Topic 8: Healthcare: Physician education
The scope of this chapter is physician educationrelated to the prevention, diagnosis and management of occupational disease. Training may include undergraduate medical education, postgraduate education and continuing education.
Physician education is a lifelong activity. Physicians are initially trained in medical school to obtain their MD degrees. They then pursue further training to become family physicians/primary care physicians or specialty training to become specialists. Physicians have requirements for continuing education from regulatory/licensing bodies.
Basic MD programs are offered by faculties of medicine. The Medical Council of Canada sets out competencies for the students. There is a section on work-related health issues in the MCC requirements. Medical schools are accredited by the Committee on the Accreditation of Canadian MD programs.
Postgraduate training (residency) programs are run by medical schools. Competencies for trainees are set by the College of Family Physicians of Canada and for specialist trainees by the Royal College of Physicians and Surgeons of Canada. The competencies relevant to occupational health will vary by specialty.
Education is a life-long activity with requirements for ongoing education for continued licensure. Continuing education activities may be run by a variety of organizations. Continuing education programs can be accredited for maintenance of competence recognition for family physicians or specialists through an accreditation process approved by the respective College.
Occupational health in medical schools
The need for improved medical student training in occupational health has been recognized in Ontario, Canada, for many years. In 1994, the Ontario Medical Association Section of Occupational and Environmental Medicine gathered together a number of groups with an interest in clinical issues related to workplace health, including government, universities, hospitals, research organizations and organized labour and a needs assessment was conducted demonstrating gaps in occupational health knowledge, skills and training. A steering committee with representation from various stakeholders, including academia, workers’ compensation board, organized labour, management, and the insurance industry, was formed and advocated for improved education for medical students. In the late 1990s, the WSIB undertook a survey of occupational health content in the medical school curricula of the then-five medical schools in Ontario. This led to the creation of the Workplace Health Champions Program (WHCP) in 1999.
The WHCP was designed to support Ontario medical schools’ work in occupational health. The program supports the development and implementation of a workplace health curriculum through a Workplace Health Champion. Each year, each of the six medical schools reports on their activities in occupational health.
Undergraduate medical education
Through the Workplace Champions reporting, we know that each medical school offers an undergraduate curriculum related to occupational health.
Postgraduate training in family and community medicine.
The Workplace Champions Program is facilitating increasing activity in family and community medicine training.
There are currently three universities in Canada that provide specialty training in Occupational Medicine: the University of Toronto, The University of Alberta and the University of Montreal. These programs generally admit one resident per year.
Other relevant specialties
Other specialties may include training objectives related to work-related disease relevant to the specialty. For example, dermatology, allergy and clinical immunology and respirology trainees may rotate through the occupational medicine clinic at St. Michael’s Hospital. While primarily trainees from the University of Toronto programs, some trainees from other Ontario universities have done electives in the clinic. Training programs may also have academic sessions on the relevant occupational diseases.
Continuing education (CE)
Continuing education is offered through several routes. Education focused on occupational medicine includes St. Michael’s Hospital occupational medicine rounds. The Ontario Medical Association Section on Occupational and Environmental Health holds an annual day in occupational medicine for physicians in Ontario. There have been other continuing education activities, such as Project ECHO. Many of the participants in these educational activities already have an interest and practice in occupational medicine.
Consultation and Review Summary
The Occupational Medicine program is currently conducting a review of the literature related to teaching at the undergraduate and postgraduate level.
Reports and reviews
There are no reports related directly to healthcare activities related to the occupational health and safety system. While a number of reports on other topics make recommendations related to better physician education on occupational topics and capture of occupational information in the (electronic) medical record, they have not studied these issues nor have expertise in them.
Stakeholder focus Groups
- Need for improved healthcare provider (HCP) education.
- Build awareness of the link between work and health.
- Provide patient/worker-specific exposure information (passport).
- Provide diagnostic trees/supports — what tests to order when.
- Clarify reporting obligations.
- Strengthen capture and coding in EMR.
Summary review findings
- National organizations set competencies and knowledge expectations for undergraduate and postgraduate medical education. The requirements for occupational health knowledge and competencies will vary depending on the level of training and the specialty.
- A review of the literature on undergraduate medical training was undertaken several years ago and is currently being updated to include undergraduate, postgraduate (residency) and continuing education.
- Details of undergraduate occupational health training in the undergraduate programs in Ontario medical schools are contained in the WSIB Workplace Champions program summary. Additional information about some activities in postgraduate programs, such as Family Medicine, is also reported.
- While we know what happens in more didactic portions of the training programs, we don’t know how occupational health is taught or emphasized in the clinical training setting. As physician learning will be influenced by their clinical training, this is important to understand.
- Uptake of CE related to occupational health appears to be limited outside the circle of those working in occupational health.
- All physicians are aware that work is a determinant of health as relevant to their scope of practice.
- Physicians have the knowledge, skills, and tools to appropriately diagnose, treat, and help prevent illnesses related to exposure in the workplace (relative to their specialty).
- Physicians understand and can navigate the OHS system as appropriate for their specialty.
Short term recommendations
8.1 Expand Workplace Champions Program to primary care training and look for ways to evaluate activity using information from literature review of medical education.
- Workplace Champions program expand to include postgraduate training in family medicine.
- Once literature review is completed, champions program and champions consider curricula design changes to include methods that were found to be effective.
8.2 Review relevant specialty training for occupational disease content and grow if possible. Start with respirology (aligned with other activities in this review).
- Through specialist network (Topic 6), engage with relevant specialties starting with respirology, to review training and identify key respirology OD clinicians at each medical school offering respirology training.
- Identify ways to enhance training and utilize technology to provide trainees with exposure to occupational respirology experts.
- Offer tailored rotations at the provincial academic OD hub for those who wish to further develop their occupational respirology knowledge and mentor for involvement in the network.
8.3 Advance continuing education offerings
- Gather information through a variety of methods and through primary care incubators about what is needed and how to provide continuing education for primary care. Identify primary care champions to help develop CE programs for primary care.
- Through specialty network, establish needs of respirologists for continuing education.
- For those working in occupational medicine in the community (company based, etc.), do needs assessment specific to OD.
- Work to develop evaluation methods.
Longer term recommendations
8.4 Based on learning from work above, expand to other specialties/specialists
- Refine medical school and family physician training.
- Extend specialist approach, with learnings from respirology to other specialties (for example Dermatology).
- Develop a CE program for primary care led by primary care providers.
- Develop a CE program for occupational medicine practitioners in the community.