Master of Medicine in Occupational Medicine

Purpose

The purpose of the qualification is to equip a basically qualified medical doctor (with a Bachelor of Medicine and Bachelor of Surgery, Level 8 or equivalent qualification) with specialised knowledge as well as the skills and attitudes required from a specialist in occupational medicine in agreement with the requirements of the Professional Board of the HPCSA, in order for the graduate to be able to function as an independent practitioner in the relevant speciality within any service providing and academic environment. This will allow learners to study occupational medicine at greater depth and in greater breadth with a particular emphasis on developing them as competent clinicians than is possible with existent qualifications at the postgraduate diploma level.

The (second) purpose is to, in accordance with the strategic framework of the University of Cape Town and its Health Science Faculty, to produce professionals that will, in a conscientious manner deliver comprehensive health care to the patient as an individual and as a member of society.

Rationale

This qualification forms part of the credentialing process, for health professionals, principally medical professionals, as practitioners in occupational medicine. The Occupational Health and Safety Act stipulates training at the level of a Postgraduate Diploma or higher as a requirement for practice in occupational medicine in South Africa.

The PG Diploma is also recognised by the Health Professional Council of South Africa as an additional qualification, although it is not equivalent to a registrable speciality in Occupational Medicine. It is envisaged that the new M Med will also be recordable as an additional qualification.

The proposed qualification will incorporate an important part of the formal training requirements for the new speciality of the qualification), which was recently gazetted (26 March 2005, Gazette 26161). The MMed qualification is also aimed at those wishing to pursue an academic career trajectory in occupational medicine research and is intended to be a stepping stone for doctoral studies in the field. The aim of this qualification is to meet the needs for formal examination certification, as well as to set standards, nationally, for such a qualification (equivalent qualifications may be offered by the country's 8 medical schools).

Recognition of Prior Learning

An applicant who has other qualifications or prior experience which have provided the applicant with a level of competence which is deemed by Senate to be sufficient for the purpose of study in the programme. The programme is designed for qualified medical practitioners holding an MBChB or equivalent qualification. Two years of supervised medical practice. This may include the internship year, and the year of compulsory community service. Learners are required to have some experience in occupational health practice and to have access to a workplace as a medical practitioner providing or managing occupational health services or inspection.An applicant who has other qualifications or prior experience which have provided the applicant with a level of competence which is deemed by Senate to be sufficient for the purpose of study in the programme.

Entry requirements

The minimum entry requirement for this qualification is

• Bachelor of Medicine and Bachelor of Surgery, Level 8.

Level, credits and learning components assigned to the Qualification.

NQF Level: 8.

Qualification type: Masters Qualification.

Designation: Occupational Medicine.

Qualifier: Master of Medicine.

Expected minimum time for completion: 4 years (full-time).

Number of credits: 440

Breakdown of NQF credits at different levels

• Fundamental: 204.
• Core: 88.
• Elective: 148.

Total: 440.

Programme Structure.

Module Names; NQF Level; Credits

1. Introductory Occupational Epidemiology and Biostatistics; NQF Level 8; 8 Credits.
2. Advanced Occupational Epidemiology; NQF Level 8; 8 Credits.
3. Occupational Health Practice Management; NQF Level 8; 8 Credits.
4. Occupational Hygiene - hazards, measurement and exposure standards; NQF Level 8; 8 Credits.
5. Occupational toxicology and Occupational medicine I; NQF Level 8; 8 Credits.
6. Occupational medicine II; NQF Level 8; 8 Credits.
7. Occupational medicine III; NQF Level 8; 8 Credits.
8. Social and Behavioural aspects of occupational health; NQF Level 8; 8 Credits.
9. Environmental health; NQF Level 8; 8 Credits.
10. Research methods in occupational health; NQF Level 8; 8 Credits.
11. Special issues in occupational health; NQF Level 8; 8 Credits.
12. Supervised clinical/industry attachments; 124 Credits.
13. Short report; NQF Level 8; 16 Credits.
14. Dissertation; NQF Level 8; 64 Credits.
15. Electives; NQF Level 8; 148 Credits.

1. Is a sound clinician, and is able to

• Exercise competence in all aspects, including examination, diagnosis, management and/or appropriate referral, of work related disease or disability or threats to health and well-being.
• These should cover work-related respiratory, dermatology, musculoskeletal, ENT, ophthalmology, neurology, reproductive, cardiology, haematology, and psychiatric and infectious conditions.
• Interpret chest radiology, lung function testing, bronchial challenge testing, audiometry, toxicological testing, vision screening, hematological and biochemical testing, testing of infection and immune function, allergy testing, and patch testing.
• Refer appropriately those conditions requiring further investigation and management.
• Assess, manage and/or refer occupational trauma and workplace emergencies.
• Counsel and/or refer employees with substance abuse and other psychosocial problems affecting work capacity.
• Advise on immunisation and prophylaxis against infectious disease arising from or affecting work, including employee travel and migrant labour.
• Assess, manage and/or refer common adult primary care problems.

2. Has special competence in medical surveillance and biological monitoring, and is able to

• Design medical surveillance programmes.
• Set up surveillance and biological monitoring protocols, including liaison with laboratories.
• Apply and interpret specific tests.
• Evaluate cost-effectiveness of medical surveillance and biological monitoring protocols.

3. Has special competence in health risk assessment, and is able to

• Understand definitions of "risk assessment" as used in different contexts, viz. workplace, epidemiological, toxicological, accident/disaster and environmental contexts.
• Conduct a workplace health risk assessment in a wide range of workplaces, and integrate relevant data from a variety of sources.
• Able to assess workplace conditions against relevant standards and regulations.

4. Has special competence in occupational health service design and audit, and is able to

• Understand the array of potential functions of a workplace based health service and to design and organise optimal mix for different contexts, including first aid, primary care, and occupational health components.
• Link the occupational health service to existing safety, environment, human resources and other management subsystems in the organisation.
• Apply quality assurance methods to occupational health services.
• Apply common audit procedures to occupational health and safety systems, and assist in preparation for such audits.

5. Has special competence in occupational health and safety law, and is able to

• Advise others on and apply the main laws in occupational health and safety, and other laws of relevance to occupational health.
• Work with lawyers on matters of civil law pertaining to occupational health.

1. Has special competence in fitness, impairment and disability assessment and workplace accommodation and disability management, and is able to:

• Assess the fitness of workers for particular jobs.
• Assess fitness requirements for high risk jobs, viz, miners, drivers, seafarers, pilots and divers.
• Assess or arrange assessment of workers with impairment and/or disability, including problems related to drug and alcohol dependency, psychotropic medication use, psychiatric problems and post-traumatic stress disorder.
• Counsel, and assist accommodation if necessary, of pregnant workers.
• Initiate and manage processes for rehabilitation of disabled workers.
• Apply understanding of the impact of any chronic or recurrent condition on work ability, and advice on any accommodation required.
• Follow procedures for compensating occupational disease and injury, and advice on medical aspects of claims procedures.
• Follow procedures required for disability retirement processes, and contribute medical advice and expertise to assist resolution of claims.

7. Has special competence in ethics in occupational health, and is able to

• Assert the importance of ethical approaches in occupational medicine in the face of conflicts of interest.
• Advise others on ethical principles and practice with regard to subjects such as confidentiality, sickness certification, HIV screening, drug and alcohol screening and consent for surveillance.
• Contribute practically to the resolution of potential or actual conflicts with medical ethical and medico-legal dimensions.

1. Has a sound knowledge of health promotion and management of common community and lifestyle diseases in the workplace, and is able to:

• Apply the principles of health promotion.
• Develop health promotion programmes for specific conditions, including HIV, TB, STDs, tobacco and alcohol related conditions.
• Manage, in collaboration with other services, conditions requiring an interdisciplinary approach such as substance abuse, stress ailments, mental illness, and cardiovascular disease.

9. Has a sound knowledge of epidemiology and research method and is able to

• Apply the principles of epidemiological measurement, study design and causal inference.
• Initiate and draft a research protocol.
• Appraise critically occupational health and medical literature.
• Participate in workplace based epidemiological studies, including sentinel and cluster investigations, aetiologic and intervention studies and formal health services evaluation.
• Handle, analyse and interpret data, with support from appropriate specialists.

10. Is familiar with the discipline of Occupational Hygiene, and is able to

• Apply the basic principles of occupational hygiene, including measurement, control and evaluation.
• Interpret and apply data and recommendations from occupational hygiene reports.
• Characterise the common hazards in a wide range of production processes found in South Africa.
• Advise on practical control systems for air pollutants, skin irritants, noise, heat, etc.
• Advise on personal protective equipment and its limitations.

11. Is familiar with the discipline of Toxicology, and is able to

• Apply the basic principles of occupational toxicology.
• Extract and use toxicological information.
• Interpret material safety data sheets.
• Communicate relevant toxicological information to a lay audience.

12. Is familiar with the discipline of Ergonomics, and is able to

• Apply the basic principles of ergonomics.
• Carry out a basic ergonomic risk assessment.
• Advise on common control strategies to prevent ergonomically related injuries or ill health.

13. Has an understanding of Industrial Relations, and is able to

• Apply the basic principles of industrial relations within the relevant institutional and workplace framework.
• Contribute constructively and ethically to resolution of industrial relations conflicts involving health matters.

14. Is a competent Manager of operations, and is able to

• Write and revise strategic and operational plans, including budgets and procedures, for occupational health services or operating units.
• To plan, organise, staff, finance, monitor and control an occupational health service or other operating unit.
• Chair, direct and contribute to committee work.

15. Has an understanding of health care delivery systems and benefits management, and is able to

• Understand the structure and dynamics of health care delivery and financing in South Africa.
• Contribute to health care and benefits policies of organisations.

16. Has an understanding of information systems, and is able to

• Demonstrate computer literacy.
• Use the internet and electronic and paper databases for information retrieval.
• Design clinic, workplace, company or regional record/health information system for management, covering injuries and illnesses.
• Use an information system to evaluate health and safety performance or clinical service.

17. Is competent in adult education and training, and is able to

• Apply the principles of adult education and learning.
• Prepare training materials for a variety of audiences.
• Conduct training seminars for a variety of audiences.
• Evaluate training sessions and materials.

18. Is a competent communicator, and is able to

• Communicate individually and in group situations with all participants in workplace organisations and occupational health: management, employees, union representatives and fellow professionals.
• Write clear and concise documents: proposals, policies, reports.
• Communicate risk information.

19. Has an understanding of Environmental Management, and is able to

• Contribute to environmental impact assessment.
• Contribute to the environmental component of a safety, health and environment policy for workplaces (or regions or districts).
• Communicate with representatives of residents/third party groups affected by workplace operations.

20. Has an understanding of Disaster Management, and is able to

• Contribute to a disaster management plan tailored to the workplace, including provision for mass exposure and casualty scenarios.

Critical Cross-Field Outcomes

Demonstrates in practice an interdisciplinary or holistic perspective, and is able to

• Integrate perspectives and skills from a variety of disciplines in medicine, public health, management, law and social sciences, in problem solving at individual, group or organisational level, through critical appraisal of the state of current the knowledge and discourse on occupational health issues.
• Work effectively with a range of professionals and practitioners engaged in occupational health.
• Reflect in problem solving an in-depth understanding of the institutional, legal, and ethical context of occupational medical and occupational health problems.
• Demonstrate good leadership skills where these may be required for the candidate's future professional work situation.
• Demonstrate good leadership skills where these may be required for the learner's future professional work situation.
• Communicate effectively using written and oral methods.
• Use science and technology responsibly and ethically.
• Plan and execute occupational health interventions effectively.

Integrated Assessment

Learners on the programme will have the opportunity to be assessed through a range of methods for both formative and summative purposes. The qualification requires the completion of 24 written assignments, 3 written examinations, a dissertation, a short report and an oral examination. Learners will have the opportunity to display a range of foundational, practical and reflexive competencies developed through their experience as professionals and throughout the course.

Formative

• Coursework: Learners will be expected to successfully complete all the coursework for the MPH (epidemiology and biostatistics track), the Postgraduate Diploma in Health Management and the Postgraduate Diploma in Occupational and Environmental Health.
• Three assignments are set and marked for each module (24 in all) and cover the range of clinical, epidemiological, toxicological and statistical content.
• In-house practicums: Attendance at 3 practicums over the first two years in which coursework takes place is a requirement. During the course of these there will be an opportunity for facilitator observation of the learners and interaction with the learners to enable the tutors to complete an assessment of the learners.
• Self-directed learning: A wide range of readings is required and assessed by means of formal literature reviews or by means of structured exercises testing critical appraisal skills. Skills to access internet resources are fostered and rewarded.
• Learners will conduct their own substantive research project following a critical review of the current literature. They will select, evaluate and refine hypotheses, develop hypotheses, set operational aims and objectives, compile methods for data collection and analysis and critically evaluate their results and limitations and discuss their implications for knowledge and implementation of preventive measures in the workplace. The standard will be of a publishable article in a quality scientific journal. Communication of the results of the research will be assessed by means of a final oral presentation and written report.
• Supervised clinical rotations and industry/workplace clinic attachments will also form an important component of the learning programme so as to ensure that the necessary clinical and occupational health management skills are acquired. Learners will be required to keep a portfolio of their practical work products (e.g. reports, policies, analyses, studies, articles) and will be required to be presented for inspection at the oral examination). At the end of each rotation, the clinical supervisor together with the complete the formative assessment form as per the College format. Where the rotation has involved a substantial clinical component, a log book is kept of procedures done and patients seen.

Summative

Exit examinations (of CMSA Fellowship of the College of Public Health Medicine - Division of Occupational Medicine)

- Certification, by head of the learner's training department, that

> The learner will have completed at least 3 calendar years as a registered learner for the qualification or an equivalent qualification at his/her University on the date of the first written paper, and has held a post recognised by the Health Professions Council of South Africa for the training of a specialist in Occupational Medicine for at least three calendar years.

> The learner has mastered at least 75% of the "skills" listed in Appendix A, Section 3, of the Regulations for Admission to the Fellowship of the College of Public Health Medicine of South Africa (Occupational Medicine), as amended up to 6 months prior to the date of the first written paper. Learners should keep a portfolio of their practical work products (e.g. reports, policies, analyses, studies, articles) and will be required to be presented for inspection at the oral discourse).

- Submission to the CMSA, by the learner, at the time of applying, of the following

> The certification by the Head of Department referred to in 1.

> Six copies of a short report (maximum 4000 words) on an occupational health topic.

> Evidence of having passed the equivalent of an the qualification dissertation in occupational medicine which has been marked by at least two external examiners.

> The proposed field/topic for discussion during the oral discourse examination (this topic must be acceptable to the convenor of the examination after consultation with the examiners: The examiners may require the learner to change, refine or amend the topic. The learner must be informed, as must the examiners, of the final topic or field for the oral discourse, in writing, at least 1 month prior to the oral examination).

• Writing of three written papers covering basic public health sciences and occupational health sciences (occupational medicine, occupational hygiene and occupational health management) by the learner, namely:

> A three hour multiple choice paper consisting of 50 questions.

> A three hour paper of short answer questions. The learner will be required to answer 10 out of 15 questions.

> A three hour paper of essay questions designed specifically to test the learner's integrative and written communication skills.

Attending, by the learner, at an oral examination in three parts, each lasting up to 30 minutes. One of these two parts will be defence of the short report before a panel of at least 4 examiners from at least two academic institutions. The second part will be an oral discourse on the topic/field of the learner's choice before a panel of at least 4 examiners from at least two academic institutions. In the third part the learner will be subjected to clinical case materials to assess occupational medicine skills. The order of these oral components is at the discretion of the convenor of the examination.

• Achievement, by the learner, of a pass grade for the aggregate mark for the examination. The final mark for the examination will be made up of a weighted average of the marks for each component. The weightings will be as follows:

> Short report and defence 1/6.

> Multiple choice paper 1/6.

> Short answers paper 1/6.

> Essay paper 1/6.

> Oral discourse 1/6.

> Occupational medical skills examination 1/6.

• The pass mark will be 50% and for the purposes of the Universities, where this mark might be part of the qualification of MMed, a mark of 75% or more is regarded as a distinction.
• Where a learner fails to achieve an overall mark of 50% for the examination the examiners may recommend that the learner be exempted from repeating one or more of the following sections in future attempts, provided that they have passed such section(s) at the current attempt and that the learner wishes this; and that the learner attempts the examination at the next available opportunity:

> The 3 written papers.

> The short report and oral defence of the short report.

> The oral discourse and clinical oral taken together.

In such cases the marks for the exempted sections must be carried forward to the next attempt, and a distinction may not be awarded at that attempt. If the learner is still unsuccessful (ie aggregate mark is still <50%) then the entire examination must be re-taken at the following attempt.