Maritime doctors’ skills and competencies: A review for policy analysis
DOI:
https://doi.org/10.33175/mtr.2020.206375Keywords:
Maritime doctors, Maritime medicine, Occupational health, Remote health servicesAbstract
Maritime medicine deals with the health of seafarers, fishermen, and offshore employees and, more specifically, with their employment, working and living conditions, and their health and safety at sea. Maritime doctors should have the appropriate training and competencies to provide the equivalent service as would be found on land. This review discusses a) the required skills and competencies of maritime doctors and b) explores the associated ongoing discussions for the establishment of a global accredited Masters programme in maritime health. A literature review was conducted using 2 databases: PubMed and Google scholar. Search terms included: maritime doctors, maritime medicine, occupational health, and skills and competencies. Literature published between 1990 and 2018 was prioritised. Thirty-five articles that discussed the skills, competencies, and education of maritime doctors and health professionals were retrieved, reviewed, and discussed, plus 8 reports and documents from relevant International Organisations webpages. We explored policies in relation to training using i) the health triangle and ii) the Kingdon model. Doctors who serve in the sector should have extensive knowledge about medical practice, but also about the environment of seafaring. The complexity of their roles, coupled with the provision of a high quality of services in global shipping, call for high quality accredited training and harmonisation of maritime health practices. The analysis of policy, using 2 policy models, showed that a window of opportunity appears to be in favour of a policy regarding the recognition of maritime medicine as a medical specialisation. International stakeholders, together with the International Maritime Health Association, should actively advocate such a perspective which will be in favour of seafarers, who will enjoy better health and wellbeing, with higher income while avoiding ill-health, as well as the shipping industry, which will employ satisfied and loyal employees, and will enjoy a higher reputation.
References
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Alcaraz, M., Solomon, E., Ching, S., Paul, M., & Teves, P. (2019). Current profile of filipino physicians doing medical examination of seafarers in the Philippines: Need for maritime medicine training. International Maritime Health (in press).
Andrioti, D., Faurby, M. D., Le, J. V., & Jensen, O. C. (2017a). Do danish maritime doctors value continuous education initiatives? Health Economics, 3(3), 1000137. doi:10.4172/2471-268X/1000137
Andrioti, D., Jensen, O., Faurby, M., Frank, S., & Le, J. V. (2017b). A gap analysis of the maritime doctors’ service profile compared to general practitioners. Retrieved from: https://docs.google.com/viewer?url=https%3A%2F%2Fwww.dendanskemaritimefond.dk%2Fwp-content%2Fuploads%2F2017%2F01%2Ffinal-report_Maritime-doctors-profile_SDU2016-124.pdf
Andrioti, D., & Jensen, O.C. (2017c) Maritime doctors and general practitioners service profiles: A research protocol. Health Science Journal, 11(2), 1. doi:10.21767/1791-809X.1000500
Asher, J. P., & Hunt, P. (2010). The right to health: A resource manual for NGOs. Martinus Nijhoff Publishers.
Bansal, V., Fortlage, D., Lee, J. G., Hill, L. L., Potenza, B., & Coimbra, R. (2007). Significant injury in cruise ship passengers: A case series. American Journal of Preventive Medicine, 33(3), 219-221.
Bloor, M., Thomas, M., & Lane, T. (2000). Health risks in the global shipping industry: An overview. Health, Risk & Society, 2(3), 329-340. doi:10.1080/713670163
Borch, D. F., Hansen, H. L., Burr, H., & Jepsen, J. R. (2012). Surveillance of maritime deaths on board Danish merchant ships, 1986-2009. International Maritime Health, 63(1), 7-16.
Buse, K., Mays, N., & Walt, G. (2012). Making health policy. Maidenhead: Open University Press. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.474.6452&rep= rep1&type=pdf
Carter, T. (2011). Mapping the knowledge base for maritime health: 3 illness and injury in seafarers. International Maritime Health, 62(4), 224-235.
Carter, T. (2016). Seafarer medicals: Population health or private gain? International Maritime Health, 67(1), 1-2. doi:10.5603/IMH.2016.0001
Carter, T., & Stannard, S. (2014). Healthcare at sea: Are regulations a guarantee of minimum standards or a barrier to improved practice? International Maritime Health, 65(4), 177-180. doi:10.5603/IMH.2014.0034
Chodnik, T., Jeżewska, M., Jaremin, B., Kotłowski, A., Leszczyńska, I., & Grubman-Nowak, M. (2013). Polish system of education in maritime health care and medical assistance for seafarers. International Maritime Health, 64(1), 24-29.
Dahl, E. (2009). Cruise ship doctor: Demands and challenges versus qualifications and training. International Maritime Health, 60(1-2), 33-35.
Dahl, E. (2010). Passenger accidents and injuries reported during 3 years on a cruise ship. International Maritime Health, 61(1), 1-8.
Dahl, E., & Stannard, S. (2015). Ship’s doctor qualifications: A response to the German recommendations. International Maritime Health, 66(1), 1-3. doi:10.5603/IMH.2015.0001
DiGiovanna, T., Rosen, T., Forsett, R., Sivertson, K., & Kelen, G. D. (1992). Shipboard medicine: A new niche for emergency medicine. Annals of Emergency Medicine, 21(12), 1476-1479.
Faurby, M. D., Jensen, O. C., Hjarnoe, L., & Andrioti, D. (2017). The costs of repatriating an ill seafarer: A micro-costing approach. Health Economics Review, 7(1), 46. doi:10.1186/s13561-017-0184-0
Hall, T. (1993). Basic elements of maritime health care. Journal of Occupational and Environmental Medicine, 25(4), 325.
Jensen, O. C., Charalambous, G., & Andrioti, D. (2018). Perceived training needs of maritime doctors and general practitioners. International Journal of Travel Medicine and Global Health, 6(4), 154-160. doi:10.15171/IJTMGH.2018.28
Jensen, O. C., Lucero-Prisno III, D. E., & Canals, M. L. (2010). Integrated occupational health care for seafarers across the continuum of primary, secondary and tertiary prevention. International Journal of Integrated Care, 10(1), e035. doi:10.5334/ijic.512
Jerončić, I., Nikolić, J., & Mulić, R. (2014). Maritime Medicine and Medicine for Seafarers. In Proceedings of the 6th International Maritime Science Conference. Solin, Croatia, pp. 412-416.
Jezewska, M., Jaremin, B., & Leszczyńska, I. (2007). Health promotion in the maritime work environment: Training of leaders. International Maritime Health, 58(1-4), 129-137. doi:10.1.1.537.1454
Lucero-Prisno, D., Muramatsu, S., Hisamune, S., & Ehara, M. (2005). Mainstreaming health in maritime education and training. International Maritime Health, 2005, 300-302.
Mayhew, C., & Grewal, D. (2003). Occupational violence/bullying in the maritime industry: A pilot study. Journal of Occupational Health and Safety, Australia and New Zealand, 19(5), 457.
McCallum, I., & Cox, R. A. (2012). Offshore medicine: Medical care of employees in the offshore oil industry. Springer Science & Business Media.
Nielsen, D., & Panayides, P. M. (2005). Causes of casualties and the regulation of occupational health and safety in the shipping industry. WMU Journal of Maritime Affairs, 4(2), 147-167.
Oldenburg, M., Rieger, J., Sevenich, C., & Harth, V. (2014). Nautical officers at sea: Emergency experience and need for medical training. Journal of Occupational Medicine and Toxicology, 9(1), 19. doi:10.1186/1745-6673-9-19
Ottomann, C. (2015). Ship’s doctors qualifications required for cruise ships: Recruiter’s comments on the German: Norwegian debate. International Maritime Health, 66(3), 160-163. doi:10.5603/IMH.2015.0031
Peck, C., McCall, M., McLaren, B., & Rotem, T. (2000) Continuing medical education and continuing proffesional development: International comparisons. BMJ, 320(7232), 432-435. doi:10.1136/bmj.320.7232.432
Peeters, M. (2005). Free movement of medical doctors: The new Directive 2005/36/EC on the recognition of professional qualifications. European Journal of Health Law, 12(4), 373-396.
Peltz, R. D., & Warger, V. J. (2002). Medicine on the seas. Tulane Maritime Law Journal, 27(2), 425-466.
Piniela, F., Silos, J., & Bernal, F. (2013). Who will give effect to the ILO's Maritime Labour Convention, 2006? International Labour Review, 152(1), 59-83. doi:10.1111/j.1564-913X.2013.00169.x
Regnier, K., Kopelow, M., Lane, D., & Alden, E. (2005). Accreditation for learning and change: Quality and improvement as the outcome. Journal of Continuing Education in the Health Professions, 25(3), 174-182. doi:10.1002/chp.26
Saarni, H. (2005). Medical examinations of seafarers and training for medical doctors in maritime health. Actual Problems of Transport Medicine, 2005(1), 124-129.
Schwarz, M. R., & Wojtczak, A. (2002). Global minimum essential requirements: A road towards competence-oriented medical education. Medical Teacher, 24(2), 125-129.
Scott, J., Lucas, R., & Snoots, R. (1997). Maritime medicine. Emergency Medicine Clinics of North America, 15(1), 241-249.
Seidenstuecker, K. H., & Neidhardt, S. (2014). Qualification of ship doctors: A German approach. Int Marit Health, 65(4), 181-186.
Seidenstuecker, K. H., & Neidhardt, S. (2015). Ship doctor’s qualification: The fast track? International Maritime Health, 66(2), 118-119. doi:10.5603/IMH.2015.0025
Shah, B., Andrioti, D., & Jensen, O. C. (2018). Training needs among maritime professionals: A cross sectional study. International Maritime Health, 69(2), 129-136. doi:10.5603/IMH.2018.0019
Sritharan, K. (2006). Maritime medicine. BMJ, 332(7546), s146-s147.
Tortell, L., Delarue, R., & Kenner, J. (2009). The EU and the ILO maritime labour convention: In our common interest and in the interest of the world. In The European Union and the Social Dimension of Globalization. Routledge, pp. 127-144.
Varvara A. Mouchtouri, V. A., Lewis, H. C., & Hadjichristodoulou, C. (2019). A systematic review for vaccine-preventable diseases on ships: Evidence for cross-border transmission and for pre-employment immunization need. International Journal of Environmental Research and Public Health, 16(15), 2713. doi:10.3390/ijerph16152713
Walters, D., & Bailey, N. (2013). Lives in peril: Profit or safety in the global maritime industry? London: Palgrave Macmillan. doi:10.1057/9781137357298
World Health Organization (WHO). (2006). The World Health Report 2006: Working together for health. Retrieved from https://www.who.int/whr/2006/en
World Federation of Medical Education. (2003). Continuing Professional Development (CPD) of Medical Doctors: WFME Global Standards for Quality Improvement. Retrieved from https://docs.google.com/viewer?url=http%3A%2F%2Fwww.whogis.com%2Fentity%2Fworkforcealliance%2Fknowledge%2Ftoolkit%2F46.pdf
Yabuki, H. (2011). The 2010 Manila amendments to the STCW convention and code and changes in maritime education and training. Journal of Maritime Researches, 1(1), 11-17.
Alcaraz, M., Solomon, E., Ching, S., Paul, M., & Teves, P. (2019). Current profile of filipino physicians doing medical examination of seafarers in the Philippines: Need for maritime medicine training. International Maritime Health (in press).
Andrioti, D., Faurby, M. D., Le, J. V., & Jensen, O. C. (2017a). Do danish maritime doctors value continuous education initiatives? Health Economics, 3(3), 1000137. doi:10.4172/2471-268X/1000137
Andrioti, D., Jensen, O., Faurby, M., Frank, S., & Le, J. V. (2017b). A gap analysis of the maritime doctors’ service profile compared to general practitioners. Retrieved from: https://docs.google.com/viewer?url=https%3A%2F%2Fwww.dendanskemaritimefond.dk%2Fwp-content%2Fuploads%2F2017%2F01%2Ffinal-report_Maritime-doctors-profile_SDU2016-124.pdf
Andrioti, D., & Jensen, O.C. (2017c) Maritime doctors and general practitioners service profiles: A research protocol. Health Science Journal, 11(2), 1. doi:10.21767/1791-809X.1000500
Asher, J. P., & Hunt, P. (2010). The right to health: A resource manual for NGOs. Martinus Nijhoff Publishers.
Bansal, V., Fortlage, D., Lee, J. G., Hill, L. L., Potenza, B., & Coimbra, R. (2007). Significant injury in cruise ship passengers: A case series. American Journal of Preventive Medicine, 33(3), 219-221.
Bloor, M., Thomas, M., & Lane, T. (2000). Health risks in the global shipping industry: An overview. Health, Risk & Society, 2(3), 329-340. doi:10.1080/713670163
Borch, D. F., Hansen, H. L., Burr, H., & Jepsen, J. R. (2012). Surveillance of maritime deaths on board Danish merchant ships, 1986-2009. International Maritime Health, 63(1), 7-16.
Buse, K., Mays, N., & Walt, G. (2012). Making health policy. Maidenhead: Open University Press. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.474.6452&rep= rep1&type=pdf
Carter, T. (2011). Mapping the knowledge base for maritime health: 3 illness and injury in seafarers. International Maritime Health, 62(4), 224-235.
Carter, T. (2016). Seafarer medicals: Population health or private gain? International Maritime Health, 67(1), 1-2. doi:10.5603/IMH.2016.0001
Carter, T., & Stannard, S. (2014). Healthcare at sea: Are regulations a guarantee of minimum standards or a barrier to improved practice? International Maritime Health, 65(4), 177-180. doi:10.5603/IMH.2014.0034
Chodnik, T., Jeżewska, M., Jaremin, B., Kotłowski, A., Leszczyńska, I., & Grubman-Nowak, M. (2013). Polish system of education in maritime health care and medical assistance for seafarers. International Maritime Health, 64(1), 24-29.
Dahl, E. (2009). Cruise ship doctor: Demands and challenges versus qualifications and training. International Maritime Health, 60(1-2), 33-35.
Dahl, E. (2010). Passenger accidents and injuries reported during 3 years on a cruise ship. International Maritime Health, 61(1), 1-8.
Dahl, E., & Stannard, S. (2015). Ship’s doctor qualifications: A response to the German recommendations. International Maritime Health, 66(1), 1-3. doi:10.5603/IMH.2015.0001
DiGiovanna, T., Rosen, T., Forsett, R., Sivertson, K., & Kelen, G. D. (1992). Shipboard medicine: A new niche for emergency medicine. Annals of Emergency Medicine, 21(12), 1476-1479.
Faurby, M. D., Jensen, O. C., Hjarnoe, L., & Andrioti, D. (2017). The costs of repatriating an ill seafarer: A micro-costing approach. Health Economics Review, 7(1), 46. doi:10.1186/s13561-017-0184-0
Hall, T. (1993). Basic elements of maritime health care. Journal of Occupational and Environmental Medicine, 25(4), 325.
Jensen, O. C., Charalambous, G., & Andrioti, D. (2018). Perceived training needs of maritime doctors and general practitioners. International Journal of Travel Medicine and Global Health, 6(4), 154-160. doi:10.15171/IJTMGH.2018.28
Jensen, O. C., Lucero-Prisno III, D. E., & Canals, M. L. (2010). Integrated occupational health care for seafarers across the continuum of primary, secondary and tertiary prevention. International Journal of Integrated Care, 10(1), e035. doi:10.5334/ijic.512
Jerončić, I., Nikolić, J., & Mulić, R. (2014). Maritime Medicine and Medicine for Seafarers. In Proceedings of the 6th International Maritime Science Conference. Solin, Croatia, pp. 412-416.
Jezewska, M., Jaremin, B., & Leszczyńska, I. (2007). Health promotion in the maritime work environment: Training of leaders. International Maritime Health, 58(1-4), 129-137. doi:10.1.1.537.1454
Lucero-Prisno, D., Muramatsu, S., Hisamune, S., & Ehara, M. (2005). Mainstreaming health in maritime education and training. International Maritime Health, 2005, 300-302.
Mayhew, C., & Grewal, D. (2003). Occupational violence/bullying in the maritime industry: A pilot study. Journal of Occupational Health and Safety, Australia and New Zealand, 19(5), 457.
McCallum, I., & Cox, R. A. (2012). Offshore medicine: Medical care of employees in the offshore oil industry. Springer Science & Business Media.
Nielsen, D., & Panayides, P. M. (2005). Causes of casualties and the regulation of occupational health and safety in the shipping industry. WMU Journal of Maritime Affairs, 4(2), 147-167.
Oldenburg, M., Rieger, J., Sevenich, C., & Harth, V. (2014). Nautical officers at sea: Emergency experience and need for medical training. Journal of Occupational Medicine and Toxicology, 9(1), 19. doi:10.1186/1745-6673-9-19
Ottomann, C. (2015). Ship’s doctors qualifications required for cruise ships: Recruiter’s comments on the German: Norwegian debate. International Maritime Health, 66(3), 160-163. doi:10.5603/IMH.2015.0031
Peck, C., McCall, M., McLaren, B., & Rotem, T. (2000) Continuing medical education and continuing proffesional development: International comparisons. BMJ, 320(7232), 432-435. doi:10.1136/bmj.320.7232.432
Peeters, M. (2005). Free movement of medical doctors: The new Directive 2005/36/EC on the recognition of professional qualifications. European Journal of Health Law, 12(4), 373-396.
Peltz, R. D., & Warger, V. J. (2002). Medicine on the seas. Tulane Maritime Law Journal, 27(2), 425-466.
Piniela, F., Silos, J., & Bernal, F. (2013). Who will give effect to the ILO's Maritime Labour Convention, 2006? International Labour Review, 152(1), 59-83. doi:10.1111/j.1564-913X.2013.00169.x
Regnier, K., Kopelow, M., Lane, D., & Alden, E. (2005). Accreditation for learning and change: Quality and improvement as the outcome. Journal of Continuing Education in the Health Professions, 25(3), 174-182. doi:10.1002/chp.26
Saarni, H. (2005). Medical examinations of seafarers and training for medical doctors in maritime health. Actual Problems of Transport Medicine, 2005(1), 124-129.
Schwarz, M. R., & Wojtczak, A. (2002). Global minimum essential requirements: A road towards competence-oriented medical education. Medical Teacher, 24(2), 125-129.
Scott, J., Lucas, R., & Snoots, R. (1997). Maritime medicine. Emergency Medicine Clinics of North America, 15(1), 241-249.
Seidenstuecker, K. H., & Neidhardt, S. (2014). Qualification of ship doctors: A German approach. Int Marit Health, 65(4), 181-186.
Seidenstuecker, K. H., & Neidhardt, S. (2015). Ship doctor’s qualification: The fast track? International Maritime Health, 66(2), 118-119. doi:10.5603/IMH.2015.0025
Shah, B., Andrioti, D., & Jensen, O. C. (2018). Training needs among maritime professionals: A cross sectional study. International Maritime Health, 69(2), 129-136. doi:10.5603/IMH.2018.0019
Sritharan, K. (2006). Maritime medicine. BMJ, 332(7546), s146-s147.
Tortell, L., Delarue, R., & Kenner, J. (2009). The EU and the ILO maritime labour convention: In our common interest and in the interest of the world. In The European Union and the Social Dimension of Globalization. Routledge, pp. 127-144.
Varvara A. Mouchtouri, V. A., Lewis, H. C., & Hadjichristodoulou, C. (2019). A systematic review for vaccine-preventable diseases on ships: Evidence for cross-border transmission and for pre-employment immunization need. International Journal of Environmental Research and Public Health, 16(15), 2713. doi:10.3390/ijerph16152713
Walters, D., & Bailey, N. (2013). Lives in peril: Profit or safety in the global maritime industry? London: Palgrave Macmillan. doi:10.1057/9781137357298
World Health Organization (WHO). (2006). The World Health Report 2006: Working together for health. Retrieved from https://www.who.int/whr/2006/en
World Federation of Medical Education. (2003). Continuing Professional Development (CPD) of Medical Doctors: WFME Global Standards for Quality Improvement. Retrieved from https://docs.google.com/viewer?url=http%3A%2F%2Fwww.whogis.com%2Fentity%2Fworkforcealliance%2Fknowledge%2Ftoolkit%2F46.pdf
Yabuki, H. (2011). The 2010 Manila amendments to the STCW convention and code and changes in maritime education and training. Journal of Maritime Researches, 1(1), 11-17.
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2020-01-01
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