Developing occupational and environmental medicine curricula for primary care residents: project EPOCH-Envi. Educating Physicians in OCupational Health and the Environment.

To help primary care residency programs develop or improve residency curricula in occupational and environmental medicine, the National Institute for Occupational Safety and Health launched a train-the-trainer initiative. This project was called EPOCH-Envi (Educating Physicians in OCcupational Health and the Environment). From 1990 to 1996, 46 2-day curriculum development workshops were held. These featured (1) guidelines on how to plan, implement, and evaluate a curriculum, (2) continuing education on occupational illnesses and injuries, (3) a worksite or environmental site visit, and (4) information resources. A total of 435 faculty from 305 residency programs participated, representing 42.5% of the family practice residencies and 24.9% of the internal medicine residencies in the United States. A survey conducted among attendees (60.4% response rate) 17 months after their workshop revealed that 65.6% of respondents had added lectures on occupational and environmental topics to the residency curriculum. Other curriculum improvements were also made. Primary care physicians manage most patients with occupational and environmental health problems or concerns. Providing technical assistance specifically designed to support occupational and environmental health education in primary care residencies can have a positive impact on curriculum content.

Teaching occupational and environmental medicine in primary care residency training programs: experience using three approaches during 1984-1991.

There is a critical shortage of physicians trained to recognize and treat occupational and environmental health problems. We implemented several required teaching programs for internal medicine and family medicine residents that focus on providing primary care for these problems. Clinical experiences were developed using the university and medical center as an example of a workplace with chemical and physical hazards. On-site experiences were also provided at local industries, but when resident stipend support for this aspect was discontinued, that part of the program was suspended. Didactic programs were associated with a statistically significant improvement in house staff knowledge scores. These occupational and environmental health issues can be introduced during residency, resulting in increased expertise in this discipline.

Mercury exposure in chloralkali plants.

The employees of two chloralkali plants were studied to correlate the signs and symptoms of mercury toxicity with levels of exposure. For purposes of comparison, the workers were divided into three groups. These groups were selected on the basis of hours worked in the mercury cell room or in other areas of mercury exposure. The population of the first plant was studied from 1957-1978, and preliminary findings were published in 1964. The second plant's population was studied for 3.5 years beginning in 1976. Time-weighted average exposure levels to mercury vapor in the high exposure group generally ranged between 0.05 to 0.10 mg/m3. No significant differences in the frequency of objective or subjective findings were noted among the three groups except for a lower post exposure systolic and post exposure diastolic blood pressure in the high exposure group in the second plant's population. There was no correlation of mercury vapor exposure with subjective or objective weight loss.