The document discusses the development of a common training module for medical examiners of seafarers. It proposes establishing an international system for training, approving, and ensuring quality of medical examiners. This would help harmonize differing national standards. The initiative involves maritime authorities from several countries collaborating to develop a draft curriculum based on Norway's experience training "petroleum doctors". The goal is a common international approach and medical certificate accepted by all parties involved in seafarer medical examinations.

1. Department of Occupational Medicine

2. Development of a common training module for medical examiners
Alf Magne Horneland
Director NCMM
Head Appelate Body NMA
President IMHA

3. Department of Occupational Medicine
Common denominator – separation factor
•What seafaring countries have in common
–Seafarers are an international workforce
–The international character of shipping
–The International conventions form IMO and ILO
–The Guidelines on the medical examination of seafarers
•What seafaring countries do not have in common
–National flags and maritime administrations
–National medical standards and certificates
–National systems for approval of doctors
–National quality assurance systems of approved doctors
•Why do we not join efforts and establish an international system, acceptable to all parties?

4. Department of Occupational Medicine
The needs – the vision
•It would be easier with an international system for
–Medical standards
–Medical certificates
–Competence requirements for approved doctors
–Training and refresher training of doctors
–Quality assurance and audit systems for doctors
•The vision:
–A common system for training, refresher training, approval, quality systems and audits for approved doctors
–A common, international medical certificate, based on common international medical standards

5. Department of Occupational Medicine
The idea
•Starting with a few countries with similar approaches
•Spread the idea to other countries
•Get the item on the agenda of the IMO and ILO
•Support and facilitate the process towards a common international approach

6. Department of Occupational Medicine
Experience from Norway
•2010:
–New regulations on medical standards for offshore workers
–Approval of “petroleum doctors” introduced
–Transitional period until 31st December 2013
•2013
–NCMM trained > 1000 petroleum doctors in Norway
•2014
–NCMM held the first petroleum doctor course in English abroad (Germany)
–New regulations on medical standards for seafarers
•Requirement for a basic training course and a refresher course

7. Department of Occupational Medicine
Authority of NMA Approved Seafarer’s Doctors
Changes
•Increased authority and responsibility of the ASDs
•Require evidence based safety risk assessment in accordance with best medical practice
•Legal obligation to justify decisions
•Public Administration Act
Challenges
•How to harmonize judgement?
•How to ensure equality and fair decisions?
•How to assure quality and competence of ASDs?

8. Department of Occupational Medicine
The initiative
•An initiative towards the maritime administrations of UK, NL, D was taken. DK joined later on. Several other countries has showed their interest
•Based on the experience from the Norwegian petroleum doctor course a draft curriculum was developed, for consideration by the cooperative partners
•May 2014:
–Curriculum accepted by the partners as a definition of desired competence.
–The different countries will have different approaches to ensure that the approved doctors get the desired competence

9. Department of Occupational Medicine
Harmonization of decisions
•Interpretation of medical standards, regulations and standards differ quite a lot
•How to harmonize judgments?
–E-learning?
–Textbooks?
–Handbooks?
–Taught courses?
–Decision trees and flow charts?
•We chose a combination.

10. Department of Occupational Medicine
The Norwegian model course
First Phase: Distant learning – estimated 12 hours
Textbook, Handbook, Compendium,
Pre-test: Assessment of clinical cases to be submitted, and multiple choice test to be passed
Second Phase: Taught Course – 18 hours
Lectures
Clinical case discussions
Final course test: Multiple choice

11. Department of Occupational Medicine
Learning outcomes – “be able to”
a. conduct medical examinations of seafarers in accordance with laws, regulations and guidelines, regarding such examinations on behalf of the British, Dutch, German and Norwegian flags.
b. conduct the medical examination in accordance with statutory requirements, medical best practice, and proper case consideration obtaining additional specialist advice and investigation where appropriate.
c. assess the safety risk which relates to the seafarer’s medical condition in general, to his or her regular and emergency duties, within a time perspective corresponding to the validity period of the medical certificate.
d. personalise the safety risk assessment relating to individual workers with medical conditions, and the consequences this may have for the individual him/herself, the safe operation of the ship and to other crew members.
e. assist the seafarer in cases of complaints and applications for exemption, and prepare a proper case for the appellate bodies

12. Department of Occupational Medicine
Learning outcomes – “understand”
a. the limitations and challenges regarding medical treatment of ill and injured seafarers whilst at sea including knowledge of available medical resources on board and the possibilities for evacuation
b. the characteristics of working places on board ships, and the different physical and mental demands which relate to different types of work on board ships
c. the different roles of doctors in different positions, and be aware of his/her own role whilst conducting medical examination of seafarers
d. the consequences of a declaration of unfitness for the individual.

13. Department of Occupational Medicine
NO
TOPIC
Taught course (hours)
Distance learning (hours)
1
The Shipping Industry and working at sea
1
1
2
Medical treatment possibilities at sea
1
3
Guidelines for the medical examination of seafarers
1
1
4
National regulations and procedures for the conduct of medical examinations of seafarers - specific to each country
1
5
Introduction to Medical selection
1
6
Risk assessment in medical selection
1
7
Vision and eye disorders
1
8
Hearing and ear disorders
1
9
Clinical case discussion: Diabetes Mellitus and other endocrine disorders
1
10
Clinical case discussion: Loss of consciousness, epilepsy, altered awareness and sleep disorders
1
11
Clinical case discussion: Degenerative neurological conditions
1
12
Clinical case discussion: Alcohol and drug abuse
1
13
Clinical case discussion: Psychological demands, psychological conditions
2
1
14
Clinical case discussion: Cardiovascular disease
2
1
15
Clinical case discussion: Respiratory disease
1
16
Clinical case discussion: Gastrointestinal disease
1
17
Malignancies
0.5
18
Physical demands and physical testing. Musculoskeletal diseases
1
19
Clinical case discussion: Obesity
1
20
Genito urinary medicine
1
21
Infectious diseases and vaccinations
1
22
Oral health and dental inspections
0.5
23
Case discussion: Medication
1
24
Allergies
0.5
25
Blood disorders
0.5
26
General questions and answers
1
27
Course evaluation
28
Examination
1
TOTAL HOURS
18
12

14. Department of Occupational Medicine
Compulsory Course for Medical Examiners – Germany – the Netherlands – Norway – UK
Lesson No
Topic
Instructor/Responsible
Time and Lecture type
1
The shipping industry and working at sea
1hour pre course study
1 hour lecture
Learning outcome
Teaching method
Method and criteria to evaluate competence
Understand the international nature of the shipping industry.
Understand the working environment on board ship and the demands it places on seafarers
Self directed learning
Participation in case discussions
Multiple choice pre course test and final test
Lesson Content
Remarks / literature
The shipping industry in general, especially its international nature
Safety and regulations
Ownership and responsibilities
Insurers’ role
Trade routes
Different cargo – different challenges
Working places on board ships and job demands
Psychosocial challenges for seafarers
The cultural diversity
The 24 hour society
Isolation and loneliness
www.marisec.org
Textbook of Maritime Medicine, Chapter 3

15. Department of Occupational Medicine
Course schedule
Petrolum doctors basic course
Petroleum doctors refresher course
NMA ASD basic course
NMA ASD refresher course
Basic Maritime Medicine
16-17 September 2014
NORWEGIAN
1-2 October 2014 ENGLISH
10-11 November 2014 NORWEGIAN
5-9 January 2015
NORWEGIAN
3-4 Feb 2015
NORWEGIAN
3-4 March 2015 ENGLISH
1-5 June 2015
NORWEGIAN

16. Department of Occupational Medicine
Audience Response Technology
•Our experience
–Effective tool in the process of harmonization
–Used in clinical case discussions
–Changes towards more similar decisions during a two-days course

17. Department of Occupational Medicine
Further steps
•Include more countries in the cooperation
•Revision based on experience in the pilot phase
•Development of refresher courses
•Can we reach international consensus?
–Assistance from the UN Agencies?

18. Department of Occupational Medicine

19. Department of Occupational Medicine