Unequal training, unequal protection: occupational medicine gaps in Europe
Abstract
Background: Work is a primary social determinant of health, yet occupational disease remains widely underdiagnosed across Europe. Occupational medicine (OM) equips doctors to identify work‑related illness, take occupational histories, support return to work, and drive workplace prevention, making it a cornerstone of public health protection. Yet OM teaching in European undergraduate curricula is variable and often limited, creating inequitable competency gaps. Where training is weakest, workers face the most risk of an unjust, population‑level disparity. This review maps OM provision across Europe and evaluates its effects on student knowledge, attitudes, and preparedness.
Methods: Following PRISMA 2020, PubMed, Scopus, ScienceDirect, and Google Scholar were searched for English, free full‑text studies (2010–2025) on undergraduate OM education in Europe. Two reviewers independently screened and extracted data. Heterogeneous study designs were synthesised narratively using SWiM guidance. Risk of bias was appraised using appropriate tools.
Results: Seven studies were included. OM teaching varied widely in content, hours (mean 24.3 h), delivery, and assessment. Programmes were predominantly lecture and seminar‑based (98% and 78%); workplace visits (43%) and ward‑based teaching (13%) were less frequent. Problem‑based learning featured in 61% of schools; 39% used no active methods. Assessments were mainly MCQs. Group assessments showed improved knowledge, attitudes, and confidence, but individual assessments revealed persistent competency gaps, directly translating into missed diagnoses and lost prevention opportunities at the population level.
Conclusions: Closing these inequitable gaps requires a defined European OM core curriculum, delivered through innovative active learning, authentic clinical exposure, and objective assessment. Improving this curriculum is a public health investment, ensuring every graduate protects working populations, regardless of where they train.
Key messages: • Harmonise undergraduate OM across Europe with a defined core curriculum and greater workplace exposure, closing inequitable competency gaps that leave workers inadequately protected.
• Replace lecture-heavy OM teaching with active learning and objective assessment to close skill gaps and equip all graduates to protect worker and public health equitably.
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- Chronic Occupational Stress and Immune–Inflammatory Dysregulation: Mechanisms, Clinical Consequences, Biomarkers and Implications for Occupational Medicine
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BibTeX
@article{galea2026unequal,
title = {{Unequal training, unequal protection: occupational medicine gaps in Europe}},
author = {L Galea and S Cuschieri},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.538},
url = {https://doi.org/10.1093/eurpub/ckag169.538},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Unequal training, unequal protection: occupational medicine gaps in Europe
AU - L Galea
AU - S Cuschieri
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.538
UR - https://doi.org/10.1093/eurpub/ckag169.538
AB - Background: Work is a primary social determinant of health, yet occupational disease remains widely underdiagnosed across Europe. Occupational medicine (OM) equips doctors to identify work‑related illness, take occupational histories, support return to work, and drive workplace prevention, making it a cornerstone of public health protection. Yet OM teaching in European undergraduate curricula is variable and often limited, creating inequitable competency gaps. Where training is weakest, workers face the most risk of an unjust, population‑level disparity. This review maps OM provision across Europe and evaluates its effects on student knowledge, attitudes, and preparedness. Methods: Following PRISMA 2020, PubMed, Scopus, ScienceDirect, and Google Scholar were searched for English, free full‑text studies (2010–2025) on undergraduate OM education in Europe. Two reviewers independently screened and extracted data. Heterogeneous study designs were synthesised narratively using SWiM guidance. Risk of bias was appraised using appropriate tools. Results: Seven studies were included. OM teaching varied widely in content, hours (mean 24.3 h), delivery, and assessment. Programmes were predominantly lecture and seminar‑based (98% and 78%); workplace visits (43%) and ward‑based teaching (13%) were less frequent. Problem‑based learning featured in 61% of schools; 39% used no active methods. Assessments were mainly MCQs. Group assessments showed improved knowledge, attitudes, and confidence, but individual assessments revealed persistent competency gaps, directly translating into missed diagnoses and lost prevention opportunities at the population level. Conclusions: Closing these inequitable gaps requires a defined European OM core curriculum, delivered through innovative active learning, authentic clinical exposure, and objective assessment. Improving this curriculum is a public health investment, ensuring every graduate protects working populations, regardless of where they train. Key messages: • Harmonise undergraduate OM across Europe with a defined core curriculum and greater workplace exposure, closing inequitable competency gaps that leave workers inadequately protected. • Replace lecture-heavy OM teaching with active learning and objective assessment to close skill gaps and equip all graduates to protect worker and public health equitably.
SN - 1101-1262
SN - 1464-360X
ER -