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Competency 2

Competency 2 – Good clinical care: clinical risk management and decision making 
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Objective – to understand and manage the legal and ethical implications of advice on suitability for work

Key Messages
1. return to work is one indicator of a successful outcome to clinical treatment 
2. individuals do not need to be 100% fit to return to work 
3. modified and adjusted work can help people with health problems return to work earlier

Area of competence Knowledge Skills Attitudes
Fitness for work [2] Understand the process of rehabilitation in the context of return to work and the support services available 
Know the basis of the UK sickness certification scheme. Know when and how certificates should be issued. Understand the impact of certification on work
Access evidence based return to work times [4]


Appreciate the benefits of employment on overall health, and the negative effects of worklessness and unsuitable jobs [5]
Risk management Understand that advice and treatment of common conditions may impact on fitness for work
Understand the concepts of hazard and risk and of occupational and environmental risk assessment and management
Discuss the likely outcomes of any medical treatment or intervention on fitness for work [7] Be willing to listen to a patient’s views, aspirations and fears
Understand the differing needs of employer and employee
Decision making Appreciate priorities – clinical, financial, legal and ethical
Be aware of the medico-legal and ethical implications of decision making and accurate recording of data
Take into account function and capability in addition to diagnosis
Analyse and synthesise the interaction between clinical and medico-legal aspects of work and health [10] Be willing to seek advice – and to change own views and to accept a patient can disagree with advice
Recognise the need to take unpalatable or difficult decisions about ‘fitness for work’ issues
Be willing to accept that a diagnostic label does not reflect functional capacity

ROLE PLAY 1 Needle stick injury [12]
ROLE PLAY 2 Pregnancy and laboratory work [13]
ROLE PLAY 3 [14]
[15]CASE STUDY 1  [16]
CASE BASED DISCUSSION 3 Train driver and PTSD [18]
Powerpoint presentations:
An introduction to occupational health – part 1  [19]
[20]An introduction to occupational health – handout [21]
Is your patient fit for work? Stakeholders and standards [22]
HSE, Health and Safety Law and Appointed/Approved Doctors [23]
Effects of ill health on work  [24]
Using an occupational history [25]
History taking, Fitness for Work [26] 
Links between health and work  [27]
Statement of Fitness for Work: the Fit Note  [28]