1. Distributed Learning in Occupational
Medicine for Family Physicians
Joel Andersen, Jeremy Beach,
Nicola Cherry
Northern Ontario School of Medicine
University of Alberta
2. Dr Joel Andersen
Curriculum Vita
• Family Physician 1976- Present
• Certification in Occupational Medicine from the Canadian Board of
Occupational Medicine, since 1995.
• Certified by the American Board of Independent Medical Examiners, since
1999.
• Expert witness status in Occupational Medicine Legal Proceedings
involving insurance companies, corporations, unions, and the legal
profession.
• Medical Director for a number of Corporations, handling Occupational
Health and Safety and accommodation/disability management Issues.
• Assistant professor in the Division of Clinical Sciences, Northern Ontario
School of Medicine
• Adjunct professor in the School of Public Health, Lakehead University.
• Research coordinator for the Family Medicine Program at the Northern
Ontario School of Medicine.
• Committee chairman of the Special Interest Focused Practice in
Occupational Medicine of the Canadian College of Family Practice.
4. Disclosure of Commercial
Support
Slide 2
• This program has received no financial support in the
form of an educational grant or otherwise.
• This program has received not received in-kind
support from any organization.
• Potential for conflict(s) of interest:
Dr. Joel Andersen has received no
payment/funding, from any organization
supporting this program AND/OR organization
whose product(s) are being discussed in this
program .
5. Mitigating Potential Bias
Slide 3
• There has been no requirement for
mitigation of bias in this
presentation.
6. TALK OUTLINE
The Problem
1. Addressing the identified lack of training amongst GP’s
in handling occupational medicine issues.
2. Providing Occ. Med. Training to Practicing Physicians
Distributed over a large Geographic Area without
disrupting practice.
The Solution
1. Develop a training program with a proven track record
to answer the needs identified for practicing physicians
in remote areas
2. Provide ongoing medical education, certification
3. Provide a peer group to access expertise in handling
occupational health problems going forward.
Ensure Future Sustainability of this program
7. The Problem
Addressing the identified lack of
training amongst GP’s in handling
occupational medicine issues
Very sparse undergraduate,
postgraduate and in practice
occupational health education
opportunities
.
8. The Problem
Addressing the identified lack of
training amongst GP’s in handling
occupational medicine issues
Undergraduate Teaching in Occ Med at NOSM
• Occupational Health & Safety lecture given in the
first week, outlining the hazards of medical
practice
• Occupational health embedded in the
population health stream, and, any teaching is
done in an integrated fashion
I.E incorporating occupational asthma in the
respiratory clinical sessions there is little opportunity
for practical occupational medicine teaching, such as
handling Workmen's Compensation issues in writing
proper return to work note, and learning the role of
the family Dr. in disability management.
9. The Problem
Addressing the identified lack of
training amongst GP’s in handling
occupational medicine issues
Postgraduate Occ Med Opportunities at NOSM
• The only formal training is a one-day session,
about two weeks before the family practice
residents graduate, where issues of handling
Workmen's Compensation and disability
management return to work are covered. This
also talks about writing adequate return to work
notes.
• In practice exposure to family medicine occ med
problems [often sub optimally managed by the
faculty GP]
10. The Problem
Addressing the identified lack of
training amongst GP’s in handling
occupational medicine issues
Occ med Training opportunities for Practicing
physicians
• most physicians realize they need extra training in
occupational medicine at 5 to 10 years in practice. I have
had many calls from physicians asking for postgraduate
educational opportunities and there are few.
• We have some CME events, there is the occupational
environment medical Association of Canada, the American
College of occupational medicine, the Canadian board of
occupational medicine, masks of science degree in
occupational medicine at McGill and,
• the newly formed foundation course in
occupational medicine, which is the focus of today's
presentation.
11. 1. The Problem
Providing Occ. Med. Training to
Practicing Physicians Distributed
over a large Geographic Area
without disrupting practice.
15. Requirements for Distributed
Community
Engaged Learning at NOSM
• widely distributed human and
instructional resources
• Occurs independent of time and place
• community partner locations
distributed across Northern Ontario
over 90 different sites
16. Curriculum Innovations at
NOSM
• case based learning
• learning in context
• longitudinal integrated curricula
• community engaged education
• distributed learning
• rural based education
• integrated clinical learning
17. So what is The Solution
To provide ongoing medical education,
certification [in occ med] to practicing
physicians over a wide geographical area
with no interruption of practice life.
To develop a training program with a
proven track record to answer the needs
identified for practicing physicians in
remote areas
Provide a peer group to access expertise
in handling occupational health problems
going forward
18. What is the Foundation Course?
• Training in occupational medicine for
Community Based Physicians
Part A: For physicians seeing work-related
cases/common occupational medicine
problems in their office.
Part B: For physicians who have completed
Part A and wish to expand their training
around providing occupational medical
services into industry.
19. Background/history
• Limited undergraduate and post graduate
occupational medicine curriculum content
available most (all?) medical schools and family
medicine residency programs, leaving most family
physicians recognizing their need for enhanced
training.
• It is recognized that Family physicians (should)
play a key part in recognizing and managing
work-related disease.
• Distance learning courses in OM have been key to
increasing competence elsewhere. (UK Model)
20. Progress to date
• Part A of the Occ Med Foundation Course
now running in 4 Provinces in Canada
• Total of 120 students in (or completed) Part A
• Pilot Part B currently running with 15 students
in Alberta.
• Set-up funding from the Imperial Oil
Foundation
• Self-funding going forward.
21. Objectives (Part A)
• Overall
– To provide knowledge and skills in the areas of
occupational medicine encountered in family
medicine
– To continue to enhance the content using
feedback/CQI tools ongoing
– Ensure that detailed objectives are outlined and
met for each module/component
22. How is the content delivered
8 modules – Sent at the start of each month
• Module 1 The Framework-Occupational Health- Provincial/ National
• Module 2 Occupational Disease: DECM 1
• Module 3 Occupational Disease: DECM 2
• Face-to-face seminar Recognizing and Managing Occupational Illness
• Module 4 Assessing Fitness for Work
• Module 5 Return to Work Planning
• Module 6 Mental Health and Work
• Face-to-face seminar Fitness for Work and Disability
• Module 7 Communication and Advocacy
• Module 8 Occupational Health for the Physician’s Office
23. How is the content delivered
• Each monthly module is comprised of:
– Text
– Boxes
– Illustrative cases
– In-text questions
– Case for monthly seminar – ‘yellow pages’
• Participants have 4 weeks to work on the module
• Estimate takes approximately 10 hours ( a full day)
to complete each module assignment
24. The role of the tutor
• In each Province at least one family medicine
and at least one occupational medicine tutor
are identified (volunteer) to lead the course.
• The mandate is to encourage and support
student-centered learning through monthly
tutorials and face-to-face workshops/seminars
25. Monthly tutorial/teleconference
• Review case and ITQs – 2 hours
– Some attend in person, some via teleconference
– Joint discussion leaders – tutor notes
– Need to include all – can be a challenge
– NOT didactic – participants often learn most from
sharing own experiences
• ‘Flipped classroom’ model
In flip teaching, the students first study the topic by themselves, typically using on line
video or module based lessons prepared by the teacher or third parties. In class students
apply the knowledge by solving problems and doing practical work. The teacher tutors the
students when they become stuck, rather than imparting the initial lesson in person.
26. Example of part of an ITQ
• List below at least three circumstances in
which you, as a family physician, might find
yourself assessing the fitness for work of one
of your patients.
27. Example of an Illustrative Case
• A colleague in your primary care network, knowing of your interest
in occupational health, comes to see you to ask for advice.
• He is intending to start performing minor dermatological
procedures in his clinic including some skin biopsies and excisions.
In order to preserve the specimens for pathology they are put
straight into containers containing formalin. A stock saturated
solution of formaldehyde is diluted with distilled water to produce
10% formalin.
• He plans that the nurse assistant helping him will do this task on the
day before he carries out the procedures so that specimen
containers are ready for use.
• What issues would you advise him to consider before doing this?
28. Face to face all day seminars
• Expected all participants attend in person – no
teleconference option
• One seminar scheduled after first 3 modules
• Second seminar scheduled close to end of the
course
• Each face to face has a different emphasis:
– First Seminar - Recognition, reporting, prevention
– Second Seminar - Fitness for work, compensation
• Each participant prepares a case for presentation
on a topic aligned with the theme for the day
29. On the day
• Welcome
• Review of modules to date
• Illustrative cases with tutors
• Participants cases
– 5+10 minute format
– No need for handout /powerpoint
• Quest Speaker Presentation
– Director of provincial OHS prevention services
– Medical Director of Provincial compensation board
30. Other components
• Feedback from participants via ‘survey
monkey’
– After each module and tutorial/teleconference
– After all day seminar
– Overall evaluation at end of course
• Informal feedback sought during
tutorial/teleconference and face to face
seminars
• Value of networking created.
31. Challenges in delivery
• Continual need to ensure high quality of product:
– Ensure meets learning needs of physicians
– Conforms to requirements of College of Family
Physicians
– Relevant to workers, employers, society
– Continuing evolution – updating and improvement
• Problem of balancing ability of local centres to
adapt with need for standardization
32. Meeting these challenges
• Ongoing review – feedback from participants,
local centre tutors,
• Keeping core of module same in each province
but with local adaptation
• Training for local centre tutors
– Participating in Alberta tutorial/teleconferences and
all day seminars
• Use of tutor notes for tutorial/teleconferences
and face to face all day seminars
• Annual tutor meetings from 2015
33. College of Family Physicians of Canada
Special Interest/Focused Practice Group in
Occupational Medicine.
Chair: Joel Andersen
Provision for PGY3 in family medicine with focus
on occupational medicine.
Provision of educational opportunities in
occupational medicine for medical students
and practicing physicians
34. The vision going forward
More knowledgeable family physicians
Fewer sick workers
Fewer sick days
More relevant WCB claims.
Improved communication:
patients/employers/ other specialists
