Occupational medicine: specialty trainingBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6545 (Published 04 November 2014) Cite this as: BMJ 2014;349:g6545
- Abeyna Jones, occupational medicine registrar, King’s College Hospital NHS Foundation Trust, London,
- John Harrison, chief medical officer, Devon and Cornwall Police, and head of the National School of Occupational Health
Abeyna Jones and John Harrison describe the pathway to diverse cross sector career opportunities in occupational medicine
Occupational medicine (OM) is a medical specialty that focuses on the relationship between health and the ability to work. Occupational health (OH) is a preventive discipline delivered by multiprofessional teams that may include doctors, nurses, physiotherapists, ergonomists, psychologists, and safety professionals. The specialty requires a broad knowledge of medicine and non-clinical skills, which includes understanding relevant government legislation relating to work; ethics; excellent communication skills; and business development.
Occupational health physicians originate from a diverse range of medical specialties and work across many sectors, including private industry, the military, and public and NHS settings. Physicians such as general practitioners or psychiatrists may develop OM as a specialist interest, pursuing further relevant postgraduate qualifications to support their portfolio credentials. OM has close relations to occupational hygiene, environmental medicine, toxicology, aviation medicine, public health, infectious diseases, and disability medicine.1
A career in OM affords a great work-life balance, with a notable absence of on calls, no emergency work, and exposure to management and leadership roles at an early stage in training. It is a diverse specialty with plenty of lucrative career opportunities, but it is not suitable for everyone. Clinicians entering the specialty may struggle with the non-prescriptive aspects of the role, lone working in some settings, and NHS trainees receive an unbanded salary.
Applicants for specialty training in OM do not need to have previous experience; however, it is advisable to spend time in one or more occupational health services to gain an understanding of the unique nature of the specialty and to ascertain whether this career is the right choice.
Historically, OM trainees have tended to originate from general practice, psychiatry, or general medicine. Opening the specialty to other disciplines has now resulted in trainees from a diverse range of backgrounds.
Possessing a wide range of clinical experience is key. Practice in the specialty has evolved from focusing only on workplace health risk management to looking at health and wellbeing in the workplace and promoting the ability to work.
The main professional bodies influencing the practice of OM are the Faculty of Occupational Medicine (FOM), which is primarily responsible for education and training in the UK, and the Society of Occupational Medicine, which is the largest professional network in the UK for doctors and healthcare professionals in OM. Membership of the FOM is conferred on doctors who have successfully completed their specialty training, including their examinations.
Launched in August 2014, the National School of Occupational Health for England and Wales has been established to provide leadership for the development of high quality training across the different specialist groups, and it will lead to the establishment of a national training framework for OH practitioners and the promotion of interprofessional training. The immediate aims of the school include addressing the falling trainee numbers by working closely with the FOM to publicise career paths, improve the recruitment process, and embrace multiprofessional training.
A new national interview process has been developed this year to ensure a robust selection methodology linked to the publicised national person specification. At the moment, this applies only to NHS applicants, although there are efforts to explore how this can be extended to non-NHS trainees. In the future there will be stratification of the national process allowing applicants to specify which region of the country they are interested in working in and to be selected using a regional scoring system.
Applicants to all training programmes must provide evidence of achievement of foundation year competences, followed by training or experience and competences of two years of core medicine, acute care common stem, surgery, or psychiatry or three years in general practice or achievement of phase 1 of the Faculty of Public Health’s training.
Desirable criteria for successfully shortlisted applicants in private industry posts usually includes work experience or a previous specialty qualification (such as in general practice or public health or membership of the Royal College of Physicians or a diploma in occupational medicine).
The structure for NHS job interviews is similar to an objective structured clinical examination, consisting of several stations that assess consultation skills, communication and presentation, prioritisation, and portfolio assessment. The structure of non-NHS job interviews varies across the sectors, but will usually consist of one or two interviews with a panel of members representing the FOM. Questions will often be based on critical analysis of a paper, relevant experience, a prioritisation exercise, and hypothetical scenarios.
Posts and training
Between August 2013 and August 2014, the ratio of applications to posts was just under 3:1, ranging from an application to post ratio of 1:1 for the Ministry of Defence to 12:1 for Health Education East of England. In August 2014, there were 41 trainees in NHS organisations, 20 trainees in private organisations, 14 trainees in the Ministry of Defence, and one trainee in an out-of-programme position. There were 21 trainees across the local education and training boards covering London, Kent, Surrey, and Sussex, making this area the region with the highest number of trainees in both NHS and private industries.
Specialty training in occupational medicine in the UK begins at ST3 level as a four year full time training programme across all sectors. Trainees have to follow a structured curriculum delivered by the FOM through local education and training boards. A minimum of 26 work based assessments should be completed during training in addition to the completion of mandatory educational activities, which include health surveillance evaluations, workplace assessments, audits, policy development, and a 10 000 word research dissertation. Annual reviews of competency progression are conducted to ensure trainees are achieving their targets.
Membership of the FOM is conferred on doctors who have successfully completed their specialty training, including the exams that are taken in two parts. Doctors will subsequently be eligible for entry on the General Medical Council’s specialist register.
Occupational medicine is a challenging specialty that requires self reliance, emotional resilience, good people skills and communication skills as well as scientific curiosity, and an obligatory interest in working environments. For further advice and information visit the FOM website (www.fom.ac.uk).
Lisa Curran is a sixth year specialty trainee (ST6) in occupational medicine at King’s College Hospital NHS Foundation Trust. She has a background in general medicine, including oncology, microbiology, HIV medicine, psychiatry, and public health. She was drawn to occupational medicine “by the broad range of specialist interests and the public health aspects, particularly infection control and environmental epidemiology.” She says, “An average week for me includes 30% clinic, 20% clinical queries, 25% governance including policy writing and meetings, 25% study. I enjoy the variety of work and that there is always something new to investigate or attend to. Communication in its many forms is a vital part of the role.”
Sade Adenekan is an ST4 at Health Management Limited, and previously worked as a consultant in public health. “I entered OM because I was a bit disillusioned with the constant changes in the reforms affecting public health, which made good practice difficult,” she says. “I wanted a change that would allow me to use my preventive medicine skills and knowledge. If you are looking for a flexible clinical specialty that involves a comprehensive consultation, working with various multidisciplinary professionals including lawyers, health and safety staff, and unions as well as engaging staff from various sectors, this is the career to be in. No one day is the same as another in OM, and if you are really lucky, you get a day out in an abattoir, fireboat, or car manufacturing plant.”
Sheetal Chavda, an ST6 at Transport for London (TFL), has a background in psychiatry, and became interested in OM after foundation training. “My educational supervisor mentioned that it may suit me as a specialty,” she says. “While doing a hospital job, I came across a job opportunity at TFL as they were looking for a medical adviser. It was a big change from what I was used to but I really enjoyed it and decided to pursue it as a career. I returned to the NHS to gain the competences that I needed in order to pursue a training post, and completed two years of core training in psychiatry. I subsequently applied for a specialist registrar post in OM at TFL. In OM, I am allocated more time for consultation, which I find rewarding. This allows me more time with the patient to explain things and provide information. I personally have found that a lot of employees who are unwell are primarily focused on their job, along with their health. Being able to make recommendations to their manager or suggest a suitable way forward so that employees can continue working can be extremely rewarding. Speaking to managers, in my opinion, is very different from speaking with anyone else in healthcare and takes practice, hence achieving a successful outcome in such cases can be an enormous source of job satisfaction in this specialty.”
Trainee statistics were retrieved from Health Education England under the Freedom of Information Act 2000.