Hello, everyone. Welcome to session 217, OEM in the medical school curriculum, or Hamilton and Ramazini go to medical school. This is a session sponsored by the environmental health section. I'm the incoming chair, and I'm going to give a plug right now, our section social hour meeting is tonight at a restaurant nearby, half a mile, called From Scratch, and there'll be lots of good people to talk with and free food. So what I'm going to do is introduce everyone right away, and then we'll go through the talks and we'll have a lot of time for discussion and questions at the end. So I'm Kathleen Fagan, I was a medical officer at OSHA for 10 years, before that practiced in Cleveland, did my residency at Cook County, am now back in Cleveland doing a little work with CWRU Med School with Karen Malloy. Dr. Greene McKenzie is professor of medicine and chief of the division of occupational and environmental medicine, executive director for health and safety and environment at Johns Hopkins. She went to med school at Yale and did her OEM fellowship and MPH at Hopkins. Dr. Kirkland has been executive director of AOEC since 1996. She received her public health doctorate from George Washington University. Dr. Claren is an associate professor of medicine at the University of Maryland School of Medicine. She is an instructional designer for online courses and launched a new elective in OEM at the med school in 2021, that's what you're going to hear about. And she will become the chair of the direct education program oversight committee this year. Dr. Malloy, who's joining us remotely, is an associate professor at CWRU in the department of family medicine, also population health, and the Marin Swetland Center for Environmental Health all at CWRU Case Western Reserve. She received her DO from West Virginia School of Osteopathic Medicine and completed her family medicine with an MS in community health at Marshall University and residency in OEM at University of Kentucky. Dr. Saberi received her medical degree and MPH at Tufts University and residency in OEM at the University of Pennsylvania. She has continued on as faculty at UPenn and also works with the VA. So I could talk a lot more about everybody, but I'm going to just move right on to our panelists. And the first one is Dr. Judith McKenzie. And you could advance your slides if you want that way, so we'll do that. Thank you, Kathy. Hi, everyone. Thanks for coming. So I'm going to talk to you a little bit about the shortage of physicians in occupational medicine. It's longstanding. From 1991, the IOM, now the National Academy of Science, noted the shortage. And 40 years later, we're still talking about it. Despite us having the lowest burnout, you've all seen the data, as well as a higher job satisfaction than other residences, we have the shortage. But it's important that we teach competencies of taking the OEM history to medical students and residents, as well, so that they can recognize illnesses and injuries and exposures that come from the workplace. Because this will lead to misdiagnosis when they become physicians, right? And it's important, because in 2019, the data showed that 2.8 cases per 100 FTEs were nonfatal injury and illnesses. The shortage is thought to be multifactorial. There's been a lot written about that, as well. We did a cross-sectional study of medical students with residents at Penn. And it was a survey of 212 medical students, and only 10% ever took a work history. We also did a survey of AOHC attendees, and after a plenary session, we did a convenient sample of 162 OCDOCs, and only 21% had heard of occupational medicine during medical school. 46% were boarded in OCMED, others were boarded in other things, some were double boarded. And most became aware of OCMED when they were working in another field, and then made a mid-career switch. One root cause identified is not teaching medical students, and Marian will tell us about a process that she's developed to integrate into the medical school curriculum. When we try to teach medical students, we often hear, we don't have room in the curriculum, we have too much basic science to teach, and things like that. But I would submit that teaching about workers, our most important asset in our country, is important. This lack of awareness is not inconsequential, because 33% felt that their career path would have been different had they heard about occupational medicine sooner, and those who were board certified were more likely to have heard about it sooner. So that's our introduction, and I'm going to move on to Kathy. Okay, so one of the things that ACOM did was they created a task force to look at the future of OEM that Judith was part of, I was part of, a number of people were part of, to look at various aspects of OEM, and there was one group that was looking at physicians and career changers, and one group that was looking at advanced practice, NPs, RNP, nurse practitioners, physicians assistants, etc. I get lost in the initials. And I was part of the group that was looking at residents and medical students. And so we were looking at the, focusing on the early recruitment of the medical students into the field, and how do we, how do we get their attention? Because when you talk to them, and you actually can get their attention, they're interested, particularly in, you know, the basic things like how much money can you make being an OCDoc? I mean, if you're a public health OCDoc, it's one thing. If you go to work for Exxon Mobil or Apple or something, it's something else. There's just a wide range, but the fact that until COVID, which I've heard of at this conference a couple of times, until COVID, almost no OCDoc was ever on call for the weekends and nights. COVID kind of changed that for a lot of you, and I'm sorry, but, you know, that's the reality of people finally recognizing what occupational physicians are good for. We actually understand work. You actually understand work. I'm not a physician. I don't know why I say we, but part of the objective was to increase the awareness of OEM among the medical students and the residents, and part of what we wanted to do was to find opportunities for the med students and the residents, and that included rotations, because a lot of times you can do a rotation as a resident or even as a medical student. My organization provides a summer residency or a summer internship program that's nine weeks to get students involved in occupational environmental medicine, and it's been very successful, but it only reaches, you know, this year we've got 24 students. That's not a whole lot of students, and not all of them are going to be going to medical school. Most of them are going to be going on to other fields, so we need to get those sort of opportunities available to the students, and when I, because I've done a lot of work with the residency program over the last 30 years, I volunteered to survey them and find out, you know, who offered rotations, who actually taught to medical schools and so forth, and in the past there was a fair amount of people that were trying to outreach to the medical students through various courses and getting involved in the toxicology course, getting involved in other things, which, you know, sort of slide in there sideways. Unfortunately, I was doing this survey in the midst of COVID, and it was like, nope, we're not even taking our own students on rotations, so one of the things I will do next fall is survey all of the residency programs again and see who has a rotation and what's available and then start spreading the word about that through AECOM and AOEC, my group and others, so that's basically where we are on that. And now we're on to Marianne. This is like speed dating, you know, it's like, the rest of the talks get to be longer. All right, let's see if I can figure out the controls. Okay, so I used the title What About Work? as a little bit of a pun almost. When patients are leaving a primary care office visit, often the last thing they say is, you know, hey, what about work? And they hand papers, you know, to their primary care doc to sign, you know, off work or whatever. It's an afterthought, and so I deliberately named this course that to kind of play on that, that it can't be an afterthought. This is a curriculum for first and second year medical students. It's brand new. The context here is that at the University of Maryland School of Medicine, there was a working group that had been working for a couple of years to totally redesign the first and second year curriculum to provide more clinical time, to provide more flexibility to integrate things like pathology and physiology and anatomy and pharmacology around organ systems. So, instead of having, you know, separate courses in each of those things, there's now the heart, and then you learn about, you know, the drugs for the heart and how things can go wrong in the heart, et cetera. And they also designed these two-year elective tracks. I had a little bit of visibility. I've only been there for five years, and I hadn't really been teaching much. I had a lecture in occupational environmental medicine to second year students. It was just like one lecture. I have some doctor-patient communication lectures that gives me a little bit of visibility. But I also had some visibility in some faculty development. So, I was kind of becoming known as like a teacher on teaching methodology, and I kind of leveraged that to map out an elective that aligned with the new curriculum. So, the new curriculum goes over two years and, you know, starts out with blood and host defenses. And then, I can't remember what the next one was, but, you know, then there's like digestion and endocrine, and there's going to be respiratory and renal and heart. And so, I pitched an elective that stretched over two years based on case studies, occupational environmental case studies that map to the organ system so that they're learning about occupational environmental kind of principles. So, for endocrinology, for example, which is the last part we taught, I spoke about endocrine disruptors and included the—we did a worksite visit, and I used a little teaching exercise about a fictional patient who lived in the neighborhood where this industry was. And then, we tried to tie it together with a movie night that was about the DuPont disaster and the PFOA. So, it's kind of all together, and they're getting to think about how these forever chemicals, you know, maybe are having an impact on obesity and diabetes and, you know, the things that they're learning about in their endocrine coursework. So, there's case-based modules. I'm trying to teach principles of OCMED that all physicians need to know. I'm not trying to convert the students to OEM. I mean, it'd be great if they do enter the pipeline. But it's 100 hours total per student, which is just awesome. The objectives, as I said already, but the principles are, like, work is a social determinant of health. They love that. They also love environmental stuff. So, I had to make sure I included some good environmental stuff. Work causation, evaluating, preventing work-related illnesses, optimizing function. When they were studying brain and behavior, we worked on opioids. And it was very interesting for them to kind of learn about chronic pain and, you know, the brain connections around opioids, because they hadn't been learning that yet. And then, the idea of cases as sentinel events that warrant a population approach. The content is monthly, six months over a year. So, it's just hard to kind of coordinate it. It's just how it wound up here. They do have to do three hours of prep work, which includes online modules that I've developed. You know, some readings, some videos, kind of depends what the topic is. And then, three hours in class, which is a little bit of lecture, but mostly team-based problem-solving, some presentations. Also, the field trips. So, we visited the Baltimore Museum of Industry, which was great. And then, we visited the old Bethlehem Steel site, which is being reclaimed as an industrial site with a lot of interesting, different kind of potential exposures. We also have movie nights, which was hard because of COVID. We just had our first movie night. And we watched Dark Waters, which was the DuPont story, with dinner and then discussion. So, it's kind of like the old symposium style. And they loved it. In the classroom, it's a flipped classroom strategy. There's very little lecture. It's more questions that they have to work together to research and kind of present back to each other or that we discuss. And then, some experiential learning. Some of the highlights. We had a field trip to go to the Earldotters. Everybody knows Earldotter? It's a great photojournalist of people at work. So, they got to participate in that, where they also got to hang out with public health students and journalism students in the audience, who had much different kinds of questions of Earldotter than they might. We looked at This Might Hurt, which is a very interesting documentary about chronic pain and had a guest speaker who is a doc who is now an addiction specialist, but is somebody that became addicted to opioids himself when he was in anesthesiology. And I think that was really useful for the students to hear from a doctor about his journey. We had a private tour of the Museum of Industry, which is a great place. And then, my favorite thing so far, like even with all this interaction, which is pretty hard, developing all this stuff. And I'm still building it as I go. So, I have first-year students now that will be heading into the second year. So, I'll have new curriculum for them. And then, I'll have a new batch of first-year students coming in in the fall. So, it's a lot of schedule juggling. But even with all the interaction, when I got a pulse check, what's working, what's not working, some of the stuff that I thought they were enjoying, they weren't enjoying as much. So, I decided to do a game, which I really got to figure out how to get published. So, raise your hand if you've been to one of those murder mystery dinners where you've been assigned a role. Okay. So, I built something like that around the case of a seasonal agricultural worker who had a pesticide exposure, but the pesticide exposure was from the neighboring golf course, where the pesticides were sprayed by a contractor. So, somebody played the contractor, somebody played the golf course owner, somebody played the employer, somebody played the guy that picks up the seasonal workers and takes them to the employer who doesn't take their names. And the story was pretty severe pesticide exposure resulting in hospitalization, but seemed like complete recovery, went out, got back to work, and then got a hospital bill. And so, the mystery was who pays for the hospital bill. And it was a pretty interesting exercise for them. We actually had a workers' compensation lawyer talk to the student that was playing the workers' comp lawyer. We had somebody playing the workers' comp claims adjuster. They had to learn about the workers' comp system. We had somebody playing a migrant clinician's network doctor who was kind of the hero of the story, kind of pulled it all together. The initial doctor that diagnosed it was not a hero, not a villain either, but just really the instructions to that student were to be so excited about the pathology here and making the right diagnosis and just kind of missing the big story, like what happens to this worker afterwards. So, anyhow, that's some of the ideas, some of the content. Impact, I've been checking in on them, what's working, what's not. And one of the questions I asked is, and so I have 16 students. One didn't respond, but when I look at people working, I am now more likely to think about their working conditions. So, I thought that would be a reasonable way to check on effectiveness of this, and very high, four and fives. I think about my own occupational risk as a health care provider more now than I did before this course. And so that's another way to try to gauge the effectiveness. So, it's early, and I'm still developing. I'm having more fun with this than anything I remember doing in my professional career. And I appreciate the opportunity to talk with you about it. And then I'm turning it over to Karen. Great. Thanks so much for the introduction, Kathy, and so glad. I really appreciate ACOM for allowing some of us to be able to do this remotely. And so I really wanted to talk about, you know, another way of thinking about it. And I love the session in that, you know, we can think of lots of different ways and ideas, and depending on our particular institution of how to increase the level of exposure to occupational environmental health into the curriculum. So, I want to really talk about kind of, you know, the path that I took for making my case for occupational environmental health at Case Western. And I've been in a number of other institutions over my career. And always it was, well, you might get, you know, one lecture on occupational lung diseases, and maybe you could teach residents and things on the family medicine residents. And obviously, if you had preventive medicine residents and occupational medicine residents, obviously, that's a whole other question. But getting the medical students involved was always a very difficult part. And as Marion has said, it is that the curriculum is so packed with so much more that you really can't introduce more lectures. And you shouldn't introduce more lectures. As we know from adult learning, you know, they want to be able to, they don't want to be lectured at. They want to be able to get specific information, but use it immediately. And the pedagogy is really very clear on that. And so the more active learning ability that we can do, I think, is really important. So go ahead to the next slide. So one of the things that I really had to do when I came to Case Western was really think about, if I wanted to get into the medical school, I had to actually learn about curriculum development. And so this is a great book to be able to read by Pat Thomas et al. And this is kind of the six steps. But as you can see, it just doesn't go around in a circle, but obviously interacts with each other. And it's a great resource to be able to do to be thinking about how do I develop the curriculum. And one thing that became really very clear is that we obviously we had, as spoken earlier, we had the needs assessment already done. There wasn't enough into the medical school. We were not going to get more lectures and we didn't want to get more lectures. So how could we actually do that? And so to be starting to think about kind of the backward design is what did you want people to know? And then how do you assess it? And then and then develop the actual curriculum from there. And so I so I was very fortunate in the fact that at Case Western, similar to the they've had a redesign in the curriculum a number of years ago and things were in they called them blocks. And the first five weeks of medical school at Case Western was on all the big topics. So it's teaching public health, population health disparities, health system science, you know, big data use. So it's all of those big topics before they got into the cellular level and in the next blocks. And so it was really very fortunate. They already had one hour of lecture on kind of covering environmental health. And so was able to be now part of a design team. So that's a good way of getting a part of it is being part of a design team, develop the curriculum and suggested maybe we need one more lecture about occupational health and one on environmental health. And that was very well accepted. And so. so from there, we started looking at, how could we introduce this in an organic way? We wanted the students to be always thinking about the social determinants of health. And a big part of that, as we know, is where people work. And obviously for environment, where people live. So it'd be fine to go to the next slide. And so the first five weeks, they had four, what they call IQ cases. That's the problem-based learning cases. And in three of the four, we were able to introduce occupational and environmental health learning objectives. So it was very easy. The cases were already done, but prior to kind of when we started talking, these patients kind of just like dropped out of the sky. And we know that patients don't drop out of the sky. They live somewhere, they work somewhere. And so it was very easy to introduce very organically into the case that was already there, where people worked and introduced a couple of learning objectives and have the students to start to discuss, what difference does it make about where people live and where people work? There was also team-based learning. There was one on population health. So we asked that one be on an environmental exposure, lead exposure, and I'll come back to the climate change one in just a moment. So that was easy. It was already done. As I said, we had two hours of lectures. The other good part about it is that they'd already had in the afternoons in that first five weeks, they wanted to introduce all of the new students. We have 185 students per year in the class. Most come from outside of Cleveland. Get them to understand about Cleveland. So going on lots of field site visits to all the public health departments and both the city and the county and lots of NGOs and various things that they needed to learn about. All of those partners within the community that they'll be working with for four years to attack the issues of population health. And so it was like, oh, hey, how about if we have some worksite visits? So with great collaboration with the laborers union, we were able to get worksite visits into construction sites and into large manufacturing site like Lincoln Electric. And then to be able to evaluate that, we then wrote some essay questions with the environmental occupational health components as part of that to start to evaluate it. I was really privileged to be able to work with a first year medical student and part of this project, which we did on evaluation, which was ended up being published in JOEM. And we can talk about that later. But then having that evaluation and having something published in an academic journal, you know, is really important to then go to all of the other block leaders and all the folks that have the rest of the curriculum to say, well, you know, this has been really successful. You know, we've really been able to blend this really well in. We're not taking up any more hours, we're just blending it in. And so that was really very helpful to go on to our next step and you can go to the next slide. And next slide, please. Yeah. So great, great. So then we were able to approach the people that ran the communications workshops and the physical diagnosis with standardized patients with central all medical students have and said, you know, we really need some questions about work in here. And obviously, you know, they're not gonna have the full big history, but being able to negotiate with all of your fellow colleagues who are developing curriculum to say, let's think about what are the first, what are the maybe the most two or three important questions that the students need to ask. And so we were able to get that part into it. And then we were able to integrate into the other cases and other blocks. So that's the first one and two years of curriculum, other exposures and jobs into those patients and the patient identities. And then really, which was really great, was then that next leap where there is a part of the cases that they do in blocks two through six, where they have to do clinical reasoning. And so there are a bunch of questions that are always there in the case. And it was great. We ended up being able to get, you know, what else could contribute to the main problem. So this is, you know, a diagnosis that they're studying in whatever system, you know, organ system that they're in. And they have to think about the occupational environmental exposures and all the social determinants. So that was like really wonderful. So it's like that, just kind of weaving it in, not asking for more hours, you know, you just kind of get it in there. And then, so now we're kind of several years down the road. It's just not something that happens overnight. Now, I said, well, okay, so we got the first two years we're doing good, how about the third year curriculum? So there is in a didactic portion of the third year curriculum on Friday afternoons. And it was recently redone and has now a fancy name called the Science and Art and Medicine Integrated or SAMI. And so I asked if I could be on the design team. And actually there were some folks that helped to promote me to say, we need to put more social determinants of health into these cases. And so these are all case-based learning that the students do on Friday afternoons, during their clinical rotations, where they're interviewing standardized patients. And, you know, again, we said, you know, these patients don't drop out of the sky. They live somewhere, they work somewhere or they're retired from some job or they're injured now. And so let's, you know, get all of those woven into these stories so that the students will continue to remember to learn how to ask the right questions, be curious, and just be always thinking about the work and the environment as a social determinants of health. So that was my journey. And it's been great fun. It's just like, as Marion said, really thrilling. And I'll pass this on to Dr. Severi. Thank you. So I'm going to start out by talking about how I got here today and in medical school. Actually, you know what? Let me tell you about yesterday at the Sappington lecture. You know, when they talk about that Jane Doe, that Jane Doe could have been me. I went to Tufts for medical school and I did get a dual degree. I got MDMPH and it's part of my capstone. I had to do a project with what I later on found out was an industrial hygienist, although I had no idea what that meant at the time, where we did home visits to homes where they had asthmatic children to check their carbon monoxide monitor. And I was like, this is what I want to do. This is like, why? I want to go to medical school, but it was just like what Dr. McKenzie said. Only 20% of med students have heard of this and I really hadn't heard of occupational environmental, even when I had done that project. And so it was like a decade before I could find my way to make it be my medical specialty. And I think a big discussion here is like, how do we pave this pipeline of folks who want to do it? And enjoy doing it. So I'll give you kind of like two examples from my teaching experience. I taught one course to Masters of Public Health graduate students. Many of them were pre-med. And also in that session, when I kind of told them what specialty I did, they had no idea. And so I really use that as teaching this fundamentals of environmental health in public health. And so it's interesting that even in public health, there's like such kind of little visibility. And then just the fact that our health really can be used as this kind of like skeleton, like Marianne said, to teach environmental health exposures. And then most recently, in the last two years, I've been teaching a six-week course elective to medical students on climate and health. And this is kind of like another opportunity to introduce what it means to be an occ health doc, Occupational Environmental Medicine. And again, kind of echoing what everybody else is saying, like hashtag no lectures. We did, what we tried to do is incorporate interactive mechanisms. One is podcasts creating, and the other one's infographic creating. And kind of like letting them teach each other, as opposed to like billing on lecturers, or us lecturing at them. So this is, and then we wrote about it in an article that was published. So you can check that out if you want. And essentially, I think maybe I'll just kind of like, oh, and then, so it's really just to say that it's really kind of not, this is not enough, right? Like me mentioning it in a class, that's not enough. The, like what do we do to kind of address this shortage? Like I work for the VA Veteran Health Administration, and there's really a shortage of staff who are trained in occ health. Nurses, physicians, you know, other licensed independent practitioners. And this morning, I did the site visits to the Rocky Mountain Center, where they got a huge, you know, like the state is now funding them to train undergrads, and like all levels of people in kind of occupational health and safety. And so maybe I'll just kind of like leave it with part of this question for us all to consider. Like how do we pave this pipeline to incorporate more people who are interested into our field? Thank you. So we built in a lot of discussion for this session, and I told everybody, keep your discussions, your presentations short, and boy did they. They really, I really. So we actually have more time than I thought we would. So that's great. Let me also talk to the remote audience and say please put your questions into the chat. There's chat and questions. I'll try to check both. So please, you know, I'll check them and I'll ask your questions. But I'm gonna open it up, actually, and we're gonna ask the man with the mic to walk around and give the mic to people who are asking questions and then give the mic to our panelists who might answer some of these questions. Let me ask you first, just generally in the audience, how many people are involved at a medical school near them, doing some kind of teaching? Okay, so that's great. I'd say at least a third, maybe a half of people are involved. And I'd be interested to hear some of your own experiences. So now let me open it up in the audience here to the live audience to any questions you might have for any of the panelists, and then I'll go look at what's coming online. There's one back there. So pardon me if I just joined a little bit late. So how many, and I have been involved with this at the Baylor College of Medicine. They started their first course elective on environmental health this year. And I did a session with the students, about 14 students, on occupational environmental health fundamentals. So my question is how many medical schools are currently doing this in US, and most of them doing it as an elective, or is there a mandatory component to this? And is there any drive to expand this to a broader public health topic rather than environmental and occupational health? As most of the students that I engage with were significantly interested in climate change and climate change alone. Thank you. So somebody want to take this? Is someone in the audience want to answer that? So I could talk about the climate change part. Great. Yeah, so, because I said I was going to come back to it, and I forgot to do that. And you're right. The students are really extremely concerned about climate change, and we are too. The US healthcare system is a huge emitter of CO2 gases. We have to clean up our own house. If the US healthcare system was a nation, we'd be 13th in the world for emitting greenhouse gases. So there is a lot of interest within the healthcare industry as itself, and also with the students that are coming in. I think that it should be triple fold as much as you can. I think we need to have as much occupational environmental health curriculum as we can, reaching as many students as we can, because no matter what specialty you are, you're going to have to figure out what to do about work, as one of the speakers said. And then, it was Marianne, I guess. And the other thing is that what we've done at Case Western is to think about climate change. After the first couple of years that we had our first TBL, and they had to offer the TBLs on those topics in the block one, I said, we really need to start talking about climate change. So I think we're in our fourth year now of teaching about climate change through a TBL. It's specifically about climate change as it relates to population health and public health. So the big issues, because that's what block one is all about. And then fortunately, again, as I did with the environmental health topics, I have a first year medical student that's working with me on, we're figuring out how to get climate change into the rest of the curriculum in the same kind of woven ways that you can do that, that every now and then in a case, it'll be easy to put in. The cases, we'll just maybe have to add like one little thing to be thinking about, oh, the heat and humidity are increasing in Cleveland. Many people do not have air conditioning. You have a patient with COPD who is worsening symptoms. What are you gonna do about that? So somewhere in those cases, and definitely within our third year curriculum, we definitely could. We have colleagues in case there's a university school medicine has 185 students. And then also we have a learner college of medicine that's connected with a Cleveland clinic that has a five-year program for training physician researchers. And they've developed a four-year curriculum for their students on climate change. And I know definitely, some of the leaders have been Harvard and other places, Columbia. So I think that certainly about climate change, there certainly is a lot more and there probably other people could talk about it. I don't know that the statistics now, but maybe somebody else does about how many schools are introducing all the topics about environmental and patient health and obviously climate change. Thanks, Karen. And I'm gonna pass it to Judith, but just to mention that, I'm facilitating, in med school, you're facilitators, you're not preceptors for first year med students. And one of my students is working with Karen this summer to develop more climate change curriculum for the med students. So in response to the first part of your question, to my knowledge, it's not really required in medical school. And the survey we did a few years ago of the over 200 medical students showed that only 10% had heard of occupational medicine. I don't know that there's a nationwide survey of medical schools to see how many teach, but my guess would be it's not required anywhere. And what I'm hearing from our speakers is that you have to weave it in and sort of sneak it in. Like no one's saying, hey, let's talk about med, right? And so climate change is one way to get it in, but as our speaker, PJ, yesterday noted, our Sappington lecturer, that we don't wanna be pigeonholed as a climate change specialty, but it is a way to get it in there. I think it's really important that we try to figure this out and maybe ACOM can come up with a strategic plan to help us all within this endeavor. But the answer is, I don't think so. And I just saw in the news today, there's a heat wave in India and Pakistan, 122 degrees, where the question is, can humans survive this temperature? So in as much as we're not addressing it, it's coming. So a question on the chat here from Sonia Myers is what are the alumni of these amazing OCMED classes doing now? So I think she's wondering, people have gone through some of this curriculum, so your group, Marianne, is just starting, so you may not know what they're doing, but if you have any thoughts about that, or Karen, are there MED students who've gone through some of this curriculum that have changed where they're going? Yeah, mine's brand new, so I haven't had anybody finish it yet, but I do have four students interested in working with me on a research project in the summer, so I think that, and there have been other students in the class that are now wanting to do occupational environmental health research topics, so I think that's, it's visibility, but I can't claim that anybody's an OCDOT yet. Karen, anything? Yeah, well, yeah, I think the first student said that we really, when we started in block one, I think they're all still in the residency, and I don't know of anybody that's gone on to occupational medicine residency as such, but definitely, it's increasing. For example, one of the centers that I work with at Case Western is the Marianne Center for Environmental Health, and there is an award named after a graduate at Case Western who was extremely interested in occupational environmental health, and who unfortunately died suddenly not too long after he graduated, and his family set up this award in his honor that is done by this wetland center, and when I first got there, the kind of award was kind of dormant, and then after a year or so of teaching, we had two people, one each year, to apply for the award, and this year, we had 10 medical students apply for the award. We were able to give out three, and this award allows extra training and research projects in occupational environmental health, so definitely, I think we're starting maybe to see kind of the snowball part of it, so hopefully. Hi, my name's Brett Perkison. I'm a program director for an med residency in Houston, and climate change is an issue that I'm very interested in. I've done a lot of lectures for, and to me, it almost seems that it really is two subjects. It's climate change should be integrated into medical school curriculums with every aspect of that, and that's kind of one of our, should be one of our goals, and then the second goal should be trying to increase the pipeline for occupational medicine doctors, and it almost could be semi-separate curriculums, but I did have one question regarding careers is in these unique, innovative curriculums you all have designed, have you tried to go beyond introducing the process of thinking in terms of occupational medicine and introducing the students to different career routes or exposing them like a rotation to people out in the field or about what is the day-to-day occupational medicine like or sort of what your thoughts are on that? Any other questions? She's not expecting an answer. No, no, we're gonna get an answer to that. At least one. Kind of indirectly. So in the case studies, you know, that that's an opportunity to talk about how an occupational medicine doc kind of approaches this kind of a case. And the case studies are different kind of settings, you know, so it might be, you know, a healthcare worker and a medical surveillance kind of a thing, or it might, you know, so there's a bunch of different ways that you can sort of sneak it in. You know, I, one of the, when we're talking about opioids, the, I used a real case of a police officer that I had evaluated who was not being able to be returned to work because of recent opioid use. And so, so I think they were able to see, you know, some of the ways that med docs, you know, work. There's, at our school, there's also, the people you've talked to, Brett, are a special interest section in occupational and environmental medicine. So these are people that are not necessarily in the elective. There's overlap. And, and so they do have career kind of days where we talk explicitly about this as a career. Anybody else want to answer? Oh good, yeah. Did some of the hands raised, do you have, are you responding to this question also? Because I was gonna kind of bounce off of that and ask you all, some of you who raised your hand and said you are involved in in med school curriculum, do you have students rotate through your clinic? And, and can you tell us a little about that? Hi, can you hear me? This is Joe Ortiz from the Army. Number one, I think what we do at Uniformed Services University is we integrate our learning into the, you know, modules of learning. So it's kind of fitting that in. I think our module is work and health with medical students. And then we also have, you know, specialty nights for, you know, encouraging people to apply. So that helps as well. But it's kind of an ongoing, you know, medical student to interns or residents, and just kind of that personal touch. And we do encourage medical students to rotate. It's just a matter of them fitting in those rotations with all their other requirements. So you're always competing with everything else that they're required to do. But it's just a matter of grabbing a few here and there. And I think it's been very helpful. So that's at least the Army side of things. Thanks. Now I won't try to steer the discussion too much, but Judith has a comment, and then, oh, Michael, and then Judith, and then someone else. Yeah, I wanted to ask something else. You know, back in the late 80s, 90s, the National Institute of Environmental Health Sciences funded a series of medical schools with academic awards where people built the same kinds of things into medical schools in five-year grants. And there were a number of successful individuals who came out of those, but all of those programs effectively died. And it's an interesting thing to see the same models arising now with the question, why did those programs die? And I wonder whether it's worth a conversation about that before getting too far into the design so that you can build sustainability into the design of the program. Do you have thoughts about it yourself, or does anyone have thoughts about that? I had some thoughts. Great, Karen. I think that one of the things, you know, over my years, you know, obviously, I've seen great programs, and it's true, things kind of come and go. And sometimes it's certainly with the academic institutions. I've seen it because of sometimes changes of the dean, who now has other priorities, and, you know, all kinds of other things that can happen within academic institutions and things. But I think it's really up to those of us who are older and have gray hair to be able to mentor young people to take over our parts. And I think that that's sometimes maybe why things have not survived. Because oftentimes things are done because you have someone who's extremely excited and really moves it along. But getting, you know, established, you know, into the curriculum, and then keeping it going, and having a champion to keep it going is really important. So I think it oftentimes it's up to those of us to be able to, you know, mentor young people within our institutions to take all those things over to make sure it keeps going forward and improves. I think one other possibility is, you know, as it says, when the stars line up and you catch a break. So the timing is everything, right? So perhaps it's a matter of timing where there is a lot of awareness around climate change, and therefore the broad topic of environmental health becomes important. But I kind of wonder that when I looked at the curriculum at least at one or two schools, occupational health had one lecture out of 12, right? Or 13. And so I think this is a nice entree point, but as was said previously by you that, you know, yeah, I think we need to think about climate change but broaden it so that we don't lose this opportunity at this time. Thank you. Mybeck? Hi. Great talk, guys. I'm a self-professed millennial. I had never heard of occupational stuff during my MPH. I'm not in medicine, but I was really focused on epidemiology and infectious diseases, and that's how I got into public health. I'd never heard of OccHealth until I started doing a fellowship with NIOSH, and so I definitely echo what we talked about yesterday in the keynote, that branding is semi an issue. I work for MD Guidelines, and we offer the ACOM guidelines free for students and residents. I started the program, and my first thing was to turn around and look up occupational residency to try to get this program started, and I could not find very many that were titled occupational residency. So my question is, do you think nomenclature is kind of an issue? I hear a lot of going back and forth between environmental health and OccHealth and preventative medicine. Are we not getting that name message out? And then you guys also mentioned in your lecture that you are kind of sliding it into different programs that are already going on in the med school. Are there specific departments that you're working with that are teaching kind of some of these strategies and are more receptive to OccHealth stuff, and like which departments do you guys work with most closely or has been the most beneficial? You have an answer? Okay. I just like to, well my name is Dorian Kenley. I'm a fellow in occupational environmental medicine at the University of Washington, and I'd just like to riff off of her point that she just made, which was excellent, which is that at least at our institution and other places I've rotated, and I've done some off-site rotations, many of our professional colleagues and peers and other specialties kind of don't know what we do. So there can be a branding issue, and you know occupational medicine is much more than backs and knees, but how many of us just get referrals for backs, knees, return to work? That is a problem. So maybe the answer is not just at the med student curriculum level. Maybe the answer is addressing this at the level of our professional peers, colleagues, and other specialties to advocate for our specialty and address that issue of this is what we do, this is our expertise. Thank you. Yeah, and actually I'll just mention that on the chat, Sonia said maybe other groups like lawyers and other types of educators, and I forgot now what she said, but other non-docs need to hear some of the same curriculum. Do panelists have, anybody have some responses? Pune. I've been working informally with Mike Gottsfeld, some of you may know him from New Jersey, as to why the residency programs closed. There were, at one point in the mid-1990s, there were 40 some occupational medicine residencies, and we're down now to under two dozen, and one of the things that was brought up is you need champions. You know, I talked to the people whose programs had closed, and they said, you know, when the person who really promoted it within the university, Ahmed, within the university, left, retired, whatever, that's what happened to the programs. Good example would be Iowa. Another good example, Columbia used to have a fantastic residency program, and they they left. So, you know, part of it is, for those of you who are working with the med schools, and working, you know, with with residency programs, to make sure that, you know, you've got champions coming up behind you, or champions on the faculty that can help you maintain the programs after, you know, if you decide you're going to another university, somebody who can take your place. It's really that that pathway, too, is not just getting the students into the program, but making sure that the program's still there. So, I have a couple of comments. Really, really good discussion so far. One of the things I wanted to say about that whole, kind of like, nomenclature and all that, I'll just give you an example of a project that I just did. About two years ago, I became the clinical lead for the VA for the state of Pennsylvania, and what I noticed was every AHRQ Health department or section in each VA hospital in the state of Pennsylvania was doing something different. And so then, what I did was, like, I created something where, essentially, I listed every possible program, you know, that these AHRQ Health departments or sections were engaged in, and then I kind of, like, put a check mark next to, you know, what each one was doing, and you should see it, like, no two look the same. So, part of it is this kind of, like, complexity of, which is good, right? It means we can do a lot, right? But it also becomes the branding. Then, which one of those are we really doing? So, and I feel like if there's someone who can really kind of, you know, is able to brand that for us in a way that's to kind of, like, you know, plays into our strengths, that would be great. That was one comment that I had, and then the other comment that I had was about this kind of, like, the quanti- like, we also have, like, a little bit of a quantifying issue, right? Like, how many schools are teaching AHRQ Health? How many, like, who's keeping track of it? Like, who's quantifying this? And so, and then, and so that, and then I feel like that plays into, roll into, like, each kind of, like, step of the way where people can enter this is each point of entry. We talked about medical schools, but then we talk about kind of, like, these residency attrition, right? Like, you need all of that, right? You can't have people go into medical school and then have no programs to participate in, right? And you need jobs, right? So that those residents can have jobs, so then you need the visibility. And I feel like when I think about other medical specialties, a big part of that role is played by their, you know, academic college, like AFB and things like that, you know. And I just wonder, like, what's ACOM's role, you know, in kind of, like, really trying to, like, fluffing up, you know, each point of entry and being able to, you know, provide that. Anyway, those were my comments. I'll give it to Peter. Hi, I'm Peter Orris from the University of Illinois, and I don't want to stay out of, I want to stay out of the large question, which keeps coming up at ACOM every year for the past 20 or 30, which is when you're grappling with. But let me go back to the NIH model just for a moment, because I want to put in a bid for a model that we had in the early 80s with the Association of Occupational Environmental Clinics and the International Joint Commission, something we called the Great Lakes Scholars Program. And the model was related to the NIHS model, but it was on the cheap. It said, we want to buy the passion of a primary care teacher within one or another academic institutions, and we want to do it at each level. We want to do it in medical school, we want to do it during residency, we want to do it in teaching of primary care within that setting, and then we also want to do it at the nursing schools. And so, therefore, instead of buying a whole person for a hundred grand or whatever it was back then, we bought about $5,000 worth of an academic's time who does general stuff but is interested in environmental health. And then that person went to the dean and said, here's $5,000 in support. I need some time to be able to do this. And we had very specific tasks. I know exactly why it died. We didn't write it up. We saw the priorities moved elsewhere, if you will. But I would just like to mention it so we don't continue to lose it. It's something you might think about in different institutions. If you buy a little time from the dean or from the chairman of the department, and you have somebody who wants to teach this stuff, we can be very specific on it. One day I'm going to find a resident who wants to write this up, and it'll be a historical piece somewhere near Alice Hamilton. Thank you. Thank you, Peter. And actually, we are at noon, so we are out of time. I want to thank all of the speakers and all of the audience. You're kidding. We have another half hour? Never mind. I'll thank you again in a half an hour. Okay. Okay, great. Great, thanks. Oh, this is funny. I misread my own. Thanks. Great discussion. I just wanted to respond to Brett and Dr. Herbson, Dr. Ferguson, Herbson. Our Penn residency is largely funded by NIOSH, and they allot every year some funds for diversity. And what we did with that one year, and I wish I could say we did it numerous years, is we have one of our residents... We have a diversity and inclusion committee, which we've had since 2008, and we do different things with it. And one year, Dr. Wheat, I assigned her to... It was her idea, actually, to have one-day observerships for college students and medical students. And because our program is a train-and-place program where our residents are placed all over the country, we actually had our residents reach out to local schools. And we had flyers and everything, and then we had match one person with one of our residents at different locations all over the country. And because we had funding from NIOSH from it, we gave each person $100 for lunch and for transportation that came from the grant. You know, I don't know who said that these things are a lot of work, and I've also heard the theme, if we systematize things, it will be easier. You know, the lift, it's a pretty heavy lift. It's extra that you're doing. It was very successful. We did it for one year, but in answer to your question, Brett, are people going out into, you know, observing? We did do that, and it was very successful. Does anyone know what the ambassador program that's going to get started at AECOM is? Because I thought it might be something like that. Who knows? Anybody know? Yeah. Yay. Oh, wait, wait, wait, wait, wait, wait, wait, wait, wait. This is being recorded, so if you have the mic. Thank you. Our session on it actually is on Wednesday morning, so I'll put a plug in for that. So it's really a program to outreach to med students and then also PA and NP students to introduce them to the fields of our field. So, yeah, come and hear more, but, you know, we're starting essentially with lunch and learns kind of food to draw people in type idea, but then, you know, hopefully expanding from there to other ways to interact. Anyway, you can hear more about it on Wednesday morning. Can I make one other separate comment? Please. You know, I hear what you are saying regarding kind of getting out there into other specialties. I happen to be internal medicine and OCMED, but I always knew I wanted to go into OCMED. My mentor kind of suggested that because he knew I wanted to get into kind of a teaching role. You know, I've maintained my credentials in part so I can go and be in clinic with the internal medicine residents, and whenever it comes up, I'm always trying to, you know, inject that there as well. I think any of us who kind of work across both fields, the more we can kind of maintain and at least make those connections is another opportunity in that regard. But because, you know, in an academic institution, it can help. Yeah, I think family medicine is also a place where we are welcome and where I think they're supposed to have some learning objectives in the residencies on OEM. Do they still? Do we know? It's not required anymore. Oh, well. But some programs probably still have that. So, yeah. We have that, I'm just kind of, you know, through Valley Medical. Yeah, I just had a comment. I'm just going to respond to Dorian's comment. I'm Debbie Cherry. I'm the residency director at the University of Washington, and we do have a challenge with our branding and referral stream, but I've done some things like spoken to our family medicine group and our PM&R group about referrals. But one of our challenges is we get referrals from so many different specialties and from within our own institution, which is huge, and also from external community clinics. It's hard to communicate with everyone the types of referrals that we want. But like I do have, we have a talk coming up with our ambulatory care council for Harborview, which is the campus of the University of Washington where we work. So, I'll be able to address many different outpatient clinics at Harborview, but that's still only a fraction of our referral stream. So, it is challenging. Want to pass it on to Scott and then Brett. Sorry about that, Debbie. I just wanted to address your point, Kathy. So, yeah, we have an occupational health dedicated clinic, but our clinic network, which is a UW affiliate, has a very robust family medicine residency, and it's required that they rotate through our clinic. It was three weeks. It's down to two. But we partner actively with the residency director, and the consensus is it's very valuable for them. And I know it sparks some interest, certainly introduces them to the field and becomes a pipeline for our referrals, but I'm sure sparks some interest in some of the residents as well. Thank you. And then Brett, did you have? Yes. And then we'll go over here. Yeah, I was just going to add, so we're part of the University of Texas, and the family medicine residents will spend, a different resident spend each month with us in our didactic programs, and that's nice because it gives them a chance to interact with our residents as well. So, I think that's useful. The other thing that I was just going to mention is, to some of the earlier questions, is the way employee health is organized at a lot of hospitals, it's almost a separate entity from other departments. And so, I know it's beyond the scope of us in this room, it may be something to work towards, where you establish occupational medicine as a department on its own, and it's interacting with the other departments on sort of an equal basis, I think would help a lot. You know, I've seen over the years, I also did family medicine boards as well, and I have seen an evolution in family medicines acceptance among specialists has improved over the years. And part of that is with the EHRs, we're reading each other's referrals a lot more, and I think that's helpful. And so, the earlier point is, maybe working on those issues where you're reading what the specialist's coming in, but they're also reading what you're doing, and also trying to get your name out there as somebody to evaluate return to works, and other things that these other specialists might not want to, and then you become a useful commodity. And that's what I've always sort of done in a practice, because it's always been a combo between primary care and occupational medicine. Thanks. There were some questions over on this side. Well, I'm Chip Carson, and I've been teaching environmental health in medical schools, five medical schools now, for about 30 years. And these initiatives do come and go. I want to, I like Dr. Orris's idea of bribing the dean to get them started. I think that's a great idea. You can come up with $5,000 somewhere from some donor to do that. And I would also endorse Dr. Kirkland's statement that it requires champions, because unless you have a champion to keep hammering on the curriculum committee and saving that spot that you have for environmental and occupational health from some other interest that's coming in hot, you won't survive. In one of my recent endeavors, I'm in the seventh year of teaching two hours of environmental medicine to medical students at the Texas Tech Medical School in El Paso. And they get this in the first year, and they get to repeat that in the second year in some way, in a practical way, in their curriculum. They have a sort of a nonstandard curriculum there. As far as I know, we do not have data on whether or not this has influenced them later in their careers or in their practice activities, but we're trying to get some of that. What I think is important to state that since everybody's interested and recognizes the need for additional environmental and occupational health information in the medical school curriculum and exposure of learning medical students to this content, we need some sort of a national strategy group that works on medical school curriculum and can plan programmed modules that can be simply adopted by medical schools or interested faculty at medical schools who want to be the champions to get this into the curriculum. And since with things that, for example, that Marianne described with this new curriculum entry in Maryland, this is a great way to do it. There were a couple other people with questions on this side, and then we'll... Michael Malley from UC Davis. I just wanted to comment on kind of my experiences interacting with students at Davis. They had some working in my office from med school when I was at occupational health there. But apart from that, I've worked a lot with the student clinics that the students actually run for people who don't have health care, their access to health care. And a lot of the students there are engaged in things, and they invite me to their meetings and opportunity to give talks. There's also rural health interest groups, and they invite me to talk to their group. So the student groups are a very good way of engaging with the students. The other opportunity has been with the undergraduate public health classes, and they are very interested. I've done talks on whatever seems current in terms of sentinel health events and focusing on that and how to follow up on a sentinel health event. We had the world's biggest sentinel health event the last couple of years, so there's lots of opportunities to talk about that. The prior ones on vaping and things like that drew a lot of interest. It seemed it got the most response when I shortened the talk and let the students take over. That was sort of an accident, but it worked better than my long talk. So I think that's the best way to go. So anyway, there's a variety of opportunities. It seems like there's undergraduate public health majors at almost all the California State Universities, so there's a lot of opportunities to work with the public health students, and a lot of them end up going into medicine, some not. But they're often in places where they have opportunities to influence public health, occupation health events, so it's a great group to work with. All right. And one more here, and then we'll bounce back and forth. Yeah. Great. Hi, my name is Luke Meese. I'm a program director in general preventive medicine near Tacoma, Washington. My question is regarding, and you had talked about specifically, social determinants of health and getting that into your curriculum, and I'm really interested in hearing a little more about that. Kind of at what level do you address that, kind of at the patient and their community, or kind of global, and any specific resources you might recommend in teaching and kind of weaving that important aspect into what we're teaching about occupational medicine? Sure. Yeah. Go ahead. Yeah. Mary Ann, and then maybe Karen after. Yeah. Well, I think somebody asked about whether occupational medicine is being taught routinely at medical schools now, and I think no, but social determinants of health is a very important topic everywhere. It's almost like an entry buzzword when you can demonstrate that people's life circumstances, their zip codes, their opportunities influence their work, which influences their health. So I think pulling it all together, you're using something that's important, I think, to medical schools and to educators. I don't know of any particular resources. Honestly, I'm moving too fast to look much up. Anybody know any good resources? Karen, do you have anything that you would suggest, if you're still there? Yeah. Okay. Yeah. So, yeah, certainly, you know, obviously, there's a—actually, the CDC has a website on it. The World Health Organization does, if you're looking at relating it to global issues, is really important, and there's a lot of, you know, in the medical literature itself, talking about the social determinants of health. So—but I can't say, you know, kind of just, you know, one particular book necessarily or article. There are so many. And I agree that for—at CASE, that, you know, that was the, you know, area that was already being talked about and looked about for people who were teaching the medical students about population health and public health. And so—but maybe they hadn't necessarily really pointed out that work was one of the big, you know, factors in the social determinants of health. And so, you know, if it's already there in the medical school training, you can build off of that to say, well, let's really weave this in to the cases and be thinking about where people work and how they work and what they're exposed to and what the answers that need to be. So, you know, I think that's a—it's a great way of being able to do that since, like Marion said, it's really—it certainly is a big topic in medical schools, obviously, at this point. And then to get back, I think there was some discussion about working with all of the other residency programs and things. And, you know, I teach at the—at CASE for the—at the family medicine residents and so have a kind of a three-year curriculum on occupational environmental health topics for them to be able to be thinking about. So, you know, I think that that's always very important, and it sounds like a lot of people are doing that. And it's another way of getting the people to really realize about the role that the occupational medicine physicians do. So I think it's really important. Thank you. There were questions over here. We'll go that side, and then we'll go back, bounce back and forth for at least another hour or two. Sorry. I'm Andrew Jeremijenko. I'm from Australia. So it's slightly different in Australia to here, but generally we do medical legal work. There's not a lot of environmental medicine. We used to have more doctors, occupational physicians in hospitals, but they've sort of all left, and most of them are really in the medical legal world. I wanted to reintroduce doctors back into hospitals, and I think you guys still have a lot of doctors back in hospitals because it gives you an opportunity. I've worked with emergency departments for 10 years, and I've found that by the time you get a patient in medical legal injury and you can't do anything, well, if you can do it at the front end when they first get injured, get them back to work soon, it makes a big difference. So the simple concept is take the hospital employee injury, employee sort of service, put it next to the emergency, allow them to send all the work injuries to the employee service as well as dealing with the employee issues, and that way you can have a rotation of residents into there. But I don't know, is that sort of a thought that anyone else has thought about? Because I find in Australia we're all in the community and we're not getting in touch with the residents or the medical students, but if you're based in the hospital and you have a service there and a centre of excellence for occupational medicine that not only just does the employees but also does all the work injuries that comes into hospitals, that that way you can have a rotation of your medical students and of your residents through that program. Somebody want to answer that? Is there an answer or a question? So answer and then we'll go to the next one. Great. I think that's a great comment. I would add to that another aspect that we can provide to hospitals is as an adjunct to things like discharge planning for people who are coming out of the hospital, going back into a job at some point, the people in the hospital have no clue what to do with that issue, and we can be very helpful in that. So pitching occupational and environmental health as a clinical service within the hospital may get some purchase, depending. Questions? Yes, over here. Hi, I'm Athea. I'm from the Yale Occupational Environmental Medicine Program, and I just had a comment on visibility. I know we're talking about medical students here, but I think we should all think about, you know, with the scarcity of board-certified occupational and environmental medicine docs, that the backbone of a lot of our practices are, you know, done, the work is done by PAs and MPs, and so in terms of visibility, I think it's also important to kind of make that connection if you have schools of nursing or PA programs to kind of, you know, introduce them also to that and get them to rotate through your clinics and show them that experience as well. Really good point. I did an interesting talk for the Ohio Bureau of Workers' Comp. They have a symposium for all of their providers, so it is, you know, it's not just physicians. It's nurses. It's PAs. It's athletic trainers, and I did a talk on returning workers to work in hot environments, and also, actually, they wanted temperatures of cold environments, so kind of climate change-ish, you know, and then I got a lot of climate change into these guys, and, you know, it was fun. It was a big audience of all kinds of people, and the one word I wanted them to remember is acclimatization, so. Yeah, just a comment to our friend from, colleague from Australia, your point. So our Occupational Medicine is part of Emergency Medicine Department, the larger Emergency Medicine Department, and about 25-plus years ago when Occupational Medicine, say, sort of formally started, and some of the pioneers are sitting in this room, Judith McKenzie. So at that time, it was felt best that it would coordinate best with Emergency Medicine, and so we have a good relationship with the ED, and, you know, they see our after-hour injuries, and a good follow-up with OccMed. Give the mic to Pam. Please. No, I also had a kind of a comment and response. For the military, we do have a lot of that same, as you're saying, most of our positions are within our hospitals and treatment centers. I think the one challenge that we've seen, though, when you kind of work for that hospital or treatment center, we tend to get pushed to only take care of what's inside that treatment center, and there's not the great recognition that our main mission is really outside of those four walls. So that can be a challenge in that setting at times. Thanks. I'm going to, just before this next comment, before the next comment, I'm just going to read the chat, if I can, without my computer glasses. So, two comments. One, the power of lively, engaging, enthusiastic instructors to help generate interest can't be understated. Another comment, another medical student-oriented activity is ongoing by the Michigan component. For seven years, we have sponsored a summer OEM internship with a stipend, which is open to students in Michigan who have completed one or two years and is timed for their summer off. It includes clinical experience and a group project, which are presented at our annual meeting, and several of which have been published in J-O-E-M. That's from Tony Burton. So, something for other components to consider. Okay. Hi, I'm Ken Lankin. I'm the enterprise medical director for Jefferson University Hospitals and University, and I wanted to bounce off what Judith Green-McKenzie had just mentioned about weaving your way into an opportunity. I think there's lots of them. I just wanted to share one recently where people know who we are, but they think that, like, basically, we're in charge of COVID and needle sticks. And so, Jefferson has this wonderful program. I'm new there, so I'm really just learning. And they have a program for second-year students who are about to go on their clinical rotations. They have a whole day dedicated for all kinds of people to come in and get people prepared for their clinical rotations. So, they asked me if I could do a talk about COVID and needle sticks. How much time do I have? They said 45 minutes. I said, okay. Is it okay if I talk just a couple minutes about what occupational medicine is? Because they probably never heard of it. They said, yeah, that's okay. So, it was great. It was a big class, 173 people or so. I took five minutes and talked about COVID. I spent 10 minutes on needle sticks. And the rest of the half hour, we talked about occupational medicine. And had those two pictures. That's great. All right. Hi. I'm Dr. Rhea Fajardo. I'm from the Philippines. I'm the president of the Philippine College of Occupational Medicine. And it's great hearing everybody's perspectives, your thoughts about how occupational medicine is very important in integrating into the medical education. And we have a similar setup also in the Philippines. It's not yet required in the medical education program. It is also quite, we need to also somehow advocate for ourselves within the professional, medical profession, within the different specialties. And it's very great to hear that maybe the American College of Occupational Medicine, Occupational Environmental Medicine, can also be one of those advocates to really push for how it is important for this practice in the real world, in the world of work. And we can't wait to collaborate with this great organization. And we hope to also learn a lot from everyone. Thank you very much. That's wonderful. Thanks. Yes. So I just wanted to share our experience and how we kind of get internal medicine involved. So if you talk about disability and disability paperwork, everyone will show up. And then because it's like everyone in internal medicine hates that, and they don't know how to do it. And, you know, you could be there to kind of help them and walk them through that and give them confidence to do it. And that's kind of how we weave ourself in and say, okay, so now we help you and you're doing disability. Like these are the other things that we can do. So if you say, you know, we're having a talk on disability paperwork and how to fill that out, I think a lot of people will show up and then you can kind of give your spiel from there. I can attest to that because I gave a lecture to the residents in our hospital called those F-Informs. That is a great title. Just one comment on kind of attracting mid-career physicians a lot. One comment on kind of attracting mid-career physicians. A lot of physicians encounter occupational medicine for the first time in practice. They have somebody, you know, a client or in their practice that needs that work. And they get engaged in it at that point. And there needs to be a better path for those people. I had a student from UC Davis School of Medicine who is now a family practitioner down in Ventura. And he wanted to do occupational medicine. We discussed a long time how he could do that. Really the best thing would be some kind of added qualification to the family medicine residency. That is an official. There's no such thing as that, but something like that, you know, or that would be an added qualification to multiple, you know, primary care specialties would be a great way of getting people into occupational medicine because it doesn't seem like, you know, that we hit that audience very well at all. Peter. Just while we're all sharing, let me put in a plug for morning report in medicine. Kathy will recall with about 35 years of general internal medicine at County Hospital and with the chairman of the department and myself being the only two people in the room usually for morning report or regularly, shall we say, for morning report, it has an amazing chilling effect just to ask, so what did the patient do for a living? And the house staff very quickly learned not to be embarrassed in front of the other 30 people there because they don't know the answer to that question. Only one problem with it. When you stop going, they stop being chilled about it, and they stop orienting that way. So I don't know how you propagate that. I mean, even after all those years, there's no carryover after that. So I do that with my little small group of eight students, first-year students, when they're talking about cases. So maybe they'll remember. I don't know. Actually, Karen did look. We're almost out of time. Oh, deja vu. Okay. Read Karen's and her student Dr. Garg's article. They looked at some results of some of their initial work putting this into the medical school curriculum and what they found out. So I'll just put a plug in for her article and Dr. Seberry's article. All right. So let's give a hand to the panelists and the great audience. Lots of talk. Thank you. Come to our meeting tonight from scratch. It's only a half mile away. Thank you. Thank you. Thank you. Thank you.

occupational health

environmental health

medical school curriculum

panel discussion

teaching challenges

social determinants of health

integration of health topics

case studies

student understanding

climate change

public health

career paths

credible sources