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Residency Program

The UCSF Occupational & Environmental Medicine (OEM) residency program is designed to prepare physicians for occupational and environmental medicine practice and leadership roles in clinical, academic, government, NGO, consulting, and corporate settings.

The UCSF Occupational and Environmental Medicine (OEM) Training Program prepares physicians for occupational and environmental medicine practice and leadership roles including in clinical, academic, governmental units, NGOs, consulting, and corporate settings. The Program provides academic didactic instruction, clinical and non-clinical proctored? experiences, and research opportunities. A large core and affiliated faculty based at UCSF, together with extramural clinical faculty and other preceptors, and our faculty partners in nursing, industrial hygiene, and ergonomics, provide this training. Graduates of the UCSF OEM Program are currently leaders in all of the practice settings listed above. Trainees will achieve competency in all core knowledge content areas in OEM, and are encouraged to develop areas of special expertise. In keeping with this goal, the educational program is individually tailored to meet the needs of each trainee. The UCSF OEM Program was founded in 1979, and is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME) for up to eight trainees.

The UCSF OEM program is housed within the Center for Occupational and Environmental Health (COEH), a multidisciplinary research and education center partnership between UCSF, UC Berkeley, and UC Davis. COEH’s mission, which aligns with the Residency and Fellowship Program’s mission, is to serve government, industry, schools, health professionals, and the general public through programs and partnerships designed to deepen understanding of occupational and environmental hazards and to prevent disease, fatalities, and injuries. Activities are grounded in multi-campus, interdisciplinary teaching programs in medicine, nursing, public health, and related fields that educate future leaders in occupational and environmental health, develop new knowledge, and bring the resources of the University of California to the public.

In addition to the traditional OEM residency program track, which is funded through support from the CDC National Institute for Occupational Safety and Health (NIOSH), we also offer an innovative and unique training track focused on vulnerable workers and occupational health disparities. This track in the residency is funded by the federal Health Resources and Services Agency (HRSA) and is one of three HRSA supported OEM programs in the country and the only one with this focus. Trainees in this track will fulfill all the ACGME requirements of our larger residency. In addition, however, this special program concentration offers the opportunity for additional clinical activities, public health field work, policy work, and didactic content relevant to low wage and vulnerable working populations as well as issues of environmental social justice. Specific examples may include work with California State agencies, outreach through the Labor Occupational Health Program at UC Berkeley, field experience with the Natural Resources Defense Council, and clinical service in community clinics serving migrant and day laborers and other uninsured and/or low wage workers.

Program Plan/Curriculum

The UCSF Occupational Medicine Residency and Fellowship is an integrated 2-year program in which the trainees progressively take on greater responsibility and achieve core competency in the areas delineated by the American College of Preventive Medicine and the American Conference on Graduate Medical Education (ACGME) . In the first year, trainees typically complete coursework to earn a MPH or MS degree from the UC Berkeley School of Public Health while also participating in a weekly clinic and other UCSF clinical activities to meet ACGME requirements for 4 months of clinical activity per year. In certain circumstances, the MPH/MS training may occur later in the training cycle. For entering trainees who already have a Master’s in Public Health or other equivalent degree, the first year curriculum will include a combination of clinical work (total 4 months) as well as other non-clinical rotations. The second year is devoted to a combination of clinical experience (four months), non-clinical rotations, and research. Residents entering the program who have completed a Master’s in Public Health or other equivalent degree as well as a primary residency such as Internal Medicine, Family Medicine, or Preventive Medicine, may be considered fro matriculation into the second year of the residency and thus eligible to complete AGME approved training in Occupational Medicine in one year.

A typical representative breakdown of the trainees’ activities by year is shown below.

First YearSecond Year
1 month of special programming (August) including industrial hygiene site visits and clinical work plus didactic training 1 month of special programming including industrial hygiene site visits and clinical work plus didactic training
8 months UC Berkeley SPH coursework
Weekly half-day clinic throughout year and 3 weeks of occupational clinical needlestick hotline coverage (nights and weekends) Weekly half-day clinic throughout year and 3 weeks of occupational clinical needlestick hotline coverage (nights and weekends)
2 1/2 months of full-time clinical rotations (July; mid-May through June) 2 1/2 to 4 months of clinical rotations
1-4months non-clinical rotations including corporate/consulting and public and environmental health rotations
2 months research

The special August program features industrial hygiene site visits. Theses site visits are constituted as an Industrial Hygiene (IH) curriculum and include a range of industrial sites and non-industrial workplaces, as well as environmental health site visits with written assessments of sites and their IH aspects. The summer training also includes selected didactic work through the Center for Occupational and Environmental Health (COEH) “Summer Institute” which further strengthens industrial hygiene training as well as other topics such as risk communication. At the site visits, the trainees are expected to observe and record occupational and environmental hazards and the corresponding control measures. Each trainee is expected to do preparatory research prior to at least two of the site visits, and to brief their colleagues on the occupational and environmental health issues related to that industry. In addition, each trainee is expected to do at least two write-ups after the site visits to summarize the hazards and risks, and to communicate recommendations. Site visits include a wide range of industries and environmental sites in the greater San Francisco Bay Area. Examples include: refineries, metals manufacturing, foundries, cement manufacturing, pharmaceutical and biotech facilities, research laboratories, sewage treatment facilities, waste handling facilities, distribution centers, food processing, dairies, farms, wineries, nail salons, construction sites, maintenance of the Golden Gate Bridge and airlines. There are 10-12 site visits during the month of August. Additional visits also occur on Thursdays in July when grand rounds are in recess.

In August of either the first or second year, trainees also take the Training in Clinical Research (TICR) Summer Workshop at UCSF which provides grounding in applied biostatistics, epidemiology, and clinical study design.

Throughout both residency years, trainees acquire skills in clinical occupational medicine through participation in weekly half-day clinics and an associated clinical conference. They also attend the biweekly OEM Grand Rounds, followed by either Journal Club or a Clinical Seminar in which faculty share unusual or challenging management issues. Trainees are expected to present at least one or two journal club article during the course of the year. During this year, the trainees are expected to choose a research project and research mentor and to begin work on a project that will be completed during the second year.

For more information on UC Berkeley School of Public Health:

The residency/fellowship program has multiple clinic sites where ongoing training of OEM trainees occurs during both years of the program. The Occupational and Environmental Medicine Clinic at UCSF/Mt. Zion is a weekly half-day clinic that provides an opportunity to evaluate complex patients with environmental or occupational health issues (as noted above). Other ongoing clinical opportunities include the SF Kaiser Permanente Occupational Medicine Clinic at Opera Plaza, the San Francisco Veterans Affairs Medical Center (SFVAMC), the San Francisco Division of the California State Poison Control System, Premier Comp (a private occupational practice in the East Bay), and a multi-site subspecialty rotation that includes dermatology, pulmonary function, neurology, complementary medicine, allergy, and ophthalmology. Another clinical opportunity occurs through the Pediatric Environmental Health Specialty Unit (PEHSU). The PEHSU is funded by the Agency for Toxic Substances and Disease Registry (ATSDR) and the U.S. Environmental Protection Agency through a cooperative agreement with the Association of Occupational and Environmental Clinics (AOEC). The PEHSU is a collaboration between the Division of OEM, the Northern California Poison Control Center, and the UCSF Department of Pediatrics. The PEHSU is directed by Dr. Mark Miller, a pediatrician. Dr. Timur Durrani, an occupational medicine and toxicology specialist, also participates. A primary function of the PEHSU is education and outreach to community physicians. Our program in Northern California also provides consultative services, by telephone and in our clinic, for pediatric environmental health problems.

Trainees are evaluated semi-annually based on how well they have achieved goals and objectives for each aspect of training through our ACGME-mandated Clinical Competency Committee (CCC) chaired by the Associate Program Director. Each resident is evaluated based on 26ACGME specified Milestones (see attached). Evaluative input includes rotation-based evaluations, self-evaluations, other faculty input, patient evaluations, 360° evaluations, and resident-maintained portfolios. The UCSF E*Value system is used to facilitate evaluation of trainees and faculty.

In addition to the CCC, a Program Evaluation Committee (the PEC, which includes one of the current residents) assesses all of the components of the Residency curriculum including rotations and coursework. Both the CCC and the PEC report to the Residency Advisory Committee that meets two times each year to integrate their input, along with other data such as structured residency and faculty surveys. The overall evaluation of each Resident is the responsibility of the Program Director, who determines whether the Resident successfully completes the program.

Interdisciplinary Experiences

The faculty of the OEM Program at UCSF approach occupational and environmental health teaching, research, and service activities from an interdisciplinary perspective. Whenever possible, interdisciplinary training opportunities with occupational and environmental health nurses (OEHN) and industrial hygienists (IH) are developed.

Paul Blanc, MD and Barbara Burgel, RN co-direct a course for both the nursing students and OEM trainees. Trainees are required to take this UCSF course entitled “Management of Clinical Occupational Health Problems”, N271.06 (offered every other year, e.g., once during the two year training period). Trainees are also required to take a similar joint nursing-medicine course in industrial hygiene taught by Patricia Quinlan CIH (Nursing 274a). A yearly post-graduate course offered by the Division of Occupational and Environmental Medicine includes approximately 20 CME hour equivalents. The COEH Summer Institute as noted previously also occurs each year. All of these efforts are interdisciplinary.

The program has many other activities where interdisciplinary interaction occurs regularly. The Occupational and Environmental Medicine Clinic at Mt Zion includes OEM, OEHN and IH trainees in the evaluation of patients and their workplaces. Workplace site visits, grand rounds, research seminars, and case conference have participants from multiple disciplines.

Joint Occupational Environmental Medicine training opportunities exist with UCSF programs in both Pulmnary Critical Care and Medical Toxicology and can be explored on a case-by-case basis.

Research Training

Training in research methods and development of research projects is a vital element of our program. The program seeks trainees who will advance the scientific knowledge base upon which the prevention and treatment of occupational disease rests, as well as those who will educate future generations of researchers. Trainees are expected to identify a research mentor in their first year of training and begin a project that will be completed in the second year. The course Training in Clinical Research (TICR) through the Department of Epidemiology and Biostatistics at UCSF already has been mentioned above. In this course, trainees are required to develop and present the design and protocol for a relevant research project. Additional training is provided in the monthly Journal Club, which has a special emphasis on epidemiological and statistical methodology. Principal faculty research mentors include Drs. Blanc, Balmes, and Steinmaus, as well as others. There are a large number of other supporting and core faculty members who sponsor trainee research activities and regularly participate in the research-training program through various interactions.

Who Should Apply

nursing

Physicians who have had primary care training (usually internal medicine, family medicine, emergency medicine) and are interested in opportunities for academic, government, or community careers in occupational and environmental medicine. Physicians who have only completed a clinical postgraduate year (PGY 1), but who demonstrate a strong commitment to occupational or environmental medicine will also be considered. Combined training programs with pulmonary medicine and with medical toxicology are also available.