126 J Occup Health, Vol. 57, 2015
job training (OJT) for 30 items, and case-based learning (CBL) for 29 items. Conclusions: Some competencies should be added to the JSOH list. CBL should be intro-duced in training programs for specialist occupational physicians.(J Occup Health 2015; 57: 126–141)
Key words: Case-based learning, Certification pro-gram, Competencies, On-the-job training, Specialist occupational physicians, Training methods
The occupational physician’s role is to protect and promote workers’ health and working ability1). In previous studies, it was reported that specialist occu-pational physicians who completed residency train-ing2) or were certified3) were associated with a greater diversity of skills and opportunities. A comprehen-sive training program and a certification program to confirm attainment of a certain level of knowledge and skills are necessary to develop specialist occu-pational physicians. A common list of competencies that allow specialist occupational physicians to play their expected roles is required to maintain consis-tency between programs. A training program could be developed to help trainees acquire the competen-cies, and a certification program could be designed to confirm their achievement of them.
The Japan Society for Occupational Health (JSOH) runs a certification program for the country’s special-ist occupational physicians. Currently, to be certi-fied as a specialist occupational physician (certified occupational physician, COP) by the JSOH, one must complete a training program outlined in the trainees’ handbook, which provides a list of 50 competencies, and objective training under the supervision of a certi-fied senior occupational physician (CSOP) and pass a certification examination. The competencies required of special occupational physicians should vary at
Abstract: Surveys on the competencies of special-ist occupational physicians and effective methods for acquisition of competencies in Japan: Koji MORI, et al. Occupational Health Training Center, Univer-sity of Occupational and Environmental Health, Japan—Objectives: The aim of this study was to study the necessary competencies for specialist occupational physicians in Japan and the effective training methods for acquiring them. Methods: A competency list (61 items) was developed for the questionnaires in the study by making use of existing competency lists from the Japan Society for Occupational Health (JSOH) as well as lists from the US and Europe. Certified senior occu-pational physicians (CSOPs) in the certification program of the JSOH completed a questionnaire on the neces-sary competencies. Examiners of the examination for certified occupational physicians (COPs) completed another questionnaire on effective training methods. Results: All 61 competencies in the questionnaires were evaluated as “necessary”. Some of the competen-cies in the list from the JSOH were evaluated lower than the items added from the American and European lists. When the respondents were categorized into a “practi-cal group”, the members of which mainly provided occupational health services, an “academic group”, the members of which belonged to research or education institutes such as medical schools, and all others, the practical group evaluated some competencies signifi-cantly higher than the academic group, particularly those related to work accommodation. Among three options for training methods, the most effective methods were lectures and textbooks for 5 competency items, on-the-
Surveys on the competencies of specialist occupational physicians and effective methods for acquisition of competencies in Japan
Koji MORI1,2, Masako NAGATA1, Mika HIRAOKA1, Megumi KUDO1, Tomohisa NAGATA2 and Shigeyuki KAJIKI2
1Occupational Health Training Center, University of Occupational and Environmental Health, Japan and 2Department of Occupational Health Practice and Management, University of Occupational and Environmental Health, Japan
J Occup Health 2015; 57: 126–141 Journal ofOccupational Health
Received Jul 9, 2014; Accepted Nov 25, 2014Published online in J-STAGE Jan 10, 2015Correspondence to: K. Mori, Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan (e-mail: [email protected])
127Koji MORI, et al.: Competencies of specialist ops and training methods
different times, and competency lists and attainment targets should be reviewed periodically. The JSOH’s current list was revised by the committee for the certi-fication program for specialist occupational physicians in 2011. However, the validity of this revision is in question because the committee did not seek opinions from CSOPs who actually train the candidate COPs, nor did it consult other stakeholders.
There are two general methods typically used to develop competencies of occupational physicians: 1) lectures and text for acquiring basic knowledge, and 2) on-the-job training (OJT) to gain competencies that occupational physicians use daily. Because existing health risks can vary widely across workplaces, it is difficult to provide adequately comprehensive training programs for each trainee. Various types of work-places must be accessed for OJT, or training methods must be invented to compensate for a lack of appro-priate OJT. As a possible solution, the case-based learning (CBL) method has been introduced in under-graduate and postgraduate training programs in public health and occupational health4−7). CBL is considered an effective method for acquiring competencies that are used less often or only pertain to specific work-places. Maximally effective training programs might be realized through a combination of the three meth-ods.
In this study, we conducted a mail survey of CSOPs to assess the validity of JSOH’s current competency list. Additionally, we asked examiners at the exami-nation for JSOH certified occupational physicians to discuss effective training methods for acquiring competencies in the list.
Methods
Development of the competency list for specialist occupational physicians for the survey
We compared the “ACOEM Core Competencies and Skill Sets Defined”, in ACOEM Competencies—20088) and the “Core Competencies for Specialist Occupational Physicians in Occupational Medicine in Europe: Scope and Competencies” developed by the WHO European Centre for Environment and Health9)
with the JSOH’s competency list for specialist occu-pational physicians. Both of these comparison lists were the newest lists published by authoritative orga-nizations in the US and Europe when we made our research plan. As shown in Table 1a−1e, we judged whether each description in the list could be matched to an existing competency in Japan. Then we exam-ined each competency that did not have an obvious match to see whether it could be combined with one or more other competencies to create a single compe-tency. As a result, 11 competencies were added to the JSOH list of 50 competencies. Finally, we rephrased
each competency to present it in a unified and more understandable format for the survey. The descrip-tions of the competencies were abbreviated as shown in the appendix.
Study 1: Survey on Necessary Competencies for Specialist Occupational Physicians in Japan
The CSOPs had at least 5 year experience in occu-pational health services as COPs and were fulfilling roles as trainers in the system. They were therefore considered appropriate respondents for the survey on necessary competencies for specialist occupational physicians in Japan. As of August 1, 2013, the total number of registered CSOPs in Japan was 315. Excluding those with addresses that were unknown or who were outside of Japan, we sent a questionnaire to 308 CSOPs and asked them to return it without any identifying information by the end of September, 2013. They were asked to rate the necessity of each competency on a scale of 1 to 5 (5=absolutely neces-sary, 4=necessary, 3=somewhat necessary, 2=not so necessary, 1=not necessary), and to write in additional competencies that they thought should have been on the list. They were also requested to report on their experience as occupational physicians as well as their current main job.
We evaluated the necessity of each competency by calculating its mean score across respondents. When multiple respondents suggested similar ideas, we care-fully examined each suggestion to see whether its topic was included in one of the 61 existing compe-tencies.
The respondents were categorized into three groups according to their current main jobs: a “practical group”, the members of which mainly provided occu-pational health services, an “academic group”, the members of which belonged to research or education institutes such as medical schools, and all others. Then, we compared the mean scores of each compe-tency for two of the groups: the “practical group” and the “academic group”. Group comparisons were analyzed by F-test and then the Student’s t-test or Welch’s t-test, using SAS Statistics 19 for Windows and a level of statistical significance of p<0.05.
Study 2: Survey on Effective Training Methods to Acquire Competencies
We developed a second questionnaire to study effec-tive methods for acquisition of competencies. The questionnaire had three options for learning methods: acquisition of knowledge with lectures and textbooks (lectures and textbooks), accumulation of daily experi-ence as occupational physicians (OJT) and experience or discussion of specific cases and measures (CBL). We asked whether each method was effective, and
128 J Occup Health, Vol. 57, 2015Ta
ble
1a.
Dev
elop
men
t of
a co
mpe
tenc
y lis
t for
the
ques
tionn
aire
s by
com
pari
ng th
e lis
ts f
rom
Jap
an, t
he U
S an
d E
urop
e
Que
stio
nnai
reJS
OH
AC
OE
MW
HO
Eur
ope
Atti
tude
and
eth
ics
for
occu
patio
nal p
hysi
cian
s
Posi
tion
and
fund
amen
tal r
oles
-U
nder
stan
ding
s of
OP’
s po
si-
tions
and
rol
es in
cor
pora
tions
Cod
e of
eth
ics
-Und
erst
andi
ngs
of p
rofe
ssio
nal
ethi
cal c
odes
and
app
licat
ion
to
prac
tice
-Rec
ogni
ze a
nd a
ddre
ss e
thic
al d
ilem
mas
in th
e pr
actic
e of
OE
M, u
sing
re
leva
nt g
uide
lines
, su
ch a
s th
e A
CO
EM
, Ass
ocia
tion
of O
ccup
atio
nal
and
Env
iron
men
tal
Clin
ics,
Int
erna
tiona
l C
omm
issi
on o
n O
ccup
atio
nal
Hea
lth, a
nd A
mer
ican
Med
ical
Ass
ocia
tion
code
s of
eth
ics.
-Adv
isin
g m
anag
emen
t an
d w
orke
rs’
repr
esen
tativ
es o
n th
e et
hica
l ba
sis
for
a po
licy
Pers
onal
hea
lth d
ata
hand
ling
-Dat
a m
anag
emen
t pay
ing
atte
n-tio
n to
pri
vacy
-Und
erst
and
and
prot
ect
pati
ents
’ le
gal
righ
ts t
o co
nfid
enti
alit
y of
m
edic
al r
ecor
ds in
form
atio
n.
Und
erst
andi
ng o
f cu
stom
ers
of o
ccup
atio
nal h
ealth
ser
vice
s
Ana
lysi
s of
cha
ract
eris
tics
of c
ompa
nies
an
d w
orke
rs-U
nder
stan
ding
s of
cus
tom
ers,
e.
g., c
orpo
ratio
n, w
orke
rs-I
dent
ify
pote
ntia
l cus
tom
ers
and
deve
lop
a m
arke
ting
plan
for
an
occu
-pa
tiona
l or
envi
ronm
enta
l hea
lth p
rogr
am.
-Adv
isin
g on
the
need
for
ful
l con
sulta
tions
with
wor
kers
’ re
pres
enta
tives
-Org
aniz
ing
data
base
s (i
nclu
ding
com
pute
rize
d da
taba
ses
and
(pos
sibl
y)
web
site
s) f
or t
he d
isse
min
atio
n an
d pu
blic
atio
n of
res
earc
h in
occ
upa-
tiona
l hea
lth a
nd s
afet
y m
atte
rs-A
sses
sing
the
occu
patio
nal h
ealth
nee
ds o
f th
e en
terp
rise
Ass
essm
ent o
f oc
cupa
tiona
l hea
lth
need
s-F
ield
obs
erva
tion
and
patr
ol-O
rgan
izin
g an
d un
dert
akin
g w
orkp
lace
insp
ectio
ns
Occ
upat
iona
l hea
lth s
ervi
ces
cons
ider
-in
g so
cial
and
cul
tura
l div
ersi
ty-R
ecog
nize
the
eff
ects
of
cultu
ral,
ethn
ic,
and
soci
al f
acto
rs,
incl
udin
g he
alth
bel
iefs
and
pra
ctic
es, o
n th
e he
alth
and
saf
ety
of w
orke
rs.
Und
erst
andi
ng o
f re
late
d re
gula
tions
and
com
plia
nce
Com
plia
nce
with
occ
upat
iona
l hea
lth
regu
latio
ns-U
nder
stan
ding
s of
OH
reg
ula-
tions
and
the
amen
dmen
ts
-Com
ply
with
and
exp
lain
app
licab
le r
egul
atio
ns, a
s w
ell
as t
heir
int
er-
pret
atio
n an
d en
forc
emen
t, to
em
ploy
ers,
em
ploy
ees,
and
pat
ient
s.-R
espo
nd to
the
requ
irem
ents
of
empl
oyee
or
com
mun
ity r
ight
-to-
know
re
gula
tions
and
adv
ise
indi
vidu
als
abou
t th
eir
righ
ts t
o ac
cess
inf
orm
a-tio
n.-R
epor
t ca
ses
of o
ccup
atio
nal
inju
ry,
illn
ess,
and
dea
th a
ccor
ding
to
exis
ting
regu
latio
ns.
-App
licat
ion
of o
ccup
atio
nal h
ealth
law
and
eth
ics
to in
divi
dual
cas
es-A
dvis
ing
man
ager
s on
the
im
plem
enta
tion
of h
ealth
and
saf
ety
and
envi
-ro
nmen
tal l
aw
-Adv
isin
g w
orke
rs a
nd w
orke
rs’
repr
esen
tativ
es o
f th
eir
lega
l obl
igat
ions
App
licat
ion
of a
men
ded
occu
patio
nal
heal
th r
egul
atio
ns-E
valu
atio
n of
com
plia
nce
with
new
legi
slat
ion
App
licat
ion
of in
dust
rial
inju
ry
insu
ranc
e
-Adv
ise
empl
oyee
s an
d em
ploy
ers
abou
t th
e ba
sic
elem
ents
of
wor
k-er
s’ c
ompe
nsat
ion
law
, com
plet
e th
e ne
cess
ary
form
s, a
nd f
ile w
orke
rs’
com
pens
atio
n cl
aim
s.-P
rovi
de m
edic
oleg
al r
epor
ts a
nd e
xper
t op
inio
ns a
nd t
esti
mon
y on
O
EM
issu
es-E
xpla
in t
he r
ight
s of
an
empl
oyee
or
citiz
en i
n re
ques
ting
assi
stan
ce
from
a g
over
nmen
t age
ncy
or in
fili
ng a
com
plai
nt.
Doc
umen
t str
uctu
res
and
plan
s
Polic
y st
atem
ent o
n oc
cupa
tiona
l hea
lth-A
dvic
e on
dev
elop
men
t of
OH
po
licy
to e
mpl
oyer
s-A
dvis
ing
on h
ealth
and
saf
ety
polic
y
Obj
ectiv
es o
f oc
cupa
tiona
l hea
lth
prog
ram
s-O
bjec
tives
of
OH
pro
gram
s an
d ev
alua
tion
of th
e at
tain
men
t-E
valu
ate
the
effe
ctiv
enes
s of
occ
upat
iona
l he
alth
ser
vice
s an
d ri
sk
redu
ctio
n m
etho
ds.
-Adv
isin
g ho
w t
o ch
oose
and
def
ine
HE
S t
arge
ts w
hich
sho
uld
be
achi
eved
by
the
ente
rpri
se i
n a
spec
ifie
d ti
me
cost
-ben
efit
ana
lysi
s of
w
ork-
rela
ted
heal
th p
rom
otio
n ac
tiviti
es-D
efin
ing
the
goal
s an
d ob
ject
ives
of
the
OH
S -C
ontr
ibut
ing
to t
he s
elec
tion
of c
rite
ria
to b
e us
ed t
o ev
alua
te o
wn
ser-
vice
pra
ctic
e
Plan
s of
occ
upat
iona
l hea
lth p
rogr
ams
-Pla
nnin
g of
OH
act
iviti
es a
nd
man
agem
ent o
f th
e pr
ogre
ss
-Des
ign
cost
-con
tain
men
t st
rate
gies
for
wor
kers
’ co
mpe
nsat
ion,
hea
lth
bene
fits
, an
d di
sabi
lity
man
agem
ent
prog
ram
s to
allo
cate
and
man
age
clin
ical
and
fin
anci
al r
esou
rces
.
Doc
umen
tatio
n of
occ
upat
iona
l hea
lth
proc
edur
es-D
ocum
enta
tion
of O
H p
roce
-du
res
Rec
ords
and
rep
orts
of
occu
patio
nal
heal
th a
ctiv
ities
-Org
aniz
ing
and
wri
ting
repo
rts
as p
reci
sely
and
qua
ntita
tivel
y as
pos
sibl
e -R
ecor
d-ke
epin
g
Info
rmat
ion
syst
em f
or o
ccup
atio
nal
heal
th s
ervi
ces
-Det
erm
ine
man
agem
ent
info
rmat
ion
need
s an
d ap
ply
med
ical
inf
or-
mat
ics,
ele
ctro
nic
heal
th a
nd p
atie
nt c
are
data
, m
anag
emen
t in
form
a-tio
n sy
stem
s, a
nd o
ther
com
pute
r te
chno
logi
es to
an
OE
M p
rogr
am.
JSO
H, J
apan
Soc
iety
for
Occ
upat
iona
l Hea
lth; A
CO
EM
, Am
eric
an C
olle
ge o
f O
ccup
atio
nal a
nd E
nvir
onm
enta
l Hea
lth8); W
HO
Eur
ope,
WH
O E
urop
ean
Cen
tre
for
Env
iron
men
t and
Hea
lth13
) .
129Koji MORI, et al.: Competencies of specialist ops and training methodsTa
ble
1b.
Dev
elop
men
t of
a co
mpe
tenc
y lis
t for
the
ques
tionn
aire
s by
com
pari
ng th
e lis
ts f
rom
Jap
an, t
he U
S an
d E
urop
e
Que
stio
nnai
reJS
OH
AC
OE
MW
HO
Eur
ope
Occ
upat
iona
l hea
lth o
rgan
izat
ion
and
role
s of
occ
upat
iona
l phy
sici
ans
Eva
luat
ion
of n
eces
sary
exp
ertis
e an
d sy
stem
-Wor
k ef
fect
ivel
y as
a t
eam
mem
ber
with
adm
inis
trat
ors,
occ
upat
iona
l he
alth
nur
ses,
nur
se p
ract
ition
ers,
and
phy
sici
an a
ssis
tant
s, d
emon
stra
t-in
g an
und
erst
andi
ng o
f th
eir
role
s in
an
occu
patio
nal h
ealth
ser
vice
.
-Rec
ogni
zing
the
nee
d fo
r sp
ecia
list
asse
ssm
ent
of t
he w
orki
ng e
nvir
on-
men
t th
roug
h us
e of
oth
er m
ulti
disc
ipli
nary
tea
m m
embe
rs (
toxi
colo
-gi
sts,
hyg
ieni
sts,
erg
onom
ists
, or
gani
zati
onal
psy
chol
ogis
ts,
etc.
) an
d or
gani
zing
the
team
-Hir
ing
expe
rts
-Pla
nnin
g th
e ef
fici
ent u
se o
f m
ultid
isci
plin
ary
reso
urce
s
Org
aniz
atio
n of
occ
upat
iona
l hea
lth
team
-Adv
ice
on e
stab
lishm
ent o
f an
O
H o
rgan
izat
ion
to e
mpl
oyer
s
-Def
inin
g th
e ro
les
of s
taff
in
prov
idin
g an
OH
S an
d fo
rmul
atin
g jo
b de
scri
ptio
ns-T
eam
-bui
ldin
g-L
eadi
ng th
e te
am
Coo
pera
tion
with
occ
upat
iona
l hea
lth
staf
f-A
dvic
e to
oth
er O
H s
taff
s an
d co
llabo
ratio
n-D
esig
ning
a tr
aini
ng p
rogr
amm
e fo
r oc
cupa
tiona
l hea
lth s
taff
Qua
lity
man
agem
ent o
f oc
cupa
tiona
l he
alth
ser
vice
s
-Des
ign,
im
plem
ent,
and
eval
uate
cli
nica
l pr
acti
ce g
uide
line
s, q
uali
ty
man
agem
ent
and
qual
ity
impr
ovem
ent
prog
ram
s, u
tili
zati
on m
anag
e-m
ent,
case
man
agem
ent,
and
othe
r ac
tivit
ies
to e
nhan
ce a
n or
gani
za-
tion’
s pe
rfor
man
ce.
Man
agem
ent
of t
he o
ccup
atio
nal
heal
th d
epar
tmen
t or
ser
vice
usi
ng
qual
ity m
anag
emen
t pri
ncip
les
-Eva
luat
ing
the
qual
ity o
f se
rvic
e pr
ovis
ion
incl
udin
g au
dit
of t
he p
ro-
fess
iona
l med
ical
asp
ects
of
occu
patio
nal h
ealth
car
e
Bud
get f
or o
ccup
atio
nal h
ealth
dep
art-
men
t-N
egot
iatin
g an
d m
anag
ing
a bu
dget
Con
trib
utio
n to
hea
lth c
omm
ittee
-Con
trib
utio
n to
hea
lth c
omm
it-te
e an
d ot
her
mee
tings
-Par
ticip
atin
g in
com
mitt
ees,
in
part
icul
ar t
he h
ealth
and
saf
ety
com
mit
-te
e
Ris
k as
sess
men
t
Iden
tific
atio
n of
exi
stin
g he
alth
haz
ards
-Ide
ntif
icat
ion
of e
xist
ing
heal
th
haza
rds
-Det
erm
ine
the
natu
re a
nd e
xten
t of
pot
entia
l oc
cupa
tiona
l an
d en
viro
n-m
enta
l che
mic
al e
xpos
ures
, con
side
ring
rou
tes
of e
xpos
ure
and
rout
es o
f ab
sorp
tion.
-Cha
ract
eriz
e ex
isti
ng a
nd p
oten
tial
occ
upat
iona
l an
d en
viro
nmen
tal
haza
rds
with
in d
efin
ed p
opul
atio
ns.
-Des
crib
e sp
ecif
ic t
hrea
ts, i
nclu
ding
a b
road
ran
ge o
f ch
emic
al, b
iolo
gi-
cal,
radi
olog
ical
and
phy
sica
l haz
ards
.
-Adv
isin
g on
the
intr
oduc
tion
of n
ew w
orki
ng s
yste
ms
and
tech
niqu
es-R
isk
asse
ssm
ent
of w
orkp
lace
haz
ards
(as
abo
ve)
with
adv
ice
on p
re-
vent
ion
of h
arm
-R
ecog
nizi
ng a
nd i
niti
atin
g th
e in
vest
igat
ion
of w
ork
abil
ity,
hea
lth
dete
rmin
ants
and
dis
ease
in th
e w
orkf
orce
Info
rmat
ion
of e
xist
ing
heal
th h
azar
ds-C
olle
ctio
n an
d un
ders
tand
ings
of
haz
ards
dat
a an
d in
form
atio
n
-Det
ect,
inso
far
as p
ossi
ble,
pre
clin
ical
or
clin
ical
eff
ects
ari
sing
fro
m
chem
ical
exp
osur
e an
d im
plem
ent a
ppro
pria
te p
reve
ntiv
e m
easu
res.
Und
erst
and,
exp
lain
, an
d be
abl
e to
app
ly t
oxic
kin
etic
dat
a (i
nclu
ding
ab
sorp
tion,
met
abol
ism
, st
orag
e, a
nd e
xcre
tion)
to
clin
ical
and
em
ploy
-m
ent-
rela
ted
deci
sion
mak
ing.
-Use
occ
upat
iona
l an
d en
viro
nmen
tal
info
rmat
ion
reso
urce
s to
con
duct
a
lite
ratu
re s
earc
h or
to
rese
arch
the
hea
lth
effe
cts
of a
che
mic
al s
ub-
stan
ce.
-Int
erpr
et a
nd a
pply
the
med
ical
, tox
icol
ogic
al, a
nd e
nvir
onm
enta
l lite
ra-
ture
s.
Mon
itori
ng o
f ex
posu
re to
hea
lth h
az-
ards
-Exp
osur
e m
onito
ring
and
eva
lu-
atio
n
-Mon
itori
ng o
f w
orkp
lace
haz
ards
incl
udin
g ph
ysic
al, c
hem
ical
, bio
logi
-ca
l, er
gono
mic
, psy
chos
ocia
l and
oth
er h
azar
ds-S
elec
ting
biol
ogic
al m
onito
ring
on
the
basi
s of
cri
teri
a of
val
idity
for
th
e pr
otec
tion
of th
e he
alth
of
the
wor
ker
conc
erne
d, w
ith d
ue r
egar
d fo
r th
e se
nsiti
vity
, spe
cifi
city
and
pre
dict
ive
valu
e of
the
test
s co
ncer
ned
-Bio
logi
cal e
xpos
ure
mon
itori
ng-A
dvis
ing
on t
ools
to
be u
sed
for
mon
itori
ng a
nd e
valu
atin
g en
terp
rise
po
licy
outc
ome
-Pro
mot
ing
mul
tidis
cipl
inar
y sc
ient
ific
wor
k on
exp
osur
e da
ta g
athe
ring
Ass
essm
ent o
f he
alth
ris
ks-A
sses
smen
t of
heal
th r
isks
-Ass
ess
clin
ical
, w
orks
ite,
and
envi
ronm
enta
l da
ta,
alon
g w
ith l
itera
ture
re
view
s in
the
perf
orm
ance
of
patie
nt e
valu
atio
ns.
-Det
erm
ine
whe
ther
a p
erso
n ha
s a
heal
th c
ondi
tion
that
inc
reas
es r
isk
from
the
effe
cts
of e
xpos
ure
to c
hem
ical
, phy
sica
l, or
bio
logi
cal a
gent
s.-E
valu
ate
and
inte
rpre
t the
res
ults
of
indu
stri
al h
ygie
ne s
urve
ys.
-Adv
isin
g on
impl
emen
tatio
n of
oth
er p
rofe
ssio
nal r
isk
asse
ssm
ents
JSO
H, J
apan
Soc
iety
for
Occ
upat
iona
l Hea
lth; A
CO
EM
, Am
eric
an C
olle
ge o
f O
ccup
atio
nal a
nd E
nvir
onm
enta
l Hea
lth8); W
HO
Eur
ope,
WH
O E
urop
ean
Cen
tre
for
Env
iron
men
t and
Hea
lth13
) .
130 J Occup Health, Vol. 57, 2015Ta
ble
1c.
Dev
elop
men
t of
a co
mpe
tenc
y lis
t for
the
ques
tionn
aire
s by
com
pari
ng th
e lis
ts f
rom
Jap
an, t
he U
S an
d E
urop
e
Que
stio
nnai
reJS
OH
AC
OE
MW
HO
Eur
ope
Hea
lth s
urve
illan
ce, d
iagn
osis
and
trea
tmen
t
Indi
cato
rs o
f he
alth
eff
ects
for
hea
lth
surv
eilla
nce
-Set
indi
cato
rs o
f he
alth
eff
ects
-Dev
elop
, im
plem
ent,
eval
uate
, and
ref
ine
scre
enin
g pr
ogra
ms
for
grou
ps t
o id
entif
y ri
sks
for
dise
ase
or in
jury
and
opp
ortu
nitie
s to
pro
mot
e w
elln
ess.
-Des
ign
and
cond
uct
surv
eill
ance
pro
gram
s in
wor
kpla
ce a
nd c
omm
unit
y se
tting
s.
-Bio
logi
cal e
xpos
ure
mon
itori
ng;
-Org
aniz
ing
heal
th s
urve
illan
ce f
or w
orke
rs e
xpos
ed t
o oc
cupa
tiona
l ha
zard
s
Qua
lity
assu
ranc
e pr
ogra
ms
of la
bora
to-
ries
-Und
erst
andi
ngs
of O
H la
bora
-to
ry q
ualit
y co
ntro
l and
sel
ectio
n of
qua
lifie
d la
bora
tori
es
Util
izat
ion
of h
ealth
sur
veill
ance
for
w
orkp
lace
impr
ovem
ent
-Dia
gnos
is o
f he
alth
eff
ects
by
heal
th s
urve
illan
ce-A
pply
ind
ivid
ual-
base
d or
com
mun
ity-
base
d in
terv
enti
ons
to p
reve
nt o
r m
itiga
te e
xpos
ure
and
resu
ltant
hea
lth e
ffec
ts.
Dia
gnos
is o
f he
alth
eff
ects
with
hea
lth
surv
eilla
nce
-Eva
luat
ion
and
impr
ovem
ent
of w
orks
ites
with
spe
cifi
c he
alth
su
rvei
llanc
e
-Cli
nica
l-G
ener
al,
Car
diol
ogy,
Der
mat
olog
y, E
mer
genc
y M
edic
ine
and
Sur
gery
, H
emat
olog
y/O
ncol
ogy,
Inf
ecti
ous
Dis
ease
, M
uscu
losk
elet
al,
Neu
rolo
gy,
Oph
thal
mol
ogy,
Oto
lary
ngol
ogy,
Psy
chia
try,
Pul
mon
ary,
R
epro
duct
ive
Med
icin
e,-E
valu
ate,
trea
t, an
d pr
oper
ly r
efer
per
sons
who
se h
ealth
may
be
affe
cted
by
acut
e or
chr
onic
con
tact
with
occ
upat
iona
l and
env
iron
men
tal c
hem
ical
s.-D
istin
guis
h he
alth
eff
ects
of
expo
sure
to c
hem
ical
s fr
om o
ther
etio
logi
es.
-Dia
gnos
ing
wor
k-re
late
d ill
hea
lth-O
rgan
izin
g ap
prop
riat
e in
vest
igat
ions
for
dia
gnos
is o
f oc
cupa
tiona
l di
seas
e-D
iffe
rent
ial
diag
nose
s of
wor
k-re
late
d an
d en
viro
nmen
t-re
late
d di
s-ea
se-A
pplic
atio
n of
erg
onom
ics
to r
ehab
ilita
tion
Ris
k re
duct
ion
Cau
se a
naly
sis
of in
dust
rial
acc
iden
ts o
r oc
cupa
tiona
l dis
ease
s-P
artic
ipat
ing
in a
naly
sis
of o
ccup
atio
nal a
ccid
ents
and
dis
ease
s
Prio
ritiz
atio
n of
ris
ks f
or r
educ
tion
plan
s-P
rior
itiza
tion
of h
ealth
ris
ks-A
dvis
e em
ploy
ers
and
empl
oyee
s re
gard
ing
indu
stri
al h
ygie
ne c
ontr
ols,
su
ch a
s w
ork
prac
tices
, res
pira
tor
use,
and
eng
inee
ring
con
trol
s.-R
ecom
men
d an
d im
plem
ent
poli
cies
and
con
trol
mea
sure
s to
red
uce
or
miti
gate
saf
ety
and
heal
th h
azar
ds.
-Und
erta
king
wor
kpla
ce a
sses
smen
ts a
nd a
dvis
ing
on c
ontr
ol m
eth-
ods
-Ass
essi
ng c
ontr
ol s
yste
ms
desi
gned
to e
limin
ate
or r
educ
e ex
posu
re-S
elec
ting
appr
opri
ate
pers
onal
pro
tect
ive
equi
pmen
t w
ith t
he a
ssis
-ta
nce
of o
ther
exp
erts
as
requ
ired
Ris
k re
duct
ion
met
hods
and
pla
ns-A
dvic
e on
sel
ectio
n an
d pl
an-
ning
of
risk
con
trol
mea
sure
s
Exe
cutio
n of
ris
k re
duct
ion
plan
s-P
lann
ing
and
exec
utio
n of
trai
n-in
g pr
ogra
ms
on r
isk
cont
rol
-Ass
essi
ng c
ontr
ol s
yste
ms
desi
gned
to e
limin
ate
or r
educ
e ex
posu
re
Ris
k co
mm
unic
atio
n
Edu
catio
n pr
ogra
ms
on r
isk
redu
ctio
n-R
isk
com
mun
icat
ion
base
d on
sc
ient
ific
evi
denc
e
-Com
mun
icat
e to
tar
get
grou
ps i
nclu
ding
hea
lth
prof
essi
onal
s, t
he p
ubli
c,
and
the
med
ia,
in a
cle
ar a
nd e
ffec
tive
man
ner
both
ora
lly a
nd i
n w
ritin
g,
the
leve
ls o
f ri
sk f
rom
rea
l or
pote
ntia
l haz
ards
and
the
ratio
nale
for
sel
ecte
d in
terv
entio
ns.
-Com
mun
icat
e cu
rren
t m
edic
al,
envi
ronm
enta
l, an
d ot
her
scie
ntif
ic k
now
l-ed
ge e
ffec
tivel
y to
tar
get
grou
ps, i
nclu
ding
pat
ient
s, e
mpl
oyee
s, e
mpl
oyer
s,
unio
ns, c
omm
unity
gro
ups,
and
the
med
ia.
-Acc
omm
odat
e cu
ltura
l, et
hnic
, edu
catio
nal,
and
lang
uage
var
iatio
ns a
mon
g w
orke
rs w
hen
prov
idin
g in
form
atio
n on
occ
upat
iona
l ha
zard
pre
vent
ion,
di
seas
e pr
even
tion,
and
hea
lth p
rom
otio
n.
-Com
mun
icat
ing
wit
h pe
ople
fro
m v
ario
us b
ackg
roun
ds a
nd w
ith
diff
eren
t lev
els
of te
chni
cal u
nder
stan
ding
Ris
k co
mm
unic
atio
n to
wor
kers
-Con
firm
atio
n an
d ev
alua
tion
of
risk
con
trol
-Mak
ing
clea
r or
al p
rese
ntat
ions
Wor
k lo
ad a
nd r
ecov
ery
from
fat
igue
Eva
luat
ion
of p
sych
olog
ical
and
phy
si-
cal l
oad
-Ass
essm
ent o
f lo
ad o
f ta
sks
and
wor
k sh
ifts
-App
ly e
rgon
omic
pri
ncip
les
to o
ptim
ize
com
fort
and
red
uce
risk
at
wor
k,
incl
udin
g ev
alua
tion
and
red
esig
n of
haz
ardo
us l
ifti
ng j
obs,
rep
etit
ive
mot
ion
wor
k, a
nd jo
bs w
ith s
peci
al v
isua
l dem
ands
.
-Adv
ise
on th
e er
gono
mic
des
ign
of th
e w
orkp
lace
and
wor
king
tool
s
Des
ign
wor
k to
hav
e a
smal
l loa
d-A
dvic
e on
job
desi
gn
Des
ign
of o
ffic
es a
nd f
acili
ties
for
empl
oyee
s' w
elfa
re-A
dvic
e on
des
irab
le w
ork
envi
-ro
nmen
t and
off
ice
amen
ities
Cou
nter
mea
sure
s ag
ains
t psy
chos
ocia
l hea
lth h
azar
ds
Men
tal h
ealth
pro
gram
s-M
enta
l hea
lth p
rogr
ams
-App
licat
ion
of o
rgan
izat
iona
l ps
ycho
logy
to
reha
bilit
atio
n in
situ
a-tio
ns o
f w
ork-
rela
ted
men
tal i
ll he
alth
Prog
ram
s to
com
bat h
ealth
eff
ects
due
to
ove
rwor
k-C
ount
erm
easu
res
for
over
wor
k
JSO
H, J
apan
Soc
iety
for
Occ
upat
iona
l Hea
lth; A
CO
EM
, Am
eric
an C
olle
ge o
f O
ccup
atio
nal a
nd E
nvir
onm
enta
l Hea
lth8); W
HO
Eur
ope,
WH
O E
urop
ean
Cen
tre
for
Env
iron
men
t and
Hea
lth13
) .
131Koji MORI, et al.: Competencies of specialist ops and training methodsTa
ble
1d.
Dev
elop
men
t of
a co
mpe
tenc
y lis
t for
the
ques
tionn
aire
s by
com
pari
ng th
e lis
ts f
rom
Jap
an, t
he U
S an
d E
urop
e
Que
stio
nnai
reJS
OH
AC
OE
MW
HO
Eur
ope
Hea
lth c
are
and
prom
otio
n
Peri
odic
gen
eral
hea
lth e
xam
inat
ion
-Pla
nnin
g an
d ex
ecut
ion
of
gene
ral h
ealth
exa
ms
and
heal
th
mea
sure
men
ts
-Des
ign,
im
plem
ent
and
eval
uate
wor
ksite
hea
lth p
rom
otio
n an
d di
seas
e pr
even
tion
pro
gram
s, i
ncor
pora
ting
Dep
artm
ent
of H
ealt
h an
d H
uman
Se
rvic
es a
nd o
ther
aut
hori
tativ
e gu
idel
ines
as
appr
opri
ate.
-Des
crib
e th
e ap
prop
riat
e us
e an
d lim
itatio
ns o
f he
alth
ris
k as
sess
men
t an
d sc
reen
ing
for
wel
l po
pula
tion
s an
d th
e ap
plic
atio
ns o
f sc
reen
ing,
as
sess
men
t, an
d ea
rly
inte
rven
tion
for
targ
eted
hig
h-ri
sk g
roup
s.
-Per
iodi
c ex
amin
atio
ns-A
naly
sis
of th
e et
hica
l asp
ects
of
heal
th s
cree
ning
-Coo
rdin
atin
g he
alth
sur
veill
ance
and
bio
logi
cal
mon
itori
ng w
ith e
nvi-
ronm
enta
l sur
veill
ance
and
oth
er r
isk
asse
ssm
ents
Eva
luat
ion
of h
ealth
con
ditio
n of
em
ploy
ee g
roup
-Eva
luat
ion
of h
ealth
con
ditio
n as
a g
roup
-Ana
lyzi
ng r
outi
nely
col
lect
ed d
ata,
inc
ludi
ng s
ickn
ess
abse
nce
and
acci
dent
dat
a
Hea
lth c
are
for
elde
r or
fem
ale
empl
oyee
s
-Hea
lth c
are
base
d on
cha
rac-
teri
stic
s, s
uch
as e
lder
age
and
fe
mal
e se
x
-Per
iodi
c ex
amin
atio
ns-E
xit e
xam
inat
ions
on
leav
ing
the
ente
rpri
se-M
anag
emen
t of
wor
kers
with
dru
g or
alc
ohol
pro
blem
s
Hea
lth g
uida
nce
base
d on
hea
lth
exam
inat
ion
-Hea
lth g
uida
nce
acco
rdin
g to
he
alth
exa
m-C
ouns
el e
mpl
oyee
s ab
out h
ealth
ris
ks a
nd li
fest
yle.
-Cou
nsel
ling
Edu
catio
n on
hea
lth p
rom
otio
n fo
r em
ploy
ee g
roup
-Hea
lth e
duca
tion
-Des
ign
and
impl
emen
t pr
oact
ive
syst
ems
of c
are
that
eff
ectiv
ely
reac
h al
l m
embe
rs o
f a
popu
latio
n, i
nclu
ding
tho
se a
t hi
gh r
isk
and
thos
e w
ho
do n
ot n
orm
ally
see
k ca
re.
-Hea
lth p
rom
otio
n ne
eds
anal
ysis
of
the
wor
king
pop
ulat
ion
-Adv
ocat
ing
and
man
agin
g an
agr
eed
wor
kpla
ce h
ealth
pro
mot
ion
pro-
gram
e-S
eeki
ng p
arti
cipa
tion
of
wor
kers
and
em
ploy
ers
in t
he d
esig
n an
d im
plem
enta
tion
of
wor
k-re
late
d he
alth
pro
mot
ion
and
wor
king
abi
lity
m
aint
enan
ce p
rogr
ames
-Eva
luat
ing
and
audi
ting
wor
kpla
ce h
ealth
pro
mot
ion
-Pro
gram
es,
espe
cial
ly w
ith
rega
rd t
o th
eir
rele
vanc
e to
occ
upat
iona
l he
alth
haz
ards
in
the
wor
kpla
ce a
nd t
he c
ontr
ol o
f no
nocc
upat
iona
l de
term
inan
ts o
f he
alth
and
wor
king
abi
lity
Wor
k ac
com
mod
atio
n
Proc
edur
es o
f fi
tnes
s fo
r du
ty a
sses
s-m
ent a
nd w
ork
acco
mm
odat
ion
-Adv
ice
on d
evel
opm
ent o
f pr
o-ce
dure
s of
wor
k ac
com
mod
atio
n
-Des
ign
and
impl
emen
t in
tegr
ated
sys
tem
s of
dis
abili
ty p
reve
ntio
n an
d m
anag
emen
t.-D
esig
n pr
otoc
ols
for
prep
lace
men
t an
d re
turn
-to-
wor
k ev
alua
tion
s.
Impl
emen
t sta
y at
wor
k an
d ea
rly
retu
rn to
wor
k pr
otoc
ols.
-Des
ign
and
impl
emen
t pr
otoc
ols
to e
valu
ate
empl
oyee
s fo
r co
nditi
ons
crea
ting
an u
ndue
ris
k to
sel
f or
oth
ers
in t
he w
orkp
lace
, in
com
plia
nce
with
the
AD
A.
Prof
essi
onal
opi
nion
s on
fitn
ess
for
duty
an
d w
ork
acco
mm
odat
ion
-Adv
ice
of w
ork
acco
mm
odat
ion
acco
rdin
g to
hea
lth e
xam
-Pre
plac
emen
t hea
lth s
cree
ning
and
med
ical
exa
min
atio
ns-A
sses
smen
t of
dis
abili
ty a
nd f
itnes
s fo
r w
ork,
rep
lace
men
t an
d fo
llow
-in
g w
ork-
rela
ted
illne
ss/in
jury
Wor
k ac
com
mod
atio
n up
on r
etur
ning
to
wor
k or
dur
ing
preg
nanc
y
-Adv
ice
of w
ork
acco
mm
odat
ion
at r
etur
ning
to w
ork
and
duri
ng
preg
nanc
y
-Add
ress
em
ploy
men
t con
cern
s fo
r pa
tient
s w
ith m
edic
al c
ondi
tions
.-C
ondu
ct e
valu
atio
ns t
o de
term
ine
fitn
ess
for
duty
in
com
plia
nce
with
ap
plic
able
reg
ulat
ions
incl
udin
g th
e A
DA
.-A
sses
s im
pair
men
t ra
ting
s in
acc
orda
nce
wit
h th
e A
mer
ican
Med
ical
A
ssoc
iatio
n G
uide
s to
the
Eva
luat
ion
of P
erm
anen
t Im
pair
men
t.-I
dent
ify
and
man
age
the
impa
ct o
f ps
ycho
logi
cal
cond
ition
s on
abi
lity
to w
ork
and
on th
e na
tura
l his
tory
of
occu
patio
nal a
nd e
nvir
onm
enta
l ill
-ne
sses
and
inju
ries
.
-Cou
nsel
ling
em
ploy
ees
rega
rdin
g si
ckne
ss a
bsen
ce a
sses
smen
t of
im
pair
men
t, di
sabi
lity
and
hand
icap
in r
elat
ion
to w
ork
-Clin
ical
man
agem
ent i
n re
habi
litat
ion
of d
isab
led
wor
kers
-Adv
isin
g on
reh
abili
tatio
n an
d re
depl
oym
ent
-Adv
isin
g on
mai
ntai
ning
agi
ng a
nd d
isab
led
wor
kers
in w
ork
Impr
ovem
ent o
f w
ork
abili
ties
of e
lder
, ill
or
hand
icap
ped
empl
oyee
s-P
rom
otin
g w
ork
abil
ity:
hea
lth,
ski
lls
and
trai
ning
in
rela
tion
to
the
dem
ands
of
wor
k
Prot
ectio
n of
rep
rodu
ctiv
e fu
nctio
n of
fe
mal
e em
ploy
ees
-Adv
ise
on p
olic
ies
and
proc
edur
es r
elat
ing
to t
he p
rote
ctio
n of
fer
tility
fo
r bo
th m
en a
nd w
omen
and
for
the
pla
cem
ent
of p
regn
ant
or l
acta
ting
wor
kers
.-R
ecom
men
d ap
prop
riat
e ac
com
mod
atio
ns a
nd jo
b pl
acem
ents
for
pre
g-na
nt e
mpl
oyee
s.
-Adv
isin
g on
fitn
ess
for
wor
k an
d ad
apta
tion
of w
ork
to t
he w
orke
r in
th
e sp
ecia
l ci
rcum
stan
ces
of v
ulne
rabl
e gr
oups
and
spe
cifi
c le
gisl
atio
n,
for
exam
ple,
the
EU
Dir
ectiv
e on
Pro
tect
ion
of P
regn
ant
and
Lac
tatin
g M
othe
rs 9
2/85
/EC
JSO
H, J
apan
Soc
iety
for
Occ
upat
iona
l Hea
lth; A
CO
EM
, Am
eric
an C
olle
ge o
f O
ccup
atio
nal a
nd E
nvir
onm
enta
l Hea
lth8); W
HO
Eur
ope,
WH
O E
urop
ean
Cen
tre
for
Env
iron
men
t and
Hea
lth13
) .
132 J Occup Health, Vol. 57, 2015Ta
ble
1e.
Dev
elop
men
t of
a co
mpe
tenc
y lis
t for
the
ques
tionn
aire
s by
com
pari
ng th
e lis
ts f
rom
Jap
an, t
he U
S an
d E
urop
e
Que
stio
nnai
reJS
OH
AC
OE
MW
HO
Eur
ope
Firs
t aid
and
em
erge
ncy
resp
onse
Firs
t aid
ski
lls a
nd tr
aini
ng f
or
empl
oyee
s-F
irst
aid
ski
lls a
nd tr
aini
ng o
f w
orke
rs-A
dvis
ing
on t
he p
rovi
sion
of
firs
t ai
d fa
cilit
ies
and
emer
genc
y pr
oce-
dure
s
Firs
t aid
pla
n an
d ar
rang
emen
t for
eq
uipm
ent
-Pla
nnin
g of
fir
st a
id a
nd a
rran
gem
ent o
f ne
cess
ary
equi
pmen
t
-App
ly k
now
ledg
e of
per
sona
l pr
otec
tion
and
oth
er a
ppli
ed a
ppro
ache
s to
he
alth
pro
tect
ion
and
the
skill
s to
eva
luat
e th
e ad
equa
cy o
f pr
otec
tion
at t
he
indi
vidu
al le
vel.
-Est
ablis
h em
erge
ncy
proc
edur
es a
nd p
roto
cols
for
the
clin
ical
man
agem
ent
of i
ndiv
idua
ls i
nvol
ved
in d
isas
ter
inci
dent
s, i
nclu
ding
spe
cifi
c m
edic
al m
an-
agem
ent p
roto
cols
.
Em
erge
ncy
resp
onse
pla
n-A
dvic
e du
ring
pla
nnin
g of
em
erge
ncy
resp
onse
pla
n
-Par
ticip
ate
in t
he d
evel
opm
ent
of e
mer
genc
y or
dis
aste
r pl
ans
for
the
wor
k-pl
ace
and
the
com
mun
ity.
-Des
ign
and
impl
emen
t a
plan
for
the
mit
igat
ion
of a
dis
aste
r in
cide
nt a
t a
wor
ksite
or
in th
e ge
nera
l com
mun
ity.
Des
ign
and
impl
emen
t a
med
ical
rec
over
y pl
an f
or m
ass
casu
alty
eve
nts
in
indu
stri
es o
r th
e ge
nera
l com
mun
ity.
-Des
ign
and
cond
uct a
n ou
tbre
ak o
r cl
uste
r in
vest
igat
ion.
-D
esig
n a
pand
emic
pre
pare
dnes
s pl
an f
or a
n or
gani
zatio
n.-M
aint
ain
a th
orou
gh u
nder
stan
ding
of
the
Nat
iona
l R
espo
nse
Pla
n an
d In
cide
nt C
omm
and
Stru
ctur
e.-R
ecom
men
d an
d im
plem
ent p
olic
ies
and
cont
rol m
easu
res
to a
ddre
ss e
mer
g-in
g in
fect
ious
dis
ease
s of
con
cern
.
Env
iron
men
t pro
tect
ion
Wor
ksite
issu
es a
nd a
pplic
able
re
gula
tions
on
envi
ronm
enta
l pr
otec
tion
-Und
erst
andi
ng o
f en
viro
nmen
-ta
l man
agem
ent s
yste
m a
nd
rela
ted
regu
latio
ns-A
dvis
ing
man
ager
s on
the
im
plem
enta
tion
of
heal
th a
nd s
afet
y an
d en
viro
nmen
tal l
aw
Prof
essi
onal
sup
port
for
env
iron
-m
ent p
rote
ctio
n-C
ontr
ibut
ion
to e
nvir
onm
enta
l m
anag
emen
t pra
ctic
es in
the
wor
kpla
ces
-Ide
ntif
y so
urce
s an
d ro
utes
of
envi
ronm
enta
l ex
posu
re a
nd r
ecom
men
d m
etho
ds o
f re
duci
ng e
nvir
onm
enta
l hea
lth r
isks
.-A
dvis
e in
divi
dual
s an
d co
mm
uniti
es a
bout
the
rep
rodu
ctiv
e im
plic
atio
ns o
f en
viro
nmen
tal e
xpos
ure.
-Adv
ise
indi
vidu
als
and
com
mun
ities
abo
ut t
he r
epro
duct
ive
impl
icat
ions
of
envi
ronm
enta
l exp
osur
e.-M
anag
e he
alth
eff
ects
ass
ocia
ted
with
air
, wat
er, o
r gr
ound
con
tam
inat
ion
by
natu
ral o
r ar
tific
ial p
ollu
tant
s.-R
ecom
men
d, in
terp
ret,
and
expl
ain
the
resu
lts o
f en
viro
nmen
tal m
onito
ring
.
-Ide
ntif
ying
, as
sess
ing
and
advi
sing
on
the
prev
entio
n of
env
iron
men
tal
haza
rds
aris
ing,
or
whi
ch m
ay r
esul
t, fr
om o
pera
tions
or
proc
esse
s in
the
ente
rpri
se-R
ecog
nizi
ng a
nd a
dvis
ing
on h
azar
dous
exp
osur
es i
n th
e ge
nera
l en
vi-
ronm
ent a
risi
ng f
rom
oth
er s
ourc
es o
r ac
tiviti
es
Scie
ntif
ic r
esea
rch
Plan
ning
and
exe
cutio
n of
sci
entif
ic
rese
arch
on
occu
patio
nal h
ealth
is
sues
-Des
ign
and
exec
utio
n of
re
sear
ch o
n O
H-R
ecog
nize
and
inve
stig
ate
pote
ntia
l sen
tinel
eve
nts.
-App
ly v
alid
ated
epi
dem
iolo
gic
and
bios
tatis
tical
pri
ncip
les
and
tech
niqu
es to
an
alyz
e in
jury
or
illne
ss d
ata
in a
def
ined
wor
ker
and
com
mun
ity p
opul
atio
ns.
-Org
aniz
ing
data
base
s (i
nclu
ding
com
pute
rize
d da
taba
ses
and
(pos
sibl
y)
web
site
s) f
or t
he d
isse
min
atio
n an
d pu
blic
atio
n of
res
earc
h in
occ
upa-
tiona
l hea
lth a
nd s
afet
y m
atte
rs-P
lann
ing
sim
ple
surv
eys
-Pro
mot
ing
mul
tidis
cipl
inar
y sc
ient
ific
wor
k on
exp
osur
e da
ta g
athe
ring
Exe
cutio
n an
d pr
esen
tatio
n of
re
sear
ch f
ollo
win
g co
des
of e
thic
s-E
xecu
tion
and
pres
enta
tion
of
rese
arch
in c
ompl
ianc
e w
ith
code
s of
eth
ics
-Con
duct
ing
a fo
rmal
sci
enti
fic
inve
stig
atio
n; c
arry
ing
out
a li
tera
ture
se
arch
and
pre
pari
ng a
rep
ort
-Int
erpr
etin
g sc
ient
ific
dat
a in
jour
nals
and
for
m o
wn
rese
arch
-Rec
ogni
zing
and
initi
atin
g an
inve
stig
atio
n of
wor
k ab
ility
, hea
lth d
eter
-m
inan
ts a
nd d
isea
se in
the
wor
kfor
ce
Aud
itO
ccup
atio
nal s
afet
y an
d he
alth
aud
it an
d re
port
ing
-Con
trib
utio
n to
OSH
aud
it an
d re
port
ing
Col
labo
ratio
n w
ith p
artie
s in
side
or
outs
ide
of c
ompa
ny
Com
mun
icat
ion
with
em
ploy
ers
and
unio
ns-C
omm
unic
atio
n w
ith e
mpl
oy-
ers
and
unio
ns-W
ork
effe
ctiv
ely
wit
h bo
th l
abor
and
man
agem
ent
to m
axim
ize
wor
kpla
ce
heal
th, s
afet
y, a
nd p
rodu
ctiv
ity.
-Coo
rdin
atin
g di
scus
sion
s le
adin
g to
agr
eem
ent
by b
oth
man
agem
ent
and
wor
kfor
ce r
epre
sent
ativ
es-E
nsur
ing
wor
kers
are
ful
ly in
form
ed o
f po
licy
and
of th
eir
righ
ts-R
epor
ting
reg
ular
ly t
o m
anag
emen
t an
d th
e w
orkf
orce
ora
lly
and
in
wri
ting
Col
labo
ratio
n w
ith h
uman
res
ourc
es
and
safe
ty d
epar
tmen
ts-C
olla
bora
tion
with
HR
and
sa
fety
dep
artm
ents
Util
izat
ion
of p
ublic
res
ourc
es a
nd
cont
ribu
tion
to c
omm
unity
-Util
izat
ion
of p
ublic
res
ourc
es
and
cont
ribu
tion
to c
omm
unity
-Com
mun
icat
e te
chni
cal
and
clin
ical
inf
orm
atio
n to
pro
fess
iona
l an
d la
y au
dien
ces.
-Com
mun
icat
ing
with
oth
er p
rofe
ssio
nals
to
orga
nize
and
del
iver
tra
in-
ing
appr
opri
atel
y
JSO
H, J
apan
Soc
iety
for
Occ
upat
iona
l Hea
lth; A
CO
EM
, Am
eric
an C
olle
ge o
f O
ccup
atio
nal a
nd E
nvir
onm
enta
l Hea
lth8); W
HO
Eur
ope,
WH
O E
urop
ean
Cen
tre
for
Env
iron
men
t and
Hea
lth13
) .
133Koji MORI, et al.: Competencies of specialist ops and training methods
which was most effective for each of the 61 compe-tencies.
COP examiners are elected from among CSOPs and evaluate the attainment of the competencies of candi-date COPs. They were therefore considered appropri-ate respondents for the survey on effective training methods for acquiring competencies as specialist occupational physicians. We directly asked all 22 COP examiners in 2013 at the examination site to participate, and responses were collected in person or by mail by the end of September, 2013.
Training methods for which half or more of the respondents answered “yes” were considered effective, and the method chosen by the greatest number of respondents as most effective was considered the most effective.
Ethical considerationsThe research procedures were approved by
the ethics review committee at the University of Occupational and Environmental Health, Japan. We obtained a list of CSOPs from the secretary’s office for the certification program in accordance with the official procedures of the JSOH. The list was destroyed once the study was completed.
Results
Study 1: Survey on Necessary Competencies for Specialist Occupational Physicians in Japan
The number of respondents was 172 (response rate 55.8%). After excluding 24 incomplete responses, 148 (effective response rate 48.1%) respondents remained for analysis. The demographic characteristics of the respondents are shown in Table 2. Most respondents (62.2%) were in the “practical” category; 25.6% were
in the “academic” category, and 12.2% in the “other” category. Most respondents (93.9%) had worked for a manufacturing company as a full-time or part-time occupational physician. All had experience as occupational physicians in a company. Among them, 72.3% had experience as a full-time (staff) occupa-tional physician, and 81.8% had experience as a part-time (contract-based) occupational physician.
As shown in Table 3, the mean scores for the all competencies were greater than 3, “somewhat neces-sary”, but those of 18 items were lower than 4, “necessary”. Among the 50 competencies that were included in the JSOH list, 14 received mean scores lower than 4. Of the 11 competencies that were added from the American and/or European lists, 7 received scores greater than 4.
The “practical group” gave significantly higher mean scores for 11 competencies than the “academic group”. This was particularly true for competencies related to work accommodation based on individual health condition, such as “procedures of fitness for duty assessment and work accommodation”, “profes-sional opinions on fitness for duty and work accom-modation”, and “work accommodation at return to work or during pregnancy”.
All of the suggested additional competencies were already included in the 61 competencies or were suggested by only a single respondent, with the excep-tion of “be able to train non-specialist occupational physicians”, which was suggested by 4 respondents.
The rankings of the mean scores among the 61 items are also shown in Table 3. There were 7 items in the JSOH’s current competency list with mean scores in a position lower than 51st. They were “documentation of occupational health procedures”,
Table 2. The demographic characteristics of the respondents in the survey
Employment condition
Practical 92 62.2%
Full time for company 58
Full time for occupational health service institute 16
Private occupational health service 18
Academic 38 25.6%
Academic institute 38
The others 18 12.2%
Mainly clinical practice in hospital or clinic 13
Others 5
Experiences as an occupational physician
Full time occupational physician 107 72.3%
Part time occupational physician 121 81.8%
Either full time or part time 148 100.0%
At a manufacturing worksite 139 93.9%
134 J Occup Health, Vol. 57, 2015
Table 3. Necessity of competencies for specialist occupational physicians
Items in JSOH list
Mean scores pvalue+ Rank*
Overall Academic Practical
Attitude and ethics for occupational physicians
Position and fundamental roles Y 4.86 4.95 4.85 0.053 1
Code of ethics Y 4.67 4.76 4.64 0.189 3
Personal health data handling Y 4.73 4.84 4.69 0.079 2
Understanding of customers of occupational health services
Analysis of characteristics of companies and workers Y 4.47 4.40 4.52 0.271 13
Assessment of occupational health needs Y 4.64 4.63 4.62 0.899 4
Occupational health services considering social and cultural diversity N 4.10 3.97 4.14 0.237 37
Understanding of related regulations and compliance
Compliance with occupational health regulations Y 4.57 4.47 4.64 0.117 7
Application of amended occupational health regulations N 4.34 4.23 4.40 0.170 19
Application of industrial injury insurance N 4.16 3.87 4.23 0.012 32
Document structures and plans
Policy statement on occupational health Y 4.30 4.11 4.34 0.059 22
Objectives of occupational health programs Y 4.05 3.97 4.05 0.564 41
Plans of occupational health programs Y 4.16 4.08 4.18 0.458 33
Documentation of occupational health procedures Y 3.74 3.63 3.76 0.340 52
Records and reports of occupational health activities N 3.76 3.68 3.76 0.566 51
Information system for occupational health services N 3.70 3.50 3.75 0.074 54
Occupational health organization and roles of occupational physicians
Evaluation of necessary expertise and system Y 4.13 4.11 4.13 0.822 35
Organization of occupational health team N 4.14 3.92 4.22 0.029 34
Cooperation with occupational health staff Y 4.37 4.37 4.34 0.822 18
Quality management of occupational health services N 3.38 3.24 3.38 0.312 61
Budget for occupational health department N 3.51 3.50 3.44 0.721 58
Contribution to health committee Y 4.62 4.71 4.57 0.163 5
Risk assessment
Identification of existing health hazards Y 4.48 4.37 4.49 0.339 11
Information of existing health hazards Y 4.42 4.24 4.47 0.056 15
Monitoring of exposure to health hazards Y 4.28 4.16 4.29 0.337 24
Assessment of health risks Y 4.29 4.13 4.31 0.159 23
Health surveillance, diagnosis and treatment
Indicators of health effects for health surveillance Y 4.02 3.95 4.00 0.705 42
Quality assurance programs of laboratories Y 3.73 3.42 3.83 0.002 53
Utilization of health surveillance for workplace improvement Y 4.52 4.29 4.50 0.070 14
Diagnosis of health effects with health surveillance Y 4.24 4.03 4.26 0.120 27
Risk reduction
Cause analysis of industrial accidents or occupational diseases N 4.34 4.29 4.32 0.807 20
Prioritization of risks for reduction plans Y 3.99 3.92 4.00 0.567 44
Risk reduction methods and plans Y 4.07 3.92 4.10 0.172 38
Execution of risk reduction plans Y 3.94 3.82 3.95 0.346 46
Risk communication
Education programs on risk reduction Y 3.89 3.76 3.90 0.330 47
Risk communication to workers Y 4.19 4.05 4.24 0.172 31
Work load and recovery from fatigue
Evaluation of psychological and physical load Y 4.02 3.97 4.26 0.031 28
Desing of work to have a small load Y 4.11 3.92 4.13 0.117 36
Design of offices and facilities for employees’ welfare Y 3.84 3.74 3.83 0.514 50
Countermeasures against psychosocial health hazards
Mental health programs Y 4.50 4.34 4.53 0.108 10
Programs to combat health effects due to overwork Y 4.48 4.26 4.55 0.017 12
135Koji MORI, et al.: Competencies of specialist ops and training methods
“quality assurance programs of laboratories”, “worksite issues and applicable regulations on environmental protection”, “professional support for environmen-tal protection”, “planning and execution of scientific research on occupational health issues”, “execu-tion and presentation of research following codes of ethics” and “occupational safety and health audit and reporting”. In contrast, there were 7 items with mean scores in a position higher than 40th among the addi-tional items from the lists for the US and Europe. They were “occupational health services considering social and cultural diversity”, “application of amended occupational health regulations”, “application of indus-trial injury insurance”, “organization of occupational health team”, “cause analysis of industrial accidents or occupational diseases”, “improvement of work abilities of elder, ill or handicapped employees” and “protection of reproductive function of female employees”.
Study 2: Survey on Effective Training Methods to Acquire Competencies
As shown in Table 4, among the three training methods suggested, OJT and CBL were judged effec-tive for all competencies. Lectures and textbooks were not judged effective for 10 items.
Lectures and textbooks were the most effective methods for only 5 items. OJT was evaluated as the most effective for 30 items, and many of them were related to legally regulated activities in Japan, such as “contribution to health committees”, “periodic general health examinations” and “programs to combat health effects due to overwork”. CBL were valuated as the most effective for 29 items, and conversely, many of them were related to services based on individual health conditions, such as “mental health programs”, “procedures of fitness for duty assessment and work accommodation” and “work accommodation at return to work or during pregnancy”, and related to ethical
Items in JSOH list
Mean scores pvalue+ Rank*
Overall Academic Practical
Health care and promotion
Periodic general health examination Y 4.26 4.13 4.26 0.381 26
Evaluation of health condition of employee group Y 4.20 4.05 4.24 0.086 30
Health care for elder or female employees Y 4.07 3.87 4.13 0.034 40
Health guidance based on health examination Y 4.39 4.24 4.42 0.197 17
Education on health promotion for employee group Y 4.33 4.16 4.36 0.150 21
Work accommodation
Procedures of fitness for duty assessment and work accommodation Y 4.51 4.29 4.56 0.033 9
Professional opinions on fitness for duty and work accommodation Y 4.59 4.40 4.63 0.047 6
Work accommodation at return to work or during pregnancy Y 4.55 4.37 4.60 0.039 8
Improvement of work abilities of elder, ill or handicapped employees N 4.07 3.87 4.14 0.049 39
Protection of reproductive function of female employees N 4.20 4.18 4.19 0.992 29
First aid and emergency response
First aid skills and training for employees Y 3.95 3.76 4.00 0.157 45
First aid plan and arrangement for equipment Y 3.85 3.58 3.91 0.024 49
Emergency response plan Y 4.01 4.11 3.92 0.199 43
Environment protection
Worksite issues and applicable regulations on environmental protection Y 3.42 3.45 3.31 0.348 60
Professional support for environment protection Y 3.49 3.45 3.42 0.885 59
Scientific research
Planning and execution of scientific research on occupational health issues Y 3.61 3.68 3.56 0.361 56
Execution and presentation of research following codes of ethics Y 3.68 3.71 3.62 0.548 55
Audit
Occupational safety and health audit and reporting Y 3.58 3.56 3.54 0.923 57
Collaboration with parties inside or outside of company
Communication with employers and unions Y 4.28 4.37 4.26 0.425 25
Collaboration with human resources and safety departments Y 4.42 4.34 4.46 0.348 16
Utilization of public resources and contribution to community Y 3.88 3.79 3.91 0.447 48
+p values for the Student’s t-test or Welch’s t-test for comparisons of mean scores between the practical and academic groups. *Rank of the mean score overall.
Table 3. Necessity of competencies for specialist occupational physicians (Continued)
136 J Occup Health, Vol. 57, 2015
Table 4. Effective methods for acquisition of competencies by specialist occupational physicians
Lectures and textbooks OJT CBL
EffectiveMost
effectiveEffective
Most effective
EffectiveMost
effective
Attitude and ethics for occupational physicians
Position and fundamental roles 12 5 19 11* 12 3
Code of ethics 13 7* 16 4 11 7*
Personal health data handling 12 4 17 4 16 9*
Understanding of customers of occupational health services
Analysis of characteristics of companies and workers 4+ 0 19 16* 14 2
Assessment of occupational health needs 11 1 18 16* 15 2
Occupational health services considering social and cultural diversity 11 1 16 11* 15 7
Understanding of related regulations and compliance
Compliance with occupational health regulations 19 10* 11 5 11 4
Application of amended occupational health regulations 16 3 13 5 11 11*
Application of industrial injury insurance 15 5 7 1 19 13*
Document structures and plans
Policy statement on occupational health 13 5 13 9* 12 5
Objectives of occupational health programs 9 0 17 12* 12 7
Plans of occupational health programs 11 0 17 13* 14 6
Documentation of occupational health procedures 14 0 16 12* 11 7
Records and reports of occupational health activities 13 2 17 11* 13 5
Information system for occupational health services 16 7 12 8 11 3
Occupational health organization and roles of occupational physicians
Evaluation of necessary expertise and system 12 2 16 10* 11 6
Organization of occupational health team 9 0 17 14* 13 4
Cooperation with occupational health staff 7+ 0 17 15* 10 3
Quality management of occupational health services 5+ 4 16 6 12 7*
Budget for occupational health department 11 0 15 13* 12 5
Contribution to health committee 11 0 18 15* 11 3
Risk assessment
Identification of existing health hazards 15 3 16 10* 14 6
Information of existing health hazards 18 5 15 4 15 10*
Monitoring of exposure to health hazards 18 2 16 8 16 9*
Assessment of health risks 17 1 13 7 17 11*
Health surveillance, diagnosis and treatment
Indicators of health effects for health surveillance 18 3 14 6 16 10*
Quality assurance programs of laboratories 18 4 13 5 15 10*
Utilization of health surveillance for workplace improvement 12 0 18 12* 17 7
Diagnosis of health effects with health surveillance 17 3 18 11* 14 5
Risk reduction 14 1 16 5 18 13*
Cause analysis of industrial accidents or occupational diseases
Prioritization of risks for reduction plans 17 2 15 7 17 10*
Risk reduction methods and plans 12 0 16 8 17 11*
Execution of risk reduction plans 11 1 15 9* 16 9*
Risk communication
Education programs on risk reduction 14 3 13 9* 15 7
Risk communication to workers 17 4 13 8* 14 7
Work load and recovery from fatigue
Evaluation of psychological and physical load 16 4 17 6 14 9*
Design of work to have a small load 17 2 16 6 14 11*
Design of offices and facilities for employees’ welfare 16 1 17 11* 14 7
Countermeasures against psychosocial health hazards
Mental health programs 14 0 17 9 19 10*
Programs to combat health effects due to overwork 13 0 18 12* 18 7
137Koji MORI, et al.: Competencies of specialist ops and training methods
considerations, such as “codes of ethics” and “personal health data handling”.
Discussion
The results of these surveys offer some insights concerning the validity and improvement of the current competency list of the JSOH, and the appro-priate training methods for development of specialist occupational physicians in Japan.
Validity of the competency list for specialist occupa-tional physicians
The competency list for specialist occupational physicians used in the study was developed on the basis of the JSOH’s list and the lists generated by analogous institutions in the US and Europe. The required competencies should change with fluctua-tions in social dynamics and issues of occupational health. During performance of the study in 2014,
the ACOEM revised its competencies10), and the European Union of Medical Specialists issued the ATOM Portfolio of Performance-Based Assessments11). Therefore, the lists used in this study as references were not the latest versions. However, because the mean scores for all 61 items were evaluated higher than “somewhat necessary” and only one item was suggested to be added as a necessary competency by more than one respondent as a write-in comment, the list appears to have validity as a set of competencies for special occupational physicians under the current situation in Japan.
Validity of the competency list in the certification program of the JSOH and necessary improvements
All 51 items in the JSOH’s current competency list were judged as necessary, but some items scored lower than competencies added from the lists for the US and Europe. For those items, mean scores in a
Lectures and textbooks OJT CBL
EffectiveMost
effectiveEffective
Most effective
EffectiveMost
effective
Health care and promotion
Periodic general health examination 14 2 19 13* 13 4
Evaluation of health condition of employee group 18 3 15 7 12 9*
Health care for elder or female employees 15 3 16 4 17 12*
Health guidance based on health examination 14 0 17 14* 14 5
Education on health promotion for employee group 15 0 19 14* 16 5
Work accommodation
Procedures of fitness for duty assessment and work accommodation 8+ 0 19 7 18 12*
Professional opinions on fitness for duty and work accommodation 8+ 0 19 12* 17 7
Work accommodation at return to work or during pregnancy 11 0 17 6 18 13*
Improvement of work abilities of elder, ill or handicapped employees 15 1 15 1 19 17*
Protection of reproductive function of female employees 18 4 15 1 16 14*
First aid and emergency response
First aid skills and training for employees 15 4 12 4 17 11*
First aid plan and arrangement for equipment 16 7* 13 4 12 7*
Emergency response plan 15 3 15 4 16 12*
Environment protection
Worksite issues and applicable regulations on environmental protection 18 11* 10 2 10 6
Professional support for environment protection 15 4 12 8* 13 7
Scientific research
Planning and execution of scientific research on occupational health issues 19 5 14 3 15 11*
Execution and presentation of research following codes of ethics 16 7* 12 4 11 7*
Audit
Occupational safety and health audit and reporting 11 3 16 5 13 11*
Collaboration with parties inside or outside of company
Communication with employers and unions 5+ 0 18 15* 13 4
Collaboration with human resources and safety departments 4+ 0 19 17* 13 2
Utilization of public resources and contribution to community 8+ 0 18 15* 11 4
+ Less than half answered that the method is effective. * Highest number for the question asking which method was most effective.
Table 4. Effective methods for acquisition of competencies by specialist occupational physicians (Continued)
138 J Occup Health, Vol. 57, 2015
position lower than 51st were associated with devel-opment and execution of management systems, such as “documentation of occupational health procedures” and “occupational safety and health audit and report-ing”; with environment protection, such as “worksite issues and applicable regulations on environmental protection” and “professional support for environmen-tal protection”; and with scientific research, such as “plans and execution of scientific research on occu-pational health issues” and “execution and presenta-tion of research following codes of ethics”. These competencies are not always required for occupational physicians in actual health practices. The results are consistent with a report indicating that the item “design and initiate research” was evaluated lowest among 14 items in a survey of ACOEM members3) and a report indicating that necessities of environmental medicine and management competencies were evaluated lower than others in a survey of specialist occupational physicians in Europe12).
In contrast, there were 7 additional items from the lists for the US and Europe with mean scores in posi-tions higher than 40th. Among them, “cause analy-sis of industrial accidents or occupational diseases” is one of the occupational physicians’ roles in the Japanese regulations, and occupational physicians are often requested to play the other roles in actual practice, too. These should be considered for addi-tion to the JSOH’s list. The competencies for work accommodation specifically for vulnerable individuals, such as “improvement of work abilities of elder, ill or handicapped employees” and “protection of repro-ductive function of female employees”, were highly ranked. Arguably, this may be regarded as a part of the competency for “work accommodation at return to work or during pregnancy”, but a more concrete description of the competency would be desirable.
The minimum legal requirement for occupational physicians is completion of a 50-hour diploma level training program, and specialist occupational physi-cians train with occupational physicians at the diplo-ma level13). The write-in comments in this survey that suggested adding “be able to train non-specialist occupational physicians” might reflect this condition, and this competency should also be considered as an addition to the JSOH’s list. The competency list should be reviewed periodically, because the needs for occupational services are affected by changes in soci-ety, technology and other factors.
The practical group evaluated several competencies as more necessary than the academic group. Most of the competencies with significant group differences were related to work accommodation for individual workers based on their health condition. Activities such as evaluating fitness for work with face-to-face
interviews and advising individuals on improvements in lifestyle were recently enhanced as a part of mental health programs or countermeasures for overwork under governmental guidelines14, 15) or regulations16). Respondents in the “practical group”, who had actual experience in dealing with such issues, appear to have evaluated the necessity of those competencies higher.
Training methods to develop specialist occupational physicians
In general, the most frequently used methods for training the necessary competencies as specialist occu-pational physicians are lectures and textbooks and OJT. Lectures and textbooks were judged less effec-tive methods than others to acquire necessary compe-tencies in the study, but they are useful in acquiring basic knowledge. OJT was evaluated as the most effective for many of the items related to legally regu-lated activities in Japan. This method is considered to be useful in acquiring competencies for routine activi-ties under the condition that a senior occupational physician works together with a trainee or in a train-ing program. However, the fact that only one or a few occupational physicians are assigned to the same worksite makes it difficult to train many occupational physicians by OJT.
CBL was evaluated as effective for the all compe-tencies and as the most effective method for 29 of 61 items in the study. Conversely, it was evaluated as most effective for competencies related to services based on individual health conditions and those related to ethical considerations. Recently, CBL has been introduced in various training programs in public health and occupational health fields. For example, the Harvard School of Public Health has a course in which all classes use a “case method”4), and some undergraduate programs that utilize CBL have been reported in Europe6, 7). We also use a “case method” in postgraduate occupational health training courses at the University of Occupational and Environmental Health, Japan17). Given recent conditions in occupa-tional health, we propose that training programs with CBL components such as discussion of actual cases and use of the “case method” should be provided, and CSOPs should encourage trainees to take advantage of such opportunities.
Limitations of the studyThe main customers for occupational health services
are employers and employees. Although it has been suggested that the viewpoints of these customers are important when considering the necessary competen-cies of occupational physicans18, 19), they have now been confirmed by specialist viewpoints in this study.
Because we were concerned that a complex ques-
139Koji MORI, et al.: Competencies of specialist ops and training methods
tionnaire with two objectives would make the response rate prohibitively low, validity of the competency list and effective training methods to acquire the compe-tencies were studied with separate questionnaires and different groups. CSOPs were chosen as the subjects for the validity survey because they actually train the candidates of COPs; COP examiners, who were also CSOPs, were chosen for the training method survey because they understand the attainments and weak-nesses of examinees. However, the low response rate of 48.1% for the validity survey and the small sample size of 19 for the training methods survey were factors that limit interpretation of the results.
Acknowledgments: We thank the CSOPs and COP examiners from the JSOH for their cooperation. This study was supported by the Occupational Health Promotion Foundation.
References
1) MacDonald E, Baranski B, Wilford (eds) . Occupational Medicine in Europe: Scope and Competencies. Bilthoven (Netherlands): WHO European Center for Environment and Health, 2000.
2) Harber P, Mummaneni S, Crawford L. Influence of residency training on occupational medicine practice patterns. J Occup Environ Med 2005; 47: 161−7.
3) Baker BA, Dodd K, Greaves IA, Zheng CJ, Brosseau L, Guidotti T. Occupational medicine physicians in the United States: demographics and core competencies. J Occup Environ Med 2007; 49: 388−400.
4) Harvard School of Public Health. Case-based learn-ing. HSPH News. [Online]. [cited 2014 Oct 24]; Available from: URL: http://www.hsph.harvard.edu/news/magazine/spr09case/.
5) Koh D, Chia S, Jeyaratnam J, Chia SE, Singh J. Case studies in occupational medicine for medical undergraduate training. Occup Med (Lond). 1995; 45: 27−30.
6) Braeckman L, Bekaert M, Cobbaut L, Ridder MD, Glazemakers J, Kiss P. Workplace visits versus case studies in undergraduate occupational medicine teaching. J Occup Environ Med 2009; 51: 1455−9.
7) Brackman LA, Fieuw AM, Van Bogaert HJ. A web- and case-based learning program for postgraduate students in occupational medicine. Int J Occup Environ Health 2007; 14: 51−6.
8) A m e r i c a n C o l l e g e o f O c c u p a t i o n a l a n d Environmental Medicine. American College of Occupational and Environmental Medicine compe-tencies—2008. J Occup Environ Med 2008; 50: 712−24.
9) World Health Organization. Global strategy on occu-pational health for all: the way to health at work. Recommendations of the Second Meeting of the
WHO Collaborating Centers in Occupational Health. Geneva(Switzerland): WHO; 1995.
10) Cloeren M, Gean C, Kesler D, et al. American College of Occupational and Environmental Medicine’s Occupational and Environmental Medicine Competencies-2014: ACOEM OEM Competencies Task Force. J Occup Environ Med 2014; 56: e21−40.
11) UEMS Occupational Medicine. Assessment Tool for Occupational Medicine, Portfolio of Performance-Based Assessments. [Online]. 2014 [cited 2014 Oct 24]; Available from: URL:http://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/publichealth/hwlgroup/atom/http://www.uems-occupationalmedicine.org/sites/default/files/Meetings/Dresen/item_5.2.2_-_occupational_medicine_-_ e u r o p e a n _ t r a i n i n g _ r e q u i r e m e n t s _ -_2013.03.11_annex_2_-_for_adoption.pdf
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13) The certificate program for specialist occupational physicians—the details of establishment and the transitions for 12 years. Sangyo Eiseigaku Zasshi 2004; 46: 89−97 (in Japanese) .
14) Ministry of Health, Labor and Welfare. Guidelines for the Maintenance and Promotion of Workers’ Mental Health. [Online]. [cited 2014 Oct 24]; Available from: URL: http://www.mhlw.go.jp/houdou/2006/03/h0331-1.html (in Japanese).
15) Ministry of Health, Labor and Welfare. Overview of “the integrated measure for the health problems prevention caused by overwork”. [Online]. [cited 2014 Oct 24]; Available from: URL: http://www.mhlw.go.jp/english/wp/wp-hw4/dl/working_conditions_labour_relations/2011071911.pdf
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140 J Occup Health, Vol. 57, 2015A
ppen
dix.
Abb
revi
atio
ns o
f co
mpe
tenc
ies
in th
e pa
per
Cat
egor
yA
bbre
viat
ions
in th
e Pa
per
Des
crip
tions
in th
e Q
uest
ionn
aire
s
Atti
tude
and
eth
ics
for
occu
patio
nal p
hysi
cian
s
Posi
tion
and
fund
amen
tal r
oles
U
nder
stan
d th
e po
sitio
n an
d fu
ndam
enta
l rol
es o
f an
occ
upat
iona
l phy
sici
an in
the
wor
kpla
ce.
Cod
e of
eth
ics
Und
erst
and
code
s of
eth
ics
for
occu
patio
nal p
hysi
cian
s an
d be
abl
e to
com
ply
with
them
.
Pers
onal
hea
lth d
ata
hand
ling
Be
able
to h
andl
e pe
rson
al h
ealth
dat
a of
wor
kers
in p
ayin
g at
tent
ion
to th
eir
priv
acy
and
acce
ss r
ight
s.
Und
erst
andi
ng o
f cu
stom
ers
of o
ccup
atio
nal h
ealth
ser
vice
s
Ana
lysi
s of
cha
ract
eris
tics
of c
ompa
nies
and
wor
kers
Be
able
to a
naly
ze c
hara
cter
istic
s of
com
pani
es in
volv
ed a
nd th
e w
orke
rs th
roug
h co
mm
unic
atio
n w
ith e
mpl
oyer
s, s
uper
viso
rs, e
mpl
oyee
s an
d ot
hers
.
Ass
essm
ent o
f oc
cupa
tiona
l hea
lth n
eeds
Be
able
to c
olle
ct n
eces
sary
info
rmat
ion
for
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rsta
ndin
g th
e w
orks
ites
and
asse
ssin
g oc
cupa
tiona
l hea
lth n
eeds
by
fiel
d pa
trol
or
othe
r m
etho
ds.
Occ
upat
iona
l he
alth
ser
vice
s co
nsid
erin
g so
cial
and
cul
tura
l di
vers
ityB
e ab
le to
pro
vide
eff
ectiv
e oc
cupa
tiona
l hea
lth s
ervi
ces
by c
onsi
deri
ng s
ocia
l and
cul
tura
l div
ersi
ty o
f w
orke
rs.
Und
erst
andi
ng o
f re
late
d re
gula
tions
and
com
plia
nce
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plia
nce
with
occ
upat
iona
l hea
lth r
egul
atio
nsB
e ab
le t
o co
ntri
bute
to
com
plia
nce
with
ind
ustr
ial
safe
ty a
nd h
ealth
reg
ulat
ions
by
unde
rsta
ndin
g ap
plic
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reg
ulat
ions
, co
llect
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info
rmat
ion
on t
he
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ts a
nd a
pply
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this
info
rmat
ion
to o
ccup
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nal h
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pra
ctic
es a
t the
wor
kpla
ce.
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licat
ion
of a
men
ded
occu
patio
nal h
ealth
reg
ulat
ions
Be
able
to e
valu
ate
appl
icab
ility
of
amen
ded
regu
latio
ns to
the
wor
ksite
and
adv
ise
an e
mpl
oyer
on
how
to c
ompl
y w
ith th
em.
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licat
ion
of in
dust
rial
inju
ry in
sura
nce
Be
able
to g
ive
prof
essi
onal
adv
ice
to a
n em
ploy
er o
n th
e ap
plic
atio
n of
indu
stri
al a
ccid
ent c
ompe
nsat
ion
insu
ranc
e or
law
suits
rel
ated
to w
ork
inju
ries
or
illne
ss.
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umen
t str
uctu
res
and
plan
s
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y st
atem
ent o
n oc
cupa
tiona
l hea
lthB
e ab
le to
adv
ise
empl
oyer
s on
dra
win
g up
pol
icy
stat
emen
ts o
n oc
cupa
tiona
l saf
ety
and
heal
th.
Obj
ectiv
es o
f oc
cupa
tiona
l hea
lth p
rogr
ams
Ba
able
to
deve
lop
obje
ctiv
es o
f oc
cupa
tiona
l he
alth
pro
gram
s in
cor
resp
onde
nce
with
act
ual
cond
ition
s of
the
wor
kpla
ce a
nd e
valu
ate
prog
ram
per
for-
man
ce.
Plan
s of
occ
upat
iona
l hea
lth p
rogr
ams
Be
able
to m
ake
a pl
an f
or o
ccup
atio
nal h
ealth
pro
gram
s an
d m
anag
e th
eir
prog
ress
.
Doc
umen
tatio
n of
occ
upat
iona
l hea
lth p
roce
dure
sB
e ab
le to
dev
elop
pro
cedu
res
and
othe
r re
late
d do
cum
ents
on
occu
patio
nal h
ealth
in c
orre
spon
denc
e w
ith a
ctua
l con
ditio
ns o
f th
e w
orkp
lace
.
Rec
ords
and
rep
orts
of
occu
patio
nal h
ealth
act
iviti
esB
e ab
le to
kee
p oc
cupa
tiona
l hea
lth r
ecor
ds a
ppro
pria
tely
and
use
them
to d
evel
op a
ctiv
ity r
epor
ts th
at a
re a
s ac
cura
te a
nd q
uant
itativ
e as
pos
sibl
e.
Info
rmat
ion
syst
em f
or o
ccup
atio
nal h
ealth
ser
vice
sB
e ab
le to
cla
rify
the
nece
ssar
y in
form
atio
n fo
r oc
cupa
tiona
l hea
lth s
ervi
ces
and
utili
ze a
n in
form
atio
n sy
stem
for
pro
vidi
ng a
nd a
naly
zing
ser
vice
s.
Occ
upat
iona
l hea
lth o
rgan
izat
ion
and
role
s of
occ
upat
iona
l phy
sici
ans
Eva
luat
ion
of n
eces
sary
exp
ertis
e an
d sy
stem
Be
able
to a
dvis
e an
em
ploy
er o
n ne
cess
ary
expe
rtis
e an
d ap
prop
riat
e sy
stem
s fo
r ef
fect
ive
occu
patio
nal h
ealth
act
iviti
es.
Org
aniz
atio
n of
occ
upat
iona
l hea
lth te
amB
e ab
le to
org
aniz
e an
occ
upat
iona
l hea
lth te
am b
y cl
arif
ying
rol
es o
f ea
ch o
ccup
atio
nal h
ealth
sta
ff a
nd le
adin
g th
e co
oper
ativ
e ef
fort
.
Coo
pera
tion
with
occ
upat
iona
l hea
lth s
taff
Be
able
to g
uide
occ
upat
iona
l hea
lth n
urse
s an
d he
alth
sup
ervi
sors
and
coo
pera
te w
ith th
em e
ffec
tivel
y.
Qua
lity
man
agem
ent o
f oc
cupa
tiona
l hea
lth s
ervi
ces
Be
able
to e
valu
ate
and
impr
ove
the
qual
ity o
f oc
cupa
tiona
l hea
lth s
ervi
ces
with
a q
ualit
y m
anag
emen
t sys
tem
.
Bud
get f
or o
ccup
atio
nal h
ealth
dep
artm
ent
Be
able
to b
udge
t for
the
occu
patio
nal h
ealth
dep
artm
ent a
nd d
evel
op a
n ef
fect
ive
exec
utio
n pl
an.
Con
trib
utio
n to
hea
lth c
omm
ittee
Be
able
to c
ontr
ibut
e to
eff
ectiv
e di
scus
sion
in a
hea
lth c
omm
ittee
and
in o
ther
opp
ortu
nitie
s.
Ris
k as
sess
men
t Iden
tific
atio
n of
exi
stin
g he
alth
haz
ards
Be
able
to id
entif
y ex
istin
g he
alth
haz
ards
in th
e w
orkp
lace
and
add
ress
them
.
Info
rmat
ion
of e
xist
ing
heal
th h
azar
dsB
e ab
le to
col
lect
info
rmat
ion
on e
xist
ing
heal
th h
azar
ds in
the
wor
kpla
ce, a
nd u
nder
stan
d an
d us
e th
e in
form
atio
n fo
r ri
sk a
sses
smen
t.
Mon
itori
ng o
f ex
posu
re to
hea
lth h
azar
dsU
nder
stan
d ex
posu
re m
onito
ring
met
hods
for
hea
lth h
azar
ds a
nd b
e ab
le to
ass
ess
wor
kers
' exp
osur
e.
Ass
essm
ent o
f he
alth
ris
ksB
e ab
le to
ass
ess
heal
th r
isks
with
haz
ard
info
rmat
ion
and
expo
sure
dat
a of
wor
kers
.
Hea
lth s
urve
illan
ce, d
iagn
osis
and
trea
tmen
t
Indi
cato
rs o
f he
alth
eff
ects
for
hea
lth s
urve
illan
ceB
e ab
le to
con
side
r ex
posu
re c
ondi
tions
to h
ealth
haz
ards
and
use
this
info
rmat
ion
to d
ecid
e on
indi
cato
rs f
or h
ealth
sur
veill
ance
.
Qua
lity
assu
ranc
e pr
ogra
ms
of la
bora
tori
esU
nder
stan
d qu
ality
ass
uran
ce p
rogr
ams
and
be a
ble
to s
elec
t a r
elia
ble
labo
rato
ry f
or h
ealth
exa
min
atio
ns.
Util
izat
ion
of h
ealth
sur
veill
ance
for
wor
kpla
ce im
prov
emen
tB
e ab
le to
gra
sp c
ondi
tions
in th
e w
orkp
lace
with
dat
a fr
om h
ealth
sur
veill
ance
, and
use
the
data
for
impr
ovem
ent.
Dia
gnos
is o
f he
alth
eff
ects
with
hea
lth s
urve
illan
ceB
e ab
le to
dia
gnos
e ad
vers
e he
alth
eff
ects
with
hea
lth s
urve
illan
ce a
nd o
ther
met
hods
.
Ris
k re
duct
ion C
ause
ana
lysi
s of
ind
ustr
ial
acci
dent
s or
occ
upat
iona
l di
s-ea
ses
Be
able
to p
artic
ipat
e in
cau
se a
naly
sis
of in
dust
rial
acc
iden
ts o
r oc
cupa
tiona
l dis
ease
s an
d co
ntri
bute
to p
reve
ntio
n of
rec
urre
nce.
Prio
ritiz
atio
n of
ris
ks f
or r
educ
tion
plan
sB
e ab
le to
pri
oriti
ze r
isks
for
red
uctio
n pl
ans
with
ris
k as
sess
men
t.
Ris
k re
duct
ion
met
hods
and
pla
nsB
e ab
le to
adv
ise
an e
mpl
oyer
on
risk
red
uctio
n m
etho
ds a
nd p
lans
acc
ordi
ng to
exi
stin
g ri
sks
in th
e w
orkp
lace
.
Exe
cutio
n of
ris
k re
duct
ion
plan
sB
e ab
le to
con
firm
exe
cutio
n of
ris
k re
duct
ion
plan
s an
d ev
alua
te th
eir
effe
ctiv
enes
s.
141Koji MORI, et al.: Competencies of specialist ops and training methods
Cat
egor
yA
bbre
viat
ions
in th
e Pa
per
Des
crip
tions
in th
e Q
uest
ionn
aire
s
Ris
k co
mm
unic
atio
n
Edu
catio
n pr
ogra
ms
on r
isk
redu
ctio
nB
e ab
le to
pla
n an
d co
nduc
t nec
essa
ry e
duca
tion
prog
ram
s on
ris
k re
duct
ion
for
ever
y la
yer
of e
mpl
oyee
s.
Ris
k co
mm
unic
atio
n to
wor
kers
Be
able
to
com
mun
icat
e w
ith w
orke
rs o
n ex
istin
g he
alth
ris
ks w
hile
con
side
ring
the
ir a
nxie
ty, a
nd t
o ad
dres
s qu
estio
ns f
rom
wor
kers
on
the
basi
s of
sci
-en
tific
evi
denc
e.
Wor
k lo
ad a
nd r
ecov
ery
from
fat
igue
Eva
luat
ion
of p
sych
olog
ical
and
phy
sica
l loa
dB
e ab
le to
eva
luat
e ps
ycho
logi
cal a
nd p
hysi
cal l
oads
of
wor
kers
acc
ordi
ng to
thei
r w
ork,
shi
ft p
atte
rn a
nd s
o on
.
Des
ign
of w
ork
to h
ave
a sm
all l
oad
Be
able
to a
dvis
e an
em
ploy
er o
n w
ork
desi
gn th
at m
akes
psy
chol
ogic
al a
nd p
hysi
cal l
oads
as
smal
l as
poss
ible
.
Des
ign
of o
ffic
es a
nd f
acili
ties
for
empl
oyee
s' w
elfa
reB
e ab
le t
o ad
vise
an
empl
oyer
on
desi
gn o
f of
fice
s an
d fa
cilit
ies
for
empl
oyee
s’ w
elfa
re, s
uch
as r
esta
uran
ts a
nd l
oung
es t
hat
faci
litat
e re
cove
ry o
f th
eir
fatig
ue.
Cou
nter
mea
sure
s ag
ains
t psy
chos
ocia
l hea
lth h
azar
ds
Men
tal h
ealth
pro
gram
sB
e ab
le to
mak
e an
app
ropr
iate
pla
n fo
r m
enta
l hea
lth p
rogr
ams,
pro
vide
cou
nsel
ing
to e
mpl
oyee
s an
d ad
vise
an
empl
oyer
on
the
nece
ssar
y ac
tions
.
Prog
ram
s to
com
bat h
ealth
eff
ects
due
to o
verw
ork
Be
able
to
cont
ribu
te t
o pr
ogra
ms
to c
omba
t he
alth
eff
ects
due
to
over
wor
k by
exe
cutin
g fa
ce-t
o-fa
ce i
nter
view
s w
ith e
mpl
oyee
s an
d ad
visi
ng e
mpl
oyer
s to
pre
vent
adv
erse
hea
lth e
ffec
ts.
Hea
lth c
are
and
prom
otio
n
Peri
odic
gen
eral
hea
lth e
xam
inat
ion
Be
able
to p
lan
and
cond
uct p
erio
dic
gene
ral h
ealth
exa
min
atio
ns to
eva
luat
e he
alth
con
ditio
ns a
nd li
fest
yles
of
empl
oyee
s.
Eva
luat
ion
of h
ealth
con
ditio
n of
em
ploy
ee g
roup
Be
able
to e
valu
ate
heal
th c
ondi
tions
, lif
esty
le a
nd o
ther
fac
tors
am
ong
empl
oyee
s as
a g
roup
.
Hea
lth c
are
for
elde
r or
fem
ale
empl
oyee
sB
e ab
le to
dev
elop
a h
ealth
car
e pl
an f
or e
lder
or
fem
ale
empl
oyee
s an
d ha
ndle
indi
vidu
al c
ases
bas
ed o
n da
ta f
or th
eir
heal
th c
hara
cter
istic
s.
Hea
lth g
uida
nce
base
d on
hea
lth e
xam
inat
ion
Be
able
to c
ondu
ct h
ealth
gui
danc
e ba
sed
on h
ealth
exa
min
atio
ns.
Edu
catio
n on
hea
lth p
rom
otio
n fo
r em
ploy
ee g
roup
Be
able
to m
ake
lect
ures
on
heal
th p
rom
otio
n to
em
ploy
ee g
roup
s.
Wor
k ac
com
mod
atio
n
Pro
cedu
res
of f
itne
ss f
or d
uty
asse
ssm
ent
and
wor
k ac
com
-m
odat
ion
Be
able
to g
ive
prof
essi
onal
adv
ice
to a
n em
ploy
er o
n pr
oced
ures
of
fitn
ess
for
duty
ass
essm
ent a
nd w
ork
acco
mm
odat
ion.
Prof
essi
onal
opi
nion
s on
fitn
ess
for
duty
and
wor
k ac
com
mo-
datio
nB
e ab
le to
sub
mit
opin
ions
on
fitn
ess
for
duty
and
wor
k ac
com
mod
atio
n ba
sed
on d
ata
from
hea
lth e
xam
inat
ions
.
Wor
k ac
com
mod
atio
n at
ret
urn
to w
ork
or d
urin
g pr
egna
ncy
Be
able
to g
ive
advi
ce to
an
empl
oyer
on
nece
ssar
y w
ork
acco
mm
odat
ion
for
retu
rnin
g to
wor
k or
dur
ing
preg
nanc
y.
Impr
ovem
ent
of w
ork
abil
itie
s of
eld
er,
ill
or h
andi
capp
ed
empl
oyee
sB
e ab
le to
sup
port
eld
er, i
ll or
han
dica
pped
em
ploy
ees
to im
prov
e th
eir
wor
k ab
ilitie
s.
Prot
ectio
n of
rep
rodu
ctiv
e fu
nctio
n of
fem
ale
empl
oyee
sB
e ab
le to
adv
ise
fem
ale
empl
oyee
s on
pro
tect
ion
of r
epro
duct
ive
func
tion,
esp
ecia
lly d
urin
g pr
egna
ncy.
Firs
t aid
and
em
erge
ncy
resp
onse
Firs
t aid
ski
lls a
nd tr
aini
ng f
or e
mpl
oyee
sH
ave
firs
t aid
ski
lls a
nd b
e ab
le to
trai
n oc
cupa
tiona
l hea
lth s
taff
and
oth
er e
mpl
oyee
s.
Firs
t aid
pla
n an
d ar
rang
emen
t for
equ
ipm
ent
Be
able
to d
evel
op a
fir
st a
id p
lan
and
arra
nge
nece
ssar
y eq
uipm
ent a
nd o
ther
req
uire
men
ts.
Em
erge
ncy
resp
onse
pla
nB
e ab
le to
giv
e pr
ofes
sion
al a
dvic
e to
an
empl
oyer
on
deve
lopm
ent o
f an
em
erge
ncy
resp
onse
pla
n.
Env
iron
men
t pro
tect
ion
Wor
ksite
iss
ues
and
appl
icab
le r
egul
atio
ns o
n en
viro
nmen
tal
prot
ectio
nB
e ab
le to
exp
lain
issu
es o
f w
orks
ites,
app
licab
le r
egul
atio
ns a
nd r
equi
rem
ents
of
a m
anag
emen
t sys
tem
for
env
iron
men
t pro
tect
ion.
Prof
essi
onal
sup
port
for
env
iron
men
t pro
tect
ion
Be
able
to g
ive
prof
essi
onal
sup
port
to a
ctiv
ities
of
envi
ronm
enta
l pro
tect
ion
in th
e w
orkp
lace
.
Scie
ntif
ic r
esea
rch
Plan
ning
and
exe
cutio
n of
sci
entif
ic r
esea
rch
on o
ccup
atio
nal
heal
th is
sues
Be
able
to d
esig
n sc
ient
ific
res
earc
h pl
ans
on o
ccup
atio
nal h
ealth
issu
es a
nd e
xecu
te th
em.
Exe
cuti
on a
nd p
rese
ntat
ion
of r
esea
rch
foll
owin
g co
des
of
ethi
csB
e ab
le to
exe
cute
sci
entif
ic r
esea
rch
and
pres
ent t
he r
esul
ts, f
ollo
win
g a
code
of
ethi
cs.
Aud
it
Occ
upat
iona
l saf
ety
and
heal
th a
udit
and
repo
rtin
gB
e ab
le to
par
ticip
ate
in a
n oc
cupa
tiona
l saf
ety
and
heal
th a
udit
and
cont
ribu
te to
the
repo
rtin
g.
Col
labo
ratio
n w
ith p
artie
s in
side
or
outs
ide
of c
ompa
ny
Com
mun
icat
ion
with
em
ploy
ers
and
unio
nsB
e ab
le to
com
mun
icat
e w
ith e
mpl
oyer
s, u
nion
s an
d ot
her
stak
ehol
ders
, with
und
erst
andi
ng o
f th
eir
posi
tions
.
Col
labo
ratio
n w
ith h
uman
res
ourc
es a
nd s
afet
y de
part
men
tsB
e ab
le to
col
labo
rate
eff
ectiv
ely
with
hum
an r
esou
rce
depa
rtm
ent,
safe
ty d
epar
tmen
t and
oth
er d
epar
tmen
ts.
Util
izat
ion
of p
ublic
res
ourc
es a
nd c
ontr
ibut
ion
to c
omm
unity
Be
able
to u
tiliz
e pu
blic
sec
tors
and
loca
l res
ourc
es e
ffec
tivel
y an
d co
ntri
bute
to lo
cal s
ocie
ty.
App
endi
x. A
bbre
viat
ions
of
com
pete
ncie
s in
the
pape
r (C
ontin
ued)