Training of Occupational Physicians in France JF Caillard. University of Rouen OH Education and Training for everyone every year Strasbourg. ICOH. September 2005

inhabitants (63 millions DOM-TOM included) au 1 er january de 20 à 64 ans ( source INSEE).INSEE France STRASBOURG

Occupational Health and Occupational Medicine in France First medical aproach in workplaces at the end of XIXth Century 1874: Creation of Labour Inspection 1898: First Work Injuries Compensation Act 1916: « De la main d’œuvre nationale après la guerre » J Leclerc and P Mazel (specialists in forensic medicine): the basis of the content of the future organisation of Occupational Medicine 1946: Services of Occupational Medicine mandatory by law for every paied worker

Basic Functions of Occupational Medicine in France Activities on the workplace (one third of occ.physician’s working time) –Improvement of working conditions –General hygiene of the workplace –Ergonomics –Prevention of work-related diseases and accidents –Health education –Epidemiology of work-related diseases Health surveillance of workers –Medical examinations providing job-fitness certificates Pre-employment and periodic Return to work –Vaccination –Networking with health and insurance organisations The Occ.Physician is an advisor on OHS matters

Trends in Occupational Medicine along the XXth century First period : 1900  end of the 50ties –Public health purposes and starting identification of OH hazards and effects – first approach in prevention From 1960 to 1969 –OM practice mainly focused on medical surveillance From 1969 to 1988 –One third of the working time to be devoted to working conditions From 1988 to 2000 –Trend toward primary prevention and multidisciplinarity – planification of activities based upon risk-assessment From 2004 on –Multidisciplinarity is an obligation – Less medical surveillance – Risk assessment is a priority – National Plan in OH – Innovation encouraged

enterprises paied workers benefit from OHS (non private sector) in 350 interenterprises services in 750 in-enterprises services 7000 specialised occupational physicians staff members (assistants, secretaries, nurses, oh technicians … OHServices Source: CISME

Occupational health services are organised and financed by the employers. Direct cost: 920 millions € ½ of preventive medicine expenses By comparison: cost for compensation of occupational diseases in 2002: 1121,46 m€ Source: CISME – ministry of labour OHServices

French system of prevention of occupational risks Ministry of Labour National council for the Prevention of OH risks Social Security INRS National Institute of Research and Safety ANACT ARACT Labour Local Authorities CNAM Regional Commission of OM Regional Observatory of OH Institutes /Dpt OM/OHE in University -Hospitals ENTERPRISES Employer - Occupational Health Team Employees representatives - HSWCTC EMPLOYEES Social Security OH Prevention Services Regional Laboratories INVS AFSSE INERIS

History of Training and Education in Occupational Medicine in France First Training Courses existing since the 30ties, particularly in Lyon, Lille, Paris (volountary basis) 1957: a special diploma is mandatory to be employed as occupational physician 1957  1977: 1 year training consisting only in theoretical courses: certificat [CES] 1977  1983: 2 years with one month in a OHS service for practical training: certificat [CES] 150 I 500

History of Training and Education in Occupational Medicine in France 1983: Reform in medical studies: 4 years are needed for all specialties(residency) at the end of 6 years of general learning II [Occupational Medicine becomes a full speciality] 1983  2004…: 4 years residency after a competition (volountary basis) (1992:special access for physicians with > 5 years practice): diploma: [DES] 2005 ….: 4 years residency after a national examination (mandatory basis) : diploma [DES] 140 I I 70

History of Training and Education in Occupational Medicine in France 1998 – 2000 and : for those practicing without any diploma: 2 years theoretical training while continuing practicing: [licence] to be authorised to practice 2003 – 2006: for non OH Practitionners wishing to join an OHService and be trained during the first period of professional exercise: 2 years: diploma [capacity] 1300 <100

Organisation of the training Institutes/Departments/ Units of Occupational Medicine in 19 University-Hospitals in charge of : –Teaching –Research –Occupational health activities –Clinics of occupational diseases –OH Services for Hospitals, Universities ….. 27 professors – 35 assistant-professors Co-operation within a network of professionals, researchers, institute,private organisations at regional, national and sometimes international level

National theoretical programme 1.Introduction to labour sciences 2.Laws and regulations in OHS 3.Work physiology and ergonomics 4.Toxicology and industrial hygiene 5.Work related diseases 6.Epidemiology – statistics – computer science 7.Management of occupational hazards 8.Miscellaneous

Theoretical and practical training DES – Residency Theory: 300 hours Practice: 2 years in clinics (or equivalent) 2 years in OH services, institutions, research centers … Licence and Capacity Theory: 280 hours Practice: work in an OH service during >2 years including 6 months in a University-Hospital (Capacity)

Two main issues To face the shortage of occupational physicians in the country To adapt the programme and the training methods

To face the shortage of occupational physicians in the country Parameters to take in account: (source. Labour medical inspectorate 2003) –The total number of needed OP is fixed by regulations: - 1 full time equivalent  1500 to 3300 employees (depending of risk assessment) - 66 % of OP are female (5 026) et 34 % males (2 585) % of OP are more than 50 years old (35,56 % females et 23,50 % males) % of OP work >152 h/month - 59 % < 152h/month

To face the shortage of occupational physicians in the country

Solutions ? - to lobby in order to get more positions for residency - to increase multidisciplinarity with more « non medical » professionals - to allow trained physicians to practice occupational medicine part-time - to increase the global «numerus clausus »

To adapt the programme and the training methods New regulations and new needs in Occupational Health Increasing consensus on good practice Importance of ethics Influence of international co-operation: - EASOM (European schools of occupational medicine - UEMS (Union of European Medical Specialities - ENSOP (European Network of Societies of Occupational Physicians - Faculty of Occupational Medicine in UK Ewan MacDonald (Occup Environ Med 2000;57:98–105) - American College of Occupational and Environmental Medicine Panel.

To adapt the programme and the training methods Working Group of the French College of Occupational Medicine Teachers (waiting more than 5 years for labour market and government decisions on reforms) Designing of a new programme including/developing new items with 3 main issues for student learning: –Knowledge –Experience –Competence Opening the discussion with stakeholders (focus groups) before approval

To adapt the programme and the training methods Examples of new items: –Risk assessment –Promotion and maintenance of work ability –Mental health –Environmental health –Public health surveillance –Communication –Management of projects –Team working –Ethics –Research methodology

To adapt the programme and the training methods Specialisation of and co-operation between regional departments of OH and call to the best specialists E-learning and distance leanrning Participative teaching Problem solving International teaching (European LMD) Multidisciplinary training for teachers (already done) and students (to be done) Sharing experience world-wide: « Thanks to the Organising and Scientific Committes of this International Congress »