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.”
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 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. Successful candidates will normally have completed satisfactorily a prescribed period of supervised training in one or more approved posts and have submitted an acceptable thesis, dissertation or substantial published work.
The regulations in this document should be read in conjunction with the separately published Regulations for Membership and guidance on specialist training.
These Regulations should be read in conjunction with the Regulations for Award of Membership (2014) and the General Faculty Examination Regulations (Annex 1) which will apply equally.
Rules pertaining to the ‘Part 1 examination’, the ‘research dissertation or equivalent evidence’ and higher specialist training are defined on the MFOM Regulations page. These Regulations and guidance give further detail related solely to the Part 2 examination for Membership (Part 2 MFOM).
A1. Normally, before applying to sit the Part 2 examination a candidate must fulfil the eligibility requirements set out in regulations M37 to M40 of the Regulations for Award of Membership (2013).
Regulations M36 to M39 are repeated below for convenience. Further guidance can be found on the MFOM Regulations page.
Before applying to sit the Part 2 examination a candidate must have passed their Part 1 MFOM examination. See Regulation M9 for conditional exemptions.
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.
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.
The Faculty’s Specialist Advisory Committee (SAC) will be the arbiter of acceptable experience or training under regulation M39.
Dated proof of meeting the ST4 training competencies (Regulation 37) is normally required by the time of application to sit the Part 2 examination. The Faculty, at its own discretion, and exceptionally, may accept later submission of this evidence; but in all circumstances it must be received before the examination is sat.
Proof of equivalent practical experience and/or training outwith UK specialist training (Regulation 38) must be received at least 4 months before the Part 2 examination date, so that the SAC has an adequate period in which to assess eligibility under Regulation 39.
A2. The Part 2 MFOM examination will comprise the following sections:
1: Multiple Choice Question Paper (MCQ)
2: Modified Essay (Structured Short Answer) Paper (MEQ)
3: An Observed Structured Practical Examination (OSPE)
All three sections are compulsory.
A3. The Part 2 MFOM examination will normally be held over two days. The MCQ and MEQ papers will be held on the first day at one or more centres. The OSPE will be held on another day, normally in the following week, and may be at one or more centres.
A4. The syllabus for the Part 2 examination will be based on the competencies for higher specialist training in Occupational Medicine in the United Kingdom (UK), as defined in the latest version of the Faculty’s GMC-approved specialist training curriculum.
A5. Questions may be asked on any part of the syllabus. Collectively, the 3 component sections of assessment will aim to sample systematically from the curriculum across examination sittings.
Details of the competencies on which the examination syllabus is based can be found within Section 2.2 of the Faculty’s Specialist Training Curriculum for Occupational Medicine.
A6. A candidate’s performance in each section will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted to preserve a common standard between examinations.
A7. Candidates will be required to pass all three of the sections listed in A2 at a single sitting.
There is no provision in the Regulations to roll-over or ‘bank’ passes from one sitting to another.
A8. This 2 hour examination paper will comprise approximately 120 questions in the format of single statements or stems with up to five completions, or related responses. Normally, questions will be in the ‘single best answer’ format – i.e. candidates will be required to choose from the alternatives the most appropriate or fitted response.
A9. Answers must be recorded on the machine-readable sheet provided. All questions are compulsory. A negative marking scheme will not be employed.
A10. Additional questions may be included for trialling, or standard setting purposes. (These items, which may appear anywhere in the paper, will not be used when calculating candidates’ scores, but may be used in relation to regulation A6.)
A11. This 3 hour examination paper will comprise approximately 10 written essay questions, most of which will be highly structured with multiple parts or subcomponents. All questions are compulsory.
A12. The Observed Structured Practical Examination will comprise 7 assessment Stations – (a) two 30 minute stations based on long clinical cases (patients and/or role play actors); (b) four 10 minute stations based on short clinical cases (usually, patients with clinical physical signs); (c) one 40 minute station based on photographic illustrations, and materials relevant to occupational hygiene. All stations are compulsory. Annex 2 provides general guidance on the OSPE and is for illustrative purposes only; the exact content of questions and administrative arrangements may.
A13. Applications for admission to the examination must be made by the closing date (i.e. not less than ten 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 such other evidence as the form dictates to confirm eligibility under regulation A1. The Faculty must receive the original signed form; under no circumstances will a photocopied or faxed form be accepted. All applications must be accompanied by the appropriate examination fee (see Annex 1). Details of times and places of examinations will be advertised on the website.
A14. Results of the examinations will be communicated to the candidates in writing as soon as is practicable. In no circumstances will results be given by telephone.
Regulations governing the MFOM examination have been published by the Faculty. It is the responsibility of candidates to ensure that they obtain the latest edition of the Regulations. These notes do not form part of the Regulations, but are included here for the guidance of candidates wishing to take the Part 2 MFOM examination.
The Part 2 MFOM examination will comprise the following sections:
1. A Multiple Choice Question (MCQ) Paper.
2. A Modified Essay Question (MEQ) (Structured Short Answer) Paper.
3. An Observed Structured Practical Examination (OSPE).
The examination will be held once or twice each year, depending on demand.
The syllabus will be based on that defined by the GMC-approved training curriculum for higher specialist training in Occupational Medicine in the United Kingdom (UK) – i.e. the Specialty Registrar’s training curriculum. Doctors in specialist training posts and those outwith such programmes may find it helpful to read Section 2.2 of the Faculty’s Specialist Training Curriculum for Occupational Medicine.
By careful selection of examination questions, the examiners will aim to offer a broad coverage of this GMC-approved training curriculum across examination sittings.
The MCQ paper will normally last for 2 hours. The paper will contain approximately 120 multiple-choice questions in ‘one from five’ (best of five) format. This means that in each question candidates will be presented with a stem and five possible answers, from which they must choose the single best answer (only one answer is the best one, although several may be true in part).
The purpose of the MCQ examination is to test factual knowledge to the standard appropriate to a specialist in Occupational Medicine. Thus, candidates can expect to be tested across a wide range of common and important occupational health topics, sampled across the whole syllabus.
All questions are compulsory. A small number of (unidentified) trialling and/or standard setting questions may appear in any paper. Responses to them do not count towards a candidate’s final score. They are part of a range of quality assurance measures the Faculty has instituted across its examinations.
The marking system for the MCQ examination is as follows:
Candidates should be aware that no mark will be awarded for any answer that is partially erased, smudged, or a double response to a question. In these circumstances the Faculty cannot safely interpret the candidate’s intentions.
The pass mark in the MCQ examination will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted (scaled) to preserve a common standard between examinations.
Some sample MCQs are given for information in Annex 3.
The MEQ paper will last for 3 hours and will usually comprise 10 MEQ-style questions, completed at a single sitting. Questions will normally be given equal weighting.
Most of the questions will be highly structured and divided into sub-sections, each of which will carry no more than 4 marks. Some questions, however, will be designed to assess the candidate’s ability to analyse, appraise, and write occupational health reports; and these may not be so highly structured. The question sheet will indicate the number of available marks for each subsection.
The purpose of the MEQ examination is to test ability to apply knowledge to clinical practice to the standard appropriate to a specialist in Occupational Medicine. The paper may contain questions from any part of the syllabus.
Candidates should ensure that their responses are legible, and are written in their mark books. They are encouraged not to submit answers on additional sheets of paper.
The pass mark in the MEQ paper will be assessed relative to an external standard set by the examiners. Raw marks may be adjusted (scaled) to preserve a common standard between examinations.
Some sample MEQs are given for information in Annex 3.
The OSPE comprises 7 parts, 6 of which (including the long and short clinical stations) will be held at either the Clinical Skills Centre, Northern General Hospital in Sheffield or another suitable venue. The 7th part comprises a photographic/occupational hygiene station and will be held separately (see below).
In all there will be 2 hours 20 minutes of assessment (with a small additional amount of waiting time between some stations), comprising:
The long and short clinical stations will be run/observed by one or a pair of examiners. Faculty staff members will be present to enforce time limits. These stations will be run on a circuit and candidates may commence the circuit at any of the long or short clinical stations. Depending on the number of candidates, it may be necessary to run two circuits simultaneously. If so, to standardise the assessments as far as practicable, each station in the two circuits will have broadly similar cases with similar tasks and questions.
The photographic/occupational hygiene station will take place at a different time to the other OSPE stations, but on the same day as the MEQ and MCQ examination papers.
In general terms:
Long and short stations
Photographic/occupational hygiene station
Further details of each station type are given below. This guidance is for illustrative purposes only. The Faculty reserves the right to vary the content of questioning, within the general framework of: 2 long clinical cases, 4 short clinical cases, 1 photographic/occupational hygiene station.
Stations A (The mental health care station) and B (The disability case station). Role players may be used for the mental health and disability patients. (There is evidence that the use of role players for such cases improves consistency.) Specific written instructions will be provided to the candidate prior to commencing the station. Typically, candidates will be expected to spend about 20 minutes taking an appropriate clinical and occupational history and developing a management plan for the patient. (In the mental health there will also be an expectation, normally, that candidates make a diagnoses; however, such information may be provided for the disability case.) A pair of examiners will observe the candidate’s ability to communicate with the patient and will assess the content of the consultation. During the final 10 minutes the examiners may question the candidate in regard to clinical, ethical and employment issues pertinent to the case in question.
Stations C to F (Short cases 1, 2, 3 and 4). These stations will each comprise one short case of 10 minutes. Two examiners will be present at the station. The candidate will be given clear written instructions prior to commencing the case. Patients will be drawn from the typical spectrum that an occupational physician could reasonably expect to see in daily practice (e.g. a musculoskeletal, abdominal, neurological, respiratory, cardiac, or dermatological case). Typically the candidate will be asked to examine the patient and will be expected to elicit and correctly interpret the relevant clinical signs. 6 minutes will be permitted for the physical examination and the candidate will be reminded at 5 minutes that there is one minute remaining. The candidate will then be asked some questions about the case, focusing particularly on the occupational relevance of the findings to case management. The examiner or pair of examiners will ask all candidates the same or similar questions, and will use a pre-designed marking scheme for each case.
Photographic/occupational hygiene station. Assessment at this station will be in two parts and will ordinarily take place separately from the other OSPE stations.
For the first half candidates will be tested on occupational hygiene, and will be presented with scenario(s) in the form of photograph(s) and or diagram(s) showing work processes. They will be asked approximately 15 questions by the examiners.
This station will examine such topics as: knowledge of common work processes/activities and their associated hazards and risks, approaches to conducting workplace risk assessments, interpretation of non-clinical workplace data and the effectiveness of control measures used (in practice) to minimise or prevent exposure.
The questions will typically be based on a specific workplace process/activity. Candidates may also be required to interpret occupational hygiene and toxicological data, such as may be found in workplace risk assessment reports, or to identify and discuss typical occupational hygiene tools and items of personal protective equipment. Questions may be illustrated by photographs or actual pieces of equipment – e.g. pictures of individuals exposed to physical, chemical, biological or ergonomic hazards; sampling instruments; face masks.
In the second half the candidate will be presented with approximately 5 illustrations and, where relevant, a short scenario; he/she will be asked a number of pre-scripted questions by the examiners. The illustrations may relate to the diagnosis, management, and prevention of occupationally-related disease or ill-health.
Of the total 250 OSPE marks, 80 are available for the short cases, 80 are available for the long cases and 90 are available for the photographic/hygiene station. The pass mark in the OSPE will be assessed relative to an external standard set by the examiners. Candidates will be scored across a range of competencies from the Approved Core Curriculum (e.g. 1.1 (i) of Good Clinical Care and 3.3 Communication Skills).
Raw marks may be adjusted (scaled) to preserve a common standard between examinations. Candidates’ total marks across all stations, adjusted/scaled as necessary, will be compared with the overall pass mark.
They will not be required to pass every station or any particular station. However, they will be required to reach a bare minimum pass standard in certain key competency areas which are not directly tested elsewhere in the Part 1 and Part 2 MFOM examinations. These may include: candidate’s approach to, and communication with, the patient; their capacity to manage the patient’s concerns; and their ability to take a detailed history, conduct a suitable clinical examination, elicit clinical signs and reach an appropriate diagnosis.
In preparing for the clinical elements of assessment, candidates for the OSPE may find it advantageous to practise their clinical skills by attending a suitable course or by a short-term attachment to a hospital unit.
The MCQ paper will contain around 120 multiple-choice questions, normally in the one from five (best of five) format, whereby candidates must choose the ONE best answer from five possible answers.
Which ONE of the following has been most clearly associated with the development of skin cancer?
c) Electromagnetic fields
d) Polycyclic aromatic hydrocarbons
Which is the most accurate statement regarding Carpal Tunnel Syndrome:
a) It Is more common in males
b) It can be associated with exposure to vibrating equipment
c) Occupationally related cases do not respond to surgery
d) It can be excluded if nerve conduction tests are normal
e) Adson’s test is a useful clinical test for diagnosis
Which ONE of the following is most true about case-control studies?
a) They are used to study many health outcomes associated with a single exposure
b) They are usually retrospective
c) Cases should be prevalent cases of the disease
d) Controls are often relatives of the cases
e) Controls should be as similar as possible to cases except that they do not have the disease of interest
a) Is caused by a paramyxovirus
b) Typically starts as a pustular lesion
c) Is common in pig farmers
d) Scarring is a common consequence of infection
e) Vaccination is not useful in controlling infection in animals
a) List 3 low molecular weight substances that are known to cause occupational asthma. (3 marks)
b) List 2 high molecular weight substances that are known to cause occupational asthma. (2 marks)
c) List the 4 investigations that are the most helpful in the diagnosis of occupational asthma. (4 marks)
d) Which of the investigations that you have listed is the first line investigation of occupational asthma thought to be caused by
a high molecular weight substance? (1 mark)
Write short notes on your approach to assessing the following pre-employment scenarios:
a) An individual with asthma applying to become a firefighter. (3 marks)
b) A doctor with HIV applying for a consultant job as a surgeon. (4 marks)
c) An individual who has recently had a heart attack applying for a job as a taxi driver. (3 marks)