Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice

BACKGROUND@#Most clinicians feel ill-equipped to assess or educate patients about toxicant exposures, and it is unclear how expert environmental medicine clinicians assess these exposures or treat exposure-related conditions. We aimed to explore expert clinicians' perspectives on their practice of environmental medicine to determine the populations and toxicants that receive the most attention, identify how they deal with toxicant exposures and identify the challenges they face and where they obtain their knowledge.@*METHODS@#A qualitative study involving semi-structured interviews with expert environmental clinicians in Australia and New Zealand was conducted. Interviews were recorded and transcribed, and themes were identified and collated until no new themes emerged.@*RESULTS@#Five dominant themes emerged from 16 interviews: (1) environmental medicine is a divided profession based on type of practice, patient cohort seen and attitudes towards nutrition and exposure sources; (2) clinical assessment of toxicant exposures is challenging; (3) the environmental exposure history is the most important clinical tool; (4) patients with environmental sensitivities are increasing, have unique phenotypes, are complex to treat and rarely regain full health; and (5) educational and clinical resources on environmental medicine are lacking.@*CONCLUSIONS@#Environmental medicine is divided between integrative clinicians and occupational and environmental physicians based on their practice dynamics. All clinicians face challenges in assessing toxicant loads, and an exposure history is seen as the most useful tool. Standardised exposure assessment tools have the potential to significantly advance the clinical practice of environmental medicine and expand its reach across other clinical disciplines.

Residency programs and the outlook for occupational and environmental medicine in Korea

OBJECTIVES: This study investigated the implementation of training courses and the overall outlook for occupational and environmental medicine (OEM) in Korea. We described the problems facing OEM residency programs in Korea, and reviewed studies dealing with the specialty of occupational health in developed countries in order to suggest directions of improvement for the OEM training courses. METHODS: We surveyed 125 OEM residents using a questionnaire in August 2012. A total of 23 questions about the training environment, residency programs, preferred institutions for post-licensure employment, and the outlook for OEM specialists were included in the questionnaire and analyzed according to the type of training institution and residency year. Responses from 88 residents (70.4 %) were analyzed. RESULTS: The major responsibilities of OEM residents were found to vary depending on whether they were trained in research institutes or in hospitals. OEM residents had a lower level of satisfaction with the following training programs: toxicology practice (measurements of biological markers, metabolites, and working environments), and OEM practice (environmental diseases and clinical training involving surgery). When asked about their eventual place of employment, OEM residents preferred institutions providing special health examinations or health management services. OEM residents reported a positive outlook for OEM over the next 5 years, but a negative outlook for the next 10 years. CONCLUSIONS: Although a standardized training curriculum for OEM residents exists, this study found differences in the actual training courses depending on the training institution. We plan to standardize OEM training by holding a regional conference and introducing open training methods, such as an open hospital system. Use of Korean-language OEM textbook may also reduce differences in the educational programs of each training institution. Toxicology practice, environmental diseases, and clinical training in surgery are areas that particularly need improvement in OEM residency training programs.

Underwater and Hyperbaric Medicine as a Branch of Occupational and Environmental Medicine

Exposure to the underwater environment for occupational or recreational purposes is increasing. As estimated, there are around 7 million divers active worldwide and 300,000 more divers in Korea. The underwater and hyperbaric environment presents a number of risks to the diver. Injuries from these hazards include barotrauma, decompression sickness, toxic effects of hyperbaric gases, drowning, hypothermia, and dangerous marine animals. For these reasons, primary care physicians should understand diving related injuries and assessment of fitness to dive. However, most Korean physicians are unfamiliar with underwater and hyperbaric medicine (UHM) in spite of scientific and practical values. From occupational and environmental medicine (OEM) specialist's perspective, we believe that UHM should be a branch of OEM because OEM is an area of medicine that deals with injuries caused by physical and biological hazards, clinical toxicology, occupational diseases, and assessment of fitness to work. To extend our knowledge about UHM, this article will review and update on UHM including barotrauma, decompression illness, toxicity of diving gases and fitness for diving.

Estimation of Demand and Supply for Occupational and Environmental Medicine Specialties in Korea (I): Estimation of Supply / 대한산업의학회지

OBJECTIVES: To estimate the supply of occupational and environmental medicine specialties in the target year of 2020. METHODS: We adopted alternative projection models combined with a demographic method as a supply forecasting method. The model uses data selected primarily from the database of the Korean Society of Occupational and Environmental Medicine (KSOEM), a survey for certified members of KSOEM, audit data from the Ministry of Employment and Labor (MOEL) and Hospital Accreditation. We assumed five viable alternatives in supply forecasting. RESULTS: Depending on the assumptions, the total occupational and environmental medicine specialties supply ranged from 706 by low-level supply estimates to 754 by high-level supply estimates in 2020. Among them, approximately 81% were estimated to engage themselves in agency for health management and periodic health examinations for workers exposed to hazards. CONCLUSIONS: The study results suggest that the supply of occupational and environmental medicine specialties is related to the policy of MOEL. Further studies are needed concerning overall policy about health and safety and for the newly demanded market.

Residency Programs for Occupational and Environmental Medicine in Korea / 한국의학교육

PURPOSE: This study was performed to obtain baseline information about the occupational and environmental medicine(OEM) residency programs in Korea. METHODS: We surveyed 39 residents for the present training condition, satisfaction, vision of OEM, the condition and satisfaction after residency programs by self- administered questionnaire. RESULTS: Residents want to get appropriate clinical and practical training to be a medical director in a factory or specialist of the occupational medicine based at a hospital. They report, however, that current system for OEM residency training program is not appropriate. The curricula, duration of the each curriculum, level of training hospital or institute need to be reconsidered. CONCLUSIONS: We need to develop more systematic residency program with support from government and OEM society.