Occupational medicine in medical schools: where are we heading

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Occupational medicine in medical schools where
are we heading?

• Anthony Seaton
• University of Aberdeen

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What does a university want?

• enhancement of its reputation
• enhancement of its income

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And this is achieved by

• Research
• grants
• fellowships and PhDs
• publications
• presentations to learned bodies
• Teaching
• undergraduate
• postgraduate
• Entrepreneurial activity

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What does occupational medicine need?

• undergraduate education
• medical and nursing
• training
• postgraduate medical, nursing and scientific
• continuing professional development
• research

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Teaching and training

• undergraduate - all medical students
• postgraduate - trainees in OEM
• continuing professional development

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The medical undergraduate curriculum

• integrated
• clinical from year 1
• multidisciplinary
• environmental/occupational factors are required
  to be included

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The medical undergraduate curriculum how to get
into it

• easy - offer to help, as course organisers are
  always looking for extra hands!
• be prepared to teach it as part of something else
  eg medicine, GP, public health
• dont promote it as something extra - simply as
  part of an integrated curriculum

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Postgraduate teaching

• demand is low in a small specialty
• already reasonable choice
• full-time (Aberdeen)
• day-release (Birmingham)
• distance learning (Manchester)
• no pressing need for more teaching centres save
  perhaps in SE England day release

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CPD

• clear role for national coordination ?SOM, FOM
• could be run through postgraduate deans
• local academic departments participate

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Teaching - the future

• greater integration of medical, nursing and other
  professional teaching at u/g level
• increased participation of OPs in local medical
  schools - u/g and CPD
• greater use of IT in distance learning
• but nothing can beat getting away from it all and
  doing a full-time course in Aberdeen!

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Research - the universities criteria

• At least a good prospect of international quality
  - ie recognition in USA and EC
• focussed, part of a planned programme, not
  diffuse or reactive
• integrated with other parts of the universitys
  portfolio
• preferably collaborative

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Research - the needs of occupational medicine

• more operational and reactive
• closer to health services/economics than
  classical mechanistic/epidemiological
• poor fit with current university OM departments
• but suitable for other departments in
  universities - OM as link

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How do you run a university department?
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The Aberdeen model

• Small department - in 1988 a professor, 2 senior
  lecturers, lecturer, secretary and technician
• targets
• u/g and p/g teaching
• research programme
• clinical service
• opportunity - the new curriculum

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The Aberdeen model

• Teaching
• p/g courses allowed case to be made to employ S/L
  ergonomist and hygienist
• u/g course allowed integration of occupational
  medicine with the core curriculum (GP, PH, child
  health, geriatrics and mental health)
• this led to higher profile in the medical school

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The Aberdeen model - undergraduate teaching

• phase 1 - man and the environment
• tutorial, essay and poster project
• phase 2 - the environment and illness
• GP tutorial, 4 OM lectures, essay
• SSM on the environment and health
• phase 3 - occupational medicine
• tutorial, slides, video, computer package and
  examination on GP/OM

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The Aberdeen model - research

• Do what you are good at and neglect the rest!
• Have a plan - the wider environment may expand
  funding opportunities
• Identify possible sponsors
• Build a team and collaborate in grant applications

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The Aberdeen model - the A to E of research

• Aetiology of asthma (Seaton)
• Air pollution (Seaton)
• Biomechanics (Pope)
• Chemical neurotoxicity (Dick)
• Diving (Ross)
• Exposure assessment (Cherrie)

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Increase in asthma a more toxic environment or a
more susceptible population?Seaton A et al
Thorax 199449171-174

• Noted reduction in fresh vegetable and fruit
  intake in UK
• hypothesised that increase in asthma was due to
• reduced antioxidant intake during pregnancy
• leading to lowered protection of child against
  allergens

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The dietary hypothesis - where does it stand?

• Dietary factors influence risk of
• wheezy illness and bronchial responsiveness
• atopy
• in utero Th-cell proliferation to allergens
• Vitamin E and fatty acids may interact to
• alter the responsiveness of the Th lymphocyte
• vary risks of diseases such as asthma and
  diabetes in populations

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Particulate air pollution and acute health
effects Seaton A et al Lancet 1995345176

• Hypothesised that
• it is not the mass but the number, and
• the ultrafine particles are important, as they
• penetrate readily indoors
• cause local lung inflammation
• which in turn results in release of mediators
• which alter blood coagulability
• which increases risk of heart attacks

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PNC when shopping
walking on Union Street
eating area shopping mall
shop
shop
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Solvents - do they damage the brain?
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Exposure estimation
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Keeping it going

• Strategy
• plan several years ahead of retiral
• integrate with other departments research and
  teaching
• Tactics
• must be research active (RAE 4 or 5)
• must have support of Dean and Principal
• external support of grant-giving bodies helpful
• identify possible successors

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And it worked for us!
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So, where do we go?

• Maintain the academic presence - chairs and
  departments
• recruit and train the next generation of
  academics
• encourage the development of u/g teaching in all
  medical schools
• be positive!

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Thanks to

• my colleagues who have done most of the work
• John Cherrie, Finlay Dick, Clive Harker, Liz
  Murphy, Monika Watt and Liz Wright
• and my secretaries
• Lesley Alexander, Lynda Cresswell and Diane
  Simpson

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Visit our website for further information

• www.abdn.ac.uk/deom