American College of Occupational and Environmental Medicine's Occupational and Environmental Medicine Competencies—2014

In 1998, the American College of Occupational and Environmental Medicine (ACOEM) recognized the need for defining important competencies for occupational and environmental medicine (OEM) physicians and published its original set of OEM Competencies,1 which were updated in 2008.2 The evolving US health care system, along with recently published research on how OEM physicians actually practice medicine,3–8 the increasing globalization of the workplace, and changes in the way US medical residency programs define clinical competency,9–15 all contributed to the need for a fresh look at OEM Competencies, presented in this revised document. Occupational and environmental medicine focuses on the interactions between work and health, and physicians who practice OEM need to understand how to prevent, evaluate, and manage adverse health effects from work and environmental hazards. This is the traditional view of OEM as “industrial medicine.” Increasingly, however, OEM physicians have become the leading experts on mitigating the impact of health conditions on work. In practice, this includes managing employee absences, evaluating work capacity, preventing work disability, assessing fitness for work, advising on appropriate work restrictions, and implementing employee wellness programs. The preventive medicine foundation of occupational medicine impacts all the different practice areas of OEM, whether it involves preventing illness related to a hazardous exposure, treating injury due to an employee health condition, or addressing unnecessary work disability after an occupational injury. The OEM physicians are required to effectively interact with a wide range of other professionals and provide guidance not only to patients but also to other clinicians and occupational health nurses, employers, safety and industrial hygiene professionals, human resource managers, attorneys, labor unions, and public health care professionals. In these interactions, OEM physicians should follow a strict code of ethics related to matters of confidentiality and potential conflicts of interest. Detailed guidance in this area is provided in ACOEM Code of Ethics.16 Effective communication in OEM includes risk communication, patient education, workforce education, development of policy and guidance documents, and medical/legal document preparation. Physicians practicing OEM typically have a much more diverse background than those practicing in most other areas of medicine. The paths toward board certification in occupational medicine are via the American Board of Preventive Medicine or the American Osteopathic Board of Preventive Medicine. Nevertheless, most physicians engaged in the practice of OEM (and most ACOEM members) are not board certified in occupational medicine but are certified in other medical fields. Thus, the OEM Competencies use the term OEM physician generically without specification of board certification. Physicians without occupational medicine board certification can take advantage of several training courses available through ACOEM and other organizations that are designed to help such physicians learn the basics of OEM, or develop highly specific content knowledge required to effectively deliver OEM-related clinical services, such as medical review officer (MRO), commercial driver medical examination, or performance of impairment rating examinations. Board certification in occupational medicine provides training related to each of the core competencies described in this document and establishes the foundation for OEM specialists to rapidly expand their competence in focused areas during the trajectory of their career. The public may confirm whether an OEM physician is board certified via the American Board of Preventive Medicine (http://www.theabpm.org), which maintains a list of board-certified allopathic (MD) occupational medicine physicians, or the American Osteopathic Board of Preventive Medicine (http://www.aobpm.org/index.cfm), which certifies doctors of osteopathy (DO) medicine. Recent research3–5,15 on OEM careers and environments has shown that OEM physicians practice in three broad clinical areas, which can be loosely categorized as follows: (1) clinical care (eg, workers' compensation injury care and work-related examinations), (2) clinical subspecialty care (eg, toxicology evaluations, medical/legal work, and case management), and (3) management/population health (eg, corporate employee health program management and OEM research). It is important for physicians who are board certified in occupational medicine to be prepared to work in all of these practice environments—many OEM physicians' practices include all three focus areas. Nevertheless, not all physicians practicing OEM need equivalent competency in these diverse areas. This document organizes the topic areas relevant to OEM practice and describes the expected basic competency within that area for all OEM physicians. This is then followed by the knowledge areas and skill sets for each of the 10 core competencies for OEM physicians, with examples of how this clinical competency is reflected on the of whether practice in patient care as clinical OEM subspecialty experts or in program or health Physicians who are board certified in occupational medicine are expected to have be prepared to rapidly the and knowledge sets to deliver care in of the three clinical of This document also which of the for core competencies are by the specific OEM competency core competency areas are (1) (2) (3) and and and the for the competencies related to OEM a to the Preventive Medicine Occupational Medicine for training in occupational medicine board certification. should be documents, relevant to the training of OEM physicians board certification. is related to competency in and of research and the of this competency is as of and and to a or in a that a In for OEM physicians to have a with employers, health care and other health care a list of core competencies is This document a list of 10 core competencies that the areas of medicine that are the of the OEM to at the The that this document diverse practice, and The competencies document the OEM competencies in use by other organizations and were as were other as in the by experts in specific content review and were from the ACOEM OEM physician in OEM is expected to be in all 10 core with knowledge and that are specific to the area of clinical practice The OEM physician should to practices (eg, medical and as the medical to such of OEM The OEM physician should have the knowledge and to provide clinical and of and that are or The OEM is also to evaluating the impact of medical conditions on the to work the of the physician should to the is in care of as as in such as case management and core competencies and and and The OEM physician should have the knowledge and to with important to occupational and environmental health, as as the wide range of and related to the interactions between work and recognized experts on to the of occupational and environmental and as as to work with or without OEM physicians are on to provide and provide The OEM physician to interact with professionals, human managers, managers, safety professionals, and professionals, and should understand the of these core competencies and and and Environmental The OEM physician should have the knowledge and to potential environmental of to the as as to Environmental most include or by or The physician should the health effects of the broad and which includes use and and core competencies and and and The OEM physician should have the knowledge and to whether a can be at work and required The physician should be to the patient in and develop a or management that to the with the The physician should have the knowledge and to provide guidance to the employee and is a need for of an employee with a disability the workplace, or is a need to other such as or disability core competencies and and The OEM physician should have the knowledge and to evaluate, and health effects of to at work or in the The physician should also have the knowledge and skill to evaluate, and manage medical and programs for core competencies and and and The OEM physician should have the knowledge and to whether is risk of an adverse from to or in the or The OEM physician should be prepared to with industrial or other safety and health care professionals and and from such professionals in is a risk with exposure, then that risk can be with for or medical The OEM physician should an of the core of industrial occupational safety and and communication, and the of the of to the health of and the public from the range of and hazards. core competencies and and and and The OEM physician has a in and with for and the workforce from health and of The OEM physician should have the knowledge and to with the management to for to or management includes resource communication and with or core competencies and and and and The OEM physician should be to and and to the health of the and most include health and health core competencies and and and and The OEM physician should have the knowledge and to evaluate, and manage medical programs for the workplace, as as the The physician should be to and preventive core competencies and and and and The OEM physician should have the and management knowledge and to and occupational and environmental health programs and OEM physicians need an of health care workers' compensation and health and knowledge of the and to the and of interest. OEM physicians in all practice are expected to be to the diverse and of those and diverse in their core competencies and and and ACOEM OEM OEM The OEM physician should have the knowledge and to provide clinical and of and that are the of the physician should to the is in care of as as in such as case management and core competencies and and ACOEM Code of and ACOEM on of in the OEM Physicians practicing in occupational health whether or of a provide patient care should be in a and examination, and appropriate and managing patients toward unnecessary work OEM physicians typically provide work injury and illness medical evaluations, and other clinical related to specific work or work fitness OEM clinicians should have a medicine knowledge to a care for is a need to manage a wide range of conditions in to care and to the impact of a on to a OEM The clinical is engaged in a focused area of practice, for impairment hazardous work toxicology or workers' compensation case OEM clinical specialists provide medical/legal and in or evaluating their occupational health or injury management OEM OEM physicians as corporate medical or work in or with for employee competency in health and preventive medicine OEM physicians are for disability management programs and employee wellness programs. competencies for OEM management include health clinical practice for and practices in and as as disability management ACOEM on by and The OEM physician should provide clinical care with an of the workplace, work and relevant such as workers' The OEM physician should understand and interactions between and occupational health conditions and risk and patient with an on and the potential between patient and occupational and environmental effectively and an work and or and manage and with the use of in related a workers' compensation case from to of required medical the relevant that may to occupational and environmental or injury. and a risk all to and to organizations and as appropriate medical confidentiality for the health and safety of patients and as a with other professionals to and occupational or environmental and to exposure, and health and clinical practice in practice of medicine. ACOEM on of in and clinical knowledge to impact of medical conditions on to work and or that and OEM physicians have knowledge and in the areas, not core for all OEM medical impairment rating by specific sets of and certification for the of of commercial examinations. to as an of more specific competencies of the can be at with risk and may in and in OEM physicians in of via in employee wellness programs and OEM physicians employers, care physicians, and in the and of as as the of with The of the OEM physician is in in such as hazardous commercial and and evaluate, and manage the effects of such as and a to work after a as of or knowledge of risk in employee risk and patient for of and and OEM physicians have knowledge and in the not core for all OEM such as to fitness for Occupational are the leading of occupational in the also as a of to hazardous in the OEM physicians should provide and management of these and to their in the and at and occupational by examination, and and the of and (and other related those by such as and conditions or other occupational and environmental and and of those by occupational and and manage injury in in who may be required to and occupational specialists and physicians practicing as OEM clinical specialists should have the knowledge and to for as as as due to to and occupational occupational (eg, as by or occupational OEM physicians have knowledge and in the areas, not core for all OEM for of and other Medicine and OEM physicians should have the knowledge and to provide medical care for a wide of and as as to and for ACOEM on in the Occupational and and for the clinical management of in hazardous and medical management and appropriate care for system, or other the of a specific and manage the work-related of conditions and in in care and of of and provide other the effects of to and relevant programs and The OEM physician should be of the conditions that can as or work-related conditions or with fitness for work, and be to appropriate and manage related to and conditions (eg, and that may to conditions to work (eg, work fitness related to and patients management to to related and The OEM physician should be to in the of of to or environmental risk of such exposure, and as of an medical for which fitness for may be an (eg, Occupational and environmental may have potential to adverse effects or may be The OEM physician should have the knowledge and to evaluate, and the and effects of occupational and environmental and in the of medical and examinations. clinical to the health effects of to such as and and occupational specialists and physicians practicing as OEM clinical specialists should have the knowledge and clinical and to in of occupational or environmental and for and in or and preventive and health risk communication, by the OEM physician can their health and and The OEM physician should be prepared to or for and the and and and conditions risk in with by and follow from public health such as the US for and and for of the for and and for and OEM physicians have knowledge and in the areas, not core for all OEM of most of the occupational by the OEM physician and and human for and of the and of the system, as as appropriate and management is OEM physicians should be to clinical conditions with in to of and work. the of and the OEM physician to the development of programs to these and focused and evaluations, the examination, appropriate or and the of occupational risk appropriate and management of patients with and and and their and such conditions are of are as follows: with to of and and occupational and risk and and of and related to or industrial to and appropriate for an and manage and OEM physicians have knowledge and in the areas, not core for all OEM and other Occupational and environmental can and effects on the and The OEM physician should have the and knowledge to evaluate, and conditions and to the of with and focused and in the of occupational and environmental or and the of and or in the of occupational or environmental or or for conditions that may be the to work may include or or care and in with conditions to the The OEM physician should have the clinical and knowledge and to manage occupational and and programs. and the need for and (eg, and basic examination, and use from the to in the of in an care or occupational health OEM physicians should be to and occupational and to an and to work and and manage and and from the and or for and or as appropriate and and to the and OEM physicians have knowledge and in the areas, not core for all OEM The OEM physician should have the clinical knowledge and to evaluate, and manage the care of patients with occupational and environmental and and manage conditions or by occupational and environmental exposure, or and manage a patient with or other related conditions ACOEM on The of the in the of and injury to with and manage with related or the use of an a and appropriate and preventive safety and industrial hygiene professionals in the and of programs and of appropriate for and OEM physicians have knowledge and in the not core for all OEM an occupational physicians practicing as OEM clinical and OEM should have the knowledge and and manage an occupational on review of and manage patients with conditions or by occupational and environmental exposure, and The OEM physician should be with the and with the of and of and the between and the that help patients with for within appropriate for the on as the than and work within appropriate as of the that patient and for for in that to disability or use with the or other that help the patient learn to and related to and include the ACOEM and guidance for the of by Occupational and Environmental Medicine The are from this and should be to the OEM of with patients The should set for and to that which is the from to use and (eg, at this The should be with and their and at take to use for of and of the the and of use and set for their patients with to management on a that includes and care the and OEM physicians have knowledge and in the areas, not core for all OEM The OEM physician should have the clinical and knowledge and skill to evaluate, and in the management or of with or in the workplace, and to occupational and environmental that may and the or employee and manage or to employee programs. and of the or manage the and in the of and programs. and manage who may be the of at work (eg, industrial exposure, and to such as for patients at risk for disability due to risk such as disability and and manage the impact of conditions on to work and on the of or ACOEM on The in with at or to a and and a and for with conditions or and or with as other medical or and occupational physicians practicing as OEM clinical and OEM should have the knowledge and and in the management of in the the medical related to and other work management that can impact employee and a of the and of the system, the OEM physician should be to the and occupational impact of and and the occupational (eg, to and (eg, workers' (eg, of and work and for occupational and a to American to the ACOEM on in the Occupational certification to the to the of the and to the of on appropriate in with an industrial in of clinical conditions (eg, use of in patient with and occupational specialists and physicians practicing as OEM clinical specialists should have the knowledge and the of occupational or environmental related or for and the appropriate the and in the of in the of and specific in the of in the of impairment such as of and (eg, by a the OEM physicians have knowledge and in the not core for all OEM Medicine The OEM physician has the clinical knowledge and skill to patients of occupational and environmental the effects of and work on and the and the of the to work. and potential adverse to and from and and provide to and the management of such and of toxicology appropriate and for or and occupational physicians practicing as OEM clinical and OEM should have the knowledge and on and to the of for and and for of or ACOEM on and Medicine The OEM physician should patients with and be prepared to for and manage the work of this and patients at risk or for and and to the work fitness safety in a the of this for in the disability and such as and those with provide appropriate to the patient and the ACOEM guidance document on in the and The OEM physician should have the knowledge and to with important to occupational and environmental health, as as the wide range of and related to the interactions between work and recognized experts on to the of occupational and environmental and as as the to work with or without OEM physicians are on to provide and provide The OEM physician to interact with other medical professionals and professionals, human managers, managers, safety professionals, and professionals, and should understand the of these core competencies and and and OEM The clinical OEM physician should be with the and related to the workers' compensation as as those the of OEM medical services, for the for commercial for medical related to the work for which such are as as the related to patient confidentiality and ACOEM on of and of in and OEM OEM physicians are with or medical a that and of industrial and knowledge and an of preventive medicine evaluating a clinical or the OEM clinical to be to research to the specific clinical and and effectively a The OEM clinical provides that an knowledge of such as OEM The OEM should understand health care and health and the relevant and the to the or other the OEM physician to understand how to and related to illness or work as as develop and employee wellness programs in with This OEM also includes advising on and related to specific of in to health for and medical and with and as as their and in to occupational health practice, to employers, and include the Occupational and and the for medical of and other fitness in employee health may The of the and related to workers' compensation and public and to confidentiality of medical the of communication and appropriate in communication and and and in the practice of OEM, relevant such as those from the of Occupational and Environmental the on Occupational and the American employers, attorneys, and their on the and the that to the practice of workers' with of the relevant of the required and with case management and of occupational to to patient care to those that to addressing health for the need to a that may impact the of an to impairment in and other health care professionals. with and to specific of for the on Occupational for and the ACOEM for the of and occupational physicians practicing as OEM clinical and OEM should have the knowledge and with and as as their and in to occupational health practice, to employers, and include the and the of with (eg, the with the and the of The ACOEM guidance document on in the The Environmental health and safety The related to the in which OEM work is disability in with the of and their to OEM physicians have knowledge and in the areas, not core for all OEM and and on OEM in the by in or or other for OEM with the Environmental The OEM physician should have the knowledge and to potential and environmental of health to the as as to Environmental most include or by or The physician should the health effects of the broad and which includes use and and core competencies and and OEM The OEM physician should be in an that includes environmental as as occupational The physician should have a basic of not only environmental but also how to risk on the of an of exposure, potential of and whether a of has should the knowledge of and how to environmental and to published should be of the to clinical and of environmental and relevant to the area practice, such as and important as how to environmental is the knowledge of and (eg, can be or to The OEM includes knowledge of and to the patient in environmental and OEM OEM clinical specialists should have a broad knowledge of of all environmental and and how to to these should have the to and risk to patients for environmental published should be the appropriate and of environmental and for environmental as as environmental and toxicology and health risk specialists should understand basic of environmental and should be in the management of clinical specific to an are OEM The OEM physician should have a of environmental the and of in with other environmental health In managing the environmental health of the should be to published risk and the of and risk and understand their The physician should be in and risk communication to The OEM should use the basic of risk and environmental to provide to the of environmental policy in the and public this should have a of risk and environmental as to the practice of environmental health for and and of environmental and of environmental health that may be by environmental risk from and and the effects with or to or environmental hazards. and occupational physicians practicing as OEM clinical and OEM should have the knowledge and to environmental and the of environmental and manage health effects with or by or and manage to environmental (eg, and and manage the health effects of human to and human and the of environmental and The OEM physician should have the knowledge and to whether a can be at work and required The physician should be to the patient in and develop a or management that to the with the The physician should have the knowledge and to provide guidance to the employee and is a need for of an employee with a disability the or is a need to other such as or disability core competencies and and ACOEM on of in and OEM The clinical OEM physician should a from the from the other and other professionals such as examination, and may as The physician then this to define and impairment in specific the of the and knowledge the of the the OEM physician should the to with or without The OEM clinical physician work and that the to The OEM should be with the risk work disability and understand how to these Physicians in this should be with management and prepared to evaluate, or manage by to physicians should be prepared to in case of for care with other to manage the OEM The OEM clinical engaged in work fitness should have the to medical disability evaluations, and disability for the of and disability OEM specialists are on to patients to work, or fitness for work are by the use of In such the OEM clinical is expected to or appropriate and to appropriate specialists for and on to the The may also be on to a fitness for in the of environmental such as or (eg, and The OEM clinical is expected to be to how health be by such environmental conditions and should be to or to the in their or an OEM The OEM physician in the of managing may be on to and or to the of with due to work-related or The physician should be to preventive on the of and review of on injury and The physician may develop such as work or to those with and to be in within an Physicians engaged in management are also on to the of OEM medical care by other physicians, and to clinical practice as as such as work and the effects of and work disability and management of clinical clinical that include the of the employee at risk for of in and and management of for or for and clinical as as to the of as the and these with public safety as by other impairment work for the use of in in to fitness for in with in to specific work work or public safety for patients with or medical to the ACOEM relevant to this to in with The in with at or to by ACOEM for the of and occupational physicians practicing as OEM clinical and OEM should have the knowledge and and of work disability and to and manage the impact of and on the of illness and injury. and for and for patients with work-related or medical preventive for who have from work and and to and for conditions an risk to or in the workplace, in with the and the and with