Master of Medicine in Occupational Medicine

Rationale

There is a need for medical specialists to practice occupational medicine - not only in South Africa, but also in the rest of the developing world and especially in Africa. The rapid industrial technological progress presents unique challenges to the health status of the working population.

"Workplace fatalities, injuries and illnesses remain at unacceptably high levels and involve an enormous and unnecessary health burden, suffering and economic loss amounting to 4-5% of GDP. According to the latest ILO estimates for the year 2000 there are 2.0 million work-related deaths per year. WHO estimates that there are only 10-15% of workers who have access to a basic standard of occupational health services".

The World Health Organization (WHO) is thus currently implementing a global strategy (Occupational Health for All) to (amongst others):

• Provide infrastructure support and development through capacity building, information dissemination and networking.
• Ssupport protection and promotion of workers' health.

Part of this strategy is "The training of occupational health and safety experts in Africa".

The development of this academic programme is directly related to this specific socio-economic need in Africa-especially in terms of the training of medical specialists and the rendering of this crucial occupational medical service to the community.

Students who have successfully complete this programme will be adequately equipped to handle occupational medical problems on a tertiary (specialist) level and would have a fulfilling career in this field of Medicine as this programme addresses a specific labour market need.

The "knowledge need" as expressed by the WHO will also addressed in the research projects performed by the candidates. It will further be supported by having trained medical specialists that are able to perform research in Occupational Medicine on an ongoing basis after their successful completion of this academic programme.

For admission to the Master of Medicine degree programme, a student shall have held the MBChB degree of this University, or an alternative qualification deemed adequate by the University, for not less than two years, and shall have been registered as a medical practitioner with the Health Professions Council of South Africa.

Application shall be made in writing and the admissibility of a candidate to the MMed degree programme shall be decided by the Senate or by the Executive Committee acting on behalf of the Senate.

Recognition of Prior Learning

The programme conforms to the University of Stellenbosch policies of Assessment Practices and Recognition of Prior Learning. The policy document clearly states the procedures and processes to be followed, including those related to recognition of prior learning.

Access to the qualification

The admission requirements are

• MBChB (or equivalent qualification as approved by the Senate).
• Completion of Internship year(s).
• Registration as a Medical Practitioner with the Health Professional Council of South Africa for a minimum of two years.

The entry-level qualification is a Professional Bachelor's Degree (Medicine) and has the appropriate number of credits at NQF Level 7.

Admission to the programme is also dependent upon the policies and procedures as set out in the Selection Criteria and in the Admission requirements for postgraduate students.

Exit Level of programme; NQF Level 9.

Duration (years); 4 years full-time.

Total credits; 480.

Learning Component; Credit allocation; NQF Level

• Fundamental; N/A.
• Core; 120 and 360; 8 and 9 respectively.
• Elective; N/A.

Total Credits; 480.

Overall Learning Outcomes

• Be able to diagnose and manage all aspects of work-related disease or disability or threats to health and well-being of individual employees.
• Be able to investigate occupational health risks in a workplace and develop an efficient and effective hazard control and management programme through workplace interventions and appropriate occupational health services.
• Be able to describe, explain and quantify occupational health risks, occupational health service needs and interventions through conducting appropriate epidemiological research and developing appropriate policy options based on study findings.

Associated Assessment Criteria for Overall Learning Outcomes

Scope of skills expected from candidates

• The mission of the occupational medicine specialist is to contribute to the maintenance of the quality of working life at the highest possible level.
• The occupational medicine specialist will typically:

> Provide a high quality ethical service, both clinical and advisory, to large organisations in the private and public sectors.

> Play a leading role in training, education and the development of the discipline of occupational health.

> If clinically based, occupy a position at a referral level in the health service.

> If managerially based, be involved in the development of policies and procedures to assist organizations to function more effectively in attaining healthy and safe working conditions.

• The occupational medicine specialist should possess the following skills, each based on a number of abilities or competencies:

> 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.

> 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.

- 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, haematological 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 immunization 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.

- 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.

- 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 ontexts.

> 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.

- 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.

• Has special competence in developing provincial, regional or district occupational medicine services, wherever appropriate, and is able to:

> Work within current policies in public sector health care delivery.

> Promote and manage a primary contact and referral system for occupational injury and disease at district, regional or provincial level.

> Work with other components of the public sector and with the private sector to contribute to an integrated system of occupational health service delivery for a province, region or district.

- 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.

• 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 advise on any accommodation required.

> Follow procedures for compensating occupational disease and injury, and advise on medical aspects of claims procedures.

> Follow procedures required for disability retirement processes, and contribute medical advice and expertise to assist resolution of claims.

- Has special competence in public policy in occupational health, and is able to

> Contribute to occupational health and safety policy, through familiarity with evolving public policy in the health, labour and environmental arenas, and with governance, administration and enforcement structures and personnel.

> Contribute to regulation appropriate to South Africa, through familiarity with the theory and philosophy of standard setting

> Write a public policy document.

> Organize a consultative process for public policy making.

- 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.

• 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.

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

> Apply the principles of epidemiological measurement, study design and causal inference.

> Write 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, analyze and interpret data, with support from appropriate specialists.

- 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.

> Characterize 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.

- 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.

- 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.

- 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.

- 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, organize, staff, finance, monitor and control an occupational health service or other operating unit.

> Chair, direct and contribute to committee work.

- 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 organizations.

- Has an understanding of information systems, and is able to

> Demonstrate a high degree of 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.

- 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.

> Carry out a lifelong commitment to educating and examining succeeding generations of occupational medicine specialists.

- Is a competent communicator, and is able to

> Communicate individually and in group situations with all participants in workplace organizations and occupational health: management, employees, union representatives and fellow professionals.

> Write clear and concise documents: proposals, policies, reports.

> Communicate risk information.

- 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.

- 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.

Integrated assessment

• Student learning is assessed in the programme via a 6-monthly discussion between the programme coordinator and each individual student.
• Students have to complete and submit a long research report (MMed dissertation) to the Head of the Department.