All right, we're going to give everyone a few minutes here to hop on and join, and then we'll get started. Great, well, hello, everyone, and welcome to ACOM's webinar, Complimentary Pathway for Achieving Board Certification in OEM. My name is Nikki Hoffman, and I'm ACOM's Associate Education Director, and I will be your today's moderator this evening. If you have any additional questions outside of this or following this webinar, please don't hesitate to email educationinfo at gmail.com. Now before we get started, I'd like to go over a few housekeeping tips. There are two features available for communication with the panelists and other attendees. You may post general messages in the chat feature. Messages can be shared with either the panelists or all participants. Use the drop-down box to select who you want to share your messages with, and go ahead and give it a try by introducing yourself to all the panelists and attendees today. Let us know your role and where you're from. If you have any questions, on the other hand, you should be submitted in the Q&A box. The panelists are monitoring this box for questions, so please be sure to post all your questions here and not into the chat box. If you're not familiar with ACOM, we are a membership organization that promotes the health and safety of workers, workplaces, and the environment through education, research development, public policy, and advancing the field of occupational health. Before we get started, just a reminder that we're recording today's session, and an email link of the recording will be sent to you, as well as it will be posted on ACOM's Learning Management System. If you haven't already, please join us at AOHC 2024 in Orlando, May 19th through the 22nd. For registration and more information, visit acom.org backslash AOHC, and we hope to see you in Orlando. We are delighted to have Drs. Levine, McKenzie, and Perkison join us for today's faculty, and I'm going to do a brief introduction. Dr. Levine is a professor of occupational and environmental medicine at the University of Texas at Tyler Health Center, and provost emeritus. He is board certified in both internal medicine and occupational medicine. He serves on the board of directors for the American Board of Preventative Medicine and is currently the vice chair for occupational and environmental medicine. He was the program director for occupational medicine residency at UTTHSC from 1994 to 2017, and a recipient of the 2021 ACOM Lifetime Achievement Award for academic excellence of research in OEM. Dr. McKenzie is an occupational and environmental medicine physician and epidemiologist, and fellow of the Royal College of Physicians of London and the American College of OEM. She serves as a medical officer at the Occupational Safety and Health Administration and is professor at the University of Pennsylvania School of Medicine. Author of over 160 publications, Dr. McKenzie is listed among the top 10% most cited preventative medicine physicians. She is passionate about graduate medical education, health and safety of workers and communities, and environmental stewardship. Dr. William Brett Perkisons is an assistant professor at the University of Texas School of Public Health and in the Department of Environmental Health Sciences. He's obtained his medical degree at UTMB Gavelston and completed residencies in family medicine at Baylor College of Medicine and Occupational Environmental Medicine at the UT School of Public Health. He is the program director for the Occupational Environmental Medicine Residency Program at the School of Public Health and regularly has complimentary pathway residents as part of the program, in addition to between four to five residents in the traditional pathway funded by either NIOSH, N-I-O-S-H, or private donations. We are glad you are able to join us for today, and we're looking forward to another fantastic webinar. I will now go ahead and turn it over to Dr. Levine. Welcome, Dr. Levine. Thank you, Nikki, and we'll swap sharing slides here. Just give me a moment. Wonderful. So, thank you so much for that introduction. I really appreciate that. I want to extend my thanks to AECOM and to you, Nikki, in terms of helping us organize this hopefully very timely and valuable webinar for the membership of AECOM, and certainly I want to thank my colleagues on the webinar for inviting me to be a participant, Dr. Perkinson in particular, who thought this would be a very timely topic, and I certainly agree. So, with that, I want to begin by really just introducing the complementary pathway and having the audience understand that the complementary pathway to occupational environmental medicine certification really is a construct of the American Board of Preventive Medicine. It's not the equivalent of a residency pathway. It is not a specific pathway sanctioned by the ACGME, as you'll hear later on, but rather it is a way that allows individuals who are interested in becoming certified by the American Board of Preventive Medicine to be eligible and to basically sit for, or the term used by many individuals is challenged, the actual exam, the initial exam to certification in preventive medicine. So why have a complementary pathway? Well, when new certification comes into being, and that's a topic for another discussion, but when new certification comes into being, very often there is a timeframe that allows physicians to use their practice experience to come into being eligible to be certified in that new specialty area. A lot of people refer to this as grandfathering, but usually that's fairly time limited. Sometimes it's five years, sometimes it's 10 years, but eventually the opportunity to, based upon some level of practice experience, become certified in a new specialty is actually limited. There's a time limit to that grandfathering period. Well, that's certainly true in occupational and environmental medicine. That is, it's not a new specialty. It's been around for quite some time, well over 50 years, closer to 75 years actually. And a number of years ago, it was decided that there were still individuals who, mid-career, were very interested in shifting into the preventive medicine specialty of OEM. And it was, in a manner of speaking, a compromise to traditional grandfathering, where you could just simply list all of your practice experience and then qualify to sit for the examination, but not necessarily have to go back and do a complete residency program, if you will. So it's somewhere in between, but it really is intended to create an avenue to accommodate these physicians who have an interest in entering the field from a mid-career standpoint. So what are the key eligibility requirements? So I'm going to cover those in two components here. The first is, what is the necessary training to qualify for or to become eligible for sitting for the OEM examination? Well, what the board looks at is certainly that the individual has two years of clinical training, including 10 months of direct patient care. And that training would, like in a residency pathway, need to be qualifying ACGME accredited training. Now, there's a lot of discussion about what is direct patient care, and you'll hear more about this perhaps from Dr. McKenzie later on, but the ACGME certainly identifies direct patient care as ambulatory and inpatient experience involving the diagnostic workup and treatment of individual patients. So that has to be in the candidate's past in order to be considered eligible for taking the examination. Additionally, one year within an ACGME accredited OEM residency training program is necessary, including at least eight months of direct patient care. Again, we can certainly talk about this in a bit if people have questions, but the decision as to the direct patient care requirement, the board actually defers to the program director that is hosting this trainee in their accredited residency program. Mind you, these trainees are not necessarily considered to be ACGME accredited residents. They are going through a program in a residency as other learners, and we look to the program director to say whether or not in the course of that year they actually met the direct patient care requirement to sit for the ABPM exam. The other eligibility requirements certainly include the MPH or equivalent master's or doctoral graduate degree with the requisite course content that includes the five core areas that we are all generally very familiar with, including epidemiology, biostatistics, health services administration, environmental health sciences, and social and behavioral sciences. Furthermore, two years of occupational and environmental medicine practice within the previous five years are necessary. So the candidate has to demonstrate at the time of their application that within the prior five years, they have two years of practice in occupational and environmental medicine that qualifies. And again, we can go into more detail later if interested as to how this decision is made and what constitutes practice of occupational and environmental medicine. One caveat to that two years is that the time spent with the residency program that one year does not qualify as a practice year in the previous five years. Finally, the individual, like every other candidate through a residency pathway or otherwise, has to have three letters of reference, at least one of which comes from an ABPM diplomat certified in OEM. So the qualifying practice activity, this two years out of the previous five years, is separate from or non-concurrent with time spent with the residency program. Moreover, the qualifying practice activity has to show experience with a range of OEM competencies, the typical knowledge and required, the knowledge that's required and the tasks performed as outlined in the exam blueprint. And that is also, you can look at elsewhere in, let's say, you know, some of the recommended competencies by ACOM, as well as certainly the competencies outlined in the milestones from ACGME in our specialty. Applicants have to describe their practice activities in the application, and they need to have an attestation from their supervisor to verify those practice activities. Applicants also need to ensure that the majority of the clinical work that they're proffering toward meeting the practice requirement, those two out of the last five years, is comprised predominantly or a majority of OEM activities. So I don't want to reiterate all that I've just said, so I'll go through this slide very quickly. But it just makes a brief comparison between the complementary pathway and what you'll hear about more in just a minute as the residency pathway. One of the things I do want to point out here that I have not mentioned previously in this slide is if you look to the first column under residency pathway, you will see in the last two rows, this qualification about one year of OEM practice within the previous three for someone going through the traditional residency pathway. That is only true if a resident is applying more than 24 months after they complete the OEM residency. They have to demonstrate some practice activity. And then the same is also true about the letters of reference. If you're applying more than 24 months after your residency program, at least one of those has to be written by a physician currently certified in OEM by ABPM. Otherwise, you wouldn't necessarily need to secure letters of reference if you're coming out right out of residency. It's the attestation of the program director that counts the most. So with that, I conclude the official requirements as they stand today for the complementary pathway. And I'm delighted to turn the podium over to Judith McKenzie. So let me quit sharing my slides here and the floor will be all yours, Judith. Thank you, Jeff. I'm going to bring my slides up now. OK, good morning, everyone. And to echo what Jeff said, thank you to Brett and also Jeff for inviting me to help with this webinar and Brett for actually thinking about it, thinking of it, and to Nikki and Akon for their help in executing. I am the past chair of the ACGME Preventive Medicine Review Committee. I was on the committee for six years and I just recently cycled off this year. I have no conflicts to report. I'm going to talk to you today about ACGME Review Committee membership, talk about the ACGME residency requirements for eligibility, outline the current ACGME residency pathways and discuss the meaning of other learner, because I think this is where a lot of program directors may have questions about actually implementing the complementary pathway within their program. So the review committee consists of various stakeholders. The ACGME staff include the executive director, associate executive director and the accreditation administrator. There's a chair, a vice chair and a resident member, and the chair and vice chair are physicians, preventive medicine physicians, and the committee consists of members, physician members from all three specialties. So OEM, aerospace, GPM and their ex-officio members, which includes the American Board of Preventive Medicine executive director, as well as the Osteopathic Board of Preventive Medicine executive director. And we have meetings twice yearly. There is various communication amongst the stakeholders and there's also a public member. And we also communicate throughout the year if issues come up and we may have ad hoc meetings throughout the year if issues come up. So how is a resident eligible? Jeff went over some of this, but a PGY resident must have had at least 10 months of direct patient care in patient outpatient settings. The traditional program is two years in length. However, residents can enter in the second year, so the OM2 year. For residents to enter in the OM2 year, again, they need their clinical time, the 10 months of direct patient care in and outpatient, plus at least 50% of MPH requirements completed or equivalent degree. And to enter the OM2 level, they have to have completed a prior ACGME accredited residency. To be considered a resident who's completed a program, the MPH or equivalent degree must be completed, and also graduate level courses within five content areas, which we refer to as the core courses. So these courses have to be within your MPH or your other degree that's approved by your program director. And they are, as you can read, epidemiology, biostatistics, health services, management and administration, environmental health and behavioral aspects of health. And if there are questions about whether your course meets the requirements, you can discuss this with the program director of the program that you're applying to and they can help you figure it out. There's for each resident must have at least four months of direct patient care in occupational settings per year. So over a 12 month year, four months of those must be direct patient care in occupational setting. Now, there is a newer 36 month format, and I think I'm not sure how many resident residences have started this. I know Dr. Sharif has started this and has been successful. This 36 month format incorporates the PG-1 year. So someone can leave directly from medical school and enter occupational medicine residency if the program director has arranged arrangements such that they can do their PG-1 year with their 10 months of direct patient care and the two years which are required. And the program director has to oversee all three years. So if a program switches from 36 to 24 month format, they can easily switch back and forth year to year. So once you switch, then you sort of become a 36 month program. But if later on you do want to switch back to 24 months, you can apply for that. So it's an application to the ACGME and the review committee reviews it and approves it. But you can still recruit residents into a 24 month program even as a 36 month program. So it doesn't mean that you cannot continue the traditional 24 month program that you've been used to. I also wanted to mention the training place program at the University of Pennsylvania. Again, as Dr. Levin pointed out, the complementary pathway for mid-career physicians. This is designed for mid-career physicians, although this program also has a traditional two year track with rotations done on site. It is an ACGME accredited program. It is not the complementary pathway. I think sometimes people may get confused and think it is, but it's ACGME accredited. Physicians train at vetted select clinical sites where they practice. So it's called a train in place program for that reason. The components include competency based training structured around subject area rotations, mentor projects, and site visits to the training site locations by program faculty, three to four per year. The main outcome measures are the same as other OEM programs, ACGME milestones, ACOM competencies, ABPM exam performance, diversity and selection, placement of graduates, and number who remain in the field. There have been over 106 graduates since inception, and we actually have trained a few complementary pathway trainees, less than five, but all the expectations were the same, curriculum was the same, they went through the same process as other residents in the program, and they have gone on to do very well. Now, other learners. I have a side of other learners because this has come up in the past. Will the ACGME have an issue if there's someone else within your accredited program who is not a resident? They would be referred to as an other learner. An other learner can be a complementary pathway trainee, a subspecialty fellow, advanced practice provider. The ACGME stipulates that when the presence of other learners has interfered with the resident's education, it needs to be reported to the DIO of your institution, and residents may also report an interference during their annual survey. Residents get the annual survey, which you're familiar with, and if there is an interference, they can report it, but I just want to make sure you understand that if it's interfering with their training, and I think a lot of residency programs have probably had other learners who have integrated quite well and have worked out quite well, so the ACGME does not necessarily tell you you cannot have other learners, only if they interfere. Back to Jeff's point, the complementary pathway is an American Board of Preventive Medicine construct. It is not under the ACGME, and the ACGME meets regularly with the executive director of the ABPM, so our review committee meets with the executive director of the ABPM. We understand that the complementary pathway exists, and the only issue would be if an other learner, so to speak, interferes with training, and this will be followed up by Brett, who actually has had residents in the complementary pathway, and he can tell you more about it. Thank you. I'm going to unshare. Okay. And Dr. Perkison, I know you wanted to relate and share your experiences of utilizing the complementary program at your university, at your program, so would you mind giving a little more information about that, and then we have had quite a number of questions come in, so why don't you go ahead and give that broad overview, and then we will get to those questions shortly. Okay. Sounds good. Thank you, Nikki. As was previously mentioned, I've been a program director for the last five years of the University of Texas School of Public Health Occupational Environmental Medicine Residency Program. We've been having complementary pathways really pretty consistently, I'd say, for the last six years. We haven't been doing that via really any, only really through, solely through word of mouth. We haven't advertised for that. We do a lot of networking in the Texas and Gulf Coast areas, and people are aware of that, and so we've had some really qualified applicants really without advertising for it. When someone comes up that is interested in the program, we've been taking one resident per year as a max. We feel like we can absorb that into our administrative section pretty well without dragging down other aspects of the program, and really what we do is we check three aspects. We want to check the credentialing of the program, of the applicant, that they did complete the required number of residency years in another specialty. We check their MPH credentials that they've got, that they've got an MPH, and then I think a very important part is looking at the clinic environment that they've been practicing in, and to meet those requirements of two of the last five years in a true occupational environmental medicine setting, whether in direct patient care, or in project development, in sort of a management level. We really want to make sure that the applicant is going to meet the criteria when they apply for their board certification. In general, when someone has done an MPH, we require really four, five core courses. In general, we need them to do a course in toxicology, fundamentals of industrial hygiene, clinical occupational medicine, and then our routing didactics for the year, occupational medicine practice. So, we want to make sure that they have the time to be able to do that. We do allow those courses to be asynchronous, the four, the five, so that even classes that are given during the day, they can be recorded, and they can take those, because we do acknowledge they've got a regular job that they're working, and then really just that Friday morning didactics is what they need to be present in person. We really treat them as if they're one of our residents. We absorb them. We send out notices to our events, to our educational events. They're part of that. We integrate them into that, but we do take special allowances, because they are working full-time. They're not required, like the NIOSH trainees, to attend all these events. And in general, these residents really offer a lot. They offer a lot of depth to our programs. Many of them have had years of experience in both the specialty and occupational environmental medicine. I think they add, there's a certain esprit de corps of having more residents than we normally would, you know, to go to add on an extra resident, and I think it's really, really enhanced our program. A couple of my thoughts in brief is that if you add more than probably two residents to your program, that begins to erode into just kind of the routine administration of your overall residency program, and probably additional administrative support is needed, at least in my own experience. And lastly, just to reiterate, that this is not an ACGME spot, and we want to prepare them for the boards, but whether they pass or they don't pass, it doesn't count against the ACGME pass rate for the residency. So really, really think very highly of it, and I think as we go forward as an organization, I think this has a lot of potential to continue to expand our specialty. So I'll pause there. Thank you. All right. Are you guys ready for some questions that we have come in? Awesome. All right. So our first question, what is a candidate who's had three or four years accredited training in an alternate ABMS specialty, general surgery, for example, but has been working in occupational medicine exclusively for several years? Would this person be eligible without a year in an ABPM affiliate program? So, great question. I'm certainly happy to try to answer that question to the best of my ability. There was a period of time, a prolonged period of time, that occupational medicine through the ABPM had what was called an alternate pathway. And actually, the alternate pathway really required that physicians graduate from medical school many years ago. I believe the date, the actual cutoff date was either 1984 or 1983. I think it was 1984. So if you graduated from medical school in that year or before, you could come through the alternate pathway for an extended period, essentially, through a practice demonstration alone. That alternate pathway actually closed a couple of years ago. So that is no longer available. To the question itself, there is not currently a pathway to initial board certification in this specialty without demonstrating the training requirements I outlined earlier, which include one year within the walls of, as an other learner, an accredited ACGME residency program in the U.S. I don't know if my colleagues have some additions to that. It is a question we get often. But, unfortunately, this was sort of the compromise, if you will, of the complementary pathway to only require one year with a residency rather than a full residency program. All right. Thank you for that. Could any of you guys elaborate and outline how eligibility would work for an occupational physician trained abroad? Could you demonstrate the competency requirements within a U.K.-based program, or do all these requirements have to be fulfilled in the U.S. practice? Additionally, I think a two-part to that question is can international students participate in this? Again, since this is a board eligibility question, I'll try to answer this one. But I encourage my colleagues, please pitch in as you deem fit. So, this is a question that comes up periodically. These cases are really handled on a case-by-case basis through the board. So, it's very hard to say to an individual, if you do XYZ, you will be eligible to take the examination. That is actually one has to actually enter the process or vet this with the board before they actually can go through a pathway like this. What I will say is that when we consider these individuals, we do try to get as much information as possible to match up equivalencies with all of the requirements that currently exist, typically through the residency pathway requirements here in the U.S. One thing that may be missing is that that candidate from internationally would actually have to demonstrate training in some sort of program, let's say in their own country, that was an approved occupational and environmental medicine residency program. Furthermore, very often, they will have already required certification in their own certifying organization before making application here in the United States. One additional point is if the intent, obviously, is to then practice occupational and environmental medicine in the United States with certification from the ABPM, the ABPM does require to maintain that certification that you hold one, that you hold at least, that you hold an unrestricted medical license in at least one of the 50 states of the United States basically. I may add in terms of the residents at ACG, MedCredit Residency Pathway, the ACGME program requirements indicate that, and I'll quote, an exceptionally qualified international graduate applicant who does not satisfy eligibility requirements, meaning going through an ACGME approved residency in the U.S. or Canada, certification body in Canada, who does not satisfy the eligibility requirements listed, but does meet other additional qualifications, may be accepted through this exception. And the other qualifications would be evaluated by the program director, resident selection committee, approval, so on and so forth. So there is a way for international graduates to enter an ACGME approved residency program. I don't know of any residents that have done this. It sounds very complicated because then once you complete the program, then you have to think about board eligibility, which I would think might be something that you'd be interested in, one would be interested in, but I wanted to bring that up and I will place the requirements in the chat in case anyone wants to refer to them. I hope that didn't confuse things more. I'll also add that, as you can see, it's sort of a two-step process. So there's acceptance to a program and then there's acceptance by the American Board of Preventive Medicine to be able to sit for the boards. And so a lot of what I felt like was important was to set applicants up to succeed and so that they meet all these criteria that they'll pass the boards. And so one is that clinical experience and make sure that that's truly an occupational medicine. And then thus far, we've certainly had applicants and residents from all over the world that have completed medical schools, but thus far they've only done residencies, U.S. accredited residencies. And as Judith mentioned, that includes Canada. There's also other parts of the world, for instance, like the American University in Lebanon is another one that is recognized as a U.S. accredited residency. But thus far, we've kept that because we want to make sure that that is accepted. As this evolves, perhaps, maybe we'll try to go further than that. But that is one of the issues that we face. Okay. While we're on the topic of international learning, we have a medical student with us from Pakistan having a M.B.B.S. degree. Is there any program they can join from a distance learning basis? I'm not familiar with that accreditation, if y'all are. It's the British equivalent of the M.D. degree. I think that still goes back to completing the residency or internship residency here in the U.S. Okay. If I understand the question correctly, I'm not sure it's what do I need to do to qualify for a program or qualify for board eligibility, but are there distance learning, perhaps, opportunities in OEM? I would think, I mean, that depends on programs and other entities. But those do exist, for instance, but not complete, only partial, right? So, you could certainly work on a conceivably an MPH degree abroad, but it's incomplete, right? So, if the ultimate goal is to sit for the board in the United States, then you would have to either meet those equivalencies or have to come here and do training in the United States. Okay. The one-year supervised postgraduate training and residency pathway specifically refers to an internship, not the OEM residency. Correct. Okay. That's correct. You can have done a residency in another specialty. And if you have been working in clinical practice, no matter what your background, you know, is, you're technically eligible to apply for the program. What would be a better option for a licensed physician who has been working in a private occupational medicine clinic for two years, completed an internship, but no ACGME residency? Would that person be eligible for a complementary pathway? I guess, just from my, you know, Jeff, let me know if that's correct. But unless you've done the two years, you've completed residency, wouldn't be eligible with just an intern year. In a number of ways. You'd have to do some sort of PG1 year in an ACGME accredited residency. That's still required. That's one of the eligibility requirements for the complementary pathway. And again, the complementary pathway is available to those individuals who've done a year in OEM with an OEM accredited residency. So, the short answer is, without doing anything in an ACGME accredited residency, other than an internship, that person probably would not qualify without additional training. I have a comment. So, the question is asking, I think it got, it disappeared, but I'm going to try to reread it. So, this person has done an internship. So, they would be eligible for the train in place program, which would be two years in length, which would involve getting the master's or other degree. And they have a training site. And if it's vetted and acceptable, then they will be eligible to apply for the ACGME accredited train in place program. And it would be two years plus the master's. So, there is eligibility, but there will be work. And your occupational medicine site, if it's vetted and accepted, could be your train in place site. Okay. How can a certified family medicine specialist of 10 years currently working in occupational medicine setting for five years be able to apply or to seat for certification? I think the answer is similar to what I just said. And in terms of being eligible for the train in place program, having completed a full residency, the requirement would be to complete one year of the training place program, assuming your clinical site is vetted and approved. But in addition, you would need the MPH or other equivalent or equivalent degree. And Brett and Jeff, you may want to speak to the complimentary pathway for this person who has completed a family medicine specialist. Yeah, I'll just add for my input that that's, it's much more doable now than it was a few years ago because MPH programs are more available online. So if you didn't have an MPH yet, you could enroll in an MPH program. You could take that on your own time, particularly those requirements, at least that our program recommends there are really requires the specific programs I'd outlined in addition to the MPH degree. And then you could, and then integrating in with an occupational medicine program, you could be able to eligible to sit for your boards. So you could do that really full time. We really like, we look for an applicant who's able to be present at least for the Friday morning for two hours on Friday mornings for the actual classes to interact. And other than that, you can do most of it remote. And what we found is that you need to have that at least at a minimum, because you really need to interact. You need to learn from people. I do feel like a complimentary pathway resident without having kind of the full immersion in these different rotations, it's a little bit of a disadvantage in that you're not getting all the experiences you would to be able to answer all the board questions. But I think with hard work and with diligence and with that much of interaction that you can do it. And yeah, it's more possible now. Yeah, so I think in essence, the person who asked that question would be eligible to go either the training piece route, but definitely the complimentary pathway route. But as Brett said, consider figuring out your MPH or your other master's degree. There might be one other slight option shortening the timeframe. So it would still require completing the MPH degree. But for a person who clearly was already trained in family medicine, board certified in family medicine, meaning that they would have completed a family medicine residency program at some point in time, they could be considered for what's called an OEM-2 position within a residency program that would shorten the timeframe they would have to spend in that residency program. But that would be the only other potential pathway that they could be considered for. Nick, it was just also, I might wanna add, I wanted to add just before the session ends, for those of y'all that are contemplating entering this program and causing more stress in your life, that what are the advantages of getting board certified? And I think one of them, just simply going through the program, even as a complimentary pathway residency, gives you a foot in the door for some opportunities that you might not normally. We have a lot of rotations in different corporate sites. Even if you're not able to do that, we still have field trips. We have evening events where you're networking with those individuals, and you're learning the language of practice for large employers that will make you a more viable applicant. And then two, the ultimate goal of getting board certified in AECOM, it is, again, getting your foot in the door. It's a chance to interact with other board certified specialists across the country, and really enriches your opportunities. You can certainly do that without board certification, but I think that really enhances that and opens up a lot of doorways. And I'm certainly glad that I did my family medicine residency, and then did occupational environmental medicine residency. It's been a very fulfilling career. So I just wanted to put that in there that I would vouch for it being worth the effort on that. And we're glad that you're attending this today. Yeah, and we will probably only, we won't be able to get to all the questions today, but we are going to do our best to keep continuing on. And if we do not get to your question, we will try to follow up with you after. But here's another one. For those leaving med school and going into residency for the first time, would it be who've won to complete the first specialty in internal medicine or something else before applying to the SAP for OEM? I mean, it's a lot to ask for two years, but I know that in my own personal experience, I have been in departments of family medicine and occupational medicine, at times doing all primary care, at times doing all occupational care. And it's given me a lot more latitude in my career. And I would say it was definitely worth that. It gives you a little bit more latitude as well as more clinical experience. You can focus more on the occupational medicine aspects of it and not so much the clinical care if you do those two extra years. But that being said, we've had plenty of leaders that are flight surgeons and others that have not gone on and completed residencies. It's quite possibly a very proficient clinician without it. That's good. And if I heard the question correctly, when should you apply? And I think it depends on the program, but I think if you are interested in a program and you apply ahead of time, I think, or even let the program director know you're interested ahead of time, especially with funding being so limited, I think that might be a good idea. Yeah, I think it depends on the program. And I think if you are interested in a program and you apply ahead of time, Dr. McKenzie, I believe this question is for you or you would like to answer this one. Would a PhD in basic medical science example and experimental pathology count as the equivalent of a MPH assuming sufficient training in the biostatistics? I can answer it generally. We have had PhDs in our program, but they have to have completed the five core courses. And it talks about an MPH or equivalent degree. It has to have some element of public health to it. Basic medical science is certainly a science PhD. So as long as the core courses are included, but before I say yes or no, I think this is something on a case-by-case basis, you'd probably have to discuss with your program director so they can go through the syllabus to ensure that your other degree is acceptable. And also maybe even communicate with the ABPM because there would be final say as to whether you can sit the boards or not. So certainly a PhD with a five core courses and enough public health bend would be fine. That's a general statement. Specifically, you may have to go on a case-by-case basis with your PD. Great. Next question. We have a program director from Canada who has still confused between the train and place versus the complimentary pathway. In the train and place, the learner stays in a clinic where they've been working before. Whereas the complimentary pathway, they need to do a year of residency and an ACGME or accredited OEM program. Can you speak to funding for these two paths, like how a learner would get paid? For the train and place program, the trainee is working at their site. So they are paid by their employer and the site has to be vetted. We have had residents who had to switch sites because it wasn't encompassing of meds sufficiently. So it's not a matter of I'll just stay at my site, but in general, if it's an occupational medicine site, it's good. We may require other experiences, but yes, their salary comes from their employer. In terms of the complimentary pathway, I'll let Dr. Perkinson respond. Well, just to add to that, now that pretty much sums it up. So we're not asking you to work for free, basically. So it's in essence, the complimentary pathway pays, you pay your own way. We don't have NIOSH funding for the complimentary pathway. That being said, our own program, you're eligible for all the different events that we have for residents and different learning opportunities. We certainly don't charge the complimentary pathway resident for that. But as far as the tuition goes, we don't have funds for that. And other learning experiences, we don't pay them a salary when they're not working at their designated work location. Thank you. All right, I believe we probably have time for maybe one or two more questions. If one is a completed an internship residency and primary care field and specialty in US trained, how does one go about proceeding with board eligibility to the ACOM OCC med board certification? Would they need to participate in an OCMED specific residency? The answer is yes. So if you complete one year of internship only, then you have to do two years of OEM residency at any of the 20 odd residences in the country, if you are going through the ACGME residency route. If you have completed a full residency program, say family medicine, internal medicine, whatever it may be, then you can enter at the PGY-2 level and do one year of OEM training, bearing in mind that you would have to have at least 50% of your master's, your MPH degree completed. And before you graduate or you are eligible for graduation, have completed the master's degree. Is there a cutoff time for any of the requirements to be met? Such a cutoff time for medical school graduation, MPH completion, or residency training completion? And can a recent practice in OCMED substitute for this? I think that's a, it's a fairly complicated question. So there are no specific time limits on when you graduated from medical school. When you complete a residency program, could determine certain additional things you have to do in terms of demonstrating some level of practice activity. For instance, if it's been two years since you completed the residency program. I'm not aware as far as the MPH degree itself that there is a time limit on when you completed that MPH degree, as long as the degree can qualify as containing all the elements necessary for consideration by the board. But to answer the final question, simple practice activity in and of itself would not be a substitute for some of these other things to qualify or to become eligible for initial certification. Great. And I think this will probably be our time for our last question. Can anyone speak to resources to help challenges of setting up a training and place residency program and specifically to what extent is outside funding necessary? I've heard that there is a grant from health and human services or other resources have become more challenging because of needs to demonstrate trainees meeting criteria for providing healthcare to underserved populations. Thank you for that. I think that's one of the grants from our train and place program. Funding has always been an issue for OCMED. NIOSH has consistently been faithful to us providing funding, but of course the NIOSH budget is also subject to forces beyond their control. So they only have what they have. HRSA, I think is funding one program at present, one OEM program. So to generally answer your question, funding certainly continues to be a challenge. ACOM has been looking at ways to increase funding. We've had task forces. There's one currently presidential task was looking at funding. That's our age old question or issue or challenge. And I guess I'll just add, so the ultimate goal is for someone to pass their boards. And so you just need an infrastructure to set that up because it's difficult enough to have somebody working full-time or almost full-time and getting exposure to some of these aspects of these programs to just sort of the essentials of occupational environmental medicine. So those are the key things. So really it's much easier to add on to an existing OEM residency program where the didactics are already in place. It would be challenging to do that on your own without, you just have to do your own program curriculum because ultimately you want people to pass the boards. I don't know. It's outside of ACGME. So theoretically, I guess it could be required. I don't know, Jeff, if you had someone to just randomly set up a teaching program with an affiliation with occupational environmental medicine clinic, if that'd be something you would consider an application since they did it on their own. If that question is about what is acceptable under the complimentary pathway, the bylaws of the board are pretty specific that that one year of experience has to be with the moniker of ACGME accreditation. Even though they're not an ACGME resident, they have to be within the confines of that approved residency training experience. Okay. Do you guys want to do one more question or should we wrap this up? I'm game. All right, let's do this. One last question. We'll squeeze it in. Would a PhD in basic medical science, we already did this one, didn't we? Yep. I apologize. I am a section chief overseeing occupational medicine at a hospital and have had multiple individuals asked to work with me for a complimentary pathway. A common question is they should do a year in ACGME residency and then work with us for two years or alternately work with us for two years and then do an ACGME year. Many individuals are scared to commit to two years of working in the field without knowing they could get one year of ACGME training. What can we do to help provide stability on this front? Are there programs that can enter into agreement in advance that if they do two years of training with me, they can be accepted? We have a shortage of thousands of occupational medicine physicians because there are no categorical residences or ways to solve the problem that I raised. I think that's a great question if I'm understanding correctly. So the question is asking, I guess the first that pops into my head is if you're interested in having them do a year with a program, I would talk to the PD and let them know, we have someone interested in coming in two years down the road so that that person can be vetted and to see if they actually qualify. And I'm not saying that they would get an acceptance ahead of time, but certainly the conversation can start and something can be worked out. I think at least that's what we've done with the training place program because people may be interested in the program but they don't have the master's degree or they're not in the right site. And we work with them over time to sort of position them so that they can be eligible. I appreciate you noting that we're short by thousands of physicians and that's why the ABPM put together the complimentary pathway to help with this where you actually can train with a program that's ACG accredited as Brett pointed out for one year. So I think there are great options and I think working with a PD would be a good start. Brett. I was just gonna add, so first of all, thank you for wanting to increase the pipeline of occupational environmental medicine residents. That's exactly what we're doing. I think that you could easily work out a system where an applicant was vetted, just similar to what we do for medical students that would be doing a transitional year certain requirements that they pass the MPH, they pass these courses, they complete a year training in place with satisfactory performances. All those are kind of prerequisite on being part of the residency program. And then the last thing I would add is talk to them about funding. As I mentioned, in our own program, we have a administrator that is 50% for a residency. And so it doesn't, the resources, and it takes a lot of resources to really do a quality residency program, to do the education and sign up and tell them which courses to sign up for, that all takes time. And so think about supplementing with a funding for that program, because I can tell you they don't have any extra funds to go around, programs are stretched pretty thin and that's part of it. So that you, for every resident that you have that goes through the VA, that there's adequate funding to really meet those needs. It's not a easy proposition, but I do appreciate your enthusiasm and I hope it goes through. We have 20 programs right now across the US and for others on the call that, I would encourage you to partner with your local residency program and try to kind of knock through some of these details. Excellent. Well, I would like to thank you all for joining today's presentation and thank you to our faculty, Drs. Levine, Dr. Perkinson and Dr. McKenzie for today's presentation. I know we did not get to all of your questions. We will try to get these addressed later, but as always, if you do have any additional questions, please email info, educationinfo at ACOM.org and we will get these passed along to our faculty and hopefully we'll get you an answer. A recording will be posted probably later next week. So check back for that reference. Any other final words from our faculty? Thank you for dialing in. We appreciate your attention and tell others and encourage them to like it on the ACOM website. Like it on the ACOM website. Yep. All right. Thank you so much for joining. Yes, thank you. Take care and have a great afternoon. Thanks so much.

board certification

Occupational and Environmental Medicine

Complimentary Pathway

American Board of Preventive Medicine

mid-career physicians

Training Place program

on-site training

collaboration between programs

career prospects

certification pathways