Drushca Lalloo

International perspective on common core competencies for occupational physicians: a modified Delphi study

Objectives The competencies required of occupational physicians (OPs) have been the subject of peer-reviewed research in Europe and individual countries around the world. In the European Union (EU), there has been development of guidance on training and common competencies, but little research has extended beyond this. The aim of this study was to obtain consensus on and identify the common core competencies required of OPs around the world. Methods A modified Delphi study was carried out among representative organisations and networks of OPs in a range of countries around the world. It was conducted in 2 rounds using a questionnaire based on the specialist training syllabus of a number of countries, expert panel reviews and conference discussions. Results Responses were received from 51 countries around the world, with the majority from Europe (60%; 59%) and North and South America (24%; 32%) in rounds 1 and 2, respectively. General principles of assessment and management of occupational hazards to health and good clinical care were jointly considered most important in ranking when compared with the other topic areas. Assessment of disability and fitness for work, communication skills and legal and ethical issues completed the top five. In both rounds, research methods and teaching and educational supervision were considered least important. Conclusions This study has established the current priorities among OPs across 51 countries of the common competencies required for occupational health (OH) practice. These findings can serve as a platform for the development of common core competencies/qualifications within specific geographical regions or internationally. This is particularly pertinent with globalisation of commerce and free movement within the EU.

Doctor and dentist contacts with an NHS occupational health service

BACKGROUND There is increasing acceptance that management of ill-health in doctors can be patchy and is not always optimal. Health can impact on performance and fitness to practice, placing an important responsibility on occupational health (OH) services. AIMS To improve our understanding of OH contacts by doctors and dentists and make some comparison of this with available sickness absence records. METHODS A retrospective descriptive evaluation of all doctor and dentist encounters with the OH service between April 2009 and March 2010 was undertaken. Doctor and dentist encounters from our electronic appointment system were analysed using Microsoft Excel. Comparisons were made with management-reported sickness absence data for this period. RESULTS Blood tests, immunizations/immunization updates accounted for 49% (295) of contacts. Management and self-referrals accounted for 26% (157) of all OH contacts. Mental health conditions were the main reason for referral (approximately one-third of all cases referred). In this group, a much higher number presented to OH, absent from work, than were recorded with sickness absence by management. Musculoskeletal, infection and skin complaints were other predominant reasons for referral. CONCLUSIONS Doctors and dentists do utilize this OH service and the issues for which they need services are wider than those of mental health. Inconsistency in the reporting of sickness absence in doctors with mental health problems has also been highlighted. This baseline information is a useful stepping stone to identifying and meeting the specific needs of doctors and dentists and can be used as a benchmark in other organizations.

Core competencies for UK occupational health nurses: a Delphi study

Background Occupational health nurses (OHNs) play a pivotal role in the delivery of occupational health (OH) services. Specific competency guidance has been developed in a number of countries, including the UK. While it is acknowledged that UK OHN practice has evolved in recent years, there has been no formal research to capture these developments to ensure that training and curricula remain up-to-date and reflect current practice. Aims To identify current priorities among UK OHNs of the competencies required for OH practice. Methods A modified Delphi study undertaken among representative OHN networks in the UK. This formed part of a larger study including UK and international occupational physicians. The study was conducted in two rounds using a questionnaire based on available guidance on training competencies for OH practice, the published literature, expert panel reviews and conference discussions. Results Consensus among OHNs was high with 7 out of the 12 domains scoring 100% in rating. ‘Good clinical care’ was the principal domain ranked most important, followed by ‘general principles of assessment & management of occupational hazards to health’. ‘Research methods’ and ‘teaching & educational supervision’ were considered least important. Conclusions This study has established UK OHNs’ current priorities on the competencies required for OH practice. The timing of this paper is opportune with the formal launch of the Faculty of Occupational Health Nursing planned in 2018 and should inform the development of competency requirements as part of the Faculty’s goals for standard setting in OHN education and training.

Peer review audit of occupational health reports—process and outcomes

BACKGROUND Peer review is widely used in the selection and publication of scientific research. Its application in clinical practice is emerging, particularly with increased emphasis on clinical governance and the imminent introduction of revalidation. AIMS To formalize our peer review process of occupational health (OH) reports and formally assess the outcomes of this process. METHODS A prospective internal audit was carried out of all peer reviewed OH reports between June and August 2010. An abbreviated assessment form, based on Questions 4-12 of the Sheffield Assessment Instrument for Letters (SAIL) was utilized. The report was assessed using the abbreviated SAIL, with one of four possible outcome options-no action, no changes made to report following discussion with author, changes made without discussion with author and changes made following discussion with author. RESULTS The audit identified that 27% of OH reports required modifications. Eighteen per cent were related to typographical errors, spelling, grammar and administrative fields being incomplete. Nine per cent were related to more complex reasons, most commonly, all the managers questions not being addressed, review arrangements not being clear and the report not being clear and understandable to the intended readership. CONCLUSIONS Peer review can be a useful tool in improving the standard of OH reports, specifically picking up minor errors and potentially more significant areas of concern. It can also be a valuable educational tool in terms of personal feedback, benchmarking and exposure to different styles of report writing.

Trends in NHS doctor and dentist referrals to occupational health

Background Ill-health in doctors can affect performance and fitness to practice, and consequently patient care and safety, placing an important responsibility on National Health Service (NHS) occupational health (OH) services. Anecdotal discussions amongst NHS occupational physicians suggest an increase in the number of doctor attendances over time, with continuing focus on mental illness. Aims To analyse OH referrals in doctors and dentists over 3 years. Methods A retrospective evaluation of all doctor and dentist referrals to the OH service in one Scottish NHS board from April 2011 to March 2014, comparing this to management-reported sickness absence (SA) data held by the organization. Results We found no significant change in overall OH referrals for doctors and dentists during the evaluation period. Mental illness was the commonest referral reason in all 3 years at 32, 38 and 30%, respectively, but no significant change in mental health referrals was demonstrated within the study period. SA events significantly increased during the three study years (356, 426 and 469, respectively; P < 0.05). OH referrals for those absent from work increased significantly between Years 1 and 3 (16 and 30, respectively; P < 0.05). Conclusions SA events and OH referrals for those absent from work significantly increased between April 2011 and March 2014, but there was no commensurate (statistically significant) increase in overall OH referrals. These findings do not support anecdotal suggestions of increasing OH (or mental ill-health) attendances but can be used as a benchmark for other NHS organizations and for future trend comparisons.

Development and implementation of clinical algorithms in occupational health practice.

Objective: Occupational health (OH) practice is framed by legal, ethical, and regulatory requirements. Integrating this information into daily practice can be a difficult task. We devised evidence-based framework standards of good practice that would aid clinical management, and assessed their impact. Methods: The clinical algorithm was the method deemed most appropriate to our needs. Using “the first OH consultation” as an example, the development, implementation, and evaluation of an algorithm is described. Results: The first OH consultation algorithm was developed. Evaluation demonstrated an overall improvement in recording of information, specifically consent, recreational drug history, function, and review arrangements. Conclusions: Clinical algorithms can be a method for assimilating and succinctly presenting the various facets of OH practice, for use by all OH clinicians as a practical guide and as a way of improving quality in clinical record-keeping.

Impact of peer review audit on occupational health report quality

Background In a previous report, we described the implementation of a formal process for peer review of occupational health (OH) reports and a method of assessment of the outcomes of this process. The initial audit identified that 27% of OH reports required modifications. Aims To assess formally, following implementation of this process, if changes in practice had occurred, i.e. whether fewer deficiencies were being identified in reports. Methods We repeated a prospective internal audit of all peer reviewed OH reports between September and November 2011. We used an abbreviated assessment form, based on questions 4–8 and 10–12 of the modified SAIL (Sheffield Assessment Instrument for Letters), with four possible outcomes: no action, no changes made to report following discussion with author, changes made without discussion with author and changes made following discussion with author. Results One hundred seventy-three reports by 10 clinicians were audited. The audit identified a 13% reduction in OH reports requiring modifications (from 27 to 14%) compared with the previous cycle. Where modifications were required, 8% of these were related to minor typographical, spelling and grammar errors and 6% were for more complex reasons. Implementation of this process also produced a reduction in clinical complaints about OH reports from customers, from three in the preceding year to none 2 years later. Conclusions Peer review improved the standard of OH reports and was associated with a reduction in customer complaints about reports.

Comparison of competency priorities between UK occupational physicians and occupational health nurses

Abstract Objectives The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1—‘rating’, round 2—‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman’s r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities.

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

BackgroundThe activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey.MethodsAn international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work.ResultsThere was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups.ConclusionThis study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles.

0114 Comparison of competency priorities between uk occupational physicians and nurses

Objectives The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key OH professional groups. Evolving OH practice and overlapping OP and OHN roles make it imperative that up-to-date competencies reflective of practice are established. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods A modified Delphi study conducted among representative networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1- ‘rating’, round 2- ‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results The principle domain (PD) competency ranks were very highly correlated (Spearman’s rho=0.972; p<0.001) with the same PDs featuring in the top four and bottom three in ranking. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically-focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities.