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The RACGP Curriculum for Australian General Practice 2016

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Curriculum coverThe complete 2016 Curriculum consists of a number of units in addition to contextual units. All units will be available for download as a PDF shortly.

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Occupational medicine

Definition

Occupational medicine deals with all aspects of the relationship between the work environment and the health of workers,1 with the aim of improving health and minimising injuries in the workplace.

General practitioners can bring medical expertise to the human interface of the workplace to help provide improved outcomes in both physical and mental health, assist in the reduction and elimination of preventable accident or injury, and reduce and prevent the potential for negative health impacts from the work environment.

Curriculum in practice

Typical cases that illustrate how the occupational medicine curriculum applies to general practice include:

  • Ricko's hand was wrapped and elevated but his clothes were drenched in blood and sawdust when he presented to your practice. His face remained pale as his workmate described the accident with a bandsaw at the mill where they worked. Ricko was passing a slab of timber through the saw when he was momentarily distracted and ran his hand up the middle with the wood. Without removing the dressing, X-ray examination confirmed a massive injury to his hand with splintered metacarpals and one missing digit. Ricko is transferred to hospital for specialised hand surgery. Some months later he has completed rehabilitation and is keen to return to work but you are uncertain as to the risk of future wound contamination and the risk of further injury. How might a workplace assessment help?
  • Alison has been working in the office of a construction company for several months but was recently relocated closer to the worksite. The new office has an exterior door that connects to the site, with the result that considerable dust enters the building and becomes airborne every time she moves a file. Alison's previously stable asthma has become problematic, with erratic peak flow readings. She has needed to use prednisone on several occasions and has needed several days off work. She wonders if this change in her previously stable asthma is due to the dust exposure in her work environment. Alison has also become highly anxious about job security as the company has commenced downsizing. She is concerned that further days off work might jeopardise her employment contract, which is up for review. What role does the workplace play in exacerbating Alison's respiratory and anxiety symptoms and what options are available to manage the situation with her employer?
  • Col presents to the local hospital, greatly agitated, having drenched one arm in pesticide. He has brought the label from the pesticide container with him and you see it is an organophosphate. Like many small owner-operators Col had not been using protective equipment, including mask or gloves, while mixing the chemicals. What emergency measures should be taken by staff and what treatment should be administered? What is Col's prognosis?

Rationale and general practice context

In Australia in 2009–2010, 1.6% of general practice encounters were work related,1 with men more likely to present with work related conditions than women.2 Nearly all of these patients (96%) were aged 15–64 years with half being in the 25–44 years age group.2

General practice occupational medicine activities traditionally include accident prevention, injury management, workers' compensation and pre-employment and occupational health medical examinations. In reality, the scope of occupational medicine in the general practice setting goes beyond these tasks.

General practitioners are well situated to give advice on the most diverse of working environments, from a sterile laboratory in a large company to a farmer on the family farm to potential health outcomes of a manufacturing process. They may not only treat, but anticipate, biomechanical sequelae for operators of equipment, often specifically engineered for a particular process with little regard for the impact on workers' health.

The list of potential occupational health and safety (OH&S) roles for the GP include: fitness to operate equipment such as forklifts or tractors; the effects of drugs, either legal or illegal, in the workplace; first aid including cardiopulmonary resuscitation; information seminars; safety drills; and interpretation of safety data information. Some GPs may be involved in monitoring the health effects of short and long term exposure to noxious substances, and all GPs have a role in the treatment of work related stress and implementing strategies to reduce its incidence.

The workplace is one of the few places, outside schools, where people gather on a regular basis, often in large numbers. This provides an ideal opportunity for health promotion and wellness programs. General practitioners are ideally placed to play a pivotal role in brokering positive health outcomes and preventing the spiral into chronic incapacity with its attendant consequences.

General practitioners are in a unique position to act as moderators between patient and employer to ensure the best possible outcomes for both parties. Specific occupational health skills are needed to maximise the special opportunities that GPs have to effect good health outcomes. Poorly managed work related conditions can cause great suffering, not only for the patient and the employer, but also the patient's family as a result of unemployment.

General practitioners are also often employers and need to be aware of their own OH&S obligations toward their employees.

Related curriculum areas

Training Outcome of the five domains of general practice

1. Communication skills and the patient-doctor relationship

OCCT1.1

Integrate knowledge of the specific confidentiality and privacy demands of work related injuries into patient management.

OCCT1.2

Communicate effectively with the patient and all parties involved in injury management while recognising that the primary responsibility is the patient's health.

OCCT1.3

Communicate appropriately with the patient's employer, workplace, insurance agencies, work rehabilitation providers and a wide range of health professionals, being mindful of the potential for communication conflicts between these stakeholders and the patient.

OCCT1.4

Facilitate good outcomes for both the patient and the employer.

OCCT1.5

Utilise appropriate translation services for patients from non-English speaking backgrounds, consistent with the communication requirements listed in the Multicultural health curriculum statement to ensure cultural competence when managing work related injury and illness.

2. Applied professional knowledge and skills

OCCT2.1

Understand the role of accident prevention and proactive risk management in the workplace to prevent physical and mental work related illness and injury.

OCCT2.2

Manage medical aspects of work related illness and injury.

OCCT2.3

Manage the expectations of all work related injury management stakeholders.

OCCT2.4

Participate in relevant work injury related administrative processes with work insurance authorities.

OCCT2.5

Perform pre-employment medicals and where relevant, onsite assessments.

OCCT2.6

Use evidence based medicine for the early intervention and active management of work related illness and injury.

OCCT2.7

Be aware of the realities of the patient's workplace, the available resources and the prevailing culture when making patient management plans.

OCCT2.8

Understand how the differences between industries and workplaces in worker safety, availability of human resources and management skills impact on negotiating best patient outcomes, especially when the patient has few or no portable skills.

3. Population health and the context of general practice

OCCT3.1

Administer workplace health programs (eg. relevant immunisations) and other strategies for the reduction of potential injury or substance exposure, or general health promotion and lifestyle programs.

OCCT3.2

Influence workplace cultures, where appropriate, to adopt practices consistent with long term beneficial health worker outcomes that may have significant flow on benefits to the wider community.

OCCT3.3

Understand how work related health disability has a wider impact beyond the worker to the patient's family and supports, which can result in hardship and suffering, especially in people from disadvantaged socioeconomic and educational backgrounds, who are particularly vulnerable to the negative impact of unemployment, financial hardship and family breakdown.

4. Professional and ethical role

OCCT4.1

Understand how working within a multidisciplinary team, including with work insurance authorities, is critical to the successful management of work related injuries.

OCCT4.2

Know the medical and legal issues in relation to medical certification.

OCCT4.3

Act as an advocate for patients, where appropriate, to ensure a successful outcome, especially for those from disadvantaged socioeconomic and educational backgrounds.

OCCT4.4

Balance any competing priorities of workers and employment as required, including maintaining appropriate professional conduct by delineating the role of medical management to work toward the best outcome for all parties.

OCCT4.5

Understand the obligations of management and the role of statutory inspectors in workplace safety breaches.

OCCT4.6

Know how a doctor's health may impair work related performance (see Doctors' health curriculum statement).

5. Organisational and legal dimensions

OCCT5.1

Know the relevant OH&S legislative requirements of employers and employees and work insurance agencies, and workers' compensation and industrial relations issues that impact on patient health.

OCCT5.2

Manage the potentially large amounts of information generated during the management of work related injuries from a range of sources to ensure that health risks to the patient are minimised from communication errors, including the maintenance of patient privacy.

OCCT5.3

Have expertise in safety matters, workers negotiations, unions and documenting workplace safety within the clinician's own workplace. This includes the clinician's own workplace health and safety legislative requirements.

Learning objectives across the GP professional life

Medical student

1. Communication skills and patient-doctor relationship

OCCLM1.1

Demonstrate asking for the patient's occupation when taking a history.

OCCLM1.2

Describe the negotiating skills needed in OH&S.

OCCLM1.3

Describe the implications of work related stress, including on personal relationships and communication.

2. Applied professional knowledge and skills

OCCLM2.1

Discuss the possible effects of illness on occupation or the relationship between an occupation and illness.

OCCLM2.2

Describe the basic role of biomechanics in workplace injuries and the role of ergonomics in the workplace.

OCCLM2.3

Outline the relationship of long and short term occupational exposure limits to noxious substances.

OCCLM2.4

Describe management issues in work related stress.

OCCLM2.5

Examine and describe workers' compensation insurance certificates, eg. Workcover certificates.

3. Population health and the context of general practice

OCCLM3.1

Understand the need for occupation related immunisation.

OCCLM3.2

Examine and describe the place of health promotion programs in the workplace.

OCCLM3.3

Describe the role of occupation related infection control measures in illness prevention.

OCCLM3.4

Describe the need and requirements for first aid training in the workplace.

4. Professional and ethical role

OCCLM4.1

Outline the roles of the GP and the occupational health doctor.

OCCLM4.2

Describe the roles and importance of professionals in the multidisciplinary work related health team, including occupational therapists and rehabilitation providers.

5. Organisational and legal dimensions

OCCLM5.1

Describe OH&S legislative requirements.

OCCLM5.2

Demonstrate awareness of regulatory standards to assess safety and ability to drive, including commercial and dangerous goods vehicles.

Prevocational doctor

1. Communication skills and patient-doctor relationship

OCCLP1.1

Describe informed consent issues with respect to the patient and their employer.

OCCLP1.2

Demonstrate the use of basic negotiating skills when aiming for best outcomes for both patient and employer.

OCCLP1.3

Describe the impact of work related injuries on the patient's family, especially in serious work related injuries in the emergency situation.

2. Applied professional knowledge and skills

OCCLP2.1

Write work injury related certificates, especially first certificates for work related emergency presentations, minor trauma and musculoskeletal diagnoses.

OCCLP2.2

Outline early management options for work related emergency presentations, minor trauma and musculoskeletal diagnoses.

3. Population health and the context of general practice

OCCLP3.1

Describe how to promote risk awareness in the workplace.

OCCLP3.2

Demonstrate appropriate occupation related immunisation.

OCCLP3.3

Demonstrate how to identify potential occupational risks within the prevocational doctor's workplace to patients and staff.

OCCLP3.4

Describe how to report potential occupational risks within the prevocational doctor's workplace to patients and staff.

4. Professional and ethical role

OCCLP4.1

Describe the personal health risks of medical practice such as fatigue and stress.

OCCLP4.2

Outline the personal responsibilities of recognising the potential risk to others from your own health status.

OCCLP4.3

Demonstrate communication with the patient's GP when appropriate.

5. Organisational and legal dimensions

OCCLP5.1

Identify and describe the appropriate circumstances and situations requiring the completion of work insurance medical certificates, eg. Workcover.

OCCLP5.2

Describe how patients may be treated in the private sector where workplace insurance, such as Workcover, is in place.

Vocational registrar

1. Communication skills and patient-doctor relationship

OCCLV1.1

Demonstrate the use of advanced negotiating skills in managing small groups, including Workcover authority, employer, insurance companies and rehabilitation providers.

OCCLV1.2

Describe the skills required for the management of stress in patients.

OCCLV1.3

Demonstrate the ability to write legal reports.

OCCLV1.4

Demonstrate how to give evidence in court.

OCCLV1.5

Demonstrate how to manage telephone calls from employers.

2. Applied professional knowledge and skills

OCCLV2.1

Demonstrate the management of common work related injuries.

OCCLV2.2

Describe the content and implications of Workcover certificates.

OCCLV2.3

Outline how to modify patient management to suit employer culture, where appropriate.

3. Population health and the context of general practice

OCCLV3.1

Identify and describe strategies to overcome low use of specific services and preventive activities.

OCCLV3.2

Record occupation in general practice patient records.

OCCLV3.3

Identify and describe common occupational illnesses (including those relevant to your local area) including specific management or where to find this information.

4. Professional and ethical role

OCCLV4.1

Describe the role of work insurance company authorised medical specialist agents, eg. health management specialists in Workcover.

OCCLV4.2

Outline how to deal with competing priorities.

OCCLV4.3

Demonstrate how to organise and review a completed functional capacity assessment.

OCCLV4.4

Describe and implement OH&S related business regulations as they apply to a medical practice.

5. Organisational and legal dimensions

OCCLV5.1

Demonstrate how to use relevant work related templates in medical software packages.

OCCLV5.2

Demonstrate the ability to coordinate care involving multidisciplinary teams and to organise case conferences when required.

OCCLV5.3

Describe patient confidentiality requirements and 'need to know' stakeholders to whom the patient has given the doctor permission to disclose, eg. insurance company and rehabilitation providers.

OCCLV5.4

Describe practitioner legal responsibilities about when to report a worker as being unsafe to drive.

Continuing professional development

1. Communication skills and patient-doctor relationship

OCCLC1.1

Outline the importance of maintaining a relationship with the patient and their experience of their illness or injury.

OCCLC1.2

Describe how to act as a communicator and negotiator with third parties, validate and quantify the illness/injury, and ensure parties involved are aware of performance limitations where appropriate.

2. Applied professional knowledge and skills

OCCLC2.1

Describe how work related injuries affect patient self esteem, confidence, income and family, and are often reinforced by feelings of vulnerability and rejection by the patient's peer group.

OCCLC2.2

Outline how to take the issues in the previous objective into account in order to ensure full recovery and return to full function.

OCCLC2.3

Outline how to deal with work related issues within the confines of the practical realities of the workplace and the patient's socioeconomic background.

3. Population health and the context of general practice

OCCLC3.1

Describe health issues related to industries that are close to the locality of your practice.

OCCLC3.2

Describe how to implement a program to reduce or ameliorate health impacts in the workplace.

OCCLC3.3

Demonstrate contribution to promoting and protecting health, and preventing illness, injury and disability in the community.

4. Professional and ethical role

OCCLC4.1

Demonstrate an ability to deal with multiple sources of work related information from patients, employers, specialists and members of the multidisciplinary team.

OCCLC4.2

Describe how patients from disadvantaged socioeconomic and education backgrounds are particularly vulnerable to the negative impact of unemployment, financial hardship and family breakdown.

OCCLC4.3

Demonstrate ability to manage OH&S in the practice environment.

5. Organisational and legal dimensions

OCCLC5.1

Discuss how to work with other organisations on population based workers' health issues.

OCCLC5.2

Describe obligations and limitations of OH&S related legislative requirements.

OCCLC5.3

Demonstrate ongoing compliance with these OH&S related legislative requirements.

References

  1. Britt H, Charles J, Henderson J, et al. General practice activity in Australia 2009–10. Canberra: Australian Institute of Health and Welfare; 2010.
  2. Charles J, Pan Y, Britt H. Work related encounters in general practice. Aust Fam Physician 2006;35:938–9.

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