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Instructor Class Description

Time Schedule:

Debra Milek
ENV H 597
Seattle Campus

Case Studies in Environmental and Occupational Health

Discusses clinical cases, recent journal articles, and global environmental health scenarios relevant to the clinical practice of environmental and occupational health. Explores collaborative management of environmental and occupational health-related illnesses and navigation of complex environmental health scenarios through real-world cases and critical analysis of published literature. Offered: AWSp.

Class description

Course Description: Developing EOH practitioners need a regular forum in which to discuss the most recent advances in clinical EOH, as well as a forum to discuss challenging patient-related cases and to learn from the “real-world” experiences of others. To provide the best possible patient care, Environmental and Occupational Health (EOH) trainees must also have the ability to select and critically analyze the clinical EOH scientific and public health literature.

This course offers an opportunity to developing EOH clinical practitioners for the discussion of real-world patient cases, and recently-published EOH scientific articles. Sessions in the course will be almost entirely student-led but with strong faculty oversight regarding specific subject matter content and appropriate scheduling, and each student will present at length, at least one clinical case presentation or community environmental health issue to be accompanied by one journal club article per quarter. Additionally, the following week will consist of a brief review of key pearls illuminated by the prior case discussion. We are fortunate to have members of our Occupational and Environmental Medicine (OEM) faculty in attendance at these sessions, so discussions are lively and engaging.

This course is designed to ensure that, upon completion of the class, providers can effectively engage in the evidence-based practice of environmental and occupational health using the most current information available, applying that information to real-world patient care and public health practice scenarios. Upon completion of this course, providers will be well-equipped to communicate information about EOH patient illnesses and injuries with their colleagues with an evidence based approach to patient care. Emphasis will be placed on multidisciplinary collaboration, using the broad expertise of UW faculty and staff combined with the current literature that addresses patient-care and community-based EOH challenges.

This course complements the curriculum of the OEM residency program, and specifically supplements the ENVH 576 course, “Clinical Occupational Medicine,” although ENVH 576 is not required to take this course.

This course is appropriate primarily for clinicians at the graduate medical/nursing school level or higher, although others who provide EOH services to individuals may also benefit from this class (particularly industrial hygienists / exposure scientists). This course may be relevant at an advanced stage of a non-clinician EOH trainee’s education and permission for non-clinicians to take the course should be discussed with the course instructor.

Email is the standard medium used for communication regarding this course, and readings will be distributed via e-mail. Students are responsible for ensuring that their correct email address is on file, and for informing the instructor if unable to use electronic media.

Course Learning Objectives:

At the end of this course, the student will be able to: Patient Care and Medical Knowledge • Obtain problem-focused patient histories that identify clinical syndromes and occupational / environmental exposures • Analyze relationships between clinical syndromes and occupational / environmental exposures • Select and interpret the most appropriate clinical tests and workplace evaluations to characterize occupational and environmental injuries and illnesses • Distinguish work-related from non-work-related or environmental conditions Interpersonal Communication Skills • Communicate effectively with colleagues and interdisciplinary teams to improve the quality of patient care • Effectively communicate information about EOH health risks and patient prognosis • Effectively communicate information about health risks in a complex global environmental health scenario Systems-Based Practice • Treat occupational and environmental injuries and illnesses more effectively, emphasizing appropriate job accommodations and work restrictions that address the physical and psychological factors in the workplace that affect a patient’s ability to successfully return to work • List and describe the needs of critical stakeholders involved in a complex, global, community-based environmental health scenario • Integrate evidence from multiple sources to perform a comprehensive risk assessment in a complex global environmental health scenario • Identify, summarize, and critically evaluate and discuss the critical issues (relevant exposures, social and economic context, political issues) surrounding complex global environmental health scenarios Practice-Based Learning and Improvement • Identify, summarize, and critically evaluate and discuss the validity and clinical relevance of recent articles in the EOH literature as they relate to cases seen in clinic Professionalism • Demonstrate timeliness and collaborative relationships with faculty and colleagues / other students

Course format:

The course consists of 12 quarterly sessions. Approximately 80% of the sessions will consist of student-led presentations of EOH cases which the student has either seen in a clinic / hospital / or another clinical setting (such as a workplace). The remaining sessions will consist of student-led presentations / discussions of 1) recent, instructor-approved, clinically-relevant articles in the EOH literature, 2) relevant, complex, current scenarios in which environmental public health concerns play a role. OEM faculty members attend all sessions.

Course Requirements: Individual Assignments Each student is required to complete: Administrative tasks Post conference surveys: Each student will complete a very brief post-conference online survey to solicit feedback, improve the course, and track attendance. DUE: Each week on Friday. Case selection: Each student must submit to the instructor for approval a brief (2-3 sentence) description of the case that will be presented the week of her or his scheduled presentation date. Further details about the case may be sent to the instructor for distribution to the class but are not required. Brief case discussions: Each week, other students and faculty will briefly (~5 minutes) describe a case seen in clinic that week. Brief discussion will follow. Case presentation: Each student will demonstrate skills in the evaluation, diagnosis, and treatment of OEM disease through the presentation of 1-2 case studies approved by the instructor. This approximately 20-minute presentation will focus on developing an appropriate differential diagnosis, evaluating the work-relatedness of the case, discussing potential treatment options and workplace modifications, and summarizing the features of the most likely diagnoses. Please present all relevant details, including appropriate displays of relevant imaging tests, specific numerical test results, pictures of flow-volume loops, et cetera. It is important to leave time for discussion; cases often present ambiguities and questions that allow us to take advantage of our experienced OEM faculty who are present. Discussion is often quite lively! Dates for each student are assigned and distributed by the chief resident.

At the discretion of the course instructor, one session may be set aside for oral demonstration of group lessons learned. Final examination: There is no final examination.

Student learning goals

This course is designed to ensure that, upon completion of the class, providers can effectively engage in the evidence-based practice of environmental and occupational health using the most current information available. Emphasis will be placed on multidisciplinary collaboration, using the broad expertise of UW faculty and staff combined with the current literature that addresses patient-care and community-based EOH challenges.

Students will apply that information to real-world patient care and public health practice scenarios.

Upon completion of this course, providers will be better equipped to critically evaluate and understand current EOH research, and to communicate information about EOH patient illnesses and injuries with their peers.

Students will learn the in depth aspects of case management in selected topics. Emphasis will be placed on multidisciplinary collaboration, using the broad expertise of UW faculty and staff combined with the current literature that addresses patient-care and community-based EOH challenges. Students will understand the roles of the different areas of expertise and how to collaborate on health issues.

Students will be learn to assess each case for etiological and preventive aspects. Students will learn to broaden their concern from individual to public health matters of concern.

Students will gain experience in teaching other colleagues through their case presentations, their choice of medical literature to supplement their case and their compilation of key case points to take away.

General method of instruction

Case presentation and group discussion supplemented by a relevant and current article from the medical literature regarding the topic. Students will provide a link of their selected peer reviewed journal article and send it to dm42@uw.edu and cc to tapangp@uw.edu at least several days before the class. Sessions in the course will be almost entirely student-led but with strong faculty oversight regarding specific subject matter content and appropriate scheduling, and each student will be assigned to at least one clinical case presentation or community environmental health issue, select one representative journal club article per quarter, and summarize key points of the topic presented.

Recommended preparation

The course is designed for physicians, PA's, NPs and nurses. Others require permission of the course director to ensure they have the appropriate background for understanding of the content and participation in presentations and discussions.

The soft cover text Current Occupational and Environmental Medicine, 4th Edition by Joseph LaDou is a great resource for basic occupational medicine and is believed to be helpful when studying for the Occ Med Board exam. They are coming out with a 5th edition shortly which will be authored by LaDou and Harrison but it's not yet available.

Class assignments and grading

The trainee selects with the approval of the instructor, a clinical case which is to be presented comprehensively with attention to complex medical and diagnostic aspects, work environment, L&I and psychosocial issues addressed in the treatment plan. Prevention of injury and public health (e.g. co-workers or others with similar exposures) considerations are also key elements to include in the presentation.

Grades are assigned based on comprehensive preparation of cases for presentation, discussion of the relationship of the injury or illness to the workplace, public health aspects of the injury and prevention prevention of the injury. Also, selection and understanding of journal articles to supplement the case presentation, summary of key points of presentation, class participation in other's presentations, and attendance are key elements upon which grades will be assigned.


The information above is intended to be helpful in choosing courses. Because the instructor may further develop his/her plans for this course, its characteristics are subject to change without notice. In most cases, the official course syllabus will be distributed on the first day of class.
Last Update by Debra Milek
Date: 10/03/2013