Educating petroleum doctors

Educating petroleum doctors An interactive course using audience response technology juni 14 Educating petroleum doctors • Background • The old r...
Author: Lenard Young
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Educating petroleum doctors An interactive course using audience response technology

juni 14

Educating petroleum doctors •

Background

• The old regulations from 1990 partly outdated and not reflecting medical and industry development

• Experience drawn from the industry-employed medical doctors. Too often reports about people holding offshore health certificate who shouldn’t have had one.

• The doctors who were issuing the health certificates: - Little knowledge about the oil&gas industry - Little knowledge about the work and professions offshore - Used to being the patients advocate - Many NOT used to being ”experts” on behalf of others than the patient

- Most NOT used to exercising selection medicine

Educating petroleum doctors •

Consequence

• ”New” regulation: Regulations regarding health requirements for persons

• •

• •

working on installations in petroleum activities offshore (Valid from 20.12.2010) ”New” guideline to the regulations (valid from 01.01.2011): - it elaborates the regulation to a high degree as the regulations itself are not very specific when it comes to medical diagoses and risk evaluation Requirement to participate at a course and pass an exam to be allowed to issue health certificates Requirement to have a refresher-course after 3 years (5 years) Applies to all certificates issued after 01.01.2014

Educating petroleum doctors • •

At the start of 2011 no existing courses/education for petroleum doctors A ”national syllabus” was approved by the Norwegian directorate of health, as late as 22.05.2013:

• ”To be approved as a petroleum doctor, the doctor must have participated at the compulsory education and passed an examination.”

• ”A significant part of the education must be dedicated to the risk evaluation of medical conditions which may affect the medical fitness of workers in the offshore petroleum industry.”

• ”This requires the (physical) presence during at least one full day of teaching.”

• ”To be resertified it is required that the doctor participates at a compulsory education and passes an examination. The syllabus for the resertification course will be determined at a later stage.”

Educating petroleum doctors • •

Further described in the syllabus: The curriculum should cover the following:



Knowledge. After the education, the doctor should:

-

Have knowledge about the principles of selection medicine

-

Have good knowledge about the acts and regulations and professional standards related to the medical examination of workers in the offshore petroleum activities

-

Have basic knowledge about the health act and regulations and the administration act relevant for the medical examination for the petroleum activities

-

Understand the consequences of a ”Not-fit-for-duty” declaration and know the procedures for dispensation applications and complaints

-

Have knowledge about the different work-tasks offshore

-

Have knowledge of offshore safety and emergency preparedness, including training and (medical) evacuation.

Know the principles for risk evaluation related to the health requirements and offshore work

Have good knowledge about the health services offshore, including possibilities and limitations to medical assistance

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Educating petroleum doctors • Skills. After the education, the doctor should - Be able to perform medical examinations and evaluate persons who are going to work offshore, according to the relevant acts and regulations

- Be able to exercise the role as a petroleum doctor with clear distinction towards other roles as a medical doctor

- Be able to perform a risk evaluation considering that the person should not be a danger to him-/herself, to others, or for the safe operation of the installation

- Be able to require additional examinations or examinations by specialists to obtain a relevant evaluation of the medical condition at hand

- Be able to guide the applicant and contribute to the further process if the health requirements are not met

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Educating petroleum doctors •

The only provider of an approved course so far is the Norwegian Center for Maritime Medicine at Haukeland University Hospital in Bergen.

• Represents broad experience within maritime and military medicine • Has the responsibility of running the ”Radio Medico”, assisting ships world wide with medical advices

• Employs among others medical doctors with experience from the Norwegian oil&gas industry

• Director currently the president of IMHA (International Maritime Health Association)

Educating petroleum doctors •

Lecturers • Alf Magne Horneland, Director NCMM, President IMHA • Arne Ulven NCMM, Research director NCMM, Former medical doctor in Statoil, decades of experience from Radio Medico • Marit Grønning, Director Norwegian center for diving medicine and professor at the University Hospital in Bergen • Endre Sundal Section Chief Neurology at the Institute of occupational medicine, Haukeland University Hospital, Bergen • Kjetil Todnem, Total E&P Norge, Member of the appeals board for offshore health certificates and the Network for health and working environment in Norwegian Oil and Gas



There have been a total of 13 courses, just over 1000 MD’s are approved • Too many doctors? The desire to have a low number of interested and qualified doctors • Too few doctors? The need to have doctors issuing certificates even in less populated areas in rural Norway.

Educating petroleum doctors •

Curriculum

9

1

Introduction to medical fitness examination / medical selection

2

Regulations 2010-12-20 No. 1780: Regulations regarding health requirements for persons working on installations in petroleum activities offshore

1

1 2

Guidelines to Regulations regarding health requirements for persons working on installations in petroleum activities offshore (IS-1879)

2

3

Public administration act

1

4

Offshore working places

1

5

Work tasks and job demands offshore

1

6

Health services and healthcare provision offshore, opportunities for and limitations of medical assistance, offshore safety and emergency response roles, including training, and evacuation methods including helicopter evacuation

1

1

7

Risk assessment with different medical conditions

1

2

8

Clinical case discussions. Assessment of individual risk, based on knowledge of likelihood of medical incidents related to medical condition, consequences of such incidents related regular and emergency situations on board, within the framework of the regulations and guidelines.

2

9

Preparation of cases for the County Governor of Rogaland. Procedures for the Complaint Commission.

10

Conclusions and evaluation of the course.

11

Course test

Total hours

Taught Course: 16 hours Homework: 14 hours

Course test

Homework

Plenary discussion

Topic

Taugth lecture

Lecture No.

CURRICULUM

6

4

1

0,5 2 7

7

2 14

10

Educating petroleum doctors Wireless audience response system

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Example of case: Diabetes type 1

Basic Course for Petroleum Doctors NCMM

The patient



Male, 32 years old, cleaner. At present not working offshore, but wants to do so.

• • •

Documented diabetes type I at age 11, otherwise healthy No diabetes in the family Uses long acting insulin (Insulin detemir) 50 ie vesp. And short acting (Insulin aspart) 8-14 ie before meals

Patient cont.

• •

Last attack of hypoglycaemia was in high school.



Hba1c a little high at present (9,7%), struggling to improve this



Measurement of blood glucose 4-5 times daily

At present only slight hypoglycaemia symptoms which are noticed early

Patient cont.



Has low grade retinopathia, treated with laser 4 years earlier



Last seen the ophtalmologist 2 months ago who concluded that there are no clear proliferative signs, «possibly slight preproliferative changes»



Recent specialist reports from endocrinologist and ophtalmologist confirm the information above

Patient cont.



Clinical interview: Well functioning, non smoker, no other medicines, moderate alcohol consumation



General status: Moderate overweight (180 cm, weight 95 kg; BMI 28. Normotensive. Good peripheral circulation and sensibility.

Q01 - Diabetes

How do you act?

1. Collect more information 2. Unlimited health certificate 3. Certificate with limitation in time validity 4. Certificate of medical unfitness

Q-01 Diabetes

Educating petroleum doctors

• • • • •

Discussions following the answers/chart Relevant statements in the regulations

Relevant text from the Guidelines General and individual risk evaluation Conclusion

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Educating petroleum doctors •

Evaluation of the course

• Instantly • By the wireless audience response system • Anonymous • High degree of participation

Participants

USA Sweden

Singapore Romania Monaco Malta Italy Holland Germany France Finland Estonia Denmark Croatia

Canada Austria 0

5

10

15

20

25

Have you issued offschore health certificates prior to attending this course?

No

14

Yes

No opinion

Not voting

72

0

14

Usefulness of attending the course Very good

64

Good

22

Average

6

Little

0

Very little

0

No opinion

0

Not voting

8

Relation between homework and taught course Much more as taught course

0

A little more as taught course

12

Adequate balance

76

A little more as homework

6

Much more as homework

0

No opinion

0

Not voting

6

Total length of course Far too short

0

Too short

4

Suitable length

72

Too long

16

Far too long

0

No opinion

0

Not voting

8

Number of cases Far too few

0

Too few

20

Suitable

62

Too many

6

Far too many

0

No opinion

0

Not voting

12

Quality of case presentations Very high

24

High

52

Average

8

Low

4

Very low

0

No opinion

0

Not voting

12

Possibility to participate in discussions Very good

70

Good

18

Average

2

Bad

0

Very bad

0

No opinon

0

Not voting

10

To which extent will this course influence your issuance of offshore health certificates in the future? * To a very great extent

12

To a great extent

34

To a little extent

38

To a very little extent

2

No change at all

2

No opinion

Not voting

4

8

To which extent do you think the use of audience response technology has contributed to a better course? To a very great extent

22

To a great extent

56

Equal to other ways of teaching

6

To a little extent

4

To a very little extent

No opinion

Not voting

2

0

10

Educating petroleum doctors • •

Way forward 3 years versus 5 years approval

• 3 years equivalent to diving doctors • 5 years equivalent to recertification period for general physicians • Incentive to participate at the course when can get credits for the recertification

• 5 years sufficient for most; what about those who still issue few certificates each year?



Resertification course

• Probably based

upon pre-course material and exercises and then a one full day of attendance, mainly dedicated to case-examples and risk evaluations.

Questions?

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