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Certificate in HAVS – Regulations & Guidance

Certificate in HAVS Regulations [1]

Certificate in HAVS Guidance [2]

Certificate in HAVS Syllabus [3]


Certificate in HAVS Regulations


A1. Candidates for the Faculty of Occupational Medicine approved certificate in Hand Arm Vibration Syndrome (HAVS) are required EITHER

(a) to provide full or limited registration with the General Medical Council of the United Kingdom


(b) to provide evidence of full or limited registration with the Nursing and Midwifery Council of the United Kingdom


(c) to possess a medical or nursing qualification acceptable to the Director of Assessment of the Faculty. These candidates must produce their original registration certificates, or diplomas of qualification, and official translation of their diplomas if not in English.

A2. Candidates who do not meet the criteria may still attend the course. They are not eligible to obtain the certificate in Hand Arm Vibration Syndrome but the course provider may at their discretion provide a certificate of attendance. This certificate should not in any way imply competence to assess or diagnose HAVS.

A3. Candidates are required to provide evidence of having completed a Faculty approved HAVS Training Course by the date of the examination.


A4. The question papers are divided into two sections. Candidates who are doctors are required to pass section A on law and pathophysiology and section B on staging, management, testing and examination. Nurses are required to pass section A only.


A5. Candidates who have successfully completed the requirements specified in A4 will be awarded the Certificate in Hand Arm Vibration Syndrome.


A6. Any further advice on the Regulations may be obtained by writing to the Chief Examiner.


Certificate in HAVS Guidance


1. The Faculty of Occupational Medicine of the Royal College of Physicians of London introduced this qualification in 2005 for doctors and nurses who wish to demonstrate a level of proficiency in Hand Arm Vibration Syndrome.

2. Regulations governing the Certificate in Hand Arm Vibration Syndrome 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 intended to provide guidance for candidates and those running courses to prepare candidates for this qualification.


3. This qualification is intended to meet the needs of registered medical and nursing practitioners who wish to demonstrate by a combination of training and examination, a level of knowledge and competence in Hand Arm Vibration Syndrome.

4. The qualification reflects the satisfactory completion of two main elements: training and the examination paper.


5. A number of institutions offer training courses for the Certificate in HAVS covering the core syllabus. The core syllabus guides the training of occupational health professionals (nurses and doctors) in the requirements for health surveillance for a workforce exposed to hand-transmitted vibration and in the diagnoses and management of an individual with HAVS. The syllabus is published by the Faculty and is in Annex A.

6. Certificate courses are approved on behalf of the Faculty by the Director of Assessment to whom applications must be made in writing at least 6 weeks before the course is due to start. Approval is valid for three years only and it is the responsibility of training courses to reapply for approval.

7. Successful completion of a Faculty approved Certificate training course is mandatory. It is required for confirmation of completion of training, that candidates should attend at least 90% of the course, or other confirmation as approved by the Faculty.


8. The purpose of the examination is to test factual knowledge.

9. The question papers are divided into two sections. Section A on law and pathophysiology, consists of approximately 30 questions, and is taken by all candidates. Section B on staging, management, testing and examination, consists of approximately 30 questions, and is taken by doctors. It is optional for nurses. Additional questions may be included for trial purposes and will not be used when calculating scores. Candidates should be aware that these questions may appear anywhere on the paper.

10. Section A and Section B both last for 30 minutes each. At the end of 30 minutes, Section A is collected and those nurses not wishing to sit Section B are invited to leave the examination room. The examination paper for Section B is then distributed. Nurses need to pass Section A only. Doctors need to pass Section A and B.

11. A candidate’s performance in each section will be assessed relative to an external standard set by examiners. Questions are reviewed after each sitting for quality assurance purposes and the pass mark may be adjusted slightly at each examination. The pass mark for the examination is normally around 75%.

12. Doctors will be required to pass Sections A and B at one sitting, there is no provision to roll-over or ‘bank’ passes from one sitting to another.


13. All examination scripts are returned to the Faculty at the end of each examination in order to maintain the integrity of the examination question bank.

14. All Faculty approved course centres contribute questions to the question bank.


15. Candidates are eligible for up to six attempts to obtain a pass in the Certificate of Hand Arm Vibration Syndrome.

16. Candidates must declare to the course centre whether or not they are re- attempting the examination and the Faculty should be informed of this for monitoring purposes.

17. Candidates must re-attempt their examination at a pre-scheduled examination diet, following completion of the course. Candidates are not permitted to make private arrangements with the Faculty approved course centres to re-attempt their examination on an individual basis outside of a scheduled examination.

18. Candidates choosing to re-attempt the examination at a course centre they have not previously attended are required to provide evidence of their previous course completion to the respective course centre. When re-attempting the examination, it is recommended that candidates attend at least the final day of the HAVS course again.


Certificate in HAVS Syllabus

This syllabus is intended to guide the training of occupational health care professionals in the requirements for health surveillance for a workforce exposed to hand-transmitted vibration, and in the diagnosis and management of an individual with HAVS. It is aimed at health professionals working in the UK occupational health setting, rather than in a medicolegal one.


A general understanding of occupational health is required. No specific knowledge of HAVS is assumed or necessary.


To allow for student interaction, this subject best lends itself to small group teaching, using a combination of formal presentations and practical sessions. An appropriately designed distance learning course would also be suitable.


Attendance at all sessions (or completion of all sections for distance learning) is required. Suitable formal assessment, for example by MCQs or short answers, is required. This should include problem-based assessments, such as examining the ability to provide management advice based upon a clinical scenario or for a given Stockholm grading.


Introduction (30 minutes)

Background to HAVS


Overview of Health Surveillance (HSG61)

Indications for health surveillance, when it is likely to be needed, and also when it may not be appropriate

Context of health surveillance, as a part of the overall control measures

Legal (45 minutes)

Relevant legislation and regulations

Overall requirements of the Regulations

Risk assessment

Exposure Action and Limit Values

Risk control

Information and training of workers

Health surveillance; statutory requirements

Workplace vibration exposure (45 minutes)

Exposures and their measurement and reporting

Relevant International/British Standards

Illustrations of different types of tool causing hand transmitted vibration

Ergonomics of tool use

Aetiology (30 minutes)

Exposure-response relationship


Pathophysiology (30 minutes)

Vascular component


Musculoskeletal component

Skeletal system

Evidence of reversibility, progress and prognosis

Health effects of hand-transmitted vibration (60 minutes)

Vascular: secondary Raynaud’s phemomena

Sensorineural including nerve entrapment

Musculoskeletal symptoms

Other conditions

Overall impact of symptoms on functional ability and work/social life

Differential diagnosis (30 minutes)

Prevalence of symptoms in non-exposed population




Classification (45 minutes)

General uses of classification

Consistency; longitudinal follow up; decisions on deployment; clinical audit; research

Stockholm Workshop Scale

The scales in practice

Other approaches

Details of health surveillance programme (45 minutes)

Setting up the programme

Pre employment assessment: evidence of pre existing vulnerability

Screening assessment, including frequency of assessment

Referral methods

Clinical assessment (60 minutes)

Value of information recorded at lower tiers

Approach to the patient

Clinical examination

Standardised tests

How to synthesis the information obtained to reach an overall classification

Management of cases of HAVS (60 minutes)

Advice to employees and employers, including confidentiality issues

Prognosis and reversibility

Measures to reduce ongoing vibration exposure

General advice on reducing the impact of the condition eg keeping warm, avoiding smoking, noise exposure

Accepted guidance on deployment action at Stage 2 and Stage 3

Individual functional assessment, disability and judging fitness for work, including safety issues

Possible application of DDA

Medicolegal and regulatory considerations