Modules for Pregraduate and Postgraduate Occupational Medicine education

Pregraduate and Postgraduate Occupational Medicine education

Hippocrate in the Health Faculty of the Panama National University

Bernardino Ramazzini

Introduction

The occupational medical practice include clinical patient assessment, exposure and clinical assessment, research and development, as well as teaching and other types of dissemination of scientific knowledge. Occupational medicine is a relatively new medical specialty and in many countries it is still not developed. In Panama, it is now officially recognized as a medical specialty and the education program is on the way. Critical thinking and asking questions about the patients occupation is significant in academics, research and especially important in occupational medicine. The basic question for the physicians is to ask the patient about his/her job and to pursue the causalities of the disease in order to propose prevention in the branch and for the patient.Evidence based medical practice is closely related to occupational medicine as an approach to clinical decision has gained considerable interest and influence during the decades in all medical specialties. The phrase 'evidence based medicine' originated in the 1980s as a way of describing the problem based learning approach[5] This module is part of this trilogy in order to develop research in health and develop society. This module aims to provide students with understanding and tools to describe and analyze how workplace risk factors determine and interact with the worker´s health. This is in order to be able to give adequate treatment, prevention, advice and to record the relevant data for research. Further to understand how the scientific research is always an integrated part of occupational medicine. The course shall provide insights on how to undertake clinical examination to identify work related health conditions of all types of patients and propose adequate prevention advice. The principle of the WHO: Preventive Healthcare the primal, the primary-, the secondary- and the tertiary prevention is the core issues of healthcare for patients and populations. More specifically the work history, risks at work, clinical, disease development, diagnosis, etiology, prognosis, treatment, population, prevention, health promotion, notification, rehabilitation, compensation, back to work are the core issues in occupational medicine like for other medical specialties. Though with much more focus on the work history and the risks at work. The course is in three parts: In the first part the students will learn about the occupational medical health examinations and some basic tools for scientific research. In the second part the invited clinical doctors from different medical specialties will present some clinical cases and show how occupational medicine is an integrated part of their medical specialty. In the third part the students will perform a group research task, a scientific literature review for the final exam. The content of the course is useful not only for clinical occupational medicine but for all medical specialties and for all other professionals in health. From the Hippocratic Oath: "That I will recognize the limits of my knowledge and pursue lifelong learning to better care for the sick and to prevent illness"

Preventive Occupational Medicine Keywords

• After having participated in the module the student should have learned:

1. That preventive healthcare, early diagnosis and health promotion is the highest priority
2. The legal obligations and the procedures for reporting occupational diseases
3. How to diagnose the most important occupational diseases in Panamá
4. The definitions of medicine, occupational medicine and occupational disease
5. The ILO list of occupational diseases and the list for Panama
6. The national incidence rates on occupational injuries and diseases
7. How to notify occupational diseases - underreporting --> Research:Medico familiarDerma, Psych
8. How other medical specialties are related: skin-, musculoskeletal-, mental-health , otolology and respiratory, etc. invited specialists
9. The ILO occupational health prevention and the Encyclopedia e-books for now and in your future work
10. How is scientific articles structured (IMRAD) search and read 10 articles of own interest
11. How an Occupational Medical clinical record is structured
12. How to integrate the PICO medical structure in the health prevention practice
13. How to use the Cochrane, PubMed and Google Scholar (Academico) for literature reviews (Prisma)
14. How to calculate the epidemiological incidence- and prevalence rates, relative risks and statistical confidence intervals with p-values
15. The basic statistics: how to calculate confidence intervals with p-values
16. How to assess the risks in the working environment by doing surveys with standard questionnaires
17. How to write a report from the survey by using the scientific structure (IMRAD) and STROBE checklist cross-sectional
18. How to do surveys in the workplace and the occupational medical knowledge Occupational Epidemiology Survey
19. In summary, will enable the students to work on a scientific base by writing their thesis and in their future job

The requirements like "should have learned" in the pre-graduated courses will be changed to "should be able to use, to carry out in practice etc" for the participants in the advanced post-graduate courses

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Teaching format

The module consists of

• Lectures
• Group work
• Students presentations
• Homework and reading

The teachers will advice the students where to find the best information, but the teachers cannot put the interest and knowledge into their brains. The students have to study by themselves ask important questions and work in the group to find solutions for their questions. Lectures will be followed by group work, exercises in the classroom and homework. Active participation is expected throughout the course. It is decisive for good results your active participation in the classroom continuous readings connected to the lectures. It’s also important to take take part in the class discussions. The workload, including student presentations, will be substantial.

Information technology requirements

• Classroom WIFI and projector
• Students´ smartphones and laptops/tablets

Study plan

Detailed study plan, click to open

PART 1 THEORETICAL	PART 2 CLINICAL	PART 3 RESEARCH
Day 1	Day 7	Day 13
Day 2	Day 8	Day 14
Day 3	Day 9	Day 15
Day 4	Day 10	Day 16
Day 5	Day 11	Day 17
Day 6	Day 12	Day 18

Selection of a JOB to study and describe

1. Each group selects one occupation of interest from the International Standard Classification of Occupations to study and describe.
2. Over the weeks (group work and homework) the group will study the occupational medical conditions of the selected occupation and present the results in a Power Point report in the |IMRAD style The report includes descriptions of: patient(s) clinical case(s), work history, diagnosis (optional more than one), etiologies, prognosis, treatment, population, risks at work, prevention, research (evidence)(prevalence, incidence, causality, prevention) notification, rehabilitation, compensation, back to work. (maximum 30 pages and 1500 words)

Group No and selected occupation	member1	member2	member3	member4	member5
Group 1:
Group 2:
Group 3:
Group 4:
Group 5:

Student presentations

Student presentations are obligatory and are elaborated by the groups of students. The teacher gives the topics and their distribution among the students. The student presentations aim at giving an overview of a selected topic from the field of clinical and population based occupational medicine. The presentations can be based upon parts of the obligatory readings supplemented by materials found by the students (typically internet materials). The oral presentation can take up to 15 minutes. In order to further the discussion another student will function as ‘discussant’. The role of the discussant is to give an assessment of the concerned presentation (including formal requirements), pose questions and inspire and conduct the following class discussion. Like other courses at the University of Panama, this module is based on ‘Activating Teaching & Active Learning’, which constitutes the core principles of education at the University of Panama: Students and teachers share the responsibility for implementing these principles throughout each programme. In the second part of the class, the students group work is search and present epidemiological literature on the patient category presented by the clinical lecturer. They will prepare a PPT for presentation in the third class hour 11-11:45. The students are requested to use the guidelines for good presentations PPT Presentations-Tips The students are requested to upload their presentations in the Dropbox after their presentation and in this way give an inspiring feed-back to the clinical lecturers.

Students

Together with teachers and fellow students at UP, the students are part of a binding learning community characterized by mutual respect, openness and commitment. Students show active involvement in class, independent studies and in collaborative work with other students. Students provide a full-time effort and continuously develop their ability to be independent and take responsibility for their own academic development. They are proactive, eager to explore and ready to learn.

Lecturers

The lecturers at UP are responsible for planning and implementing teaching and learning activities that support students’ active learning, both inside and outside the lecture room. The planning of the teaching reflects the lecturers’ high academic and professional level and their clear focus on the learning objectives of each module and the program. Teachers´ support, guide and challenge students in a learning community characterised by mutual respect, openness and commitment.

Feedback and evaluation

Students at the Faculty of Health Science continuously receive feedback in various forms. The types of feedback that students can expect to receive when participating in the module take various forms. This may involve direct oral or written feedback from teachers on assignments, oral feedback from teachers on questions posed during seminars, different forms of peer feedback including feedback on written assignments and oral presentations. Immediately after the oral examination students always receive feedback by the examiners. Furthermore their peers will provide feedback on assignments and oral presentations throughout the module using different assessment tools including surveys. In the first part the surveys will be used to evaluate the gab of knowledge at start and what has been obtained at the end. The ppts produced by the students in the second and third part gives feedback to the invited teachers and the module responsible teacher and the faculty. Also the teaching form with English and Spanish will be evaluated by the students to have a continuously improvement of the teaching. In this first planned module there are no equirements of grade for the student's. There will be a group based feed back on the research tasks and the activity: 1) assessment of the working environment in a selected job category 2) assessment of a review of some articles about a work-related disorder. This will be held in the last weeks of the course. The students´completed research tasks in the scientific form, a Thesis, can be published in different media, one is this one: http://www.u488424.mono.net/ Public- Occupational and Environmental Health]

Textbooks and other teaching materials

There is no need for buying a book(s). The reading materials for a start are selected parts of the below cited materials:

• Tropical Occupational Medicine - in Developing Countries ´
• ILO Occupational Health prevention
• ILO Encyclopaedia of occupational health and safety

The students are invited to edit and make corrections in the Wikibook and/or translate some chapters to Spanish. To do that, just create your own username and password an then you are ready to work. The lecturer of the course will give detailed readings for each lecture in the e-ducativa learning programs and the Wikibook Students are advised to visit the respective uploaded articles in the library of the programs. There is a collection of relevant references for the module.

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Research tools

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The development of the sciences is necessary in a modern society. This includes research training in universities, research-based teaching in universities and the establishment of research centers and scientific journals. This module is part of this trilogy in order to develop research in health to develop the society. Over time the health professionals should acquire skills in 1) epidemiology, 2) evidence based medicine, 3) the use of electronic tools like Epi-data, Zotero, Epi-info, Excel and Spss 4) reading English articles 5) train to present good power points. Besides they must have a deep interests to solve the health problems by research and have ideas on how to get valid data: 1) a sample of original new data from questionnaires or registers 2) data collected for a planned master's thesis 3) data from of a finished master thesis to be re-analyzed and edited for publication as a scientific article or a letter to the Editor. Training on how to do and how to use the research is available in many countries in different levels. The fundamental aims of the PhD studies are to train doctoral researchers, carry out research and write a doctoral thesis In the Nordic countries in medicine are 180 ECTS, 3 years full time with 3 international published articles. Others countries have less academic requirements and some even do not require published international peer reviewed articles. The master courses include research training in some countries, but lamost nothing in developing countries. Many students in the Spanish maritime master courses have finalised their tesis with an articles published in Medicina maritima. For maritime health professionals, there are many ways to acquire research skills over time. A research training time-span can be composed of different modules from different universities. Most important is your own ideas and dedication for your planned studies and if this is the first time, always contact experienced scientists.

1. How to write a flawless manuscript
2. Standard questionnaires in English
3. Standard questionnaires in Spanish
4. The PRISMA Statement
5. The STROBE statement
6. Checklist/STROBE cross-sectional
7. STROBE Statement checklists English
8. The EQUATOR -network CLINCAL CASE reporting-guidelines

Student learning activities

The students are expected to:

• Actively participate in the lectures, group work and presentations in the classroom
• Read the basic relevant text books chapters as well as the additional reading given by the instructor
• Prepare for the group work and in classroom exercises
• Prepare and present a relevant to the module topic
• Prepare the questions and facilitate the classroom discussions on the topic
• Use designated tools for peer assessment and feedback

Seafarer on board a ship.

Miraflores locks in the Panama Canal

Content of the classes

Introduction to the Occup Medical WikiBook / make the mail lists and working groups 2-5 in each Head of the occupational medical association in Panama will come and tell why the students should choose occupational medicine/health and the possibilities for work E-ducativa and first survey about what they are going to choose as a specialty How to search the scientific literature – using PubMed and Google Scholar Zotero Dropbox

Invited clinical lecturers

Among other specialist:

• Maritime medicine
• Ortopedic
• Psychiatry
• Dermatology
• Other...

Home work

The homework is mainly dedicated to run over the materials used in the lectures and the group work to get feedback in the classes.

Guidelines for the invited lecturers to prepare 1-2 clinical-case lectures

The invited guest teachers select 1-2 patients for a systematic presentation. A power point template is available for preparing their presentations in a systematic way: Template for clinical case PPTx presentation. Further inspiration for a systematic desciption of the clinical cases is here 'The occupational medical patient record ' All the description for a patient, should be 200-500 words + pictures and tables as the basis for the oral lecture. The occupational medical record often describes shortly the patient's whole life context from the cradle to the current situation. For children, the mother's Exposures during pregnancy can have negative impact on the fetal development and the child's later development. The description of each patient goes over the lifetime from childhood, schooling, and work, with particular attention to the special hazardous effects through life that could be the cause of the disease. Further, please include the need for reporting as a occupational disease and the scientific evidence on the link between some hazardous exposures in the life (work and home) and the development of the disease. How many cases are reported in Panama per year as occupational disease with the selected diagnosis? The invited guest teachers will have 30 minutes to present the clinical cases and to talk on how occupational medicine is part of his/her clinical specialty. Then follows 15 minutes with questions and discussions with the students, about the work and home risk factors for the development of the disease, the prognosis and the possibility for the patient to return to his/her habitual professional and workplace. The students will continue with part 2 of the class, the group work to search and present epidemiological literature on the same type of patients and prepare a PPT for presentation in the last class hour 11-11:45. As it is one of the aim is to inspire the students to produce good ppt presentations, the guest teachers are requested to be good models and to use guidelines for good presentations like this:

• Presentations-Tips
• The invited lecturers are kindly requested to upload their pptx (or in PDF for large files) in a Dropbox one week before their classroom lecture [https://www.dropbox.com/home

Ergonomic Nordic questionnaire