Education and Training

Advice for doctors wishing to enter training from 1st August 2007

Could you be a specialist in occupational medicine? What is occupational medicine about? How do the current changes to training affect recruitment?

This document sets out briefly what you need to know if you are considering embarking on specialist training in occupational medicine in 2007.

What is occupational medicine?

Occupational medicine is the medical specialty which covers the multi-faceted relationship between health and work. It is concerned with ensuring that workplaces and work practices are safe and not detrimental to employees’ health, and that employees are fit for the job they are doing. If there are problems, either with the workplace or with an employee’s fitness, the occupational physician’s role is to advise on adjustments to the workplace, and/or to give appropriate advice and support to the employee.

Occupational medicine has an important part to play in rehabilitating employees back into work, after sickness or injury. Rehabilitation is currently high on the government’s agenda. The driving force behind this is twofold: both a recognition that employment is, in general, good for people – economically, socially, psychologically and in terms of general well-being – and also that many millions of work days are lost every year, some unnecessarily, to the nation’s economy. Providing high quality objective professional advice, sometimes in difficult situations, and with an awareness of the various agendas of government, employers, employees, trades unions and pensions trusts, is a demanding role.

Occupational medicine also plays a key role in providing impartial, evidence-based advice to third parties, such as insurance and pension companies, about retirement on grounds of ill-health and related matters.

With a 10% reduction in accidents at work since 1997, Great Britain today has one of the best health and safety records in the world. Yet 40 million working days are still lost every year to occupational ill health and injury, and a third of those people coming onto Incapacity Benefit have come from work.
(“Health, Work and Well-being – Caring for Our Future”, HM Government, October 2005)

What is the work like?

The work is varied, combining clinical medical practice with the need to influence and shape the behaviour of both individuals and organisations. It involves visiting workplaces, liaising closely with medical and non-medical colleagues. Occupational health is almost invariably provided by a multidisciplinary team with occupational physicians and nurses playing key roles.

Many large organisations in both manufacturing and service industries have their own in-house occupational health services. This includes multinational companies, where jobs can require work in many different countries.There are also increasing numbers of independent providers which may give good opportunities for part time, varied work. Out of hours commitments are usually minimal.

Occupational physicians work not only in the NHS and the Defence Medical Services, but also a wide range of commerce and industry, including aviation, nuclear power plants, call centres, building sites, oil rigs, shops and factories.

There are opportunities to develop special interest areas such as Travel Medicine, Disability Assessment Medicine, Aviation Medicine, Occupational Dermatology, Respiratory Medicine, Sports and Exercise Medicine, Radiation Medicine and Diving Medicine.

What makes an occupational physician?

The occupational physician must have not only a sound clinical background but also knowledge of employment and anti-discrimination legislation, as well as of environmental and health and safety law.
Occupational physicians have to be able to identify, assess the risk to health of, and know how to control, workplace hazards and also know how to recognise, prevent and manage occupational disease.
In assessing for fitness for work, occupational physicians need to understand not only the health of the employee but also the workplace context – taking into account the workforce and the psychological and physical environment – and any implications this may have for the employee’s health.
Occupational physicians must be effective communicators. They work closely with occupational health nurses and with colleagues in primary and secondary care. They also have to be able to relate effectively to other health professionals such as occupational hygienists and ergonomists, as well as to management, trade unions and staff representatives in the workplace.
They need to be aware of the potential to promote health, by working with employers on improving workplace practices, and by working with employees on making lifestyle changes.

There is a strong evidence base showing that work is generally good for physical and mental health and well-being…The provisos are that account must be taken of the nature and quality of work and its social context; jobs should be safe and accommodating.
‘Is work good for your health and well-being?’ Evidence review by Professors Gordon Waddell and Kim Burton, 2006. Published by The Stationery Office (TSO) ISBN 978 0 11 703694 9.

Occupational physicians must have an understanding of epidemiology and disease prevention; they have a key role in assessing risks of workforce exposures to a wide range of hazards, and advising management on these risks and on their implications for employees’ health and for business continuity.
Occupational health is prominent on political and business agendas and there is currently a high level of demand for occupational physicians.

How do I train to become an occupational physician?

To train for this demanding but rewarding career, doctors are invited to join the Faculty of Occupational Medicine as Specialty Registrars (StRs). This is a faculty of the Royal College of Physicians of London, but has operated as an independent organisation since 1978, and is responsible for all higher specialist training in occupational medicine in the UK.
Higher specialist training is conducted in approved training posts and supervised by consultant occupational physicians, in an agreed training programme. Posts are available in the NHS, in a wide variety of industries and within the Defence Medical Services. StRs keep a personal training record and are subject to annual assessments by the Regional Postgraduate Dean – which must be satisfactory. Flexible training may be available, if arranged with the Regional Postgraduate Dean.

Occupational physicians typically deal with issues such as work-related stress, diseases caused by asbestos, noise induced hearing loss, occupational asthma and work related back pain. They are also centrally involved in assessments for fitness for work and for retirement on grounds of ill health.

Current changes to training

Major changes are underway in training for occupational medicine, as is the case with all medical specialties. In line with the changes being required of all medical training, by the Postgraduate Medical Education and Training Board (PMETB), training in occupational medicine is now competency based. Trainees will be assessed by a combination of work place based assessments, dissertation and a new examination system.
The length of the new training programme will be indicative, and acquisition of competencies, rather than completion of length of training, will be the goal. Doctors entering training in occupational medicine who can demonstrate appropriate competencies - and this will include, for instance, doctors who have completed general practitioner training - will not have to start from scratch but at an appropriate point.
However, all specialist trainees will have to pass two examinations and write a dissertation (or have already produced research of equal standing) in order to progress. In addition, trainees will undergo work place based assessments, which will be a mixture of formative and summative assessments. Summative assessments will inform the Deanery assessment process, the Annual Review of Competence Progression (ARCP) (previously called RITAs). There will be an exit examination in the final year.

The New Curriculum in Occupational Medicine

Changeover from the old to the new system

Doctors entering training in or after 1st August 2007 will operate under the new system.
Doctors who are already in training by 31 July 2007 will operate under the current regulations. However, there is provision for existing trainees to opt to move to the new curriculum. For further advice for existing trainees see Briefing for trainees registered before 1st August 2007.

How to apply

There are occupational medicine training posts in the NHS, in industry and in the Defence Medical Services.

Applications to the NHS

Doctors wishing to apply for training in the NHS will, for the most part, be recruited through the Medical Training Application Service (MTAS) system, which is a national system which recruits twice a year. For up to date information please see the NHS Modernising Medical Careers website. Once accepted into training, doctors are allocated a National Training Number - (NTN).

A small number of posts within the NHS are funded differently from the majority of NHS posts. Trainees entering these posts will be allocated a National Training Number (Industry) – (NTN(I)). Training posts in this category which recruited trainees through the NHS recruitment system, prior to the changes in training will, from now, recruit through MTAS, as set out in the paragraph above. NTN(I) posts, like all other posts, have to be formally approved by PMETB.

NHS NTN(I) training posts which previously recruited their trainees outwith the NHS system will continue to do so; that is, they will follow the pattern as set out for industry in the paragraph below.

Applications for posts in Industry

Doctors wishing to apply for a training post in industry will apply directly to the company which is providing the post. These posts are normally advertised in the BMJ. A Faculty of Occupational Medicine representative will attend the appointment panel. Once appointed by the company, the trainee will then have to have their appointment confirmed by a Deanery panel, which will allocate an NTN(I).

Applications for posts in the Defence Medical Services

Doctors wishing to apply for a training post in the Defence Medical Services must already be serving Medical Officers. Candidates selected by the DMS will be presented to a specialty training appointment committee arranged by the Defence Postgraduate Medical Deanery (DPMD) which includes external representation (usually from the West Midlands Deanery). DMS candidates will have to meet the same person specification requirements as their civilian counterparts. The training programme, in PMETB approved programmes, will follow the pattern required for civilian trainees whilst also meeting the needs of the DMS. Successful candidates will be awarded a DPMD NTN which will be held until they finish training; however if they leave the Armed Forces prior to completion of training the DPMD NTN will have to be relinquished.

Demonstrating an interest in occupational medicine

When applying to for specialist training, doctors should demonstrate an interest in occupational medicine. Examples of how this might be done are:

Evidence of recognition of the role of workplace exposures in generating ill health; this might be illustrated by clinical cases that have been managed in previous practice
Participation/interest in GP provision of occupational health services
Contact with/visits to local occupational health departments, occupational physicians, or the Regional Specialty Advisers
Readership of relevant journals, eg Occupational and Environmental Medicine, Occupational Health
Demonstration of awareness of workplace health issues of topical interest and current policy developments
Membership of the Society of Occupational Medicine

Person Specification for occupational medicine trainees

The Person Specification for occupational medicine trainees is currently being updated.

Further information

If you would like further information, please do get in touch. Contact David Greening at david.greening@facoccmed.ac.uk.