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High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Competency is defined as possession of sufficient physical, intellectual, and behavioral qualifications to perform a task or serve in a role which adequately accomplishes a desired outcome. Recognizing the need for defining competencies essential to occupational and environmental medicine (OEM) physicians, the American College of Occupational and Environmental Medicine developed its first set of OEM Competencies in 1998. Later updated in 2008, and again in 2014, the increasing globalization and modernization of the workplace, along with published research on OEM practice, required an update to ensure OEM physicians stay current with the field and practice of OEM. Delineation of core competencies for the profession provides employers, government agencies, health care organizations, and other health practitioners a solid context of the role and expertise of OEM physicians., Competing Interests: The author declares no conflicts of interest., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Context: Diversity in the US physician workforce is important. Physicians Underrepresented in Medicine (UIM) are more likely to serve poor, uninsured, and vulnerable populations., Objective: To increase the number of UIM physicians in Occupational Medicine., Program: An Inclusion and Diversity Committee, consisting of the program director, trainees, and graduates, was created with the goal of recruiting and developing UIM residents and increasing Occupational and Environmental Medicine awareness. Outreach to UIM residents and medical students at local, regional, and national meetings, creation and distribution of descriptive brochures, and supervised 1-day observerships were some of the interventions., Results: Only 4 Underrepresented Minorities physicians out of 65 (6%) graduated during the first decade of the program 1997-2007; this increased to (16/70) 23% during the following decade subsequent to establishing the Inclusion and Diversity Committee., Conclusion: A multifaceted strategic approach can help increase UIM physician participation in graduate training programs, helping address health equity., Competing Interests: The authors do not have any potential conflicts of interest to declare., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Context: There is a long-standing shortage of formally trained Occupational & Environmental Medicine (OEM) physicians despite OEM practitioners experiencing high satisfaction and low burnout., Objective: To explore the root causes of this shortage and suggest potential remedies., Methods: Cross-sectional surveys were administered to medical students queried regarding OEM training, practicing OEM physicians queried regarding timing of specialty choice, and OEM Train-in-Place (TIP) program graduates queried regarding satisfaction with training., Results: Of 247 medical student respondents, 70% had heard of OEM, 60% through one lecture. Of the 160 OEM physicians, 17% first became aware of OEM as medical students, and most would have chosen a different path had they heard sooner. Most TIP program trainees reported that they would not have undertaken specialty training without a TIP program (89%)., Conclusions: Strategies to introduce OEM earlier in medical education and TIP programs for mid-career physicians may help overcome persistent shortages of OEM specialists., Competing Interests: The authors do not have any potential conflicts of interest to declare., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To determine prevalence and key drivers of burnout in Occupational and Environmental Medicine physicians in the United States., Methods: A nationwide survey of Occupational Medicine physicians was conducted using the Qualtrics® platform. Burnout, measured by the Maslach Burnout Inventory®, Social Support, and Job Satisfaction were assessed., Results: The response rate was 46%, the overall burnout prevalence 38%, and most respondents were men (69%). The mean age and mean years in practice were 56 years and 20 years respectively. Physicians working in government/military (48%) and private medical center group settings (46%) were significantly more likely to report burnout, with consultants (15%) reporting the lowest rate., Conclusions: Although the overall burnout prevalence is lower in Occupational Medicine physicians compared with most specialties, the rate varies significantly by practice setting (15% to 48%) affirming the impact of organizational factors.

Objective: The National Institute for Occupational Safety and Health recommends that institutions establish a medical surveillance program for workers who handle hazardous drugs. Our aim was to investigate current practices with occupational medicine practice (OMP) national leaders., Methods: A series of qualitative telephone interviews were conducted with 11 OMP national leaders from medical centers in 10 states. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes., Results: All respondents were board-certified physicians in medical center OMP. Interviews up to 45 minutes found three themes: policy interpretation, benefits and barriers to surveillance, and potential respondent-generated solutions. Three of 10 medical centers provided medical surveillance., Conclusions: Medical surveillance for hazardous drugs is infrequent, and consensus is lacking regarding standard practices. Further work is needed to minimize risk to health care workers.

Background: Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine., Objective: We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine., Methods: Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field., Results: Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field., Conclusions: Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties., Competing Interests: Conflict of interest: The authors declare they have no competing interests. This article is based on an oral presentation at the International Conference on Residency Education, Ottawa, Ontario, Canada, October 18–20, 2012, and on a poster presentation at the American College of Occupational and Environmental Medicine Conference, San Antonio, Texas, April 27–30, 2014.

To assess vaccine coverage rates before and after implementation of a COVID-19 vaccine mandate among Health care Personnel (HCP) and demographic characteristics associated with vaccine uptake Design, Setting, and Participants: Cohort study conducted among 10,889 hospital employees followed from Dec 16, 2020 - October 31, 2021, at a large academic hospital in Philadelphia. Main Outcome and Measures: Time to COVID-19 vaccination and vaccine series completion rates before and after implementation of a COVID-19 vaccine mandate based on age, gender, race/ethnicity, and level of patient contact/occupational group. The vaccination series completion rate was 86.0% prior to mandate announcement, and increased to 98.7% after mandate implementation. Rates before mandate announcement were highest among Asians (96.2%), Whites (94.0%), males (89.7%), employees ≥ 65 years of age (95.2%), and employees with direct patient care (physicians, 99.0%, and nurses, 93.3%). Hospital educational initiatives (including Town Halls and discussions with Black and Hispanic employees with the lowest vaccination rates) appeared to improve uptake. The largest increase in series completion after mandate announcement occurred among Blacks, those of other/multiracial backgrounds, and Hispanics (35.6%, 22.4%, and 10.8%, respectively) as well as those with some or no direct patient contact (24.5% and 18.3%, respectively). Medical or religious exemptions were approved for 64 (<0.6%) employees and 38 (<0.4%) left their positions (8 voluntary, 30 involuntary) specifically due to the COVID-19 vaccine mandate. No clinically meaningful differences by age, gender, or race/ethnicity for those who were vaccinated under the mandate versus those who left their positions were noted. These results suggest that while mandates may be challenging to institutions and enforcement unpopular, they play an important role in reducing hesitancy and securing high vaccination rates among HCP, a group at high risk of COVID-19 given their employment and who can be a source of disease transmission to patients. [ABSTRACT FROM AUTHOR]

Occupational and environmental medicine (OEM) is an ACGME-accredited preventive medicine specialty focused on work as a social determinant of health and population health. OEM providers recognize and mitigate workplace and environmental hazards, treat resultant injuries and illnesses, and promote the health, wellness and resiliency of workers and communities. Multidisciplinary residency training in clinical medicine, epidemiology, public and population health, toxicology, exposure and risk assessment, and emergency preparedness equips them with the skill set needed for leadership roles in diverse settings. These include clinical practice, academia, corporate settings, and governmental agencies. Despite robust job opportunities, a shortage of formally trained OEM physicians remains and is expected to worsen given a declining number of training programs. We examine root causes of the system-level issues impacting the supply of OEM physicians and potential solutions. [ABSTRACT FROM AUTHOR]

Objective: To determine factors associated with return to work in US diplomats injured during a work assignment in Cuba. Methods: In this case series work ability was determined at each visit. Questionnaires used included the Symptom Score Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Quality-of-Life Inventory, and Patient Health Questionnaire. Results: Of the 45 employees referred to Occupational Medicine, the mean age was 42.5 years, 60% were men, 68% were never out of work, 22% were out of work for some period, and 15% remain out of work. Vestibular, cognitive, hearing, sleep, and visual symptoms, and a higher initial symptom score were significantly associated with work inability while psychiatric symptoms were not. Conclusions: This exposure resulted in prolonged illness with cognitive impairment and other clinical manifestations associated with work inability. [ABSTRACT FROM AUTHOR]

The article presents the Occupational Physicians Scholarship Fund (OPSF) as a private support for postgraduate physician training entering the field of occupational and environmental medicine (OEM). The fund is responding to the shortage of physicians in OEM that specialize in the prevention, diagnosis and treatment of illnesses and injuries associated in the workplace and the environment. The success of the fund was measured based on the number of scholars who become diplomates of the American Board of Preventive Medicine, certified in Occupational Medicine (ABPM/OM), scholar performance on the ABPM/OM-certifying examination, retention of scholars and their membership in American College of Occupational and Environmental Medicine (ACOEM).

Focuses on the External Practicum Year Residency Training Program in Occupational and Environmental Medicine at the University of Pennsylvania Medical Center in Pennsylvania. Requirements for admission to the program; Objectives of the program; Approaches for the evaluation and improvement of the program.

The article provides information on the perceived occupational cluster. It mentions that occupational clusters were found to have been caused by polycyclic aromatics found in soot. It recounts that most of the clusters that have yielded etiologic information have been occupational and not environmental. The perceived occupational clusters require investigation through the utilization of a systematic, integrated approach and workers must be informed of the results regardless of whether or not it was confirmed as an epidemiological and statistical cluster. It presents the CDC protocol for occupational disease cluster investigation wherein a four-stage process is recommended including initial response, assessment, major feasibility study and etiologic investigation.

A report on a series of six Forum Articles from the American College of Occupational and Environmental Medicine (ACOEM) Task Force on Climate Change which discusses the impact of climate change on the workplace and workers' health.

The article offers information on the importance of incorporating occupational health data into electronic health records (EHRs) for all clinicians caring for workers. The topics covered include the support of the American College of Occupational and Environmental Medicine (ACOEM) for collecting and sharing occupational health information in EHRs, the criteria for EHR systems to effectively share this information, and the recommendations for recording and using occupational information in EHRs.