indicated.(G)

6. Identify non-occupational/environmental factors that may contribute to occupational/environmental disease or injury. (G)

7. Refer and follow up or manage patients with serious occupational or environmental injuries and illnesses. (G)

8. Elicit patients' concerns about exposures and establish a therapeutic alliance incorporating risk communication. (S)

9. Report all findings to affected individuals and pertinent information to organizations and employers as appropriate (considering medical confidentiality issues), advocating for the health and safety of patients and employees. (G)

10. Evaluate and treat medical conditions commonly seen by a general medical practitioner. (G)

11. Apply clinical practice guidelines in one's practice of medicine.(G)

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Clinical-Cardiology

Individuals with underlying cardiac risk factors and disease may encounter special concerns in safety-sensitive jobs, while working around certain chemical agents, and in performing exertional labor. OEM physicians assist patients, employers, primary care physicians and cardiologists in the secondary and tertiary prevention of cardiac disease, as well as the accommodation of workers with cardiac concerns. The perspective of the OEM physician is particularly useful in placing workers in special assignments such as emergency response, hazardous waste, forklift, and respirator use. OEM physicians may also be the first providers to respond to a cardiac emergency such as a myocardial infarction in the workplace.

1. Recognize, evaluate, and manage the cardiac effects of chemical asphyxiants such as carbon monoxide, methylene chloride, and cyanide. (S)

2. Evaluate a person's ability to perform exertional work after a major cardiac event such as a myocardial infarction or coronary artery bypass graft surgery. (S)

3. Address employment concerns for patients with cardiac conditions such as hypertension, coronary artery disease, heart failure, arrhythmias, etc.(G)

4. Perform or arrange for cardiovascular diagnostic tests when indicated to evaluate fitness for duty. (S)

5. Identify abnormal electrocardiograms and refer for follow-up as appropriate. (G)

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Clinical-Dermatology

Occupational dermatoses are one of the leading causes of occupational disease in the United States. Dermatoses also occur as a result of exposure to hazardous compounds in the home environment. OEM physicians can provide early recognition, diagnosis, and management of these disorders and make necessary recommendations to minimize their occurrence both in the workplace and at home.

1. Differentiate occupational skin disorders by history, examination, and diagnostic evaluation. (S)

* Diagnose and determine the cause of allergic contact dermatitis (including urticaria), particularly those caused by common antigens such as latex, epoxy monomer, and nickel. (s)

* Diagnose primary irritant-induced dermatoses. (g)

* Diagnose actinic skin damage, as well as photosensitization dermatitis, including cases due to exposure to coal tar, psoralens, and polychlorinated biphenyls (PCBs). (s)

* Diagnose occupational acne, including chloracne. (s)

* Differentiate work-aggravated dermatoses. (s)

* Diagnose occupational cutaneous infections (eg, herpetic whitlows).(g)

* Identify skin neoplasias, especially as caused by coal tar, ultraviolet radiation, or ionizing radiation. (g)

* Diagnose occupational pigmentary disorders, including vitiligo.(s)

2. Manage occupational and environmental skin injuries and dermatoses.(G)

* Treat and prevent recurrence of contact dermatitis.(g)

* Treat chemical burns, including those caused by caustics, acids, and hydrofluoric acid. (g)

* Manage occupational bullae and calluses. (g)

* Manage folliculitis barbae in workers who may be required to shave.(g)

3. Identify and control occupational/environmental risk factors for the development of skin disorders. (S)

4. Use patch tests to evaluate patients with contact dermatitis and other conditions. (S)

* Interpret patch test reports obtained from a dermatologist and use as a basis for establishing the etiology and nature of contact dermatitis and other potentially atopic conditions. (s)

* Apply and interpret patch tests. (o)

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Clinical-Emergency Medicine and Surgery

The OEM physician has the knowledge and skill to provide acute medical care for a wide variety of common injuries and illnesses, as well as to stabilize and refer individuals for emergency care.

1. Establish emergency procedures and protocols for the clinical management of individuals involved in hazardous materials incidents, including substance-specific first-aid and medical management protocols.(S)

2. Define the basic procedures associated with disaster planning and the delivery of emergency medical services. (S)

3. Identify medical and surgical emergencies and manage or refer as indicated. (G)

4. Provide acute medical and surgical care in an emergency situation, including the treatment of traumatic injuries and lacerations, referring as indicated. (G)

5. Diagnose and manage the work-related implications of surgical conditions. (G)

6. Diagnose and manage injuries associated with physical hazards including: (G)

* Heat (eg, heat stress, heat stroke, heat syncope, heat exhaustion, and heat cramps). (g)

* Cold (eg, hypothermia, frostbite, chilblains, and immersion foot).(g)

* Radiation. (s)

* Lasers. (s)

* Vibration. (s)

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Clinical-Ear, Nose, and Throat

The OEM physician has the clinical knowledge and skills to identify, evaluate, diagnose, and manage the care of patients with common occupational and environmental otolaryngological conditions.

1. Diagnose and manage nasopharyngeal conditions caused or aggravated by occupational and environmental exposure, including allergies, rhinitis, pharyngitis, laryngeal polyps, and granulomata. (G)

2. Evaluate and manage a patient with hearing loss or other occupationally related otologic conditions. (S)

* Identify, clinically manage, and prevent further injury to individuals with noise-induced hearing loss. (s)

* Evaluate and manage individuals with external otitis related to, or complicated by, the use of hearing protection. (g)

3. Perform and interpret an audiogram, identify a standard threshold shift, and implement appropriate treatment and preventive interventions.(G)

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Clinical-Hematology/Oncology

Occupational and environmental exposures may have potential to cause adverse hematologic effects or may be carcinogenic. The OEM physician has the knowledge and skills to evaluate, diagnose, and prevent the hematologic and carcinogenic effects of occupational and environmental exposures.

1. Interpret hematologic laboratory studies in the context of medical surveillance and post-exposure examinations. (S)

2. Perform clinical evaluations to detect the health effects of exposure to hematologic toxins such as benzene, lead, and arsine. (S)

3. Evaluate patients, clinical data, and exposure data to render opinions regarding causation in cases of suspect occupational or environmental cancer.(S)

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Clinical-Infectious Disease

Bloodborne, waterborne, and airborne pathogens pose unique challenges for travelers and in occupational and/or environmental settings. Early recognition and preventive action by the OEM physician can minimize their spread, health effects, and recurrences.

1. Identify, manage, and prevent bloodborne, airborne, waterborne, foodborne, and fomiteborne pathogen exposure and associated illnesses. (G)

2. Identify, manage, and prevent diseases of travelers. (S)

3. Order appropriate immunizations for employees and travelers.(G)

4. Identify, manage, and prevent infestations and zoonotic conditions.(S)

5. Identify, manage, and prevent health effects associated with poor sanitation, exposure to human waste, and/or water contaminated by human pathogens. (S)

6. Identify, manage, and prevent building-related infectious diseases.(S)

7. Identify, manage, and prevent sexually transmitted infections and diseases. (G)

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Clinical-Musculoskeletal

Musculoskeletal injuries comprise a majority of the acute occupational injuries seen by the OEM physician and cause major productivity, financial, and human losses for employees and employers alike. Thorough understanding of the anatomy, physiology, and pathology of the musculoskeletal system, as well as appropriate diagnostic and management skills, are essential. OEM physicians are able to correlate clinical conditions with functional capacity in relation to activities of daily living and work. Applying the principles of epidemiology and ergonomics enables the OEM physician to facilitate the development of programs to prevent these conditions.

1. Perform focused and comprehensive musculoskeletal evaluations of the spine and extremities, including the history, physical examination, laboratory studies, and the investigation of occupational risk factors.(G)

2. Select and interpret appropriate diagnostic tests in the evaluation of patients with musculoskeletal conditions involving the spine and extremities, with particular attention to low back conditions. (G)

3. Identify, manage, and prevent acute and chronic musculoskeletal disorders and their associated disabilities, and determine when such conditions are work-related. (G)

* Diagnose, manage, and prevent spine disorders, including low back pain. (g)

* Diagnose, manage, and prevent cumulative trauma disorders, with attention to specificity of diagnosis and etiology, and both occupational and non-occupational risk factors. (g)

* Diagnose, manage, and prevent joint and extremity injuries and disorders. (g)

4. Prescribe rehabilitation services and ergonomic interventions for an injured worker. (G)

5. Refer occupational musculoskeletal conditions for appropriate surgical intervention when indicated. (G)

6. Assess and manage post-treatment, including post-operative, return-to-work for musculoskeletal injuries. (G)

7. Identify delayed recovery and manage chronic musculoskeletal pain syndromes. (G)

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Clinical-Neurology

Occupational and environmental exposures can cause acute and chronic effects on the central and peripheral nervous systems. Both occupational and non-occupational neurologic conditions may also impact an employee's ability to work. The OEM physician has the skills and knowledge to evaluate, diagnose, and prevent exposure-related neurologic conditions and to facilitate the placement of workers with neurologic disorders.

1. Perform focused neurological and mental status examinations in the evaluation of occupational/environmental injuries or illnesses.(G)

2. When indicated, select and utilize the results of neurological and mental status examination procedures or consultations in the evaluation of occupational or environmental injuries or illnesses. Such studies may include: (S)

* Magnetic resonance imaging. (s)

* Computed tomography. (s)

* Central nervous system (CNS) electrodiagnostic studies (eg, electroencephalogram, evoked potentials). (s)

* Peripheral nerve electrophysiologic studies (eg, nerve-conduction studies; electromyography). (s)

* Neuropsychological batteries. (s)

3. Manage the interface between medical care and the workplace for neurologic conditions such as seizure disorders, cerebrovascular accidents, neuromuscular disorders, and mental impairments. (G)

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Clinical-Ophthalmology

The OEM physician has the clinical and administrative knowledge and skills to: (1) evaluate and treat occupational eye injuries; (2) develop and implement vision screening and protection programs; and (3) use information from the eye examination, such as visual acuity tests, to assist in the proper placement of workers.

1. Interpret routine visual screening results in establishing fitness for duty in various occupational settings. (G)

* Screen for near, distance, and color vision. (g)

* Identify the visual requirements for various occupations (including regulatory requirements), and correlate these requirements with job tasks and job hazards in determining fitness for duty and accommodations. (s)

2. Identify the need for specialized ophthalmologic services and surveillance (eg, lasers, ethambutol use). (G)

3. Recognize and treat occupational eye diseases and injuries and refer to an ophthalmologist when appropriate. (G)

* Diagnose and manage infectious and irritative conjunctivitis.(g)

* Diagnose and treat ultraviolet photokeratitis. (g)

* Identify and remove superficial foreign bodies from the eye, with follow-up care as indicated. (g)

* Identify and treat ocular chemical exposures and burns (including alkali, acid, and hydrofluoric acid). (s)

* Use fluorescein stain to evaluate the cornea when indicated.(g)

4. Use a slit lamp to evaluate ophthalmologic conditions. (O)

5. Evaluate intraocular pressures. (O)

6. Assess the workplace for potential hazards to the eye and address issues of eye protection, including the use of safety glasses and contact lenses. (G)

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Clinical-Psychiatry

The OEM physician has the clinical and administrative knowledge and skill to: (1) recognize, evaluate, and assist in the management or triage of workers with psychological or drug-related problems presenting in the workplace; (2) arrange for, coordinate, or provide MRO services for workplace drug testing programs; (3) assist in the proper placement of workers with psychiatric or substance-related problems; and (4) identify occupational and environmental factors that may affect mental hygiene.

1. Take a psychiatric and psychosocial history and perform a mental status examination. (G)

2. Identify the troubled or psychologically impaired employee and manage or refer appropriately to community resources, including employee assistance programs. (G)

3. Identify and interpret danger signs of the violent, homicidal, or suicidal employee, manage the situation, and refer appropriately. Participate in the design of violence prevention and response programs. (G)

4. Identify and manage the impact of psychological conditions on ability to work and on the natural history of occupational and environmental illnesses and injuries. (S)

* Specify restrictions and accommodations for employees with psychiatric conditions, in compliance with the ADA. (s)

* Specify restrictions and accommodations for employees taking psychotropic medications. (s)

* Identify and treat or refer individuals with psychopathology aggravating and/or presenting as other medical conditions. (g)

5. Diagnose and manage workers who may be under the influence of psychoactive chemicals at work (eg, industrial exposure, medications, recreational drugs, alcohol). (G)

6. Design, implement, and evaluate substance abuse testing programs, performing medical review officer (MRO) functions as appropriate. (O)

* Serve as an MRO. (A listing of the specific competencies of the MRO can be obtained online from the Medical Review Officer Certification Council at http://www.mrocc.com.) (o)

7. Identify and assist in the management of psychological stressors in the workplace. (G)

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Clinical-Pulmonary

With a thorough understanding of the anatomy, physiology, and pathology of the respiratory system, the OEM physician is able to assess the causes and occupational impact of respiratory disorders and pulmonary impairment. The OEM physician applies this knowledge and clinical acumen in the context of regulations relating to respiratory protection and in the interpretation of research, including epidemiological investigations.

1. Prevent, identify, diagnose, treat and/or refer occupational/environmental lung disorders, including: (S)

* Occupational asthma and bronchoreactivity (eg, toluene diisocyanate sensitization, exposure to inhaled allergens, byssinosis, reactive airways dysfunction syndrome [RADS]). (s)

* Pneumoconioses (eg, silicosis, coal workers' pneumoconiosis, asbestosis, hard-metal disease, benign radio-opaque pneumoconiosis, chronic beryllium disease). (s)

* Irritant inhalations (eg, acids, alkalis, oxides of nitrogen, phosgene, phosphine). (s)

* Chronic obstructive pulmonary disease (COPD). (s)

* Hypersensitivity pneumonitis. (s)

2. Develop a differential diagnosis for occupational/environmental lung disorders. (S)

3. Manage work restrictions for both occupational and non-occupational lung diseases. (S)

4. Perform and interpret a spirogram according to American Thoracic Society standards. (G)

5. For the work-up of pulmonary conditions, order and interpret the appropriate diagnostic tests, including: (S)

* Pulmonary function testing. (s)

* Imaging studies (eg, chest radiographs, magnetic resonance imaging, computed tomography, plain tomography). (s)

* Peak-flow testing and post-shift spirometry in the assessment of exposure-related bronchoreactivity. (s)

* Post-bronchodilator pulmonary function testing in the assessment of bronchoreactivity. (s)

* Methacholine and specific challenge testing in the assessment of exposure-related bronchoreactivity. (s)

* Exercise disability tests in the assessment of pulmonary impairment.(s)

* Allergy testing. (s)

6. Interpret x-ray results reported by an International Labor Organization (ILO) B-Reader. (S)

7. Perform ILO B-Readings. (O)

8. Perform respirator certification examinations tailored to the anticipated workplace exposures, to the exertional demands of the job, and to the type of respiratory protection used. (G)

9. Design and oversee a medical surveillance program designed specifically to prevent occupational lung disease. (S)

10. Review, interpret, and explain the public health and clinical implications of epidemiological studies that address occupational lung hazards. (S)

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Clinical-Reproductive Medicine

The OEM physician has the clinical knowledge and skill to advise patients about reproductive risks of occupational and environmental exposures; the effects of exposure and work on fertility, pregnancy, and the fetus; and the ability of the pregnant worker to perform work. The OEM physician also advises employers about the development of policies for the placement and accommodation of pregnant employees.

1. Identify potential adverse reproductive outcomes to both men and women from chemical, biological, physical, biomechanical, and psychological exposures and provide advice to employees and employers regarding the management of such exposures. (S)

2. Advise individuals and communities about the reproductive implications of environmental exposure. (S)

3. Recommend appropriate accommodations and job placements for pregnant employees. (S)

4. Advise on corporate policies and procedures relating to the protection of fertility for both men and women and for the placement of pregnant or lactating workers. (S)

5. Identify and utilize up-to-date sources of reproductive toxicology information. (S)

6. Establish a working relationship with the employee's treating physician in the management of work-related reproductive concerns.(G)

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Clinical-Toxicology

Hazardous material exposures occur at work, at home, and in the general environment. Clinical acumen as well as knowledge of hazardous material databases equip the OEM physician to identify, manage, and prevent occupational and environmental toxicity. General principles of clinical toxicology underlie emergency, non-urgent, and target organ-specific medical management.

1. Determine the nature and extent of potential occupational and environmental chemical exposures, considering routes of exposure and routes of absorption. (S)

* Use appropriate written and computerized databases (eg, MSDSs, Registry of Toxic Effects of Chemical Substances [RTECS]) to identify the hazardous ingredients of chemical agents. (s)

* Identify the physical characteristics of hazardous agents (eg, liquid/gas/vapor/particulate). (s)

* Estimate the likely degree of absorption based upon circumstances of exposure, considering factors such as the nature of the substance, the route of exposure, concomitant exposures, and characteristics of the patient (eg, age, susceptibility factors). (s)

2. Detect, insofar as possible, preclinical or clinical effects arising from chemical exposure and implement appropriate preventive measures.(S)

* Identify, obtain, and evaluate biomarkers or other tests to assess exposure and/or health effects, including biological monitoring techniques that assay the substance, its metabolites, or other indices.(s)

* Identify clinical or biochemical evidence of target organ damage when exposure hazard is recognized. (s)

3. Evaluate, treat, and/or properly refer persons whose health may be affected by acute or chronic contact with occupational and environmental chemicals. (S)

* Recognize and institute appropriate emergency care for life-threatening respiratory, CNS, renal, cardiac, or other target organ failure, pending the identification of a specific exposure agent. (o)

* Identify the likely toxic exposure on the basis of clinical signs and symptoms. (s)

* Identify chronic health effects (eg, hepatotoxicity, asthma, central and peripheral nervous system toxicity, interstitial fibrosis) resulting from toxic exposure and obtain necessary confirmatory testing. (s)

* Manage medical care and secondary preventive measures for individuals chronically affected by toxic exposure. (s)

4. Assess clinical, worksite, and environmental data, along with literature reviews in the performance of patient evaluations. (S)

* Obtain detailed exposure information including exposure histories, MSDSs, industrial hygiene reports, and other data. (s)

* Evaluate the severity of exposure to hazardous agents, considering dose/response relationships. (s)

* Interpret exposure data in the context of the scientific literature(human and animal) and the patient's presentation. (s)

5. Understand, explain, and be able to apply toxicokinetic data(including absorption, metabolism, storage, and excretion) to clinical and employment-related decision-making. (S)

6. Determine if a person has a health condition that increases risk from the effects of exposure to chemical, physical, or biological agents.(S)

7. Distinguish health effects of exposure to chemicals from other etiologies. (S)

8. Manage an effective therapeutic alliance with the patient whose health is affected by toxic exposure or who fears that his or her health may be affected by toxic exposure. (G)

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Regulations and Government Agencies

The OEM physician complies with and has the knowledge and skills to help bring organizations into compliance with state and federal regulations relating to OEM, as well as general public health laws. The physician is further able to effectively utilize the services of government agencies to facilitate the protection of worker and public health.

1. Comply with and explain applicable regulations, as well as their interpretation and enforcement, to employers and employees. (G)

* OSHA regulations, including the General Duty Clause.(g)

* Legislation and regulations protecting the employment rights of persons with disabilities (eg, ADA). (g)

* DOT regulations, including those of Federal Highway Administration and the Federal Railroad Administration. (g)

* FAA regulations. (o)

* EPA regulations. (s)

* Family Medical Leave Act. (g)

* Other federal regulations. (s)

* State and local regulations. (g)

2. Explain the rights of an employee or citizen in requesting assistance from a government agency or in filing a complaint. (S)

3. Respond to the requirements of employee/community right-to-know regulations and advise individuals about their rights to access information.(S)

4. Understand and protect patients' legal rights to confidentiality of medical records information. (G)

5. Advise employees about the basic elements of workers' compensation(WC) law, complete the necessary forms, and file WC claims. (G)

6. Report cases of occupational injury, illness, and/or death according to existing regulations. (G)

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Environmental Health and Risk Assessment

Society has become increasingly concerned about contamination of the environment and its resultant effects on health. OEM physicians rely on the principles of environmental toxicology and risk assessment in their evaluation of the environment and the effects on individual and community health.

1. Identify sources and routes of environmental exposure and recommend methods of reducing environmental health risks. (S)

* Identify and manage population exposure to environmental toxins (eg, heavy metals, solvents, pesticides, asbestos, silica, carbon monoxide, hydrogen sulfide, dioxin, PCBs). (s)

* Identify and manage concerns about the health effects of human exposure to contaminated water, sewage, and human waste. (s)

* Explain outdoor air pollution sources and health effects. (s)

* Explain the causes, health effects, and controls for indoor air pollution, including "sick building syndrome" and "building-related illness."(s)

* Explain water pollution sources and health effects. (s)

* Explain health risks associated with exposure to hazardous waste.(s)

* Explain the risks associated with household chemicals. (s)

* Explain and control the health risks associated with exposure to radon and ultraviolet radiation. (s)

* Explain the psychological effects associated with acute or chronic exposure to actual or perceived environmental hazards. (s)

2. Perform a risk assessment. (O)

* Explain the basic methodology of risk assessment. (s)

* Identify exposure-related health hazards. (s)

* Assess dose-response relationships. (o)

* Evaluate levels of exposure. (o)

* Characterize risk. (o)

3. Communicate to target groups, including health professionals, the public, and the media, in a clear and effective manner, both orally and in writing, the levels of risk from real or potential hazards and the rationale for selected interventions. (S)

* Manage communication and reactions to a perceived or actual cluster of disease. (s)

* Manage communication and reactions to an episode of mass psychogenic illness. (s)

* Manage communication and reaction to widespread exposure or perceived exposure to toxic materials. (s)

* Explain the health impact of global environmental changes, including global warming, ozone depletion, ultraviolet radiation exposure, and persistent organic chemicals. (s)

* Manage communication with communities affected by pesticide applications, hazardous waste sites, transportation accidents, and other environmental and industrial exposures. (s)

* Explain the controversies associated with electromagnetic field exposure. (s)

4. Interpret and explain the results of environmental monitoring studies. (S)

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Clinical Preventive Services

The OEM physician has the knowledge and skills to define, develop, and administer programs to improve the health of employee and dependent populations, as well as counsel employees about their lifestyle risk factors and clinical preventive needs. The physician is able to apply a full range of primary, secondary, and tertiary preventive methods to this end.

1. Design, implement and evaluate worksite health-promotion and disease-prevention programs, incorporating DHHS and other authoritative guidelines as appropriate. (S)

2. Describe the appropriate use and limitations of health risk assessment and screening for well populations and the applications of screening, assessment, and early intervention for targeted high-risk groups. (S)

3. Interpret abnormal laboratory findings in asymptomatic workers and recommend further evaluation and/or treatment as indicated. (G)

4. Counsel employees about health risks and lifestyle. (G)

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Management and Administration

The OEM physician has the administrative and management knowledge and skills to plan, design, implement, manage, and evaluate comprehensive occupational/environmental health programs, projects, and protocols that enhance the health, safety, and productivity of workers, their families, and members of the community. The spectrum of activities may vary substantially depending upon the physician's practice setting and the characteristics of the organization(s) served.

1. Analyze the impact of managed care and other delivery/reimbursement models on the health of employee and dependent populations, provider needs and behaviors, and organizational performance.(O)

2. Design, implement, and evaluate clinical practice guidelines, quality management/quality improvement programs, utilization management, case management, and other activities to enhance an organization's performance.(S)

3. Use appropriate management principles in conflict resolution, negotiation, consensus building, problem-solving, team building, and change management. (S)

* Partner with employers, labor unions, and others in addressing the health, safety and welfare of employees, their dependents, and retirees.(s)

4. Use personnel management principles in selection, retention, promotion, motivation, appraisal, and discipline of employees, and in managing workforce diversity. (S)

5. Identify potential customers and develop a marketing plan for an occupational/environmental health program. (S)

6. Communicate technical and clinical information to professional and lay audiences. (S)

* Give presentations to employees, employers, labor unions, and others on occupational and environmental health and safety topics.(s)

7. Determine management information needs and apply medical informatics, electronic health and patient care data, management information systems, and other computer technologies to an OEM program. (S)

* Apply information systems to medical surveillance programs(eg, scheduling exams, documenting clinical data, and tracking, reporting and analyzing outcomes). (o)

* Apply information systems to track worker disability and return-to-work. (o)

* Apply information systems to manage medical and exposure records.(o)

* Apply information systems to manage revenues and expenditures, including departmental budgets, billing, and collections. (o)

* Apply information systems for scheduling of occupational and environmental health services. (o)

* Use information technology (eg, e-mail, local and wide area networks, Internet) to communicate with colleagues, clients, and others. (s)

* Use information technology to write reports (eg, word processing), as well as to manage and present data (spreadsheets, databases, presentation graphics). (s)

8. Manage data effectively. (S)

* Design a data-collection strategy. (s)

* Collect and prepare data for analysis. (s)

* Analyze data and present results in tabular, graphical, and verbal formats. (s)

9. Establish protocols to manage patient records and protect confidentiality. (G)

10. Manage professional liability risk for a health care organization.(O)

* Select and negotiate professional liability insurance coverage. (o)

* Respond to patient dissatisfaction or complaints. (g)

* Investigate allegations of malpractice. (s)

11. Implement the philosophy and concepts of continuous quality improvement and statistical process control. (O)

12. Prepare a business plan for an occupational health service, program, or project. (S)

* Define an organization's or program's vision, mission, goals, objectives, and strategies. (s)

* Perform a SWOT (strengths, weaknesses, opportunities, threats) analysis. (s)

* Prepare an operational budget for an occupational/environmental health service or program. (s)

* Define staffing and personnel requirements for an occupational/environmental health service. (s)

* Specify facilities, equipment, and supplies required by an occupational/environmental health service. (s)

* Establish a pricing structure for occupational health services, including fee-for-service and capitated arrangements.(s)

13. Comply with WC health care services rules, reimbursement, and reporting requirements. (G)

14. Develop and implement corporate health policies, procedures, protocols, and guidelines.(O)

15. Work effectively as a team member with administrators, occupational health nurses, nurse practitioners, and physician assistants, demonstrating an understanding of their roles in an occupational health service.(G)

16. Design cost-containment strategies for WC, health benefits, and disability management programs to allocate and manage clinical and financial resources. (S)

* Obtain necessary demographic and cost data. (s)

* Ensure patient/individual confidentiality in the process. (s)

17. Evaluate the effectiveness of occupational health services and risk reduction methods. (S)

* Design and implement process and outcome measures and be able to benchmark with other organizations. (s)

* Apply techniques of process improvement. (o)

* Demonstrate program cost-effectiveness. (s)

18. Participate in the development of emergency or disaster plans for the workplace and/or the community. (S)

* Applying knowledge of occupational hazards, the workplace, and community resources, work with local medical and community resources in developing an appropriate disaster response plan. (s)

* Develop emergency response plans ranging from developing patient treatment protocols for a specific chemical to evacuation and community planning for catastrophic industrial emergencies. (s)

19. Work effectively with both labor and management to maximize workplace health, safety, and productivity. (G)

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Medical/Legal

The OEM physician is a recognized expert on issues relating to the causation of occupational and environmental injuries and illnesses, as well as the ability to perform work with or without reasonable accommodations. As a result, the physician is frequently called upon to provide expert testimony, to draft reports that render an unbiased expert opinion on contested cases, and to provide peer review.

1. Perform independent medical evaluations. (S)

2. Provide expert opinions and testimony on OEM issues. (S)

3. Write medical-legal reports. (S)

4. Provide peer reviews. (S)

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Research and Education

The profession of medicine requires ongoing scholarly inquiry, lifelong learning, and the ability to teach others. The techniques and methodologies of research and education are required of a competent OEM physician in order to expand our knowledge of occupational and environmental hazards, to stay current and competent, and to communicate this knowledge in proper perspective to others.

1. Use occupational and environmental information resources to conduct a literature search or to research the health effects of a chemical substance. (S)

2. Interpret and apply the medical, toxicological, and environmental literatures. (G)

3. Design and conduct a scientific investigation. (S)

* Formulate a hypothesis. (s)

* Perform a literature review. (s)

* Select and apply research design methods. (s)

* Seek and secure human or animal subjects review panel approval when indicated. (s)

* Identify and secure necessary resources. (s)

* Collect and prepare data for analysis. (s)

* Analyze data and present results in tabular, graphical, and verbal formats. (s)

* Draw conclusions, and discuss the implications of the research findings. (s)

4. Write a report suitable for publication. (S)

5. Design a curriculum, conduct a course, and evaluate learning outcomes.(S)

6. Interpret and present technical and clinical data for a variety of audiences. (S)

* Apply principles of adult learning. (s)

* Handle oral presentations in a professional manner. (s)

* Prepare effective written reports for a variety of audiences.(s)

* Defend conclusions and recommendations, using appropriate data and logical reasoning. (s)

* Evaluate learning outcomes. (s)

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Social Sciences

Cultural, ethnic, socioeconomic, and occupational characteristics can influence a worker's definition and reaction to health, illness and injury. The OEM physician applies medical anthropologic and sociologic insights in order to communicate more effectively with patients and enhance safety, health, and productivity in the context of individual health behaviors, cultural beliefs, and social forces.

1. Identify social, cultural, and ethnic issues that relate to policies, risks, research, and interventions in occupation and environmental medicine. (S)

2. Recognize the effects of cultural, ethnic, and social factors, including health beliefs and practices, on the health and safety of workers.(G)

3. Accommodate cultural, ethnic, educational, and language variations among workers when providing information on occupational hazard prevention, disease prevention, and health promotion. (S)

4. Provide clinical care and health counseling with an awareness of how cultural and social beliefs influence patient knowledge, attitudes, and behaviors. (G)

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Professionalism

The OEM physician uniquely interacts with patients, employees, employers, labor unions, attorneys, payers, and others in the community on issues relating to workers, the workplace, and the community environment. The attitudes, behaviors and image of the OEM physician must reflect and uphold the ethics, standards, and competencies of the specialty.

1. Recognize and address ethical dilemmas in the practice of OEM, using relevant guidelines, such as the ACOEM, Association of Occupational and Environmental Clinics, International Commission on Occupational Health, and AMA codes of ethics. (G)

* Educate employers, clients, attorneys, employees, and their representatives on the ethical issues and the codes that apply to the practice of OEM. (g)

2. Apply principles of risk management to the practice of occupational and environmental medicine. (G)

* Ensure that patients clearly understand their medical conditions, their recommended and prescribed treatments, their work status(ie, restrictions and accommodations), and the urgency of any follow-up plans. (g)

* Maintain clear, concise documentation of patient and employee encounters, including telephone encounters and encounters with company representatives on patient issues. Demonstrate that assessments and plans follow logically from clinical findings. (g)

* Review all diagnostic, screening, and surveillance studies ordered in the context of the individual's medical and occupational profile, including examining data for temporal or work-group trends, and do so in a timely manner. (g)

* Maintain communication with referral physicians that is adequate to ensure follow up on important clinical findings. (g)

* Consistently use informed consent and release of information documentation when indicated and ensure patient understanding before they apply their signature. (g)

* Interact with individuals with a clear understanding of when a doctor-patient relationship exists and when it does not. (g)

* Use appropriate procedures when terminating a doctor-patient relationship with difficult, non-compliant, or otherwise incompatible patients. (g)

3. Interact with patients, employees, employers, and other clients to achieve health-related goals. (G)

4. Maintain current medical, scientific, and regulatory knowledge, recognizing one's limits and seeking additional resources as needed.(G)

5. Communicate current medical, environmental, and/or other scientific knowledge effectively to target groups, including patients, employees, employers, unions, community groups, and the media. (S)

6. Document patient encounters accurately and completely. (G)

7. Apply time-management principles. (G)

8. Develop and implement a personal lifelong learning plan. (G)

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Appendix A-Definition of the Word "Competency"

There are several relevant dictionary definitions of the word competency, including:

1. The quality or state of: (a) having requisite or adequate ability or qualities; (b) having the capacity to function or develop in a particular way; or (c) being legally qualified or adequate.1

2. (a) Sufficiency of qualification; capacity to deal adequately with a subject; suitable, fit, appropriate, proper. (b) Suitable to a person's rank or position, (c) Possession of the requisite qualifications for, or to; properly qualified.2

3. The quality of being competent, adequacy, possession of required skills, knowledge, experience, qualification or capacity for some purpose. Properly qualified. Adequate but not exceptional.3

However, for the purpose of this document, the panel defines the term competency as "possession of sufficient physical, intellectual and behavioral qualifications (ie, knowledge, skills, abilities, and attitudes) to perform a task or serve in a role which adequately accomplishes a desired outcome."

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Appendix B-Panel, Contributors, and Process

Panel members: Mark J. Upfal, Chairman; William S. Shaw,Associate Chairman; Roy L. DeHart; David C. Deubner; Susan L. Kess; Robert J. McCunney; Royce Moser, Jr; Glenn Pransky; Dennis E. Schultz; Rosemary K. Sokas; and Melissa D. Tonn.

Given the diversity of the field, there was a need for varied expertise to develop and refine this list. For this reason, the ACOEM Board of Directors established this diverse panel, bringing together national experts that represented a range of OEM expertise in areas including:

* Ambulatory clinic practice

* Specialty clinic practice

* Academia

* Industry

* Government (OSHA, Agency for Toxic Substances and Disease Registry)

* Environmental medicine

* Consultation practice

* Administration

The panel is especially grateful for the additional contributions of the following individuals who provided support, comments, and valuable insights to this project: Susan Adamowski; George Anstadt; Lisa Berry; Bernard Blais; Beverly Blaney; James Blessman; William Boucher; D. W. Chen; Mary Ann Clemens; Linda Cocchiarella; Robert Dedmon; Raymond Demers; John Dougherty; Alan Engelberg; Edward Emmett; Richard Gallagher; Robert Goldberg; J. Fred Green; Dean Grove; Tee Guidotti; Natalie Hartenbaum; Mary Jane Heaney; Don Hoops; Hazel Keimowitz; Ann Kuhnen; Dorothy Lane; Douglas Linz; Sushil Mankani; Robert McClellan; Ewan McDonald; Victoria Neale; Carol O'Neill; Kent Peterson; Sharon Popp; Robert Rhodes; Virginia Ross; Linda Roth; Michael Sauri; Maryjean Schenk; Elias Shaptini; Malcolm Sim; Craig Vitrano; Peter Wald; Paul Werner; James Wittmer; and Joyce Young.

In addition to those listed, we thank all others who may have contributed formally or informally to the success of this project, including the ACOEM Board of Directors, ACOEM Council and Committee Chairpersons, individuals affiliated with the American College of Preventive Medicine (ACPM), the US DHHS Health Resources and Services Administration (HRSA), the American Board of Preventive Medicine (ABPM), and the Accreditation Council on Graduate Medical Education, the European Association of Schools of Occupational Medicine (EASOM), and the Department of Epidemiology and Preventive Medicine at Monash University, Victoria, Australia.

The panel built upon many prior efforts and a variety of available resources, including:

* Chen DW, Lane DS, Ross V. "FINAL REPORT, Improving Training of Preventive Medicine Residents Through the Development and Evaluation of Competencies." US Department of Health and Human Services, Public Health Service, Health Resources and Services Administration in cooperation with the American College of Preventive Medicine; November 1993.

* Guidotti TL. "Learning Objectives for Training and Continuing Education in Occupational Medicine." Am J Prev Med. 1992; 8(4):249-256.

* Upfal M, Gallagher R, Roth L, Pransky G. "Educational contracting in an occupational & environmental medicine residency program," Occupational and Environmental Residency Directors' Annual Meeting, San Antonio, Texas, April 1996.

* Wayne State University/University of Massachusetts Medical Center Residency Program OEM Competencies List.

* "Training Manual for Preventive Medicine Residency Directors: Core Curriculum for OEM." American College of Preventive Medicine, 1993.

* Minutes of the ACOEM Ad Hoc Committee to Define the Competencies of Occupational Medicine, EA Shaptini, MD, Chairman.

* Recommended Core Educational Guidelines for Family Practice Residents: OCCUPATIONAL MEDICINE. Endorsed by the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and the American Occupational Medical Association; AAFP Reprint No. 266, revised 1990.

* Jensen NM, Dirkx JM. "Environmental and Occupational Medicine." A Curriculum for Internal Medicine Residency: The University of Wisconsin Program, The American College of Physicians.

* Study Guide Materials, Exam Content Outlines; The American Board of Preventive Medicine Incorporated, revised 1996.

* Requirements for Resident Training in Occupational Medicine; The Accreditation Council on Graduate Medical Education.

* DRAFT Medical Management Competencies obtained from HRSA/ACPM, January, 1997.

* DRAFT Program Requirements for Residency Education in Medical Management; The Accreditation Council on Graduate Medical Education.

* Core Curriculum in Environmental Medicine. American College of Occupational and Environmental Medicine, Chicago, IL.

* Basic Curriculum in Occupational and Environmental Medicine. American College of Occupational and Environmental Medicine, Chicago, IL.

* "An Inventory of Knowledge and Skills Relating to Disease Prevention and Health Promotion." Association of Teachers of Preventive Medicine; Washington, DC.

* The Training of Occupational Physicians," The Australasian Faculty of Occupational Medicine, The Royal Australasian College of Physicians, Sydney, Australia, December, 1995.

Once the list was initially drafted, it was widely disseminated by posting on the World Wide Web and distributed to all ACOEM committee chairmen, council chairmen, officers, and directors. This resulted in ample input from a variety of sources, which was then processed by the panel and incorporated into the current version 1.0. The entire set of competencies is currently maintained in a Microsoft Access 2.0 database in order to provide flexibility and adaptability to potential applications of this list in the future. Cited Here...

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Appendix C-Plans and Recommendations for Future Efforts

As the field of OEM undergoes evolution with the many changes in the delivery of health care to populations, it is anticipated that this document will also evolve. ACOEM seeks to maintain an open process, incorporating the insights of all interested parties, whether physician or stakeholder (eg, employee, patient, employer, client, professional organization) so that this document can be updated at least biennially. It is believed that an open process will enhance the meaningfulness, utility, and validity of this list. We envision that additional work will arise from this project to include the development of performance measures to assist the adaptation of this list to the potential purposes listed, as well as formal validation of the competencies, perhaps to include a role delineation research component.

Role delineation of OEM practice will facilitate the process of defining competencies in the future. Initially, this might involve surveys of varied stakeholders, such as OEM specialists, purchasers (including large and small employers, insurers, medical administrators), hospitals, managed care organizations, vocational rehabilitation agencies, employees, patients, and/or other primary care specialties that currently provide OEM services. In addition to such surveys, a field review of current OEM physician practice may be helpful. While progress on defining competencies should not be delayed pending the results of such survey research, the results of role delineation research will be incorporated if and when available.

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Appendix D-The American College of Occupational and Environmental Medicine (ACOEM)

ACOEM Mission Statement

ACOEM provides leadership to promote optimal health and safety of workers, workplaces and environments by educating health professionals and the public, stimulating research, enhancing quality of practice, guiding public policy, and advancing the field of occupational and environmental medicine.

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ACOEM Vision Statement

ACOEM is the preeminent organization of physicians who champion the health and safety of workers, workplaces and environments.

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Appendix E-The ACOEM Board of Directors

PRESIDENT Robert S. Rhodes, MD, Williamsville, NY;PRESIDENT-ELECT: William W. Greaves, MD, Milwaukee, Wis;1ST VICE PRESIDENT: Robert J. McCunney, MD, Cambridge, Mass;2ND VICE PRESIDENT: Robert L. Goldberg, MD, Modesto, Calif;SECRETARY: William B. Bunn III, MD, Chicago, Ill;TREASURER: Edward J. Bernacki, MD, Baltimore, Md.

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Directors-1995-1998

Ian R. Gardner, MB, Pennant Hills NSW, Australia; Dean A. Grove, MD, Naperville, Ill; Jeffrey S. Harris, MD, Mill Valley, Calif; Edward P. Horvath, Jr, MD, Cleveland, Ohio; Mark J. Upfal, MD, Detroit, Mich;PAST PRESIDENT: Kent W. Peterson, MD, Charlottesville, Va.

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Directors-1996-1999

Christopher R. Brigham, MD, Portland, Me; Kenneth H. Chase, MD, Washington, DC; Anne S. Roberts, MD, Knoxville, Tenn; Robert B. Swotinsky, MD, Sudbury, Mass; Mary Sue H. Wester, MD, Minneapolis, Minn.

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Directors-1997-2000

Cherryl J. Christensen, DO, Cincinnati, Ohio; Tee L. Guidotti, MD, Edmonton, AB, Canada; John P. Holland, MD, Olympia, Wash; William S. Shaw, MD, Denver, Colo; Melissa D. Tonn, MD, Houston, Tex.

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House of Delegates Officers

SPEAKER: Timothy J. Key. MD, Birmingham, Ala;SPEAKER-ELECT: Robert L. Levitin, MD, Phoenix, Ariz;RECORDER: Robert R. Orford, MD, Scottsdale, Ariz. William S. Shaw, MD, Denver, Colo; Melissa D. Tonn, MD, Houston, Tex.

1. Merriam-Webster's Collegiate Dictionary, 10th Edition, 1993. Cited Here...

2. Oxford English Dictionary, 2nd Edition, 1989. Cited Here...

3. Random House Dictionary of the English Language, 2nd Edition, 1987. Cited Here...

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Section Description

The American College of Occupational and Environmental Medicine Panel to Define the Competencies of Occupational and Environmental Medicine; Approved by the ACOEM Board of Directors, January 31, 1998

© Williams & Wilkins 1998. All Rights Reserved.

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