Harborview Medical Center

Occupational Medicine Service

Faculty Contact
Drew Brodkin, MD
Associate Professor, Medicine

Address
Box 359739
325 9th Avenue
Seattle, WA 98104

Phone: (206) 744-3005
Email: werd@uw.edu

Overall Educational Purpose
To provide broad exposure to patients with occupational and environmental diseases.

Team Structure

Principle Teaching Methods
Case discussion and review
Each case is discussed extensively in clinic.

Rounds
There is a weekly case conference in which residents may voluntarily participate.

Didactics
There is a weekly journal club/didactic lecture/research in progress review session available for residents to attend on a regular basis.

Educational Content
Mix of Diseases
Patients presenting to the Occupational Medicine Service encompass a broad spectrum of disorders which may be caused or aggravated by occupational exposures. Common cases include patients with occupationally-related respiratory diseases (asthma, asbestosis), hepatitis secondary to hepatotoxins (solvents), nephritis (solvents), and musculoskeletal diseases, including low back pain and cumulative trauma disorders of the upper extremity.

Patient Characteristics
The Occupational Medicine Service sees a broad range of patients from varying socio-economic groups, and approximately forty percent of patients are covered under workers’ compensation, with the remainder divided among third-party insurance, Medicaid and self pay. The ethnic mix of patients reflects that of the city of Seattle.

Types of Clinical Encounters
The vast majority of patients are see in the Occupational Medicine Outpatient Clinic, with less than ten percent seen on acute consultative bases. Evaluations usually include an initial in-depth encounter which lasts approximately forty-five minutes to one and one-half hours and includes full medical history, occupational history, physical examination and appropriate laboratory tests.

Procedures
Occasional Carpal Tunnel Injections.

Services
The Occupational Medicine Program maintains a full library of textual materials to facilitate research on occupational and environmental diseases and exposure assessment. In addition, access to Medline is provided. A smaller set of reference texts is provided in the immediate clinic area for use during clinic hours.

Rotation Specific Schedule
Monday


Tuesday


Wednesday


Thursday
8:00 Medicine Grand Rounds
9:15 Resident Teaching Conference

Friday


Call and Weekend Responsibilities


Principle Educational Materials Used
Recommended Readings

Pathologic materials


Methods Used in Evaluating Resident and Program Performance
At the end of the rotation, the resident is evaluated in writing and their performance reviewed with them verbally by every attending and fellow he or she has interacted with for a significant amount of time. The evaluator rates the resident on a nine-point scale in each component of clinical competence (i.e. patient care, medical knowledge, practice based learning improvement, interpersonal and communication skills, professionalism, system based learning, educational attitudes, leadership, overall clinical competence).

The resident is given the opportunity to evaluate in writing the quality of the curriculum and the extent to which the educational goals and objectives of the rotation have been met. The resident also evaluates the teaching competence of each attending and fellow with whom s/he has interacted for a significant amount of time.

Explicit Lines of Responsibility for Care of Patients on this Service
Patients are seen either via a consultation service or, more commonly, in the Occupational Medicine Clinic. Residents see individual patients and present each case to the attending physician. The attending discusses the cases in detail with the residents and personally sees each patient.

The care of all patients is the direct responsibility of the Occupational Medicine attending. Attendings directly oversee the care of each patient at the time of the encounter by a resident/fellow.

Last Revised April 13, 1998 by Scott Barnhart, MD