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Letter To The Editor

Students' Perception of Occupational Medicine

Franco, Giuliano MD

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Journal of Occupational & Environmental Medicine: March 1996 - Volume 38 - Issue 3 - p 240-241
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To the Editor: I have been intrigued by the paper of Graber and colleagues1 that reports the view of academic deans about environmental health curricula in US medical schools. This letter is intended to contribute to the debate about the current low profile of environmental and occupational medicine in medical schools by presenting some recent observations from amongst medical students in Italy.

Until 6 years ago, the course of Occupational Medicine (OM) was not compulsory for medical students. In the past, no more than 5% of students had an elective course in OM, and their attendance at the course was primarily because of personal interest in the discipline. The recent introduction of OM in the curriculum as a mandatory course might have caused uncertainty amongst the students as to the clear and correct identification of the discipline and its role in the formation of the profession.2

This consideration led me to carry out a survey to investigate students' perception of the discipline in the Medical School of the University of Modena in the academic year 1994-1995. Fifty-eight students (out of 76) in the fifth year were administered a 19-item questionnaire, before and after the course, with the aim of evaluating their perception of OM. The questionnaire was built with the purpose of exploring a number of aspects, including: (1) awareness of the relationship between work, environment, and health, and their importance in contributing to the formation of doctors, (2) knowledge about the role of the OM specialist, (3) opinion about the cultural and professional links with other disciplines and professionals. Detailed results have been submitted for publication in La Medicina del Lavoro and are currently in press.3

The already-quoted paper by Graber reports the US deans do not consider the development of knowledge about the relationship between environment and work, and health, a critical competency. It seems amazing that deans do not appreciate the desirability of collecting the occupational history. This fact expresses the low attention currently paid to environmental health topics, even though a high percentage of deans suggests that these topics should be more emphasized if the curriculum were less crowded. On the contrary, Italian medical students consider the subject worthwhile in the formation of the general practitioner. This observation agrees with the report by Graber that students in the United States support increased emphasis on environmental health.

Italian students correctly indicate the primary functions of the occupational medicine physician, which were better evidenced after the course had been attended. Before the course, OM specialists were considered to bear primarily a preventive (84%) and an educational function (86%), whereas fewer than half of the students indicated the diagnostic function. These percentages increased after the course, respectively, to 100%, 95%, and 90%. In addition, the function of organization was indicated by 68% of the students.

Before the course, only 14% of the students believed that OM had no professional links with other disciplines, whereas after the course, this percentage grew to 82%. Students emphasized the cultural and professional links of the discipline with epidemiology (from 41 to 82%), statistics (from < 5 to 54%), internal medicine and pulmonology (from 13 to 52%), and oncology (from < 5 to 45%). Furthermore, other disciplines were quoted (including work organization and chemistry), testifying to students' attitudes toward OM inter-disciplinarity.

Students share deans' opinions that non-patient-related environmental activities are less important than competence and abilities in patient-related activities. But students suggest that more emphasis should be given to occupational medicine, even though the curriculum is overcrowded. However, they suggested the need to focus better on the objectives of the different courses to avoid overlapping of subjects, whose relevance should be selected according to the criteria of prevalence, urgency and seriousness, need of intervention, and pedagogical exemplarity. This is exactly our concern.

Giuliano Franco, MD

Chair of Occupational Medicine; University of Modena; 41100 Modena, Italy


1. Graber DR, Musham C, Bellack JP, Holmes D. Environmental health in medical school curricula: view of academic deans. J Occup Environ Med. 1995;37:807-811.
2. Franco G. The present state of occupational and environmental medicine in Italy. Int Arch Occup Environ Health. 1995, in press.
3. Franco G, Bisio S, Minisci E. Percezione della disciplina "Medicina del Lavoro" da parte degli studenti del Corso di Laurea in Medicina dell'Università di Modena prima e dopo la frequenza del corso nell'anno accademico 1994-95. Med Lav., in press.

Section Description

Readers are invited to submit letters for publication in this department. Submit them to: The Editor, Journal of Occupational and Environmental Medicine, PO Box 370, Bryn Mawr, PA 19010. Letters should be typewritten and double spaced and should be designated “For Publication.”

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