Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

Background: The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey. Methods: An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work. Results: There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups. Conclusion: This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles

Comparison of competency priorities between UK occupational physicians and occupational health nurses

Objectives: The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods: A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1—‘rating’, round 2—‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results: In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman’s r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions: This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities

Research and teaching activity in UK occupational physicians

Background: For all doctors, including occupational physicians (OPs), research and teaching are considered core requirements of medical education and continuing professional development. Academic skills are also vital to evidence-based practice and advancement of occupational health (OH) as a specialty. In recent years, attention has focussed on the declining UK OH academic base and the research– practice gap, and increased practitioner participation in research is encouraged. Aims: To establish a baseline of research and teaching activity among UK OPs, identify related barriers and inform strategies to overcome them. Methods: An online survey including specific career profile questions derived from consensus following expert panel discussions. It formed part of a larger Delphi study on UK OH research priorities. Results: We received 213 responses, about 18% of 1207 practising UK OPs. Of these, 162 (76%) undertook research at some career-point, of which 44 (27%) were currently research-active. Similarly, 154 (72%) undertook teaching at some career-point, of which 99 (64%) were currently teaching-active. Of those who had never undertaken research (n = 51) or teaching (n = 59), 40 and 42% were interested in doing so, respectively. Key barriers were lack of time and opportunity, the former particularly for respondents practising in industry, where ‘commercial’ demands take priority, rather than healthcare. Conclusions: This study establishes a benchmark of academic activity among UK OPs and identifies related barriers. These ‘target’ barriers can shape research funding priorities and education to increase participation and develop the UK OH academic base

The Teachers' Health and Wellbeing Study Scotland

© NHS Health Scotland 2004In Scotland, as in the rest of Europe and the UK, issues of health and well being have come to be of increasing concern in the contemporary workplace, and no less so in the teaching profession where levels of ill-health retirement and workrelated sickness absence have become perennial concerns (Wilson 2002; Brown and Macdonald, forthcoming; Travers and Cooper 1996). Indeed, it has been estimated that stress in physical and psychological terms may cost taxpayers in Scotland approximately £43 million per year and, in addition, that some £37 million a year is spent on supply teachers to cover for those who are absent. Furthermore, it has been proposed that anything between £750,000 – £1.5 million might be saved every year in Scotland through the introduction of comprehensive teacher support systems (Goss 2001). While it is a well-established fact that teaching is one of the most stressful jobs (Smith et al, 2000a, 2000b; Trunch, 1980; Tuetteman and Punch, 1990), very little primary data on teachers in Scotland actually exist. Rather, the evidence base in Scotland is dominated by reviews cataloguing the evidence and arguments concerning the nature and sources of teacher stress, for example, the Scottish Council for Research in Education (SCRE) has published two of the most detailed reviews of the sources and prevalence of teachers’ stress (Johnstone, 1989; Wilson, 2002). In an effort to form a baseline picture of teachers’ health needs in Scotland, as well as a more strategic view of what could be done to address these growing problems, NHS Health Scotland and the charity Teacher Support Scotland (TSS) with support from the Esmee Fairburn Foundation commissioned research to explore the issue of teachers’ health and well being. The explicit aim of the endeavour was to address the ‘growing perception in Scotland that there is a need for consistent and systematic support for teachers on a national basis’ (NHS Health Scotland 2003), the concern being that teacher recruitment,. retention and morale will be adversely affected if such support is not forthcoming. There were three components to the research, the aims of which were: 1. to map the context and support which is currently offered to teachers in Scotland. 2. to ask teachers themselves about their health needs and the support they would like to be offered in the future. 3. to catalogue the interventions from around the world which might be effective in addressing teachers’ health and well being. Data were collected for each strand respectively through: 1. A survey of the HR Departments of all 32 Scottish Local Authorities to determine the nature and extent of support for health and well being issues among teachers. 2. A health and well being questionnaire survey of a sample of teachers drawn from the register of the General Teaching Council of Scotland and a focus group session with staff members in a SEN school. 3. A “rapid evidence assessment” using international social science and occupational health databases to search for relevant literature on health interventions which have been used to improve health and well being in the teaching profession across the world. This report summarises the results from all three strands of the research project.NHS Health Scotland, Esmee Fairbairn Foundation, Teacher Support Scotlan

Role of age and health in perceptions of returning to work: a qualitative study

Background: People aged over 50 years form a growing proportion of the working age population, but are at increased risk of unemployment compared to other age groups. It is often difficult to return to work after unemployment, particularly for those with health issues. In this paper, we explored the perceptions, attitudes, and experiences of returning to work after a period of unemployment (hereafter RTW) barriers among unemployed adults aged over 50 years. Method: In-depth semi-structured interviews were conducted with a diverse sample of 26 unemployed individuals aged 50–64 years who were engaged with the UK Government’s Work Programme. Data were thematically analysed. Results: Age alone was not discussed by participants as a barrier to work; rather their discussions of barriers to work focused on the ways in which age influenced other issues in their lives. For participants reporting chronic health conditions, or disabilities, there was a concern about being unfit to return to their previous employment area, and therefore having to “start again” in a new career, with associated concerns about their health status and managing their treatment burden. Some participants also reported experiencing either direct or indirect ageism (including related to their health status or need to access healthcare) when looking for work. Other issues facing older people included wider socio-political changes, such as the increased pension age, were felt to be unfair in many ways and contradicted existing expectations of social roles (such as acting as a carer for other family members). Conclusion: Over-50s experienced multiple and interacting issues, at both the individual and societal level, that created RTW barriers. There is a need for employability interventions that focus on supporting the over-50s who have fallen out of the labour market to take a holistic approach, working across healthcare, employability and the local labour market, providing treatment and skills training for both those out of work and for employers, in order to create an intervention that that helps achieve RTW and its associated health benefit

Current research priorities for UK occupational physicians and occupational health researchers: a modified Delphi study

Objectives: Studies identifying national occupational health (OH) research priorities have been conducted in several countries to establish where OH research should be focused and where funding should be targeted. However, the UK findings are now over 20 years old, and OH practice is continuously evolving. The aim of this study was to identify current research priorities for UK occupational physicians (OPs) and occupational health researchers (OHRs). Methods: Current research priorities in OH were identified using a modified Delphi technique. This was conducted in two rounds to achieve consensus. Research priorities were rated, and then ranked using questionnaires developed from expert panel discussions, key research topics identified from the medical literature and participant feedback. Overall and intergroup comparisons were completed for the ranking scores. Results Consensus among OPs and OHRs was high with almost all (9/10) primary domains rated as ‘very important’ or ‘absolutely necessary’ by more than 54% of respondents. The research priority areas ranked highest were jointly economic evaluation/cost effectiveness studies and disability management followed by occupational disease/injury/illness. Occupational health policy was ranked lowest after sickness absence management and health promotion. The secondary domain analysis identified priority emphasis on mental health and psychosocial hazards within the workplace and the need to further develop evidence-based guidance for clinical OH practice. Conclusions: We identified the current research priorities for UK OPs and OHRs. The findings will inform future national OH research strategy and support research that addresses important knowledge gaps within OH and other interdisciplinary specialties

Falling Incapacity Benefit claims in a former industrial city: policy impacts or labour market improvement?

This article provides an in-depth study of Incapacity Benefit (IB) claims in a major city and of the factors behind their changing level. It relates to the regime prior to the introduction of the Employment and Support Allowance (ESA) in 2008. Glasgow has had one of the highest levels of IB in Britain with a peak of almost one fifth of the working age population on IB or Severe Disablement Allowance (SDA). However, over the past decade the number of IB claimants in Glasgow, as in other high claiming areas, has fallen at a faster rate than elsewhere, and Glasgow now has twice the national proportion of working-age people on IB/SDA rather than its peak of three times. The rise in IB in Glasgow can be attributed primarily to deindustrialisation; between 1971 and 1991, over 100,000 manufacturing jobs were lost in the city. Policy response was belated. Lack of local statistics on IB led to a lengthy delay in official recognition of the scale of the issue, and targeted programmes to divert or return IB claimants to work did not begin on any scale until around 2004. Evidence presented in the article suggests that the reduction in claims, which has mainly occurred since about 2003, has been due more to a strengthening labour market than to national policy changes or local programmes. This gives strong support to the view that excess IB claims are a form of disguised unemployment. Further detailed evaluation of ongoing programmes is required to develop the evidence base for this complex area. However, the study casts some doubt on the need for the post-2006 round of IB reforms in high-claim areas, since rapid decline in the number of claimants was already occurring in these areas. The article also indicates the importance of close joint working between national and local agencies, and further development of local level statistics on IB claimants

Comparing anxiety and depression in information technology workers with others in employment: a UK Biobank cohort study

Objectives: Despite reported psychological hazards of information technology (IT) work, studies of diagnosed mental health conditions in IT workers are lacking. We investigated self-reported mental health outcomes and incident anxiety/depression in IT workers compared to others in employment in a large population-based cohort. Methods: We evaluated self-reported mental health outcomes in the UK Biobank cohort and incident diagnosed anxiety/depression through health record linkage. We used logistic regression and Cox models to compare the risks of prevalent and incident anxiety/depression among IT workers with all other employed participants. Furthermore, we compared outcomes within IT worker subgroups, and between these subgroups and other similar occupations within their major Standard Occupational Classification (SOC) group. Results: Of 112 399 participants analyzed, 4093 (3.6%) were IT workers. At baseline, IT workers had a reduced odds (OR = 0.66, 95%CI: 0.52–0.85) of anxiety/depression symptoms and were less likely (OR = 0.87, 95%CI: 0.83–0.91) to have ever attended their GP for anxiety/depression, compared to all other employed participants, after adjustment for confounders. The IT technician subgroup were more likely (OR = 1.22, 95%CI: 1.07–1.40) to have previously seen their GP or a psychiatrist (OR = 1.31, 95%CI: 1.06–1.62) for anxiety/depression than their SOC counterparts. IT workers had lower incident anxiety/depression (HR = 0.84, 95%CI 0.77–0.93) compared to all other employed participants, after adjustment for confounders. Conclusions: Our findings from this, the first longitudinal study of IT worker mental health, set the benchmark in our understanding of the mental health of this growing workforce and identification of high-risk groups. This will have important implications for targeting mental health workplace interventions

Predicting connectivity, population size and genetic diversity of Sunda clouded leopards across Sabah, Borneo

Context The Sunda clouded leopard is vulnerable to forest loss and fragmentation. Conservation of this species requires spatially explicit evaluations of the effects of landscape patterns on genetic diversity, population size and landscape connectivity. Objectives We sought to develop predictions of Sunda clouded leopard population density, genetic diversity and population connectivity across the state of Sabah, Malaysian Borneo. We also wished to quantify the differences in connectivity metrics from an empirically optimized model of landscape resistance with one based on expert opinion. Methods We investigated connectivity metrics for Sunda clouded leopards across Sabah, based on an empirically optimised, movement based model, and an expert-opinion derived model. We used simulation modelling to predict and compare the patterns and causes of differences in the local neighbourhood population density, distribution, and genetic diversity across the two different resistance maps, at two dispersal distances. Results The empirical model produced higher estimates of population size, population density, genetic diversity and overall connectivity than the expert-opinion model. The overall pattern of predicted connectivity was similar between models. Both models identified a large patch of core habitat with high predicted connectivity in Sabah’s central forest region, and agreed on the location and extent of the main isolated habitat fragments. Conclusions We identified clear relationships between landscape composition and configuration and predicted distribution, density, genetic diversity and connectivity of Sunda clouded leopard populations. Core areas are comprised of large and unfragmented forest blocks, and areas of reduced forest cover comprise barriers among patches of predicted remaining habitat