Workplace Visits Versus Case Studies in Undergraduate Occupational Medicine Teaching

A short review of undergraduate occupational medicine training

BACKGROUND

Medical schools worldwide allocate little time and utilize varying formats in the teaching of occupational medicine (OM) to undergraduate medical students.

AIMS

To identify undergraduate OM teaching formats and highlight key findings in these different methods.

METHODS

A limited literature search conducted on PubMed and Scopus identified relevant articles published in English and between the years 2009 and 2018. Our inclusion criteria were papers containing the key words ('occupational medicine' AND ('medical students' OR 'undergraduate medical')) OR ('occupational medicine' AND ('training' OR 'education' OR 'teaching')) in the title or abstract and those that specifically discussed OM education.

RESULTS

The literature search yielded 1479 papers. Seven of them fulfilled the inclusion criteria and were reviewed in full. Formats in OM education of undergraduate medical students include, either singly or in combination, the use of case studies, didactic sessions, workplace visits, text-based readings and pro forma.

CONCLUSIONS

OM education has a very small footprint in most undergraduate medical curricula. The studies show that different teaching formats are utilized, often in combination. Case-based discussions and workplace visits are frequently used with good qualitative results. Text-based readings will serve well to build good foundational knowledge, though there is no conclusive evidence that students will perform better.

Attitudes and behaviors of chiropractic interns toward occupational history taking

OBJECTIVE

This study uses a pre- and post-training program evaluation of chiropractic interns to (1) describe changes in their frequency of occupational history taking before and after a 1-hour training and (2) to document the attitudes and beliefs regarding occupational health and history taking.

METHODS

All chiropractic interns at 1 clinic location completed questionnaires assessing their attitudes and perceptions regarding documenting the occupational history of their patients each trimester they were enrolled in the study. Each intern enrolled in the study for 2 or more trimesters participated in a 1-hour-long training session on taking an occupational history. The supervising clinician independently evaluated charting behaviors of interns for the duration of the study.

RESULTS

The supervising clinician assessed 20 interns' level of documenting occupational history for 202 new patient or reexamination visits. A majority of interns (85% at baseline) were interested in occupational health, and 80% believed that occupational history taking was "very important." Intern charting behaviors increased after training related to documentation of past occupation (62.9% from 32.4%) and relating the chief complaint to work (59.7% from 30.0%). Detailed occupational history taking remained low throughout the study but demonstrated a doubling in documentation after training (16.1% from 8.6%).

CONCLUSION

Chiropractic interns and clinicians should be adequately trained in occupational health history documentation practices as they are likely to care for work-related injuries. Short training modules appear to be effective in demonstrating small changes in documentation related to occupational history taking.

Survey of the necessary competencies and proficiency of safety officers in Thailand

Competency is important for professionals' effective performance and career development. However, little is known about the necessary competencies and proficiency in these for Thai safety officers. Therefore, this study aimed to identify the necessary competencies for this group and to compare proficiency in each competency between senior and junior safety officers. A descriptive, cross-sectional study was conducted among 73 safety officers using a self-administered questionnaire. Twenty-five competencies were classified as necessary. Mean proficiency scores were higher for senior safety officers than for more junior safety officers for all examined competencies; however, this difference was not statistically significant for 'first aid' or for 'air sampling and analytical methods'. Regulatory compliance was assessed as the most important competency. Gaps between necessity and proficiency were observed in managing safety programs for the junior group. In both groups, proficiency was lowest in the competency of mental health. The results indicate that Thai safety officers' training needs may be particularly high for regulatory compliance, managing safety programs, and mental health. Lifelong learning is important for enabling occupational safety and health practitioners to fulfill current requirements in Thailand and elsewhere. Multiple training approaches and a specialist qualification program may encourage competency development, especially for junior practitioners.

A questionnaire to measure medical students' attitudes towards occupational medicine

BACKGROUND

Occupational medicine is not well represented in medical curricula. Educational programmes should aim at raising the interest of medical students in occupational medicine.

AIMS

To develop a questionnaire to measure the attitude of medical students towards occupational medicine.

METHODS

We drew up statements about attitudes. We used a 5-point Likert scale to elicit answers from second-year medical students. We analysed the questionnaires with exploratory factor analysis to find common scales. After item reduction, we used the questionnaire in third-year medical students from another medical faculty, before and after education.

RESULTS

Responses from 141 second-year and 208 third-year medical students were available. Analysis resulted in 18 statements in three scales: a career as an occupational physician, occupational medicine as an interesting speciality and role of the occupational physician. We measured modest changes following an occupational medicine programme. Further development of the questionnaire with qualitative research will lead to better usability.

CONCLUSIONS

This questionnaire can be used to measure attitude towards occupational medicine; however, this questionnaire needs to be developed further.

Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan

OBJECTIVES

The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them.

METHODS

A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occupational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the necessary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods.

RESULTS

All 61 competencies in the questionnaires were evaluated as "necessary". Some of the competencies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a "practical group", the members of which mainly provided occupational health services, an "academic group", the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies significantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-job training (OJT) for 30 items, and case-based learning (CBL) for 29 items.

CONCLUSIONS

Some competencies should be added to the JSOH list. CBL should be introduced in training programs for specialist occupational physicians.

Development and evaluation of a virtual patient-based exam in occupational medicine

Occupational medicine (OM), especially the ability to recognize potentially workplace-related diseases or accidents, is important for medical students to learn. The assessment in OM at the Ludwig-Maximilians-University is implemented as a paper-based, multiple-choice question exam that does not assess the students’ ability to remember occupational aspects in clinical contexts. Therefore, the aim of this study was to create and evaluate an online exam based on 19 virtual patients to assess the aspects of OM in an interdisciplinary setting. Thirty-nine medical students participated in the exam with an average score of 65%. The score for freetext questions assessing OM aspects was low (39%). The study showed that the implementation of an interdisciplinary VP-based exam is feasible. The integration of such an interdisciplinary exam would be feasible, for example, as an open-book assessment.

Comparison of two case-based learning conditions with real patients in teaching occupational medicine

OBJECTIVE

To investigate the impact of three different training formats in occupational medicine (OM) on perceptions and performance of undergraduate students.

METHODS

A comparative study which included all fourth-year medical students was conducted over a three-year period. The year group in 2010 (211 students) received paper case studies followed by one small group session. The format used in 2011 actively engaged 188 students in the learning process by adding collaborative work and group discussions to the written information. In 2012, the approach comprised no longer constructed text cases but 212 students encountered real patients. Students' perceptions were obtained by questionnaire. Their learning performance was assessed through review of written reports and score on oral presentations. Statistical differences in ratings were analyzed using Fisher's exact and Kruskal-Wallis tests.

RESULTS

All three formats were found to equally achieve the stated learning objectives. The year groups with incorporation of active learning strategies and patient contacts had significant better test performance compared to those receiving only written case studies. Real patient students gave statistically significant higher rates for relevance, authenticity and appropriate difficulty level of the training than did students who discussed written case studies.

CONCLUSION

Both approaches with augmented interaction in 2011 and 2012, improved performance and satisfaction among students. However, students valued the use of real patients higher than paper-form cases.

Undergraduate teaching of occupational medicine in European schools of medicine

PURPOSE

General practitioners play or should play a role in occupational medicine (OM), either in diagnosing occupational diseases or in counseling on return to work. Nevertheless, their training has been reported to be insufficient in most single country studies.

AIMS

The objectives of this study were to analyze the content and extent of undergraduate teaching of OM in European medical schools.

METHODS

An e-mail questionnaire survey of the teaching of OM to undergraduates was undertaken from December 2010 to April 2011 in all medical schools and medical faculties listed in 27 European countries (n = 305).

RESULTS

Among the 305 universities identified, 135 answered to the questionnaire, giving a response rate of 44%. The mean number of hours given to formal instruction in occupational medicine to medical undergraduates was 25.5 h. Nevertheless, this number of hours varied widely between countries, but also within countries. Overall, 27% of medical schools gave their students 10 h of teaching or less, 52% 20 h or less and 69% 30 h or less. Whereas occupational diseases and principles of prevention were covered in most schools, disability and return to work were very poorly represented among the topics that were taught to students.

CONCLUSION

Dedicated undergraduate teaching on occupational health or OM in European medical schools is present in most medical schools, usually at a low level, but is very variable between and within countries. Medical schools across Europe are very unequal to provide qualifying doctors education on the topics they will frequently come across in their working lives.

The challenge of teaching occupational medicine to medical students: the Université de Montréal experience

Nonrecognition and mismanagement of work-related diseases is often linked to inadequate medical training. However, undergraduate training in occupational medicine faces many challenges, including lack of student interest and limited curriculum time. The purpose of this article is to present an undergraduate training program developed in one medical school to ensure that all medical students acquire the basic knowledge to recognize work-related health conditions and understand the fundamental principles of workers' comprehensive care. The program involves various learning methods including case studies, small-group learning, interactive large-group teaching, field activities, and e-learning. It has resulted in improving students' attitudes and competencies in occupational medicine and requires little curriculum time.

The effectiveness of case-based learning in health professional education. A BEME systematic review: BEME Guide No. 23

BACKGROUND

Case-based learning (CBL) is a long established pedagogical method, which is defined in a number of ways depending on the discipline and type of 'case' employed. In health professional education, learning activities are commonly based on patient cases. Basic, social and clinical sciences are studied in relation to the case, are integrated with clinical presentations and conditions (including health and ill-health) and student learning is, therefore, associated with real-life situations. Although many claims are made for CBL as an effective learning and teaching method, very little evidence is quoted or generated to support these claims. We frame this review from the perspective of CBL as a type of inquiry-based learning.

AIM

To explore, analyse and synthesise the evidence relating to the effectiveness of CBL as a means of achieving defined learning outcomes in health professional prequalification training programmes.

METHOD

SELECTION CRITERIA

We focused the review on CBL for prequalification health professional programmes including medicine, dentistry, veterinary science, nursing and midwifery, social care and the allied health professions (physiotherapy, occupational therapy, etc.). Papers were required to have outcome data on effectiveness.

SEARCH STRATEGIES

The search covered the period from 1965 to week 4 September 2010 and the following databases: ASSIA, CINAHL, EMBASE, Education Research, Medline and Web of Knowledge (WoK). Two members of the topic review group (TRG) independently reviewed the 173 abstracts retrieved from Medline and compared findings. As there was good agreement on inclusion, one went onto review the WoK and ASSIA EndNote databases and the other the Embase, CINAHL and Education Research databases to decide on papers to submit for coding. Coding and data analysis: The TRG modified the standard best evidence medical education coding sheet to fit our research questions and assessed each paper for quality. After a preliminary reliability exercise, each full paper was read and graded by one reviewer with the papers scoring 3-5 (of 5) for strength of findings being read by a second reviewer. A summary of each completed coding form was entered into an Excel spread sheet. The type of data in the papers was not amenable to traditional meta-analysis because of the variability in interventions, information given, student numbers (and lack of) and timings. We, therefore, adopted a narrative synthesis method to compare, contrast, synthesise and interpret the data, working within a framework of inquiry-based learning.

RESULTS

The final number of coded papers for inclusion was 104. The TRG agreed that 23 papers would be classified as of higher quality and significance (22%). There was a wide diversity in the type, timing, number and length of exposure to cases and how cases were defined. Medicine was the most commonly included profession. Numbers of students taking part in CBL varied from below 50 to over 1000. The shortest interventions were two hours, and one case, whereas the longest was CBL through a whole year. Group sizes ranged from students working alone to over 30, with the majority between 2 and 15 students per group. The majority of studies involved single cohorts of students (61%), with 29% comparing multiple groups, 8% involving different year groups and 2% with historical controls. The outcomes evaluation was either carried out postintervention only (78 papers; 75%), preintervention and postintervention (23 papers; 22%) or during and postintervention (3 papers; <3%). Our analysis provided the basis for discussion of definitions of CBL, methods used and advocated, topics and learning outcomes and whether CBL is effective based on the evaluation data.

CONCLUSION

Overwhelmingly, students enjoy CBL and think that it enhances their learning. The empirical data taken as a whole are inconclusive as to the effects on learning compared with other types of activity. Teachers enjoy CBL, partly because it engages, and is perceived to motivate, students. CBL seems to foster learning in small groups though whether this is the case delivery or the group learning effect is unclear.