Learning

OEM Competencies

To assist practicing physicians to keep current and to serve as knowledgeable representatives of the specialty, ACOEM has identified the following 10 core competencies for occupational and environmental medicine (OEM).

Download the complete version of the 2021 OEM Core Competencies.
1) Clinical Occupational and Environmental Medicine 
  1. OEM physicians should have the knowledge and skills to provide evidence-based clinical evaluation and treatment of injuries and illnesses that are occupationally or environmentally related. OEM physicians’ expertise is also applied to evaluating the impact of personal medical conditions or work-related conditions on the ability to perform work tasks. Throughout the course of care, physicians should seek to maximize the patients’ functional abilities. Knowledge and skill are essential in a broad range of specialties including dermatology, internal medicine, neurology, pulmonary, infectious diseases, orthopedics, psychiatry, pain management, sleep medicine, and others. Individuals with underlying risk factors or disease may encounter special concerns in certain positions. OEM physicians utilize their knowledge and skill to identify those conditions which may present a safety concern or may be exacerbated by certain exposures. Working with other professionals which may include safety, human resources, labor relations, industrial hygiene and/or the employee’s health care provider, OEM physicians evaluate and coordinate appropriate cautions and job task in individuals with high consequence disease or risk factors. Their perspective is crucial in evaluating workers in certain positions such as emergency response, hazardous waste, commercial driving, forklift operation, or those requiring respirator use. These positions have the potential for a high consequence outcome for the population served if there is a sudden or emergent medical event during work. Clinical expertise may be applied in face-to-face care of patients or caring for populations, as well as activities such as case management and peer-to-peer discussions. OEM services may also be provided through telehealth. OEM physicians have responsibility for employee health or population health management as part of their clinical OEM practice. (ACGME: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism)
2) OEM Related Law and Regulations 

OEM physicians should have the knowledge and skills necessary to understand and apply regulations applicable to occupational and environmental health as well as the range of laws and regulations related to interactions between work and health. They should also be aware of voluntary standards, guidance, or recommendations regarding work practices, exposures, and other factors which may impact the health and safety of workers from organizations such as NIOSH, Department of Transportation (DOT), American Congress of Governmental Industrial Hygienists (ACGIH), and ACOEM. OEM physicians need to interact knowledgeably with non-medical professionals in various roles including human resources operations, industrial hygiene, safety, labor relations, government affairs, and legal, and should understand the laws, regulations, standards, and practices that guide these professionals. (ACGME: Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice)

3) Environmental Health 

OEM physicians should have the knowledge and skills necessary to recognize potential chemical, physical, and biological environmental causes of health concern to individuals as well as to community health. Environmental issues most often include air, water, or soil contamination by natural or artificial pollutants. OEM physicians hey should be competent in taking an exposure history that includes environmental as well as occupational sources and must understand how to identify environmental hazards. They can also characterize risk, based on an assessment of exposure that includes potential routes of exposure and risk assessment. They understand dose-response relationships and how to compare environmental and biomonitoring data to published standards. OEM physicians should be aware of common clinically significant environmental agents and diseases relevant to the geographic area where they practice, such as lead, asbestos, arsenic, and radon. (ACGME: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice)

4) Work Fitness and Disability Management 

OEM physicians should have the knowledge and skills to determine whether workers can safely be at work and perform required job tasks. They should be able to evaluate the individual, coordinate care with other specialists and utilize evidence-based guidelines to develop a treatment or management plan. OEM physicians should be able to utilize information from employers, other providers, and professionals such as case managers, ergonomists, therapists, vocational rehabilitation specialists, safety professionals, attorneys, and human resources to facilitate an outcome that aligns an individual’s abilities with the job requirements and essential functions. OEM physicians should have the knowledge and skills necessary to communicate and provide guidance to the employee and employer when there is a need for integration of an employee with a disability or impairment/functional limitations into the workplace, or when there is a need to pursue other avenues such as vocational rehabilitation or disability benefits. This would include whether such disability is due to musculoskeletal or cognitive function, the prognosis and progression of the medical condition including substance abuse or the effect of treatment such as medications or other therapy. Some OEM providers may perform disability evaluations or independent medical examinations utilizing current disability or impairment rating resources. Others may be responsible for developing and managing transitional or alternate work placement programs or evaluating the effectiveness of OEM medical care delivered by other physicians, and monitor adherence to evidence-based practice guidelines as well as clinical outcomes. (ACGME: Patient Care, Medical Knowledge, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice)

5) Toxicology 

OEM physicians should have the knowledge and skills to recognize, evaluate, and manage health effects of exposures to toxic agents at work or in the general environment. They should be familiar with and able to use existing resources and databases (eg, safety data sheets [SDS], PubChem, threshold limit values [TLV], etc.) to characterize the potential risk from occupational and environmental chemical exposures. OEM physicians can interpret industrial hygiene reports and other data describing specific exposure conditions to determine potential routes of exposure and possible overexposure. They should be familiar with the adverse effects of such overexposures on exposed individuals, as well as the standard clinical and biological tests used to confirm such adverse effects. OEM physicians can implement standard components of medical surveillance and biological monitoring appropriate for individuals exposed to specific chemicals. They should also have knowledge of specific legally mandated surveillance and monitoring procedures for those chemicals. (ACGME: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Professionalism and Systems-Based Practice)

6) Hazard Recognition, Evaluation, and Control 

OEM physicians should have the knowledge and skills to assess if there is risk of an adverse event from exposure to physical, chemical, biological, or psychosocial hazards in the workplace or environment. They should be prepared to collaborate with industrial hygienists or other qualified safety and health professionals and interpret measurements and reports from such professionals in context. If there is a risk with exposure, that risk can be characterized with recommendations for control measures or medical surveillance. OEM physicians should demonstrate an understanding of the core principles of industrial hygiene, ergonomics, occupational safety and risk assessment and communication, and apply Hierarchy of Controls principles to protect the health of individual workers, patients, and the public from known physical, chemical, biological, or psychosocial hazards. (ACGME: Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills and Systems-Based Practice)

7) Disaster Preparedness and Emergency Management 

OEM physicians may have a critical role in emergency preparedness, emergency management, and pandemic preparation and mitigation. This includes playing a key role in protecting employees and families, health systems, companies, and government agencies, as well as contributing to the health of the national and global workforce by anticipating and preventing the economic consequences of disasters. OEM physicians may be called upon to treat those impacted by the emergency or disaster or to evaluate emergency responders. OEM physicians should be able to describe specific threats, including a broad range of physical, chemical, biological or psychosocial hazards. Depending on their practice setting, the OEM physician may need the knowledge and skills to collaborate with the employer management team to plan for workplace response to natural or manmade disasters. Emergency management planning includes resource mobilization, worker population tracking, communication, procurement of medical products, financing, leadership and governance, and contingency planning. Collaboration with local, state, or federal agencies is essential. (ACGME: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills and Systems-Based Practice)

8) Health and Productivity 

OEM physicians should be able to identify and address individual and organizational factors in the workplace toward optimizing worker health and enhancing human performance. They should be able to assess the degree of impact of those factors (ie, smoking, depression, burnout, and other medical conditions) and be able to advise on or create programs relevant to that workplace to address the concern (ie, smoking cessation, physical activity, depression or blood pressure screening, weight management, mindfulness, or resiliency training) that will improve worker wellness. OEM physicians should be able to understand data management and reporting systems and assess aggregate data from health risk assessments, health insurance claim data and the effect of implemented wellness related programs. They should be knowledgeable of the organizational structure and be able to communicate data to senior management of an organization. Overall, OEM physicians should have the ability to provide guidance to an organization on optimal health and human performance programs to consider for the workforce and may participate in decisions about the optimal method to deliver those services. They provide advice to support the organization promoting a culture of health and ensuring that any program aligns with business goals in accordance with best practice in supporting workplace health and safety. OEM physicians should have a strategy to demonstrate their value to the system and the return on investment of suggested or implemented initiatives. The goal being creating and sustaining a healthy, safe, and high-performance workforce. (ACGME: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills and Systems-Based Practice)

9) Public Health, Surveillance, and Disease Prevention 

OEM physicians should be able to assess, prepare and respond to individual and population risks for common occupational and environmental disorders as well as emerging and catastrophic events such as pandemics, bioterrorism, climate/weather occurrences. They should have the knowledge and skill to develop, evaluate, and manage medical surveillance programs for the workplace as well as the public to identify trends and sentinel events. They should be knowledgeable and able to apply appropriate screening guidelines, as well as immunization and chemo-prophylaxis recommendations for workers. This includes those from the US Preventive Services Task Force (USPSTF), Hospital Infection Control Advisory Committee on Immunizations, Centers for Disease Control and Prevention (CDC), and guidelines (eg, bloodborne pathogen exposure) and applicable Occupational Safety and Health Administration (OSHA) standards. OEM physicians should be able to apply primary, secondary, and tertiary preventive approaches to individual and population-based disease prevention and health promotion, and be able to develop, implement and evaluate the effectiveness of appropriate clinical preventive services for both individuals and populations. Deploying information technology to address current and emerging occupational hazards and utilizing available information, they should have the ability to appropriately communicate risk to workers, organizations, and the public. OEM physicians should also possess data management skills as well as know how to access and advise expert epidemiology and biostatistics support in acquiring, managing, and interpreting data relevant to the populations they serve in order to make evidence-based interventions based on the best available evidence. They should be able to measure, organize and improve public health service or a surveillance system. (ACGME: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice)

10) OEM Related Management and Administration

OEM physicians should have administrative and management knowledge and skills to plan, design, implement, manage, and evaluate comprehensive occupational and environmental health programs and projects and work with leadership and governance to ensure the health and safety of employees. OEM physicians need an understanding of health care benefits, workers’ compensation systems, electronic health records, and knowledge of the laws and regulations applicable to their jurisdiction, industry, and population of interest. They should understand and be able to articulate the differences in assessment between the concepts of medical causation and those related to workers’ compensation and other legal and regulatory standards. OEM physicians in all practice settings are expected to be sensitive to the diverse needs and cultural backgrounds of those they serve and anticipate meeting these needs in their practices. OEM physicians should be able to collaborate as part of a larger OEM team which may include physician colleagues, other health care providers, industrial hygienists, safety professionals, ergonomists, physical therapists, athletic trainers, employers, legal experts, human resources professionals, insurance carriers, case managers, adjustors, etc., and may play a leadership role in those teams. They may be expected to evaluate and implement clinical practice guidelines, quality improvement programs, outcome assessment strategies and medical informatics programs as they apply to day-to-day clinical patient care. OEM physicians should be able to manage many of the programs essential to the success of the above nine core competencies. (ACGME: Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice)