I
Volume 68 February 1975
91
Section of Occupational Medicine President C R Lowe MD Meeting 28 March 1974
Panel Discussion: Postgraduate Training for Occupational Medicine Surgeon Captain H R Mallows (Office of the Commander in Chief, Naval Home Command, Portsmouth, PO1 3LR)
of Director of Environmental Medicine. This has provided a marked unifying and strengthening effect of all aspects of preventive medicine in the service.
Future Training Programmes Constraints on future training programmes are threefold: the Todd concept of three years' Naval Hygiene and Army Health Much of the work of medical officers in each of general professional training and four years the armed services, outside the hospitals, could further professional training; the demise of the properly be called occupational medicine though DPH at the London School of Hygiene and none of the services actually has a specialty so Tropical Medicine and the birth of the MSc (Social Medicine), and the partial eclipse of the named. DIH by the MSc (Occupational Medicine); and Naval medical officers who most obviously the establishment of the Faculty of Community practise occupational medicine do so in the Medicine. Royal Dockyards and are specialists in hygiene Neither MSc separately meets the needs of the (preventive and industrial medicine). Their training has included the Diplomas in Public services as fully as the old combination of DPH Health and Industrial Health which have also and DIH and it is impracticable to take both. been taken by army health specialists (together Each service already has graduates from the MSc with the DTM & H), and by a number of RAF (Occupational Medicine) course but the first medical officers who are not, however, recog- service candidate from the RAMC has yet to nized at present as specialists. In addition to start the MSc (Social Medicine) course in October hygiene, the Navy has specialties in aviation 1974. medicine, physiology and submarine and nuclear All three services have taken an active interest medicine which, until four years ago, had largely separate training programmes and career struc- in the formation of the Faculty of Community tures. They could, however, be considered to Medicine and have contributed a substantial represent merely different facets of preventive or number of Foundation Fellows and Members, occupational medicine within the particular though many felt it was unfortunate that the naval environment with much common ground Faculty did not adopt the full Todd definition of in the training required. Community Medicine which referred to 'the broad questions of health and disease in, for Director of Environmental example particular geographical and occupational Medicine sections of the community'. Their exclusion of In 1970, therefore, the post of Professor of Naval occupational groups and the vain attempt to Hygiene, which had been in abeyance since the form a separate Faculty of Occupational Mediwar, was revived with wider responsibilities to cine have led to divisions which have inevitably cover the complete nonclinical field, particularly weakened the representation of preventive in respect of postgraduate training and career medicine and have unnecessarily complicated the planning, and with a more comprehensive title training and career planning. A Service Viewpoint
92 Proc. roy. Soc. Med. Volume 68 February 1975
2
Future training of naval nonclinical specialists will almost certainly be based upon the combination of the MSc (Occupational Medicine) and MFCM, supplemented as required by in-service training and by the DAvMed. Some physiologists will also continue to do research leading to doctorates in medicine or philosophy, and occasionally the MRCP will be taken.
though unfortunately not yet for all of the branches of preventive medicine, particularly excluding, of course, occupational medicine.
Aims ofService Training The aims of this training are primarily to meet naval requirements, and secondarily to ensure that the naval consultant is recognized to be of comparable status with his civilian colleagues whilst still serving and, hopefully, will be considered employable by them on retirement! Establishing such comparability has been unnecessarily complicated, however, by the present unfortunate dichotomy of occupational and community medicine.
Conclusion Without wishing to assume the role of recruiter to the Faculty, the conclusion for occupational physicians nevertheless appears quite obvious: 'We haven't beaten them, we'd better join them'.
Acknowledgment: I am indebted to the Medical Director General (Naval) for permission to publish this paper. The opinions expressed in it, however, are personal and do not, necessarily, reflect official policy.
Dr Peter L Pelmear (GKN Forgings Ltd, Bromsgrove, Worcestershire)
The insistence of this Section and the Society of Occupational Medicine on the fundamental The View of an Occupational Physician importance of a clinical element in Occupational Medicine, and the exclusion by the Faculty of In considering the training needs of an occupaCommunity Medicine in an almost scandalized tional physician in industry it is important to manner of anyone who is so rash as to admit appreciate that his role and practice is ultimately that he ever puts a stethoscope around his neck determined by the attitude of his employer; the are difficult for a naval hygiene specialist to type and size of the industry or organization; understand. As a naval medical officer of health and, last but not least, its profitability. he is entirely acceptable to the Faculty, but his practice in fact includes a large element of truly Few industrialists when recruiting an occupaoccupational medicine though, admittedly, with- tional physician for the first time have any idea out any of the personal clinical element which the what the job specification should be. All too Society of Occupational Medicine would consider often they presume that the doctor's remit should essential. In his next appointment, however, he be threefold: to provide primary medical care may well become the senior medical officer of a for the directors, independent of the general dockyard and, having dusted his stethoscope and practitioner; to bring about a dramatic reduction bought a new battery for his auriscope, he is in sickness absence; and to protect the company back into the Society's fold but persona non from frivolous litigation claims. On this premise grata to the Faculty. It is surprising that this some industrialists will be satisfied to recruit any situation appears to him somewhat Gilbertian? doctor who is available and assume that he will know what and how to contribute. The more Lessons of Naval Experience enlightened, however, after proper enquiry, will The lessons from recent naval experience which look for a physician experienced in both clinical might have application in the civilian field are, medicine and industrial practice to establish and firstly, the unifying value of a single spokesman direct their medical service. The doctor should for the whole field of preventive medicine be able to advise the directors on all aspects of instead of four separate ones representing nar- health and safety relevant to the industry; to rower sectional and sometimes superficially provide a screening and monitoring health conflicting interests; secondly, clear recognition examination service for all the employees so as to of the handicap under which all branches of ensure correct placement and maintenance of preventive medicine have laboured through health; to provide a therapeutic service for having neither a Royal College of their own nor emergency treatment and aftercare; to give any formal connexion with one, and lastly, an health education; to participate in training proeager acknowledgment, therefore, of the im- grammes for management, new recruits, and portance of the establishment by the Faculty of first aiders; to undertake epidemiological studies Community Medicine of such a formal associa- and applied research which may be relevant and tion with the Royal Colleges of Physicians - to the advantage of the company.
Volume 68 February 1975
91
Section of Occupational Medicine President C R Lowe MD Meeting 28 March 1974
Panel Discussion: Postgraduate Training for Occupational Medicine Surgeon Captain H R Mallows (Office of the Commander in Chief, Naval Home Command, Portsmouth, PO1 3LR)
of Director of Environmental Medicine. This has provided a marked unifying and strengthening effect of all aspects of preventive medicine in the service.
Future Training Programmes Constraints on future training programmes are threefold: the Todd concept of three years' Naval Hygiene and Army Health Much of the work of medical officers in each of general professional training and four years the armed services, outside the hospitals, could further professional training; the demise of the properly be called occupational medicine though DPH at the London School of Hygiene and none of the services actually has a specialty so Tropical Medicine and the birth of the MSc (Social Medicine), and the partial eclipse of the named. DIH by the MSc (Occupational Medicine); and Naval medical officers who most obviously the establishment of the Faculty of Community practise occupational medicine do so in the Medicine. Royal Dockyards and are specialists in hygiene Neither MSc separately meets the needs of the (preventive and industrial medicine). Their training has included the Diplomas in Public services as fully as the old combination of DPH Health and Industrial Health which have also and DIH and it is impracticable to take both. been taken by army health specialists (together Each service already has graduates from the MSc with the DTM & H), and by a number of RAF (Occupational Medicine) course but the first medical officers who are not, however, recog- service candidate from the RAMC has yet to nized at present as specialists. In addition to start the MSc (Social Medicine) course in October hygiene, the Navy has specialties in aviation 1974. medicine, physiology and submarine and nuclear All three services have taken an active interest medicine which, until four years ago, had largely separate training programmes and career struc- in the formation of the Faculty of Community tures. They could, however, be considered to Medicine and have contributed a substantial represent merely different facets of preventive or number of Foundation Fellows and Members, occupational medicine within the particular though many felt it was unfortunate that the naval environment with much common ground Faculty did not adopt the full Todd definition of in the training required. Community Medicine which referred to 'the broad questions of health and disease in, for Director of Environmental example particular geographical and occupational Medicine sections of the community'. Their exclusion of In 1970, therefore, the post of Professor of Naval occupational groups and the vain attempt to Hygiene, which had been in abeyance since the form a separate Faculty of Occupational Mediwar, was revived with wider responsibilities to cine have led to divisions which have inevitably cover the complete nonclinical field, particularly weakened the representation of preventive in respect of postgraduate training and career medicine and have unnecessarily complicated the planning, and with a more comprehensive title training and career planning. A Service Viewpoint
92 Proc. roy. Soc. Med. Volume 68 February 1975
2
Future training of naval nonclinical specialists will almost certainly be based upon the combination of the MSc (Occupational Medicine) and MFCM, supplemented as required by in-service training and by the DAvMed. Some physiologists will also continue to do research leading to doctorates in medicine or philosophy, and occasionally the MRCP will be taken.
though unfortunately not yet for all of the branches of preventive medicine, particularly excluding, of course, occupational medicine.
Aims ofService Training The aims of this training are primarily to meet naval requirements, and secondarily to ensure that the naval consultant is recognized to be of comparable status with his civilian colleagues whilst still serving and, hopefully, will be considered employable by them on retirement! Establishing such comparability has been unnecessarily complicated, however, by the present unfortunate dichotomy of occupational and community medicine.
Conclusion Without wishing to assume the role of recruiter to the Faculty, the conclusion for occupational physicians nevertheless appears quite obvious: 'We haven't beaten them, we'd better join them'.
Acknowledgment: I am indebted to the Medical Director General (Naval) for permission to publish this paper. The opinions expressed in it, however, are personal and do not, necessarily, reflect official policy.
Dr Peter L Pelmear (GKN Forgings Ltd, Bromsgrove, Worcestershire)
The insistence of this Section and the Society of Occupational Medicine on the fundamental The View of an Occupational Physician importance of a clinical element in Occupational Medicine, and the exclusion by the Faculty of In considering the training needs of an occupaCommunity Medicine in an almost scandalized tional physician in industry it is important to manner of anyone who is so rash as to admit appreciate that his role and practice is ultimately that he ever puts a stethoscope around his neck determined by the attitude of his employer; the are difficult for a naval hygiene specialist to type and size of the industry or organization; understand. As a naval medical officer of health and, last but not least, its profitability. he is entirely acceptable to the Faculty, but his practice in fact includes a large element of truly Few industrialists when recruiting an occupaoccupational medicine though, admittedly, with- tional physician for the first time have any idea out any of the personal clinical element which the what the job specification should be. All too Society of Occupational Medicine would consider often they presume that the doctor's remit should essential. In his next appointment, however, he be threefold: to provide primary medical care may well become the senior medical officer of a for the directors, independent of the general dockyard and, having dusted his stethoscope and practitioner; to bring about a dramatic reduction bought a new battery for his auriscope, he is in sickness absence; and to protect the company back into the Society's fold but persona non from frivolous litigation claims. On this premise grata to the Faculty. It is surprising that this some industrialists will be satisfied to recruit any situation appears to him somewhat Gilbertian? doctor who is available and assume that he will know what and how to contribute. The more Lessons of Naval Experience enlightened, however, after proper enquiry, will The lessons from recent naval experience which look for a physician experienced in both clinical might have application in the civilian field are, medicine and industrial practice to establish and firstly, the unifying value of a single spokesman direct their medical service. The doctor should for the whole field of preventive medicine be able to advise the directors on all aspects of instead of four separate ones representing nar- health and safety relevant to the industry; to rower sectional and sometimes superficially provide a screening and monitoring health conflicting interests; secondly, clear recognition examination service for all the employees so as to of the handicap under which all branches of ensure correct placement and maintenance of preventive medicine have laboured through health; to provide a therapeutic service for having neither a Royal College of their own nor emergency treatment and aftercare; to give any formal connexion with one, and lastly, an health education; to participate in training proeager acknowledgment, therefore, of the im- grammes for management, new recruits, and portance of the establishment by the Faculty of first aiders; to undertake epidemiological studies Community Medicine of such a formal associa- and applied research which may be relevant and tion with the Royal Colleges of Physicians - to the advantage of the company.
