Occupational medicine was recognised as a medical specialty in 2005. Prof Rajen Naidoo and Dr. Saloshni Naidoo were accredited as specialists with HPCSA. At that stage, our Department immediately applied to the HPCSA for recognition as a training site. This was approved together with four registrar positions. The provincial Department of Health agreed to the creation of these registrar posts. In November 2005 the first registrar was appointed, followed by another in January 2007. By March 2008 all four posts were filled.
The registrar training is a four year full time programme, in which trainees have to meet the requirements of the syllabus set out by the College of Public Health Medicine of South Africa. Trainees are expected to undergo a series of rotations during their tenure, undertake a research project, maintain a six-monthly training log and sit for a written and oral examination conducted by the College.
This programme is intended to prepare trainees to achieve the following exit competencies:
• Be able to diagnose and manage all aspects of work-related disease or disability or threats to health and well-being of individual employees.
• Be able to investigate occupational health risks in a workplace and develop an efficient and effective hazard control and management programme through workplace interventions and appropriate occupational health services
• Be able to describe, explain and quantify occupational health risks, occupational health service needs and interventions through conducting appropriate epidemiological research and developing appropriate policy options based on study findings.
The registrars undertake several clinical, health management and research rotations during the four year period in the Department. Their primary clinical occupational medicine experience is from attendance at the specialist Occupational Medicine Clinic run at King Edward Hospital one half day per week. This clinic is one of only three specialist level clinics in the country, and sees referrals from private and public sector health professionals. Registrars take responsibility for each new case seen.
Further clinical training is obtained through rotations in the Division of Respiratory Medicine, Dermatology, Orthopaedics, Radiology, Neurology and ENT. These rotations vary from a full six-month term, through to shorter terms or even to a few sessions per week in a discipline.
Workplace worker management experience is gained through a six month rotation at the eThekwini Municipality’s Occupational Health Service. With over 20 000 employees, the local government has work activities extending from electrical, construction, forestry and gardening through to cleaning and sewage work. The students assess workers exposed to this large variety of potential hazards, and are expected to make clinical and fitness to work decisions, under the supervision of Dr. Stanley Naraidu, the Director of the service.
Additional worker management training is gained through rotations at the Employee Health Service at King Edward Hospital (KEH). The hospital employs approximately 3000 workers ranging from medical specialists, nursing staff, paramedical staff such as physiotherapists and radiographers, through to general assistants, facing biological, chemical and physical hazards on a daily basis. Towards the end of 2008, additional rotations at Inkosi Albert Luthuli Central Hospital’s (IALCH) Employee Health Service were also included.
The IALCH and KEH rotations also provide an opportunity for the conduct of programme development, including medical surveillance programmes and workplace risk assessment. Registrars are expected to conduct risk assessments in the various sections/departments of the hospital and based on these assessments develop medical surveillance programmes for the workers in that section.
The final training experience that registrars receive is in health service management, with particular reference to occupational health. This experience is currently gained within KEH, where registrars are expected to interact with the senior management of the institution, including the Chief Executive Officer, the Hospital Medical Manager and Nursing Manager etc, in order to establish the infrastructure and institutional management for occupational health and safety.
In addition registrars have weekly attachments in private sector occupational health services as a training requirement of the HPCSA. Registrars participate in weekly discussion forums which allow them the opportunity to explore theoretical and clinical aspects of occupational medicine with specialists in occupational medicine. Currently the department has four registrar training posts.
The Department actively participates in the College of Medicines of South Africa National Examinations of registrars in occupational medicine. Prof Rajen Naidoo and Dr. Saloshni Naidoo have been either core or additional examiners in all examinations held to date. The last two examinations have been held in Cape Town (2009) and Johannesburg (2010).