Education for the practice of occupational medicine: knowledge, competence, and professionalism

The multistep process of education is delineated by the sequential phases: (1) Knowledge Transfer, (2) Competence Development, and (3) Professional Inculcation. The realities of practice modes and curricular time constraints are important determinants of the breadth and depth of the information provided in the Knowledge Transfer process. Accordingly, it is proposed that Phase 1, the Knowledge Acquisition Process, be organized into two components: (1) Core Knowledge, requiring both significant breadth and depth; and (2) Augmentive Knowledge, providing wide breadth and appropriate but variable depth. This curricular organizing proposition recognizes that: (1) the wide breadth of multiple stores of knowledge inherent in the practice of PM and EOM considerably exceeds many other medical specialities; (2) the duration of training is inherently shorter; and (3) its practitioners generally operate as members of teams consisting of other professionals (e.g., attorneys, engineers, business administrators, industrial hygienists, sociologists, psychologists). Obviously, it is unreasonable to expect the members of such teams to each have comparable depth and breadth of knowledge. A broad knowledge base, implicit in Augmentive Knowledge, provides the capacity for recognition, understanding, and application of capabilities brought by other professionals. Facilitating communications between team members, each possessing a broad knowledge base, enhances the effectiveness of the knowledge, competence, and professionalism of collaborative efforts. Phase 2, Competency, consists of the coherent integration of multiple stores of information applicable to the management of a clearly defined task with a clearly measurable outcome. The accomplishment of true competency is not based on the simple possession of multiple stores of knowledge; rather it depends on the facility and effectiveness with which information bases are marshaled, integrated, and communicated. Clearly, the effectiveness of this process increases with its interaction; it is unreasonable to expect a significant degree of competence immediately upon graduation from a training program. Phase 3, Professionalism, and its basic ethos provides the governing context for the sound application of competencies. Although it is difficult to teach, only with its accomplishment can the educational process be considered whole, albeit never complete.