American College of Occupational and Environmental Medicine Competencies—2008

The American College of Occupational and Environmental Medicine (ACOEM) recognized the need for defining important competencies for occupational and environmental medicine (OEM) physicians and in 1998 published its original set of OEM competencies. With medical advances and evolving issues of international and national importance, these competencies have been updated. Basic competencies set the minimum expectations for physicians. Although being competent in a subject may not mean that it is a current element of an individual physician’s practice, the physician must have the knowledge base and skill so that they could include it in their practice. Continued medical education is expected of all physicians, and directing their efforts to state-of-the-art OEM is crucial. The listing of competencies by ACOEM assists practicing physicians in their efforts to keep current and to serve as knowledgeable representatives of the specialty. For the purpose of this document, competency is defined as “possession of sufficient physical, intellectual, and behavioral qualifications (ie, knowledge, skills, abilities, and attitudes) to perform a task or serve in a role which adequately accomplishes a desired outcome.” In order for OEM physicians to have a solid identity for employers, government agencies, health care organizations, and other health practitioners, a short list of core competencies is essential. This document presents a list of 10 core competencies that identify the areas of medicine that are the basis of the OEM specialty. The core competencies identify broad definitions of content that must be further clarified. A listing of the skills that would be expected with each competency is crucial. Because of the diversity of OEM practitioners, there are a host of skills that define the specialty. This approach of identifying core competencies accompanied by extensive clarification will provide assistance to training programs as well as to those organizations and businesses that will be starting or expanding occupational and environmental services. The process used to arrive at the competencies was straightforward. The committee that developed this document represents diverse practices including academics, corporate, private practice, government, and residency directors. The OEM competencies in use by other organizations and countries were evaluated, as well as other current publications as outlined in the reference materials. Input was sought by experts in specific content area. A physician specializing in OEM is expected to be competent in all 10 core competencies, whereas a non-OEM physician may have a few of the listed skills. In addition to the specific OEM competencies, there are important skills that those practicing OEM may obtain but that are not an aspect of the basic foundation of OEM. Competencies that are expected of all physicians are also separated out from the OEM specific competencies. The 10 core competencies are listed and defined on the next few pages. The ACOEM 10 Core Competencies Clinical OEM OEM-related law and regulations Environmental health Work fitness and disability integration Toxicology Hazard recognition, evaluation, and control Disaster preparedness and emergency management Health and productivity Public health, surveillance, and disease prevention OEM-related management and administration Core Competencies Defined Clinical OEM. The physician has the knowledge and skills to provide evidence-based clinical evaluation and treatment for injuries and illnesses that are occupationally or environmentally related. OEM Related Law and Regulations. The physician has the knowledge and skills necessary to comply with regulations important to occupational and environmental health. This most often includes those regulations essential to workers’ compensation, accommodation of disabilities, public health, worker safety, and environmental health and safety. Environmental Health. The physician has the knowledge and skills necessary to recognize potential environmental causes of concern to the individual as well as to community health. Environmental issues most often include air, water, or ground contamination by natural or artificial pollutants. The physician has knowledge of the health effects of the broad physical and social environment, which includes housing, urban development, land use and transportation, industry, and agriculture. Work Fitness and Disability Integration. The physician has the knowledge and skills to determine whether a worker can safely be at work and complete required job tasks. The physician has the knowledge and skills necessary to provide guidance to the employee and employer when there is a need for integration of an employee with a disability into the workplace. Toxicology. The physician has the knowledge and skills to recognize, evaluate, and treat exposures to toxins at work or in the general environment. This most often includes interpretation of laboratory or environmental monitoring test results as well as applying toxicokinetic data. Hazard Recognition, Evaluation, and Control. The physician has the knowledge and skills necessary to assess whether there is risk of an adverse event from exposure to physical, chemical, or biological hazards in the workplace or environment. If there is a risk with exposure, then that risk can be characterized with recommendations for control measures. Disaster Preparedness and Emergency Management. The physician has the knowledge and skills to plan for mitigation of, response to, and recovery from disasters at specific worksite as well as for the community at large. Emergency management most often includes resource mobilization, risk communication, and collaboration with local, state, or federal agencies. Health and Productivity. A physician will be able to identify and address individual and organizational factors in the workplace to optimize the health of the worker and enhance productivity. These issues most often include absenteeism, presenteeism, health enhancement, and population health management. Public Health, Surveillance, and Disease Prevention. The physician has the knowledge and skill to develop, evaluate, and manage medical surveillance programs for the workplace as well as the general public. The physician has the knowledge and skills to apply primary, secondary, and tertiary preventive methods. OEM Related Management and Administration. The physician has the administrative and management knowledge and skills to plan, design, implement, manage, and evaluate comprehensive occupational and environmental health programs and projects. ACOEM OEM Core Competencies and Skill Sets Defined Clinical OEM The physician has the knowledge and skills to provide evidence-based clinical evaluation and treatment for injuries and illnesses that are occupationally or environmentally related. The physician provides clinical care with an understanding of the workplace, work exposures, and relevant statutes, such as workers’ compensation. Throughout the course of care, the physician seeks to maximize the patient’s functional as well as with an on and the potential and occupational or environmental and manage occupational or environmental illnesses and injuries with the use of in when or factors that may to occupational or environmental disease or and or manage with occupational or environmental injuries and exposures and a risk all to and to organizations and as medical for the health and of and clinical in of and manage injuries with physical hazards including and and and with risk factors and disease may in and in OEM physicians employers, care physicians and in the and tertiary prevention of as well as the accommodation of with The of the OEM physician is in in such as emergency and evaluate, and manage the effects of such as and a to perform work a event such as a or Occupational are of the causes of occupational disease in the also as a of exposure to in the environment. OEM physicians can provide recognition, and management of these and necessary recommendations to their in the workplace and at occupational by and and determine the of those by such as and as well as including to exposure to and occupational including occupational as by or occupational including occupational and environmental injuries and and of including those by and occupational and in may be required to Medicine and The OEM physician has the knowledge and skill to provide medical care for a of injuries and as well as to and for emergency emergency and for the clinical management of in including and medical management and emergency care for or other the of a specific exposure and manage the of Occupational and environmental exposures may have potential to adverse effects or may be The OEM physician has the knowledge and skills to evaluate, and the and effects of occupational and environmental laboratory in the of medical surveillance and clinical to the health effects of exposure to toxins such as and clinical and exposure to in of occupational or environmental and for and in occupational or environmental and preventive by the OEM physician can their health and manage, and and exposure and manage, and of manage, and and injuries a of the occupational injuries by the OEM physician and and for and understanding of the and of the as well as and management skills, are essential. OEM physicians are able to clinical with functional in to of and the of and the OEM physician to the of programs to these and comprehensive including the physical laboratory and the of occupational risk in the evaluation of with evidence-based manage, and and and their disabilities, and determine when such are manage, and including manage, and with to of and and occupational and risk manage, and and injuries and and for an recovery and manage Occupational and environmental exposures can and effects on the and The OEM physician has the skills and knowledge to evaluate, and and to the of with and in the evaluation of occupational or environmental injuries or and the results of and or in the evaluation of occupational or environmental injuries or may include or The OEM physician has the clinical and administrative knowledge and skills to evaluate and treat occupational and and and use from the such as to in the of the need for and surveillance and treat occupational and injuries and to an when and manage and and treat and from the with care as and treat exposures and and to evaluate the when The OEM physician has the clinical knowledge and skills to evaluate, and manage the care of with occupational and environmental and manage or by occupational and environmental exposure, including and and manage a with or other occupationally manage, and further to with and manage with to, or the use of and an identify a and treatment and preventive The OEM physician has the clinical and administrative knowledge and skill to recognize, evaluate, and in the management or of with or in the workplace and to identify occupational and environmental factors that may the or employee and manage or to community including employee assistance and of the or manage the and in the of prevention and response and manage may be the of at work exposure, and in the management of in the workplace. With a understanding of the and of the the OEM physician is able to assess the causes and occupational of and treat and occupational or environmental including the Occupational and exposure to workers’ of work for occupational and and a to American and For the of occupational or order and the including the and in the of in the of and specific in the of disability in the of results by an to the workplace exposures, to the of the and to the of The OEM physician has the clinical knowledge and skill to of occupational and environmental the effects of exposure and work on and the and the of the worker to perform potential adverse to and from chemical, physical, and exposures and provide to and the management of such and of Law and The OEM physician with and has the knowledge and skills to organizations into with and federal regulations to as well as general public health The physician is further able to the of government to the of worker and public health. The OEM physician is a recognized on issues to the of occupational and environmental injuries and as well as the to perform work with or a the physician is on to provide to that an on and to provide with and as well as their interpretation and to employers, and Occupational and Health including the and regulations the of with with of regulations including those of and regulations Environmental regulations federal regulations and regulations to the of employee or community regulations and their to and to of medical and address in the of relevant such as the of Occupational and Environmental on Occupational Health, and American of employers, and their representatives on the issues and the that apply to the of OEM. and the basic of workers’ complete the necessary and workers’ of occupational and to and and on OEM on and to the of for and and for the of or the of an employee or in assistance from a government or in a Environmental Health The physician has the knowledge and skills necessary to recognize potential chemical, physical, and biological environmental causes of health concern to the individual as well as to community health. Environmental issues most often include air, water, or ground contamination by natural or artificial pollutants. The physician has knowledge of the health effects of the broad physical and social environment, which includes housing, urban development, land use and transportation, industry, and agriculture. and of environmental exposure and of environmental health and manage population exposure to environmental toxins and manage the health effects of exposure to water, and and health the health and for including and and health health with exposure to the with and control the health with exposure to and the effects with or exposure to or environmental and the of environmental health effects with air, water, or ground contamination by natural or artificial pollutants. and the results of environmental Work Fitness and Disability The physician has the knowledge and skills to determine whether a worker can safely be at work and complete required job tasks. The physician has the knowledge and skills necessary to provide guidance to the employee and employer when there is a need for integration of an employee with a disability into the workplace. The OEM physician has the to determine work fitness on the work of the worker and the functional of the and of disability prevention and management. for of the employee and the risk factors for in the and apply for the of to identify and manage the of and on the natural of and and manage recommendations for or for preventive for and for and at work and to work and to evaluate for an risk to or in the workplace, in with the and clinical as well as or accommodation recommendations to the of as defined the into work functional for the use of in in in required by relevant or for with medical such as such as including of such as and to determine fitness for in with regulations including the fitness for and clinical for with potential for exposures to include the work or work that the other physical such as biological and other or concern is of in with the American to the of and job for and manage the of on to work and on the natural of occupational and environmental illnesses and a and and perform a and for with in with the and for and treat or with or as other medical Toxicology The physician has the knowledge and skills to recognize, evaluate, and treat exposures to toxins at work or in the general environment. This most often includes interpretation of laboratory or environmental monitoring test results as well as applying toxicokinetic data. exposures at at and in the general environment. Clinical as well as knowledge of the OEM physician to manage, and occupational and environmental of clinical and medical management. the and of potential occupational and environmental exposures, of exposure and of and of of to identify the of the physical of or the of on of exposure, factors such as the of the the of exposure, exposures, and of the as or clinical effects from exposure and preventive measures. and evaluate or other to assess exposure and health including biological monitoring that the its or other clinical or of when exposure is and health may be by or with occupational and environmental the exposure on the basis of clinical and health effects and from exposure and obtain necessary medical care and preventive for by and environmental with in the of exposure including exposure and other data. the of exposure to exposure in the of the and and the patient’s and be able to apply toxicokinetic and to clinical and whether a has a health that risk from the effects of exposure to chemical, physical, or biological health effects of exposure to from other occupational and environmental to a or to the health effects of a and apply the and environmental Hazard Recognition, Evaluation, and The physician has the knowledge and skills necessary to assess whether there is risk of an adverse event from exposure to physical, chemical, or biological hazards in the workplace or environment. If there is a risk with exposure, then that risk can be characterized with recommendations for control measures. The OEM physician has the knowledge and skills to evaluate the of such exposures on the health of individual and the public. The physician may with other such as and occupational health on such and potential occupational and environmental hazards defined a workplace of occupational health and an environmental and the results of and apply exposure the American of and exposure Environmental and other in the of and physical to optimize and risk at including evaluation and of and with and such as work and and and control to or and health and exposure to and exposure to the of a and health and manage health effects with and the hazards of and and manage a for to and the use of programs to comply with the and with the management of the effects of and other a risk the basic of risk health of to including health the and the in a and and in the of risk from or potential hazards and the for and to a or of and to an of and to exposure or exposure to materials. the health of environmental including exposure, and with by and other environmental and the with the workplace and for potential hazards and address the need for and other exposure control methods. and control occupational or environmental risk factors for the of the workplace for potential hazards to the and address issues of including the use of and the of a the for and these with job and job hazards in fitness for and Disaster Preparedness and Emergency Management The physician has the knowledge and skills to plan for mitigation of, response to, and recovery from disasters at specific worksite as well as for the community at large. Emergency management most often includes resource mobilization, risk communication, and collaboration with local, state, or federal agencies. specific including a broad of chemical, and physical on Preparedness and Emergency Management as a Core in Occupational and Environmental knowledge of and other to health and the skills to evaluate the of at the individual and a plan for for the and a plan for the health of the in the of emergency or for the workplace and the knowledge of occupational the workplace, and community work with medical and community in an response emergency response from treatment for a specific to and community for and a plan for the mitigation of a at the worksite or general emergency and for the clinical management of in including specific medical management and a medical recovery plan for in or general and an or a preparedness plan for an a understanding of the and Health and A physician will be able to identify and address individual and organizational factors in the workplace to optimize the health of the worker and enhance productivity. These issues most often include absenteeism, presenteeism, health enhancement, and population health management. and evaluate worksite health and disease prevention of Health and and other as the use and of health risk and for well and the of and for health and current and other knowledge to including employers, community and the the effects of and social including health and on the health and of and when on occupational disease and health Public Health, Surveillance, and Disease The physician has the knowledge and skill to develop, evaluate, and manage medical surveillance programs for the workplace as well as the general public. The physician has the knowledge and skills to apply primary, secondary, and tertiary preventive methods. implement, evaluate, and programs for to identify for disease or and to the population to identify exposures, risk and of the of the programs and of care that all of a including those at risk and those not and surveillance programs in workplace and community and medical surveillance programs in the workplace and in to environmental to identify exposure, of the and results in clinical and public health and medical surveillance programs in the workplace to with regulations when specific work such as specific for prevention of occupational such as and results in fitness for in occupational such as for and in response to when to health laboratory in and further evaluation and treatment as the of surveillance and and potential and the public health and clinical of that address occupational and and to or in a defined worker and community individual or to or exposure and health the population to identify or areas for prevention and and a or plan for the the of and and control to address of Management and The OEM physician has the administrative and management knowledge and skills to plan, design, implement, manage, and evaluate comprehensive occupational or environmental health and that enhance the health, safety, and productivity of their and of the The of may on the physician’s and the of the implement, and evaluate clinical management and and other to enhance an potential and a plan for an occupational or environmental health and clinical to and to employers, and on occupational and environmental health and management and apply medical health and care management and other to an OEM to medical surveillance programs clinical and and to worker disability and to to manage medical and exposure to manage and including and for of occupational and environmental health services. and to with and to as well as to manage and to manage and Work as a with occupational health practitioners, and physician an understanding of their in an occupational health for workers’ compensation, health and disability management programs to and manage clinical and necessary and data. or individual in the the of occupational health and risk methods. and process and and be able to with other of process Work with and management to maximize workplace health, safety, and productivity. of OEM are other skills that are in the OEM physician The OEM physician may need to complete training or in These other skills may include the and The of medicine and the to If an OEM physician in or the and of and education are required to be OEM physician would from practicing these skills to the knowledge of occupational and environmental to current and and to this knowledge in to and a a a and apply methods. and or when and necessary and for and results in and and the of the a for a a and evaluate and and clinical for a of of in a for a of and and Clinical OEM physician may competency in other clinical skills to enhance the of their medical practice. may be by such as residency education or a to evaluate with and other test from a and use as a basis for the and of and other and or use a to evaluate that may be work or related. medical to assess functional manage, and and or for when to evaluate fitness for Management and The OEM physician may be in a role that management or administrative skills. This is for those OEM physicians are in a or a but are also an element of practice. the of care and other and on the health of employee and and and organizational management in and management. with employers, and in the health, and of their and management in and of and in risk for a health care and to or of a plan for an occupational health or an or and a an for an occupational or environmental health or and for an occupational or environmental health and required by an occupational or environmental health a for occupational health including and implement, and evaluate medical as as an listing of the specific competencies of the can be from the at of the competencies specific to ACOEM has expectations that an OEM physician will a of in those areas of medical that would be a basic foundation of for specialty. skills are as they would to the of OEM. and and occupational can an and to health, and The OEM physician medical and to and to enhance safety, health, and productivity in the of individual health and social with employers, and other to an with the health is by a exposure or that or health may be by and issues that to and in and environmental The OEM physician with employers, and in the community on issues to the workplace, and the community environment. The and of the OEM physician must and the and competencies of the specialty. of risk management to the of OEM. that their medical their and their work (ie, and and the of of and employee including and with representatives on that and from clinical all and surveillance in the of the medical and occupational including for or and so in a with physicians that is to on important clinical use and of when and understanding they apply their with with a understanding of when a and when it when a with or and a a with the physician in the management of health and In addition to clinical skills, the physician is expected to have basic skills that are in each clinical to provide clinical care of the complete or physical as by the for the clinical in the evaluation of with an understanding of the for such results and for as and treat medical evidence-based medical when to medical and and provide medical and care in an emergency as a for occupational or environmental into clinical care and health with an of and social knowledge, and and The OEM physician is expected to by a of of current state-of-the-art This knowledge be to the of medicine by the OEM current and knowledge, and and as and the and of and process a and for and results in and American College of Occupational and Environmental Occupational and environmental medicine Occupational medicine physicians in the and core competencies. A of occupational health competencies and Health. for the of occupational knowledge, and for training and education in occupational Occupational and Environmental A to the public health from in preventive medicine and The Occupational and Health training for a Health Occupational Medicine in and The for and Clinical Medicine and Medicine ACOEM of Core in Occupational ACOEM and other ACOEM including and and training from the of at the of and the of at in Public Health Core of of Public Health by used with the of the 1998 competencies, including the of Medicine the and of in an occupational and environmental medicine residency Core Occupational and Environmental from the for Medicine Core for Occupational Environmental and occupational medicine competencies A for Medicine The of and Management Competencies of Medicine and of in Core in Environmental Medicine in Basic in Occupational Medicine and of and to Disease and Health of of This document was developed by the ACOEM on and and was by the ACOEM of on The on OEM Competencies and the OEM for their The also this by the committee at the of and it to