Abstract
Background
Current Canadian Occupational Medicine residency program training routes and curriculum are being redesigned, using a competence by design model and reverting to a primary entry specialty likely in 2027. This is an opportunity to improve training standards and better prepare residents to address psychosocial risk prevention and worker’s compensation.
Aims
To conduct an environmental scan on the educational experience pertaining to mental health and psychosocial risks.
Methods
We conducted an environmental scan in 2025 collecting data on requirements, educational experiences, and examination on mental health and psychosocial risks for occupational medicine residents via contacts with program directors and the chair of the subspecialty exam committee, review of the national academic half-day curriculum, Royal College of Physicians and Surgeons of Canada standards and objectives, accreditation standards, and a recommended reference textbook.
Results
Few requirements are mandated in specialty accreditation standards, mostly about mental health and addiction medicine experiences, delivered by all programs. The national academic half-day curriculum includes 8% of programmed sessions on these issues (mental health and addiction medicine diagnosis, stress models, burnout, bullying, psychosocial risks and work organization). Several additional learning experiences were noted locally such as learning modules or optional webinars.
Conclusions
Programs go beyond requirements and deliver educational experiences addressing psychosocial factors. Canadian academic occupational medicine specialists have been able to influence educational standards at the undergraduate level and have an opportunity to do the same with the updated residency standards. An international framework for psychosocial risks education in occupational medicine residency training may be helpful.
Key learning points.
What is already known about this subject:
Canadian Occupational Medicine residency programs are going through fundamental re-design with a return to an independent primary entry specialty, using a competence by design model.
National workshops are being conducted to draft new specialty standards expected to be implemented in 2027.
What this study adds:
All three Occupational Medicine programs comply with the current requirements, which are sparse and mostly centred on mental health diagnostic assessment and fitness for work considerations.
However, programs go beyond requirements and deliver learning experiences on psychosocial factors, aiming at equipping residents with skills to help them provide relevant prevention advice and better assess work-relatedness of mental health conditions.
What impact this may have on practice or policy:
This environmental scan will help develop the new occupational medicine residency standards and ensure psychosocial risks are part of the teaching experience.
There may be a need for better links between academic occupational medicine specialists and work and organizational psychosocial factors experts to ensure that key skills are taught to occupational medicine residents.
We would like to encourage occupational medicine residency program directors across the world to reflect on how psychosocial risks are addressed in their programs, and to foster international collaboration to build shared educational frameworks that would strengthen occupational medicine residency educational experiences.
Introduction
In 2024, the National Institute for Occupational Safety and Health (NIOSH) has released an urgent call to address work-related psychosocial hazards and improve worker well-being [1]. Such hazards are a major threat to occupational health and safety. The current situation in Canada is not better than in the United States of America. Improvements are urgently required with regard to the prevention of psychosocial risks and the compensation of work-related mental health conditions.
Canada has ratified the International Labour Organization (ILO) Violence and Harassment Convention (C190) in 2023 [2]. Most provinces and territories are equipped with legislation on violence and harassment at the workplace [3]. However, still as of 2025, most of the guidance in the prevention of psychosocial hazards in Canada is soft law or grey literature [4], including a national voluntary standard on psychological health and safety in the workplace [5]. Canada does not have a national programme establishing priorities in occupational health and safety, like other countries such as France with the Plan National Santé au Travail (National Occupational Health Programme) [6] or the United Kingdom’s Occupational Health: Working Better consultation outcome [7]. Prevention of psychosocial risks is typically dealt with mostly along any other risks, without prioritizing this topic.
Whilst most provinces and territories provide presumptive coverage for mental health conditions in first responders exposed to workplace psychological trauma, compensation for any other work-related mental health condition is much more difficult. Even though it is estimated that 10% to 13% of suicides are somewhat related to workplace factors [8], these are very rarely compensated by workers’ compensation boards in Canada. Relative to approximately 4500 deaths by suicide every year in Canada, less than 10 fatalities related to mental health conditions are usually compensated by workers’ compensation boards [9].
In this context, it is critical to ensure that occupational medicine specialists are adequately trained in the field of psychosocial risks and work-related mental ill-health. Canadian occupational medicine residency program requirements are currently being fundamentally redesigned, and undergoing a double transformation [10]: (1) a switch from a time-based approach (where skills are deemed acquired after the resident has completed a certain number of weeks in a rotation) to a competence by design (CBD) model (which is a hybrid form of competence-based medical education within time constraints) [11] and (2) a switch from a 2-year subspecialty program available only to residents with prior training in core internal medicine or public health and preventive medicine, to a full and independent 5-year specialty program accessible directly after medical school graduation.
Therefore, we are taking the opportunity offered by these large educational shifts to conduct an environmental scan regarding the educational experience pertaining to mental health and psychosocial risks and how it is currently delivered. The scan will inform the current review of training standards for Occupational Medicine, ultimately improve the skills of qualified occupational medicine specialists so they can be best prepared to meet populational needs related to the prevention of psychosocial risks.
Methods
An environmental scan is the process of seeking, gathering, interpreting and using information from the internal and external environments of an organisation to inform strategic decision-making and to direct future organisational actions [12]. An environmental scan can include interviews, observation, interpretation of documents and materials, literature review, and personal experience. Environmental scans have been used for educational needs assessments [13] such as curriculum reviews in physiatry [14] or assessing academic faculty diversity programs [15].
For this environmental scan completed in January and February 2025, we gathered information on educational experiences related to mental health and psychosocial risks from the following stakeholders.
All three Canadian occupational medicine residency program directors (QDM for the University of Alberta, VS for the University of Toronto, LP for the Université de Montréal) or recent past program directors. No Canadian occupational medicine residency program was excluded from the analysis. Internal information gathered included educational experiences related to mental health and psychosocial risks such as rotations (mandatory or electives), locally run teaching sessions or asynchronous teaching modules: this information has been collected by QDM, with email requests sent to the two other program directors (V.S. and L.P.).
The national occupational medicine academic half-day curriculum in its latest version (2024), and its previous version (2020), along with the learning objectives of sessions related to psychosocial risks identified from presenters’ teaching materials (when available). The three Canadian occupational medicine residency programs have a joint national academic half day system. Residents from each residency program connect via videoconference for weekly teaching sessions. Topics are taught based on a 2-year national curriculum designed by all three program directors, and allowing national experts to teach directly to residents. The national academic half-day curriculum has been updated in 2024 after a national quality improvement initiative conducted in 2023. Current residents, recent graduates (5 years or less) and members of the residency program committees of the three programs have been invited to review and comment upon the previous curriculum (2020) and make suggestions for new topics, via a bilingual (French and English) national online survey.
The Royal College of Physicians and Surgeons of Canada (RCPSC), the regulatory college for all medical and surgical specialties, except for Family Medicine [16]. We have consulted (1) the latest version (2012) of the Standards of Training (STR), which defines eligibility requirements to enter the residency program, and training requirements during the 2-year program (i.e. type of rotations and their durations); (2) the latest version (2013) of the Objectives of Training (OTR) listing all competencies residents need to acquire during their residency; (3) the Occupational Medicine exam committee chair, to collect information about the exam requirements in the field of psychosocial risks and work-related mental health issues.
The CanERA standards for Occupational Medicine, in its latest version (2024) [17]. CanERA (Canadian Excellence in Residency Accreditation) is the postgraduate medical accreditation system in charge of maintaining national standards for accreditation of Canadian post-graduate medical education institutions (i.e. faculties of medicine) and their residency programs, all medical and surgical specialties and subspecialties included (including Family Medicine). The CanERA standards include mandatory indicators, which must be met to achieve full compliance, and exemplary indicators, which “provide objectives beyond the mandatory expectations and may be used to introduce indicators that will become mandatory over time” [17].
The LaDou and Harrison textbook of Occupational Medicine, used by all residents, in its latest version (6th edition, from 2021) [18]. This is considered as the recommended reference textbook in Canada, though not official. It is also a textbook written by a large group of co-authors, almost all affiliated with US-based institutions, with a strong dominance of California-based authors. The Canadian specificities of occupational medicine are not discussed in this textbook.
The University of Alberta Research Ethics Board (REB) has determined on 6 January 2025 that this project did not require REB review, and that ethics approval was not required.
Results
Findings from this environmental scan related to Canadian occupational medicine learning experiences about psychosocial risks and work-related mental health issues are summarized below. Extensive details are provided in Supplementary Materials.
What is required? The review of the RCPSC standards (OTR and STR) contained no requirements nor objectives related to either mental health or psychosocial risks. The CanERA standards include one mandatory indicator related to mental health and psychiatry (indicator 4.1.2.6): “the residency program has access to clinical specialties including … mental health and psychiatry” (Box S1, Supplementary Materials). The CanERA standards are also comprised of two exemplary indicators related to mental health and psychiatry:—occupational medicine residency programs should offer curriculum plans that include “opportunities for residents to develop knowledge and skills in the area of mental health, wellness management, substance abuse” (indicator 3.2.2.11)—occupational medicine residency programs should “liaise as appropriate with teaching services in … mental health, psychiatry” (indicator 4.1.2.12).
What is taught during national academic half-days? The current national academic half-day curriculum is organized on a 2-year period. Residents can start their residency while either the first or the second year of the curriculum is delivered. It is expected that they participate in all sessions during their 2-year residency. The first year of the curriculum includes a total of 43 sessions, and the second year includes a total of 40 sessions. Seven sessions (8% of the total) are entirely dedicated to mental health/psychiatry and psychosocial risks. There are three mental health and psychiatry sessions, on the following topics: (1) post-traumatic stress disorder (PTSD) delivered by a psychiatrist working exclusively in the field of occupational psychiatry; (2) mental health, work, and depression delivered by another occupational psychiatrist; and (3) addiction medicine diagnoses, delivered by a psychiatrist and addiction medicine specialist.
Four sessions are dedicated to psychosocial factors, hazards, and risks, delivered by an occupational medicine specialist, trained in work psychology (QDM) on the following topics: (1) models of stress, including the general adaptation syndrome from Hans Selye, the transactional model of stress from Lazarus and Folkman, the European Agency for Safety and Health at Work (EU-OSHA) and USA National Institute for Occupational Safety and Health (NIOSH) definitions of stress, the Job Strain model from Robert Karasek and the Effort-Reward Imbalance model from Johannes Siegrist; (2) burnout and bullying, introducing residents to Christina Maslach’s tri-dimensional model of burnout, and providing a critical perspective on this syndrome, reviewing criteria to characterize harassment and ethical concerns with worker-directed interventions; (3) psychosocial risks and activity, including categorization of psychosocial factors, introduction to several standards that can be used for the management of psychosocial risks at the workplace (including the International Organization for Standardization (ISO) 45003:2021 standard and the national safety council standard); (4) management, lean management, and health effect, which is a session dedicated to work organization, where principles of Taylorism, Fordism and lean management are described, as well as operating leeway and the effect of different forms of work organization on health indicators.
The learning objectives as written in the teaching materials are provided in Box S2, Supplementary Materials. The topic of psychosocial factors and mental health is also included in other teaching sessions as a connected topic, such as the teaching sessions on musculoskeletal disorders and ergonomics (M.B. and L.P.), or on healthcare workers (V.S.). The 2023 national quality improvement initiative did not lead to any change in academic half day sessions related to psychosocial risks and mental health.
What are the rotations offered in each program? All three programs offer a dedicated mental health rotation, which includes psychiatry and/or addiction medicine for a period of 4 to 8 weeks in total. Residents are exposed to mental health, addiction medicine and psychosocial risks cases on an unpredictable basis as part of other occupational medicine rotations (Workers’ compensation boards, occupational and environmental medicine clinics, industry-based rotations …). Further details on rotations are provided in Box S3, Supplementary Materials.
What are the additional teaching experiences offered in each program? The Université de Montréal program provides mandatory learning modules, for residents to work under the supervision of an occupational medicine specialist. These modules top off the rotations and must be completed while the resident is in the corresponding rotation (e.g. the mental health module must be completed during the mental health rotation). Each module contains different sections on different topics (such as occupational stress, mental health diagnoses or personal factors influencing mental health at work), including documents for residents to review such as relevant peer-reviewed publications, videos or grey literature reports. They provide their residents with one module on mental health at work, and one on addiction medicine. The University of Alberta program has initiated in 2025 a series of six online seminars dedicated to the study of psychosocial risks, expanding on the sessions delivered during the national academic half days. These sessions are optional for occupational medicine residents, and opened to other learners including medical students, residents in internal medicine, public health and preventive medicine and psychiatry, and physicians in independent practice. Further details on local additional learning experiences are provided in Box S4, Supplementary Materials.
What is in the reference textbook? The LaDou and Harrison textbook (6th Edition) [18] includes two chapters related to mental health. The chapter on occupational mental health and substance-use disorders (Chapter 36) includes information on how to diagnose mental conditions (depression, bipolar disorders, generalized anxiety disorders, post-traumatic stress disorders, substance-use disorders). There is a short paragraph on occupational stress, a section on fitness for work challenges for workers presenting with such conditions, and another on how to respond to substance use disorders in the workplace. The second chapter is on workplace violence prevention (Chapter 38). This chapter provides a typology of workplace violence. Prevention is discussed with the following topics: management commitment and employee involvement, worksite analysis, hazard prevention and control, training and education, recordkeeping and program evaluation.
What is examined? Questions related to mental health and psychosocial risks are included under two groups of questions of the exam. The first group is about clinical questions and represents 35 to 55% of all occupational medicine exam questions. Within this section, there are some questions on mental health diagnoses (such as post-traumatic stress disorders, mood disorders …) The second group is on issues in occupational medicine practice, which represents 10% of all occupational medicine exam questions. Within this section, there are some questions on workplace stress, fatigue, shift work, violence, harassment, bullying, substance use at work.
Discussion
Canadian occupational medicine residency programs integrate psychosocial risks more extensively than required in the learning experience. Despite the few requirements in specialty accreditation standards on learning experiences about psychosocial risks, in practice, the three Canadian occupational medicine residency programs provide a large number of both national and local teaching experiences.
The few existing requirements are solely on the mental health, psychiatry and addiction medicine side. Such learning experiences are meant to educate residents regarding how to properly diagnose mental health and substance-use-related conditions. Such skills are highly relevant for occupational medicine specialists assessing the fitness for work, particularly of workers engaged in safety-sensitive positions. However, the topic of mental health at work should not be restricted to fitness for work considerations. If this were the only relevant consideration, then the mental health component of fitness to work would be adequately addressed by psychiatrists and addiction medicine specialists. Several authors, such as Lerouge [19] or Rugulies et al. [20] have explained that such mental health approach is usually associated with worker-directed individualized initiatives in the workplace and fail to grasp work-directed prevention addressing organizational issues.
Indeed, in our view, current requirements alone fail to fully equip residents in occupational medicine with the skillsets that will help them provide recommendations in terms of prevention of psychosocial risks, advising on appropriate disability accommodations, and advising for compensation purposes regarding work-related mental health conditions, which are largely under-recognized in Canada [21]. In acknowledging the importance of this area of prevention, Canadian residency programs are providing residents with such teaching experiences regardless. Furthermore, it is precisely this aspect of the topic that cannot be outsourced to psychiatrists and addiction medicine specialists. These skills are core to the job of occupational medicine specialists, but could also involve other occupational health professionals, such as work psychologists and ergonomists.
Hence, it has been critical that Canadian academic occupational medicine specialists involved in residency education have pushed to implement such learning experiences in the curriculum.
There have been a few recent opportunities to elevate implementation of psychosocial risk learning experiences in medical education in Canada. In 2018, the Occupational Medicine Specialists of Canada (OMSOC, the national specialty association in Canada) mandated Baillargeon et al. [22] to define the core occupational medicine competencies for medical students in undergraduate medical education. This was the first official document in which expectations for medical students in terms of knowledge related to psychosocial risks were outlined. At the same time, the objectives of the Medical Council of Canada examination, which must be passed by all medical students in Canada prior to entering residency, outline that medical students need to “identify hazards in the workplace that could have an impact on the health problem (work and exposure history)”, and includes “psychological and work organization hazards (e.g. workplace stressors, workplace bullying)” [23].
However, with regard to occupational medicine residency education, the 2013 version of the Objectives of Training in the Subspecialty of Occupational Medicine (OTR) is still in use in 2025, and does not mention psychosocial factors. In preparation for the current re-design of the residency program, Durand-Moreau has coordinated a national working group in 2021 and 2022 to reflect on the scope of practice of occupational medicine [10]. The purpose of this document was to draft a list of skills that each resident should acquire by the end of their residency program, which facilitated the conception of the new CBD-based standards for occupational medicine residency programs.
We expect these updated standards to be released in 2026, implemented in 2027, and we expect these will include both educational experiences related to the assessment of mental health conditions, as well as enhancing expectations in terms of assessing psychosocial exposures, factors and hazards.
When we put this environmental scan into a historical perspective, we come to understand that residency requirements are not necessarily imposed on programs from the top to the bottom. Rather, occupational medicine specialists have a real influence to align these standards with the evolutions of the field and the needs of workplaces. The corollary is that such implementation also depends on the capacity of occupational medicine specialists to recognize these changes.
The Canadian workforce of occupational medicine specialists is extremely small in Canada [24]. This necessarily reduces the opportunity to bring new perspectives into curriculum development. The small number of academics in our discipline represents a limitation of our environmental scan as we had a very small total number of programs to include in our review. This did not allow us to provide a lot of relevant quantitative data. Hence, we conducted a qualitative analysis including all three Canadian programs.
One path that would help ensure better implementation of teaching experiences would be to develop bridges between international experts in the field of psychosocial risks and occupational medicine specialists, so an international framework of what is expected for occupational medicine specialists could be delineated. Then, such a framework could be used, adapted, and assessed to make sure that occupational medicine specialists recognize what they need to know and apply in the field of psychosocial risks.
Supplementary Material
Acknowledgements
The authors are grateful to Ashley Clelland, Medical Education Research Assistant in the Department of Medicine, University of Alberta, for her advice on this project, and comments on the manuscript.
Contributor Information
Q Durand-Moreau, Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
M Baillargeon, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
M -L Durand-Hémery, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
L Patry, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
V Spilchuk, Division of Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
A Adisesh, Department of Medicine, Dalhousie University, Halifax, NS, B3H 2Y9, Canada; UConn Health, Division of Occupational and Environmental Medicine, Farmington, CT 06030-2945, United States.
Supplementary data
Supplementary data are available at Occupational Medicine online.
Funding
None declared.
Competing interests
None declared.
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