2015 年 57 巻 2 号 p. 126-141
Objectives: The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them. Methods: A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occupational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the necessary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods. Results: All 61 competencies in the questionnaires were evaluated as “necessary”. Some of the competencies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a “practical group”, the members of which mainly provided occupational health services, an “academic group”, the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies significantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-job training (OJT) for 30 items, and case-based learning (CBL) for 29 items. Conclusions: Some competencies should be added to the JSOH list. CBL should be introduced in training programs for specialist occupational physicians.
(J Occup Health 2015; 57: 126—141)
The occupational physician's role is to protect and promote workers' health and working ability1). In previous studies, it was reported that specialist occupational physicians who completed residency training2) or were certified3) were associated with a greater diversity of skills and opportunities. A comprehensive training program and a certification program to confirm attainment of a certain level of knowledge and skills are necessary to develop specialist occupational physicians. A common list of competencies that allow specialist occupational physicians to play their expected roles is required to maintain consistency between programs. A training program could be developed to help trainees acquire the competencies, and a certification program could be designed to confirm their achievement of them.
The Japan Society for Occupational Health (JSOH) runs a certification program for the country's specialist occupational physicians. Currently, to be certified as a specialist occupational physician (certified occupational physician, COP) by the JSOH, one must complete a training program outlined in the trainees' handbook, which provides a list of 50 competencies, and objective training under the supervision of a certified senior occupational physician (CSOP) and pass a certification examination. The competencies required of special occupational physicians should vary at different times, and competency lists and attainment targets should be reviewed periodically. The JSOH's current list was revised by the committee for the certification program for specialist occupational physicians in 2011. However, the validity of this revision is in question because the committee did not seek opinions from CSOPs who actually train the candidate COPs, nor did it consult other stakeholders.
There are two general methods typically used to develop competencies of occupational physicians: 1) lectures and text for acquiring basic knowledge, and 2) on-the-job training (OJT) to gain competencies that occupational physicians use daily. Because existing health risks can vary widely across workplaces, it is difficult to provide adequately comprehensive training programs for each trainee. Various types of workplaces must be accessed for OJT, or training methods must be invented to compensate for a lack of appropriate OJT. As a possible solution, the case-based learning (CBL) method has been introduced in undergraduate and postgraduate training programs in public health and occupational health4–7). CBL is considered an effective method for acquiring competencies that are used less often or only pertain to specific workplaces. Maximally effective training programs might be realized through a combination of the three methods.
In this study, we conducted a mail survey of CSOPs to assess the validity of JSOH's current competency list. Additionally, we asked examiners at the examination for JSOH certified occupational physicians to discuss effective training methods for acquiring competencies in the list.
We compared the “ACOEM Core Competencies and Skill Sets Defined”, in ACOEM Competencies—20088) and the “Core Competencies for Specialist Occupational Physicians in Occupational Medicine in Europe: Scope and Competencies” developed by the WHO European Centre for Environment and Health9) with the JSOH's competency list for specialist occupational physicians. Both of these comparison lists were the newest lists published by authoritative organizations in the US and Europe when we made our research plan. As shown in Table 1a–1e, we judged whether each description in the list could be matched to an existing competency in Japan. Then we examined each competency that did not have an obvious match to see whether it could be combined with one or more other competencies to create a single competency. As a result, 11 competencies were added to the JSOH list of 50 competencies. Finally, we rephrased each competency to present it in a unified and more understandable format for the survey. The descriptions of the competencies were abbreviated as shown in the appendix.
| Questionnaire | JSOH | ACOEM | WHO Europe |
|---|---|---|---|
| Attitude and ethics for occupational physicians | |||
| Position and fundamental roles | -Understandings of OP's positions and roles in corporations | ||
| Code of ethics | -Understandings of professional ethical codes and application to practice | -Recognize and address ethical dilemmas in the practice of OEM, using relevant guidelines, such as the ACOEM, Association of Occupational and Environmental Clinics, International Commission on Occupational Health, and American Medical Association codes of ethics. | -Advising management and workers' representatives on the ethical basis for a policy |
| Personal health data handling | -Data management paying attention to privacy | -Understand and protect patients' legal rights to confidentiality of medical records information. | |
| Understanding of customers of occupational health services | |||
| Analysis of characteristics of companies and workers | -Understandings of customers, e.g., corporation, workers | -Identify potential customers and develop a marketing plan for an occupational or environmental health program. | -Advising on the need for full consultations with workers' representatives -Organizing databases (including computerized databases and (possibly) websites) for the dissemination and publication of research in occupational health and safety matters -Assessing the occupational health needs of the enterprise |
| Assessment of occupational health needs | -Field observation and patrol | -Organizing and undertaking workplace inspections | |
| Occupational health services considering social and cultural diversity | -Recognize the effects of cultural, ethnic, and social factors, including health beliefs and practices, on the health and safety of workers. | ||
| Understanding of related regulations and compliance | |||
| Compliance with occupational health regulations | -Understandings of OH regulations and the amendments | -Comply with and explain applicable regulations, as well as their interpretation and enforcement, to employers, employees, and patients. -Respond to the requirements of employee or community right-to-know regulations and advise individuals about their rights to access information. -Report cases of occupational injury, illness, and death according to existing regulations. |
-Application of occupational health law and ethics to individual cases -Advising managers on the implementation of health and safety and environmental law -Advising workers and workers' representatives of their legal obligations |
| Application of amended occupational health regulations | -Evaluation of compliance with new legislation | ||
| Application of industrial injury insurance | -Advise employees and employers about the basic elements of workers' compensation law, complete the necessary forms, and file workers' compensation claims. -Provide medicolegal reports and expert opinions and testimony on OEM issues -Explain the rights of an employee or citizen in requesting assistance from a government agency or in filing a complaint. |
||
| Document structures and plans | |||
| Policy statement on occupational health | -Advice on development of OH policy to employers | -Advising on health and safety policy | |
| Objectives of occupational health programs | -Objectives of OH programs and evaluation of the attainment | -Evaluate the effectiveness of occupational health services and risk reduction methods. | -Advising how to choose and define HES targets which should be achieved by the enterprise in a specified time cost-benefit analysis of work-related health promotion activities -Defining the goals and objectives of the OHS -Contributing to the selection of criteria to be used to evaluate own service practice |
| Plans of occupational health programs | -Planning of OH activities and management of the progress | -Design cost-containment strategies for workers' compensation, health benefits, and disability management programs to allocate and manage clinical and financial resources. | |
| Documentation of occupational health procedures | -Documentation of OH procedures | ||
| Records and reports of occupational health activities | -Organizing and writing reports as precisely and quantitatively as possible -Record-keeping |
||
| Information system for occupational health services | -Determine management information needs and apply medical informatics, electronic health and patient care data, management information systems, and other computer technologies to an OEM program. | ||
JSOH, Japan Society for Occupational Health; ACOEM, American College of Occupational and Environmental Health8); WHO Europe, WHO European Centre for Environment and Health13).
| Questionnaire | JSOH | ACOEM | WHO Europe |
|---|---|---|---|
| Occupational health organization and roles of occupational physicians | |||
| Evaluation of necessary expertise and system | -Work effectively as a team member with administrators, occupational health nurses, nurse practitioners, and physician assistants, demonstrating an understanding of their roles in an occupational health service. | -Recognizing the need for specialist assessment of the working environment through use of other multidisciplinary team members (toxicologists, hygienists, ergonomists, organizational psychologists, etc.) and organizing the team -Hiring experts -Planning the efficient use of multidisciplinary resources |
|
| Organization of occupational health team | -Advice on establishment of an OH organization to employers | -Defining the roles of staff in providing an OHS and formulating job descriptions -Team-building -Leading the team |
|
| Cooperation with occupational health staff | -Advice to other OH staffs and collaboration | -Designing a training programme for occupational health staff | |
| Quality management of occupational health services | -Design, implement, and evaluate clinical practice guidelines, quality management and quality improvement programs, utilization management, case management, and other activities to enhance an organization's performance. | Management of the occupational health department or service using quality management principles -Evaluating the quality of service provision including audit of the professional medical aspects of occupational health care |
|
| Budget for occupational health department | -Negotiating and managing a budget | ||
| Contribution to health committee | -Contribution to health committee and other meetings | -Participating in committees, in particular the health and safety committee | |
| Risk assessment | |||
| Identification of existing health hazards | -Identification of existing health hazards | -Determine the nature and extent of potential occupational and environmental chemical exposures, considering routes of exposure and routes of absorption. -Characterize existing and potential occupational and environmental hazards within defined populations. -Describe specific threats, including a broad range of chemical, biological, radiological and physical hazards. |
-Advising on the introduction of new working systems and techniques -Risk assessment of workplace hazards (as above) with advice on prevention of harm -Recognizing and initiating the investigation of work ability, health determinants and disease in the workforce |
| Information of existing health hazards | -Collection and understandings of hazards data and information | -Detect, insofar as possible, preclinical or clinical effects arising from chemical exposure and implement appropriate preventive measures. Understand, explain, and be able to apply toxic kinetic data (including absorption, metabolism, storage, and excretion) to clinical and employment-related decision making. -Use occupational and environmental information resources to conduct a literature search or to research the health effects of a chemical substance. -Interpret and apply the medical, toxicological, and environmental literatures. |
|
| Monitoring of exposure to health hazards | -Exposure monitoring and evaluation | -Monitoring of workplace hazards including physical, chemical, biological, ergonomic, psychosocial and other hazards -Selecting biological monitoring on the basis of criteria of validity for the protection of the health of the worker concerned, with due regard for the sensitivity, specificity and predictive value of the tests concerned -Biological exposure monitoring -Advising on tools to be used for monitoring and evaluating enterprise policy outcome -Promoting multidisciplinary scientific work on exposure data gathering |
|
| Assessment of health risks | -Assessment of health risks | -Assess clinical, worksite, and environmental data, along with literature reviews in the performance of patient evaluations. -Determine whether a person has a health condition that increases risk from the effects of exposure to chemical, physical, or biological agents. -Evaluate and interpret the results of industrial hygiene surveys. |
-Advising on implementation of other professional risk assessments |
JSOH, Japan Society for Occupational Health; ACOEM, American College of Occupational and Environmental Health8); WHO Europe, WHO European Centre for Environment and Health13).
| Questionnaire | JSOH | ACOEM | WHO Europe |
|---|---|---|---|
| Health surveillance, diagnosis and treatment | |||
| Indicators of health effects for health surveillance | -Set indicators of health effects | -Develop, implement, evaluate, and refine screening programs for groups to identify risks for disease or injury and opportunities to promote wellness. -Design and conduct surveillance programs in workplace and community settings. |
-Biological exposure monitoring; -Organizing health surveillance for workers exposed to occupational hazards |
| Quality assurance programs of laboratories | -Understandings of OH laboratory quality control and selection of qualified laboratories | ||
| Utilization of health surveillance for workplace improvement | -Diagnosis of health effects by health surveillance | -Apply individual-based or community-based interventions to prevent or mitigate exposure and resultant health effects. | |
| Diagnosis of health effects with health surveillance | -Evaluation and improvement of worksites with specific health surveillance | -Clinical-General, Cardiology, Dermatology, Emergency Medicine and Surgery, Hematology/Oncology, Infectious Disease, Musculoskeletal, Neurology, Ophthalmology, Otolaryngology, Psychiatry, Pulmonary, Reproductive Medicine, -Evaluate, treat, and properly refer persons whose health may be affected by acute or chronic contact with occupational and environmental chemicals. -Distinguish health effects of exposure to chemicals from other etiologies. |
-Diagnosing work-related ill health -Organizing appropriate investigations for diagnosis of occupational disease -Differential diagnoses of work-related and environment-related disease -Application of ergonomics to rehabilitation |
| Risk reduction | |||
| Cause analysis of industrial accidents or occupational diseases | -Participating in analysis of occupational accidents and diseases | ||
| Prioritization of risks for reduction plans | -Prioritization of health risks | -Advise employers and employees regarding industrial hygiene controls, such as work practices, respirator use, and engineering controls. -Recommend and implement policies and control measures to reduce or mitigate safety and health hazards. |
-Undertaking workplace assessments and advising on control methods -Assessing control systems designed to eliminate or reduce exposure -Selecting appropriate personal protective equipment with the assistance of other experts as required |
| Risk reduction methods and plans | -Advice on selection and planning of risk control measures | ||
| Execution of risk reduction plans | -Planning and execution of training programs on risk control | -Assessing control systems designed to eliminate or reduce exposure | |
| Risk communication | |||
| Education programs on risk reduction | -Risk communication based on scientific evidence | -Communicate to target groups including health professionals, the public, and the media, in a clear and effective manner both orally and in writing, the levels of risk from real or potential hazards and the rationale for selected interventions. -Communicate current medical, environmental, and other scientific knowledge effectively to target groups, including patients, employees, employers, unions, community groups, and the media. -Accommodate cultural, ethnic, educational, and language variations among workers when providing information on occupational hazard prevention, disease prevention, and health promotion. |
-Communicating with people from various backgrounds and with different levels of technical understanding |
| Risk communication to workers | -Confirmation and evaluation of risk control | -Making clear oral presentations | |
| Work load and recovery from fatigue | |||
| Evaluation of psychological and physical load | -Assessment of load of tasks and work shifts | -Apply ergonomic principles to optimize comfort and reduce risk at work, including evaluation and redesign of hazardous lifting jobs, repetitive motion work, and jobs with special visual demands. | -Advise on the ergonomic design of the workplace and working tools |
| Design work to have a small load | -Advice on job design | ||
| Design of offices and facilities for employees' welfare | -Advice on desirable work environment and office amenities | ||
| Countermeasures against psychosocial health hazards | |||
| Mental health programs | -Mental health programs | -Application of organizational psychology to rehabilitation in situations of work-related mental ill health | |
| Programs to combat health effects due to overwork | -Countermeasures for overwork | ||
JSOH, Japan Society for Occupational Health; ACOEM, American College of Occupational and Environmental Health8); WHO Europe, WHO European Centre for Environment and Health13).
| Questionnaire | JSOH | ACOEM | WHO Europe |
|---|---|---|---|
| Health care and promotion | |||
| Periodic general health examination | -Planning and execution of general health exams and health measurements | -Design, implement and evaluate worksite health promotion and disease prevention programs, incorporating Department of Health and Human Services and other authoritative guidelines as appropriate. -Describe the appropriate use and limitations of health risk assessment and screening for well populations and the applications of screening, assessment, and early intervention for targeted high-risk groups. |
-Periodic examinations -Analysis of the ethical aspects of health screening -Coordinating health surveillance and biological monitoring with environmental surveillance and other risk assessments |
| Evaluation of health condition of employee group | -Evaluation of health condition as a group | -Analyzing routinely collected data, including sickness absence and accident data | |
| Health care for elder or female employees | -Health care based on characteristics, such as elder age and female sex | -Periodic examinations -Exit examinations on leaving the enterprise -Management of workers with drug or alcohol problems |
|
| Health guidance based on health examination | -Health guidance according to health exam | -Counsel employees about health risks and lifestyle. | -Counselling |
| Education on health promotion for employee group | -Health education | -Design and implement proactive systems of care that effectively reach all members of a population, including those at high risk and those who do not normally seek care. | -Health promotion needs analysis of the working population -Advocating and managing an agreed workplace health promotion programe -Seeking participation of workers and employers in the design and implementation of work-related health promotion and working ability maintenance programes -Evaluating and auditing workplace health promotion -Programes, especially with regard to their relevance to occupational health hazards in the workplace and the control of nonoccupational determinants of health and working ability |
| Work accommodation | |||
| Procedures of fitness for duty assessment and work accommodation | -Advice on development of procedures of work accommodation | -Design and implement integrated systems of disability prevention and management. -Design protocols for preplacement and return-to-work evaluations. Implement stay at work and early return to work protocols. -Design and implement protocols to evaluate employees for conditions creating an undue risk to self or others in the workplace, in compliance with the ADA. |
|
| Professional opinions on fitness for duty and work accommodation | -Advice of work accommodation according to health exam | -Preplacement health screening and medical examinations -Assessment of disability and fitness for work, replacement and following work-related illness/injury |
|
| Work accommodation upon returning to work or during pregnancy | -Advice of work accommodation at returning to work and during pregnancy | -Address employment concerns for patients with medical conditions. -Conduct evaluations to determine fitness for duty in compliance with applicable regulations including the ADA. -Assess impairment ratings in accordance with the American Medical Association Guides to the Evaluation of Permanent Impairment. -Identify and manage the impact of psychological conditions on ability to work and on the natural history of occupational and environmental illnesses and injuries. |
-Counselling employees regarding sickness absence assessment of impairment, disability and handicap in relation to work -Clinical management in rehabilitation of disabled workers -Advising on rehabilitation and redeployment -Advising on maintaining aging and disabled workers in work |
| Improvement of work abilities of elder, ill or handicapped employees | -Promoting work ability: health, skills and training in relation to the demands of work | ||
| Protection of reproductive function of female employees | -Advise on policies and procedures relating to the protection of fertility for both men and women and for the placement of pregnant or lactating workers. -Recommend appropriate accommodations and job placements for pregnant employees. |
-Advising on fitness for work and adaptation of work to the worker in the special circumstances of vulnerable groups and specific legislation, for example, the EU Directive on Protection of Pregnant and Lactating Mothers 92/85/EC |
JSOH, Japan Society for Occupational Health; ACOEM, American College of Occupational and Environmental Health8); WHO Europe, WHO European Centre for Environment and Health13).
| Questionnaire | JSOH | ACOEM | WHO Europe |
|---|---|---|---|
| First aid and emergency response | |||
| First aid skills and training for employees | -First aid skills and training of workers | -Advising on the provision of first aid facilities and emergency procedures | |
| First aid plan and arrangement for equipment | -Planning of first aid and arran gement of necessary equipment | -Apply knowledge of personal protection and other applied approaches to health protection and the skills to evaluate the adequacy of protection at the individual level. -Establish emergency procedures and protocols for the clinical management of individuals involved in disaster incidents, including specific medical management protocols. |
|
| Emergency response plan | -Advice during planning of emergency response plan | -Participate in the development of emergency or disaster plans for the workplace and the community. -Design and implement a plan for the mitigation of a disaster incident at a worksite or in the general community. Design and implement a medical recovery plan for mass casualty events in industries or the general community. -Design and conduct an outbreak or cluster investigation. -Design a pandemic preparedness plan for an organization. -Maintain a thorough understanding of the National Response Plan and Incident Command Structure. -Recommend and implement policies and control measures to address emerging infectious diseases of concern. |
|
| Environment protection | |||
| Worksite issues and applicable regulations on environmental protection | -Understanding of environmental management system and related regulations | -Advising managers on the implementation of health and safety and environmental law | |
| Professional support for environment protection | -Contribution to environmental management practices in the workplaces | -Identify sources and routes of environmental exposure and recommend methods of reducing environmental health risks. -Advise individuals and communities about the reproductive implications of environmental exposure. -Advise individuals and communities about the reproductive implications of environmental exposure. -Manage health effects associated with air, water, or ground contamination by natural or artificial pollutants. -Recommend, interpret, and explain the results of environmental monitoring. |
-Identifying, assessing and advising on the prevention of environmental hazards arising, or which may result, from operations or processes in the enterprise -Recognizing and advising on hazardous exposures in the general environment arising from other sources or activities |
| Scientific research | |||
| Planning and execution of scientific research on occupational health issues | -Design and execution of research on OH | -Recognize and investigate potential sentinel events. -Apply validated epidemiologic and biostatistical principles and techniques to analyze injury or illness data in a defined worker and community populations. |
-Organizing databases (including computerized databases and (possibly) websites) for the dissemination and publication of research in occupational health and safety matters -Planning simple surveys -Promoting multidisciplinary scientific work on exposure data gathering |
| Execution and presentation of research following codes of ethics | -Execution and presentation of research in compliance with codes of ethics | -Conducting a formal scientific investigation; carrying out a literature search and preparing a report -Interpreting scientific data in journals and form own research -Recognizing and initiating an investigation of work ability, health determinants and disease in the workforce |
|
| Audit | |||
| Occupational safety and health audit and reporting | -Contribution to OSH audit and reporting | ||
| Collaboration with parties inside or outside of company | |||
| Communication with employers and unions | -Communication with employers and unions | -Work effectively with both labor and management to maximize workplace health, safety, and productivity. | -Coordinating discussions leading to agreement by both management and workforce representatives -Ensuring workers are fully informed of policy and of their rights -Reporting regularly to management and the workforce orally and in writing |
| Collaboration with human resources and safety departments | -Collaboration with HR and safety departments | ||
| Utilization of public resources and contribution to community | -Utilization of public resources and contribution to community | -Communicate technical and clinical information to professional and lay audiences. | -Communicating with other professionals to organize and deliver training appropriately |
JSOH, Japan Society for Occupational Health; ACOEM, American College of Occupational and Environmental Health8); WHO Europe, WHO European Centre for Environment and Health13).
The CSOPs had at least 5 year experience in occupational health services as COPs and were fulfilling roles as trainers in the system. They were therefore considered appropriate respondents for the survey on necessary competencies for specialist occupational physicians in Japan. As of August 1, 2013, the total number of registered CSOPs in Japan was 315. Excluding those with addresses that were unknown or who were outside of Japan, we sent a questionnaire to 308 CSOPs and asked them to return it without any identifying information by the end of September, 2013. They were asked to rate the necessity of each competency on a scale of 1 to 5 (5=absolutely necessary, 4=necessary, 3=somewhat necessary, 2=not so necessary, 1=not necessary), and to write in additional competencies that they thought should have been on the list. They were also requested to report on their experience as occupational physicians as well as their current main job.
We evaluated the necessity of each competency by calculating its mean score across respondents. When multiple respondents suggested similar ideas, we carefully examined each suggestion to see whether its topic was included in one of the 61 existing competencies.
The respondents were categorized into three groups according to their current main jobs: a “practical group”, the members of which mainly provided occupational health services, an “academic group”, the members of which belonged to research or education institutes such as medical schools, and all others. Then, we compared the mean scores of each competency for two of the groups: the “practical group” and the “academic group”. Group comparisons were analyzed by F-test and then the Student's t-test or Welch's t-test, using SAS Statistics 19 for Windows and a level of statistical significance of p<0.05.
Study 2: Survey on Effective Training Methods to Acquire CompetenciesWe developed a second questionnaire to study effective methods for acquisition of competencies. The questionnaire had three options for learning methods: acquisition of knowledge with lectures and textbooks (lectures and textbooks), accumulation of daily experience as occupational physicians (OJT) and experience or discussion of specific cases and measures (CBL). We asked whether each method was effective, and which was most effective for each of the 61 competencies.
COP examiners are elected from among CSOPs and evaluate the attainment of the competencies of candidate COPs. They were therefore considered appropriate respondents for the survey on effective training methods for acquiring competencies as specialist occupational physicians. We directly asked all 22 COP examiners in 2013 at the examination site to participate, and responses were collected in person or by mail by the end of September, 2013.
Training methods for which half or more of the respondents answered “yes” were considered effective, and the method chosen by the greatest number of respondents as most effective was considered the most effective.
Ethical considerationsThe research procedures were approved by the ethics review committee at the University of Occupational and Environmental Health, Japan. We obtained a list of CSOPs from the secretary's office for the certification program in accordance with the official procedures of the JSOH. The list was destroyed once the study was completed.
The number of respondents was 172 (response rate 55.8%). After excluding 24 incomplete responses, 148 (effective response rate 48.1%) respondents remained for analysis. The demographic characteristics of the respondents are shown in Table 2. Most respondents (62.2%) were in the “practical” category; 25.6% were in the “academic” category, and 12.2% in the “other” category. Most respondents (93.9%) had worked for a manufacturing company as a full-time or part-time occupational physician. All had experience as occupational physicians in a company. Among them, 72.3% had experience as a full-time (staff) occupational physician, and 81.8% had experience as a part-time (contract-based) occupational physician.
| Employment condition | |||
| Practical | 92 | 62.2% | |
| Full time for company | 58 | ||
| Full time for occupational health service institute | 16 | ||
| Private occupational health service | 18 | ||
| Academic | 38 | 25.6% | |
| Academic institute | 38 | ||
| The others | 18 | 12.2% | |
| Mainly clinical practice in hospital or clinic | 13 | ||
| Others | 5 | ||
| Experiences as an occupational physician | |||
| Full time occupational physician | 107 | 72.3% | |
| Part time occupational physician | 121 | 81.8% | |
| Either full time or part time | 148 | 100.0% | |
| At a manufacturing worksite | 139 | 93.9% |
As shown in Table 3, the mean scores for the all competencies were greater than 3, “somewhat necessary”, but those of 18 items were lower than 4, “necessary”. Among the 50 competencies that were included in the JSOH list, 14 received mean scores lower than 4. Of the 11 competencies that were added from the American and/or European lists, 7 received scores greater than 4.
| Items in JSOH list | Mean scores | p value+ | Rank* | |||
|---|---|---|---|---|---|---|
| Overall | Academic | Practical | ||||
| Attitude and ethics for occupational physicians | ||||||
| Position and fundamental roles | Y | 4.86 | 4.95 | 4.85 | 0.053 | 1 |
| Code of ethics | Y | 4.67 | 4.76 | 4.64 | 0.189 | 3 |
| Personal health data handling | Y | 4.73 | 4.84 | 4.69 | 0.079 | 2 |
| Understanding of customers of occupational health services | ||||||
| Analysis of characteristics of companies and workers | Y | 4.47 | 4.40 | 4.52 | 0.271 | 13 |
| Assessment of occupational health needs | Y | 4.64 | 4.63 | 4.62 | 0.899 | 4 |
| Occupational health services considering social and cultural diversity | N | 4.10 | 3.97 | 4.14 | 0.237 | 37 |
| Understanding of related regulations and compliance | ||||||
| Compliance with occupational health regulations | Y | 4.57 | 4.47 | 4.64 | 0.117 | 7 |
| Application of amended occupational health regulations | N | 4.34 | 4.23 | 4.40 | 0.170 | 19 |
| Application of industrial injury insurance | N | 4.16 | 3.87 | 4.23 | 0.012 | 32 |
| Document structures and plans | ||||||
| Policy statement on occupational health | Y | 4.30 | 4.11 | 4.34 | 0.059 | 22 |
| Objectives of occupational health programs | Y | 4.05 | 3.97 | 4.05 | 0.564 | 41 |
| Plans of occupational health programs | Y | 4.16 | 4.08 | 4.18 | 0.458 | 33 |
| Documentation of occupational health procedures | Y | 3.74 | 3.63 | 3.76 | 0.340 | 52 |
| Records and reports of occupational health activities | N | 3.76 | 3.68 | 3.76 | 0.566 | 51 |
| Information system for occupational health services | N | 3.70 | 3.50 | 3.75 | 0.074 | 54 |
| Occupational health organization and roles of occupational physicians | ||||||
| Evaluation of necessary expertise and system | Y | 4.13 | 4.11 | 4.13 | 0.822 | 35 |
| Organization of occupational health team | N | 4.14 | 3.92 | 4.22 | 0.029 | 34 |
| Cooperation with occupational health staff | Y | 4.37 | 4.37 | 4.34 | 0.822 | 18 |
| Quality management of occupational health services | N | 3.38 | 3.24 | 3.38 | 0.312 | 61 |
| Budget for occupational health department | N | 3.51 | 3.50 | 3.44 | 0.721 | 58 |
| Contribution to health committee | Y | 4.62 | 4.71 | 4.57 | 0.163 | 5 |
| Risk assessment | ||||||
| Identification of existing health hazards | Y | 4.48 | 4.37 | 4.49 | 0.339 | 11 |
| Information of existing health hazards | Y | 4.42 | 4.24 | 4.47 | 0.056 | 15 |
| Monitoring of exposure to health hazards | Y | 4.28 | 4.16 | 4.29 | 0.337 | 24 |
| Assessment of health risks | Y | 4.29 | 4.13 | 4.31 | 0.159 | 23 |
| Health surveillance, diagnosis and treatment | ||||||
| Indicators of health effects for health surveillance | Y | 4.02 | 3.95 | 4.00 | 0.705 | 42 |
| Quality assurance programs of laboratories | Y | 3.73 | 3.42 | 3.83 | 0.002 | 53 |
| Utilization of health surveillance for workplace improvement | Y | 4.52 | 4.29 | 4.50 | 0.070 | 14 |
| Diagnosis of health effects with health surveillance | Y | 4.24 | 4.03 | 4.26 | 0.120 | 27 |
| Risk reduction | ||||||
| Cause analysis of industrial accidents or occupational diseases | N | 4.34 | 4.29 | 4.32 | 0.807 | 20 |
| Prioritization of risks for reduction plans | Y | 3.99 | 3.92 | 4.00 | 0.567 | 44 |
| Risk reduction methods and plans | Y | 4.07 | 3.92 | 4.10 | 0.172 | 38 |
| Execution of risk reduction plans | Y | 3.94 | 3.82 | 3.95 | 0.346 | 46 |
| Risk communication | ||||||
| Education programs on risk reduction | Y | 3.89 | 3.76 | 3.90 | 0.330 | 47 |
| Risk communication to workers | Y | 4.19 | 4.05 | 4.24 | 0.172 | 31 |
| Work load and recovery from fatigue | ||||||
| Evaluation of psychological and physical load | Y | 4.02 | 3.97 | 4.26 | 0.031 | 28 |
| Desing of work to have a small load | Y | 4.11 | 3.92 | 4.13 | 0.117 | 36 |
| Design of offices and facilities for employees' welfare | Y | 3.84 | 3.74 | 3.83 | 0.514 | 50 |
| Countermeasures against psychosocial health hazards | ||||||
| Mental health programs | Y | 4.50 | 4.34 | 4.53 | 0.108 | 10 |
| Programs to combat health effects due to overwork | Y | 4.48 | 4.26 | 4.55 | 0.017 | 12 |
| Health care and promotion | ||||||
| Periodic general health examination | Y | 4.26 | 4.13 | 4.26 | 0.381 | 26 |
| Evaluation of health condition of employee group | Y | 4.20 | 4.05 | 4.24 | 0.086 | 30 |
| Health care for elder or female employees | Y | 4.07 | 3.87 | 4.13 | 0.034 | 40 |
| Health guidance based on health examination | Y | 4.39 | 4.24 | 4.42 | 0.197 | 17 |
| Education on health promotion for employee group | Y | 4.33 | 4.16 | 4.36 | 0.150 | 21 |
| Work accommodation | ||||||
| Procedures of fitness for duty assessment and work accommodation | Y | 4.51 | 4.29 | 4.56 | 0.033 | 9 |
| Professional opinions on fitness for duty and work accommodation | Y | 4.59 | 4.40 | 4.63 | 0.047 | 6 |
| Work accommodation at return to work or during pregnancy | Y | 4.55 | 4.37 | 4.60 | 0.039 | 8 |
| Improvement of work abilities of elder, ill or handicapped employees | N | 4.07 | 3.87 | 4.14 | 0.049 | 39 |
| Protection of reproductive function of female employees | N | 4.20 | 4.18 | 4.19 | 0.992 | 29 |
| First aid and emergency response | ||||||
| First aid skills and training for employees | Y | 3.95 | 3.76 | 4.00 | 0.157 | 45 |
| First aid plan and arrangement for equipment | Y | 3.85 | 3.58 | 3.91 | 0.024 | 49 |
| Emergency response plan | Y | 4.01 | 4.11 | 3.92 | 0.199 | 43 |
| Environment protection | ||||||
| Worksite issues and applicable regulations on environmental protection | Y | 3.42 | 3.45 | 3.31 | 0.348 | 60 |
| Professional support for environment protection | Y | 3.49 | 3.45 | 3.42 | 0.885 | 59 |
| Scientific research | ||||||
| Planning and execution of scientific research on occupational health issues | Y | 3.61 | 3.68 | 3.56 | 0.361 | 56 |
| Execution and presentation of research following codes of ethics | Y | 3.68 | 3.71 | 3.62 | 0.548 | 55 |
| Audit | ||||||
| Occupational safety and health audit and reporting | Y | 3.58 | 3.56 | 3.54 | 0.923 | 57 |
| Collaboration with parties inside or outside of company | ||||||
| Communication with employers and unions | Y | 4.28 | 4.37 | 4.26 | 0.425 | 25 |
| Collaboration with human resources and safety departments | Y | 4.42 | 4.34 | 4.46 | 0.348 | 16 |
| Utilization of public resources and contribution to community | Y | 3.88 | 3.79 | 3.91 | 0.447 | 48 |
The “practical group” gave significantly higher mean scores for 11 competencies than the “academic group”. This was particularly true for competencies related to work accommodation based on individual health condition, such as “procedures of fitness for duty assessment and work accommodation”, “professional opinions on fitness for duty and work accommodation”, and “work accommodation at return to work or during pregnancy”.
All of the suggested additional competencies were already included in the 61 competencies or were suggested by only a single respondent, with the exception of “be able to train non-specialist occupational physicians”, which was suggested by 4 respondents.
The rankings of the mean scores among the 61 items are also shown in Table 3. There were 7 items in the JSOH's current competency list with mean scores in a position lower than 51st. They were “documentation of occupational health procedures”, “quality assurance programs of laboratories”, “worksite issues and applicable regulations on environmental protection”, “professional support for environmental protection”, “planning and execution of scientific research on occupational health issues”, “execution and presentation of research following codes of ethics” and “occupational safety and health audit and reporting”. In contrast, there were 7 items with mean scores in a position higher than 40th among the additional items from the lists for the US and Europe. They were “occupational health services considering social and cultural diversity”, “application of amended occupational health regulations”, “application of industrial injury insurance”, “organization of occupational health team”, “cause analysis of industrial accidents or occupational diseases”, “improvement of work abilities of elder, ill or handicapped employees” and “protection of reproductive function of female employees”.
Study 2: Survey on Effective Training Methods to Acquire CompetenciesAs shown in Table 4, among the three training methods suggested, OJT and CBL were judged effective for all competencies. Lectures and textbooks were not judged effective for 10 items.
| Lectures and textbooks | OJT | CBL | ||||
|---|---|---|---|---|---|---|
| Effective | Most effective | Effective | Most effective | Effective | Most effective | |
| Attitude and ethics for occupational physicians | ||||||
| Position and fundamental roles | 12 | 5 | 19 | 11* | 12 | 3 |
| Code of ethics | 13 | 7* | 16 | 4 | 11 | 7* |
| Personal health data handling | 12 | 4 | 17 | 4 | 16 | 9* |
| Understanding of customers of occupational health services | ||||||
| Analysis of characteristics of companies and workers | 4+ | 0 | 19 | 16* | 14 | 2 |
| Assessment of occupational health needs | 11 | 1 | 18 | 16* | 15 | 2 |
| Occupational health services considering social and cultural diversity | 11 | 1 | 16 | 11* | 15 | 7 |
| Understanding of related regulations and compliance | ||||||
| Compliance with occupational health regulations | 19 | 10* | 11 | 5 | 11 | 4 |
| Application of amended occupational health regulations | 16 | 3 | 13 | 5 | 11 | 11* |
| Application of industrial injury insurance | 15 | 5 | 7 | 1 | 19 | 13* |
| Document structures and plans | ||||||
| Policy statement on occupational health | 13 | 5 | 13 | 9* | 12 | 5 |
| Objectives of occupational health programs | 9 | 0 | 17 | 12* | 12 | 7 |
| Plans of occupational health programs | 11 | 0 | 17 | 13* | 14 | 6 |
| Documentation of occupational health procedures | 14 | 0 | 16 | 12* | 11 | 7 |
| Records and reports of occupational health activities | 13 | 2 | 17 | 11* | 13 | 5 |
| Information system for occupational health services | 16 | 7 | 12 | 8 | 11 | 3 |
| Occupational health organization and roles of occupational physicians | ||||||
| Evaluation of necessary expertise and system | 12 | 2 | 16 | 10* | 11 | 6 |
| Organization of occupational health team | 9 | 0 | 17 | 14* | 13 | 4 |
| Cooperation with occupational health staff | 7+ | 0 | 17 | 15* | 10 | 3 |
| Quality management of occupational health services | 5+ | 4 | 16 | 6 | 12 | 7* |
| Budget for occupational health department | 11 | 0 | 15 | 13* | 12 | 5 |
| Contribution to health committee | 11 | 0 | 18 | 15* | 11 | 3 |
| Risk assessment | ||||||
| Identification of existing health hazards | 15 | 3 | 16 | 10* | 14 | 6 |
| Information of existing health hazards | 18 | 5 | 15 | 4 | 15 | 10* |
| Monitoring of exposure to health hazards | 18 | 2 | 16 | 8 | 16 | 9* |
| Assessment of health risks | 17 | 1 | 13 | 7 | 17 | 11* |
| Health surveillance, diagnosis and treatment | ||||||
| Indicators of health effects for health surveillance | 18 | 3 | 14 | 6 | 16 | 10* |
| Quality assurance programs of laboratories | 18 | 4 | 13 | 5 | 15 | 10* |
| Utilization of health surveillance for workplace improvement | 12 | 0 | 18 | 12* | 17 | 7 |
| Diagnosis of health effects with health surveillance | 17 | 3 | 18 | 11* | 14 | 5 |
| Risk reduction | 14 | 1 | 16 | 5 | 18 | 13* |
| Cause analysis of industrial accidents or occupational diseases | ||||||
| Prioritization of risks for reduction plans | 17 | 2 | 15 | 7 | 17 | 10* |
| Risk reduction methods and plans | 12 | 0 | 16 | 8 | 17 | 11* |
| Execution of risk reduction plans | 11 | 1 | 15 | 9* | 16 | 9* |
| Risk communication | ||||||
| Education programs on risk reduction | 14 | 3 | 13 | 9* | 15 | 7 |
| Risk communication to workers | 17 | 4 | 13 | 8* | 14 | 7 |
| Work load and recovery from fatigue | ||||||
| Evaluation of psychological and physical load | 16 | 4 | 17 | 6 | 14 | 9* |
| Design of work to have a small load | 17 | 2 | 16 | 6 | 14 | 11* |
| Design of offices and facilities for employees' welfare | 16 | 1 | 17 | 11* | 14 | 7 |
| Countermeasures against psychosocial health hazards | ||||||
| Mental health programs | 14 | 0 | 17 | 9 | 19 | 10* |
| Programs to combat health effects due to overwork | 13 | 0 | 18 | 12* | 18 | 7 |
| Health care and promotion | ||||||
| Periodic general health examination | 14 | 2 | 19 | 13* | 13 | 4 |
| Evaluation of health condition of employee group | 18 | 3 | 15 | 7 | 12 | 9* |
| Health care for elder or female employees | 15 | 3 | 16 | 4 | 17 | 12* |
| Health guidance based on health examination | 14 | 0 | 17 | 14* | 14 | 5 |
| Education on health promotion for employee group | 15 | 0 | 19 | 14* | 16 | 5 |
| Work accommodation | ||||||
| Procedures of fitness for duty assessment and work accommodation | 8+ | 0 | 19 | 7 | 18 | 12* |
| Professional opinions on fitness for duty and work accommodation | 8+ | 0 | 19 | 12* | 17 | 7 |
| Work accommodation at return to work or during pregnancy | 11 | 0 | 17 | 6 | 18 | 13* |
| Improvement of work abilities of elder, ill or handicapped employees | 15 | 1 | 15 | 1 | 19 | 17* |
| Protection of reproductive function of female employees | 18 | 4 | 15 | 1 | 16 | 14* |
| First aid and emergency response | ||||||
| First aid skills and training for employees | 15 | 4 | 12 | 4 | 17 | 11* |
| First aid plan and arrangement for equipment | 16 | 7* | 13 | 4 | 12 | 7* |
| Emergency response plan | 15 | 3 | 15 | 4 | 16 | 12* |
| Environment protection | ||||||
| Worksite issues and applicable regulations on environmental protection | 18 | 11* | 10 | 2 | 10 | 6 |
| Professional support for environment protection | 15 | 4 | 12 | 8* | 13 | 7 |
| Scientific research | ||||||
| Planning and execution of scientific research on occupational health issues | 19 | 5 | 14 | 3 | 15 | 11* |
| Execution and presentation of research following codes of ethics | 16 | 7* | 12 | 4 | 11 | 7* |
| Audit | ||||||
| Occupational safety and health audit and reporting | 11 | 3 | 16 | 5 | 13 | 11* |
| Collaboration with parties inside or outside of company | ||||||
| Communication with employers and unions | 5+ | 0 | 18 | 15* | 13 | 4 |
| Collaboration with human resources and safety departments | 4+ | 0 | 19 | 17* | 13 | 2 |
| Utilization of public resources and contribution to community | 8+ | 0 | 18 | 15* | 11 | 4 |
Lectures and textbooks were the most effective methods for only 5 items. OJT was evaluated as the most effective for 30 items, and many of them were related to legally regulated activities in Japan, such as “contribution to health committees”, “periodic general health examinations” and “programs to combat health effects due to overwork”. CBL were valuated as the most effective for 29 items, and conversely, many of them were related to services based on individual health conditions, such as “mental health programs”, “procedures of fitness for duty assessment and work accommodation” and “work accommodation at return to work or during pregnancy”, and related to ethical considerations, such as “codes of ethics” and “personal health data handling”.
The results of these surveys offer some insights concerning the validity and improvement of the current competency list of the JSOH, and the appropriate training methods for development of specialist occupational physicians in Japan.
Validity of the competency list for specialist occupational physiciansThe competency list for specialist occupational physicians used in the study was developed on the basis of the JSOH's list and the lists generated by analogous institutions in the US and Europe. The required competencies should change with fluctuations in social dynamics and issues of occupational health. During performance of the study in 2014, the ACOEM revised its competencies10), and the European Union of Medical Specialists issued the ATOM Portfolio of Performance-Based Assessments11). Therefore, the lists used in this study as references were not the latest versions. However, because the mean scores for all 61 items were evaluated higher than “somewhat necessary” and only one item was suggested to be added as a necessary competency by more than one respondent as a write-in comment, the list appears to have validity as a set of competencies for special occupational physicians under the current situation in Japan.
Validity of the competency list in the certification program of the JSOH and necessary improvementsAll 51 items in the JSOH's current competency list were judged as necessary, but some items scored lower than competencies added from the lists for the US and Europe. For those items, mean scores in a position lower than 51st were associated with development and execution of management systems, such as “documentation of occupational health procedures” and “occupational safety and health audit and reporting”; with environment protection, such as “worksite issues and applicable regulations on environmental protection” and “professional support for environmental protection”; and with scientific research, such as “plans and execution of scientific research on occupational health issues” and “execution and presentation of research following codes of ethics”. These competencies are not always required for occupational physicians in actual health practices. The results are consistent with a report indicating that the item “design and initiate research” was evaluated lowest among 14 items in a survey of ACOEM members3) and a report indicating that necessities of environmental medicine and management competencies were evaluated lower than others in a survey of specialist occupational physicians in Europe12).
In contrast, there were 7 additional items from the lists for the US and Europe with mean scores in positions higher than 40th. Among them, “cause analysis of industrial accidents or occupational diseases” is one of the occupational physicians' roles in the Japanese regulations, and occupational physicians are often requested to play the other roles in actual practice, too. These should be considered for addition to the JSOH's list. The competencies for work accommodation specifically for vulnerable individuals, such as “improvement of work abilities of elder, ill or handicapped employees” and “protection of reproductive function of female employees”, were highly ranked. Arguably, this may be regarded as a part of the competency for “work accommodation at return to work or during pregnancy”, but a more concrete description of the competency would be desirable.
The minimum legal requirement for occupational physicians is completion of a 50-hour diploma level training program, and specialist occupational physicians train with occupational physicians at the diploma level13). The write-in comments in this survey that suggested adding “be able to train non-specialist occupational physicians” might reflect this condition, and this competency should also be considered as an addition to the JSOH's list. The competency list should be reviewed periodically, because the needs for occupational services are affected by changes in society, technology and other factors.
The practical group evaluated several competencies as more necessary than the academic group. Most of the competencies with significant group differences were related to work accommodation for individual workers based on their health condition. Activities such as evaluating fitness for work with face-to-face interviews and advising individuals on improvements in lifestyle were recently enhanced as a part of mental health programs or countermeasures for overwork under governmental guidelines14, 15) or regulations16). Respondents in the “practical group”, who had actual experience in dealing with such issues, appear to have evaluated the necessity of those competencies higher.
Training methods to develop specialist occupational physiciansIn general, the most frequently used methods for training the necessary competencies as specialist occupational physicians are lectures and textbooks and OJT. Lectures and textbooks were judged less effective methods than others to acquire necessary competencies in the study, but they are useful in acquiring basic knowledge. OJT was evaluated as the most effective for many of the items related to legally regulated activities in Japan. This method is considered to be useful in acquiring competencies for routine activities under the condition that a senior occupational physician works together with a trainee or in a training program. However, the fact that only one or a few occupational physicians are assigned to the same worksite makes it difficult to train many occupational physicians by OJT.
CBL was evaluated as effective for the all competencies and as the most effective method for 29 of 61 items in the study. Conversely, it was evaluated as most effective for competencies related to services based on individual health conditions and those related to ethical considerations. Recently, CBL has been introduced in various training programs in public health and occupational health fields. For example, the Harvard School of Public Health has a course in which all classes use a “case method”4), and some undergraduate programs that utilize CBL have been reported in Europe6, 7). We also use a “case method” in postgraduate occupational health training courses at the University of Occupational and Environmental Health, Japan17). Given recent conditions in occupational health, we propose that training programs with CBL components such as discussion of actual cases and use of the “case method” should be provided, and CSOPs should encourage trainees to take advantage of such opportunities.
Limitations of the studyThe main customers for occupational health services are employers and employees. Although it has been suggested that the viewpoints of these customers are important when considering the necessary competencies of occupational physicans18, 19), they have now been confirmed by specialist viewpoints in this study.
Because we were concerned that a complex questionnaire with two objectives would make the response rate prohibitively low, validity of the competency list and effective training methods to acquire the competencies were studied with separate questionnaires and different groups. CSOPs were chosen as the subjects for the validity survey because they actually train the candidates of COPs; COP examiners, who were also CSOPs, were chosen for the training method survey because they understand the attainments and weaknesses of examinees. However, the low response rate of 48.1% for the validity survey and the small sample size of 19 for the training methods survey were factors that limit interpretation of the results.
Acknowledgments: We thank the CSOPs and COP examiners from the JSOH for their cooperation. This study was supported by the Occupational Health Promotion Foundation.
| Category | Abbreviations in the Paper | Descriptions in the Questionnaires |
|---|---|---|
| Attitude and ethics for occupational physicians | ||
| Position and fundamental roles | Understand the position and fundamental roles of an occupational physician in the workplace. | |
| Code of ethics | Understand codes of ethics for occupational physicians and be able to comply with them. | |
| Personal health data handling | Be able to handle personal health data of workers in paying attention to their privacy and access rights. | |
| Understanding of customers of occupational health services | ||
| Analysis of characteristics of companies and workers | Be able to analyze characteristics of companies involved and the workers through communication with employers, supervisors, employees and others. | |
| Assessment of occupational health needs | Be able to collect necessary information for understanding the worksites and assessing occupational health needs by field patrol or other methods. | |
| Occupational health services considering social and cultural diversity | Be able to provide effective occupational health services by considering social and cultural diversity of workers. | |
| Understanding of related regulations and compliance | ||
| Compliance with occupational health regulations | Be able to contribute to compliance with industrial safety and health regulations by understanding applicable regulations, collecting information on the amendments and applying this information to occupational health practices at the workplace. | |
| Application of amended occupational health regulations | Be able to evaluate applicability of amended regulations to the worksite and advise an employer on how to comply with them. | |
| Application of industrial injury insurance | Be able to give professional advice to an employer on the application of industrial accident compensation insurance or lawsuits related to work injuries or illness. | |
| Document structures and plans | ||
| Policy statement on occupational health | Be able to advise employers on drawing up policy statements on occupational safety and health. | |
| Objectives of occupational health programs | Ba able to develop objectives of occupational health programs in correspondence with actual conditions of the workplace and evaluate program performance. | |
| Plans of occupational health programs | Be able to make a plan for occupational health programs and manage their progress. | |
| Documentation of occupational health procedures | Be able to develop procedures and other related documents on occupational health in correspondence with actual conditions of the workplace. | |
| Records and reports of occupational health activities | Be able to keep occupational health records appropriately and use them to develop activity reports that are as accurate and quantitative as possible. | |
| Information system for occupational health services | Be able to clarify the necessary information for occupational health services and utilize an information system for providing and analyzing services. | |
| Occupational health organization and roles of occupational physicians | ||
| Evaluation of necessary expertise and system | Be able to advise an employer on necessary expertise and appropriate systems for effective occupational health activities. | |
| Organization of occupational health team | Be able to organize an occupational health team by clarifying roles of each occupational health staff and leading the cooperative effort. | |
| Cooperation with occupational health staff | Be able to guide occupational health nurses and health supervisors and cooperate with them effectively. | |
| Quality management of occupational health services | Be able to evaluate and improve the quality of occupational health services with a quality management system. | |
| Budget for occupational health department | Be able to budget for the occupational health department and develop an effective execution plan. | |
| Contribution to health committee | Be able to contribute to effective discussion in a health committee and in other opportunities. | |
| Risk assessment | ||
| Identification of existing health hazards | Be able to identify existing health hazards in the workplace and address them. | |
| Information of existing health hazards | Be able to collect information on existing health hazards in the workplace, and understand and use the information for risk assessment. | |
| Monitoring of exposure to health hazards | Understand exposure monitoring methods for health hazards and be able to assess workers' exposure. | |
| Assessment of health risks | Be able to assess health risks with hazard information and exposure data of workers. | |
| Health surveillance, diagnosis and treatment | ||
| Indicators of health effects for health surveillance | Be able to consider exposure conditions to health hazards and use this information to decide on indicators for health surveillance. | |
| Quality assurance programs of laboratories | Understand quality assurance programs and be able to select a reliable laboratory for health examinations. | |
| Utilization of health surveillance for workplace improvement | Be able to grasp conditions in the workplace with data from health surveillance, and use the data for improvement. | |
| Diagnosis of health effects with health surveillance | Be able to diagnose adverse health effects with health surveillance and other methods. | |
| Risk reduction | ||
| Cause analysis of industrial accidents or occupational diseases | Be able to participate in cause analysis of industrial accidents or occupational diseases and contribute to prevention of recurrence. | |
| Prioritization of risks for reduction plans | Be able to prioritize risks for reduction plans with risk assessment. | |
| Risk reduction methods and plans | Be able to advise an employer on risk reduction methods and plans according to existing risks in the workplace. | |
| Execution of risk reduction plans | Be able to confirm execution of risk reduction plans and evaluate their effectiveness. | |
| Risk communication | ||
| Education programs on risk reduction | Be able to plan and conduct necessary education programs on risk reduction for every layer of employees. | |
| Risk communication to workers | Be able to communicate with workers on existing health risks while considering their anxiety, and to address questions from workers on the basis of scientific evidence. | |
| Work load and recovery from fatigue | ||
| Evaluation of psychological and physical load | Be able to evaluate psychological and physical loads of workers according to their work, shift pattern and so on. | |
| Design of work to have a small load | Be able to advise an employer on work design that makes psychological and physical loads as small as possible. | |
| Design of offices and facilities for employees' welfare | Be able to advise an employer on design of offices and facilities for employees' welfare, such as restaurants and lounges that facilitate recovery of their fatigue. | |
| Countermeasures against psychosocial health hazards | ||
| Mental health programs | Be able to make an appropriate plan for mental health programs, provide counseling to employees and advise an employer on the necessary actions. | |
| Programs to combat health effects due to overwork | Be able to contribute to programs to combat health effects due to overwork by executing face-to-face interviews with employees and advising employers to prevent adverse health effects. | |
| Health care and promotion | ||
| Periodic general health examination | Be able to plan and conduct periodic general health examinations to evaluate health conditions and lifestyles of employees. | |
| Evaluation of health condition of employee group | Be able to evaluate health conditions, lifestyle and other factors among employees as a group. | |
| Health care for elder or female employees | Be able to develop a health care plan for elder or female employees and handle individual cases based on data for their health characteristics. | |
| Health guidance based on health examination | Be able to conduct health guidance based on health examinations. | |
| Education on health promotion for employee group | Be able to make lectures on health promotion to employee groups. | |
| Work accommodation | ||
| Procedures of fitness for duty assessment and work accommodation | Be able to give professional advice to an employer on procedures of fitness for duty assessment and work accommodation. | |
| Professional opinions on fitness for duty and work accommodation | Be able to submit opinions on fitness for duty and work accommodation based on data from health examinations. | |
| Work accommodation at return to work or during pregnancy | Be able to give advice to an employer on necessary work accommodation for returning to work or during pregnancy. | |
| Improvement of work abilities of elder, ill or handicapped employees | Be able to support elder, ill or handicapped employees to improve their work abilities. | |
| Protection of reproductive function of female employees | Be able to advise female employees on protection of reproductive function, especially during pregnancy. | |
| First aid and emergency response | ||
| First aid skills and training for employees | Have first aid skills and be able to train occupational health staff and other employees. | |
| First aid plan and arrangement for equipment | Be able to develop a first aid plan and arrange necessary equipment and other requirements. | |
| Emergency response plan | Be able to give professional advice to an employer on development of an emergency response plan. | |
| Environment protection | ||
| Worksite issues and applicable regulations on environmental protection | Be able to explain issues of worksites, applicable regulations and requirements of a management system for environment protection. | |
| Professional support for environment protection | Be able to give professional support to activities of environmental protection in the workplace. | |
| Scientific research | ||
| Planning and execution of scientific research on occupational health issues | Be able to design scientific research plans on occupational health issues and execute them. | |
| Execution and presentation of research following codes of ethics | Be able to execute scientific research and present the results, following a code of ethics. | |
| Audit | ||
| Occupational safety and health audit and reporting | Be able to participate in an occupational safety and health audit and contribute to the reporting. | |
| Collaboration with parties inside or outside of company | ||
| Communication with employers and unions | Be able to communicate with employers, unions and other stakeholders, with understanding of their positions. | |
| Collaboration with human resources and safety departments | Be able to collaborate effectively with human resource department, safety department and other departments. | |
| Utilization of public resources and contribution to community | Be able to utilize public sectors and local resources effectively and contribute to local society. | |
