Undergraduate occupational medicine education in European Medical Schools: better training to meet today’s challenges | BMC Medical Education

The aim of this study was to provide an updated overview of occupational medicine (OM) education for medical students in European medical schools. The results of this study give an insight into the current state of OM education for undergraduate students in European medical schools, with a comparison to the conditions that existed ten years ago.

The present survey outcomes are consistent with those of the previous study by Gehanno et al. [35]. It should be noted the variability in the number of hours devoted to OM training, the covered topics and the compulsory or voluntary nature of the training, among others in undergraduate OM training across European countries. Furthermore, it was observed that there is a general tendency to prioritize classical content (occupational diseases, history of OM) over topics that have grown in significance within the field of OM recently. These encompasses collaboration between general practitioners and OM specialists, return to work, and environmental effects.

Our results showed that the adaptation of training to new contexts and needs is frequently suboptimal. Perhaps the most obvious example is that themes that have acquired prominence in the recent decade, such as occupational cancer [36] and psychosocial risks [37], are in very similar numbers to those of 2014. In other words, one in every four students at European institutions receives no training in these areas.

Another illustrative example of the results of this study is the increase in OM history instruction from 2014 to the present (55% vs. 48%) In contrast, the environmental impact of industrial activity, which is the topic most closely related to the climate emergency, had not only decreased in terms of its percentage of instruction (43% vs. 47%), but also the number of hours (1.4 h per week vs. 1.7). Furthermore, a comparable trend was observed in another relevant topic: “How to collaborate with the OM physician.” The proportion of respondents who indicated receiving instructions on collaborating with the OM physician remained relatively unchanged, with a slight decrease from 57 to 55%. This finding underscores the need for a new shared competency framework for medical students studying OM within European countries, including the UK. Such a framework would standardize competencies and enhance collaboration between medical professionals across Europe [12].

Nevertheless, our findings indicate an increasing use of modern instructional tools and methodologies, particularly learner-centered approaches such as problem-based learning and e-learning. These methods have been proposed as effective in stimulating students’ interest in OM [11, 33, 38]. This focus on more technological methods has not prevented other approaches from increasing, albeit less than desired. Practices that have been shown to be beneficial, such as visits to work environments and work placements [21], have only experienced a slight increase (43% vs. 38%). Nevertheless, it should be bear in mind that our present survey was conducted during the first quarter of 2022, in the context of the COVID-19 pandemic.

Moreover, a potential increase was observed in the average time spent on OM teaching, compared to 2014, although in the most favorable scenario, the average time spent on occupational health teaching was less than 30 h during the academic course. However, currently some medical faculties do not include OM in their curricula, despite of the importance in acquiring core OM competencies [12,13,14, 21]. This implies that a proportion of medical students at European universities have limited or no opportunity to study occupational medicine (OM) during their undergraduate training. It is therefore reasonable to assume that the lack of knowledge about essential aspects of occupational medicine (OM) and the lack of necessary skills will have a negative impact on their future professional performance as physicians.

It should be noted that this inconsistent fragmented scenario among countries occurs in a continent that offers the best conditions for academic harmonization due to its geopolitical location and common academic regulations [39]. The global situation drawn by other institutions such as ACOEM and IOMSC in their joint reports of 2017 and 2022 is even more concerning. Hence, our findings show no real improvement on the situation described a decade ago [35].

It must be reminded that basic university training in this area was identified by Green-Mckenzie et al. [1, 21] as one of the most critical factors that would motivate a young doctor to pursue a career in OM. Furthermore, these authors have recently reported on similar needs in the training of their students in United States medical schools and their relationship to the vocational deficit and the consequent decline of occupational and environmental specialists that the United States currently faces.

It is also worth recalling how the COVID-19 pandemic revealed significant deficiencies in the occupational safety and health (OSH) training of health care workers. In the early weeks of the epidemic and in the aftermath of the pandemic, healthcare workers with inadequate occupational safety and health training were unnecessarily exposed to the COVID-19 virus, resulting in the deaths of a significant number of healthcare workers [1]. In addition, the pandemic demonstrated the vital role of occupational health and safety professionals in maintaining the functioning of production systems and their workers [40]. Adequate training in occupational and environmental health and safety is essential to prepare new physicians for any new pandemic or crisis that may arise in the future (including that related to climate change).

Once again, we must not underestimate the lack of OM training in medical schools in Europe, because it is a major problem, as is the decline in the number of occupational health physicians in Europe, their replacement, and the readiness of our doctors to face a possible new health crisis in the future [2]. The results obtained justify an urgent debate on the competencies/knowledge that every doctor should possess in OM upon completing their medical school curricula. It is necessary to establish a core curriculum for undergraduate training in OM in Europe and implicate OM professional associations as well as international organizations directly involved in the OM field. With a substantial sample distributed around Europe, this study’s international viewpoint and extensive information make it a valuable source of data to evaluate. Despite its limitations, the agreement with Gehanno’s results [35] invites us to consider the data obtained as trustworthy.

However, it is important to note that the findings of this study are limited as not all European countries were included. Adding to that a significant drop in the response rate (15.3% vs. 44.3%) is observed in this second survey. Several possible explanations can be put forward for this relatively low response rate. It is reasonable to assume that most of the non-respondents do not incorporate significant levels of OM teaching into their medical student curriculum. In other words, the universities that were unwilling to participate in the study may be those that do not offer adequate OM teaching. Indeed, in this second survey, responses were received from a small number of European universities stating that OM training was not offered at all in the undergraduate curriculum of their medical school. Consequently, while data from the current study are compared with those from a 2014 study, it is acknowledged that the composition of participating faculties may have differed between the two time periods. Variations in faculty demographics and expertise could potentially impact the comparability of results, affecting the validity and reliability of the findings.

Another potential explanation for this low response rate is the ageing of the OM workforce in recent years. This trend may also extend to OM teachers in medical schools. As previously highlighted, it has been observed that the OM workforce is ageing, with up to 40% of practitioners over the age of 50 [13, 41]. This situation is of significant concern, as the lack of adequate generational replacement of occupational physicians teaching in medical schools could exacerbate the consequences of suboptimal undergraduate education in occupational medicine.

Moreover, while a 100% response rate was achieved in some surveyed countries, responses from nations such as France, Italy, and Germany were notably scarce, despite the long-standing tradition of OM undergraduate teaching within the medical curriculum in these countries. This implies that a representative sample of all Faculties of Medicine was not obtained from European nations.

The very recent publication in 2024 of a new Competence Framework in Occupational Medicine for the training of new doctors in all UK medical schools [12], which puts an end to the fragmentation, lack of standardization and inconsistency that had been proven to exist [15,16,17,18] within different UK universities, may be a good example to consider at this time. An example to consider as it has been defined after years of study, with the involvement and consensus of all parties concerned and established from a pragmatic perspective to respond to real needs.

Although there may be local differences between medical schools in different European countries or within individual nations, a basic OM competency framework should be generated, established and required for all European countries. It is needed to ensure that every European graduate has “the necessary knowledge and skills to deliver positive OM outcomes for patients, as well as the tools to manage their own resilience and the demands of a career in medicine, whatever their chosen” [12]. In European Union (EU) member countries, such a common basic OM competency framework must be considered not only a necessity, but as a mandatory requirement based on the European Community legislation related to the free movement of professionals [39, 42].

It is imperative that undergraduate OM instruction in European medical schools to be updated, harmonized, and standardized. But to address this issue, European societies, regulatory agencies, academic institutions, and policy makers must work together promptly. Cooperation of WHO, International Commission on Occupational Health (ICOH), European Union information agency for occupational safety and health. (EU-OSHA), International Labour Organization (ILO), European Union of Medical Specialists of occupational medicine (UEMS-OM), and other international organizations is also needed.