Core Group: Occupational/Environmental Medicine - Week 11

University of Connecticut - School of Medicine
Farmington, Connecticut

Instructor(s): Storey, Eileen
Subject area: Health / Medicine
Department: Medicine
Level: Graduate
Learning objective: Develop Individual Skills, Provide Information, Provide Real-World Experience
Teaching style: Active Learning, In-class Activity

Please note that the copyright for this course project is retained by the instructor.

The following unit is designed to be used for second year medical students in a small group session. At the University of Connecticut Medical School, the unit is included in the eleventh week of medical student curriculum.

Reading assignments to be completed prior to class are included. Each student is required to do a write-up on the patients who are interviewed during class time. Also, each student is required to complete a full occupational/environmental history on a patient at his or her Student Continuity Practice. The write-up is due two weeks after this session.

Week 11: November 2 & 4, 1999
1:00 - 5:00PM
Principles of Clinical Medicine(PCM)Student Continuity Practice

Cell injury; Mediators of inflammation & their pathophysiological effects; granulomatous inflammation; resolution of inflammation; environmental & nutritional cell injury; Pharmacokinetics I,II & III; antibody-mediated hypersensitivity in human diseaseCore Group: 1:00-5:00
  • Occupational Health: Interviews with Patients
  • Oral presentation from SCP
  • Hospital Preparation
  • Continue to practice history & PE.
  • Continue to practice oral presentations.
  • Submit Journal #3.
  • Submit Home Health Write-up

  • .
    CORE GROUP: Occupational/Environmental Medicine

    The student will:
    1. Obtain an occupational and environmental exposure history from visiting patients.
    2. Become familiar with the Sentinel events list
    3. Write-up one of the histories.
    4. Recognize that occupational diseases are reportable to public health agencies.

    Occupational exposures are some of the most important environmental exposures. In essentially all cases, occupationally induced illness and injury are preventable, largely through non-medical risk management interventions, such as engineering design, product substitution, and education. Thus, many of the most effective prevention activities of environmental medicine occur outside the traditional clinical paradigm. However, many of the interventions flow directly from an individual physician-patient encounter that identifies a health problem or risk attributable to specific environmental factors or conditions. The clinical encounter provides a unique opportunity for the clinician to use prevention-oriented primary care. Moreover, a single diagnosed case of environmental or occupational illness often serves as a sentinel event, alerting the public health community that prevention has failed, that other members of the population may be at risk, and that intervention is needed.

    The primary avenue for collecting information from a patient is through the medical interview. For example, if a patient appears with asthma-like symptoms, which, upon careful interviewing, are identified as being worse at work and better on the weekend, the clinician may begin to explore a work-related condition. If the clinician fails to ask about the temporal relationship and treats only the asthmatic conditions, the patient's symptoms may continue to progress. Associating illness with exposures is difficult for several reasons. Symptoms may not be unique for an illness linked to an exposure; a long latency may intervene between exposure and illness; and exposure may aggravate rather than cause an illness. Because practitioners are not taught to explore exposure histories during medical interview, they lack the most useful tool for making a proper diagnosis of such illness.

    The goal of this afternoon's exercise is to introduce students to the importance of taking an exposure history routinely during the course of every medical history. Although the additional patient data need not be burdensome or time consuming, the information can yield significant rewards when important associations between exposure and disease are recognized. This afternoon's materials and handouts provide initial interview techniques as well as an outline of a more detailed exposure history.

    The Core Group's agenda will be as follows:
    (1) The video, "Introduction to the Exposure History"* will be in each MDL. The group should watch the video, and afterward briefly discuss points in the history which were important.
    (2) Patients will join each Core Group. One student should interview each patient, beginning with an HPI and moving into a pertinent occupational and environmental history. If time permits after patients leave or between patients, a different student should present the patient verbally to the group.
    (3) All students should write up each HPI and the occupational and environmental history.

    *Developed by Schenck, M. Wayne State University. An NIEHS Academic Award recepient.

    Read (in Reading Section):
    1. Division of Occupational and Environmental Medicine. (1997). The Occupational and Environmental History.
    2. Kipen, HM & Craner, J. (1992). Sentinel pathophysiologic conditions: An adjunct to teaching occupational and environmental disease recognition and hsitory taking. Environmental Research, 54, 93-100.
    3. Sprince, NL. (1997). Tailoring the history to the clinical presentation. Presented at the National Institute of Environmental Health and Safety Academic Award Annual Meeting, June 4-5.
    4. Tarcher, AB (ed.). (1992). Appendix D and Appendix D2. Principles and practice of environmental medicine. 963-970. New York: Plenum.

    1. Write-up #3: Complete Medical History and focused Physical Exam including occupational/environmental history.
    2. Hospital Write-up.

    This document was last modified on 06/14/2000 03:08:03 PM

    This resource was acquired by CEEM (Consortium for Environmental Education in Medicine), a program of Second Nature, under the auspices of a NIEHS grant to gather and disseminate environmental health educational resources over the internet in order to help medical and allied health sciences faculty identify, locate and use resources for incorporating environment and health perspectives into their curricula. CEEM has authorized the use of these materials on this website for archival purposes. Please note that the copyright for this material is retained by the instructor and/or contributing institution.