The Faculty of Occupational Medicine of the Royal College of Physicians of London was established “to develop and maintain the good practice of occupational medicine with a view to providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity.” The Faculty admits Associates and Members.
Membership of the Faculty of Occupational Medicine (MFOM) is intended for registered medical practitioners who are committed to the full-time or part-time practice of occupational medicine, and confers formal recognition of competence. It is the highest level of competence recognised by assessment by the Faculty and its syllabus is detailed under the Regulations.
It is a normal requirement for those who aspire to being on the Specialist Register as Specialists in Occupational Medicine in the UK and will be awarded to those who have completed the requisite higher professional training, together with Part 1 and Part 2 Membership examinations, and demonstrated appropriate competencies through workplace-based assessments and a
research dissertation or equivalent evidence.
Membership may also be available to medical practitioners outwith UK Specialist Training who can demonstrate an equivalent level of competence, as outlined in these regulations.
M1. Regulations M2 to M46 will apply to:
(a) Trainees who have entered an approved higher specialist training post or programme in occupational medicine in the United Kingdom (UK) after 31 July 2007;
(b) Trainees who enrolled in an approved higher specialist training post or programme in occupational medicine in the UK before 1 August 2007 and who transferred to the PMETB (now GMC) approved curriculum before 1 January 2009 (to whom certain transitional rules, T1 to T3, may also apply, as defined in the 2008 Regulations for Membership: http://www.fom.ac.uk/wp-content/uploads/MFOMregs2008.pdf)
(c) Doctors outwith approved UK training posts or programmes who are seeking a higher qualification in occupational medicine in the UK.
Trainees who enrolled in an approved higher specialist training post or programme in occupational medicine in the UK before 1 August 2007 and who did not transfer to the PMETB (now GMC) approved curriculum and assessment system before 1 January 2009 will be assessed under Section B of the 2011 Regulations for Membership: http://www.fom.ac.uk/wp-content/uploads/MFOMregs2011.pdf
Doctors outwith approved UK training posts who seek a higher qualification in occupational medicine, and who enrolled in an overseas training post approved ad personam by the Faculty prior to 3 April 2008, will be assessed under the 2008 Regulations for Membership: http://www.fom.ac.uk/wp-content/uploads/MFOMregs2008.pdf
These regulations should be read in conjunction with the latest version of the Faculty’s approved Curriculum for Higher Specialist Training on Occupational Medicine.
M2. Every candidate for the award of Membership must hold a medical qualification recognised by the Faculty.
Candidates who are not registered with the General Medical Council of the United Kingdom will need to produce their original medical registration certificates or diplomas of medical qualification, and official translations of their diplomas, if not in English.
M3. Formal assessment for the MFOM will consist of three centrally administered assessments:
1. A Part 1 examination.
2. A research dissertation or equivalent evidence (see M12).
3. A Part 2 Examination.
M4. Award of Membership will require all three of the elements of assessment in M3 to have been passed and such other conditions of relevant experience or training as specified in these regulations to have been met.
M5. The Part 1 examination will comprise a multiple choice question (MCQ) paper, designed to assess factual knowledge to a level appropriate to the trainee’s stage of training. This will be the same examination as set for the MCQ component of the Diploma in Occupational Medicine. It will assess the same knowledge base and use the same question sets and there will be a common pass mark across both the Diploma MCQ and the Part 1 examination. (The Part 1 Membership, however, will not include the portfolio and oral defence components of the Diploma, which are tested by other means and at a different level during the specialist training programme.)
M6. Other than as specified in M7 to M10 (eligibility and exemptions) and in D2 (Diploma regulations – training courses), such regulations, written guidelines, and administrative arrangements as are in force in relation to the MCQ component of the Diploma in Occupational Medicine examination will apply to the Part 1 examination. These are published separately and should be read in conjunction with this section of the Membership regulations.
M7. Before applying to sit the Part 1 examination a candidate must either
(a) be enrolled in an approved post or programme recognised for higher specialist training in occupational medicine in the UK and be registered as a trainee with the Faculty (and have paid trainee registration fee and subscriptions); or
(b) provide evidence of:
(i) general professional training (see Annex 1) over a period of at least 3 years following the date of graduation given on their diploma of medical qualification and
(ii) at least 1 year of full-time training or experience (or the equivalent pro-rata) in occupational medicine in a post or posts recognised by the Faculty.
Documentary evidence submitted under M7(b) will require translation, if not in English.
M8. No candidate will normally be allowed more than six attempts at the Part 1 examination. However, Regulation F3 makes provision for the Faculty’s Specialist Advisory Committee (SAC) to consider a candidate’s eligibility to make a further attempt or attempts, subject to acceptable evidence of additional education experience. Any attempt that ends in a withdrawal from the examination as a whole which is accepted by the Faculty as arising from extenuating circumstances under Regulations F13, F14 and F15 will not count towards the total of six.
M9. Candidates who have passed the MCQ element of the Faculty’s Diploma in Occupational Medicine will be deemed to have passed the Part 1 Membership examination, provided that the date on which they sat and passed the MCQ is:
(a) not more than seven years before their enrolment in or re-entering an approved post or programme recognised for higher specialist training in occupational medicine in the UK, or
(b) not more than seven years before the date on which they sit the Part 2 MFOM examination if the candidate is not enrolled in an approved post or programme recognised for higher specialist training in occupational medicine in the UK.
M10. An exemption to Part 1 will also apply to those who have passed the AFOM examination, provided that the date on which they sat and passed the AFOM is not more than seven years before:
(a) their enrolment (or re-entry) into an approved post or programme recognised for higher specialist training in occupational medicine in the UK or
(b), if not enrolled in higher specialist training, their application for Membership.
Guidance to candidates
The conditions that must be met before applying to sit the Part 1 examination are set out in M7. The Faculty’s Specialist Advisory Committee (SAC) will be the arbiter of acceptable training or experience under regulation M7(b). Exemptions may apply if a candidate has passed the MCQ component of the Diploma examination (subject to time limitations as set out in M9) or has passed the AFOM examination (subject to time limitations as set out in M10).
Candidates for the Part 1 examination are strongly recommended to read the Diploma guidelines insofar as these relate to the MCQ examination. The guidelines include sample questions, a learning syllabus and other useful details not repeated here. The Diploma in Occupational Medicine Examination Regulations, Syllabus, and Guidance Notes for Candidates and Teaching Centres are available on application and can be found on the DOccMed Regulations page.
It also recommended that in preparation for the Part 1 examination candidates undertake an appropriate academic course, such as a Faculty-approved Diploma Training Course. This is not mandatory (i.e. Diploma regulation D2 does not apply) if the intention is only to sit the Part 1 examination.
Some candidates may elect voluntarily to attempt the Diploma (although this is not a requirement of specialist training). Those who pass the Part 1 examination will be deemed to have passed the Diploma MCQ, provided that they pass the other Diploma components within five years of passing their Part 1 Membership examination (Diploma regulation D5). All other Regulations relating to the Diploma will need to be satisfied, and in this context Diploma regulation D2, the requirement to complete a Faculty-approved Diploma training course, is mandatory. Please see the DOccMed Regulations for more details.
Guidance to ARCP panels
A trainee in a programme of higher specialist training beginning after 31 July 2007 will normally be required to pass the Part 1 examination before being eligible to progress in their training to ST4. Exceptions may arise (e.g. in the event of illness), but careful thought should be given as to whether or not a longer training period is in the candidate’s best interests.
The preset limits prescribed in these regulations are such that the usual number of times the Part 1 examination can be attempted is six. . However, in the event of repeated failure, ARCP panels may take a view on suitability to remain in training, considering local and personal factors, judgement about a candidate’s likely ability to progress and practise eventually as an independent specialist.
M11. All candidates will be required to submit evidence of having acquired relevant competencies in research methods defined in the latest version of the Faculty’s officially approved Curriculum for Higher Specialist Training in Occupational Medicine.
Guidance to candidates in higher specialist training and to ARCP panels
Most candidates use the dissertation to provide evidence of successful completion of the research competencies in the Faculty’s approved curriculum. However the dissertation rarely covers ALL of the competencies in the approved Curriculum. Any competencies that are not covered by the dissertation must be addressed by other work during training (e.g. an audit) and assessed separately (e.g. by the educational supervisor, the ARCP, and in the Part 1 and Part 2 MFOM examinations).
M12. This evidence may take one of several forms:
(a) Most candidates will undertake and complete a piece of primary or secondary research or substantial audit during their time in approved training, and present their findings as a dissertation of prescribed format (M18).
The following alternatives may be suitable equivalent evidence:
(b) a body of substantial published primary or secondary research (M19-M21);
(c) a thesis accepted by a university for the award of a higher degree (such as MD, PhD, Master of Science, MPhil) (M14, M22-M23).
M13. All dissertations must include a statement of contributions, to include those of the candidate and of any others who have helped design, execute, analyse or present the project. Where authorship of a work submitted under M12(b) is shared, the contributions of all authors should be declared, especially those of the candidate, and the candidate’s contribution should be accepted as material in the judgement of the Chief Examiner (Research Methods); such work may be submitted by only one of the candidates.
M14. Normally, the submitted work should be relevant to the broad field of occupational health. However, at the discretion of the Chief Examiner (Research Methods), submissions demonstrating high-level mastery of research may be admissible, even if outwith the field of occupational health (e.g. a PhD or MD on a different medical topic). Queries as to the relevance of the topic should be addressed to the Chief Examiner (Research Methods), whose decision will be final.
M15. Assessors appointed by the Chief Examiner (Research Methods) will evaluate the submitted work against the criteria set out in these regulations.
M16. The final decision, both as to admissibility for assessment and as to final adequacy, will rest with the Chief Examiner (Research Methods).
M17. No candidate will normally be allowed more than six submissions relating to the dissertation (whether on a new topic or in amendment, requested by the assessors or Chief Examiner (Research Methods)). However, Regulation F3 makes provision for the Faculty’s Specialist Advisory Committee (SAC) to consider a candidate’s eligibility to make a further attempt or attempts, subject to acceptable evidence of additional education experience. Any attempt that ends in a withdrawal from the examination as a whole which is accepted by the Faculty as arising from extenuating circumstances under Regulations F13, F14 and F15 will not count towards the total of six.
M18. Any dissertation submitted to the Faculty for final assessment must be typewritten or printed, written in English, and should have the following attributes:
M19. In the context of these regulations “substantial published primary or secondary research” means one substantial review or at least 2 substantial peer-reviewed research papers other than short reports, letters and the abstracts of meetings. The Faculty’s Chief Examiner (Research Methods) will be the final arbiter as to qualifying contributions.
M20. The works under M19 must be written in English and published in a refereed scientific journal(s) held by nationally respected reference libraries or cited by MEDLINE, BIDS Embase, or PubMed on dates within seven years of submission. Papers that are “in press” will also be allowable, if documentary evidence is provided of acceptance by the journal’s editor.
M21. Multi-author works must be accompanied by confirmation – signed by at least one of the other authors of the paper – of the contribution made by the candidate. This contribution must be substantial in terms of authorship, design and execution. The work must satisfy the criteria outlined in M11 and M14, and will be reviewed for this purpose by Faculty appointed assessors.
M22. Candidates may elect to submit a thesis that has been written in English and accepted by a university (e.g. as a Master of Science Degree in Occupational Health or Occupational Medicine) within seven years of submission. Such submissions must satisfy the criteria outlined in M11 and M14, and will be reviewed for this purpose by Faculty appointed assessors.
M23. Exceptionally, candidates may enter training in occupational medicine having already successfully completed an MD or PhD in a medical subject or may successfully complete an MD or PhD during the course of their training. In such cases, trainees may submit their thesis abstract to the Chief Examiner (Research Methods) for a view on the relevance of their topic under M14. If deemed admissible under M14, the MD or PhD will need to satisfy the criterion outlined in M11 and may be reviewed for this purpose by Faculty appointed assessors.
For work that has already been published following peer review or assessed by a university and awarded a degree, the main focus will not normally be on whether the scientific standard has been met, but on whether the criterion in M11 is met – i.e. whether the work demonstrates mastery of a subject, normally within the broad field of occupational health, and shows ability to define a question, design and complete a project to provide answers, present evidence, discuss findings, and write a report.
The Faculty recommends those who enter training and contemplate submitting a substantial published work or a university-assessed thesis carried out prior to training to submit their work at an early stage for consideration. Annual Review of Competence Progression (ARCP) panels may wish to consider whether any reduction can be made in the normal four year duration of training for those whose previous work satisfies the research competency: this is best resolved in time for the first ARCP review and due allowance should be made for the several months that may be needed to assess the material submitted the Faculty; a possible delay to training could arise in the event of late discovery of inadmissibility, when the candidate will need to identify an alternative project for the dissertation.
M24. If planning to undertake a dissertation for purpose (M12(a)), candidates should submit an outline protocol for their proposed work before data collection. The title and an outline of the work should be submitted on Form M2 to the Chief Examiner (Research Methods). This should be no more than 1,000 words in length and should focus on the rationale and method of study, together with timelines for proposed completion and any relevant ethical issues.
M25. The Chief Examiner (Research Methods) will appoint protocol reviewers and advise on the relevance of the chosen topic under M14 with the aim of providing the candidate with suggestions of points to be considered when conducting the project. The responsibility to modify research plans in the light of the feedback received lies with the candidate.
The response will usually be made within about 6 to 8 weeks of receipt.
M26. Submission of an outline is not required in relation to substantial published work or an examined degree (M12 (b) or (c)).
The safeguard of submitting an outline proposal (M24-M25) exists to avoid trainees investing time in a study that is likely to fail in its final assessment. The process is not one of formal approval by the Faculty; rather, it is a way of offering candidates simple advice and early feedback.
The Faculty cannot assume the responsibility of checking that suggestions are acted upon; this lies with the candidate, who is advised to discuss changes of plan with their educational or academic supervisor.
Those in an approved training programme can submit an outline proposal at any time, but it is recommended that they do this early on. Most trainees will conduct and write up their dissertation in ST4 and ST5 (after the Part 1 examination and before the Part 2 examination), but experience suggests that developing a good idea and laying the foundations for a good study take time.
Most research projects that collect health data will require ethics committee approval. Trainees should discuss the requirement with their supervisor, should budget extra time for this, and should indicate how issues of ethical approval will be/have been handled in any outline and final submissions to the Faculty. Note that the Faculty Ethics Committee is not constituted to grant ethical approval to individual trainee dissertations. Instead, proposals will normally need to be submitted to a Local Research Ethics Committee, an MREC, or to another appropriate committee such as those established by universities or the Armed Forces or the Health and Safety Executive.
M27. On the completion of the work, candidates should submit two unbound copies of their evidence to the Faculty for final assessment, together with Form M3 and the appropriate fee. A maximum of five keywords should be included on the submission form.
M28. For those submitting a dissertation written for purpose (M12(a)):
(a) the length of the written work should be around 8,000 to 10,000 words (in general, credit will not be given for exceeding this limit);
(b) good quality A4 paper must be used and the pages must be numbered;
(c) the work must include an abstract of no more than 300 words, positioned at the start;
(d) the volume must bear the title, the name of the candidate, the name of the qualification for which the dissertation is being submitted and the date of submission;
(e) where appropriate, a shortened version of the title should appear on the first page of the text;
(f) candidates should provide a detailed statement of their contributions to the work and state clearly, in an acknowledgement, what help they have received with the study; the respective contributions of other parties should be clear to the assessors.
M29. Those submitting substantial published research or the awarded thesis of a university (M12(b), M12(c)) should:
(a) ensure that the text is clear, legible and easy to read;
(b) provide proof of acceptance/publication by one or more journals (with the original publications appended for reference), or confirmation of the degree awarded and university in question;
(c) provide a detailed statement of their contributions to the work. For multi-author work, this must include an affirmation from at least one other author;
(d) provide a frontispiece bearing an overall title, the name of the candidate, the name of the qualification for which the dissertation is being submitted, the date of submission and an abstract summarising the work.
Guidance to ARCPs and supervisors on the submission timetable
There is no regulatory restriction on the timing of submission for final assessment of the thesis or alternative evidence (former linkage with entry to the part 2 MFOM examination in ST6 has been removed with the passing of these Regulations). However, for trainees in higher specialist training in the UK, it would be prudent to budget 12 months from the projected completion of training for such assessment, thus allowing time for marking, amendment, reassessment, major requested revisions, acceptance and delivery in the finally approved and bound format. The Faculty recommends, therefore, that satisfactory progression from ST5 to ST6 at ARCP review should normally be conditional on the trainee having submitted their work under Regulation M27. This notional timetable should be discussed with the trainee early on in their training programme.
Guidance on the format of submissions of equivalent evidence
The format should assist the assessors. Candidates should review the guidance intended for dissertations written “for purpose” and consider whether their proposed submission is broadly comparable in length, content, and presentation. There is no need to modify a submission if the original format is similar to that of a dissertation. However, submissions of different format may benefit from amplification (e.g. by means of a more detailed literature review, additional data tables, or a contextualising Appendix) or from reformatting along similar lines as a dissertation “for purpose” (in which case it may be helpful to include a statement that only the format has changed and not the content).
M30. Following receipt of the final submission, the Faculty will appoint two independent assessors to evaluate the work. Usually, the assessors will be specialist occupational physicians. However, in certain circumstances the Faculty may appoint an assessor who is an expert in the relevant field of study, but not an occupational physician; and if so, at least one assessor will be a specialist occupational physician.
M31. The assessors may require the candidate to attend for an oral assessment of their work, should this be considered essential in forming a judgement about the candidate’s mastery of the subject and of the techniques used.
M32. The assessors will agree a joint mark within bands (excellent pass, good pass, clear pass, marginal pass, marginal fail, clear fail) and will provide structured feedback.
M33. If the assessors are unable to agree as to whether the submission meets the required standard, the Chief Examiner (Research Methods) will either (a) act as a third assessor and adjudicator, or b) appoint a third assessor and adjudicator, or (c) in exceptional circumstances, appoint two new assessors. An expert advisor may be appointed to assist the original assessors with highly technical content in a dissertation.
M34. After acceptance of the work and before Membership can be awarded, the candidate must provide one copy bound in boards and cloth back for retention in the Faculty library. The colour to be used is Arbelave 563 (green). The title is to be printed on the front cover and the information on the spine is to read (from top to bottom): MFOM, name of candidate, year of submission of bound copy. The abstract of the final submission will normally be published on the Faculty’s web site.
M35. The Part 2 examination will comprise the following sections:
1. A Multiple Choice Question (MCQ) Paper.
2. A Modified Essay Question (Structured Short Answer) (MEQ) Paper.
3. An Observed Structured Practical Examination (OSPE).
M36. Before applying to sit the Part 2 examination a candidate must have passed their Part 1 examination. See Regulation M9 for conditional exemptions.
M37. If enrolled in an approved post or programme recognised for higher specialist training in occupational medicine in the UK, the candidate must also provide evidence, following local Annual Review of Competency Progression (ARCP) panel review, of having achieved the end competencies of ST4 training.
Guidance on M37
The competencies referred to are those defined in the approved Curriculum for Higher Specialist Training in Occupational Medicine, and elaborated with guidance in the Specialty Training Handbook. Candidates must normally submit the evidence referred to in M38 with their examination application. Exceptionally, and at its own discretion, the Faculty may accept later submission of this evidence; but in all circumstances it must be received before the examination is sat. Higher specialist trainees can first attempt the part 2 MFOM examination six months through ST5 (18 months before the projected completion of their training), but not before this.
M38. If not enrolled in an approved post or programme of specialist training in the UK, the candidate must also provide evidence of at least 4 years of full-time practical experience or training in occupational medicine (or the equivalent pro-rata) in a post or posts acceptable to the Faculty.
M39. The Faculty’s Specialist Advisory Committee (SAC) will be the arbiter of acceptable experience or training under regulation M39.
Guidance on M38-M39
Among other things, the SAC will normally seek evidence of:
(i) a sufficient breadth, as well as a sufficient duration of experience in occupational medicine (across a range of settings and covering a range of occupational health problems of a kind encountered in specialist training or practice); and
(ii) structured employment involving the support and, ideally, the formal supervision of a senior occupational physician of consultant status. Normally the applicant will need to hold such a post for at least 6 months within the 12 months prior to their application to be eligible to sit the Part 2 examination; the practice of occupational medicine must be a substantial component of their work.
Final discretion as to the evidence required rests with the Faculty’s SAC. Such evidence will need to be submitted at least 4 months in advance of application to sit the Part 2 examination to allow due time for consideration by the SAC Applicants under regulation M38 will need to demonstrate that they meet the required criteria of practical experience or training, as judged by the SAC, whether or not they are granted exemption under M40 (below).
M40. Candidates who have passed the AFOM examination in its entirety will be exempted both the Part 1 and Part 2 examinations, provided that the date on which they sat and passed the AFOM is not more than seven years before (a) their enrolment (or re-entry) into an approved post or programme recognised for higher specialist training in occupational medicine in the UK (b) if not enrolled in higher specialist training, their application for Membership.
M41. The Part 2 examination will normally be held over two days (with the written exam on one and the OSPE exam on another) and will usually be a month apart.
M42. Full details of the Part 2 examination are published separately. Questions may be chosen from any part of the curriculum, which will be based on the current GMC-approved training curriculum for higher specialist training in Occupational Medicine in the UK.
Details of the Part 2 MFOM can be found on the Part 2 MFOM page. Details of the current specialist training curriculum can be found within Section 2.2 of the Faculty’s Specialist Training Curriculum for Occupational Medicine.
M43. Applications for admission to the Part 2 examination must be made by the closing date i.e. not less than 10 weeks before the date of the examination. The application is to be submitted on the Faculty’s generic application form, which is available from the forms page, together with evidence of employment and training as detailed above. The Faculty must receive the original signed form and under no circumstances will a photocopied or faxed form be accepted. All applications must be accompanied by the fee (see General Faculty Examination Regulations). Details of times and places of examinations will be available to candidates well before the due dates.
M44. Candidates will be required to pass all three sections of the Part 2 examination at a single sitting. No candidate will normally be allowed more than six attempts at the Part 2 examination. However, Regulation F3 makes provision for the Faculty’s Specialist Advisory Committee (SAC) to consider a candidate’s eligibility to make a further attempt or attempts, subject to acceptable evidence of additional education experience. Any attempt that ends in a withdrawal from the examination as a whole which is accepted by the Faculty as arising from extenuating circumstances under Regulations F13, F14 and F15 will not count towards the total of six.
M45. Applications for Membership are made on Form M4. The completed form should be sent to the Academic Dean at the Faculty. The Academic Dean and President are responsible for approving the application on behalf of the Faculty Board. A Membership Admission fee is payable to the Faculty at the time of the application for Membership; this will include provision of a certificate of Membership.
Where application is linked with an approved UK programme of higher specialist training in occupational medicine, Form M4 should be countersigned by the candidate’s supervisor and Regional Specialty Advisor. If the candidate’s application for Membership is approved, the Faculty will make a recommendation for inclusion on the Specialist Register to the GMC, with details of the candidate’s training and qualifications. Candidates may then apply to the GMC for a CCT. On receipt of the recommendation from the Faculty, the candidate’s application form and the required fee, the GMC will process the CCT application.
M46. The Faculty may refuse to admit to assessment any candidate who infringes a regulation of the Faculty Board or whose behaviour is considered to be prejudicial to the proper management and conduct of the assessment.
This information applies to those outwith UK specialist training posts or programmes.*
It is a requirement, before attempting the Part 1 MFOM examination, that candidates who are not enrolled in UK specialist training shall provide evidence of adequate and acceptable General Professional Training.
The aim of General Professional Training is to enable a doctor to obtain a broad medical experience before embarking upon specialist training. It normally occupies a period of at least two years after full registration and completion of the pre-registration year and the time is spent in a series of specialty registrar posts accepted for the purpose. General Practice
Vocational Training in the UK (GPVT) will also meet this requirement.
It is important that the experience gained should be wide and varied. Thus, in addition to filling posts in General (Internal) Medicine, trainees are encouraged to work in other specialties. Multi-disciplinary rotations in specialty registrar posts (not necessarily restricted to hospital practice) can offer such experience.
(This list is illustrative and not necessarily comprehensive. If in doubt, applicants can inquire about the suitability of their experience the Faculty’s SAC will be the final arbiter of admissibility.)
* From 1 August 2007, for purposes of obtaining a CCT, the experience required at enrolment into UK higher specialist training is that defined in the latest version of the Faculty’s approved Curriculum for Higher Specialist Training on Occupational Medicine. Such enrolment will automatically qualify a candidate to attempt the Part 1 examination (under Membership regulation M7(b)).