Well, good morning. Thank you for joining us for the basic course in occupational medicine part two. The following are some required disclosure slides as well as a brief orientation of our college. So the American Osteopathic College of Occupational and Preventive Medicine is a group of medical specialists that practice occupational and preventive medicine. There are three divisions of public health. There's occupational medicine, which includes disability impairment evaluation medicine. There's general public health and preventive medicine to include correctional medicine and aerospace medicine, which also includes undersea and hyperbaric medicine. So all three of these deal with populations of patients in particular environments. Our college exists mainly to provide you with good quality CME that helps you improve your competency as well as providing you with networking opportunities to some real champions of our profession. We have our basic course in occupational environmental medicine. It's a three-part course. You don't have to take the parts in any order. We also do the Federal Motor Carrier Safety Administration's commercial driver medical examiner course and we do a medical review officer course in collaboration with the Medical Review Officer Certification Council. Our basic course in occupational medicine provides you with a pathway to achieve a certificate of added qualification in occupational medicine for physicians that have a primary AOA board in any discipline. Through our sister organization OPAM, we can also train your PAs and APRNs as well as your MD colleagues. I mentioned our OPAM workshops. They're listed here again for you. So welcome to our basic course in occupational environmental medicine. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education, ACCME, through a joint providership agreement with the American Osteopathic Association and our college, the American Osteopathic College of Occupational Medicine. The AOA is accredited by ACCME to provide continuing medical education for physicians. We have designated this course for seven and a half Category 1A AOACME credits and the American Osteopathic Association designates this activity for a maximum of 7.5 AMA PRA Category 1 credits. Physicians should only claim the credit commensurate with the extent of their participation in this activity. The American Osteopathic Association has implemented a policy to comply with the current Accreditation Council for Continuing Medical Education standards for integrity and independence and accredited continuing education requiring resolution of all conflicts of interest. Faculty declaring a relevant commercial interest must be identified in the activity syllabus and our program. In accordance with disclosure policies of the AOA and ACCME, every effort has been made to ensure all CME activities are balanced, independent, objectives and scientifically rigorous. These policies include complying with ACCME standards for integrity and independence and accredited continuing education and resolving all possible conflicts of interest for all individuals in control of content. All relevant financial relationships have been mitigated. The following faculty presenters and planning committee members have indicated they have no relationship that can be perceived as a potential conflict of interest nor will any offloaded drug usage be discussed. The information in this educational course is provided for general medical education purposes only. It is not meant to substitute any of the other courses. General medical education purposes only is not meant to substitute for the independent medical judgment of the physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors and faculty. They do not represent an endorsement by the AOA. In no event will the AOA be liable for any decision made or action taken in the lines upon the information provided through the CME course. AOCOPM and AOA acknowledge that no support other than course registration fees have been accepted in the offering of this course. We have a grievance process. Please let me or one of our officers know immediately if you have any problems with handouts, program content, or any other issue with the conference. Concerned about our compliance with the AOA's uniform guidelines may be expressed to us or to the AOA. We've got contact info there. This certificate of added qualification occupational environmental medicine represents credentialing in the field of medicine. The CAQ is approved by the AOA through established criteria and a written exam is administered by the American Osteopathic Board of Preventive Medicine. That is a separate distinct organization from our college. So currently if you're a graduate of a COCA accredited osteopathic medical school and you did at least your AOA internship and you either accumulate 100 hours of broad-based CME or you complete the basic course in occupational medicine or a comparable review course. You also have to maintain a current board certification in any AOA approved primary specialty. You have to have an unrestricted license and you have to adhere to the AOA code of ethics. There's some changes that were being considered. I think we've got everything mitigated now and in the basic courses I'm going to continue as it's been formatted and held previously. So there's information about the CAQ and about our full board certification through the board. It's our current information about the board. And again there's two different organizations and this slide shows you that our college is a teaching entity. We're a separately incorporated 501c3 organization. The board on the other hand the American Osteopathic Board of Preventive Medicine is a business unit a department of the AOA and as such it maintains the item bank and conducts a job task analysis every decade to make sure that their test is reliable and valid. There's info on joining the college and we'll now go through this basic course comprehensive needs assessment. We will introduce the faculty as they present each of their lectures. Thank you. Okay well welcome. My clock says 9.03 we'll go ahead and get started. Dr. Elizabeth Clark who you'll hear from throughout the day has asked me to go through a brief introduction to the basic course in the CAQ and occupational medicine. This course has its roots back in the 1980s. At the time what we tried to do was approximate a fellowship but allow you to continue working while you go through this process of completing the basic course in occupational environmental medicine. The original faculty took the 27 or so broad topic areas and divided it into three different modules basic courses one two and three. You do not need to take the parts in order. We cannot offer the three parts in a three-day weekend because they want us to spread it out over a year with the idea that you're doing some concurrent practice-based learning and you're doing some independent evidence-based medicine scholarship and study. But anyway upon completion of the three parts of the basic course as long as you maintain a primary AOA board certification in any primary discipline you're eligible to sit the exam for a certificate of qualification in occupational and environmental medicine. The board does maintain an alternate pathway where you accumulate I believe it's 100 hours of occupational medicine CME and if you can show evidence of that usually it's within the last two cycles and I know we're doing away with cycles so I'm sure it'll be defined as within the last five or six years. You can you can also qualify that way. I don't recall anybody qualifying through the alternate pathway most everyone does the three parts of the basic course. It ensures that you have exposure to all of the broad categorical areas that that's on the exam. So hopefully you all can see this Microsoft Word document. This is part of the handout packet that Rhonda's posted and it's also in the YAP app. Hopefully you all have the YAP app. You can see here there's a couple of QR codes for you to look at at full color slides on our app. There's also a link to the evaluation attestation form that we'll turn on later today. If you haven't done the pre-test please do so as early as possible. Perhaps when I'm talking because I'm not really saying a lot that's important but do so as early as possible and we'll do a review of the basic of the pre-test around the lunch hour. So there's agreements procedure. We would encourage you to call us first if you have issues talk to one of our officers but also you can always reach out to our accreditor in in their contact infos here. So I've kind of gone through the CAQ and people ask me well how should I study and I tell well the best way is to keep the the handout pack. So keep the YAP app and we'll keep the you know all three cycles on there. So as you pick up each of the course you'll gain exposure to those handout packs and reviewing these slide decks are probably the best way to study but we also have some other resources. One of which and this is our this is our comprehensive basic course needs assessment. So I've got some of the same info I just described to you but then after this these preliminary pages we have our needs assessment. This kind of shows you how the exam domain distribution is. So you know clinical occupational environmental medicine is 13 percent of the exam, industrial hygiene and safety is 16 percent but you'll also have a few questions on some of these other topics substance abuse reproductive hazards and we cover all these in different modules within this course. After the domain distribution you'll begin with our various learning objectives and I've provided you with the learning objectives for the entire course not just this module not just part two. A little full disclosure every time we do this to for the convenience of the speakers that have travel needs we sort of resort the order in which we provide these lectures. So these the alpha sorting of this document may not be identical to the agenda that's on the first page but you'll see the learning objectives here on part two. So like I said they're not in the same order and then ionizing and non-ionizing radiation we began providing that as a study guide. We don't actually do a lecture on it anymore because we wanted to do a health and physical exam module instead so we felt like that was a little bit more important than the rare occasion where you'll be dealing with ionizing and non-ionizing radiation. At the very end of this are some of our evidence-based sources. If a lot of it comes out of the the McKinney textbooks and the Ladue textbooks but you could look at this and as you pull these sources if you notice there's a more recent edition we would invite you to let us know so we could update our source guide here. We do have a couple of documents that are available e-books that Dr. Liz, I'm sorry Dr. Mims Mabey's done recently so our e-books are also available through our website and Rhonda's provided you with the link here. With that, I'll pause and see if y'all have any questions about the overview. So, at the end of the course, we'll ask you to complete the evaluation and attestation. That document has three purposes. One is to attest to how many hours you actually attended. So, like Dr. Vellon was expressing concerns earlier that he may not be able to sit through the entire course today because he's having some tech issues and what happens if he gets booted off. What I'd like for you to do in light of the fact that we are going to upload these to the AOA's on-demand portal and give each of you complementary access to that. If you intend to watch all eight or eight and a half hours, however much is on the attestation, go ahead and attest to what you promised to do. That way, we don't have to do your CMA in two components. Dr. Randolph, I'm going to mute you, I think. Oh, sorry. Sorry. That's okay. Okay. So, anyway, yeah. So, if you miss a module but you know you're going to review it later as soon as it's available to you, go ahead and attest that you've completed that module as well. The other part of that document is going to be a little outcomes assessment. We also do a post-test. So, we'll send you the link to the post-test as well. At this time, I'll invite any of you to unmute or put in the chat should you have any questions. All right. The survey is closed when I click it, right? I'm sorry. Say that again, Dr. Vellon. Yeah, saying that the survey is closed. Yeah. There's a... Rhonda put in the chat the correct link. Apparently, there was an issue with the link. So, I could also email that to everyone. But, if you look in the chat window and scroll up, Rhonda posted the actual link to the pre-test. Now, the evaluation is going to remain closed for most of the day, but we'll open it up later this afternoon for the evaluation and attestation. Okay. All right. Looks good. So, pre-test should be open and I just sent, re-typed in the link to it. So, if that continues to be closed, just send me another chat and I'll troubleshoot it. Thank you. Yes, sir. So, at this time, I'm going to introduce our course chair, Dr. Elizabeth Clark. Dr. Clark is a past president of AOCOPM. She's a fellow of our college. She went to med school at KCUMB and graduated in 1987. She's board certified in family medicine, preventive medicine, aerospace medicine, as well as occupational medicine. She's also a member of the National Registry of Certified Medical Examiners course, and she's a fellow both of our college and the FAIMA. She spent 25 years in the Air Force as a flight surgeon. So, I'll welcome Dr. Clark. Dr. Clark, please come up to the podium. Thank you, Mr. President. Thank you, Mr. President. So, I think what I'd like to do, we're a little ahead of schedule. If everybody's friendly with this suggestion, how about we spend a little bit of time reviewing the pre-test? Would y'all be friendly with that? Yeah. So, we can do this verbally. I'll take this off so you guys can hear better. As we go through the questions, if anybody has any questions about the questions, please chime in because this is way better as a discussion than as me just talking. So, according to the OSHA bloodborne pathogen standard, how long must training records, keyword there is training, be maintained? And so, we had a bunch of people that said, and so, the first, we had about half the people said for at least three years, and the other group of people said for the duration of employment plus 30 years. That's the OSHA standard for cop records. No. Well, wait a minute. So, this bloodborne pathogen, the keyword here is training. Training records, right. Exposure records, you maintain forever and longer. But that's not under the bloodborne pathogen. It is for exposures, not for training. Okay. Yeah, but if it's not bloodborne pathogen, OSHA has a different standard. They do. It's like they're different ones for different exposures, but bloodborne pathogen. So, this is the keyword in this question was the key root word that people messed up was training. And so, the training records, you need them for three years. And then, you're good as far as proving you trained them because it's just supposed to train them every two years. Then, you should have trained them again anyway. So, it shouldn't make a difference. But the question about if they were exposed, those records you keep for a long, long time. So, that was where people got a little bit confused on that. That's employment plus 30, right? It's employment plus, I forget if it's 20 or 30, but it's employment plus forever. This is actually one of those questions that if you're ever talking to your EMR people and you want to make their heads hurt, remind them of this. And where are the records that were in the paper charts from 10 years ago that they shredded? But if it's an OSHA 2 log, you've still got to keep it duration employment plus third, right? Correct. So, the way the bloodborne pathogen standard works is there's a special version of the OSHA log that just has to do with needle stick exposures and bloodborne pathogen exposures. So, you would follow that process. It goes on the 300 log and there's a, I want to say a 105- It wasn't bloodborne pathogen. It's a straight needle stick. Not a needle stick, just a work injury. That's 30 years plus, employment plus 30 years. I don't think if it's just on the OSHA log, you keep those forever long and keep OSHA logs. I actually don't know how long that is. The tricky part about this is- It's not a bloodborne pathogen. I don't know the answer to that question. It's a good question. I don't know the answer to it. I don't know. Where I spend all my time is worrying about what goes on the OSHA log, not how long you keep them once you write on them. No, but it's not a bloodborne pathogen. That's the question. But the bloodborne pathogen is going on their own special weird way. Let's go on to the next question because that's why some people had trouble with that one. The next question, which of the following types of ionizing radiation has a large mass, it does not penetrate the skin, but it's dangerous if inhaled or ingested? The correct answer most people got was alpha particles. They're big, but they can't go through stuff. That's the one you can block with a piece of paper. Which of the following conditions is considered a disability under the ADAAA? And do you have them in writing there? What's the question? Alcoholism, sober for eight years. So alcoholism, sober. Hold on. Let's go through them one at a time, but you'll have to read me what the other answers are because they're cut off. Alcoholism, sober for eight years. Alcoholism, sober for eight years would be covered because the person's currently sober. That's important. Current substance use to HR. So they report current substance abuse. It's right below where it says answer. I see it now. So the current substance abuse reported to HR requesting assistance would not be covered by the ADA because it is current substance abuse. A drug worker fails a drug test. That is definitely not covered by ADA. And then gender identity is one of the specific exclusions as of the ADAAA. And I actually don't, I actually suspect that this will continue to be excluded. Not that you can't, not the treatment part, none of that stuff, but to accommodate you in a special way may not be something that the ADAAA wants to go down that road. Let's keep going to the next question. Okay. Exposure to epoxy resin can result in which of the following? So metal fume fever would be no because epoxies aren't metal. It's well, are neither zinc nor copper, which are the only metals that cause metal fume fever. Allergic dermatitis would be a yes. Polymer fume fever would be normally no. But if you burned them, we'll have a whole different discussion because that's where polymer fume fever gets a problem. And it's not acro osteolysis. That's perfectly correct. Okay. Question five. What is the most effective treatment for carbamate pesticide toxicity? So always everybody here got it right. It's atropine. This is one of the ones where 2-PAM doesn't do anything. And methylene blue is that we're in the wrong neighborhood. That's not one of the things for carbamate. Valium, if they're seizing, you use valium, but it's not really an antidote. Which OSHA standard requires an employer to protect their employees from ergonomic hazards? The ergonomic standard was the correct answer for approximately three days back in like 2008. And it's not been the correct answer since then. It went into effect and was immediate, the next president immediately canned it. So that's not true. It is the general general rule. So that's not true. It is the general duty clause. And pretty much anything in OSHA world where you say, could this be a hazard to the worker and there's no specific standard, you always go back to the general duty clause. It just says everybody that comes to work has to go home healthy. Yeah. Right now, there's no, on the books, there's no ergonomic standard. Correct. The ergonomic standard. That's right. Ineffective regulations. It was in effect for under a day. Maybe it was two days, but it was very, very... It was a very short-lived standard and there were some problems with it because there were some activities that you could never be permitted. Some businesses would have had a very hard time because the very thing they do would have automatically been not allowed. Okay. Question seven. Which of the following exposures should be assessed during the facility walkthrough? There are multiple correct answers. We'll do this in a couple of minutes. Lunchroom smoking policies, union politics, air conditioning temperatures, and lockout, tag out if they have an effective system. All of those are pretty much correct answers. All of them? Except not the air conditioning one. Air conditioning is not correct. Yeah. The air conditioning one at various workstations might be something you would notice and comment on. So when I will do a walkthrough, I'm using every sense I have to determine whether I think we have a problem. Now that may be guided and we'll talk about that in a little bit. But there's nothing that I would not want to know about. But I agree that the air conditioning is... It's not that I want to comment on the air conditioning. It's not my major focus. But if I noticed something that was especially bad, you know, it's 140 degrees in this workstation, that might be important. Why are you looking at union politics? Um, is the union... As part of the walkthrough, I would ask about union politics. You're correct. It is not an exposure. Which of the following exposures should be assessed? That you're correct. It's not... People would argue it's not exposure. I've been exposed to union politics before. Yeah. Sucks. So we'll keep going. Know about it. It's not officially exposure. Okay. Question eight. The blood borne pathogen standard covers workers in which of the following settings? And the short answer is it would only be the athletic trainers. And the reason is because that's who is expected, whose job description is to provide medical care. Anybody who might vicariously provide it is not covered specifically under the blood borne pathogen standards. So, you know, the maintenance guy at the golf course could see somebody bleeding and help with first aid, but that's not part of their job expectations. Whereas an athletic trainer or a lifeguard, it is specifically what they're there to do. So they're covered by the blood borne pathogen standard. Enforcement of the ADA and the ADAAA and all that kind of stuff. Everybody got it right. It's the Equal Employment Opportunity Commission, EEOC. Which of the following symptoms of altitude sickness is indicative of a threatening condition? And the big deal here is the pink frothy sputum. The other one that could be on that list would be if they had changes in cognition. They're the ones that you have to really worry about. Dyspnea on exertion is going to be everybody at altitude. If you have any questions, you get a chance to go to Pike's Peak. You'll get to kind of see that on your own. And then at the bottom, we put happy stuff. Are there any questions about any of the questions?

occupational environmental medicine

Certificate of Added Qualification

disability impairment evaluation

aerospace medicine

hyperbaric medicine

ACCME standards