ACOEM OEM Core Competencies 2021-19

ACOEM GUIDANCE STATEMENT
ACOEM OEM Core Competencies: 2021

Natalie P. Hartenbaum, MD, MPH, Beth A. Baker, MD, MPH,
Jeffrey L. Levin, MD, MSPH, DrPH, Kenji Saito, MD, JD,
Yusef Sayeed, MD, MPH, MEng, and Judith Green-McKenzie, MD, MPH,
Work Group on OEM Competencies
Competency is defined as possession of sufficient the evolution of the curricula in US OEM In these interactions, OEM physicians should
physical, intellectual, and behavioral qualifica- residency programs required an update to follow a strict code of ethics related to mat-
tions to perform a task or serve in a role which these OEM competencies to stay current with ters such as confidentiality and potential
adequately accomplishes a desired outcome. Rec- the overall field and practice of OEM.10–17 conflicts of interest. The ACOEM Code of
OEM focuses on the interaction Ethics provides detailed guidance.19 Effec-
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ognizing the need for defining competencies

essential to occupational and environmental med- between work, the environment, and health. tive communication is expected of the OEM
icine (OEM) physicians, the American College of This includes the arrangements of work; the physician operating in a largely collaborative
Occupational and Environmental Medicine devel- physical, chemical, and organizational envi- context executing tasks such as risk commu-
oped its first set of OEM Competencies in 1998. ronments in the workplace; and the health nication, patient education, workforce edu-
Later updated in 2008, and again in 2014, the outcomes of environmental exposures and cation, development of policy and guidance
increasing globalization and modernization of the social determinants. Physicians practicing documents, and medical/legal document
workplace, along with published research on OEM OEM are expected to understand how to preparation.
practice, required an update to ensure OEM physi- recognize, prevent, evaluate, diagnose, treat, In general, OEM physicians possess a
cians stay current with the field and practice of and manage adverse health effects from much more diverse background than physi-
OEM. Delineation of core competencies for the workplace and environmental hazards, as cians practicing in most other areas of medi-
profession provides employers, government agen- well as, how to create and promote a culture cine in that their role frequently extends
cies, health care organizations, and other health of wellness in the workplace. Moving from beyond solely clinical medicine. An eye to
practitioners a solid context of the role and exper- the traditional view of OEM as ‘‘industrial population medicine is essential.19,20
tise of OEM physicians. medicine,’’ OEM physicians have become Research on OEM careers and practice indi-
the leading experts on mitigating the impact cate that OEM physicians typically practice in
of health conditions on work and conversely three broad areas4–6,16: (1) clinical care such
PART 1: INTRODUCTION AND
the impact of work conditions on health. In as workers’ compensation injury or illness
10 CORE COMPETENCIES practice, this may include direct patient care, care management and work-related place-
managing employee absences, evaluating ment examinations; (2) clinical subspecialty
The American College of Occupa- work capacity, preventing work disability, care such as toxicology and environmental
tional and Environmental Medicine and assessing fitness-for-work duties based hazard evaluation, causation analysis and
(ACOEM) recognizes the need for defining on knowledge of the workplace environ- medical/legal work, work fitness, and disabil-
competencies essential to occupational and ments, occupations, and job tasks; advising ity management; and (3) management/popu-
environmental medicine (OEM) physicians. on appropriate work restrictions, disaster lation health to include corporate employee
The first set of OEM competencies was pub- preparedness, surveillance; and designing health program management, pandemic pre-
lished in 1998,1 later updated in 2008,2 and and implementing programs focused on paredness and exposure management, OEM
again in 2014.3 Increasing globalization and employee health and human performance. research, and benefit management.20–24
modernization of the workplace, along with In essence, OEM focuses on the National There tends to be a great deal of overlap
published research on OEM practice,4–9 and Institute for Occupational Safety and among these areas and while many OEM
Health’s (NIOSH) Total Worker Health1 physicians’ practice includes all three practice
From the American College of Occupational and Program.18 The preventive medicine foun- environments, those who are board certified
Environmental Medicine, Elk Grove, Illinois. dation of occupational medicine serves as in occupational medicine should be able to
This guidance paper was developed by ACOEM the basis for the various practice areas in competently work in all three areas. However,
Work Group on OEM Competencies under OEM, ranging from preventing or limiting like other specialties, not all physicians prac-
the auspices of the Council on OEM Practice
and approved by the ACOEM Board of Direc- the impact of illness or injury related to a ticing OEM need equivalent competency in
tors on February 6, 2021. ACOEM requires all hazardous exposure or work injury to ensur- each of these diverse areas.
substantive contributors to its documents to ing that neither the individual or others will Pathways toward board certification
disclose any potential competing interests, be harmed if a medical condition may impact in occupational medicine (OM) are through
which are carefully considered. ACOEM
emphasizes that the judgments expressed herein a worker’s ability to perform a task safely. the American Board of Preventive Medi-
represent the best available evidence at the time OEM physicians are also required to cine (ABPM) or American Osteopathic
of publication and shall be considered the posi- effectively utilize a multidisciplinary Board of Preventive Medicine (AOBPM).
tion of ACOEM and not the individual opinions approach, which involves collaboration with Residency programs in OM provide train-
of contributing authors.
The author declares no conflicts of interest. a wide range of other professionals. This may ing consistent with the American Council
Address correspondence to: Marianne Dreger, MA, include among others, other medical special- for Graduate Medical Education (ACGME)
ACOEM, 25 Northwest Point Blvd, Suite 700, ists and health care providers, employers, requirements, OEM milestones, ABPM
Elk Grove Village, IL 60007 (info@acoem.org). safety and industrial hygiene professionals, core content areas, and the ACOEM core
Copyright ß 2021 American College of Occupa-
tional and Environmental Medicine human resource managers, attorneys, labor competencies as described in this docu-
DOI: 10.1097/JOM.0000000000002211 unions, and other public health professionals. ment. Both ABPM and AOBPM maintain
JOEM Volume 63, Number 7, July 2021 e445
Copyright © 2021 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited
Hartenbaum et al JOEM Volume 63, Number 7, July 2021
a list of certified physicians through and Improvement; (4) Interpersonal and Their perspective is crucial in evaluating
their organization. Communication Skills; (5) Professional- workers in certain positions such as
However, most physicians engaged ism; and (6) Systems-Based Practice.15 emergency response, hazardous waste,
in the practice of OEM are not board certi- ACGME has also published milestones commercial driving, forklift operation,
fied in occupational medicine (OM) but are which OM resident trainees are required or those requiring respirator use. These
often board certified in other medical fields. to achieve prior to graduation. Achieve- positions have the potential for a high
According to its membership data, approx- ment of these milestones also are required consequence outcome for the population
imately 42% to 47% of ACOEM physician prior to the resident being able to sit for the served if there is a sudden or emergent
members are board certified in OM and OM certifying examination. medical event during work. Clinical
65% to 71% are board certified in another Appendix A describes the ACGME expertise may be applied in face-to-face
specialty. (These numbers do not add up to competencies and Appendix B the ACGME care of patients or caring for populations,
100% as some members are double certi- milestones. Appendix C presents the content as well as activities such as case man-
fied and captured in both categories.) outline of the ABPM and AOBPM OM agement and peer-to-peer discussions.
In this document, competency is certification examinations. These should OEM services may also be provided
defined as possession of sufficient physical, be considered reference documents, relevant through telehealth. OEM physicians
intellectual, and behavioral qualifications to the current training of new OEM physi- have responsibility for employee health
(ie, knowledge, skills, abilities, and atti- cians seeking board certification. Appendix or population health management as
tudes) to perform a task or serve in a role D is related to competency in techniques and part of their clinical OEM practice.
which adequately accomplishes a desired methodologies of research and education. (ACGME: Patient Care, Medical
outcome. Delineation of core competencies Knowledge, Interpersonal and Commu-
for the profession provides employers, gov- OEM CORE COMPETENCIES nication Skills, Professionalism.)
ernment agencies, health care organiza- Physicians specializing in OEM are 2. OEM Related Law and Regulations:
tions, and other health practitioners a expected to be competent in all 10 core OEM physicians should have the knowl-
solid context of our role. competencies, with knowledge and skills that edge and skills necessary to understand
This document organizes key topics are specific to their area of clinical practice and apply regulations applicable to occu-
relevant to OEM theory and practice into 10 focus. OEM physicians should endeavor to pational and environmental health as
core competency areas, relevant for all apply evidence-based best practices, such as well as the range of laws and regulations
OEM physicians. It then describes the shared medical decision-making, outcome related to interactions between work and
knowledge areas and skill sets for each of measurements and continuous quality health. They should also be aware of
those 10 areas, further describing how each improvement, as the medical system evolves voluntary standards, guidance, or recom-
of the three practice areas may be addressed to incorporate such standards of care. mendations regarding work practices,
within some of the competencies. exposures, and other factors which
The term ‘‘OEM physician’’ is used 1. Clinical Occupational and Environ- may impact the health and safety of
generically, without specification of board mental Medicine: OEM physicians workers from organizations such as
certification. These OEM Core Competencies should have the knowledge and skills NIOSH, Department of Transportation
define knowledge and skills that one who to provide evidence-based clinical eval- (DOT), American Congress of Govern-
considers oneself an OEM physician should uation and treatment of injuries and ill- mental Industrial Hygienists (ACGIH),
possess. Those with more advanced training nesses that are occupationally or and ACOEM. OEM physicians need to
such as through residency programs should be environmentally related. OEM physi- interact knowledgeably with non-medi-
expected to demonstrate increased knowledge cians’ expertise is also applied to evalu- cal professionals in various roles includ-
and skills beyond what is presented in this ating the impact of personal medical ing human resources operations,
document. In essence, this document denotes conditions or work-related conditions industrial hygiene, safety, labor rela-
the minimum competencies required of a on the ability to perform work tasks. tions, government affairs, and legal,
practicing OEM physician. Physicians with- Throughout the course of care, physi- and should understand the laws, regula-
out OM board certification can avail them- cians should seek to maximize the tions, standards, and practices that guide
selves of training courses available through patients’ functional abilities.25,26 these professionals. (ACGME: Practice-
ACOEM and other organizations designed to Knowledge and skill are essential in a Based Learning and Improvement, Inter-
teach the basics of OEM. These courses also broad range of specialties including der- personal and Communication Skills,
provide specialized content on topics such as matology, internal medicine, neurology, Professionalism and Systems-Based
medical review officers (MRO), commercial pulmonary, infectious diseases, orthope- Practice.)
driver medical examiners (CDME), or perfor- dics, psychiatry, pain management, sleep 3. Environmental Health: OEM physi-
mance of an independent medical examina- medicine, and others. Individuals with cians should have the knowledge and
tion (IME), necessary for the effective underlying risk factors or disease may skills necessary to recognize potential
delivery of highly specific OEM-related clin- encounter special concerns in certain chemical, physical, and biological envi-
ical services. Other courses may focus on positions. OEM physicians utilize their ronmental causes of health concern to
toxicology, ergonomics, or health and knowledge and skill to identify those individuals as well as to community
human performance. conditions which may present a safety health. Environmental issues most often
ACGME denotes six core competen- concern or may be exacerbated by cer- include air, water, or soil contamination
cies required of the physician seeking OM tain exposures. Working with other pro- by natural or artificial pollutants. OEM
board certification.14 This document indi- fessionals which may include safety, physicians should be competent in tak-
cates which of these six competencies are human resources, labor relations, indus- ing an exposure history that includes
primarily addressed through the 10 OEM trial hygiene and/or the employee’s environmental as well as occupational
Core Competencies outlined in this docu- health care provider, OEM physicians sources and must understand how to
ment. The six ACGME core competency evaluate and coordinate appropriate cau- identify environmental hazards. They
areas are: (1) Patient Care; (2) Medical tions and job task in individuals with can also characterize risk, based on
Knowledge; (3) Practice-Based Learning high consequence disease or risk factors. an assessment of exposure that includes
e446 ß 2021 American College of Occupational and Environmental Medicine
JOEM Volume 63, Number 7, July 2021 ACOEM Guidance Statement and ACOEM OEM Core Competencies—2021
potential routes of exposure and risk effects of exposures to toxic agents at families, health systems, companies,
assessment. They understand dose– work or in the general environment. and government agencies, as well as
response relationships and how to com- They should be familiar with and able contributing to the health of the
pare environmental and biomonitoring to use existing resources and databases national and global workforce by
data to published standards. OEM (eg, safety data sheets [SDS], Pub- anticipating and preventing the eco-
physicians should be aware of common Chem, threshold limit values [TLV], nomic consequences of disasters.
clinically significant environmental etc.) to characterize the potential risk OEM physicians may be called upon
agents and diseases relevant to the geo- from occupational and environmental to treat those impacted by the emer-
graphic area where they practice, such chemical exposures. OEM physicians gency or disaster or to evaluate emer-
as lead, asbestos, arsenic, and radon. can interpret industrial hygiene reports gency responders. OEM physicians
(ACGME: Patient Care, Medical and other data describing specific should be able to describe specific
Knowledge, Interpersonal and Commu- exposure conditions to determine threats, including a broad range of
nication Skills, Professionalism and potential routes of exposure and pos- physical, chemical, biological, or psy-
Systems-Based Practice.) sible overexposure. They should be chosocial hazards. Depending on their
4. Work Fitness and Disability Manage- familiar with the adverse effects of practice setting, OEM physicians may
ment: OEM physicians should have the such overexposures on exposed indi- need the knowledge and skills to col-
knowledge and skills to determine viduals, as well as the standard clinical laborate with the employer manage-
whether workers can safely be at work and biological tests used to confirm ment team to plan for workplace
and perform required job tasks. They such adverse effects. OEM physicians response to natural or manmade dis-
should be able to evaluate the individual, can implement standard components asters. Emergency management plan-
coordinate care with other specialists of medical surveillance and biological ning includes resource mobilization,
and utilize evidence-based guidelines monitoring appropriate for individuals worker population tracking, communi-
to develop a treatment or management exposed to specific chemicals. They cation, procurement of medical prod-
plan. OEM physicians should be able to should also have knowledge of specific ucts, financing, leadership and
utilize information from employers, legally mandated surveillance and governance, and contingency plan-
other providers, and professionals such monitoring procedures for those chem- ning. Collaboration with local, state,
as case managers, ergonomists, thera- icals. (ACGME: Patient Care, Medical or federal agencies is essential.
pists, vocational rehabilitation special- Knowledge, Practice-Based Learning (ACGME: Patient Care, Medical
ists, safety professionals, attorneys, and and Improvement, Professionalism Knowledge, Practice-Based Learning
human resources to facilitate an outcome and Systems-Based Practice.) and Improvement, Interpersonal and
that aligns an individual’s abilities with 6. Hazard Recognition, Evaluation, and Communication Skills and Systems-
the job requirements and essential func- Control: OEM physicians should have Based Practice.)
tions. OEM physicians should have the the knowledge and skills to assess if 8. Health and Human Performance:
knowledge and skills necessary to com- there is risk of an adverse event from OEM physicians should be able to
municate and provide guidance to the exposure to physical, chemical, biolog- identify and address individual and
employee and employer when there is a ical, or psychosocial hazards in the organizational factors in the workplace
need for integration of an employee with workplace or environment. They should toward optimizing worker health and
a disability or impairment/functional be prepared to collaborate with indus- enhancing human performance. They
limitations into the workplace, or when trial hygienists or other qualified safety should be able to assess the degree of
there is a need to pursue other avenues and health professionals and interpret impact of those factors (ie, smoking,
such as vocational rehabilitation or dis- measurements and reports from such depression, burnout, and other medical
ability benefits. This would include professionals in context. If there is a conditions) and be able to advise on or
whether such disability is due to muscu- risk with exposure, that risk can be create programs relevant to that work-
loskeletal or cognitive function, the characterized with recommendations place to address the concern (ie, smok-
prognosis and progression of the medical for control measures or medical surveil- ing cessation, physical activity,
condition including substance abuse or lance. OEM physicians should demon- depression or blood pressure screen-
the effect of treatment such as medica- strate an understanding of the core ing, weight management, mindfulness,
tions or other therapy. Some OEM pro- principles of industrial hygiene, ergo- or resiliency training) that will
viders may perform disability nomics, occupational safety and risk improve worker wellness. OEM physi-
evaluations or IMEs utilizing current assessment and communication, and cians should be able to understand data
disability or impairment rating resour- apply Hierarchy of Controls principles management and reporting systems
ces. Others may be responsible for devel- to protect the health of individual work- and assess aggregate data from health
oping and managing transitional or ers, patients, and the public from known risk assessments, health insurance
alternate work placement programs or physical, chemical, biological, or psy- claim data and the effect of imple-
evaluating the effectiveness of OEM chosocial hazards. (ACGME: Medical mented wellness related programs.
medical care delivered by other physi- Knowledge, Practice-Based Learning They should be knowledgeable of
cians, and monitor adherence to evi- and Improvement, Interpersonal and the organizational structure and be
dence-based practice guidelines as Communication Skills and Systems- able to communicate data to senior
well as clinical outcomes. (ACGME: Based Practice.) management of an organization. Over-
Patient Care, Medical Knowledge, Inter- 7. Disaster Preparedness and Emer- all, OEM physicians should have the
personal and Communication Skills, gency Management: OEM physicians ability to provide guidance to an orga-
Professionalism and Systems-Based may have a critical role in emergency nization on optimal health and human
Practice.) preparedness, emergency manage- performance programs to consider for
5. Toxicology: OEM physicians should ment, and pandemic preparation and the workforce and may participate in
have the knowledge and skills to rec- mitigation. This includes playing a key decisions about the optimal method to
ognize, evaluate, and manage health role in protecting employees and deliver those services. They provide
ß 2021 American College of Occupational and Environmental Medicine e447
advice to support the organization pro- a surveillance system. (ACGME: are occupationally or environmentally
moting a culture of health and ensuring Patient Care, Medical Knowledge, related. Their expertise is also applied to
that any program aligns with business Practice-Based Learning and Improve- evaluating the impact of personal medical
goals in accordance with best practice in ment, Interpersonal and Communica- conditions or work-related conditions on
supporting workplace health and safety. tion Skills, Professionalism and the ability to perform work tasks. Through-
OEM physicians should have a strategy Systems-Based Practice.) out the course of care, the physician should
to demonstrate their value to the system 10. OEM Related Management and seek to maximize the patient’s functional
and the return on investment (ROI) of Administration: OEM physicians abilities.25,26 Knowledge and skill are
suggested or implemented initiatives. should have administrative and man- essential in a broad range of specialties
The goal being creating and sustaining agement knowledge and skills to plan, including dermatology, internal medicine,
a healthy, safe, and high-performance design, implement, manage, and eval- neurology, pulmonary, infectious diseases,
workforce. (ACGME: Patient Care, uate comprehensive occupational and orthopedics, psychiatry, pain management,
Medical Knowledge, Practice-Based environmental health programs and sleep medicine, and others. Individuals
Learning and Improvement, Interper- projects and work with leadership with underlying risk factors or disease
sonal and Communication Skills and and governance to ensure the health may encounter special concerns in certain
Systems-Based Practice.) and safety of employees. OEM physi- positions. OEM physicians utilize their
9. Public Health, Surveillance, and Dis- cians need an understanding of health knowledge and skill to identify those con-
ease Prevention: OEM physicians care benefits, workers’ compensation ditions which may present a safety concern
should be able to assess, prepare and systems, electronic health records, and or may be exacerbated by certain expo-
respond to individual and population knowledge of the laws and regulations sures. Working with other professionals
risks for common occupational and applicable to their jurisdiction, indus- which may include safety, human resour-
environmental disorders as well as try, and population of interest. They ces, labor relations, industrial hygiene and/
emerging and catastrophic events such should understand and be able to artic- or the employee’s health care provider,
as pandemics, bioterrorism, climate/ ulate the differences in assessment OEM physicians will evaluate and coordi-
weather occurrences. They should between the concepts of medical cau- nate appropriate cautions and job task in an
have the knowledge and skill to sation and those related to workers’ individual with a high consequence disease
develop, evaluate, and manage medi- compensation and other legal and reg- or risk factors. Their perspective is crucial
cal surveillance programs for the ulatory standards. OEM physicians in in evaluating workers in certain positions
workplace as well as the public to all practice settings are expected to be such as emergency response, hazardous
identify trends and sentinel events. sensitive to the diverse needs and cul- waste, commercial driving, forklift opera-
They should be knowledgeable and tural backgrounds of those they serve tion or those requiring respirator use. These
able to apply appropriate screening and anticipate meeting these needs in positions have the potential for a high con-
guidelines, as well as immunization their practices. OEM physicians sequence outcome for the population
and chemo-prophylaxis recommenda- should be able to collaborate as part served if there is a sudden and emergent
tions for workers. This includes of a larger OEM team which may medical event during the course of work.
those from the US Preventive Services include physician colleagues, other Clinical expertise may be applied in face-
Task Force (USPSTF), Hospital Infec- health care providers, industrial to-face care of patients or caring for pop-
tion Control Advisory Committee hygienists, safety professionals, ergo- ulations, as well as activities such as case
on Immunizations, Centers for Disease nomists, physical therapists, athletic management and peer-to-peer discussions.
Control and Prevention (CDC), and trainers, employers, legal experts, OEM services may also be provided
applicable OSHA guidelines (eg, human resources professionals, insur- through telehealth. OEM physicians have
bloodborne pathogen exposure). OEM ance carriers, case managers, adjust- responsibility for employee health or pop-
physicians should be able to apply pri- ors, etc., and may play a leadership ulation health management as part of their
mary, secondary, and tertiary preventive role in those teams. They may be clinical OEM practice. (ACGME: Patient
approaches to individual and popula- expected to evaluate and implement Care, Medical Knowledge, Interpersonal
tion-based disease prevention and clinical practice guidelines, quality and Communication Skills, Professional-
health promotion, and be able to improvement programs, outcome ism.)
develop, implement and evaluate the assessment strategies and medical
effectiveness of appropriate clinical informatics programs as they apply Clinical: General
preventive services for both individuals to day-to-day clinical patient care. OEM physicians should provide
and populations. Deploying informa- OEM physicians should be able to clinical care with an understanding of the
tion technology to address current and manage many of the programs essential workplace, work exposures, and relevant
emerging occupational hazards and uti- to the success of the above nine core statutes and regulations, such as federal
lizing available information, they competencies. (ACGME: Practice- or state medical standards and workers’
should have the ability to appropriately Based Learning and Improvement, compensation. They should understand
communicate risk to workers, organiza- Interpersonal and Communication and identify interactions between personal
tions, and the public. OEM physicians Skills, Professionalism and Systems- and occupational health conditions and risk
should also possess data management Based Practice.) factors and understand the process for the
skills as well as know how to access and evaluation of causation of occupational ill-
advise expert epidemiology and biosta- PART 2: KNOWLEDGE AND nesses and injuries. Some may be able to
tistics support in acquiring, managing, SKILL SETS prepare detailed root cause analysis reports.
and interpreting data relevant to the 1. Clinical Occupational and Envi-
populations they serve in order to make ronmental Medicine: OEM physicians Core Knowledge and Skills
evidence-based interventions. They should have the knowledge and skills to 1. Obtain appropriately detailed patient
should be able to measure, organize provide evidence-based clinical evaluation histories, with an emphasis on occu-
and improve public health service or and treatment of injuries and illnesses that pation and exposure.
2. Identify the potential relationship their occupational or environmental Clinical: Dermatology

between patient medical complaints health programs and injury manage-
Occupational dermatoses, among the
and physical findings with occupa- ment procedures.
leading causes of occupational disease in
tional/environmental exposures. 2. Perform utilization review and complex
the United States, may also result from
3. Interpret applicable and relevant clini- case management.
exposure to hazardous compounds in the
cal laboratory tests and imaging stud- 3. Perform IMEs.
home or other environments. Dermatology
ies in the context of diagnosing, 4. Perform impairment rating examina-
issues may impact performance of some job
treating, mitigating, and preventing tions using specific sets of guidelines.
tasks. OEM physicians should provide
occupational and environmental injury 5. Perform functional capacity evaluations.
early recognition, diagnosis, and manage-
and illness/disease. 6. Perform CDMEs (National Registry of
ment of relevant dermatologic disorders
4. Evaluate the potential relationship Certified Medical Examiners [NRMCE]
and make necessary recommendations for
regarding work relatedness and effec- certification required).
prevention, treatment, or fitness for duty.
tively communicate and support that 7. Perform airman medical examinations
opinion. (aviation medical examiner [AME] cer-
5. Identify non-occupational/environmen- tification required). Core Knowledge and Skills
tal factors that may contribute to work- 8. Review drug tests (MRO certification 1. Differentiate occupational skin disor-
related disease or injury. required in some settings, recom- ders by history, examination, and
6. Diagnose and treat or refer and man- mended in others). diagnostic evaluation.
age occupational/environmental ill- 9. Apply principles of population manage- 2. Identify and refer if appropriate, work-
nesses and injuries with the use of ment which include understanding aggravated dermatoses.
consultants in related disciplines health risks, epidemiological principles, 3. Identify and refer if appropriate, the
when indicated. clinical practice guidelines for chronic cause of allergic contact dermatitis and
7. Manage a workers’ compensation case disease management and current prac- allergic contact urticaria (and other
treatment plan from first visit to clo- tices in disease detection, prevention, related IgE-mediated allergic responses),
sure, including provision of required and treatment, as well as disability particularly those caused by common
medical documentation, following the management principles. antigens such as latex, epoxy monomer,
relevant jurisdictional rules. nickel, and rhus.
8. Elicit patients’ concerns about exposures Clinical: Cardiology 4. Identify and refer if appropriate, pri-
and establish a therapeutic alliance OEM physicians should be aware of mary irritant-induced dermatoses.
incorporating risk communication. the cardiac conditions that can present as 5. Identify and refer if appropriate, poten-
9. Report all findings to affected individ- work-related conditions, complicate work- tially contagious skin conditions such as
uals and pertinent information to orga- related conditions or interfere with fitness those caused by varicella/zoster, herpes,
nizations and employers as appropriate for work. methicillin-resistant Staphylococcus
(considering medical confidentiality Aureus (MRSA), or other skin infection
issues), advocating for the health and Core Knowledge and Skills causing pathogens.
safety of patients and employees. 1. Recognize, evaluate, manage, and refer if 6. Identify and refer if appropriate other
10. Identify and refer the injured or ill appropriate, the cardiac effects of chem- occupational dermatoses such as occu-
employee for definitive treatment ical asphyxiants such as carbon monox- pational acne, occupational cutaneous
and diagnosis for non-occupational ill- ide, methylene chloride, and cyanide. infections, occupational skin neoplasia,
ness and injury. 2. Evaluate a person’s ability to perform occupational pigmentary disorders.
11. Work as a team member with other strenuous or safety-sensitive work after 7. Manage occupational and environmen-
professionals to identify and evaluate a cardiac event (such as myocardial tal skin injuries and dermatoses such as
occupational or environmental hazards infarction, stent/angioplasty, arrhyth- lacerations, contact or allergic dermati-
and recommend methods to reduce mia, placement of pacemaker or tis, chemical and other types of burns.
exposure, mitigate risk and improve implantable cardioverter defibrillator, 8. Evaluate the impact of dermatologic
worker health and human performance. coronary artery bypass graft surgery) conditions on the performance of
12. Apply evidence-based clinical practice and the risk of sudden or gradual job tasks.
guidelines in one’s practice of medicine. impairment or incapacitation due to that
13. Utilize clinical knowledge to assess cardiac condition. Additional Knowledge and Skills
the impact of medical conditions on 3. Apply knowledge of cardiac risk factors Some OEM physicians have addi-
the ability to perform work tasks and if in employee risk assessment and tional knowledge and skills in the following
necessary, consider modifications patient counseling. areas, not considered core for all OEM
which would be needed for perfor- 4. Interpret electrocardiogram for ische- physicians, referring to dermatologists as
mance of job tasks. mia, evidence of infarction, conduction clinically indicated:
14. Recognize the importance of early and disorders and arrhythmias and refer
safe return to work for injured workers if appropriate. 1. Perform repair of skin lacerations.
and focus on functional improvement. 2. Perform testing for diagnosis of allergic
Additional Knowledge and Skills contact dermatitis and other atopic con-
Additional Knowledge and Skills Some OEM physicians have addi- ditions.
Some OEM physicians have additional knowledge and skills in the following 3. Perform skin biopsy.
tional knowledge and skills in the following areas, not considered core for all OEM
areas, not considered core for all OEM physicians, referring to cardiologists as
physicians: appropriate: Perform cardiovascular evalu- Clinical: Emergency Medicine
ations such as stress testing, echocardiog- OEM physicians should have the
1. Assist programs or companies in devel- raphy, or diagnostic ultrasound to assess knowledge and skills to provide acute med-
oping, implementing, or evaluating fitness for duty. ical care for a wide variety of common
injuries and illnesses, as well as to stabilize Clinical: Gastroenterology a. Bloodborne, airborne, waterborne,
and refer individuals for emergency care. and food borne pathogen exposure
OEM physicians should be aware of
and associated illnesses.
the gastroenteric conditions that can present
Core Knowledge and Skills b. Infestations and zoonotic condi-
as, or complicate work-related conditions
1. Establish emergency procedures and tions.
or interfere with fitness for work.
protocols for the clinical management c. Transmission of infection by those
of individuals involved in hazardous Core Knowledge and Skills in certain occupations such as food
materials incidents, including sub- service workers.
1. Evaluate abnormal liver function
stance-specific first aid and medical 2. Understand and apply recommenda-
enzymes in the context of evidence of
tions from public health authorities,
management protocols. exposure to workplace or environmental
2. Recognize and secure appropriate emer- such as CDC, and World Health Orga-
toxicants.
gency care for life-threatening respira- nization (WHO), and other relevant
2. Evaluate personal risk of exposure to
tory, central nervous system, renal, organizations for immunization of the
hepatotoxic agents.
cardiac, or other target organ failure, working populations.
3. Evaluate gastroenteric conditions and
pending the identification of a specific 3. Apply CDC, OSHA, or other require-
their impact on the worker’s health
exposure agent. ments or recommendations for infec-
and ability to work.
3. Perform basic wound repair techniques. tious disease prevention, surveillance,
4. Evaluate ophthalmic injuries and refer Clinical: Hematology/Oncology exposure evaluation and treatment.
as appropriate. 4. Understand the role of the OEM physi-
OEM physicians should have the
5. Manage the effects of exposure to phys- cian as it relates to endemics, epidem-
knowledge and skills to evaluate, diagnose,
ical hazards including heat, cold, and ics, and pandemics.
and minimize the hematologic and carcino-
radiation exposure. 5. Manage incidents of potential blood-
genic effects of occupational and environ-
6. Understand locally relevant emergency borne pathogen, tuberculosis, or other
mental exposures.
preparedness programs and triage occupational infectious disease expo-
Core Knowledge and Skills sure according to applicable govern-
concepts.
ment guidelines.
1. Interpret hematologic laboratory studies
Additional Knowledge and Skills in the context of medical surveillance Additional Knowledge and Skills
Some OEM physicians have addi- and post-exposure examinations.
Some OEM physicians have addi-
tional knowledge and skills in the following 2. Perform clinical evaluations to detect
tional knowledge and skills in the following
areas, not considered core for all OEM the health effects of exposure to hema-
areas, not considered core for all OEM
physicians: tologic toxicants such as benzene, lead,
physicians:
and arsine.
1. Utilize diagnostic testing such as radio- 3. Evaluate hematologic/oncologic medi-
1. Evaluate travel medicine issues and
graphs, ultrasound, or pulmonary test- cal conditions or their treatment on
provide appropriate advice and treat-
ing as part of emergency evaluations. impact on the worker’s health and abil-
ment as indicated.
2. Perform therapeutic and diagnostic ity to work.
2. Participate in research and education on
injections. infectious agents and unusual zoonoses.
3. Treat and manage simple fractures Additional Knowledge and Skills 3. Manage specific occupational infec-
including splinting and casting. Board-certified occupational medi- tious diseases found in various venues
4. Manage ophthalmic injuries including cine specialists and physicians practicing such as biosafety labs, animal care or
removal of foreign body. as OEM clinical specialists should have the medical centers.
following additional knowledge and skills: 4. Manage/advise on employee’s health
Clinical: Endocrinology Evaluate patients, clinical data, and expo- and safety in response to epidemic/pan-
OEM physicians should be aware of sure data to render opinions regarding cau- demic situation including on mitigation
the endocrine conditions that can present sation in cases of suspected occupational or activities such as physical distancing,
as, or complicate work-related conditions environmental cancer. use of personal protective equipment
or interfere with fitness for work. (PPE), hygiene, testing, contact tracing,
Clinical: Infectious Disease treatment, and vaccination.
Core Knowledge and Skills Bloodborne, waterborne, foodborne, 5. Design and manage preventive pro-
1. Select appropriate initial diagnostic and airborne pathogens pose unique chal- grams such as for needlestick
tests to evaluate workplace issues lenges for travelers and in occupational and/ or immunizations.
related to common endocrine condi- or environmental settings. OEM physicians
tions. should have the knowledge and skill to provide Clinical: Musculoskeletal
2. Assess the impact of poorly controlled early recognition and preventive action of Musculoskeletal injuries comprise a
endocrine conditions, such as diabetes infectious disease resulting from workplace majority of the acute occupational injuries
mellitus on the worker’s health and exposures or having an impact on perfor- seen by the OEM physician and may cause
ability to work. mance, including, when appropriate, contact major human performance, financial, and
3. Evaluate the role that endocrine condi- investigations, screening, prophylaxis, and human losses for employees and employers
tions (eg, hypothyroidism, diabetes) health risk communication, to minimize their alike. Thorough understanding of the anat-
might cause or exacerbate work-related spread, health effects, and recurrences. omy, physiology, and pathology of the mus-
conditions (eg, carpal tunnel syn- culoskeletal system, as well as appropriate
drome). Core Knowledge and Skills diagnostic and management skills are
4. Treat and refer as appropriate, endo- 1. Identify, manage, treat, or refer for treat- essential. OEM physicians should be able
crine emergencies in the workplace ment, and implement steps to prevent or to correlate clinical conditions with func-
such as hypoglycemia. mitigate: tional capacity in relation to activities of
daily living and work. Applying the prin- Clinical: Neurology ultraviolet photokeratitis, ocular chemi-
ciples of epidemiology and ergonomics cal exposures and burns (including
Occupational and environmental
enables the OEM physician to facilitate alkali, acid, and hydrofluoric acid).
exposures can cause acute and chronic
the development of programs to prevent 3. Identify the need for specialized
effects on the central and peripheral nervous
these conditions. ophthalmologic evaluation.
systems. OEM physicians should have the
4. Evaluate the impact of ophthalmic
skills and knowledge to evaluate, diagnose,
abnormalities in fitness for duty deter-
Core Knowledge and Skills and prevent exposure-related neurologic
minations.
1. Perform focused and comprehensive conditions and to facilitate the placement
musculoskeletal evaluations, including of workers with neurologic disorders. Additional Knowledge and Skills
the history, physical examination, Some OEM physicians have addi-
appropriate imaging or laboratory stud- Core Knowledge and Skills tional knowledge and skills in the following
ies, and the investigation of occupa- 1. Perform focused neurological and men- areas, not considered core for all OEM
tional risk factors. tal status examinations in the evaluation physicians:
2. Utilize knowledge of the pathophysiol- of occupational/ environmental injuries
ogy, evaluation, and management of or illnesses. 1. Perform slit lamp examination.
work-related musculoskeletal injury. 2. When indicated, select, and utilize the 2. Measure intraocular pressure.
3. Interpret common diagnostic studies results of neurological and mental status 3. Utilize diagnostic tools such as ultra-
used to evaluate musculoskeletal con- examination procedures or consulta- sound to evaluate ophthalmic injuries.
ditions in occupational medicine. tions in the evaluation of occupational 4. Removal of ophthalmic superficial for-
4. Understand options and controversies in or environmental injuries or illnesses, or eign bodies.
the treatment of musculoskeletal for personal neurological conditions
conditions. that may be impacting the ability to Clinical: Otolaryngology
5. Identify, manage, and prevent acute and perform work tasks. Such studies may OEM physicians should have the
chronic musculoskeletal disorders and include imaging, electrodiagnostic or clinical knowledge and skills to identify,
their associated disabilities, and deter- electrophysiologic studies or neuropsy- evaluate, diagnose, and manage the care of
mine when such conditions are work- chological/neurocognitive testing. patients with common occupational and
related. 3. Recognize neurologic emergencies and environmental otolaryngological condi-
6. Some conditions of particular interest treat or refer as appropriate. tions.
include spine disorders; cumulative 4. Collaborate with specialists and, pri-
trauma disorders; joint and extremity mary care providers to appropriately Core Knowledge and Skills
injuries and disorders; degenerative dis- treat and determine if workers can 1. Diagnose and manage nasopharyngeal
eases of bones, joints, and connective safely continue to work or return conditions caused or aggravated by occu-
tissue. to work. pational and environmental exposure,
7. Identify appropriate rehabilitation ser- 5. Understand and interpret diagnostic including allergies, rhinitis,or pharyngitis.
vices for an injured worker. testing (eg, nerve conduction studies 2. Evaluate and treat or refer as appropri-
8. Identify delayed recovery and manage or electromyography). ate, an individual with hearing loss or
chronic musculoskeletal pain syn- 6. Evaluate the impact of neurologic con- other occupationally related otologic
dromes with referral as appropriate. ditions on fitness for duty, especially in conditions such as external otitis related
9. Evaluate the impact of musculoskeletal safety-sensitive occupations. to, or complicated by, the use of
conditions on fitness for duty. hearing protection.
Additional Knowledge and Skills 3. Identify noise-induced hearing loss and
Additional Knowledge and Skills Some OEM physicians have addi- counsel on means to prevent further
Some OEM physicians have additional knowledge and skills in the following damage.
tional knowledge and skills in the following areas, not considered core for all OEM 4. Interpret an audiogram, identify a stan-
areas, not considered core for all OEM physicians: Perform diagnostic testing or dard threshold shift, and implement
physicians: treatment utilizing ultrasound, nerve con- appropriate treatment and preventive
duction studies, electromyography, or interventions.
1. Utilize diagnostic tools such as radio- nerve blocks. 5. Support safety and industrial hygiene
graphs or ultrasound for evaluation of professionals in the mitigation and/or
musculoskeletal injuries and pain syn- Clinical: Ophthalmology abatement of occupational noise sour-
dromes. OEM physicians should have the ces, the design and implementation of
2. Perform diagnostic or therapeutic injec- clinical and administrative knowledge and hearing conservation programs, and in
tions for musculoskeletal injuries and skills to manage occupational eye injuries the selection of appropriate hearing pro-
pain syndromes including but not lim- and oversee vision screening and protection tection options for employees.
ited to the following: joint and soft programs. 6. Develop, implement, and manage an
tissue injections including bursal, ten- occupational hearing conservation pro-
don sheath, nerve sheath, barbotage, Core Knowledge and Skills gram.
tenotomy, and aspiration, using imaging 1. Perform ophthalmic examinations, 7. Evaluate the impact of hearing abnor-
techniques as appropriate. including visual acuity and color/depth malities in fitness for duty.
3. Perform casting and splinting for mus- tests, assessment for foreign bodies or
culoskeletal disorders and fractures. other abnormalities. Additional Knowledge and Skills
4. Utilize knowledge of biomechanics of 2. Recognize and treat, or refer to specialist Some OEM physicians have addi-
injury and apply to preventive strategies as appropriate, occupational ophthalmic tional knowledge and skills in the following
(ergonomics, prevention programs, pre/ diseases and injuries. These may include areas, not considered core for all OEM
post shift biomechanical training, etc.). infectious and irritant conjunctivitis, physicians:
1. Perform audiometric testing. 3. Identify and evaluate with referral as 2. Identify and recommend appropriate
2. Perform hearing loss causation analysis appropriate workers who may be under work restrictions and accommodations
based on review of longitudinal the influence of psychoactive chemi- for both occupational and non-occupa-
audiometric measurements. cals at work (eg, industrial exposure, tional lung diseases.
3. Evaluate and manage patients with medications, recreational drugs, alco- 3. Perform and interpret a spirogram
complicated nasopharyngeal conditions hol). appropriate standards.
caused or aggravated by occupational 4. Support access to psychological care, 4. Perform respirator certification exami-
and environmental exposure, including such as work-focused cognitive behav- nations tailored to the anticipated work-
vocal cord dysfunction, laryngeal pol- ioral therapy, for patients at risk for place exposures, to the exertional
yps, neoplasms, and granulomata. disability due to behavioral risk factors demands of the job, and to the type of
such as pain catastrophizing, disability respiratory protection used.
Clinical: Pain Management beliefs and fear/avoidance behavior. 5. Advise on appropriate respirator
OEM physicians should be familiar 5. Perform a mental health and psycho- options, in consultation with an indus-
with the diagnosis, treatment associated with social history. trial hygienist if needed, in consider-
various types and presentations of pain. 6. Evaluate the impact of psychological ation of clinical conditions (eg, use of
conditions and their treatment on fit- pressure demand respirator in patient
Core Knowledge and Skills ness for duty. with cardiac disease).
1. Understand the difference between 7. Determine the need for and recom- 6. Evaluate the impact of pulmonary con-
acute and chronic pain, including the mend appropriate limitations or ditions and their treatment on the work-
neurologic pathways mediating each. accommodations for workers with er’s health and ability to work.
2. Utilize treatment approaches that will mental health conditions. 7. Apply the hierarchy of controls to
help patients with pain maintain optimal 8. Utilize evidence-based guidelines to reduce exposure and minimize risk for
function consistent with current best provide appropriate treatment and pulmonary disease and impairment.
practice and evidence-based medicine. assess return to work for individuals
3. Follow evidence-based treatment guide- with mental health conditions. Additional Knowledge and Skills
lines related to acute opioid prescription 9. Ability to recognize and advise on Some OEM physicians have addi-
and chronic opioid management. workplace interventions to prevent tional knowledge and skills in the following
4. Refer to pain management specialists as burnout in colleagues and employees. areas, not considered core for all OEM
appropriate and collaborate on a treat- 10. Understand the impact of social deter- physicians:
ment plan that includes functional res- minants of health on employee health
toration and return-to-work planning. and wellness. 1. Perform and interpret or refer as appro-
5. Evaluate the impact of pain and any priate for diagnostic testing for pulmo-
treatment on fitness for duty, especially Additional Knowledge and Skills nary disease including pulmonary
in safety sensitive positions. Some OEM physicians have addi- function testing, methacholine and
6. Utilize state’s prescription drug tional knowledge and skills in the following other challenge testing, pulmonary
monitoring program. areas, not considered core for all OEM imaging studies and allergy testing.
physicians: 2. Perform International Labor Organiza-
Additional Knowledge and Skills tion (ILO) B reading of radiographic
Some OEM physicians have addi- 1. Identify and assist in the management of abnormalities of pneumoconiosis.
tional knowledge and skills in the following psychological stressors in the work- 3. Utilize diagnostic ultrasound to evalu-
areas, not considered core for all OEM place. ate lung function and pathology related
physicians: 2. Participate in the implementation of to occupational injury and exposures.
workplace mental health programs
1. Manage long-term opioid therapy. which can impact employee human per-
Clinical: Reproductive Medicine
2. Manage outpatient opioid detoxifica- formance, morale, and disability.
tion. 3. Participate in the design of violence OEM physicians have the clinical
3. Perform diagnostic testing or treatment prevention and response programs. knowledge and skill to advise patients
utilizing ultrasound, nerve conduction 4. Counsel employees on resiliency prac- about reproductive risks of occupational
studies, electromyography, or nerve tice. and environmental exposures; the effects
blocks of exposure and work on fertility, preg-
Clinical: Pulmonary nancy, and the fetus; and the ability of
Clinical: Psychiatry OEM physicians should be able to the pregnant worker to perform work.
OEM physicians should have the assess the causes and occupational impact
knowledge and skill to recognize, evaluate, of respiratory disorders and pulmonary Core Knowledge and Skills
and assist in the management or triage of impairment. 1. Identify potential adverse reproductive
workers with psychological or substance outcomes to both men and women
related disorders presenting in the workplace. Core Knowledge and Skills from chemical, biological, physical,
1. Prevent, identify, diagnose, treat and/or biomechanical, and psychological
Core Knowledge and Skills refer occupational/environmental lung exposures and provide advice to
1. Identify the impaired employees with disorders, including but not limited to employees and employers regarding
mental health or drug abuse issues and work-related asthma, pneumoconiosis, the management of such exposures.
refer as appropriate including to irritant inhalations, chronic obstructive 2. Identify and utilize up-to-date sources
employee assistance programs. pulmonary disease, hypersensitivity of reproductive toxicology information.
2. Identify and interpret warning signs of pneumonitis, inhalation fever, bronchi- 3. Recommend appropriate restrictions
the violent, homicidal, or suicidal olitis obliterans, lung cancer, mesothe- and accommodations for pregnant or
employee and refer as appropriate. lioma, and obstructive sleep apnea. lactating employees.
Additional Knowledge and Skills practice, to employers, employees, and with Disabilities Act [ADA], ADA
patients, including: Amendment Act [ADAAA], Reha-
a. OSHA standards and regulations, bilitation Act of 1973).
including the General Duty Clause. b. Genetic Information Nondiscrimi-
b. The privacy provisions of the nation Act (GINA).
physicians: Advise on policies and proce-
Health Insurance Portability and c. Family Medical Leave Act (FMLA).
dures relating to the protection of fertility
Accountability Act (HIPAA), d. Short- and long-term disability man-
for both men and women and for placement
including exceptions related to agement and outcomes related to
of pregnant or lactating workers.
workers’ compensation and public impairment and disability.
Clinical: Sleep Medicine safety. e. Environmental health and safety
c. DOT and other federal regulations regulations.
OEM physicians should recognize
regarding fitness for duty in safety- f. Rules related to the various jurisdic-
patients with sleep disorders and be prepared
sensitive positions. tions in which OEM work is done
to refer for testing and manage the work
d. Federal and state drug testing reg- (workers’ compensation, veterans’
fitness/safety aspects of this condition.
ulations. benefits, military disability evalua-
Core Knowledge and Skills e. Drug-free workplace programs. tion, etc.).
2. Understand and protect patients’ legal 2. Respond in compliance with the
1. Recognize patients at risk for, or having
rights to confidentiality of medical requirements of employee/community
symptoms of, sleep disorder such as
records information. right-to-know regulations and advise
obstructive sleep apnea, circadian
3. Understand the risks of electronic individuals about their rights to access
rhythm sleep disorders or fatigue.
communication and apply appropriate information.
2. Refer for evaluation and diagnostic testing
controls in communication and record- 3. Provide medical-legal reports and
as appropriate, individuals where sleep
keeping. expert opinions and testimony on
disorders may impact work performance.
4. Maintain complete, timely, and legible OEM issues.
3. Evaluate the impact of sleep disorders
records. 4. Participate in the rule-making process
on fitness for duty, especially in safety-
5. Recognize and address ethical dilem- by participating in committees or work-
sensitive positions.
mas in the practice of OEM, using ing groups, providing testimony, or
Additional Knowledge and Skills relevant guidelines. other activities for sharing OEM exper-
6. If providing workers’ compensation tise with the decision makers.
related care, comply with require-
ments of relevant statutes, including 3. Environmental Health: OEM
completion of the required forms and physicians should have the knowledge
physicians: Advise on and implement a
cooperation with case management and skills necessary to recognize potential
fatigue risk management program.
and return-to-work planning. chemical, physical, and biological environ-
7. Report cases of occupational injury, mental causes of health concern to the
2. OEM Related Law and Regula-
illness, and/or death according to individual as well as to community health.
tions: OEM physicians should have the
existing regulations. Environmental issues most often include
knowledge and skills necessary to under-
8. Balance ethical principles applicable air, water, or soil contamination by natural
stand and apply the regulations applicable
to individual patient care to those that or artificial pollutants. OEM physicians
to occupational and environmental health, as
apply to addressing population health should be competent in taking an exposure
well as the wide range of laws and regula-
concerns, for example, the need to history that includes environmental as well
tions related to the interactions between
report a hazard that may impact others, as occupational sources. The physician
work and health. They should also be aware
against the wishes of an affected must understand how to identify environ-
of voluntary standards, guidance or recom-
patient. mental hazards. OEM physicians can also
mendations regarding work practices, expo-
9. Respond appropriately to impairment characterize risk based on an assessment of
sures and other factors which may impact the
in self and other health care profes- exposure that includes potential routes of
health and safety of workers from organiza-
sionals. exposures and risk assessment. They under-
tions such as NIOSH, DOT, ACGIH, and
10. Appropriately implement and explain stand dose–response relationships and how
ACOEM. OEM physicians need to interact
consensus standards applicable to spe- to compare environmental and biomonitor-
knowledgeably with non-medical professio-
cific groups of employees. ing data to published standards. OEM
nals in various roles including human resour-
physicians should be aware of common
ces operations, industrial hygiene, safety, Additional Knowledge and Skills clinically significant environmental agents
labor relations, government affairs and legal,
Some OEM physicians have addi- and diseases relevant to the geographic area
and should understand the laws, regulations,
tional knowledge and skills in the following where they practice, such as lead, asbestos,
standards, and practices that guide these
areas not considered core for all OEM arsenic, and radon. (ACGME: Patient Care,
professionals. (ACGME: Practice-Based
physicians. Medical Knowledge, Interpersonal and
Learning and Improvement, Interpersonal
Communication Skills, Professionalism
and Communication Skills, Professionalism
1. Comply with and explain applicable and Systems-Based Practice.)
and Systems-Based Practice.)
regulations, as well as their interpreta-
tion and enforcement, in relation to Core Knowledge and Skills
Core Knowledge and Skills occupational health practice, to employ- OEM physicians should have the
The OEM physician should have the ers, employees, and patients. These knowledge and skills to:
knowledge and skills to: include:
a. Legislation and regulations protect- 1. Identify sources and routes of environmen-
1. Understand and apply applicable reg- ing the employment rights of persons tal exposure and recommend methods of
ulations, related to occupational health with disabilities (eg, the Americans reducing environmental health risks.
2. Recognize and manage common ill- necessary to communicate and provide psychological, personal medical, and
nesses that may be impacted by guidance to the employee and employer work injury conditions on the natural
environmental exposures. when there is a need for integration of an history of illness and injury.
3. Characterize health risks based on haz- employee with a disability or impairment/ 2. Design and implement protocols to
ard identification, exposure assessment, functional limitations into the workplace, or evaluate prospective and current
and effectively communicate risk from when there is a need to pursue other ave- employees for conditions creating an
a variety of exposures. nues such as vocational rehabilitation or undue risk to self or others in the work-
4. Understand basic principles of envi- disability benefits. This would include place, in compliance with the ADA and
ronmental mitigation and exposure whether such disability is due to musculo- ADAAA, and consistent with the regu-
control and be aware of governmental skeletal or cognitive function, the prognosis lations and standards of the applicable
agencies or private resources that can and progression of the medical condition system of evaluation.
perform environmental monitoring and including substance abuse or the effect of 3. Assess and express impairment in terms
mitigation. treatment such as medications or other required by the relevant legal or benefit
therapy. Some OEM providers may per- systems.
Additional Knowledge and Skills form disability evaluations or IMEs utiliz- 4. Perform IMEs.
Some OEM physicians have addi- ing current disability or impairment rating
tional knowledge and skills in the following resources. Others may be responsible for 5. Toxicology: OEM physicians
areas not considered core for all OEM developing and managing transitional or should have the knowledge and skills to
physicians. alternate work placement programs or eval- recognize, evaluate, and manage health
uating the effectiveness of OEM medical effects of exposures to toxic agents at work
1. Identify common environmental con- care delivered by other physicians, monitor or in the general environment. They should
taminants indoors and outdoors and adherence to evidence-based practice be familiar with and able to use existing
understand how to assess exposure to guidelines as well as clinical outcomes. resources and databases (eg, SDS, Pub-
these contaminants. (ACGME: Patient Care, Medical Knowl- Chem, TLVs, etc.) to characterize the
2. Understand when to obtain environmen- edge, Interpersonal and Communication potential risk from occupational and envi-
tal monitoring. Skills, Professionalism and Systems-Based ronmental chemical exposures. OEM physi-
3. Interpret and explain the results of envi- Practice.) cians can interpret industrial hygiene reports
ronmental monitoring and compare to and other data describing specific exposure
established guidelines or recommenda- Core Knowledge and Skills conditions to determine potential routes of
tions. 1. Integrate work disability prevention and exposure to determine possible overexpo-
4. Identify and treat individual health management principles into delivery of sure. They should be familiar with the
effects associated with environmental clinical care. adverse effects of such overexposures on
exposures. 2. Establish clinical treatment protocols the exposed individuals, as well as the stan-
5. Identify and manage population expo- that are consistent with current best dard clinical and biological tests used to
sure to environmental toxins. practice and evidence-based medicine. confirm such adverse effects. OEM physi-
6. Interpret published quantitative risk 3. Explain and make clinical decisions as cians can implement standard components
assessments and the principles of com- well as placement/accommodation rec- of medical surveillance and biological mon-
parative, cumulative and integrated risk ommendations relating to the concept of itoring appropriate for individuals exposed
assessment and understand their limita- ‘‘direct threat’’ as defined under the to specific chemicals. They should also have
tions. ADA and reconcile these decisions with knowledge of specific legally mandated (eg,
7. Employ the basic scientific tools of public safety considerations as defined OSHA) surveillance and monitoring proce-
toxicology, risk assessment, and envi- by other systems. dures for those chemicals. (ACGME: Patient
ronmental epidemiology to provide evi- 4. Translate impairment assessments into Care, Medical Knowledge, Practice-Based
dence-based input to the creation of safe work functional capacity state- Learning and Improvement, Professionalism
environmental policy in both the private ments for the use of employers in plac- and Systems-Based Practice.)
and public sector. ing employees in jobs.
5. Conduct evaluations to determine fit- Core Knowledge and Skills
4. Work Fitness and Disability ness for duty in compliance with appli- OEM physicians should have the
Management: OEM physicians should cable regulations in reference to specific knowledge and skills to:
have the knowledge and skills to determine work exposures, work tasks, or public
whether a worker can safely be at work and safety concerns. 1. Evaluate, manage and/or properly refer
perform required job tasks. OEM physi- 6. Address employment concerns for persons with health effects from toxic
cians should be able to evaluate the indi- patients with identified temporary or exposures.
vidual, coordinate care with other permanent medical conditions. 2. Understand the potential toxicity, includ-
specialists, and utilize evidence-based 7. Refer to the ACOEM guidance docu- ing medical surveillance requirements
guidelines to develop a treatment or man- ments relevant to this topic. and protection standards related to mate-
agement plan. They should be able to utilize rials used by working populations rou-
information from the employer, other pro- Additional Knowledge and Skills tinely served clinically (eg, pre-placement
viders, and other professionals such as case Some OEM physicians have addi- or surveillance examinations).
managers, ergonomists, therapists and tional knowledge and skills in the following 3. Obtain information about hazardous
vocational rehabilitation specialists, safety areas, not considered core for all OEM materials implicated or suspected in
professionals, attorneys, and human resour- physicians: toxic exposure evaluations (eg, from
ces to facilitate an outcome that aligns the SDS and other sources).
individual’s abilities with the job require- 1. Design and implement integrated sys- 4. Use available information from patient,
ments and essential functions. OEM physi- tems of work disability prevention and employer, and other sources, incorpo-
cians should have the knowledge and skills management including the impact rating information about protective
equipment used, to characterize risk of patients, and the public from the range 9. Assess the workplace and environment
exposure, absorption, and toxic effects. of known physical, chemical, biological, for potential hazards and address the
5. Order clinically appropriate laboratory or psychosocial hazards. (ACGME: Medi- need for PPE and other exposure
studies to determine acute organ or cal Knowledge, Practice-Based Learning control methods.
metabolic effects. and Improvement, Interpersonal and Com-
6. Determine need for referral for spe- munication Skills and Systems-Based Prac- 7. Disaster Preparedness and
cialty evaluation or further exposure tice.) Emergency Management: OEM physi-
evaluation. cians may have a critical role in emergency
7. Recognize conditions that may be sen- Core Knowledge and Skills preparedness, emergency management and
tinel events associated with toxic expo- 1. Recognize common occupational haz- pandemic preparation and mitigation. This
sures and take appropriate action to ards and most appropriate exposure includes playing a key role in protecting
protect the health of others who may control measures based on the hierarchy employees and families, health systems,
be exposed. of controls which may include PPE. companies, and government agencies, as
2. Understand protective measures appro- well as contributing to the health of the
Additional Knowledge and Skills priate for the hazards of interest in the national and global workforce, anticipating,
Some OEM physicians have addi- working populations served. and preventing the economic consequences
tional knowledge and skills in the following 3. Communicate concerns related to health of disasters. OEM physicians may be called
areas not considered core for all OEM hazards to appropriate employer health upon to treat those impacted by the emer-
physicians. and safety professionals; participate in gency or disaster or to evaluate emergency
mitigation efforts. responders. OEM physicians should be able
1. Evaluate, manage, and treat persons to describe specific threats, including a broad
whose health may be affected by Additional Knowledge and Skills range of physical, chemical, biological, or
toxic exposures. Some OEM physicians have addi- psychosocial hazards. Depending on their
2. Determine the nature and extent of toxic tional knowledge and skills in the following practice setting, OEM physicians may need
exposures, considering routes of expo- areas not considered core for all OEM the knowledge and skills to collaborate with
sure and routes of absorption. physicians. the employer management team to plan for
3. Interpret exposure data in the context of workplace response to natural or manmade
the scientific literature (human and ani- 1. Characterize existing and potential disasters. Emergency management planning
mal), published guidelines or regula- occupational and environmental haz- includes resource mobilization, worker pop-
tions and the patient’s presentation. ards within defined populations. ulation tracking, communication, procure-
4. Understand, explain, and be able to 2. Evaluate and interpret the results of ment of medical products, financing,
apply toxicokinetic data (including industrial hygiene surveys or risk leadership and governance, and contingency
routes of exposure, absorption, metabo- assessments. planning. Collaboration with local, state, or
lism, storage, and excretion) to clinical 3. Interpret and apply published exposure federal agencies is essential. (ACGME:
and employment-related decision-mak- limits such as OSHA permissible expo- Patient Care, Medical Knowledge, Prac-
ing. sure limits (PELs), ACGIH’s TLVs and tice-Based Learning and Improvement,
5. Interpret and apply information from biologic exposure indices (BEIs), Envi- Interpersonal and Communication Skills
medical, toxicological, and environ- ronmental Protection Agency standards, and Systems-Based Practice.)
mental health literature. and other criteria in the assessment of
6. Perform complex causation analysis chemical and physical hazard expo- Core Knowledge and Skills
and provide a rationalized and well- sures. 1. Knowledge of local threats, for exam-
supported written report. 4. Apply ergonomic principles to optimize ple, nuclear plants, chemical production
7. Effectively communicate risk, necessary comfort and reduce risk at work, includ- facilities.
actions, and reassurance to patients. ing evaluation and redesign of hazard- 2. Participate in local emergency response
ous lifting jobs, repetitive motion work, exercises.
6. Hazard Recognition, Evalua- and jobs with special visual demands. 3. Understand how to activate/notify
tion, and Control: OEM physicians should 5. Advise employers and employees others in the emergency response sys-
have the knowledge and skills necessary to regarding industrial hygiene and safety tem.
assess if there is risk of an adverse event controls, such as work practices, respi- 4. Recognize sentinel events that may rep-
from exposure to physical, chemical, bio- rator use, and engineering controls. resent a potential disaster or epidemic.
logical, or psychosocial hazards in the Recommend and implement policies 5. Understand local clinical role in the com-
workplace or environment. They should and control measures to reduce or miti- munity emergency/disaster response plan.
be prepared to collaborate with industrial gate safety and health hazards.
hygienists or other qualified safety and 6. Design and manage a hearing conserva- Additional Knowledge and Skills
health professionals and interpret measure- tion program for workers exposed to Some OEM physicians have addi-
ments and reports from such professionals loud noise. tional knowledge and skills in the following
in context. If there is a risk with exposure, 7. Perform a risk assessment and identify areas not considered core for all OEM
then that risk can be characterized with exposure-related health hazards, evalu- physicians.
recommendations for control measures or ate level of exposure, and characterize
medical surveillance. OEM physicians risk. 1. Describe specific threats, including a
should demonstrate an understanding of 8. Communicate to target groups includ- broad range of chemical, biological,
the core principles of industrial hygiene, ing health professionals, patents, the radiological, and physical hazards.
ergonomics, occupational safety and risk public, and the media, in a clear and 2. Apply knowledge of personal protection
assessment and communication, and apply effective manner the levels of risk from and other approaches to health protec-
the principles of the Hierarchy of Controls real or potential hazards and the ratio- tion to evaluate the adequacy of protec-
to protect the health of individual workers, nale for selected interventions. tion at the individual level.
3. Participate in the development of emer- Medical Knowledge, Practice-Based Learn- catastrophic events such as pandemics, bio-
gency or disaster plans for the working and Improvement, Interpersonal and terrorism, climate/weather occurrences.
place and/or the community. Communication Skills and Systems-Based OEM physicians should have the knowledge
4. Establish emergency procedures and Practice.) and skill to develop, evaluate, and manage
protocols for the clinical management medical surveillance programs for the work-
of individuals involved in disaster inci- Core Knowledge and Skills place as well as the public in order to identify
dents, including specific medical 1. Recognize burnout in employees. trends and sentinel events. They should
management protocols. 2. Perform health risk assessments, bio- be knowledgeable and able to apply appro-
5. Design and implement a plan for the metric screenings, or other appropriate priate screening guidelines, as well as
mitigation of a disaster incident at the interventions to modify health risk immunization and chemoprophylaxis rec-
worksite or general community. behaviors in the clinical setting. ommendations for workers. This includes
6. Assist in the design and implementation 3. Counsel employees about health risks those from USPSTF, Hospital Infection
of a medical recovery plan for mass and lifestyle. Control Advisory Committee on Immuniza-
casualty events in industry or general 4. Use tools and best practices to identify, tions, CDC, and applicable OSHA guide-
community. measure, and modify individual and lines (eg, bloodborne pathogen exposure)
7. Design and/or conduct an outbreak and/ population health risk behaviors. and standards. OEM physicians should be
or cluster investigation. 5. Accommodate cultural, ethnic, educa- able to apply primary, secondary, and ter-
8. Design a pandemic preparedness plan tional, and language variations among tiary preventive approaches to individual
for an organization. workers when providing information on and population-based disease prevention
9. Maintain a thorough understanding of occupational hazard prevention, disease and health promotion, and be able to
local, regional, state, and national prevention, and health promotion. develop, implement and evaluate the effec-
response plans and Incident Command tiveness of appropriate clinical preventive
Structure. Additional Knowledge and Skills services for both individuals and popula-
Some OEM physicians have addi- tions. Deploy information technology to
8. Health and Human Perfor- tional knowledge and skills in the following address current and emerging occupational
mance: OEM physicians should be able areas not considered core for all OEM hazards. Utilizing available information,
to identify and address individual and orga- physicians. they should have the ability to appropriately
nizational factors in the workplace towards communicate risk to workers, organizations,
optimizing worker health and enhancing 1. Design, implement and evaluate work- and the public. OEM physicians should also
human performance. They should be able site health-promotion and disease-pre- possess data management skills as well as
to assess the degree of impact of those factors vention programs, incorporating know how to access and advise expert epi-
(ie, smoking, depression, burnout, and other Department of Health and Human Ser- demiology and biostatistics support in
medical conditions) and be able to advise on vices (DHHS) and other authoritative acquiring, managing, and interpreting data
or create programs relevant to that work- guidelines as appropriate. relevant to the populations they serve in
place to address the concern (ie, smoking 2. Understand and apply the concepts of order to make evidence-based interventions.
cessation, physical activity, depression or the NIOSH Total Worker Health1 They should be able to measure, organize
blood pressure screening, weight manage- approach. and improve public health service or a sur-
ment, mindfulness, or resiliency training) 3. Describe the appropriate use and limi- veillance system. (ACGME: Patient Care,
that will improve worker wellness. OEM tations of health risk assessment and Medical Knowledge, Practice-Based Learn-
physicians should be able to understand data screening for well populations and the ing and Improvement, Interpersonal and
management and reporting systems and applications of screening, assessment, Communication Skills, Professionalism
assess aggregate data from health risk assess- and early intervention for targeted high- and Systems-Based Practice.)
ments, health insurance claim data and the risk groups.
effect of implemented well-being related 4. Advise on methods for prevention of Core Knowledge and Skills
programs. OEM physicians should be psychosocial risks at a collective level. 1. Design and execute a medical surveil-
knowledgeable of the organizational struc- 5. Communicate current medical, environ- lance program to protect workers,
ture and be able to communicate data to mental, and/or other scientific knowl- ensuring compliance with applicable
senior management of an organization. edge effectively to target groups, regulations when appropriate as well
Overall, OEM physicians should have the including patients, employees, employ- as monitor, interpret, and act on results.
ability to provide guidance to an organiza- ers, unions, community groups, and 2. Advise employers concerning trends in
tion about optimal health and human perfor- the media. occupational injury and illness.
mance programs to consider for the 6. Recognize the effects of cultural, ethnic, 3. Implement prevention programs such as
workforce and may participate in decisions and social factors, including health the National CDC Diabetes Prevention
about the optimal method to deliver those beliefs and practices, on the health Program.
services. They should provide advice to and safety of workers. 4. Evaluate and manage situations of sus-
support the organization promoting a culture 7. Execute cost/benefit analysis, ROI, pected chemical impairment, including
of health, and ensuring that any program value of investment. collection of specimens ensuring appro-
aligns with business goals, in accordance 8. Critically review the OEM and medical priate chain of custody, in compliance
with best practice in supporting workplace literature. with applicable rules and regulations.
health and safety. OEM physicians should 5. Manage incidents of potential blood-
also have a strategy to demonstrate their 9. Public Health, Surveillance, and borne pathogen, tuberculosis, or other
value to the system and the return on invest- Disease Prevention: OEM physicians occupational infectious disease expo-
ment of suggested or implemented initia- should be able to assess, prepare and sure according to applicable govern-
tives. The ultimate goal is creating and respond to individual and population risks ment guidelines.
sustaining a healthy, safe and high-perfor- for common occupational and environmen- 6. Identify appropriate exposure controls
mance workforce. (ACGME: Patient Care, tal disorders as well as emerging and which may include appropriate PPE,
with industrial hygiene and safety, to related to workers’ compensation and other management, and other activities to
mitigate hazards faced in the workplace. legal and regulatory standards. OEM physi- enhance an organization’s perfor-
7. Intervene in response to positive find- cians in all practice settings are expected to mance.
ings when indicated to measurably be sensitive to the diverse needs and cul- 2. Communicate technical and clinical
improve health outcomes. tural backgrounds of those they serve and information to professional and lay
8. Interpret abnormal laboratory findings anticipate meeting diverse needs in setting audiences. Give presentations to
in asymptomatic workers and recom- up their practices. OEM physicians should employees, employers, labor unions,
mend further evaluation and/or treat- be able to collaborate as part of a larger and others on occupational and envi-
ment as indicated. OEM team which may include physician ronmental health and safety topics.
9. Recognize and report or investigate colleagues, other health care providers, 3. Recognize potential sources of system
potential sentinel events. industrial hygienists, safety professionals, or program failure and use root cause
ergonomists, physical therapists, athletic analysis to plan solutions.
Additional Knowledge and Skills trainers, employers, legal experts, human 4. Evaluate health services provided to
Some OEM physicians have addi- resources professionals, insurance carriers, employees by determining relevant
tional knowledge and skills in the following case managers, adjustors, etc., and may outcome parameters and by using
areas not considered core for all OEM play a leadership role in those teams. benchmarks and quality metrics based
physicians. OEM physicians may be expected to eval- on the medical literature to measure
uate and implement clinical practice guide- and improve outcomes.
1. Develop, implement, evaluate, and lines, quality improvement programs, 5. Design cost-containment strategies for
refine screening programs for groups outcome assessment strategies and medical workers’ compensation, health bene-
to identify risks for disease or injury informatics programs as they apply to day- fits, pharmacy benefits, retiree benefits
and opportunities to promote wellness to-day clinical patient care. OEM physi- and disability management programs
and mitigate progression in disease cians should be able to manage many of the to allocate and manage clinical and
management programs. programs essential to the success of the financial resources.
2. Design and implement proactive sys- above nine core competencies. (ACGME: 6. Expanding the footprint of OEM to
tems of care that effectively reach all Practice-Based Learning and Improve- employees’ families and communities.
members of a population, including ment, Interpersonal and Communication 7. Evaluate the effectiveness and cost-
those at high risk and those who do Skills, Professionalism and Systems-Based effectiveness of occupational health
not normally seek care. Practice.) services and risk reduction methods.
3. Design and conduct surveillance pro- 8. Work effectively with both labor and
grams in workplace and/or community Core Knowledge and Skills management to make system-based
settings. 1. Establish protocols to manage patient changes to maximize workplace
4. Review, interpret, and explain the pub- records and protect confidentiality. health, safety, and human perfor-
lic health and clinical implications of 2. Work effectively as a team member with mance.
epidemiological studies that address administrators, occupational health 9. Manage OEM issues in an interna-
occupational hazards. nurses, nurse practitioners, physician tional workforce, researching geo-
5. Apply validated epidemiologic and bio- assistants, and others, demonstrating graphic variation in disease risk and
statistical principles and techniques to an understanding of their roles in an developing an understanding of cul-
analyze injury/illness data in a defined occupational health service. tural and regulatory differences that
worker and community populations. 3. Identify potential customers and must be considered in program design.
6. Apply primary, secondary, and tertiary develop an education and marketing 10. Manage and set up international work-
prevention approaches to disease pre- plan for an occupational environmental sites, evacuation of injured workers
vention and health promotion to indi- health program. overseas, and manage expatriates.
viduals and communities. 4. Use information technology (eg, e-mail, 11. Evaluate, analyze, and utilize data sys-
7. Recommend and implement policies local and wide area networks, internet, tems to use information management
and control measures to address emerg- video conferencing technologies) to tools to identify, acquire, process, use,
ing infectious diseases of concern. communicate with colleagues, clients, and share information.
and others.
10. OEM Related Management 5. Determine management information Additional Resources
and Administration: OEM physicians needs and apply medical informatics,
should have the administrative and man- electronic health and patient care data, American Board of Preventive Medi-
agement knowledge and skills to plan, management information systems, and cine—https://www.theabpm.org/
design, implement, manage, and evaluate other computer technologies to an Accreditation Council for Graduate
comprehensive occupational and environ- OEM program. Medical Education Program Require-
mental health programs and projects and ments—https://www.acgme.org/Spe-
work with leadership and governance to Additional Knowledge and Skills cialties/Program-Requirements-and-
ensure the health and safety of employees. Board-certified OM specialists and FAQs-and-Applications/pfcatid/20/Pre-
OEM physicians need an understanding of other physicians practicing as OEM clinical ventive%20Medicine
health care benefits, workers’ compensa- specialists and OEM population managers Journal of Occupational and Environ-
tion systems, electronic health records and may need the following additional knowl- mental Medicine—https://journals.lww.
knowledge of the laws and regulations edge and skills: com/joem/pages/default.aspx
applicable to their jurisdiction, industry, National Institute of Occupational
and population of interest. OEM physicians 1. Design, implement, and evaluate Safety and Health (NIOSH)—https://
should understand and be able to articulate clinical practice guidelines, quality www.cdc.gov/niosh/
the differences in assessment between the management/quality improvement pro- Centers for Disease Control and Preven-
concepts of medical causation and those grams, utilization management, case tion—https://www.cdc.gov
Agency for Toxic Substance and Disease 3. American College of Occupational and Envi- acgme.org/Specialties/Overview/pfcatid/20.
Registry (ATSDR)—https://www.atsdr. ronmental Medicine. Occupational and environ- Assessed June 1, 2021.
cdc.gov mental medicine competencies: J Occup 16. Ducatman AM, Vanderploeg JM, Johnson M,
Environ Med. 2014; 56:e21–40. Available at: et al. Residency training in preventive medi-
American College of Occupational and https://acoem.org/acoem/media/PDF-Library/ cine: challenges and opportunities. Am J Prev
Environmental Medicine (ACOEM)— Publications/OEM_Competencies/ACOEM- Med. 2005;28:403–412.
https://www.acoem.org OEM-COMPETENCIES.pdf. Accessed July
22, 2020. 17. Harber P, Wu S, Bontemps J, Rose S, Saechao
Association of Occupational and Envi- K, Liu Y. Value of occupational medicine board
ronmental Clinics (AOEC)—http:// 4. Harber P, Bontemps J, Saechao K, Wu S, Liu Y, certification. J Occup Environ Med. 2013;55:
Elashoff D. Career paths in occupational medi- 532–538.
www.aoec.org cine. J Occup Environ Med. 2012;54:1324–
Department of Transportation—https:// 1329. 18. CDC NIOSH. NIOSH Total Worker Health.
Available at: https://www.cdc.gov/niosh/twh/
www.transportation.gov 5. Harber P, Rose S, Bontemps J, et al. Occupa- default.html. Accessed July 19, 2020.
Occupational Safety and Health Admin- tional medicine practice: activities and skills of
19. ACOEM Committee on Ethical Practice in
istration—https://www.osha.gov a national sample. J Occup Environ Med.
2010;52:1147–1153. Occupational and Environmental Medicine.
World Health Organization—https:// ACOEM Code of Ethics. Elk Grove, IL: Amer-
6. Harber P, Rose S, Bontemps J, et al. Occupa- ican College of Occupational and Environmen-
www.who.int tional medicine practice: one specialty or three?
Environmental Protection Agency— tal Medicine; 2009. Available at http://
J Occup Environ Med. 2010;52:672–679. www.acoem.org/codeofconduct.aspx.
https://www.epa.gov 7. Baker BA, Dodd K, Greaves IA, Zheng CJ, Accessed February 24, 2020.
CDC – NCEH: National Center for Brosseau L, Guidotti T. Occupational medicine 20. Green McKenzie J. Emmett E: characteristics
Environmental Health—https://www. physicians in the United States: demographics and outcomes of an innovative train-in-place
cdc.gov/nceh/ and core competencies. J Occup Environ Med. residency program. J Graduate Medical Educ.
2007;49:388–400. 2017;9:634–639.
Food and Drug Administration—https://
8. McAdams M, Kerwin JJ, Olivo V, Goksel HA. 21. Baker BA, Greaves IA, Rice HR. Occupa-
www.fda.gov National Assessment of the Occupational Safety tional medicine residency graduate survey:
Department of Labor—https://www. and Health Workforce. Washington, DC: assessment of training programs and core
dol.gov National Institute for Occupational Health competencies. J Occup Env Med. 2007;49:
LaDou J, ed. Current Occupational and and Safety; 2011. 1325–1388.
Environmental Medicine. 5th ed. New 9. Delclos GL, Bright KA, Carson AI, et al. A 22. Baker B, Kesler D, Guidotti T. Occupational
global survey of occupational health competen- and environmental medicine: public health and
York, NY: McGraw Hill; 2014. cies and curriculum. Int J Occup Environ medicine in the workplace. Am J Public Health.
ACOEM Occupational Medicine Prac- Health. 2005;11:185–198. 2020;110:636–637. Available at: https://ajph.
tice Guidelines—https://acoem.org/ 10. Emmett EA, Green-McKenzie J. External prac- aphapublications.org/doi/pdfplus/10.2105/
Practice-Resources/Practice-Guide- ticum-year residency training in occupational AJPH.2020.305625. Assessed June 1, 2021.
lines-Center/MDGuidelines and environmental medicine: University of 23. Green-McKenzie J, Savanoor U, Duran H, et al.
Pennsylvania Medical Center Program. J Occup
Rom WN, Markowitz SB. Environmen- Environ Med. 2001;43:501–511.
Outcomes of a survey-based approach to deter-
tal and Occupational Medicine, 4th ed. mine factors contributing to the shortage of
11. Meyer JD, Becker PE, Stockdale T, Ducatman occupational medicine physicians in the United
2007. Wolter Kluwer. AM. The West Virginia Occupational Safety States. J Public Health Manag Pract. 2021;
Levy BS, Wegman DH, Baron SL, Sokas and Health Initiative: practicum training for a 27(Suppl 3):S200–S205.
RK. Occupational and Environmental new marketplace. Am J Prev Med. 24. Miller LA, HRSA-Funded Preventive Medicine
Health, 7th ed. 2017. Oxford University 1999;16:347–350. Residency Program Directors Workgroup. The
Press. 12. Dinman BD. Education for the practice of SARS-CoV-2 pandemic: real-time training and
occupational medicine: knowledge, compe- service for preventive medicine residents. J
tence, and professionalism. J Occup Environ Public Health Manag Pract. 2021;27(Suppl
Med. 2000;42:115–120. 3):S123–S128.
REFERENCES 13. Michas MG, Iacono CU. Overview of occupa- 25. Mueller K, Konicki D, Larson P, Hudson TW,
tional medicine training among US family med- Yarborough C. ACOEM Expert Panel on Func-
1. American College of Occupational and Envi- icine residency programs. Fam Med. 2008; tional Outcomes. Advancing value-based med-
ronmental Medicine. Occupational and environ- 40:102–106. icine: why integrating functional outcomes with
mental medicine competencies: v 1.0. J Occup 14. Guidotti T. Learning objectives for training and clinical measures is critical to our health care
Environ Med. 1998;40:427–440. continuing education in occupational medicine. future. J Occup Environ Med. 2017;59:e57–e62.
2. American College of Occupational and Envi- Am J Prev Med. 1992;8:249–256. 26. Mueller KL, Hudson III TW, Bruns D, et al.
ronmental Medicine. American College of 15. Accreditation Council for Graduate Medical Recommendations from the 2019 symposium
Occupational and Environmental Medicine Education. ACGME Program Requirements on including functional status measurement in
Competencies—2008. J Occup Environ Med. for Graduate Medical Education in Preventive standard patient care. J Occup Environ Med.
2008;50:712–724. Medicine. 2020. Available at: https://www. 2020;62:e457–e466.
PART 3: APPENDICES c. Applying primary, secondary, and ter- initiative of the Accreditation Council for
tiary preventive approaches to individ- Graduate Medical Education (ACGME)
Appendix A – ACGME Six ual and population-based disease and the American Board of Preventive
prevention and health promotion. Medicine to be published in 2020.
Competencies and ACGME
d. Evaluating the effectiveness of clinical As a product of the Next Accredita-
Program Requirements for preventive services for both individuals
Graduate Medical Education in tion System of the ACGME, the milestones
and populations. represent a ‘‘trajectory of professional
Preventive Medicine/Specific e. Developing policies and plans to sup- development in essential elements of com-
Competencies for Occupational port individual and community health petency’’ and offer a framework for mea-
Medicine Residencies efforts. suring resident progress and outcomes in
The Accreditation Council for Grad- f. Applying the principles of ergonomics the relevant specialty. Five levels were
uate Medical Education (ACGME) is a in a real or simulated workplace setting included within the milestones in keeping
private, nonprofit council that evaluates to reduce or prevent worker injury. with the Dreyfus Model of expertise devel-
and accredits medical residency programs g. Applying the principles of toxicology opment, such that Level 4 was construed as
in the US. Established in 1981, its mission in a real or simulated workplace setting a graduation benchmark and Level 5
is to improve health care by assessing and to reduce or prevent worker injury. aspirational.
advancing the quality of resident physi- h. Conducting a real or simulated work- The initial attempt culminated in a
cians’ education through exemplary accred- place walk-through to identify and mit- set of Milestones 1.0 with considerable
itation. ACGME intermittently updates its igate hazards and relay this information variability between specialties in both con-
common program and residency specific to worksite administration. tent and developmental progression across
program requirements. The most current, i. Applying toxicologic and risk assess- milestone levels. Responsive to a wide
detailed requirements can be found on the ment principles in the evaluation range of stakeholders, feedback, and data,
ACGME web site at https://www.acg- of hazards. the revision process is underway to reduce
me.org. ACGME recommended all resi- j. Developing plans in response to senti- complexity and offer additional resources
dency programs evaluate their trainees nel events using primary, secondary, to programs in the form of a Supplemental
under six core competencies that are and tertiary prevention methods; par- Guide, with examples of how the mile-
included in the updated ACGME Common ticipating in emergency preparedness stones are to be implemented. Noteworthy
Program Requirements (Residency) in programs in at least one workplace among the several changes made for Mile-
2020. All residency programs must inte- setting. stones 2.0 is the greater harmonization
grate the following core competencies into k. Demonstrating competence in their across the non-patient care and medical
their curriculum: knowledge of factors that impact the knowledge milestones.
health of individuals and populations. The Milestones are designed only
Patient Care and Procedural Skills l. Lifestyle management. for use in evaluation of residents in the
Medical Knowledge m. Social determinants of health. context of their participation in ACGME-
Practice-based Learning and Improve- n. Knowledge of the use of available tech- accredited residency programs. The Mile-
ment nology, such as telemedicine, to reduce stones provide a framework for the assess-
Interpersonal Skills and Communication health disparities. ment of the development of the resident in
Professionalism o. Industrial hygiene, safety, and ergo- key dimensions of the elements of physi-
Systems-based Practice nomics. cian competence in a specialty or subspe-
p. Occupational epidemiology. cialty. They neither represent the entirety
The ACGME Residency Review q. Risk/hazard control and communica- of the dimensions of the six domains of
Committee (RC) for Preventive Medicine tion; and toxicology. physician competency, nor are they
(PM) last revised its required Competencies For complete 2020 ACGME require- designed to be relevant in any
for Preventive Medicine Residencies in ments, visit: other context.
general and Occupational Medicine Resi- ACGME Common Program
Edgar L, Roberts S, Holmboe E.
dencies on July 1, 2020. RC requirements Requirements Milestones 2.0: a step forward. J Graduate
for PM include requirements for all preven- https://www.acgme.org/Portals/0/ Medical Education. 2018;10:367–369.
tive medicine residency programs which PFAssets/ProgramRequirements/CPRResi-
Edgar L, McLean S, Hogan SO,
encompass occupational medicine, aero- dency2020.pdf Hamstra S, Holmboe ES. The Milestones
space medicine, and public health/general ACGME RC for Preventive Medi- Guidebook, 2nd ed. ACGME: Chicago,
preventive medicine. ACGME now allows cine Competencies for Occupational 2020. Available at: https://www.acg-
preventive medicine residencies to include Medicine me.org/Portals/0/MilestonesGuidebook.
the PGY1 or internship year. Previously, all https://www.acgme.org/Portals/0/ pdf?ver=2020-06-11-100958-330.
PM residents had to complete their intern- PFAssets/ProgramRequirements/380_Pre-
ship prior to being accepted into a PM ventiveMedicine_2020.pdf?ver=2020-06-
residency program. Currently, they may 30-144631-400 Appendix C: Content Outline of
enter prior to or after internship. Preventive the ABPM OM Examination
medicine RC requirements for occupational Appendix B – The Preventive American Board of Preventive Med-
medicine residencies in which residents are Medicine Milestone Project: icine Occupational Medicine Examination
to demonstrate competence include: Occupational Medicine Content
The current Preventive Medicine I. Prevention, Exposure Assess-
a. Conducting research for innovative sol- Milestone Project is online at http:// ment, Hazard Recognition and Control
utions to health problems. www.acgme.org/Portals/0/PDFs/Mile- A. Hazard Characterization
b. Diagnosing and investigating medical stones/PreventiveMedicineMilestones-
problems and medical hazards in OccupationalMedicine.pdf. The Occupa- 1. Walk through assessment
the community. tional Medicine Milestones 2.0 is a joint 2. Industrial hygiene surveys
B. Toxicological Principles 1. Occupational disease 1. Effects on work capacity

a. Pneumoconiosis 2. Identify, manage, and refer impaired
1. Toxicokinetics b. Asthma employee
2. Carcinogenesis c. Allergic and immunologic disease 3. Workplace stress
3. Hydrocarbons and solvents d. Inhalation disorders
4. Metals e. Cancer M. Reproductive Disorders
5. Gases 2. Pulmonary function testing
6. Dusts 3. Respirator certification 1. Common reproductive toxins and
7. Pesticides 4. Prevention their effects
8. Nitrogen compounds 2. Risk and exposure
9. Chemical warfare agents E. Heart and Vascular System 3. Protection of fertility
C. Ergonomics 1. Effects of physical and chemical agents N. Dermatology

2. Physically and psychologically stressful
1. Evaluation duties 1. Allergic and irritant dermatitis
2. Control 3. Fitness for duty 2. Urticaria
3. Infections
D. Physical Hazards F. Hepatic and Gastrointestinal 4. Neoplasia
5. Pigmentation disorders
1. Ionizing radiation 1. Liver and biliary tract disorders 6. Work-aggravated dermatoses
2. Non-ionizing radiation 2. Cancer
3. Noise 3. Liver function testing O. Clinical Toxicology: Evaluate and treat
4. Dysbarism exposure to toxins
5. Temperature G. Genitourinary P. Pain Management: Acute and chronic
6. Mechanical and electromagnetic management
7. Vibration 1. Renal disorders
8. Lasers 2. Renal and bladder cancer III. OEHS Administration and
Systems-Based Practice
E. Chronobiology H. Hematology/Oncology A. Surveillance
1. Fatigue 1. Hematologic disorders 1. Principles of surveillance

2. Shift work 2. Hematologic cancers 2. Occupational disease surveillance
3. Travel 3. Clinical and laboratory studies 3. Medical surveillance programs in the
a. Medical surveillance workplace
F. Occupational Safety and Controls b. Post-exposure
G. Industrial Hygiene B. Medical ethics and confidentiality
I. Infectious Diseases and Biohazards C. Regulations
1. Engineering controls
1. Blood borne pathogens 1. OSHA
2. Personal protective equipment
2. Tuberculosis 2. EPA
3. Administrative controls
3. Diseases of travelers and workers 3. ADA and ADAAA
4. Zoonotic disease 4. GINA
H. Environmental Health
5. Building-related illnesses 5. FMLA
I. Risk Assessment
6. Biologic warfare
D. Workers’ Compensation
J. Musculoskeletal
II. Clinical Patient Care
A. General Patient Evaluation and Testing 1. Payment principles
1. Spine disorders and back pain 2. Disability assessment
a. Diagnosis and management 3. Health care delivery systems
1. Exposure and occupational history
b. Treatment and Prevention 4. OEHS program management
2. Causation and work-relatedness
2. Upper extremity disorders
3. Contributing factors
a. Entrapment neuropathies E. Health and Human performance
b. Overuse syndromes
B. Eyes
3. Joint and extremity injuries and disor- 1. Health risk assessments
ders 2. Nutrition
1. Screening
2. Injury 3. Physical activity
K. Neurologic Disorders 4. Lifestyle medicine
C. Ear, Nose and Throat
1. Neurological and mental status exams F. Emergency and Disaster Management
2. Neurotoxic exposures
1. Noise and solvent induced hearing loss
3. Central nervous system disorders 1. Programmatic planning
2. Acute acoustic trauma
4. Peripheral neuropathy 2. Chemical
3. Assessment: Audiometry
5. Interpretation of neurologic testing 3. Biological
4. Barotrauma
6. Sleep disorders 4. Nuclear
D. Pulmonary
L. Mental Disorders G. Transportation Medicine
1. Commercial driver medical examina- Medicine examination which covers d. Apply knowledge of biostatistics
tions administration, environment, and clinical and epidemiology or secure such
topics. expertise as necessary
H. Disability Administration e. Seek and secure human or animal
subjects review panel approval
1. Disability prevention and management when indicated.
2. Americans with Disabilities Act Appendix D – OEM Research f. Identify and secure other necessary
3. Fitness for duty and return to work and Education resources.
The profession of medicine requires g. Collect and prepare data for analy-
I. Substance Use and Abuse ongoing scholarly inquiry, lifelong learn- sis.
ing, and the ability to teach others. If an h. Analyze data and present results in
1. Employee assistance programs
OEM physician participates in research or tabular, graphical, and verbal for-
J. Workplace Violence education, competence in the techniques mats.
and methodologies of research and educa- i. Draw conclusions discuss implica-
American Osteopathic Board of tion are required. These competencies are tions and identify limitations of the
Preventive Medicine – Occupational also essential to effective population health research findings.
Medical Examination Content management in that the ability to collect or 2. Write a report suitable for informing
Treatment access data as well as manipulate the data is policy in the workplace locally, glob-
Rules and Regulations essential to effective population manage- ally or nationally, to support an inter-
Epi/Biostat ment to ensure a healthy workforce. The vention to improve outcomes, or for
Health Management/Impairment OEM physician can use these skills to help publication.
Toxicology identify trends, sentinel events, and haz- 3. Interpret and present technical and clin-
Hearing ards. Data may include surveillance data, ical data for a variety of audiences.
Dermatology and injury and infectious disease data, a. Apply principles of adult learning.
Respiratory/Industrial Hygiene among others. b. Handle oral presentations in a
Reproductive professional manner.
Decompressions 1. Design and conduct a scientific investi- c. Prepare effective written reports for
Vibrations gation. a variety of audiences.
Radiation a. Formulate a hypothesis. d. Defend conclusions and recommen-
b. Perform a literature review. dations, using appropriate data and
There is also an oral portion of the c. Select and apply research design logical reasoning.
American Osteopathic Board of Preventive methods e. Evaluate learning outcomes.

ACOEM OEM Core Competencies 2021-19

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ACOEM OEM Core Competencies 2021-19

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ACOEM GUIDANCE STATEMENT

ACOEM OEM Core Competencies: 2021

ognizing the need for defining competencies

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2. Identify the potential relationship their occupational or environmental Clinical: Dermatology

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B. Toxicological Principles 1. Occupational disease 1. Effects on work capacity

C. Ergonomics 1. Effects of physical and chemical agents N. Dermatology

1. Fatigue 1. Hematologic disorders 1. Principles of surveillance

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JOEM Volume 63, Number 7, July 2021 e445