Occupational and environmental medicine in preventionist residency training programs.

In the United States today, there remains a need to train physicians with expertise in occupational medicine and its corollary, environmental medicine. To determine whether preventive medicine residency training programs provide trainees with skills and knowledge in occupational and environmental medicine, we conducted a survey among directors of general preventive medicine and combined general preventive medicine/public health programs in the United States that listed such emphases in the Directory of Preventive Medicine Residency Programs in the United States and Canada. Of the programs surveyed, over 50% included occupational and environmental medicine training opportunities. Individuals who have trained in these settings have obtained employment in positions related to this training, and some have obtained certification. Our findings suggest that preventive medicine training programs may provide an avenue for training and certification in occupational and environmental medicine.

A survey of residency management training: general preventive medicine graduates.

General preventive medicine residents at the University of Arizona are introduced to management skills and issues during graduate medical training to prepare them for future administrative positions. Our objectives were to learn whether administration training was effective and if acquired skills are useful in present job duties of graduates. We mailed a questionnaire to former general preventive medicine residents who had graduated between 1983 and 1992. Twenty-one (81.8%) of the 26 graduates returned a completed questionnaire rating the extent to which certain training activities improved administration skills and assessing the extent to which residency training overall prepare them for administrative work. Ratings reflected adequate preparation and usefulness of skills on the job. The survey indicates that administrative training should begin during residency years and that a variety of short-term and long-term activities, organized throughout both academic and practicum years can produce reasonable success in graduates. Medical Subject Headings (MeSH): preventive medicine, training.

Meanwhile back at the ranch: training residents in clinical preventive medicine.

In view of the current growing interest in prevention as an integral part of health care, it is timely to consider clinical preventive medicine (CPM) training approaches that best prepare physicians to deliver appropriate and effective preventive services. During CPM training, skills residents most need to acquire include methods of counseling on health promotion and techniques for advising patients on reducing health risks by changing disease-promoting behavior. University of Arizona residents in the General Preventive Medicine program receive this training focus at Canyon Ranch, a Tucson health resort and university training site. This training is an important component of the CPM area of emphasis in the residency program. Training emphasizes risk reduction and health promotion with a large volume of patients whose aim is to effect lifestyle changes. Emphasis is placed on acquiring skills in clinical prevention. Counseling and patient education are the primary foci. Evaluation data indicate that residents' perception of the rotation's benefit to their education is high, and interest in considering practice in a similar setting is reinforced as a result of the experience. Medical educators in preventive medicine and primary care need to turn their attention to finding appropriate training sites with suitable role models to teach counseling and patient education skills.

Training the clinician-manager. Assessing the reality.

Occupational medicine residents at the University of Arizona have been introduced to administrative skills and issues as part of residency training since 1983. A questionnaire survey of 17 program graduates was conducted to assess effectiveness of training and applicability of skills to present job position. Seventeen of the graduates surveyed (100%) returned a completed questionnaire. Graduates rated the extent to which certain training activities improved administrative skills, such as community-based rotations, a 1-month administration rotation, chief resident responsibilities, committee work, program or clinic administration, and residency training overall. Although ratings overall were low, we believe this stems from the need for training that residents discover on the job. The survey emphasized the importance of administrative training during the residency years and underscored the need for renewed training efforts on our part.

Work site risk assessment.

Awareness of the connection between work and health can be reinforced by primary care practitioners through visits to community workplaces. Physicians can use observation skills to increase understanding of work processes, hazardous exposures, potential adverse health effects, and preventive principles and control measures during inspection of work sites. They can also use site visits to augment the office occupational history and to obtain a community industrial profile. Adequate advance planning is imperative to ensure successful visits. The use of site visits by physicians is one method of realizing the goal of increased physician awareness of the work-relatedness of disease.

Prevention and treatment of travel-related illness.

Traveler's diarrhea, malaria, acquired immunodeficiency syndrome and jet lag are among the issues for the traveler preparing for a trip to or returning from developing countries. With appropriate measures, most travel-related diseases can be prevented. Diarrheal diseases, schistosomiasis, sexually transmitted diseases and AIDS can be prevented with proper avoidance behavior. Diseases such as hepatitis, rabies, yellow fever and meningitis can be prevented with immunization. Chemoprophylaxis can prevent malaria, altitude sickness and sinus barotrauma. Diagnosing an illness in a returning traveler requires a high index of suspicion regarding diseases that might have been acquired during travel. Resources for accessing up-to-date information concerning prophylaxis, diagnosis and treatment of travel-related illnesses are available.

Introducing management skills and issues in preventive medicine residency programs: a survey.

A questionnaire survey of 60 accredited preventive medicine residency programs was conducted to determine the percentage of programs in which management training is undertaken and to identify the nature of such training. Forty eight of the 60 programs (80%) returned a completed questionnaire. Forty three of the 48 programs responding (90%) state that the teaching of management skills is a defined goal of their program. Ninety percent introduce management skills in the practicum year in an administration rotation or by providing opportunities to practice management skills in other rotations. Thirty five (73%) of responding programs present didactic sessions containing a focus on management issues, and academic year courses contain a focus on management skills or issues in 46 (96%). Considering the need for management training in preventive medicine careers, we are encouraged by these figures. However, although this survey determined the extent to which management training is undertaken and the reported content thereof, it did not attempt to evaluate the depth or effectiveness of this training. Therefore, we must continue to emphasize a longitudinal and multidimensional approach to management training during the residency years.

Farming: a hazardous occupation.

Physicians with patients who work in rural areas need to be aware of the potential for illness and injury and be well-versed in preventive measures necessary to help keep these patients well. Physicians also need to be aware that the family's principal worker is not the only one exposed to the work hazards. The family joins in the duties of the farm and shares the risks. Physicians can play an important role in reinforcing the need for safe agricultural work practices.

Parasitic diseases. International travel. Preparing your patient.

Patients who travel to developing nations are those most likely to encounter parasitic diseases. Using a risk assessment approach and the resources introduced in this article, the primary care physician can prepare them for travel and continue their care on return. Immunizations and patient education are the major modes of prevention, coupled with chemoprophylaxis for malaria and traveler's diarrhea. Traveling pregnant women and young children need special precautions. A large body of preventive and therapeutic knowledge, including parasitology, is at the core of emporiatrics, the science of travel medicine.

Career choices of general preventive medicine residency graduates: 1981-1986.

To identify career choices made by recent graduates of general preventive medicine residency programs, all funded residency programs in general preventive medicine (excluding federal and military programs) were surveyed. Eighty-two percent of programs responded and reported on the career choices of 241 graduates who graduated from 1981 to 1986. In order of preference, the categories of career choice were: program activities (36.5%), teaching (19.1%), clinical services (17.0%), and research (6.2%). About one-fifth (21.2%) chose other activities. The number of graduates more than doubled between the periods 1981-1983 and 1984-1986. There was a threefold increase in the percentage of graduates involved primarily in research; however, there was a 33% decrease in the percentage of graduates who became professional academicians.

A travelers' clinic in an academic setting.

The Department of Family and Community Medicine at the University of Arizona has operated a travelers' clinic since 1983, staffed primarily by faculty and residents from the sections of preventive medicine, occupational medicine, and family medicine. We describe the clinic experience in providing preventive medical services to international travelers. Summer months are the busiest. Destinations of the travelers show a clear predominance of travel to less-developed countries, and this is reflected in the immunizations and prescriptions provided. After their trips, travelers reported a low incidence of diarrhea of generally low severity. The travelers' clinic is also a positive experience for resident physicians who help staff it, particularly those specializing in general preventive medicine.