Occupational and Environmental Medicine Content Outline

Test Specifications

Domain	Percent of Exam
I. Clinical Occupational Medicine	48%
II. Health, Wellness, and Human Performance Optimization	8%
III. Work Fitness, Impairment, and Disability Prevention	15%
IV. Hazard and Disaster Prevention and Management	8%
V. Environmental Medicine	8%
VI. Occupational Epidemiology, Analytics, and Research	5%
VII. Systems-based Practice and Administration	8%

Domains, Tasks, Knowledge

I. Clinical Occupational Medicine

Tasks

• T1.1 Provide direct patient care to employees for both workplace and related non-workplace illnesses and injuries that impact wellbeing.
• T1.2 Utilize clinical treatment practice guidelines consistent with current best practice and/or evidence-based medicine to deliver high-quality, efficacious patient care.
• T1.3 Recognize, prevent, evaluate, diagnose, treat, and manage adverse health effects from workplace and environmental hazards.
• T1.4 Formulate appropriate differential diagnoses considering occupational and non-occupational etiologies of illness and injury.
• T1.5 Make recommendations regarding work restrictions and/or accommodations that keep employees safe and contribute to progressive functional restoration.
• T1.6 Perform and/or review clinical evaluations to make work determinations.
• T1.7 Provide opinions when requested for occupational medicine cases (e.g., workers compensation, environmental causation).
• T1.8 Write medical reports and provide requested opinions (e.g., for mechanisms of injury/illness/causation arising out of employment (AOE), MMI determination, treatment plan) to various stakeholders.
• T1.9 Review and apply up-to-date research and emerging trends (e.g., new technologies, AI interface, ultrasound) into the practice of occupational medicine.
• T1.10 Review best practice models for providing clinical treatment in telehealth/virtual care.
• T1.11 Develop and review evidence-based recommendations for the effective use of personal protective equipment (PPE).
• T1.12 Identify symptoms and clinical signs of exposures to toxicological substance (for example, recognizing symptoms and signs of arsenic exposure or symptoms and signs of lead exposure in the workplace).
• T1.13 Develop, update, and/or apply guidelines and processes for special medical evaluations within the context of occupational medical practice (e.g., Independent Medical Evaluations, impairment evaluation).
• T1.14 Perform independent or third-party review of clinical cases and services requested.
• T1.15 Develop and apply guidelines consistent with the requirements of regulatory agencies (e.g., Department of Transportation Commercial Driving Examinations, FAA, NRC, DOD).

Knowledge

• K1.1 Impact and management of acute and chronic disease and/or comorbidities
• K1.2 Anatomic or body systems-based diseases or disorders affected or caused by workplace exposures such as:
  1. Cardiovascular diseases (e.g., peripheral vascular disease, hypertension, Coronary Artery Disease, lipid disorders)
  2. Respiratory diseases (e.g., COPD, asthma, reactive airway, obstructive sleep apnea, pneumoconiosis, sensitization)
  3. Neoplastic diseases (e.g., colorectal, breast, prostate, leukemia, skin)
  4. Infectious diseases (e.g., blood borne pathogens, zoonotic, parasites, TB, measles, pertussis, STIs, COVID-19)
  5. Metabolic disorders and nutrition (e.g., metabolic syndrome, diabetes, thyroid disorder, chronic kidney disease, gout)
  6. Musculoskeletal disorders (e.g., spinal pathology, tendinopathy, bursitis)
  7. Neurological disorders (e.g., Traumatic brain injury, syncope, seizures, migraine, occipital neuralgia, trigeminal neuralgia, sensory neural hearing loss, radiculopathy, neuropathy, cauda equina)
  8. Psychiatric disorders (e.g., PTSD, depression, generalized anxiety disorder, personality, homicidal ideation)
  9. Oral health, vision, and hearing disorders and injuries related to the workplace
  10. Reproductive health disorders (e.g., menstrual disorders, ovarian cancer, cervical cancer, uterine cancer)
  11. Dermatological conditions (e.g., melanoma, herpes, impetigo, contact dermatitis)
  12. Substance use disorders (e.g., opioid addiction, illicit drug use, alcohol, tobacco)
• K1.3 Risk factors, signs, symptoms, and approaches to prevention related to physical, mental, and behavioral diseases and disorders
• K1.4 Diagnostic studies and assessments for acute and chronic conditions based on evidence-based guidelines (e.g., imaging studies [point of care ultrasound], physical therapy and functional capacity evaluations, EMG/NCS, laboratory studies, industrial hygiene reports, spirometry, EKG)
• K1.5 Clinical presentations of common occupational exposures (e.g., silica, beryllium, lead) and relevant management for various occupational industries
• K1.6 Evidence-based treatment and injury and illness management along the disease course continuum, including conservative and interventional and/or surgical care (e.g., physical therapy with eccentric exercises for tendinopathy, ESI for subacute or chronic radiculopathy)
• K1.7 Components of medical reports (e.g., requirements for documentation, dosage/frequency of medications, causation, restrictions, MMI, apportionment)
• K1.8 Provision of care via telehealth/virtual care
• K1.9 Legal issues related to various healthcare delivery models
• K1.10 OSHA legal Standards (e.g., medical surveillance requirements, recordable conditions, lead, radiation, asbestos, silicosis)
• K1.11 Use of personal protective equipment (PPE), including respiratory selection, FIT testing
• K1.12 Evidence-based trends, technology, and innovation and application and their impact in occupational medicine
• K1.13 Determinants of health ecosystems including built environments in which people live (e.g., housing, community, neighborhoods) and how these affect health and work performance
• K1.14 Practice Guidelines applicable to clinical and occupational medicine
• K1.15 Ethical guidelines for clinical care
• K1.16 Guidelines for Utilization Review and application
• K1.17 Travel medicine guidelines
• K1.18 Causation analysis (e.g., NIOSH, Bradford Hill criteria)

II. Health, Wellness, and Human Performance Optimization

Tasks

• T2.1 Develop and/or advocate for a culture of wellness, including wellness and lifestyle initiatives, to address health issues and reduce health disparities that arise from environmental conditions.
• T2.2 Perform periodic physical and mental health assessments of individuals in the workforce to identify opportunities for individuals to reach their full working potential.
• T2.3 Design and implement programs focused on improving health and safety and human performance.
• T2.4 Assess readiness for change and implement change initiatives using behavioral change models.
• T2.5 Create policies and advise on the promotion of human performance optimization across multiple stakeholders.
• T2.6 Lead efforts to promote health and safety, disease prevention, and a culture of wellness in all workplace populations at all functional levels.
• T2.7 Develop policies and programs that identify and address physical and mental health (e.g., burnout, co-morbid conditions).

Knowledge

• K2.1 Impact of acute and chronic disease on work optimization
• K2.2 Evidence-based guidelines, medical literature, and other current resources related to human performance optimization
• K2.3 Immunization programs
• K2.4 Human factors and ergonomics
• K2.5 Wellness/health programs, such as those developed in partnership with NIOSH
• K2.6 Value resulting from investing in human capital
• K2.7 Resources for building mental resilience and psychological well-being
• K2.8 Behavioral change models (e.g., adaptation, transtheoretical model/stages of change)
• K2.9 Barriers to effective communication (e.g., health literacy, cultural competencies) amongst diverse groups, including patients and populations
• K2.10 Current evidence and research related to the physical and mental health status of physicians and the workforce

III. Work Fitness, Impairment, and Disability Prevention

Tasks

• T3.1 Develop prevention and clinical programs that integrate work fitness, impairment, and disability prevention and management principles.
• T3.2 Create and communicate clear and specific activity recommendations for employees with injuries or illnesses considering restrictions or limitations based on exam findings and functional recovery.
• T3.3 Develop recommendations for policies and procedures that facilitate stay at work/return-to-work.
• T3.4 Address work-related health issues for employees with identified temporary or permanent limitations or restrictions.
• T3.5 Identify activities that injured employees or those with restrictions can safely perform.
• T3.6 Develop post-offer and preplacement recommendations to employers to address restrictions and/or limitations for new hires.
• T3.7 Interpret and apply the results of assessments, including but not limited to physical abilities, to match functional abilities of employees to job duties and requirement in order to reduce risk of adverse outcomes.
• T3.8 Conduct evaluations to determine work assignments (for placement for new hire, return to work, fitness for duty, functional capacity evaluation) in compliance with applicable regulations, including ADAAA, in the context of specific work exposures, work tasks, or public safety concerns.
• T3.9 Mitigate the impact of health conditions on work and the impact of work conditions on health.
• T3.10 Perform and interpret drug screens and report on fitness for work.

Knowledge

• K3.1 Work fitness, impairment, and disability prevention and management principles and models
• K3.2 Types and requirements of fitness for duty exams for various occupations and industries
• K3.3 Biomechanical limitations and restrictions
• K3.4 Musculoskeletal injuries
• K3.5 Exposure assessment
• K3.6 Exposure to inciting agents or events
• K3.7 Accommodations required for return-to-work
• K3.8 Laws and regulations related to disability and employee rights, including but not limited to Americans with Disabilities Act Amendments Act [ADAAA], EEOC, GINA)
• K3.9 Guidelines for the evaluation of impairment and disability (e.g., AMA Guides to the Evaluation of Impairment, Official Disability Guidelines [ODG], American College of Occupational and Environmental Medicine [ACOEM], MD Guidelines)
• K3.10 Special considerations related to safety sensitive roles or jobs and mitigation factors
• K3.11 Procedures to manage absenteeism and presenteeism
• K3.12 Occupational illness or injury compensation programs
• K3.13 Distinctions in the various types of doctor/patient relationships when performing specialized examinations (e.g., IMEs, fitness-for-duty, DOT/Commercial Driving, FAA, FCE)
• K3.14 Specialized examinations for various occupations (for example, CDME, FAA, diving, firefighting, coast guard)
• K3.15 Federal regulations regarding medical review officer responsibilities (e.g., SAMHSA and DOT drug testing guidelines)

IV. Hazard and Disaster Prevention and Management

Tasks

• T4.1 Perform comprehensive evaluation of the industry or workplace to identify and mitigate the hazards and associated risks to which individuals or populations are exposed and which may affect human health and work performance.
• T4.2 Develop comprehensive plan of care to address hazards.
• T4.3 Perform routine site visits to assess the work environment and implement actions to mitigate risks to prevent illness and injury.
• T4.4 Develop incident management and response plans (e.g., disaster preparedness plans) in collaboration with physician and key stakeholders.
• T4.5 Develop future response plans and incident command activities as they relate to human health (e.g., response to a pandemic, oil spill, space, toxic exposure).
• T4.6 Develop policies and protocols for the identification of exposures, (e.g., biological, toxicological, radiation) impacting the workplace population and surrounding communities.
• T4.7 Communicate potential health risks to multiple stakeholders (e.g., employees, public, media, community members, businesses, corporate partners) in cooperation with local authorities (e.g., department of public health).

Knowledge

• K4.1 Hierarchy of controls, including engineering controls, administrative controls, and personal protective equipment
• K4.2 Physical hazards, ergonomics, robotics-human-work interface, cumulative trauma, repetitive microtrauma, and other factors contributing to falls, slips, injuries, or loss of life or limb
• K4.3 Risk factors treatment and management of chemical exposures (e.g., metal, gas, fumes, dust)
• K4.4 Principles of disaster mitigation and management
• K4.5 Infectious diseases (e.g., COVID, Avian Flu, SARS, rabies, TB) and bloodborne pathogens
• K4.6 Radiation exposure (e.g., UV exposure, nuclear, ionizing and non-ionizing)
• K4.7 Noise exposure thresholds and impacts
• K4.8 Extremes of temperature leading to heat or cold-related illnesses (e.g., frostbite)
• K4.9 Biological hazards (e.g., vector-borne disease, micro-organisms, viruses, bacteria, prions)
• K4.10 Reproductive hazards
• K4.11 Electrical and fire hazards
• K4.12 Agricultural hazards (e.g., in farming, ranching)
• K4.13 Hazards related to animal handling
• K4.14 Hazards related to working confined spaces
• K4.15 Hazards unique to transportation industry (e.g., motor vehicles, submarines, railroads, ships)
• K4.16 Hazards related to working from heights
• K4.17 Hazards related to pharmaceutical production, manufacturing, handling
• K4.18 Hazards related to construction
• K4.19 Hazards related to working in the health care profession
• K4.20 Hazards related to nano/microtechnology
• K4.21 Environmental toxicants and hazards (e.g., chemicals, household products, pesticides, radiation)
• K4.22 Principles of toxicology (e.g., interaction of exposures and individuals, toxicokinetics, toxicodynamics) and methods (e.g., hazard identification, exposure assessment, dose response assessment, risk characterization and management)

V. Environmental Medicine

Tasks

• T5.1 Assess the environment for conditions and hazards (e.g., silica, beryllium) using standard methodologies, standard metrics, and available resources from occupational medicine and other disciplines (e.g., industrial) hygiene to control for potential harm.
• T5.2 Determine the impact of environmental factors, agents, and considerations on the workplace and workforce to develop policies and implement procedures that mitigate and manage health risks for individuals and populations.
• T5.3 Determine the risk of workplace products and byproducts, workplace events, and disasters (e.g., leaks, spills into surface water, explosions, fires) to prevent or minimize adverse effects on the external environment.
• T5.4 Develop policies and protocols in conjunction with relevant stakeholders to contain, manage, and remediate the impact of an environmental event (e.g., biological, toxicological, radiation).
• T5.5 Develop policies and protocols for internal and external communications in conjunction with relevant stakeholders (e.g., CDC, practitioners, federal, state, local government agencies, industry, public relations) to respond to environmental threats.
• T5.6 Develop, advocate and/or implement programs for wellness and lifestyle initiatives to address health issues arising from environmental conditions.

Knowledge

• K5.1 Laws and regulations related to environmental and workplace conditions (e.g., EPA, OSHA, RCRA, Clean Water Act)
• K5.2 Exposure limits and relevant standards, including but not limited to Occupational Safety and Health Administration Permissible Exposure Limits (OSHA PELs), American Industrial Hygiene Association (AIHA), Environmental Protection Agency (EPA), American Conference of Governmental Industrial Hygienists Threshold Limit Values (ACGIM TLVs), National Institute for Occupational Safety and Health Recommended Exposure Limits (NIOSH REL)
• K5.3 Environmental agents (e.g., chemical, biological, radiological, nuclear, explosive)
• K5.4 Environmental factors related to community health (e.g., air and water quality, sanitation, heat and cold stress, food safety, household and workplace injuries, noise)
• K5.5 Environmental considerations related to social determinants of health
• K5.6 Health disparities arising from environmental conditions and/or exposures
• K5.7 Research on intersection of environmental exposures and chronic medical conditions
• K5.8 Health conditions related to environmental factors of natural and/or man-made disasters (e.g., climate change, war, migration, resettlement)
• K5.9 Management of biproducts and waste
• K5.10 Environmental remediation processes (e.g., Superfund)
• K5.11 Environmental agents in the workplace potentially leading to health conditions (e.g., Sick Building Syndrome)
• K5.12 Diseases related to occupation or the environment such as asthma
• K5.13 Principles of mitigation and management for various environmental exposures

VI. Occupational Epidemiology, Analytics, and Research

Tasks

• T6.1 Design, conduct, and/or interpret descriptive and analytic studies that investigate the association between occupational exposures (e.g., repetitive stress injuries, radiation) and health outcomes.
• T6.2 Analyze research findings and recommend policies and procedures to key decision makers related to occupational and environmental medicine.
• T6.3 Customize communications about scientific research finding to enhance understanding of key stakeholders (e.g., safety officers, ground level employees, human resources, executive level).
• T6.4 Critically review the scientific literature and incorporate research from related disciplines such as industrial hygiene, safety, and toxicology to identify evidence-based practices and apply them to the workplace.
• T6.5 Analyze trends from diverse sources to recommend actions related to occupational and environmental medicine (e.g., actions related to minimizing work injuries, early return-to-work, reducing costs).
• T6.6 Develop and/or follow guidelines and policies for gathering private health information ethically and sharing information safely.
• T6.7 Adhere to ethical standards for the conduct of occupational and environmental medical research.
• T6.8 Provide expert opinion with evidence-based research that is free of bias and prejudice.

Knowledge

• K6.1 Study design and methodologies
• K6.2 Approval process for conducting studies
• K6.3 Ethical practices when conducting research
• K6.4 Data analysis techniques (e.g., descriptive and inferential statistics)
• K6.5 Procedures to evaluate validity and reliability of research
• K6.6 Data privacy (e.g., procedures to maintain security and confidentiality; what can be disclosed)
• K6.7 Tools to measure/surveil populations (e.g., EHR, wellness trackers, biometric analysis techniques)
• K6.8 Policies and procedures related to informed consent
• K6.9 Presentation methodologies (e.g., formal research report, white paper, PowerPoint) appropriate to audience
• K6.10 Basic concepts related to storing, securing, protecting, managing, sharing, and manipulating data
• K6.11 Informatics tools appropriate to research question and study design

VII. Systems-based Practice and Administration

Tasks

• T7.1 Identify health inequities and health disparities and optimize solutions for mitigation.
• T7.2 Comply with applicable laws and regulations related to the provision and management of health care systems and programs.
• T7.3 Facilitate organizational and corporate compliance with applicable laws and regulations related to the practice of occupational medicine.
• T7.4 Participate in identification of systemic workplace hazards and/or processes that are harmful in order to recommend and implement solutions.
• T7.5 Implement programs that focus on new laws, regulations, and policies to enhance workforce safety.
• T7.6 Develop comprehensive action plan to address workplace violence.
• T7.7 Design surveillance programs to identify and minimize health disparities.
• T7.8 Design and/or implement medical surveillance programs to identify and mitigate specific exposures.
• T7.9 Support the development and implementation of safety, wellness, surveillance, and health programs using evidence-based methods.
• T7.10 Develop programs to assess the interactions between those in the workplace and machines; that is, the human-machine interface (e.g., assembly processes, robotics, AI in occupational health).
• T7.11 Develop timely, effective, scientifically based, and trusted communications with other interdisciplinary teams, (including human resources and safety managers) to enhance safety and optimize the health of the working population.
• T7.12 Design and evaluate pre-placement protocols that reflect work duties to minimize injury.
• T7.13 Use clinical informatics data (e.g., from EHR, telemedicine) to improve workplace safety and clinical outcomes (e.g., maximum medical improvement, early return-to-work).
• T7.14 Apply environmental policies and regulations related to health promotion to the workforce.
• T7.15 Develop guidelines for employee health in compliance with applicable standards and best practices.

Knowledge

• K7.1 Laws and regulations related to administration of health care systems and applicable to the workplace or environment (e.g., ADAAA, GINA, EEOC, OSHA, TSCA, RCRA, FMLA)
• K7.2 Employee health standards and guidelines (e.g., CDC, NIOSH, OSHA, JCAHO, WHO)
• K7.3 Immunization programs
• K7.4 Regulatory differences across federal, state, and local jurisdictions
• K7.5 Workers’ compensation programs and federal and state regulations
• K7.6 Workplace regulations related to drug testing and Medical Review Office (MRO) applications
• K7.7 Causes of health inequities and disproportionate impact of hazards
• K7.8 Approaches to mitigate and/or eliminate health disparities
• K7.9 Data analytics tools to support system-wide change
• K7.10 Surveillance methods and techniques
• K7.11 Methods of financial analysis (e.g., cost benefit analyses/ROI, resource allocation)
• K7.12 Job analysis data (e.g., job descriptions, job safety analysis)
• K7.13 Communication strategies and methods for various constituencies and audiences