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AgMed Program

The Occupational and Environmental Medicine Gap in the Family Medicine Curriculum:
Needs Assessment in South Carolina (Part I)

Schuman SH, Mohr LJ, and Simpson WM. The Occupational and Environmental Medicine Gap in the Family Medicine Curriculum: Needs Assessment in South Carolina (Part I). JOEM 1997; 39(12): 1183-1185.

Abstract: The occupational and environmental medicine (OEM) gap in US medical education is widely recognized. In 1992, a federal initiative stimulated a primary care approach to improve residency training in South Carolina. Faculty from each of the state's seven family medicine residency training programs formed the Environmental Medicine Curriculum Committee (EMCC). The committee was charged with the responsibility of designing and implementing OEM curriculum into the residency training at the seven residency sites. The EMCC had to focus on what could be accomplished in a sequential process described in this three part report. Guidelines for curriculum were strongly suggested by three surveys which are presented on the following table.

Abstract: Part two of the three-part report examines five of the key elements for occupational and environmental medicine (OEM)training in family medicine residency. These were introduced bathe Environmental Medicine Curriculum Committee (EMCC) faculty in South Carolina. Each element is being designed, tested, and updated by clinicians in the residency network.

• A three-year longitudinal plan with core and elective computer assisted instructional modules.
• A new ambulatory reminder for a routine OEM history: WHACS each patient annually.
• A one-month mandatory OEM rotation for second or third year residents.
• An expanded database of OEM/FM case studies with emphasis on presenting complaint, differential diagnosis, and risk management.
• A two-task, four-prototype approach (clinical guide) to the next OEM patient that you see in your clinic, defining level of exposure and severity of symptoms.

Abstract: A four-prototype approach to the OEM patient in a busy primary care setting is described. A 2 x 2 table illustratesthe two diagnostic, interrelated tasks during the outpatient,non-urgent visit: (a) sick? yes/no, and (b) exposed? yes/no. One may have the basic skills for task (a) but feel insecure for task(b). With OEM experience, creative use of resources (database sand consultants), and patient cooperation, a better balance between task (a) and task (b) can be achieved.