The importance of Environmental and Occupational Medicine is increasingly being recognized within the medical and lay communities, where there is increased interest in the health effects of toxic agents and an appreciation of the advantages of prevention, early recognition, and treatment. There is, however, an undersupply of trained Environmental and Occupational Medicine specialists, and primary care physicians are most likely to have initial contact with patients for whom environmental or occupational conditions are an issue. Therefore, strong emphasis must be placed on providing skills to deal with these issues to primary care providers. Training should be focused at all professional levels to maintain and advance the skills acquired at earlier stages of training. This proposal aims to provide training in Environmental and Occupational Medicine for persons at all stages of professional practice. For medical students, we will institute a coordinated curriculum that will mesh with other subjects in the curriculum. This will vertically integrate the curriculum and avoid the need to add additional class hours to an already stressed teaching schedule. For residents, the focus is on increased interactions in the form of teaching conferences such as Grand Rounds within the core primary care disciplines of Internal Medicine, Family Practice, Pediatrics, and Ob/Gyn. For the post-residency physician, increased visibility through Continuing Medical Education forums will be used. In addition to these measures, formal courses in research methods and environmental/occupational epidemiology will be offered for persons at all levels of training. The effect of the program will be monitored by evaluating indices of interest (e.g., course enrollment) as well as knowledge, attitudes, and behavior (e.g., the presence of occupational histories on initial patient work-ups) among medical students and residents.
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