Occupational medicine (OM) teaching is under-represented and inconsistent in UK medical school training. Unless universities take action, inadequate OM teaching provision will leave tomorrow's doctors unprepared to support their patients to return to work after illness/injury, to remain at work and to identify occupational diseases. This Editorial presents a newly developed competency framework to assist universities to deliver OM education more consistently. This will support tomorrow's doctors to achieve healthy working lives for their patients.

Abstract Background The information technology (IT) workforce has been growing more rapidly than others, with occupational health (OH) risks of sedentary behaviour, physical inactivity and poor diet, yet studies of their non-communicable disease risk, notably cancer, are lacking. Aims To investigate cancer risk in IT workers compared to others in employment and the nine major Standard Occupational Classification (SOC) groups. Methods We evaluated incident diagnosed cancers in the UK Biobank cohort through national cancer registry linkage. Cox proportional hazard regression models, with 15-year follow-up, were used to compare incident cancer risk among IT workers with all other employed participants and with the nine major SOC groups. Results Overall, 10 517 (4%) employed participants were IT workers. Adjusting for confounders, IT workers had a slightly lower cancer incidence compared to all other employed participants (Model 2: hazard ratio = 0.91, 95% confidence interval [CI] 0.83–1.01). Compared to the nine major SOC groups, they had a similar (Major Groups 2, 5 and 8) or lower (Major Groups 1, 3, 4, 6, 7 and 9) cancer incidence. Conclusions Despite their occupational risks of sedentary behaviour, poor diet and physical inactivity, IT workers do not have an increased cancer incidence compared to all other employed participants and the nine major SOC groups. This study paves the way for large, longitudinal health outcome studies of this under-researched and rapidly growing occupational group.

I wish to make some observations on the significant editorial and related paper by Lalloo and Macdonald [1,2]. I make these comments as an Independent Medical Examiner appointed by a WorkCover authority in an Australian jurisdiction. My work mainly relates to workers compensation cases in contrast to the paper by Lalloo and Macdonald which mainly relates to referrals for sickness absence. However, I find the issues and principles they raised are similar which underlines the importance of their paper for clinical practice. I have found the overall concept in approaching ‘complex’ patients should be one of exploring illness behaviour and the several medical, psychosocial, organizational and systems influences that may shape this behaviour. The concept of red, yellow, blue and black flags is a useful structural framework. I am surprised that the authors downplay the importance of biopsychosocial factors in case complexity. Their comment is based on the analysis of 200 complex cases of experienced occupational physicians using a template. Therefore, adequacy of the history taking becomes critical to the soundness of the database. In my experience explorations of childhood trauma (‘did you have a happy childhood?’) and for migrants an exploration of the circumstances in which they fled their country sometimes reveals horrific traumas causing long-term psychological scars [3]. If these sensitive but crucial matters were not covered in the template history, their importance will be downplayed.

‘Are you a real doctor?’ A question I was asked by a new-start administrator, during my specialist training. Ironically, it was something I was beginning to ask myself when I first started out in occupational medicine. After years in hospitals and general practice, I was in unfamiliar territory. My days were no longer predominated by ordering medical investigations, formulating differential diagnoses and prescribing treatment. My duty was not only to the patient. Were my days of being a ‘real’ doctor over? If my primary function was not diagnosing and treating patients, what value would I add? As my training progressed, I was enlightened. I discovered the power of (good) work; the benefits to the individual (improved physical and mental health, better socioeconomic prospects, reduced mortality and inequality); to government (economic growth, reduced social security dependency); and to creating a happier and healthier society. A key reward to restoring an ill...

Objectives Despite reported psychological hazards of information technology (IT) work, studies of diagnosed mental health conditions in IT workers are lacking. We investigated self-reported mental health outcomes and incident anxiety/depression in IT workers compared to others in employment in a large population-based cohort. Methods We evaluated self-reported mental health outcomes in the UK Biobank cohort and incident diagnosed anxiety/depression through health record linkage. We used logistic regression and Cox models to compare the risks of prevalent and incident anxiety/depression among IT workers with all other employed participants. Furthermore, we compared outcomes within IT worker subgroups, and between these subgroups and other similar occupations within their major Standard Occupational Classification (SOC) group. Results Of 112 399 participants analyzed, 4093 (3.6%) were IT workers. At baseline, IT workers had a reduced odds (OR = 0.66, 95%CI: 0.52-0.85) of anxiety/depression symptoms and were less likely (OR = 0.87, 95%CI: 0.83-0.91) to have ever attended their GP for anxiety/depression, compared to all other employed participants, after adjustment for confounders. The IT technician subgroup were more likely (OR = 1.22, 95%CI: 1.07-1.40) to have previously seen their GP or a psychiatrist (OR = 1.31, 95%CI: 1.06-1.62) for anxiety/depression than their SOC counterparts. IT workers had lower incident anxiety/depression (HR = 0.84, 95%CI 0.77-0.93) compared to all other employed participants, after adjustment for confounders. Conclusions Our findings from this, the first longitudinal study of IT worker mental health, set the benchmark in our understanding of the mental health of this growing workforce and identification of high-risk groups. This will have important implications for targeting mental health workplace interventions.

Objectives: Clinical case complexity is an inherent factor in occupational health (OH), yet it is poorly defined and understood. Our aim was to identify the multiple sources of complexity in OH and propose a conceptual complexity framework model for clinical OH practice. Methods: Through a scoping review, expert panel consensus, and content analysis of OH clinical case reports, we identified relevant complexity-contributing factors (CCFs) specifically tailored to the OH setting, which we defined and validated. Results: The proposed model consists of three primary domains (PDs); health factors, workplace factors and biopsychosocial factors. Twenty-seven CCFs are described and defined within these PDs. Conclusions: This work lays the foundation for improved understanding, identification, and assessment of complexity in OH. This is imperative for ensuring high quality clinical practice standards, identifying training needs and appropriate triaging/resource allocation.

Introduction Informational technology (IT) and the IT workforce are rapidly expanding with potential occupational health implications. Yet to date, IT worker health is under-studied and large-scale studies are lacking. Objectives To investigate health, lifestyle and occupational risk factors of IT workers. Methods We evaluated self-reported health, lifestyle and occupational risk factors for IT workers in the UK Biobank database. Using logistic regression, we investigated differences between IT workers and all other employed participants. Regression models were repeated for IT worker sub-groups (managers, professionals, technicians) and their respective counterparts within the same Standard Occupational Classification (SOC) major group (functional managers, science and technology professionals, science and technology associate professionals). Results Overall, 10,931 (4%) employed participants were IT workers. Compared to all other employed participants, IT workers reported similar overall health, but lower lifestyle risk factors for smoking and obesity. Sedentary work was a substantially higher occupational exposure risk for IT workers compared to all other employed participants (OR=5.14, 95%CI:4.91–5.39) and their specific SOC group counterparts (managers: OR=1.83, 95%CI:1.68–1.99, professionals: OR=7.18, 95%CI:6.58–7.82, technicians: OR=4.48, 95%CI:3.87–5.17). IT workers were also more likely to engage in computer screen-time outside work than all other employed participants (OR=1.42, 95%CI:1.35–1.51). Conclusions Improved understanding of health, lifestyle and occupational risk factors from this, the largest to date study of IT worker health, can help inform workplace interventions to mitigate risk, improve health and increase the work participation of this increasingly important and rapidly growing occupational group.

Objectives: Clinical case complexity is an inherent factor in occupational health (OH), yet it is poorly defined and understood. Our aim was to identify the multiple sources of complexity in OH and propose a conceptual complexity framework model for clinical OH practice. Methods: Through a scoping review, expert panel consensus, and content analysis of OH clinical case reports, we identified relevant complexity-contributing factors (CCFs) specifically tailored to the OH setting, which we defined and validated. Results: The proposed model consists of three primary domains (PDs); health factors, workplace factors and biopsychosocial factors. Twenty-seven CCFs are described and defined within these PDs. Conclusions: This work lays the foundation for improved understanding, identification, and assessment of complexity in OH. This is imperative for ensuring high quality clinical practice standards, identifying training needs and appropriate triaging/ resource allocation.

Objectives: Clinical case complexity is an inherent factor in occupational health (OH), yet it is poorly defined and understood. Our aim was to identify the multiple sources of complexity in OH and propose a conceptual complexity framework model for clinical OH practice. Methods: Through a scoping review, expert panel consensus, and content analysis of OH clinical case reports, we identified relevant complexity-contributing factors (CCFs) specifically tailored to the OH setting, which we defined and validated. Results: The proposed model consists of three primary domains (PDs); health factors, workplace factors and biopsychosocial factors. Twenty-seven CCFs are described and defined within these PDs. Conclusions: This work lays the foundation for improved understanding, identification, and assessment of complexity in OH. This is imperative for ensuring high quality clinical practice standards, identifying training needs and appropriate triaging/resource allocation.

Background For all doctors, including occupational physicians (OPs), research and teaching are considered core requirements of medical education and continuing professional development. Academic skills are also vital to evidence-based practice and advancement of occupational health (OH) as a specialty. In recent years, attention has focussed on the declining UK OH academic base and the research-practice gap, and increased practitioner participation in research is encouraged. Aims An establish a baseline of research and teaching activity among UK OPs, identify related barriers and inform strategies to overcome them. Methods An online survey including specific career profile questions derived from consensus following expert panel discussions. It formed part of a larger Delphi study on UK OH research priorities. Results We received 213 responses, about 18% of 1207 practising UK OPs. Of these, 162 (76%) undertook research at some career-point, of which 44 (27%) were currently research-active. Similarly, 154 (72%) undertook teaching at some career-point, of which 99 (64%) were currently teaching-active. Of those who had never undertaken research (n = 51) or teaching (n = 59), 40 and 42% were interested in doing so, respectively. Key barriers were lack of time and opportunity, the former particularly for respondents practising in industry, where 'commercial' demands take priority, rather than healthcare. Conclusions this study establishes a benchmark of academic activity among UK OPs and identifies related barriers.These 'target' barriers can shape research funding priorities and education to increase participation and develop the UK OH academic base.

Objectives Studies identifying national occupational health (OH) research priorities have been conducted in several countries to establish where OH research should be focused and where funding should be targeted. However, the UK findings are now over 20 years old, and OH practice is continuously evolving. The aim of this study was to identify current research priorities for UK occupational physicians (OPs) and occupational health researchers (OHRs). Methods Current research priorities in OH were identified using a modified Delphi technique. This was conducted in two rounds to achieve consensus. Research priorities were rated, and then ranked using questionnaires developed from expert panel discussions, key research topics identified from the medical literature and participant feedback. Overall and intergroup comparisons were completed for the ranking scores. Results Consensus among OPs and OHRs was high with almost all (9/10) primary domains rated as 'very important' or 'absolutely necessary' by more than 54% of respondents. The research priority areas ranked highest were jointly economic evaluation/cost effectiveness studies and disability management followed by occupational disease/injury/illness. Occupational health policy was ranked lowest after sickness absence management and health promotion. The secondary domain analysis identified priority emphasis on mental health and psychosocial hazards within the workplace and the need to further develop evidence-based guidance for clinical OH practice. Conclusions We identified the current research priorities for UK OPs and OHRs. The findings will inform future national OH research strategy and support research that addresses important knowledge gaps within OH and other interdisciplinary specialties.

Background: The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey. Methods: An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work. Results: There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups. Conclusion: This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles.

Objectives The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key OH professional groups. Evolving OH practice and overlapping OP and OHN roles make it imperative that up-to-date competencies reflective of practice are established. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods A modified Delphi study conducted among representative networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1- ‘rating’, round 2- ‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results The principle domain (PD) competency ranks were very highly correlated (Spearman’s rho=0.972; p<0.001) with the same PDs featuring in the top four and bottom three in ranking. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically-focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities.

Objectives The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs.Methods A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1-'rating', round 2-'ranking'), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions.Results In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman's r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups.Conclusions This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The 'clinically focused' competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional 'core' OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities.

Background Sickness absence (SA) remains a significant problem globally, notably in developed countries. Early intervention to enhance return to work has been identified as a key priority in disability and SA management and these interventions implemented in the early stages of SA episodes indicate that 'early' and 'very early' intervention may result in a quicker return to work and be cost-effective. The objective of this systematic review is to investigate the effectiveness of 'very early' (under 15 days) SA workplace interventions to enhance return to work. Methods A systematic literature search was conducted in Pubmed, HMIC, Cochrane library database, CINAHL, PsychInfo and Embase. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Randomised controlled trials, controlled trials, cluster-randomised trials, cross-over designs, before and after studies and interrupted time-series published in English until September 2014 were included if they assessed the effectiveness of workplace interventions to reduce SA in workers who were on sick leave no longer than 15 days. Primary outcome measures included rates of and time until RTW, productivity loss, and recurrences of SA. The Cochrane Collaboration tool was used to assess the risk of bias. Results We found limited available evidence on the benefits of 'very early' workplace interventions in terms of RTW after a SA episode compared to usual care. Only three randomised controlled trials classed as high or intermediate quality were identified. Early part-time sick leave together with appropriate job modifications led to a reduction on the duration and recurrence of SA, and increased self-perception of health and quality of life. There is evidence of benefit of intervening during the first two weeks of SA for musculoskeletal disorders and less for workers with mental health problems. Conclusion Our review identified a lack of substantive evidence from the literature at this time point to support 'very early' intervention compared to usual care. Consensus is required on the definition of 'early' and 'very early' interventions and further research is recommended to improve understanding of the factors influencing when and how best to intervene for maximum gain.

Background Ill-health in doctors can affect performance and fitness to practice, and consequently patient care and safety, placing an important responsibility on National Health Service (NHS) occupational health (OH) services. Anecdotal discussions amongst NHS occupational physicians suggest an increase in the number of doctor attendances over time, with continuing focus on mental illness. Aims To analyse OH referrals in doctors and dentists over 3 years. Methods A retrospective evaluation of all doctor and dentist referrals to the OH service in one Scottish NHS board from April 2011 to March 2014, comparing this to management-reported sickness absence (SA) data held by the organization. Results We found no significant change in overall OH referrals for doctors and dentists during the evaluation period. Mental illness was the commonest referral reason in all 3 years at 32, 38 and 30%, respectively, but no significant change in mental health referrals was demonstrated within the study period. SA events significantly increased during the three study years (356, 426 and 469, respectively; P < 0.05). OH referrals for those absent from work increased significantly between Years 1 and 3 (16 and 30, respectively; P < 0.05). Conclusions SA events and OH referrals for those absent from work significantly increased between April 2011 and March 2014, but there was no commensurate (statistically significant) increase in overall OH referrals. These findings do not support anecdotal suggestions of increasing OH (or mental ill-health) attendances but can be used as a benchmark for other NHS organizations and for future trend comparisons.