THE AUSTRALASIAN FACULTY OF

OCCUPATIONAL AND
ENVIRONMENTAL MEDICINE

STAGE B – WRITTEN EXAMINATION

Sample Questions and Marking Guide

Paper 2

Royal Australasian College of Physicians © 2015, 2021

AFOEM STAGE B WRITTEN – SAMPLE PAPER 2

Sample Questions
Question 1 (20 marks)
This question is made up of multiple parts that must be answered. Ensure that
you provide responses to Parts A, B, C, D and E.

Scenario
You provide occupational and environmental health management advice to
companies with short- and long-term overseas contracts. A film crew of 20 is
preparing for a 13-week expedition to a Himalayan republic to make a documentary
on rebuilding efforts in the capital city and nearby mountain villages that were badly
hit by a succession of earthquakes several months previously. Few roads are
passable so most travel will be on foot. There is rudimentary sanitation and an erratic
water supply, local health services are virtually non-existent and access to field
hospitals run by foreign aid workers may be difficult.

The filming will occur in the dry season (November−February) at altitudes of

1350 metres in the capital to 2400 metres in the villages, with a temperature range of
-2 °C to 23 °C.

It is 5 weeks prior to the film crew’s departure. The crew’s director has approached
you seeking robust occupational and environmental health management advice for
his team.

Part A

Using the hazard classification system (1 mark), list six significant hazards the crew
are likely to encounter during the expedition (3 marks).

(4 marks)

Part B
What are four (4) preventive health measures that you should undertake before the
deployment to minimise the likelihood of problems arising?

(4 marks)

Part C

What are four (4) organisational measures that you should you put in place to
minimise the impact of any health problems that might occur?

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 1

Scenario (continued)
The crew’s director tells you that one of the cameramen had filmed the Sydney
hostage crisis 10 months previously, and for a time afterwards experienced PTSD-
type symptoms, for which he had medication and counselling. His skills are highly
regarded, the director is very keen to take him and the crew member is enthusiastic
about going.

Part D

What are four (4) issues you should take into account in determining whether or not
this person should be deployed?

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 2

Scenario (continued)
Although the villages of interest are considered too low for altitude sickness to be a
problem, you have been asked to brief the team about this condition. This is because
some people do not tolerate altitude well or there may be a need to go higher.

Part E

Outline your advice in terms of general precautions, symptoms and signs, and
management guidelines for altitude sickness.

(a) What are two (2) general precautions for altitude sickness? (1 mark)

(b) What are three (3) symptoms and signs you would expect with altitude sickness?
(1.5 marks)

(c) What are three (3) management guidelines for altitude sickness? (1.5 marks)

(4 marks)

– END OF QUESTION 1 –

AFOEM – STAGE B – SAMPLE PAPER 2 3

Question 2 (20 marks)
This question is made up of multiple parts that must be answered. Ensure that
you provide responses to Parts A, B, C, D and E.

Scenario
You are a full-time occupational physician (OP) in private practice, providing services
to a number of large clients including Blue Telco, a telecommunications company.
Wei has been referred to you to assess whether he suffered a work-related injury
and his current fitness to work.

Wei Lung is a 30-year-old, full-time telecommunications technician who has been

with his current employer for two years. He ceased work on the advice of his general
practitioner for 2 months after an incident, and has been referred to you to address
his fitness to work.

Wei emigrated from China with his family 6 years ago. He has worked as a
telecommunications technician for 5 years. He is currently working in rural
Queensland. He normally works within buildings, laying cables on each floor through
ceilings and office spaces. This involves moderately heavy manual handling with
awkward postures and climbing of ladders.

Wei and a colleague were involved in work that was unusual for them, laying cable
on the roof of a building on a hot humid day, and in proximity to radiofrequency (RF)
microwave telecommunications antennae. Wei and his colleague were not
RF-trained, and no information was given to them by the building owner as to the
power output of these antennae.

The workers both spent 2 days working approximately 1.5 metres below the
antennae on the first day, and 20 metres or so below the antennae on the second
day.

By the end of the second day, Wei developed new tension-type global headaches
with a floating feeling, with loss of concentration. He has no nausea or vertigo. Wei
has never had similar headaches or any psychiatric history of note.

You examine him and find him alert, well orientated and groomed, with normal
speech. Sitting and standing blood pressure were 130/70 mmHg and pulse
80 beats per min and regular. He scored a perfect 30/30 on the Standardised
Mini-Mental State examination with normal neurological examination and CT scan
of the brain. Wei is very concerned about his exposure to microwave radiation.

AFOEM – STAGE B – SAMPLE PAPER 2 4

Part A

Describe the precautionary principle as it applies to assessing environmental safety

(1 mark).

Identify three considerations in applying the precautionary principle to an

environmental health risk assessment (3 marks)

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 5

Scenario (continued)
You consider that RF radiation and heat are potential exposures in this situation.

Part B

Outline four (4) factors you consider relevant to assessing the health risk of RF
radiation exposure in this situation.

(4 marks)

Part C

Identify four environmental factors and four potential health effects that would form
part of your risk assessment for heat exposure in Mr Lung’s role.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 6

Scenario (continued)
You are asked by Blue Telco’s insurer to perform a worksite visit and prepare
a report.

Part D

Identify four key aspects you will consider in your report.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 7

Scenario (continued)
Blue Telco asks you to develop a health and safety program to reduce the risk of any
of their workers getting heat-related illnesses.

Part E

Describe four (4) key aspects of a health and safety program and give an example of
how you would implement each of them in this case.

(4 marks)

– END OF QUESTION 2 –

AFOEM – STAGE B – SAMPLE PAPER 2 8

Question 3 (20 marks)
This question is made up of multiple parts that must be answered. Ensure that
you provide responses to Parts A, B, C, D and E.

Scenario
You receive a call from the manager of a semiconductor research laboratory. The
laboratory employs one researcher and two laboratory assistants. One of the
assistants reported to the manager that he was concerned about being exposed to
heavy metals due to inadequate clean-up procedures.

The assistant operates a vacuum chamber where a mixture of fine mercury, gallium,
cadmium and arsenic powder is deposited on a substrate. The materials are
manipulated through portals in the chamber. During maintenance, the assistants
dismantle the chamber and hand scrub the contaminated parts. The laboratory floor
is vacuumed with a standard vacuum cleaner. Due to lack of space, the lunch
common room is adjacent to the open laboratory.

The laboratory has been in operation for 6 months and is currently closed pending
further investigation.

Part A

(a) What are the potential routes of absorption of heavy metals? (1 mark)

(b) Considering the routes of exposure for the above scenario, please list and
explain when/where the exposures are likely to occur. (3 marks)

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 9

Scenario (continued)
The laboratory assistant organises his own urinary tests through his general
practitioner, with the following results:

Mercury Not detected

Arsenic Within normal range
Gallium 3 times above the normal range
Cadmium Not detected

From your research, you discover very little is known of gallium toxicity. There is one
case report of muscle spasms and a suggestion of genotoxicity in animal studies.
The laboratory assistant is very anxious about the potential impact on his health,
particularly cancer risk. You see him at your clinic.

Part B

What are four (4) points relevant to medical history and four (4) points relevant to
occupational history that you will need to obtain from the laboratory assistant?

(4 marks)

Part C
Taking into consideration the laboratory assistant’s anxiety, describe four matters
that you would discuss with him?

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 10

Scenario (continued)
The laboratory manager wants to re-open the laboratory and seeks your advice on
limiting the risk.

Part D

Identify eight components or aspects you would consider in establishing a health

surveillance program.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 11

Scenario (continued)
You review the other laboratory assistant, who is 60 years of age, and who produces
the following test result from his general practitioner:

Creatinine 123 µmol/L

eGFR 55 mL/min

Part E

(a) What are two (2) common occupational and two (2) non-occupational causes of
chronic renal impairment that you should you consider in this case? (2 marks)

(b) What are four (4) further investigations that you should consider undertaking to
determine the cause of his impaired renal function? (2 marks)

(4 marks)

– END OF QUESTION 3 –

AFOEM – STAGE B – SAMPLE PAPER 2 12

Question 4 (20 marks)
This question is made up of multiple parts that must be answered. Ensure that
you provide responses to Parts A, B, C, D and E.

Scenario
You are an occupational physician in private practice and consult to a number of
industries. You are approached by the human resources (HR) manager for a local
call centre. The HR manager is concerned about the high levels of sickness absence
among employees at the call centre over the last year and asks for your help in
addressing the problem.

He tells you that the call centre has 250 employees and that the work activity is
sedentary office-based work. He describes that over the last 2 years there have been
a number of changes, including restructuring of the teams and a new IT system, with
performance measurement/management systems (including KPIs) built into the
system. He reports that there is a planned review of staffing levels and that staff are
aware that there will most likely be redundancies.

The HR manager has noted that the team leaders, who manage return to work as
they see fit, have become increasingly frustrated by the high absences, which affect
their performance measures.

The union has suggested that the new IT system is the main factor contributing to
the sickness absence.

You start by identifying what further information you need.

Part A

(a) What are four (4) factors that might be contributing to the sickness absence since
the introduction of the new IT system? (2 marks)

(b) List four (4) other potential important organisational or workplace factors that
might contribute to the sickness absence in this call centre. (2 marks)

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 13

Scenario (continued)
The HR manager tells you that he would like to initiate a wellness program to help
address the sickness absence issue at the call centre. He tells you that, in the past,
voluntary blood pressure checks were conducted by a nurse during Heart Week, but
no other wellness initiatives have occurred in recent times. He advises you that the
manager is reluctant to spend unjustified money.

Part B

(a) List four (4) potential benefits to the organisation from a wellness program.
(1 mark)

(b) Describe three (3) factors that contribute to a successful long-term wellness
program explaining why each factor is important. (3 marks)

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 14

Scenario (continued)
You consult to a construction company that has a proud history of low accident and
lost time injury rates. With a recent boom in construction, the company has grown
rapidly from 200 to 300 employees and has recruited a number of casuals. The
health and safety manager approaches you with a concern about an increase in
minor accidents over the last 6 months. From her visits to the company’s sites, she
has identified that the ‘safety culture’ is not strong at two of the sites. On her visits,
she observed that some workers appeared not to be wearing PPE and that the
worksite was messy.

She outlines to you a number of pressures on the company, and that one of these is
the time pressure associated with keeping to schedule.

Part C

List four (4) factors from the scenario that might contribute to the increase in
accidents at the two construction sites.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 15

Scenario (continued)
The health and safety manager was impressed with your advice and returns with a
request to help her develop a drug and alcohol policy. During her recent investigation
into the increase in accidents, she has been told by some of the workers that there
may be an issue with drug use in the workplace. She has discussed it with
management, which has identified that the first step is to develop a robust drug and
alcohol policy.

Part D

(a) List the types of legislation that need to be considered when developing a drug
and alcohol policy. (1 mark)

(b) What are six (6) important aspects you should cover in the development of a
relevant drug and alcohol policy for this construction company? (3 marks)

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 16

Scenario (continued)
The drug and alcohol policy is accepted, procedures are developed and a program of
testing (pre-employment, post-incident and random) is implemented. There is a
campaign to promote the importance of a drug and alcohol-free workplace, and the
offer of specialised rehabilitation support for addiction and abuse of drugs and
alcohol for those that want support is provided.

The company has adopted a continuous quality improvement cycle (Plan –

Implement – Review – Improve) in keeping with the company’s demand for quality.
The management team requests a ‘quality assurance’ process for the drug and
alcohol policy, and seek your advice on what measures can be monitored to ensure
that the program is effective; that is, delivering a drug and alcohol-free workplace.

Part E

Identify four (4) important measures that can be monitored to assess the
effectiveness of delivering a drug and alcohol-free workplace.

Explain why each measure is important.

(4 marks)

– END OF QUESTION 4 –

AFOEM – STAGE B – SAMPLE PAPER 2 17

Question 5 (20 marks)
This question is made up of multiple parts that must be answered. Ensure that
you provide responses to Parts A, B, C, D and E.

Scenario
In your private occupational medicine practice, one of your clients is the regional
ambulance service. It employs ambulance officers and paramedics who are involved
in first response healthcare services. The work tasks of both ambulance officers and
paramedics include driving ambulances and other vehicles for which they are
required to have an unrestricted private vehicle licence in Australia and New
Zealand.

The company asks you to assess and provide an independent medical assessment
report on Peter Williams, one of its station managers (a trained paramedic), who had
a single, unprovoked generalised tonic–clonic seizure 6 weeks ago. There is no
known cause, and all investigations to date have been within normal limits, including
MRI and EEG. The company would like your opinion on Peter’s fitness to return to
full work tasks, as he is keen to return to employment immediately. He usually drives
a command vehicle, which provides back-up to the ambulance crew or acts as a first
response.

Part A

What are four (4) important considerations with regards to assessing Peter’s fitness
for return to work, with this condition and in this role?

Your answer for each consideration should include a brief comment on why you
consider it to be important.

(4 marks)

Part B

Define:
(a) legislation and regulations (2 marks)
(b) medical standards (1 mark)
(c) guidelines (1 mark)
as each are used to assess fitness to return to a safety critical task such as driving.

You should relate your answers to (a), (b) and (c) to the medico-legal framework in
your jurisdiction.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 18

Scenario (continued)
Six months later, the station manager, Peter, has a further seizure. His treating
neurologist diagnoses epilepsy and commences Peter on sodium valproate (Epilim).
The neurologist reports that the risk of further seizures associated with this diagnosis
means that Peter is restricted from driving in any capacity for at least 12 months.

The company now request an assessment to provide an opinion about Peter’s

fitness for work in an alternative role that does not include driving.

Part C

Consider the relevant factors in this case in the following framework:

(a) individual
(b) medico-legal
(c) work task
(d) workplace
Four each of the four components of this framework, identify two pieces of
information you would obtain during your assessment, to assist with forming your
opinion on his fitness for work.

(4 marks)

AFOEM – STAGE B – SAMPLE PAPER 2 19

Scenario (continued)
Peter works in the control room in an alternative role for a year after his second
seizure. He has no seizures during that period, remains on sodium valproate
(Epilim), and has had his private driving licence reinstated via his usual general
practitioner. As per the terms of his employment, Peter is only required to have a
private driving licence to perform the driving aspects of his usual role.

His manager asks you whether, in your opinion, there should be changes to the
ambulance standards so that all personnel in driving roles would be assessed
against the commercial driving standards. This would mean all employees with a
diagnosis of epilepsy would be restricted from driving. The relevant union groups are
unhappy about the potential for changes as other medical conditions which would be
considered using such an approach may exclude staff that are already employed.
The manager asks you to prepare some notes on major points for him to take to a
meeting with the union.

Part D

(a) Outline two (2) justifications for changing the medical standard for driving roles in
the ambulance service. Provide a short justification for your reason under each
heading. (2 marks)

(b) What are two further organisational considerations in the introduction of a

change in policy such as this? (2 marks)

(4 marks)

Part E

Occupational medicine specialists are often requested to undertake independent

medical examinations.

(a) What are two (2) features of an independent medical examination?

(1 mark)

(b) As a physician, what are four (4) of your roles and responsibilities to the patient
in this type of assessment? (2 marks)

(c) As a medical provider, what are two (2) resources available to provide
information on the proper conduct of an independent medical examination,
should you require this? (1 mark)

(4 marks)

– END OF QUESTION 5 –

– END OF PAPER 2 –

AFOEM – STAGE B – SAMPLE PAPER 2 20

Marking Guide
Question 1 (20 marks)

Marking guide for Part A

• Use the hazard classification system

Hazards:

Physical
• Unstable terrain
• Falling objects
• Slips, trips and falls
• Aftershocks
• Cold
• Heat
• Altitude

Chemical
• Water pollutants
• Air pollutants

Biological
• Disease from poor sanitation (cholera, typhoid, dysentery, etc.)
• Infections (e.g. hepatitis, malaria, tuberculosis, encephalitis, STDs)
• Vermin

Psychological
• Mental stress from observing poverty, illness, devastation
• Fatigue/stress from long hours, isolation, personal circumstances, group
dynamics

AFOEM – STAGE B – SAMPLE PAPER 2 21

Marking guide for Part B
• Perform thorough medical and including psychiatric examination of all
personnel including immunisation status and travel history, pregnancy
status of females
• Exclusion of those with significant cardiorespiratory disease,
musculoskeletal problems, substance abuse disorders, conditions
potentially needing hospital care, the immunosuppressed, etc.
• If cleared to deploy, specify restrictions (if any) on types of
activities/exposures
• Ensure medical documentation and written self-management plan carried
• Identify any medication requirements and ensure enough are taken
• Identify diseases that may be prevalent in the area of operation and
determine appropriate medication
• Ensure appropriate vaccinations (Hep A/B, typhoid, rabies, meningococcal
meningitis, Japanese encephalitis, cholera, polio)
• Provide routine (e.g. loperamide, antibiotics, antimalarials, analgesics,
sunscreen, insect repellent) and emergency (e.g. morphine, adrenaline)
drugs, and medical supplies (needles, dressings, etc.), water purification
tablets
• Identify a means of re-supply
• Any other reasonable response

Marking guide for Part C

Organisational measures (4 required):
• Defined leadership roles and responsibilities
• Policies/procedures for dealing with illness and injury
• Prepare contingency plan for emergency medical evacuation and
repatriation
• Pre-deployment briefing re hazards, disease and accident prevention, etc.
• Means of effective communication (including to friends/family)
• Review of local medical and hospital facilities and services
• Mechanism for payment of any medical care required
• Adequate health insurance cover
• Policies/procedures for victims of violence, theft, kidnap, etc.
• Post-deployment medical examination and debriefing
• Or other reasonable response

AFOEM – STAGE B – SAMPLE PAPER 2 22

 Marking guide for Part D
Issues (4 required):
• The psychological and physiological demands are likely to be high
• Social and other support mechanisms are likely to be poor
• The feasibility of having a specific team member act as mentor/support
person
• The feasibility of taking a supply of anxiolytic medication, and of re-supply
• The lack of medical/psychiatric facilities locally for urgent and follow-up
care
• The access to medical evacuation
• The practicability of utilising a medical adviser at home
• The risks associated with PTSD relapse and lack of prompt
recognition/treatment
• Last clinical assessment and treating psychiatrist’s opinion as to current
mental status
• Or other reasonable response

AFOEM – STAGE B – SAMPLE PAPER 2 23

 Marking guide for Part E

(a) General precautions (2 required):

• Avoid flying in and climbing straight away
• Acclimatise slowly by gradual rate of ascent (including rest days, one for
every 900 metres)
• Avoid overexertion, use porters to reduce load carrying, etc.
• Hydrate well, check by urine volume
• Encourage early reporting of symptoms (peer pressure not to divulge)
(b) Symptoms/signs (3 required):
• Headache
• Nausea, possible vomiting
• Loss of appetite
• Mild shortness of breath with minimal exertion,
or at rest
• Difficulty sleeping
• Dizziness/light-headedness
• Mild weakness
• Swelling of the face and hands
• Resting pulse above 110/min
• Difficulty keeping up
• Impaired coordination (tandem walking, etc.)
• Impaired judgement/antisocial behaviour
(c) Management (3 required):
• Do not go higher with headache symptoms
• Acetazolamide (unlikely to be carrying oxygen)
• Minimise physical exertion
• Descend to below where symptoms first occurred, ascend again once
acclimatised
Or other reasonable response.

– END OF QUESTION 1 –

AFOEM – STAGE B – SAMPLE PAPER 2 24

Question 2 (20 marks)

Marking guide for Part A

Description – precautionary principle suggests that if there are threats of serious

or irreversible environmental harm or damage, then the lack of full scientific
certainty about whether the harm will occur, should not be used as a reasoning to
avoid or postpone the implementation of controls or other measures to prevent
the potential environmental harm.

Considerations:
Shifting of burden of proof is from demonstrating the presence of risk to
demonstrating the absence of risk - responsibility of a proponent to demonstrate
safety rather than the responsibility of a public authority to show harm.

Taking preventive action in the face of uncertainty.

Exploring a wide range of alternatives to possibly harmful actions.

Increasing public participation in decision-making.

AFOEM – STAGE B – SAMPLE PAPER 2 25

 Marking guide for Part B
Health risk assessment should consider

Potential health effects from the hazard (hazard assessment):

• RF EMR – thermal biological effects (tissue heating) with possible tissue
dysfunction or damage (esp testes, eyes) or mild heat illness symptoms.
• Non thermal effects such as unclear links with carcinogenesis (2B IARC for
some intracranial tumours)
• Psychologial effects – anxiety from working with hazard
Assessment of potential exposure:
• Source of exposures is the microwave (< 300 GHz) antennae – how close
were workers, were workers in line of exposure
• Data from company/building owner about power/other characteristics of the
antennae
• Was other workers affected/do they have symptoms/concerns

Assessment of any controls/protection measures:

• Was it turned on at the time
• Is the source (the antenna) compliance with RF standards

Other reasonable response will be considered.

Candidate does not need to set answer out in same form/with same subheadings.

AFOEM – STAGE B – SAMPLE PAPER 2 26

 Marking guide for Part C
Environmental conditions (4 required):
• Temperature
• Humidity
• Air movement
• Radiant heat (infrared EMR)
• Shade
Possible health effects (4 required):
• Heat:
o skin irritation/prickly heat
o heat exhaustion
o heat syncope
o heat stroke
o cataract (not here but in furnace occupations)
o aggravation of cardiovascular disease (not here) – related to length of
time of exposure and effectiveness of barriers
• Do both workers have symptoms?
• Mental injury anxiety directly related to working
with hazard

AFOEM – STAGE B – SAMPLE PAPER 2 27

 Marking guide for Part D
• Permission
• PPE
• Safety
• Personnel report: addressee, contents, etc.
Documentation:
• Antennae sources
• Service history
• Output
• Manufacturer’s guidelines
• RF training and SOP
• Industry standards
• Worksafe regulations
Work environment:
• Antennae location and shielding
• Distances
• Actual RF measurements
Job tasks:
• Location of work performed
• Work schedule
• Rest breaks and overtime
• (Other exposures − manual handling/heat exposures/heights)

Other reasonable answers will be considered.

Candidate does not need to set answer out in same form/with same subheadings.

AFOEM – STAGE B – SAMPLE PAPER 2 28

 Marking guide for Part E
Education:
• Hot outdoor work, main issues are individual risk (susceptibility) and
providing heat respite (shade, rest), hydration (+salts), and self/other
recognition of
heat-related illness, and response to symptoms
• Education/information/induction available for all workers/supervisors
• Work-rest periods
• Hydration protocols (urine colour, volume, etc.)
• Hydration available on site
Monitoring:
• Temperature monitoring and alert (daily weather, etc.)
• Appropriate clothing
• Pre-employment screening (exclusion of high-risk workers)
• Self-buddy monitoring ‘in the field’
• Response to symptoms – stop work, cool down, what to drink, first aid, etc.
Response to incidents:
• Incident and near-miss reporting (so that risk can be further reduced in
future)
• Investigation of events
• Incorporation of ‘heat illness’ into key H&S messages
• Emergency response protocol
Implementation:
• Education/information is accessible (e.g. pictures, translation)
• Individual information given to all workers on induction
• Reminders/urine colour charts in all toilets and other areas
• Reminders/fluid volume protocol in all areas
• Video or training sessions

Other reasonable answers will be considered.

– END OF QUESTION 2 –

AFOEM – STAGE B – SAMPLE PAPER 2 29

Question 3 (20 marks)

Marking guide for Part A

(a) Inhalation, ingestion, dermal exposure

1 mark for identifying all three routes

(b) (i) Inhalation:
• During dismantling of the chamber and
• During use of a vacuum cleaner
(ii) Ingestion:
• Contamination of the adjacent lunch room
• Inadequate hand washing
• During smoking
(iii) Dermal:
• During hand scrubbing of parts especially if PPE not used
• Open wounds
• In the presence of skin disorders

One mark for at least one potential exposure pathway for each exposure route.

Other reasonable options not listed here may be awarded marks.

AFOEM – STAGE B – SAMPLE PAPER 2 30

 Marking guide for Part B
General medical history (4 points required):
• Current symptoms specific to symptoms relating to substances in the
question (mercury, arsenic, gallium, cadmium)
• Current health status
• Past medical history
• Medications
• Social history, including smoking and alcohol, hobbies
• Family history, including children, pregnancies

Occupational history (4 points required):

• How long in current job
• Description of current job, including duties and hours
• Where, when and to what he believes he may have been exposed
• Past occupational history including previous exposures
• Use of PPE
• Previous health surveillance and results

Other reasonable options not listed here may be awarded marks.

Marking guide for Part C

Advice (4 points required):
• Explore further why he is so anxious about cancer and what he has read.
• Reassure him that his concerns are being taken seriously by management
and yourself.
• Indicate that although you cannot entirely exclude an adverse health effect,
this is highly unlikely based on the current medical evidence.
• Discuss the lack of medical evidence for an association with cancer.
• Advise him that his results will be stored for future reference in the event of
further research.
• Offer him follow-up testing.
• Advise him that an investigation is underway and measures will be put in
place to minimise and monitor the risk of further exposure.

Other reasonable options not listed here may be awarded marks.

AFOEM – STAGE B – SAMPLE PAPER 2 31

 Marking guide for Part D
Health surveillance program proposal (8 points required):
• Purpose of health surveillance − ensure controls effective and reinforce
safe work practices
• What health surveillance will be undertaken? This will be determined by
a walk through survey and results of hygiene monitoring. Also, whether
there is a recognised valid and reliable form of health surveillance for a
particular exposure.
• Decide on which tests and laboratory will be used
• Associated costs
• Legislative requirements/notification of abnormal results
• Practical considerations − who to screen, when, how will be
implemented
• Storage of results
• Confidentiality
• Feedback of results to individual workers and de-identified results to
employer unless informed consent from worker
• Follow-up of abnormal results
• Action to be taken in case of abnormal results
• Education of workforce, enlisting safety representative’s assistance
(may be regarded with suspicion)
Other reasonable options not listed here may be awarded marks.

AFOEM – STAGE B – SAMPLE PAPER 2 32

 Marking guide for Part E
(a) Common/occupational/non-occupational causes of chronic renal
impairment (2 required from each):
Common causes
• Hypertension
• Diabetes
• Polycystic disease
• heart failure, cirrhosis (reduced blood flow to kidneys)
• Intrinsic glomerular/interstitial/tubular diseases
• Obstruction from prostatic disease/metastatic cancer

Occupational causes
• Heavy metals e.g. lead, cadmium, mercury
• Carbon disulfide
• Organic solvents e.g. choloroform, carbon tetrachloride, ethylene
glycol
• Silica
Other reasonable responses will be considered.
(b) Further investigations(4 required):
• Full renal function test including UEC
• Other bloods − FBC, ESR/CRP, iron studies, Ca, phosphate, lipids, serum
electrophoresis
• MSU − blood/protein
• Quantify proteinuria − urine ACR/PCR
• Renal ultrasound +/- biopsy
• Blood sugar
• Renal doppler (renal hypertension)
Other reasonable responses will be considered.

– END OF QUESTION 3 –

AFOEM – STAGE B – SAMPLE PAPER 2 33

Question 4 (20 marks)

Marking guide for Part A

(a) IT system contribution to sickness absence (4 factors required):
• Lack of consultation
• Lack of training
• Complicated or difficult system to learn or use
• Reluctance of members to change
• Physical aspects of the system (e.g. amount of keying/mouse use or size of
font, navigating through different fields, doubling of actions)
• Reliability of system (e.g. glitches or freezing) possibly causing frustration
• KPIs may be unrealistic, or may result in perception of distrust, or in anxiety
• There may be changes to IT policy restricting computer use for private
purpose
(b) Other potential organisational/workplace and other factors (not necessarily
from description) (4 required):
Organisational
Change/uncertainty/stressors/consistency of treatment for individuals, clear
policy and procedures, data monitoring

Workplace
Sick day culture, availability of alternative or modified duties, tasks − do they
allow a return to work if not fully fit?

Temperature/air quality, desk, support for safe working methods – i.e. micro
pauses/stretches
Other reasonable responses will be considered.

AFOEM – STAGE B – SAMPLE PAPER 2 34

 Marking guide for Part B
(a) Potential benefits (4 required):
• Enhanced recruitment and retention of healthy employees
• Reduced healthcare costs
• Decreased rates of illness and injuries
• Reduced employee absenteeism
• Improved employee relations and morale
• Increased productivity
(b) Contributing factors (3 required):
• Maintain confidentiality
• Multilevel leadership – CEO/middle managers/wellness campaign
manager/workplace champion
• Alignment – planning and patience – carrots, not sticks – compliment
business priorities
• Scope relevance quality – individualised/fun/high standards
• Accessibility – on-site integration/online access
• Partnerships
• Communications
• Organisational policies and management support aligned with program goals
• Effective resourcing, communication and marketing
of programs
• Involving workers in design and implementation
of programs
• Tailoring programs to employee needs and attain high participation rates
• Ensuring programs evaluated and results reported back to participants
• Control potential liability e.g. screening failure or exercise-related injuries, etc.

Marking guide for Part C

Factors (4 required):
• Rapid growth of company
• Casuals
• Lack of strong safety culture at the sites
• Failure to follow safety practices – PPE
• Housekeeping
• Time pressure
Other reasonable responses will be considered.

AFOEM – STAGE B – SAMPLE PAPER 2 35

 Marking guide for Part D
(a) Types of legislation
• WHS/HSE legislation
• Privacy legislation
• Anti-discrimination legislation
• must identify these above three to get one mark

(b) Important steps (6 required):

• Gather information − accidents and absenteeism, low productivity or the
use of alcohol as part of the workplace ‘scene’
• Raise awareness of the issues − posters or pamphlets, information
session for staff
• Ask for interested persons to be involved in helping develop a policy for
drugs and alcohol
• Draft a written policy that:
- contains a clear statement commitment to a drug and alcohol-free
workplace – this is necessary for it to be an effective policy
- contains a clear statement of the behaviour expected of employees
and apply equally to all personnel
- forms part of an overall health and safety program.
• Address issues in the work environment that increase the use of drugs
and alcohol
• Provide an atmosphere of support for problems, and be as non-punitive
as possible
• Circulate the draft policy to all employees for comment – finalise the
policy and set a date for its introduction
• Inform all employees of the policy
• Include details of the policy in orientation for new staff
• Set a date for review of the policy – e.g. 12 months after
implementation date
• Engage stakeholders’ consultation – union, client’s legal advisor
• Determine whether it’s purely pre-employment or random as well, or
post incident – fair system of identifying random employees
• Scope: Applies only to safety critical workers? Or everyone including
executives?
• Identify who is responsible and steps taken to interpret results
• Outline clear plan if an individual tests positive
• Integration into other systems in workplace, e.g. ISO. Consider any
existing policies or procedures within the company, or if multinational,
whether such policies exist elsewhere/headquarters.
Other reasonable responses will be considered.

AFOEM – STAGE B – SAMPLE PAPER 2 36

 Marking guide for Part E
Measures that could be monitored (4 required):
• Accident/incident rates – why – based on the assumption that D&A use
affects safety, the ultimate measure is accident/incident rates. Multiple
contributors to this rate – indirect measure.
• Proportion of positive test results – post-incident and random – need ratio or
proportion, not just pure number. Need comparative rate i.e. increasing,
decreasing. Why − measures extent of problem, whether improving or not.
• Testing rates − how often they test – is this frequent enough? – have a
benchmark.
• EAP utilisation – why – indicates that employees are seeking help.
• Pre-employment testing – positive rate trend indicative of whether the
company has well-established reputation for not accepting those with D&A
issues
• Absence rate
Other valid measures that a candidate adequately justifies.

– END OF QUESTION 4 –

AFOEM – STAGE B – SAMPLE PAPER 2 37

Question 5 (20 marks)

Marking guide for Part A

Nature of condition − why?
• Significant condition, incapacitating
• Exclude underlying cause (nil found in info, but consider other possibilities,
e.g. AOD-related, other comorbid medical conditions)
• Evidence-based risk of recurrence of seizures following initial unprovoked
• Consequences of a seizure while driving or operating in an emergency care
role, such as physical risk to self and others
• Single seizure, no current diagnosis of epilepsy

Legislative requirements related to driving − why?

• Relevant driving medical standards and obligations of medical practitioners
applicable for the state/country that is operated in with regards to stand-
down periods from driving post seizure and threshold for return to driving
• Who can clear him to return driving (if specified)?

Nature of his usual role − why?

• What does it involve (driving, what kind – solo or with others, working alone,
etc.)?
• Important to fully understand full usual role requirements in order to be able
to appropriately advise on fitness

Relevant medical standards (if any) for the workplace OR if none, workers
in other ambulance services, OR comparable first response roles e.g.
firefighters if no specific organisational standards exist − why?
• Need to understand this standard for your assessment and whether it is met
• May need to liaise with company medical personnel if they exist
• Also consider any professional requirements for the employee
(professional body)

What is the alternative work available, if any − why?

• To attempt to maintain the employee at work in suitable role while increased
risk exists as beneficial medically, socially, financially and professionally.

Do you have relevant consent to obtain complete information − why?

• Important as incomplete information may lead to an inappropriate, unsafe or
unjustifiable assessment outcome.

AFOEM – STAGE B – SAMPLE PAPER 2 38

 Marking guide for Part B
(a) Regulations/legislation – government-produced law. Often under umbrella
of Act, e.g. Work Health and Safety Act. Criminal and other offences can occur
if legislation not followed. Legislation is passed by a parliament and regulations
are a detailed set of legal requirements to support legislation.
(b) Medical standards − policy and protocols. Usually determined by an
industry-based group or employer in a specific industry in consultation with
experts and interest groups. Can be more detailed interpretation of legislation or
employment-specific and developed by experts. Possible employment-related
consequences if standards not met, e.g. Austroads driving standards.
(c) Guidelines − recommendations for ‘best practice’ or meeting Health and
Safety requirements. Not enforceable, unless called up by legislation and then
lawful. Collection of expertise and often input from industry groups, e.g. medical
aspects of fitness to drive in NZ, guidance for medical practitioners.

AFOEM – STAGE B – SAMPLE PAPER 2 39

 Marking guide for Part C
(a) Individual
• Epilepsy control
• Comorbid factors medically, including any cognitive concerns secondary
to seizures or medication
• Willingness of the employee to return to alternative role
• Transferable skills of the employee for an alternative role
(b) Medico-legal
• Whether any medical standards exist or relevant legislation for work in
other areas of the workplace (i.e. potential alternative roles) that need to be
considered
• Whether there are liability issues for the employer to consider
• Whether the employee’s treating medical practitioner is supportive of return
to work and will provide certification
(c) Work tasks
• Is the work alone or with others?
• What would be the consequences for another seizure in an alternative role
– i.e. is it work with machinery or at heights, etc.?
• Is shift work involved?
• Is adequate training available for an alternative role?
• Are there potential triggers for seizure in the work environment (e.g.
strobe lighting)?
• Are cognitive tasks of the role suitable?
(d) Workplace
• Are there concerns from other employees about a return to work of
this individual?
• Are there any current employment issues/distress among other staff?
• What are the policies on redeployment?
Or other reasonable response for any of the above factors.

AFOEM – STAGE B – SAMPLE PAPER 2 40

 Marking guide for Part D
(a)
• Public safety − passenger carrying driving activity requires speed and
accuracy when driving in emergency situations, often under stress, at night, in
traffic etc. Other public carrying vehicles (e.g. taxi) have higher driving
standards. Consequences of accident are high.
• Driver/employee safety − some medical conditions may be made worse by
stress of driving and should be more carefully assessed against a higher
standard. (Need a better argument, or really the same as line above!)
• Other reasonable response
(b) Considerations:
• Negotiate/communication with employees, unions, other stakeholders
• Will new standards be introduced for all employees or only new entrants
• What will be process for current employees who do not meet medical
standard – what are redeployment options.
• Are there legal risks for company if current employee’s employment is
terminated because of new medical standards.
• Is there potential for a large number of current staff to not meet standard
and be either temporarily or permanently unable to continue driving – how
will this impact service delivery
• Other reasonable response.

There is a likely range of answers, so if they are appropriate under each heading,
then the mark will be achieved as per the marking guide comments.

AFOEM – STAGE B – SAMPLE PAPER 2 41

 Marking guide for Part E
(a) Features of an IME (2 required):
• An IME is not a treating doctor assessment but an independent
assessment, usually a ‘one off’ but may include review if required
• Consideration of all relevant prior facts of the case and assessment of
clinical information presented at the time of the assessment by the patient
(history and clinical examination), presented as a report outlining consent,
sources of information, relevant facts of history and observations.
• Should be an expert opinion which is as objective as possible and not
having consideration of a doctor-patient relationship, advocacy or the
desire (actual or perceived) of the referring party.
• Should be undertaken by an expert in the area being assessed
• Other reasonable response
(b) Responsibilities to patient (4 required):
• Conduct assessment with respect and dignity
• Advise upfront the independent nature of the IME and that no treatment
advice will be given
• Explain context of referral and information sighted
• Explain to whom the report will be addressed and the nature of what it will
contain (e.g. answers to questions patient may have asked)
• Provide information on your specialty and expertise
• Obtain consent to continue with the assessment on the basis of the above
• Conduct assessment as per professional standards/with proper care
• Other reasonable response
(c) External agencies (2 required):
• Practising body:
- New Zealand – NZMC
- Australia – AMA/AHPRA
• Medical indemnity provider
• Senior/experienced colleague who works in medicolegal field
• Other responses may include some referring bodies (Worker’s
compensation insurers or regulators, ACC in NZ, legal professionals)
• Other reasonable response

– END OF QUESTION 5 –

– END OF PAPER 2 –

AFOEM – STAGE B – SAMPLE PAPER 2 42