Curriculum standards

About this resource

The new Advanced Training in Occupational and Environmental Medicine curriculum consists of curriculum standards and learning, teaching, and assessment (LTA) programs.

This document outlines the curriculum standards for Advanced Training in Occupational and Environmental Medicine for trainees and supervisors. The curriculum standards should be used in conjunction with the Advanced Training in Occupational and Environmental Medicine LTA programs.

The new curriculum was approved by the College Education Committee in May 2024. Please refer to the College website for details on its implementation.

Download the curriculum standards PDF

LG1: Competencies

Competencies outline the expected professional behaviours, values and practices that trainees need to achieve by the end of training.

Competencies are grouped by the 10 domains of the professional practice framework.

Competencies will be common across training programs.

Medical expertise

Professional standard. Physicians apply knowledge and skills informed by best available current evidence in the delivery of high-quality, safe practice to facilitate agreed health outcomes for individual patients and populations.

Knowledge. Apply knowledge of the scientific basis of health and disease to the diagnosis and management of workers/patients.

Synthesis. Gather relevant data via age- and context- appropriate means to develop reasonable differential diagnoses, recognising and considering interactions and impacts of comorbidities. Develop diagnostic and management plans that integrate an understanding of individual patient circumstances, including work factors, psychosocial factors and specific vulnerabilities, epidemiology, and population health factors in partnership with patients, families, or carers, and in collaboration with the health care team.

Diagnosis and management. Develop diagnostic and management plans that integrate an understanding of individual patient circumstances, including work factors, psychosocial factors and specific vulnerabilities, epidemiology, and population health factors in partnership with patients, families, or carers, and in collaboration with the health care team.

Communication

Professional standard. Physicians collate information, and share this information clearly, accurately, respectfully, responsibly, empathetically, and in a manner that is understandable.

Physicians share information responsibly with patients, families, carers, colleagues, community groups, the public, and other stakeholders to facilitate optimal health outcomes.

Effective communication. Use a range of effective and appropriate verbal, nonverbal, written and other communication techniques, including active listening.

Communication with workers/patients, families, and carers. Use collaborative, effective, and empathetic communication with workers/patients, families, and carers.

Communication with professionals and professional bodies Use collaborative, respectful, and empathetic clinical communication with colleagues, other health professionals, professional bodies, and agencies.

Written communication. Document and share information about patients to optimise worker/patient care and safety.

Privacy and confidentiality. Maintain appropriate privacy and confidentiality, and share information responsibly.

Quality and safety

Professional standard. Physicians practice in a safe, high-quality manner within the limits of their expertise.

Physicians regularly review and evaluate their own practice alongside peers and best practice standards and conduct continuous improvement activities.

Worker/Patient safety. Demonstrate a safety focus and continuous improvement approach to own practice. Assess and manage workplace risks and harms to promote safer workplaces.

Harm prevention and management. Identify and report risks, adverse events, and errors to improve healthcare systems.

Quality improvement. Participate in quality improvement activities to improve quality of care and safety of the work environment.

Worker/Patient engagement. Enable workers/patients to contribute to the safety of their care.

Teaching and learning

Professional standard. Physicians demonstrate a lifelong commitment to excellence in practice through continuous learning and evaluating evidence.

Physicians foster the learning of others in their profession through a commitment to mentoring, supervising, and teaching.

Lifelong learning. Undertake effective self-education and continuing professional development.

Self-evaluation. Evaluate and reflect on gaps in own knowledge and skills to inform self-directed learning.

Supervision. Provide supervision for junior colleagues and/or team members.

Teaching. Apply appropriate educational techniques to facilitate the learning of colleagues and other health professionals.

Patient education. Apply appropriate educational techniques to promote understanding of health and disease amongst patients and populations.

References

1. Adapted from Richardson D, Oswald A, Chan M-K, Lang ES, Harvey BJ. Scholar. In: Frank JR, Snell L, Sherbino J, editors. The Draft CanMEDS 2015 Physician Competency Framework – Series IV. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2015 March.

Research

Professional standard. Physicians support creation, dissemination and translation of knowledge and practices applicable to health. They do this by engaging with and critically appraising research, and applying it in policy and practice to improve the health outcomes of patients and populations.

Evidence-based practice. Critically analyse relevant literature and refer to evidence-based clinical guidelines, workplace policies and codes of practice, and apply these in daily practice.

Research. Apply research methodology to add to the body of medical knowledge and improve practice and health outcomes.

References

Cultural safety*

Professional standard. Physicians engage in iterative and critical self-reflection of their own cultural identity, power, biases, prejudices and practising behaviours. Together with the requirement of understanding the cultural rights of the community they serve; this brings awareness and accountability for the impact of the physician’s own culture on decision-making and healthcare delivery. It also allows for an adaptive practice where power is shared between patients, family, whānau and/or community and the physician, to improve health outcomes.

Physicians recognise the patient and population’s rights for culturally safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making. This shift in the physician’s perspective fosters collaborative and engaged therapeutic relationships, allows for strength-based (or mana-enhanced) decisions, and sharing of power with the recipient of the care, optimising health care outcomes.

Physicians critically analyse their environment to understand how colonialism, systemic racism, social determinants of health and other sources of inequity have and continue to underpin the healthcare context. Consequently, physicians then can recognise their interfacing with, and contribution to, the environment in which they work to advocate for safe, more equitable and decolonised services and create an inclusive and safe workplace for all colleagues and team members of all cultural backgrounds.

Critical reflection. Engage in iterative and critical self-reflection and demonstrate cultural safety in the context of their own cultural identity, power, biases, prejudices and practising behaviours.

Allyship. Recognise the patient and population’s rights to culturally-safe care, including being an ally for patient, family, whānau and/or community autonomy and agency over their decision-making.

Inclusive communication. Apply culturally-safe communication, acknowledging the sharing of power, and cultural and human rights to enable patients, families and whānau to engage in appropriate patient care decisions.

Culturally-safe environment. Contributes to a culturally-safe learning and practice environment for patients and team members. Respect patients may feel unsafe in the healthcare environment.

*The RACP has adopted the Medical Council of New Zealand’s definition of cultural safety: Cultural safety can be defined as:²

the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.
the commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided.
the awareness that cultural safety encompasses a critical consciousness where health professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities.

References

2. Curtis et al. “Why cultural safety rather than cultural competency is required to achieve health equity”. International Journal for Equity in Health (2019) 18:174

Ethics and professional behaviour

Professional standard. Physicians’ practice is founded upon ethics, and physicians always treat patients, their families, communities, and populations in a caring and respectful manner.

Physicians demonstrate their commitment and accountability to the health and wellbeing of individual patients, communities, populations, and society through ethical practice.

Physicians demonstrate high standards of personal behaviour.

Beliefs and attitudes. Reflect critically on personal beliefs and attitudes, including how these may impact on patient care.

Honesty and openness. Act honestly, including reporting accurately, and acknowledging their own errors.

Patient welfare. Prioritise patients’ welfare and community benefit above self-interest.

Accountability. Be personally and socially accountable.

Personal limits. Practise within their own limits and according to ethical principles and professional guidelines.

Self-care. Implement strategies to maintain personal health and wellbeing.

Respect for peers. Recognise and respect the personal and professional integrity, roles, and contribution of peers.

Interaction with professionals. Interact equitably, collaboratively, and respectfully with other health professionals.

Respect and sensitivity. Respect patients, maintain appropriate relationships, and behave equitably.

Privacy and confidentiality. Protect and uphold patients’ rights to privacy and confidentiality.

Compassion and empathy. Demonstrate a caring attitude towards patients and endeavour to understand patients’ values and beliefs.

Health needs. Understand and address patients’, families’, carers’, and colleagues’ physical and emotional health needs.

Medical and health ethics and law. Practise according to current community and professional ethical standards and legal requirements.

Judgement and decision making

Professional standard. Physicians collect and interpret information, and evaluate and synthesise evidence, to make the best possible decisions in their practice.

Physicians negotiate, implement, and review their decisions and recommendations with patients, their families and carers, and other health professionals.

Diagnostic reasoning. Apply sound diagnostic reasoning to clinical problems to make logical and safe clinical decisions.

Resource allocation. Apply judicious and cost-effective use of health resources to their practice.

Task delegation. Apply good judgement and decision making to the delegation of tasks.

Limits of practice. Recognise their own scope of practice and consult others when required.

Shared decision making. Contribute effectively to team-based decision-making processes.

Leadership, management, and teamwork

Professional standard. Physicians recognise, respect, and aim to develop the skills of others, and engage collaboratively to achieve optimal outcomes for patients and populations.

Physicians contribute to and make decisions about policy, protocols, and resource allocation at personal, professional, organisational, and societal levels.

Physicians work effectively in diverse multidisciplinary teams and promote a safe, productive, and respectful work environment that is free from discrimination, bullying, and harassment.

Managing others. Lead teams, including setting directions, resolving conflicts, and managing individuals.

Wellbeing. Consider and work to ensure the health and safety of colleagues and other health professionals.

Leadership. Act as a role model and leader in professional practice.

Teamwork. Negotiate responsibilities within the healthcare team and function as an effective team member.

Health policy, systems, and advocacy

Professional standard. Physicians apply their knowledge of the nature and attributes of local, national, and global health systems to their own practices. They identify, evaluate, and influence health determinants through local, national, and international policy.

Physicians deliver and advocate for the best health outcomes for all patients and populations.

Health needs. Respond to the health needs of the local community and the broader health needs of the people of Australia and Aotearoa New Zealand.

Prevention and promotion. Incorporate disease prevention, health promotion, and health surveillance into interactions with individual workers/patients, their social support networks and workplaces and employers.

Equity and access.Work with workers/patients and social support networks to address determinants of health that affect them and their access to needed health services or resources.

Stakeholder engagement. Involve communities and patient groups, including employers, unions, governments and insurers, in decisions that affect them to identify priority problems and solutions.

Advocacy. Advocate for prevention, promotion, equity, and access to support worker/patient and population health needs within and outside the clinical environment.

Resource allocation. Understand the factors influencing resource allocation, promote efficiencies, and advocate to reduce inequities.

Sustainability. Manage the use of health care resources responsibly in everyday practice.

Entrustable Professional Activities

Entrustable Professional Activities (EPAs) outline the essential work tasks trainees need to be able to perform in the workplace.

LG2: Team leadership

Learning Goal 2

Team leadership

Lead a team of health and other professionals

This activity requires the ability to:

lead discussions that target and manage appropriate vocational outcomes and/or relevant prudential risk outcomes as occupational health outcomes
articulate individual responsibilities, expertise, and accountability of team members, values-based organisational policies, and ethical frameworks and clinical standards for good clinical governance
understand the range of team members’ skills, expertise, and roles
act as a role model
prioritise workload
manage multiple concurrent tasks
engage in conflict management and resolution

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate clinical competence and skills by effectively supporting team members
synthesise information with other disciplines to develop optimal, goal-centred plans for patients
provide coordinated and quality health care for populations or patients as a member of a multidisciplinary team
use evidence-based care to meet the needs of patients or populations
assess and effectively manage clinical risk in various scenarios

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate adequate knowledge of health care issues by interpreting complex information
demonstrate suitable presentation skills
assess the spectrum of problems to be addressed
apply medical knowledge to assess the impact and clinical outcomes of management decisions

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

provide support and motivate patients, populations, health professionals and workplace stakeholders by effective and clear communication
demonstrate a transparent, consultative style by engaging patients, families, carers, relevant professionals, workplace stakeholders and/or the public in shared decision making
work with patients, families, carers, other health professionals and workplace stakeholders to resolve conflict that may arise when planning and aligning goals
demonstrate rapport with people at all levels by tailoring messages to different stakeholders

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

communicate effectively with colleagues
communicate adequately with patients, their families, and/or carers, and/or the public
respect the roles of team members

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

develop and implement measures of worker health and safety
identify opportunities to support good work that protects and promotes the health of the worker and improves care
review quality and safety incidents
identify opportunities to improve care by participating in surveillance and monitoring of adverse events and near misses
identify activities within systems to reduce errors, improve patient and population safety, and implement cost-effective change
place safety and quality of care first in all decision making
encourage and adopt insights and outcomes-driven scientific innovation from team members for organisational improvement

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

participate in safety audits and other activities that affect the quality of practice and management provided, giving feedback to the organisation or group
participate in multidisciplinary collaboration to provide effective health services and operational change
use information resources and electronic medical record technology where available

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

regularly self-evaluate personal professional practice, and implement changes based on the results
actively seek feedback from supervisors and colleagues on their own performance
identify personal gaps in skills and knowledge, and engage in self-directed learning
maintain current knowledge of new technologies, health care priorities, and changes of patients’ expectations
teach competently by imparting professional knowledge
manage and monitor learner progress, providing regular assessment and feedback

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

accept feedback constructively, and change behaviour in response
recognise the limits of personal expertise, and involve other health professionals as needed
demonstrate basic skills in facilitating colleagues’ learning

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate culturally competent relationships with colleagues and patients
demonstrate respect for diversity and difference
take steps to minimise unconscious bias, including the impact of gender, religion, cultural beliefs, and socioeconomic background on decision making

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate awareness of cultural diversity and unconscious bias
work effectively and respectfully with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
demonstrate understanding and acumen for fostering safe organisational culture
encourage open discussions of ethical and clinical concerns
respect differences of multidisciplinary team members
understand the ethics of resource allocation by aligning optimal patients and organisational care
effectively consult with stakeholders, achieving a balance of alternative views
acknowledge personal conflicts of interest and unconscious bias
act collaboratively to resolve behavioural incidents and conflicts such as harassment and bullying

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

support ethical principles in clinical decision making
maintain standards of medical practice by recognising the health interests of patients or populations as primary responsibilities
respect the roles and expertise of other health professionals
work effectively as a member of a team
promote team values of honesty, discipline, and commitment to continuous improvement
demonstrate understanding of the negative impact of workplace conflict

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

evaluate health services and clarify expectations to support systematic, transparent decision making
make balanced decisions when faced with multiple and conflicting perspectives
ensure medical input to organisational decision making
adopt a systematic approach to analysing information from a variety of specialties and workplace stakeholders to make decisions that benefit health care delivery

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

monitor services and provide appropriate advice
review new health care interventions and resources
interpret appropriate data and evidence for decision making

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

collaborate with and motivate team members
acquire and apply leadership techniques in daily practice
combine team members' skills and expertise in delivering patient care and/or population advice
demonstrate the ability to develop and lead effective multidisciplinary teams by developing and implementing strategies to motivate others
build effective relationships with multidisciplinary team members to achieve optimal outcomes
ensure all members of the team are accountable for their individual practice

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

understand the range of personal and other team members’ skills, expertise, and roles
acknowledge and respect the contribution of all health professionals involved in patients’ care
participate effectively and appropriately in multidisciplinary teams
seek out and respect the perspectives of multidisciplinary team members when making decisions

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

advocate for clinical governance, including continuous improvement of health outcomes specific to occupational and environmental medicine in a variety of settings, including corporate and non-medical
advise how stakeholders can adhere to regulatory and authoritative governmental frameworks for health protection at and for work
engage in appropriate consultation with stakeholders on the delivery of health care
advocate for the resources and support for healthcare teams and workplaces to achieve organisational priorities
influence the development of organisational policies and procedures to optimise health outcomes and provide good work
identify the determinants of health of the population, and mitigate barriers to access to care
remove self-interest from solutions to health advocacy issues

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

communicate with stakeholders within the organisation about health care delivery
understand methods used to allocate resources to provide high-quality care
promote the development and use of organisational policies and procedures

LG3: Supervision and teaching

Learning Goal 3

Supervision and teaching

Supervise and teach professional colleagues

This activity requires the ability to:

provide work-based teaching in a variety of settings
teach professional skills
create a safe and supportive learning environment
plan, deliver, and provide workplace-based assessments
encourage learners to be self-directed and identify learning experiences
supervise learners in day-to-day work, and provide feedback
support learners to prepare for relevant assessments

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

combine high-quality care with high-quality teaching
explain the rationale underpinning a medicolegally sound structure for making decisions
consider patient-centric, risk-based, outcomes-driven views during consultations
demonstrate the appropriate correlation and reconciliation of relevant actuarial health information, such as relevant epidemiological information, with any clinical patient-specific factors when giving advice
encourage learners to consider the rationale and appropriateness of investigation and management options

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

teach learners using basic knowledge and skills

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

establish rapport and demonstrate respect for junior colleagues, medical students, and other health professionals
communicate effectively when teaching, assessing, and appraising learners
actively encourage a collaborative and safe learning environment with learners and other health professionals
encourage learners to tailor communication as appropriate for different patients, such as younger or older people, and different populations
support learners to deliver clear, concise, and relevant information in both verbal and written communication
listen and convey information clearly and considerately

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate accessible, supportive, and compassionate behaviour

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

support learners to deliver quality care and programs that support good work that protects and promotes worker health while maintaining their own wellbeing
apply lessons learned about patient safety by identifying and discussing risks with learners
assess learners’ competence, and provide timely feedback to minimise risks to care and workers’ health
maintain the safety of patients and organisations involved with education, and appropriately identify and action concerns

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

observe learners to reduce risks and improve health outcomes

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate knowledge of the principles, processes, and skills of supervision
provide direct guidance to learners in day-to-day work
work with learners to identify professional development and learning opportunities based on their individual learning needs
offer feedback and role modelling
participate in teaching and supervision professional development activities
encourage self-directed learning and assessment
develop a consistent and fair approach to assessing learners
tailor feedback and assessments to learners’ goals
seek feedback and reflect on own teaching by developing goals and strategies to improve
establish and maintain effective mentoring through open dialogue
support learners to identify and attend formal and informal learning opportunities
recognise the limits of personal expertise, and involve others appropriately

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate basic skills in the supervision of learners
apply a standardised approach to teaching, assessments, and feedback without considering individual learners’ needs
implement teaching and learning activities that are misaligned to learning goals
adopt a teaching style that encourages learner self-directedness

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

clarify junior colleagues’ research project goals and requirements, and provide feedback regarding the merits or challenges of proposed research
monitor the progress of learners’ research projects regularly, and may review research projects prior to submission
support learners to find forums to present research projects
encourage and guide learners to seek out relevant research to support practice

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

guide learners with respect to the choice of research projects
ensure that the research projects planned are feasible and of suitable standards

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

role model a culturally appropriate approach to teaching
encourage learners to seek out opportunities to develop and improve their own cultural safety
encourage learners to consider culturally safe care of Aboriginal and Torres Strait Islander and Māori peoples into patients’ management
consider cultural, ethical, and religious values and beliefs in teaching and learning

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

function effectively and respectfully when working and teaching with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

apply principles of ethical practice to teaching scenarios
act as a role model to promote professional responsibility and ethics among learners
respond appropriately to learners seeking professional guidance

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate professional values, including commitment to high-quality clinical standards, compassion, empathy, and respect
provide learners with feedback to improve their experiences

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

prioritise workloads and manage learners with different levels of professional knowledge or experience
link theory and practice when explaining professional decisions
promote joint problem solving
support a learning environment that allows for independent decision making
use sound and evidence-based judgement during assessments and when giving feedback to learners
escalate concerns about learners appropriately

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

provide general advice and support to learners
use health data logically and effectively to investigate difficult diagnostic problems

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

maintain personal and learners’ effective performance and continuing professional development
maintain professional, clinical, research, and/or administrative responsibilities while teaching
create an inclusive environment whereby the learner feels part of the team
help shape organisational culture to prioritise quality and work safety through openness, honesty, shared learning, and continued improvement

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate the principles and practice of professionalism and leadership in health care
participate in mentor programs, career advice, and general counselling

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

advocate for suitable resources to provide quality supervision and maintain training standards
explain the value of health data in the care of patients or populations
support innovation in teaching and training

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

incompletely integrate public health principals into teaching and practice

LG4: Quality improvement

Learning Goal 4

Quality improvement

Identify and address quality systems in health care delivery and workplaces

This activity requires the ability to:

develop, implement, assess, evaluate, and clinically govern systems that protect and/or promote occupational and environmental health
identify and report actual and potential incidents (near misses), including by integrating human factors strategy with incident-related policy
conduct, evaluate, design, and govern system improvement activities
adhere to and lead the development of health protection standards and best practice guidelines
audit clinical guidelines, workplace health protection programs, and health outcomes, including but not limited to psychosocial health outcomes
contribute to the development of policies and protocols designed to protect workers/patients, enhancing health care and supporting good work that protects and promotes workers’ health outcomes
monitor one’s own practice, and develop individual improvement plans

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use population health outcomes to identify opportunities for improvement in delivering appropriate care and support good work that protects and promotes workers’ health
review workers/patients or population health outcomes to identify opportunities for improvement in delivering appropriate care and support good work that protects and promotes workers’ health
evaluate environmental and lifestyle health risks, and advocate for healthy lifestyle choices
evaluate environmental and workplace risks to inform programs that support good work and protect and promote the continuous, systematic improvement of health outcomes at and for work
use standardised protocols to adhere to best practice
review health and safety events
develop, implement, assess, and evaluate a medical surveillance program
regularly monitor personal professional performance
identify risks to health arising from one’s own work activities
demonstrate an understanding and delivery of health promotion activities
identify high-risk transitions, such as between compensation schemes and in / out of work) and key risks for workers/patients during transition, and manage the transition in a demonstrably risk-based, outcomes-driven way
recognise changes in workers’/patients’ conditions, and provide values-driven, structured recommendations in a medicolegally appropriate, evidence-based, and authoritative framework on how to manage them

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

contribute to processes on identified opportunities for improvement
recognise the importance of prevention and early detection in clinical practice
use local guidelines to assist workers’/patients’ care decision making

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

support workers/patients to have access to, and use, easy-to-understand, high-quality information about health care, workplace health risks, and their effective control
support workers/patients to share decision making about their health care
assist workers/patients to access their health information, as well as complaint and feedback systems
discuss with workers/patients any safety and quality concerns they have relating to their care and the management of workplace health risks
implement the organisation’s open disclosure policy

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate awareness of the evidence for consumer engagement and its contribution to quality improvement in health care
apply knowledge of how health literacy might affect the way workers/patients or populations gain access to, understand, and use health information

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate safety skills, including infection control and adverse event reporting
participate in organisational quality and safety activities, including:
- clinical incident reviews
- corrective action preventive action plans
- morbidity and mortality reviews
- root cause analyses
- workplace injury and illness reviews
participate in systems for surveillance and monitoring of adverse events and near misses, such as workplace injuries and illness events and near misses, including reporting such events
identify improvement opportunities for improvement, and report appropriately
use health and safety audits, data and outcomes, learnings from incidents, and complaints to improve the management of workplace health and safety risks
discuss risk management approaches and systems used by corporate organisations

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate understanding of a systematic approach to improving the quality and safety of health care

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

translate quality improvement approaches and methods into practice
participate in professional training in quality and safety to ensure a contemporary approach to safety system strategies
supervise and manage the performance of junior colleagues in the delivery of high-quality, safe care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

work within organisational quality and safety systems for the delivery of clinical care
use opportunities to learn about safety and quality theory and systems

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use protocol for human research that is approved by a human research ethics committee, in accordance with the national statement on ethical conduct in human research

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate that workers’/patients’ participation in research is voluntary and that workers/patients understand the purpose, methods, demands, risks, and potential benefits of the research

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

undertake professional development opportunities that address the impact of cultural bias on health outcomes

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

communicate effectively with workers/patients from culturally and linguistically diverse backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

align improvement goals with the priorities of the organisation
contribute to developing an organisational culture that enables and prioritises worker health and safety

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

comply with professional regulatory requirements and codes of conduct

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use decision-making support tools, such as guidelines, protocols, pathways, and reminders
analyse and evaluate current processes to improve the management of workplace health and safety risks

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

access information and advice from other health practitioners to identify, evaluate, and improve workers’/patients’ care management

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

formulate and implement quality improvement strategies as a collaborative effort involving all key health professionals and other stakeholders, such as employers, worker representatives, and health and safety professionals
support, facilitate, build, and clinically govern multidisciplinary team activities to reduce workplace health and safety risks, and promote multidisciplinary programs of education
actively involve other stakeholders, such as occupational hygienists, in workplace improvement projects

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate attitudes of respect and cooperation among members of different professional teams
partner with clinicians and managers to ensure workers/patients receive appropriate care and information on their care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

participate in all aspects of the development, implementation, evaluation, and monitoring of governance processes
participate regularly in multidisciplinary meetings where quality and safety issues are standing agenda items, and where innovative ideas and projects for improving workplace health and safety are actively encouraged
measure, analyse, and report a set of workplace-specific process of risk management and health and safety indicators, participating in the design and implementation of organisational systems for:
- clinical, and safety and quality education and training
- defining the scope of workplace health risks
- performance monitoring and management

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

maintain a dialogue with service managers about issues that affect worker/patient care
contribute to relevant organisational policies and procedures
shape an organisational culture that prioritises safety and quality through openness, honesty, learning, and quality improvement

LG5: Clinical assessment, investigation and management

Learning Goal 5

Clinical assessment, investigation, and management

Clinically assess, investigate, and manage the ongoing care of workers/patients

This activity requires the ability to:

identify and access sources of relevant information about workers/patients
take workers’/patients’ histories, including occupational and environmental exposure histories
examine workers/patients
synthesise findings to develop provisional and differential diagnoses
discuss findings with workers/patients, their families and/or carers, and employers, with appropriate consent and consideration of privacy
undertake management in line with medical practice, guidelines, and recommendations
share findings with other health professionals and relevant parties
determine fitness to work
consider causative factors
generate multidisciplinary biopsychosocial management plans
develop return to work programs
formulate comprehensive evidence-based written reports that articulate the above components of care

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

elicit accurate, organised, and problem-focused medical histories, considering occupationally and environmentally related risk factors
elicit suitable mental health histories that include psychosocial workplace hazards that increase the risk of physical and psychological conditions in the workplace
discuss non-work-related mental health conditions, physical conditions, psychosocial and other factors that may affect work
perform full and appropriate occupational histories and examinations to establish the nature and extent of problems
perform mental state examinations where required
synthesise and interpret findings from histories and examinations to devise the most likely provisional diagnoses via reasonable differential diagnoses
identify and perform suitable investigations
develop an evidence-based model for disease and injury causation
assess the severity of problems, the likelihood of complications, and clinical outcomes
develop management plans based on relevant guidelines, workplace information, and the workers’/patients’ circumstances
develop, implement, assess, and evaluate health surveillance programs
identify the workers’/patients’ disorders requiring management
consider age, chronic disease status, social supports, worker/patient preference, and lifestyle, organisational, and personal factors in the development of management plans
consider non-pharmacologic therapies
plan for follow-up and monitoring

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

elicit worker/patient-centred histories, considering psychosocial factors
perform accurate physical examinations
perform statutory health surveillance
recognise and correctly interpret abnormal findings
synthesise pertinent information to direct clinical encounters and diagnostic categories
demonstrate an understanding of disease causation
develop appropriate management plans
identify and manage adverse events
describe and assign causation of injuries and diseases to workplace exposures and events using evidence-based medicine

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

communicate openly, listen, and take workers’/patients’ concerns seriously, giving them adequate opportunity to ask questions
provide information to workers/patients and their family and/or carers to enable them to make fully informed decisions from various diagnostic, management, and therapeutic options
provide information to co-workers and/or workplaces as medically and ethically appropriate and legally required
communicate clearly, effectively, respectfully, and promptly with other health professionals involved in workers’/patients’ care
demonstrate suitable report writing and presentation skills
discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with workers/patients
educate workers/patients and employers about the benefits of good work and appropriate safe return to work
write clear and legible management plans in plain language
communicate with workers/patients, families and/or carers about the benefits and risks of proposed therapies
ensure workers/patients understand management plans by repeating back pertinent information, such as the time frame, tasks, and when to return for review
explore workers’/patients’ understanding of and preferences for non-pharmacological and pharmacological management
ensure appropriate information is provided at all steps of the management pathway

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

anticipate, read, and respond to verbal and nonverbal cues
demonstrate active listening skills
communicate workers’/patients' situations to colleagues, including senior clinicians
discuss and explain the rationale for treatment options with workers/patients, families and/or carers
explain the benefits and burdens of therapies, considering workers’/patients’ individual circumstances
write clear and legible management plans
seek further advice from experienced clinicians or pharmacists when appropriate
provide instructions on medication administration effects and side effects

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate safety skills, including infection control and adverse event reporting
recognise and effectively deal with aggressive and violent worker/patient behaviours
obtain informed consent before undertaking any investigations or providing treatment (except in an emergencies)
ensure workers/patients are informed of the material risks associated with any part of proposed management plans
review as appropriate to monitor progress and adjust management

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

perform hand hygiene, and take infection control precautions at appropriate moments
take precaution against assaults from confused or agitated workers/patients, ensuring appropriate care of workers/patients
document history and physical examination findings, and synthesise with clarity and completeness

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
regularly reflect upon and self-evaluate professional development
obtain informed consent before involving workers/patients in teaching activities
turn clinical activities into an opportunity to teach, appropriate to the setting
check workers/patients understand management plans, including adherence issues

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

set unclear goals and objectives for self-learning
self-reflect infrequently
deliver teaching considering learners’ level of training
undertake continuing professional development to maintain currency with prescribing guidelines
reflect on prescribing, and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate the ability to search for, find, compile, analyse, interpret, and evaluate information relevant to the research subject
critically appraise research material to consider new management that may lead to improved worker/patient outcomes
use sources of independent information about management to ensure accurate summaries of the available evidence on management options

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

refer to guidelines and medical literature to assist in clinical assessments when required
demonstrate understanding of the limitations of evidence and the challenges of applying research in daily practice
make therapeutic decisions according to the best evidence
recognise where evidence is limited, compromised, or subject to bias or conflict of interest

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use plain-language worker/patient education materials, and culturally safe language
demonstrate culturally safe communication and care for Aboriginal and Torres Strait Islander and Māori peoples, and members of other cultural groups
use professional interpreters, health advocates, or family or community members to assist in communication with workers/patients, and understand the potential limitations of each
acknowledge workers’/patients’ beliefs and values, and how these might affect health
offer workers/patients effective choices based on their expectations of treatment, health beliefs, and cost
interpret and explain information to workers/patients at the appropriate level of their health literacy

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

display respect for workers’/patients’ cultures, and attentiveness to social determinants of health
display an understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
appropriately access interpretive or culturally focused services
appreciate workers/patients cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of pharmacological and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate professional values, including compassion, empathy, respect for diversity, integrity, honesty, and partnership to all workers/patients
hold information about workers/patients in confidence, unless the release of information is required by law or public interest
assess workers’/patients’ capacity for decision making, involving a proxy decision maker appropriately
provide information to workers/patients about their proposed management plan that may include:
- details (hours / tasks)
- timeframe
- timing of periodic review
demonstrate understanding of the ethical implications of industry-funded research and marketing

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate professional conduct, honesty, and integrity
consider workers’/patients’ decision-making capacity
identify workers’/patients’ preferences regarding management and the role of families in decision making
not advance personal interest or professional agendas at the expense of workers/patients or social welfare
consider the efficacy of medicines in treating illnesses, including the relative merits of different non-pharmacological and pharmacological approaches
follow regulatory and legal requirements and limitations regarding prescribing

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

apply knowledge and experience to identify workers’/patients’ problems, making logical, rational decisions, and acting to achieve positive outcomes for workers/patients
use a holistic approach to health, considering comorbidity, uncertainty, and risk
use the best available evidence for the most effective therapies and interventions to ensure quality care
use a systematic and worker/patient-centred approach to determine management plans

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate clinical reasoning by gathering focused information relevant to patients’ care
recognise personal limitations, and seek help in an appropriate way when required
consider the following factors for all proposed management options:
- funding and regulatory considerations
- organisational culture
- organisational resources
- sociocultural supports
- worker/patient characteristics and preferences

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

work effectively as a member of multidisciplinary teams, including non-health professionals to achieve the best health outcome for workers/patients
demonstrate awareness of colleagues in difficulty, and work within the appropriate structural systems to support them while maintaining worker/patient safety

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

share relevant information with members of the health care team

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

participate in health promotion, disease prevention and control, screening, and reporting notifiable diseases
aim to achieve optimal cost-effective worker/patient care to allow maximum benefit from available resources
choose management approaches with consideration of comparative efficacy and cost effectiveness
development management plans for individual workers/patients considering available supports, current management, history, and preferences, ensuring that resources are used wisely for the benefit of workers/patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

identify and navigate components of the healthcare system relevant to workers’/patients’ care
identify and access relevant community resources to support workers’/patients’ care

LG6: Communication with workers, patients, communities, third parties, and other stakeholders

Learning Goal 6

Communication with workers, patients, communities, third parties, and other stakeholders

Communicate with a range of stakeholders, including workers, patients, communities, professional bodies, businesses, health administration, insurers, and employers

This activity requires the ability to:

communicate with appropriate stakeholders given the specific context
communicate within an appropriate cultural context, and include family and/or carers and other team members
apply written consent and privacy considerations when involving employers
manage employee / worker / insurer / employer expectations when not in a worker/patient-treating role
adopt a worker/patient-centred, employee, or client perspective, ensuring consent to share relevant medical information is acquired
select and use appropriate modalities and communication strategies
structure conversations intentionally
verify understanding of information conveyed
negotiate mutually agreed management plans when managing workers/patients
develop and implement plans or reports for ensuring actions occur
ensure assessment, management, and/or rehabilitation plans are documented
compose complex reports for workers/patients, employers, and insurers, including those within the medicolegal context

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

anticipate and be able to correct any misunderstandings workers/patients may have about their conditions and/or risk factors
recognise occupational factors relevant to illness that need enhancement or clarification
write a timely letter or report containing a clear opinion back to the referring doctor or party
use evidence-based guidelines to inform opinion
compose detailed workers’/patients’ reports in response to worker/patient, workplace, and referrer requests, including appropriately answering questions posed by the referrer
use internally consistent recommendations, and make use of best practice guidelines and evidence
develop a written management, rehabilitation, and/or return to work plan in conjunction with all relevant parties
coordinate medical aspects of care with other professionals towards attaining appropriate and time-defined realistic outcome measures
monitor goals and define outcome measures, and keep workers/patients and other relevant parties, including the employer (where appropriate), informed of progress towards this plan
use the opportunity for worksite visits to explore issues more holistically, in a broader context and in terms of workers’ health and risk management
seek to understand the concerns and goals of workers/patients, and plan management in partnership with them and their family, whanau and/or carers
educate workers/patients about the work/environmental-relatedness of their conditions
provide information to workers/patients to enable them to make informed decisions about diagnostic, management, and therapeutic options

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

interpret information within referral letters
recognise information that needs enhancement or clarification
use email and internet, and, where applicable, electronic discharge summaries and prescribing
apply knowledge of the scientific basis of health and disease to the management of workers/patients
demonstrate understanding of the clinical problems being discussed
draft initial reports around workers/patients and environmental issues
formulate management plans in partnership with workers/patients

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use appropriate communication strategies and modalities for communication, such as emails, face-to-face, or phone calls
provide information to workers/patients and referrers
write timely, concise, internally consistent, and evidence-based reports
use plain language, avoiding jargon, acronyms, and complex medical terms
obtain consent to discuss workers’/patients’ management plans with workers’/patients’ primary health care providers
communicate effectively with management, OHS staff, unions, and workers on all relevant occupational health areas for organisations
manage difficult conversations, such as those regarding performance, fitness for work and community outrage
confirm worker/patient understanding of discussions and potential management and rehabilitation plans
recognise the role of family or employers in communication
identify and mediate differences between the expectations of employers, supervisors, return to work coordinators and workers
communicate effectively with policy and decision-makers
manage communication with the media as required
differentiate between objective and subjective arguments

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

manage consultations involving third parties, such as employers in conflict with employees
communicate in written and verbal formats with insurers, relevant employers, and return to work coordinators
establish rapport with referring doctors
select appropriate modes of communication
engage workers/patients in discussions, avoiding the use of jargon
check workers’/patients’ understanding of information
adapt communication styles in response to workers’/patients’ age, developmental level, and cognitive, cultural, physical, situational, and socioeconomic factors
collaborate with worker/patient liaison officers as required
encourage and answer questions

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

recognise workers’/patients’ vulnerability in terms of their history and physical examination
implement policies and procedures to manage complaints and negative feedback
provide information to workers/patients in a way they can understand before asking for their consent
consider workers’/patients’ capacity for decision making and consent, particularly if there is a history or signs of cognitive impairment

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

inform workers/patients of the material risks associated with proposed management plans
treat information about workers/patients as confidential

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

discuss and explain the purpose, nature, and extent of assessments and third-party assessments to be conducted
obtain informed consent or other valid authority before involving workers/patients in teaching

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

respond appropriately to information sourced by workers/patients, and to workers’/patients’ knowledge regarding their condition

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

refer to evidence-based guidelines
conduct research in accordance with prescribed ethical and institutional research guidelines
provide easily understandable information to workers/patients that is based on guidelines issued by the relevant research authorities and guidelines
obtain an informed consent or other valid authority before involving workers/patients in research

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

refer to evidence-based clinical guidelines
demonstrate an understanding of the limitations of the evidence and the challenges of applying research in daily practice

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

manage barriers to effective communication within teams
demonstrate culturally safe communication with Aboriginal and Torres Strait Islander and Māori peoples
effectively communicate with members of other cultural groups by meeting workers’/patients’ specific communication, cultural, and language needs
use qualified language interpreters or cultural interpreters to help meet workers’/patients’ communication needs
provide plain language and culturally appropriate written materials to workers/patients and clients when possible

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

identify when to use interpreters
allow enough time for communication across linguistic and cultural barriers

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

describe the procedure for obtaining consent for the release of confidential medical records and images to a third party
identify secure storage of medical information
describe the special reporting requirements and obligations of a medical assessment performed on behalf of a third party, including presentation of information to lawyers and insurers
explain to workers/patients the purpose of assessments and the reporting arrangements, and seek consent to collect and release relevant medical information
recognise local laws and workers compensation guidelines on incapacity payments and return-to-work
encourage and support workers/patients to be well informed about their health, and to use this information wisely when they make decisions
recognise social determinants of health when caring for workers/patients
demonstrate respectful professional relationships with workers/patients and colleagues
prioritise honesty, workers’/patients’ welfare, and community benefit above self-interest
develop a high standard of personal conduct, consistent with professional and community expectations
outline obligations to workers/patients and their management when conducting third party assessments
support workers’/patients’ rights to seek second opinions
obtain written consent and discuss with workers/patients when communicating with employers about management and rehabilitation
recognise personal health, symptoms of mental health changes, and avenues for self-management

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

manage alternative and conflicting views from relevant parties
manage the ethical issues of the two roles of communication with workers/patients and external agencies
respect the preferences of workers/patients
communicate appropriately, consistent with the context, and respect workers’/patients’ needs and preferences
maximise workers’/patients’ autonomy, and support their decision making
avoid sexual, intimate, and financial relationships with workers/patients
demonstrate a caring attitude towards workers/patients
respect workers/patients, including protecting their rights to privacy and confidentiality
behave equitably towards all, irrespective of gender, age, culture, socioeconomic status, sexual preferences, beliefs, contribution to society, illness-related behaviours or the illness itself
use social media ethically and according to legal obligations to protect workers’/patients' confidentiality and privacy

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

coordinate a team, including a team of nurses and allied health professionals, in occupational health units
use conflict resolution skills to facilitate team interactions
involve health managers as part of multidisciplinary teams to obtain resources, data, and access to services for better worker outcomes
communicate effectively with team members involved in workers’/patients’ care or rehabilitation, and with workers/patients, their families, and/or carers
discuss medical assessments, treatment, management, and rehabilitation plans, and investigations with workers/patients, in a collaborative manner
facilitate an environment where all team members feel they can contribute and their opinion is valued
communicate accurately and succinctly, and motivate others on the health care team

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

work effectively as part of an occupational health and safety team that may include:
- environmental scientists
- ergonomists
- occupational health nurses
- occupational hygienists
- risk engineers
answer questions from team members
summarise, clarify, and communicate responsibilities of health care team members
keep health care team members focused on worker/patient outcomes

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

collaborate with other services, such as community health centres and consumer organisations, to help workers/patients navigate the healthcare and workers compensation systems
demonstrate the ability to detail legal and other obligations of parties
describe the special reporting requirements of a medical assessment performed on behalf of a third party
recognise relevant state, hospital, and workplace policies and guidelines in preparing reports
source evidence-based information, and prepare specific medical, general, and medicolegal communication, including:
- expert opinion reports, including that for the general population
- giving evidence in court
- giving objective and considered opinions
- preparing opinions for community advocates or guardianship tribunals

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

communicate with and involve other health professionals as appropriate
source information and prepare specific medicolegal communication, including:
- letters of support on behalf of workers/patients
- police statements
- reports for insurers and other relevant third parties

LG7: Analysis and application of data

Learning Goal 7

Analysis and application of occupational health data

Research within the workplace and environment

This activity requires the ability to:

find, assess, and apply appropriate evidence to the management of workplaces, groups of workers, and individual workers
apply epidemiological principles to the management of problems in the workplace
be able to communicate and apply the principles of evidence review by incorporating up-to-date research in written worker/patient risk assessments and environmental assessment reports

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate understanding of the principles of evidence-based medicine, the limitations of evidence, and the challenge of applying research findings to daily clinical practice, and supporting good work that protects and promotes worker health
appraise support for alleged causal associations between health effects and exposures
differentiate between the expression of health-related phenomena as frequencies or rates
discuss the potential effect of chance (random variation) on measurements, observations, and the results of investigations
discuss the need for insight sufficient to depict the truth, and fairly interpret the findings of studies
use the steps of outbreak investigation to address infectious diseases or other disease clusters within work environments

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

apply principles of data collection and interpretation within an occupational and environmental setting
apply the principles of validity, reliability, sensitivity, and specificity of data collection methodologies in the context of health surveillance
demonstrate practical knowledge of confounders and bias, and how to account for these within a medical surveillance program or the interpretation of reports of epidemiological studies in occupational or environmental settings
discuss health data collection and management within current legislative systems, including guidelines around chemical exposure and privacy legislation

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

present scientific information in understandable forms for both managers and workers
communicate principles of causation and causal relationship
present data using clear and simple tables and diagrams

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

apply appropriate quality processes to the collection and storage of health and health surveillance data

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

find relevant information in general medical literature, specialist occupational health literature, and grey literature, including government policies, standards, codes, and recommendations

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

perform efficient and comprehensive searches of the medical literature

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

explain scientific information and workplace data to different populations and ethnicities

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

manage individual and workplace population data in an ethical manner

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

display a knowledge of relevant legislation

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate and articulate clear decision making with points for and against

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

display an understanding of the levels of evidence

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

lead a team of researchers, managers, and participants within work environments

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

apply international, national, state / territory, and local regulations, policies, and codes to the management of workplace data

LG8: Occupational and environmental screening, surveillance, and investigations

Learning Goal 8

Occupational and environmental screening, surveillance, and investigations

Select, organise, and interpret screening, surveillance, and diagnostic investigations

This activity requires the ability to:

develop a risk management approach, including health prevention activities
select, plan, and use evidence-based clinically and occupationally appropriate screening, surveillance, and diagnostic investigations with the aim of preventing disease or identifying early disease
prioritise workers/patients receiving investigations by using a risk-based approach and evaluating the anticipated value of investigations
work in partnership with workers/patients to facilitate choices that are right for them
work in partnership with employers and other stakeholders to ensure preventive activities, including evidence-based occupational screening, surveillance, and investigations, including assisting in meeting their statutory requirements
provide aftercare for workers/patients as needed
interpret the results and outcomes of investigations at both worker/patient and worker population levels as needed
communicate the outcome of investigations to workers/patients and other key stakeholders, such as employers and regulators
compose comprehensive medical and scientific reports outlining the results of occupational exposure for workers/patients, employers, regulator and insurance organisations, and medicolegal purposes

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use screening tools used in occupational medicine, including those used in determining fitness to work and disease prevention
develop, implement, assess, and evaluate evidence-based health surveillance programs, including legislated programs for hazardous substances
choose evidence-based investigations, and frame them as an adjunct to comprehensive clinical assessments
assess workers’/patients’ concerns, and determine the need for specific tests that are likely to result in overall benefit
develop plans for investigations, identifying exposure patterns and timing of surveillance
recognise and correctly interpret abnormal findings, considering workers’/patients’ specific circumstances, and act accordingly

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate the principles around biological monitoring and biological effect monitoring
outline the principles of medical surveillance, including toxicodynamic and toxicokinetic
describe legislative requirements around occupational health surveillance
provide rationale for investigations
understand the significance of abnormal test results and act on these
consider worker/patient factors and comorbidities
consider age-specific reference ranges

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

explain to workers/patients their legal obligations with regard to occupational health surveillance
explain to workers/patients the potential benefits, burdens, costs, risks, and side effects of each option, including the option to have no investigations
use clear and simple language, and check that workers/patients understand the terms used and agree to proceed with proposed investigations
identify workers’/patients’ concerns and expectations, providing adequate explanations on the rationale for individual test ordering
confirm whether workers/patients have understood the information they have been given and the need for more information before deciding
use written or visual material or other aids that are accurate and up to date to support discussions with workers/patients
explain findings or possible outcomes of investigations to workers/patients, families, and the employer with appropriate consents in place
give information that workers/patients may find distressing in a considerate way

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

discuss the benefits, complications, indications, and risks of investigations with workers/patients before ordering investigations
explain the results of investigations to workers/patients
arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate
complete medical certificates and legislated documents appropriately

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

identify adverse outcomes that may result from a proposed investigation, focusing on workers’/patients’ individual situations

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

consider safety aspects of investigations when planning them
seek help with interpretation of test results for less common tests or indications or unexpected results

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use appropriate guidelines, evidence sources, and decision-support tools
participate in clinical audits to improve test ordering strategies for diagnoses and screening

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

undertake professional development to maintain currency with investigation guidelines

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

provide workers/patients with relevant information if a proposed investigation is part of a research program
obtain written consent from workers/patients if the investigation is part of a research program

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

refer to evidence-based clinical guidelines
consult current research on investigations and procedures

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

respect workers’/patients’ views and preferences about any proposed investigation and the adverse outcomes they are most concerned about

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

consider workers’/patients’ attitudes, beliefs, and cultural and religious backgrounds, and how these might influence the acceptability of proposed investigations

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

remain within the scope of authority given by workers/patients (except for emergencies)
discuss with workers/patients how decisions will be made once the investigation has started and the worker/patient is not able to participate in decision making
respect workers’/patients’ decisions to refuse diagnostic investigations, even if their decisions may not be appropriate or evidence-based
explain the expected benefits as well as the potential burdens and risks of any proposed investigation before obtaining informed consent or other valid authority
demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information
maintain individual worker/patient confidentiality when reporting results to employers or others

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

identify appropriate proxy decision makers when required
choose not to investigate in situations where it is not appropriate for ethical reasons
practise within current ethical and professional frameworks
practise within own limits, and seek help when needed
involve workers/patients in decision making regarding investigations and obtaining the appropriate informed consent, including financial consent, if necessary

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
adjust the investigative path depending on test results received
consider whether workers’/patients’ conditions may get worse or better if no tests are selected

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

choose the most appropriate investigation for the clinical scenario in discussion with workers/patients
recognise personal limitations and seek help in an appropriate way when required

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

consider the role other members of the health care team might play, and what other sources of information and support are available
consider the role that other stakeholders such as employers, unions, and other medical specialists might play, and what other sources of information and support are available
check results in a timely manner, taking responsibility for following-up results

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate understanding of what parts of an investigation are provided by different doctors or health professionals

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

develop a risk management framework supported by preventive activities relevant to the work environment, exposures, and worker population
select and justify investigations regarding appropriateness, cost effectiveness, safety, the pathological basis of disease, and utility
consider resource utilisation through peer review of testing behaviours
engage with unions and employers to gain support for recommended health surveillance programs

LG9: Hazard identification and risk assessment

Learning Goal 9

Hazard identification and risk assessment

Workplace and environmental hazard assessment

This activity requires the ability to:

identify, assess, and manage all workplace and environmental hazards that may have an effect on workers’ health
obtain the nature and extent of likely relevant exposures from workers/patients or community members, including histories and other appropriate records
describe the causation of injuries and diseases through evidence-based models
interpret reports around workplace, organisational, and/or environmental hazards
comment on workplace ,organisational, and/or environmental hazards’ potential health effects and required mitigations
relate and make persuasive recommendations on important hazards within workplaces and/or environment
outline processes to review current risk control measures
anticipate and alleviate potential hazards, including risk assessments and management principles
prepare clinical reports recognising the extent of exposure when defining the work-relatedness or environment-relatedness of a disease

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

develop, implement, assess, and evaluate systems to identify and manage workplace and environmental hazards
describe routes of exposure / pathological processes associated with hazards
describe the potential health effects of common and important hazardous occupational exposures, including:
- biological
- chemical
- ergonomic
- physical
- psychosocial
assign causal links between exposures and diseases / injuries
explain the mechanism of injury or disease
offer evidence both for and against controversial conditions
predict the likely properties of a class of substance
apply the underlying principles of hazards to practical situations in familiar and unfamiliar workplaces and environmental settings
apply simple numerical reasoning to discussions concerning hazardous exposures
anticipate the likely route of exposure and rapidity of action based on the properties of a listed substance or a substance with similar properties
complete a psychosocial risk assessment

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

describe hazards and risks, with reference to likelihood and severity
identify hazards in various workplaces and environmental settings
identify potential sources of hazards
outline processes to assess and, where appropriate, alleviate potential hazards, including risk assessment and management principles

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

use audience-appropriate verbal and written communication
prepare well-organised, clear reports
identify terms that may create ambiguity or that would be difficult to understand without specialised knowledge
consult with others relevant to the anticipation and management of workplace hazards
communicate effectively with groups of workers and community members where emotions may be high due to actual or perceived health impacts

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

describe and categorise occupational and environmental hazards
enlist commonly used terminology to describe risks and hazards in the workplace
interpret reports from other occupational health professionals, including occupational hygienists
use various media forms constructively
state clearly what is the case and what is likely to happen
create or arrange for preventive measures to be given verbally and in writing to relevant people

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

assess the adequacy of reports prepared by ergonomists, occupational hygienists, and organisational psychologists
determine whether current hazard control mechanisms and procedures are satisfactory

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

interpret reports prepared by ergonomists, occupational hygienists, and organisational psychologists

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

regularly self-evaluate personal professional practice, and implement changes based on the results
actively seek feedback from supervisors and colleagues on own performance
maintain current knowledge of new technologies, health care priorities and changes of workers’/patients’ expectations

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

accept feedback constructively, and change behaviour in response
recognise the limits of personal expertise, and involve other health professionals as needed

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate a systematic approach and clear understanding of research and statistical terminology
access, use, and interpret Safety Data Sheets (SDSs)
access and evaluate current sources of information relevant to occupational and environmental hazards

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate culturally safe relationships with colleagues and workers/patients
demonstrate respect for diversity and difference
identify unconscious bias, including the impact of cultural beliefs, gender, religion, and socioeconomic background on decision making

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate awareness of cultural diversity and unconscious bias
work effectively and respectfully with people from different cultural backgrounds

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

promote a team culture of shared accountability for decisions and outcomes
encourage open discussion of ethical concerns
respect differences of multidisciplinary team members
consult with stakeholders, achieving a balance of alternative views
acknowledge personal conflicts of interest and unconscious bias

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

respect the roles and expertise of other health professionals
work effectively as a member of a team
promote team values of honesty, discipline, and commitment to continuous improvement
recognise the negative impact of workplace conflict

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

apply risk prediction rules and risk calculators to define event risk in individual workers/patients and groups of people
recognise situations in which knowledge of physical or psychosocial hazards can be put to good and apt use
link biological hazards with workplace or community situations and the likely exposure of workers/patients or members of the community
assess the organisational culture, task demands, and work environment impacting workers/patients
perform simple measurements, but know when hygiene / ergonomic expertise should be sought
plan, prioritise, and conduct walkthroughs of workplaces in line with a manual handling code of practice or standards for lighting
evaluate workplace and environmental hazards by conducting preliminary quantitative or semi-quantitative measurements and risk assessments
assess the adequacy of reports prepared by environmental professionals, ergonomists, occupational hygienists, and toxicologists

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

interpret appropriate data and evidence for decision making

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

discuss the features of a broad range of occupations, identifying likely workplace hazards
seek guidance from colleagues and educational supervisors on the scope and depth of inspections
develop and lead effective multidisciplinary teams by developing and implementing strategies to motivate others
involve other occupational health professionals
work with organisational leaders to achieve necessary health-relevant change

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

assess the range of personal and other team members’ skills, expertise, and roles
participate effectively and appropriately in multidisciplinary teams
seek out and respect the perspectives of multidisciplinary team members when making decisions

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

consult with stakeholders on the development and implementation of programs that support good work through improved worker health protection and promotion
describe relevant codes, guides, laws, and standards that relate to workplace exposures, including psychosocial hazards
advocate for resources and support for health care teams and workplaces to achieve organisational priorities
influence the development of organisational policies and procedures to optimise health outcomes
identify the determinants of health of the population, and mitigate barriers to access to care
remove self-interest from solutions to health advocacy issues
recognise poor management practices that allow workers to be alienated, bullied, harassed, ill-trained, or likely to put fellow workers at risk
identify stakeholders who hold the greatest influence on changes to occupational health and safety practice in the workplace

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

promote the development and use of organisational policies and procedures

LG10: Fitness for work assessment

Learning Goal 8

Fitness for work assessment

Assess workers’/patients’ ability to return to work

This activity requires the ability to:

review job task analysis, job descriptions, and employer-specific policies and procedures
assess task demands, psychosocial hazards, and environment of employees’ work
define and negotiate the standards of fitness required
perform clinical assessments of fitness for work that include evaluations of psychosocial factors that increase the risk of poor return to work outcomes
elicit careful, well-targeted occupational and educational histories
interpret, synthesise, and critically review reports provided by other health professionals in determining fitness for work, including functional capacity evaluations and neuropsychological reports
describe the consequences of injury and/or illness and, in particular, its effect on workers’/patients’ ability to work
prepare and implement return to work or rehabilitation plans for workers/patients
compose detailed medical reports in response to worker, employer, insurer, and/or medicolegal requests

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate a holistic approach to hazard identification within the workplace
interpret job task analysis
interpret functional capacity assessments and neuropsychological reports appropriately
determine the biomechanical components of manual work, and understand the interplay of psychosocial hazards in the development and management of musculoskeletal conditions and impacts on fitness to work
determine the psychological and physiological components of roles and how they may impact on fitness to work
identify potential psychosocial factors present in workers/patients that may lead to poor return to work outcomes
conduct focused walkthroughs of workplaces directed at the placement of workers
identify the likely requirements for alertness, consistent performance, judgement, responsiveness, stamina, and strength for common occupational roles
discuss with workers/patients the implications for employment of medication and convalescence from procedures
describe the likely effect of levels of substance use on impairment
estimate the level of impairment, the nature of workers’/patients’ disabilities, and what roles they can perform
describe the consequences of therapeutic drug use on workers’/patients’ performances
describe the consequences of surgical procedures on workers’/patients’ performances, and the likely recovery period for procedures affecting workers’/patients’ mobility or stamina
evaluate the likely effect of described work conditions on health, given the individual circumstances of workers/patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

demonstrate understanding of occupational hazards and risks within workplaces
demonstrate some interpretation of job task analysis
understand the components and needs of specialised testing, such as functional capacity and neuropsychological assessments
define common terms used to describe body actions and the ways of moving articles at work

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

discuss the schedule of items for the level of fitness required for the work involved
discuss ways to maintain employment for workers no longer able to meet the demands of their job, e.g. through non-work-related illness
question workers and employer representatives in ways that serve to cross-check subjective remarks
manage situations where workers are found not to be fit according to the examination standard, including the management of anger
write workers’ compensation reports that refer to fitness for work or impairment assessments
elicit relevant information about the requirements of jobs and their ambience from conversations with employer representatives

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

draft and complete medical certificates and reports

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

identify special rules on fitness for driving (such as crane, forklift, heavy vehicle, personal, and rail), and fitness for air crew and diving

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

gain understanding of workers’/patients’ daily activities based on careful and comprehensive occupational histories, and persist sufficiently in questioning to obtain this

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

discuss the application of the various guides to assessing impairment in Australia and Aotearoa New Zealand
recognise the World Health Organization’s international classification of disability, functioning, and health

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

recognise equal opportunity and/or disability discrimination law
recognise local laws and guidelines on incapacity payments and return to work

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

assess the organisational demands on workers/patients and how they affect day-to-day work
discern and refuse to accept standards or schedules of fitness testing that are not congruent with work requirements
define appropriate restrictions for workers/patients in the workplace if needed
define appropriate placements for people with disabilities
differentiate between impairment, functional capacity, and social participation, and recognise that severe impairment is not necessarily mirrored by a major change to social participation and vice versa
explain and negotiate a return to work plan, where a worker has limited capacity for work

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

liaise in a timely and appropriate manner with other health care professionals involved in workers’/patients’ care

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

demonstrate extensive in-depth knowledge of the standards of fitness in relevant legislation or industry standards
demonstrate in-depth knowledge of fitness to work guidelines

Knowledge guides

Knowledge guides provide detailed guidance to trainees on the important topics and concepts trainees need to understand to become experts in their chosen specialty.

Trainees are not expected to be experts in all areas or have experience related to all items in these guides.

LG11: Key clinical systems of occupational and environmental medicine

Key presentations and conditions

Trainees will have a comprehensive depth of knowledge of these occupationally and environmentally related medical presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able tinterpret the reported results of each investigation or procedure.

Trainees will know how texplain the investigation or procedure tworkers/patients, families, and carers, and be able texplain procedural risk and obtain informed consent where applicable.

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Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these intcare.

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Cardiovascular

Acute emergency cardiac conditions
Cardiovascular diseases caused by chemicals and environmental pollutants, such as:
- air pollution
- carbon disulphide
- carbon monoxide
- chlorofluorocarbons
- heavy metals
- hydrocarbons
- organic nitrates
- organophosphates
Peripheral vascular diseases caused by chemical exposures, such as arsenic

Ear, nose, and throat

Hearing loss:
- age-related
- noise-induced
Ototoxicity

Gastrointestinal

Infectious hepatitis, including blood borne pathogens such as hepatitis B and C
Liver disease (acute and chronic) as a result of occupational exposures (largely chemical exposures)
Obesity and effects of bariatric surgery (work-related concerns)
Occupationally related hepatic cancer conditions

Gender and age-related concerns

Dementia syndromes
Osteoarthritis
Osteoporosis
Physiological and pathological pregnancy-related concerns that affect work capacity

Immunology and allergy

Allergic disorders:
- adverse drug reactions
- allergic rhinitis
- anaphylaxis
- atopic dermatitis (eczema)
- conjunctivitis
Occupational asthma
Occupational dermatitis
Sinusitis

Infectious diseases

Blood borne pathogens, including:
- hepatitis B
- HIV
COVID 19 / influenza
Infectious diseases linked ttravel, including:
- dengue
- malaria
- Ross River virus
Leptospirosis
Q fever

Kidney

Acute kidney injury
Chronic kidney disease (CKD)
Glomerulonephritis (acute and chronic), including nephritic syndromes and rapidly progressive glomerulonephritis
Occupationally related cancers, including bladder cancer
Work-related causes of renal impairment

Musculoskeletal

Arthropathies
Bursitis in multiple joints
Carpal and cubital tunnel syndromes
De Quervain tenosynovitis
Disc bulge / Discogenic pain / Prolapse
Dupuytren contracture / disease
Lateral and medial epicondylitis
Lumbar spondylosis and spondylolisthesis
Muscle sprains, strains, and tears
Non-specific back and neck pain
Non-specific upper limb pain
Rotator cuff injuries
Tendonitis and tendinopathies
Triangular fibrocartilage complex (TFCC) injury
Trigger finger
Upper limb work-related disorders

Neurological

Acute and chronic neurological diseases resulting from chemical exposures, including heavy metals and solvents
Delirium due orkplace exposures such as:
- acute toxicity
- heat
- hypoxia
Entrapment of nerve roots, nerve plexuses, and peripheral nerves
Epilepsy and seizure-related disorders
Heat-related neurological conditions
Multiple sclerosis
Narcosis from inhalation of solvent and related vapours
Neurocognitive deficits caused by exposure theavy metals and solvents
Parkinson disease-like conditions caused by chemical exposures, such as manganese
Peripheral neuropathies

Pain conditions

Chronic pain syndromes
Complex regional pain syndrome

Psychiatric and psychological

Adjustment and mood disorders
Anxiety-related disorders, including post-traumatic stress disorder
Psychotic disorders
Self-harm and suicidal behaviour
Somatic disorders
Substance use, overdose, or toxic effects of illicit drug use

Respiratory

Hypersensitivity pneumonitis
Mineral dust disease, including:
- pneumoconiosis, such as:
  - asbestosis
  - coal workers’ pneumoconiosis
  - silicosis
- typical radiological findings
Occupationally related lung cancers, including mesothelioma
Occupationally related asthma, both aggravated and caused by workplace exposures
Sleep apnoea

Rheumatological

Chronic fatigue syndrome
Fibromyalgia / Chronic pain

Skin

Benign and malignant skin conditions caused by UV radiation
Occupationally related skin infections, such as:
- bacterial
- fungal
- protozoal
- viral
Occupationally related dermatitis, including allergic and irritant
Ulcerative skin conditions due to chemical exposures

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical and occupational history
conduct an appropriate examination
consider the context, including the work environment and culture, work organisation and management support
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on workers/patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to workers’/patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Biostatistics
Environmentally related medical conditions
Epidemiology
Occupational and environmental legislation
Occupational hygiene
Occupationally related medical conditions
Primary health care and general medical conditions
Toxicology

Cardiovascular system

Occupational contributors to cardiovascular disease, and agents that can precipitate relevant symptoms
The impact of cardiovascular disease on functioning within a workplace

Common ear conditions

Ototoxins
Principles of noise mapping, hierarchy of controls for noise control, and their links to ear protection programs

Common eye conditions

Occupational impact of impaired vision, including:
- blindness
- situations where full colour vision is or isn’t required
The occupational significance of:
- restricted visual fields or scotomata
- squint

Endocrine and gastrointestinal systems

End-organ effects of obesity and diabetes and their effect on work
Strategies for the management of:
- diabetes
- functional bowel disorders
- obesity

Immune system

Common investigations and what information they offer
Exposures recognised to cause:
- aplastic anaemia
- haemolysis
- leukaemia
Potential impact of immunosuppression in the workplace
Special needs of workers who have undergone organ transplantation

Kidney and genitourinary systems

Issues affecting capacity to work:
- chronic kidney failure and its treatment
- continence issues
- obstructive urinary disorders
- work-related causes of renal impairment
Recognised occupational causes of cancer of the genitourinary tract

Mental health

Appropriate use, purpose, and limitations of neuropsychological tests
Commonly used psychotropic medications and their side effects
Treatment of substance abuse

Musculoskeletal

Functional recovery with joint disorders treated conservatively or with surgical prosthesis
Recovery of function following:
- bursal inflammation
- dislocations
- fractures
- ruptures
- spinal disc pathologies
- sprains
- strains
- tendinopathies
Recovery of function with use of prosthesis after amputation of part of a limb

Occupational dermatology

Allergic dermatitis:
- contact
- irritant
Altered skin integrity related to exposure to occupational hazards
Benign and malignant skin lesions related to occupational exposures, such as UV radiation

Pregnancy and reproductive systems

Classes of substances recognised to be endocrine disrupters
Sensitivity to exposure during different stages of pregnancy
Strategies for managing pregnant workers in the workplace
Well-recognised teratogens
Work-related causes of adverse reproductive outcomes

Respiratory and sleep system

Effects and impacts of:
- asbestos exposure
- diving physiology
- respiratory disease on capacity for work
- shift work on circadian rhythm and functioning within a working environment
Effect of occupational and environmental toxins on the respiratory system
Obstructive sleep apnoea and impact on fitness for work and driving
Pathophysiological basis and causes of airway inflammation
Well-recognised causes of occupational asthma and hypersensitivity pneumonitis

Acute care

Defibrillation
Fluid resuscitation
Inotropic support
Management of acute workplace injuries, such as:
- burns
- eye injuries
- fractures
- lacerations
Oxygen delivery and assisted ventilation

Audiology testing

Pure-tone audiometric testing
Speech discrimination
Tuning fork tests:
- Rinne
- Weber

Biological monitoring

Biological effects monitoring
Biological exposure indices
Biological exposure monitoring

Cardiovascular testing

ECG
Stress tests

Neurological testing

Neuropsychiatric evaluations

Respiratory testing

Complex lung function interpretation
Office based spirometry testing
Peak flow monitoring
Tests for sleep apnoea

Screening tools

Cardiovascular risk scores
Imaging tools, including the appropriate use, purpose, and limitations of commonly applied imaging, such as:
- CT scans
- MRI
- nuclear medicine scans
- ultrasound
- x-ray, including ILO grading systems
Mental health-related screening tools, such as:
- Beck Depression Inventory (BDI)
- Depression Anxiety Stress Scales (DASS)
- Kessler Psychological Distress Scale (K10)
- Mini-Mental State Examination (MMSE)
Sleep apnoea scores / screening

Visual screening

Colour vison testing
Depth perception
Office tests for eye functioning / injury
Task-specific testing, such as lantern tests
Visual acuity and visual field testing

Ability to coordinate the management of non-work-related conditions that impact on work capacity
Knowledge and use of information from global and local organisations influencing occupational and environmental health

Conditions with limited knowledge and/or treatment strategies

This refers to conditions perceived as having an impact on work, but for which there is limited evidence-based information, such as:
- building-related illnesses, such as sick building syndrome
- chronic pain syndromes
- malingering
- multiple chemical sensitivity
- myalgic encephalomyelitis (ME) / chronic fatigue syndrome (CFS)
- war-related illnesses

Drugs and alcohol

Effects of recreational and prescribed drugs on workers undertaking safety-critical tasks
Medicinal marijuana
Role of medical review officers and the Australian Medical Review Officers Association (AMROA)
Toxicology and interpretation of test reports

Extreme environments

Advice on managing health risks associated with:
- diving and working in caissons
- freezing climates
- high altitude
- remote environments
- very hot climates, including deep underground

Infectious diseases

Food-borne and water-borne infections of local relevance
Implications of infection and working with others
Respiratory infectious diseases, such as flu strains

Mental health

Community resources that may assist recovery of function, such as anger management
Depression and anxiety and their implications for work
Implications of substance abuse for work
Major psychiatric illness and its implications for work
Mental health concerns, such as those due to accidents, fire, threats, and warfare, and their implication for work, such as post-traumatic stress disorder (PTSD) within the workplace
Mental health conditions and standards for safety critical work
Personality disorder and neurodivergent conditions, and their effects on co-workers, company reputation, and vehicle driving
Ways to overcome stigma experienced at work by people with psychiatric illness
Work-related preventive measures for bullying and harassment

Population-specific issues

Cultural safety-related issues within the workplace
Normal physiological changes associated with ageing
National driving standards – Assessing Fitness to Drive and related train driving standards
National guidelines that determine fitness for roles
National health promotion guidelines, including:
- national guidelines on vaccination programs
- national screening programs for neoplastic diseases
National Standard for Health Assessment of Rail Safety Workers

LG12: Health promotion and illness prevention

Epidemiology, pathophysiology, and clinical sciences

Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to workers/patients, their families, and/or carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Biomedical, environmental, genetic, and socioeconomic risk factors and risky health behaviours, and know where preventive effort can be best applied
Key public health problems and health needs of priority population groups
National Health Priority Areas (NHPAs) and risk factors in Australia:
- arthritis and other musculoskeletal conditions
- asthma
- cancer
- cardiovascular disease
- diabetes
- injury
- mental health
NHPAs and risk factors in Aotearoa New Zealand:
- alcohol, and illicit and other drug use
- cancer
- cardiovascular disease
- diabetes
- immunisation and vaccinations
- mental health
- nutrition
- obesity
- oral health
- physical activity
- smoking
- suicide
- violence
Notifiable diseases and their reporting process
Population characteristics that lead to inequality in health status
Principles of:
- benefits, costs, importance, side effects, and use of screening
- epidemic control
- illness prevention (1°, 2°, 3° prevention) and screening
- infection control
- outbreak investigation
- use of worker/patient registers and disease recall systems
The major burden of disease and injury, and the major risk factors causing this burden, in Australia and Aotearoa New Zealand

Interpret indicators for measuring health status, such as:
- adverse health events
- aggregate health indicators
- causes of decreased quality of life
- hospitalisation rates
- injury rates
- measures of positive dimensions of health
- mortality

Changing trends in occupational disease and injury in the broader community
Demographics and participation rates in prevention or screening programs
Disease patterns to inform and contextualise clinical practice
Economic implications of policies and procedures that support safe practice
Economics of prevention and health promotion, including the influence of compensation mechanisms
Effects of work and social gradient on health
Evidence-based occupational disease and injury trends in daily practice
Health conditions affecting safety at work and related to employment
Health inequities in relation to priority population groups, such as:
- diverse groups
- Indigenous people
- people with a disability
- prisoners / people held in detention settings
- rural / remote areas
- socioeconomically disadvantaged
- veterans
Immunisation and epidemic control
Measures of cost effectiveness and anticipated positive health outcomes
Organisational plans for:
- drug and alcohol abuse prevention
- healthy eating
- physical activity
- smoking cessation
- weight reduction
Population health status data identifying health issues, including:
- common notifiable diseases
- commonly reported chronic conditions
- factors related to good health
- leading causes of death
- leading causes of hospitalisation
Workplace health surveillance programs, including those described in legislation
Protocol and processes of interaction between workers/patients and available health system resources

LG13: Hazard recognition, evaluation, and control of risk

Key presentations and conditions

Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

Less common or more complex presentations and conditions

Trainees will understand these presentations and conditions.

Trainees will understand the resources that should be used to help manage workers/patients with these presentations and conditions.

View

Epidemiology, pathophysiology, and clinical sciences

Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

View

Adverse health effects of workplace hazards
Classification of workplace hazards:
- biological
- chemical
- physical
- psychosocial
Differences between:
- biological effects
- disease or injury
- exposures
- hazards
Human factors principles, including but not limited to those that underpin the hierarchy of controls
Mitigation strategies using the hierarchy of controls
Models for causation that are medicolegally authoritative

Physical hazards

Atmospheric pressure changes
Cold
Electricity
Ergonomic
Heat
High-pressure injuries
Radiation:
- ionising
- non-ionising
- radioactive particles
Sound / Noise
Vibration

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on workers/patients and their quality of life when developing a management plan

Manage

provide evidence-based management tailored to workers’/patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve, lead, and guide multidisciplinary teams to adopt risk-based outcomes driven approaches to ensure health and vocational outcomes, where and as appropriate

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Biological hazards

Bacteria
Fungi
Prions
Protozoa
Toxins
Venom
Viruses

Chemical hazards

Carcinogenic and teratogenic substances presently used in bulk in Aotearoa New Zealand and Australia
Categorised by physical state:
- dusts
- fumes
- gases
- liquids
- solids
Categorised by effects:
- asphyxiant
- carcinogenic
- corrosive
- explosive
- flammable
- irritant
- oxidising
- sensitising
- toxic
Mineral dusts
Volatile liquids with vapours capable of causing narcosis and other health effects

Physical hazards

Changes in ambient pressure
Cold
Ergonomic hazards
Electricity
Heat
High-pressure injuries
Manual handling
Radiation:
- ionising
- non-ionising
- other clinically relevant electromagnetic phenomena
Slips, trips, or falls
Sounds and loud noises, such as:
- banging
- whining
- whirring
- whooshing
Sources of drowning or engulfment
Sources of physical trauma
Vibration

Psychosocial hazards

Bullying
External pacing
Harassment, including sexual harassment
High and low job demands
Low job control
Low reward and recognition
Low role clarity
Mentally and/or physically traumatic events and moral injury
Not part of decision making
Poor organisational change management
Poor organisational justice
Poor physical and/or organisational environmental conditions
Poor support
Poor workplace relationships, including interpersonal conflict
Remote or isolated work
Violence and aggression

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on workers/patients and their quality of life when developing a management plan

Manage

provide evidence-based management tailored to workers’/patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve, lead, and guide multidisciplinary teams to adopt risk-based outcomes driven approaches to ensure health and vocational outcomes, where and as appropriate

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Different types and sources of venom and antivenin
Distinguishing features of:
- bacteria
- fungi
- prions
- protozoa
- viruses
Health surveillance programs with attention to both biological exposure and effect monitoring
Routes of exposure, the mechanism of injury, and the pathological effects
Understanding of the physical, chemical and toxicological properties of substances, such as:
- acid, alkali, pKa and pH
- aromatic and aliphatic compounds
- basic physical laws that relate to chemical reactions, gases, pressure, and temperature
- compounds and mixtures
- diffusion and osmosis
- effects of particle size, including nanoparticles, such as inhalable and respirable
- electrolysis and electrolytes
- enzymes and their properties
- flammability and explosion
- gases
- halogens and halogenated organic material
- inert gases
- ions and polar molecules
- metal and heavy metals
- odour threshold
- oxidation and reduction
- solubility
- volatile organic compounds

Environmental Health and Social Impact Assessment (EHSIA)
Formulate comprehensive evidence-based reports around hazards and their health effects
Occupational hygiene sampling
Relating occupational hygiene measurements, including health effects and health risks for identified hazards
Risk assessment and worksite visit processes

Available literature, such as material safety data sheets and appropriate data bases relevant to agent and exposure
Critical, scientific technical analysis of quantitative and qualitative methodologies used in occupational hygiene studies
Reference framework to address foreseeable health and organisational risks relating to substances
The hierarchy of controls
The principles and practical application of occupational hygiene, including the principles of:
- evidence-based management with consideration of the person and the context, including management support, the work environment and culture, and work organisation
- occupational history taking
Toxicology of chemical substances, including pharmacodynamics, pharmacokinetics, and half-lives

LG14: Policy development and workplace relations

Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to workers/patients, their families, and/or carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Sources of information about past significant events, including written and electronic records and interpersonal information within the organisation
Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis (or related) of occupational health services
Systematic approach to assessing and evaluating workplace health programs
Worksite visits

Awareness of trends toward casual work, employment of immigrants, employment through agency hire and contracting companies, flexible working hours, outworkers, part-time work, and working from home, and how they may affect occupational health and safety and issues such as consultation with workers, reporting of hazards, and reporting of injuries
Broad economic factors that influence business, and factors influencing the allocation of resources within businesses
Budgets
Commonly used or established occupational health and safety services that can be used for reference
Components of business plans / organisational objectives
Define the limitations, purpose, spectrum, and strengths of:
- disability support organisations
- environmental activist groups
- government (local, state, and federal levels) and the relevance of their agencies to occupational or environmental health
- human resource management
- legislative compliance
- local single-issue community action groups
- management of change
- policy and procedure development
- production
- strategic planning
- union representatives who visit or are employed in workplaces
Different quality assurance processes, and their strengths and weaknesses
Discern what is essential from what may be ‘nice to have’
Factors influencing workplace culture
Interaction with managers and leaders
Issues at stake in a disagreement, and respond to the associated emotional concomitants
Organisational needs, based on its type and culture
Potential need for a staged introduction of services offered
Refusal to undertake inappropriate activities
Relevant codes of practice, industry standards, and laws
Set up, maintain the independence of, and evaluate the performance of an occupational health service sufficiently equipped at a suitable location
The workplace health and safety culture at organisations
Types and likelihood of risks
Types of organisational structures

LG15: Business continuity, disaster preparedness, and emergency management

Epidemiology, pathophysiology, and clinical sciences

Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

View

Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to workers/patients, their families, and/or carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Environmental incidents

The nature of hazards, duration of their fugitive presence, and extent of spread
The nature, severity, and clinical foreseeability of health complaints, health outcomes, and who these are likely to affect or do affect

Outbreak of an acute disorder

The likely availability and reasonable practicability of preventive measures
The natural history, clinical features, clinical foreseeability of harm, and foreseeable severity of harm from clustered medical conditions

Environmental incidents

Environmental audits
Method and periodicity of air and water monitoring, and the interpretation of monitoring results

Outbreak investigations

Methodology of outbreak investigation and report writing

Remediation of contaminated sites

Measures of satisfactory decontamination

Environmental incidents

Actions related to histories of environmental incidents, and how they have arisen
Assessment of technical reports against foreseeable health risks and relevant outcomes, including reports on:
- human factors
- occupational hygiene
- safety systems
- toxicology
Critical evaluation of relevant technical reports
Likely ameliorative efforts already undertaken in environmental incidents
Management of stakeholders, who may have differing perceptions and agendas, in environmental health issues
Risk communication
Scientific methodologies that have regulatory or authoritative recognition

Outbreak of acute disorders

How to keep those affected and relevant community members appropriately informed
How to recognise and support organisations’ staff health strategies with respect to clusters, outbreaks, epidemics, pandemics, and the endemic nature of conditions
Medical and medicolegal determinants of need for isolation or separation of cases
Methodologies for formulating reasonable plans and strategies with awareness of own personal role(s), including the potential for relevant perceptions of bias and/or conflicts of interest
Organisations that should be notified, and individuals who should be involved
The appropriate involvement of families and others who are close to those affected
The foreseeable reaction of those involved and those nearby
The method, and likely time required, to confirm cases and coordinate effective, sustainable, and timely health protection responses
The role of emergency services

Remediation of contaminated sites

Approaches to this type of problem and their usual effects
Consequences of adverse weather or problems of access
Critical analysis of health monitoring information and systems
Environment and planning laws, and who is responsible for administering them
Interfaces between operations and health protection regulations
Likely appearance of sites once work is completed
Sensitive areas in proximity
Site history
Strategies for the transport and disposal of soil
The remediation process, from beginning to end
Toxicological nature of contamination

Site health emergency response capability

An understanding of site health and safety risks and external response capabilities
Site emergency health response capabilities required to respond to onsite acute illnesses and injuries

LG16: Environmental issues in occupational and environmental medicine

Epidemiology, pathophysiology, and clinical sciences

Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

View

Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to workers/patients, their families, and/or carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Broader environmental concerns

Air pollution and indoor air quality
Land / Soil pollution
Noise pollution
Water pollution

Core concepts in environmental health

Community resources and action
Dose / Response
Environmental justice
Exposure
Individual susceptibility
Risks and benefits
Toxicity

Workplace environment

Freezing climates
High altitude
Radioactive substances
Underwater – diving
Very hot climates

Environmental risk assessments

Environmental risk assessment limitations
Exposure guidelines and monitoring
Interpret air and water monitoring results
Interpret relevant technical reports to elicit information on hazardous exposure monitoring
Qualitative and/or quantitative risk assessments to evaluate potential exposure levels (and reference to environmental exposure standards, such as air and water) to assess potential human health risks from environmental hazards

Reference regulations and regulatory bodies

National air quality measures and relevant national and state regulations
National standards for drinking water
Regulatory bodies, including additions such as the per- and polyfluoroalkyl substances (PFAS) taskforce, that oversee:
- air quality
- chemical approval and use
- environmental pollutants from industry, such as mining and pastoral
- radiation – ionising and non-ionising
- sanitation systems
- water quality

Environmental issues related to work practice

Community response management for environmental exposures or health clusters
Difference between occupational and environmental standards, and the different contexts in which they are applied
Disposal systems, environmental and/or health effects, and scale of:
- burning of coal, gas, wood, and other sources of carbon
- exhausts for diesel and petrol
- key waste streams
- PFAS, including specifically perfluorooctane sulfonate (PFOS)
- recycling waste streams
- recycling wastewater
Government decision making approaches to heath and the environment
Key environmental regulations
Laws and standards of the transport and storage of hazardous substances, including radioactive substances
Programs that predict and mitigate health effects in occupational groups working in:
- bushfire smoke
- post-flood areas
Special interest groups and their involvement with environmental issues groups
Strengths and limitations of environmental standards
The impact of climate change on health and the environment, and initiatives to reduce carbon emissions, such as city greening
The importance of advocating for health benefits within business environments
The susceptibility of population sub-groups due to:
- age
- infirmity
- pregnancy
- social circumstances

Health-affecting environmental issues

Common types of health-affecting environmental issues
Modifiable environmental issues contributing to the burden of disease within Australia and/or Aotearoa New Zealand.
Population health monitoring, including the use of:
- assessment of sub-clinical effects
- biomarkers
- clusters of health events
The health inputs in developing business measurement tools, such as environmental, social, and governance (ESG)
The World Health Organization’s summaries on environmental health covering main environmental issues contributing to the global burden of diseases

Social and environmental justice

Chemicals widely used in the environment that could affect health within their country of practice
Current predictions on changes to weather systems within regions; these predictions should be able to be used to modify adverse health effects within the occupational community and the wider population
Health needs in camps for refugees or internally displaced people
Industrial activities impacting environmental justice in communities
The concepts of distributive and procedural justice
The current environmental issues affecting the health of Aboriginal and Torres Strait Islander and Māori peoples
The history and philosophical concepts of the environmental justice movement
The impacts Aboriginal and Torres Strait Islander and Māori peoples face living remotely, as defined by these communities
The understanding of te ao Māori, and the importance of te taiao (the environment that surrounds us) in terms of whakapapa; elements such as awa (river), maunga (mountain), and whenua (land) are not property or commodities, but ancestors with whom we are intimately connected, and resources of cultural and spiritual significance. Maintaining environmental relationships in healthy balance is a fundamental for wai ora (healthy environments), including:
- access to sanitation facilities and hygiene hardware
- animal and pest management
- drinking water quality
- dust and weed management
- energy poverty related to cooling and heating
- indoor air quality related to cooking methods
- location of rural and remote communities
- quality of housing and maintenance
- regular power supply
- sewage and waste management

LG17: Occupational health and safety, and legislation

Legal organisational and regulatory issues

Trainees will have in-depth knowledge of the topics listed under each legal, organisation and regulatory issue heading.

For the legal concepts listed, Trainees should be able to describe and identify the broad legal concepts as they apply to occupational and environmental medicine and the knowledge required to apply the information correctly.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Courts

Effective contributions to the legal process
Medical:
- panels
- referees
- reports
Purpose of courts
Rules, including the constraints on expert evidence

Industrial agreements

Local industrial relations mechanisms

Laws related to workplace and environmental hazards

Legal administering authorities
Non-legislated guides and standards
Relevant codes, guides, and standards, including sections of a statute that are:
- pivotal
- seldom applied
Types and tiers of law

Medical reports

Broad content of workplace and environmental compensation laws
Equipment required for medical report preparation
Legal and insurance requirements
Legal purpose of medical reports
Published guidelines for report preparation

Common law

Influence of common law on occupational and environmental medicine

Industrial

Local industrial relations mechanisms and their documented effects on health and safety
Nature of employer responses
Physiological basis of industrial agreements, such as on fatigue or shift work, from overlays generated by industrial negotiation
Vigour of activism by local employee representatives and advocates

Medical reporting

Completion of medical certificates / documentation for governmental and non-governmental organisations
General purposes for which compensation is provided by both common and statute law, such as:
- incapacity payments, which may be time-limited
- lump sums for impairment
- payment of medical expenses
Workers’/patients’ understanding of ethical and legal impacts of medical reporting

LG18: Epidemiology and causation

Epidemiology, pathophysiology, and clinical sciences

Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

View

Investigations, procedures, and clinical assessment tools

Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Trainees will know how to explain the investigation or procedure to workers/patients, their families, and/or carers, and be able to explain procedural risk and obtain informed consent where applicable.

View

Important specific issues

Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

View

Common types and causes of selection and measurement bias, and the way they might distort study results
Commonly used measures of association in epidemiology
Identify and assess the presence and influence of potential confounders and how they may affect the interpretation of association between a putative determinant and a health outcome
Incidence as a measure of absolute risk
Incidence, incidence density, and prevalence, and their meanings
Injury and disease causation models, such as the Bradford Hill criteria
Interpretation of rates and the information they convey
Study design, methodology, and sampling
The assessment and management of putative disease clusters
The difference between the expression of health-related phenomena as frequencies or rates
The distinction between confounding and interaction (or effect modification)
The meaning of confidence intervals and p-values
The potential effect of chance (random variation) on measurements, observations, and the results of investigations
The variety of methods available to deal with confounding

Appropriate illustrations graphically summarising the distribution of single variables or the relationship between two or more variables
Appropriate tables and graphs
Indicators for measuring health status
Relevant statistical processes, with an understanding of:
- accident causation theories
- accident / incident investigation
- root cause analysis
Tabulations summarising the distribution of single variables or the relationship between two or more variables
The calculation and interpretation of appropriate statistics

Scientific journal articles
Scientific report writing skills
Study designs, including their advantages and disadvantages
Suitable presentation skills

Site:	RACP Online Learning
Course:	Advanced Training Curricula
Book:	Curriculum standards

Printed by:	Guest user
Date:	Friday, 29 August 2025, 7:46 AM

Description

Advanced Training in Occupational and Environmental Medicine

Table of contents

About this resource

LG1: Competencies

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety*

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

Entrustable Professional Activities

2

3

4

5

6

7

8

9

10

LG2: Team leadership

Medical expertise

Communication

Quality and safety

Teaching and learning

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG3: Supervision and teaching

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG4: Quality improvement

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG5: Clinical assessment, investigation and management

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Judgement and decision making

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG6: Communication with workers, patients, communities, third parties, and other stakeholders

Medical expertise

Communication

Quality and safety

Teaching and learning

Research

Cultural safety

Ethics and professional behaviour

Leadership, management, and teamwork

Health policy, systems, and advocacy

LG7: Analysis and application of data