Duke EOHW | GlaxoSmithKline | NC OEES | OHS Wilmington | Womack Army Medical Center | Other Sites

 

Duke Employee Occupational Health and Wellness (EOHW)

This state of the art comprehensive corporate medical program won the 1999 ACOEM Corporate Health and Safety award. Residents are supervised by the corporate medical director Gregg Stave MD, MPH, JD, a former graduate of the Duke OEM program. The GlaxoSmithKline OHS staff includes physicians, physician assistants, occupational health nurses, toxicologists, industrial hygienists, radiation specialists, and biohazards safety specialists. GlaxoSmithKline OHS provides a broad variety of services designed to protect and enhance employee health. Clinical programs include post-hire medical evaluations, medical surveillance, work site visits and hazard assessment, reproductive health evaluations and medical emergency response. Work-related injuries and illnesses are evaluated and treated at onsite clinics. Other activities include development of internal health and safety exposure limits for new chemical entities, health promotion and worker productivity programs, and consultation to human resources to select managed care and workers compensation plans. Residents spend up to four months at this practicum site and work closely with on-site physicians, nurses, industrial hygienists, toxicologists and safety personnel. The manufacturing facilities in Zebulon, NC, and research laboratories provide examples of worker protection via containment, and an opportunity to assess ergonomic hazards and chemical and biological related exposure concerns. Residents are given responsibility for projects focused on improving work site safety as well as administrative program development and health promotion projects. Residents are responsible for at least one major project and participate in all activities of the occupational health service.

 

A physician epidemiologist, Rickey Langley MD MSPH, and certified industrial hygienist serve as onsite preceptors for resident projects. Residents are involved in longitudinal activities or block rotations within this Department. The primary educational objective of the practicum experience at OEES is to offer resident trainees an opportunity to actively participate in public health investigations of occupational and environmental health hazards that have statewide impact. Residents are involved in the initial assessment of a health hazard, planning and conducting an investigation, and preparing recommendations for action by the State Health Department. Secondary objectives include understanding occupational and environmental health statutes and regulations, and understanding the legal and ethical constraints when mediating between legitimate citizen health concerns vs. industry/economic interests. Residents also have an opportunity for hands on training in environmental monitoring techniques and interpretation of data generated from sampling results. Additional opportunities include designing epidemiologic studies and interpretation of occupational disease surveillance data. Resident projects include a written report that is reviewed by the onsite preceptor and Duke faculty. Some studies may lead to publication.

 

Resident health hazard evaluations have included:

 

 

Dr. John Cromer, formerly a full-time faculty member at Duke OEM, directs this busy community based occupational health service in Wilmington, NC and serves as the resident preceptor. The OEM team consists of Dr. Cromer and a physician assistant, as well as four nurses, an x-ray technician, an occupational health nurse and a physical therapist. A state of the art physical therapy and work hardening center are located near the clinic. Residents may spend 1-2 months at this practicum site which is strongly recommended. The service provides on-site medical care for Federal Paper Board Company, a large unionized paper manufacturing facility, and the local General Electric Aerospace division plant, that manufactures aircraft engines and nuclear reactor components. Services are provided both at the clinic and at the work site. Other clients include Corning Glass (manufacturing fiberoptic cables), American Crane (manufacturing and welding steel products), Interroll (manufacturing bearings and rollers), Bulk Lift (manufacturing bag house materials), Siemens (manufacturing circuit breakers), City of Wilmington (serving police, fire fighters, waste workers, etc.) and some 300 other local industries.

 

Residents see patients for medical surveillance and injury care in the clinic as well as at onsite industrial clinics. Most of their time, however, is spent in addressing work-related concerns through site visits in association with company safety and industrial hygiene personnel. A detailed written evaluation of safety and health concerns and recommendations for changes for each site visit is required by the end of the rotation.

 

Womack Army Medical Center (WAMC) Occupational Health Clinic

• Program Development: review and modification of programs as delineated by OSHA regulations, Army regulations and applicable state and local laws. Programs include:
  • Medical Surveillance Programs
  • Occupational Vision Program
  • Respiratory Protection Program
  • lllness Absence Monitoring
  • Work Site Visit Program

• Hazard Investigations:
  • Work site visits to verify complaints
  • Identify hazards
  • Recommend solutions
  • The resident can expect to participate in 2-3 such visits per week and is responsible for writing a report and recommendations for preventive intervention

• Administration:
  • Communicate with supervisors and managers about ways to manage work site hazards.
  • Work with the Civilian Personnel Office in their dealings with the Department of Labor
  • Work with the Office of Workers Compensation Program

• Teaching:
  • Provide Occupational Medicine in service training to staff at the Occupational health clinic
  • Occupational Medicine education to primary care practitioners at WMAC

• Clinical:
  • Participate in clinical assessments to determine work-fitness and ability to return to work
  • Opportunities are available to evaluate and participate in functional capacity examinations (FCEs)

• Interdisciplinary Team Meetings:
  • Participate in weekly educational meetings of OEM physicians, nurses, and industrial hygienists to discuss hazard management and employee health issues
  • Residents present occupational health seminars

• Interact with the Industrial Hygiene staff and Safety personnel in evaluations of hazards and complaints from around the post
  
• Participate in clinical consultations with staff in the areas of toxicologic disease assessment, reproductive health assessment and medical surveillance
  
• Participate in and manage epidemiologic investigations
  

 

Residents also spend one to two days per week participating in OEM faculty consultations in the occupational and environmental medicine clinics serving clients from local industry. Patients are referred by primary care physicians who suspect a possible occupational illness, attorneys and insurance companies. Many consultations concern toxic illness or involve the evaluation of workers with chronic musculoskeletal disorders. Residents gain familiarity with MEDLINE and other occupational health data bases by performing relevant literature searches. Presentation skills are honed in staff meetings where difficult cases are discussed. Diagnostic decision making and writing skills are developed during faculty review of the final report written by the resident. A similar format is followed for hospital inpatient consultations.

 

A multitude of other short-term and longitudinal experiences are available through faculty consultations and research. Examples include reproductive health evaluations and investigations of indoor air quality. Faculty provide national corporate medical consulting services to a large textile manufacturing company and large chemical manufacturing company, offering opportunities for investigating exposure-related health complaints and surveillance for work related illness. Residents have the opportunity to participate in an occupational pulmonary rotation at the UNC School of Medicine. Clinical rotations are also available in neurology and dermatology at Duke Medical Center, depending on resident interest and previous training.