Like any physician, the maritime physician must have a strong knowledge base acquired during his medical studies. He must also, through additional training, acquire a good understanding of the maritime environment and the skills essential to practising medicine in isolation.
Several countries have developed and implemented training courses dedicated to maritime physicians. These range from simple degree diplomas to full programmes of specialist medical training. All training courses should provide physician trainees with the same knowledge base and skills regardless of the country and be validated through adequate assessment methods. The knowledge base and skills that are necessary for maritime physicians can be defined, based on common reference sources that are globally accepted by maritime professionals in collaboration with experienced teachers in the domain. These basic competencies (knowledge and skills) could usefully first be established at the international level and then be adapted to fit countries’ specific legislation and mode of operation for medical assistance at sea.
In Europe, the first attempts to harmonize teaching courses were made at the workshops in Barcelona and Brest under the guidance of the International Maritime Health Association. It became obvious at these workshops that maritime medical training ought to be developed at three levels: the international level, the European level, and, of course the national level. The first objective of maritime professionals’ training is for physicians to become familiar with the maritime environment (oceanography, climatology), ships, living and working conditions on board, as well as international rules and regulations. It is especially important for physicians to know about seafarers’ international rights, international sanitary regulations, and the roles of flag states at sea and port states when the ship is docked (see chapter 6). Maritime physicians must also be knowledgeable about the specifics of the risks that may arise on board a ship: noise, vibrations, electromagnetic fields, radars, and toxic substances (see relevant chapters). They also need to understand ergonomic constraints and be able to assess occupational safety on board.
Aside from these fundamentals, the training must address specific health problems that a maritime physician is likely to encounter during his practice: acute intoxications, sickness associated with travel (hypothermia, heat stroke, drowning, tropical infections and seafarers psychopathologies), risks in port (such as preparing seafarers for going into a port and the health problems encountered in ports), and finally, forms of ill health that may affect sailors after returning home.
The teaching curriculum in France also includes a special course on maritime emergencies: emergency plans, water sporting casualties, on-shore accidents, and diving accidents. Our goal is to address all situations that a maritime physician is likely to encounter in their practice and for trainees to acquire the skills that are expected from them by their employers as well as the skills needed to assist professionals or non-professional seafarers.
Experience is a recommended criterion for any doctor who performs seafarer medical examinations
….should have knowledge of the living and working conditions on board ships and the job demands on seafarers in so far as they relate to the effects of health problems on fitness for work, gained wherever possible through special instruction and through knowledge based on personal experience of seafaring; (ILO/IMO/JMS/2011/8 Guidelines on the Medical Examination of Seafarers)
Opportunities for a physician to acquire competence in the field of general occupational medicine and occupational maritime medicine are now available in all seafaring nations. However, to achieve full awareness of the living and working conditions that prevail on board a ship is more problematic.
No course is available to the aspiring maritime physician to obtain this kind of knowledge, and relevant employment on ships is hard to get. The national military service (draft) used to offer some opportunity to learn about the details of medicine on board, particularly in the navy. However, in most countries this possibility is now restricted to the active or reserve military physicians.
On board experience is essential because no textbook can compensate for lack of hands-on activity on board. No textbook can fully explain the physical environment of a ship at sea, and particularly not the situations created by an accident or any medical incident. However, knowledge of the different duties on board from visits to ships in harbour may be a useful approach. .
Only large ships (500 or more gross tons) carrying 15 or more seafarers and engaged in a voyage of more than three days' duration) are equipped with an infirmary or accommodation dedicated to medical care. On smaller vessels there is no space apart from the dispensary, and if a medical condition occurs, the primary concern will be to locate where treatment can take place. This will often have to be on a berth in a tiny cabin with limited access and poor lighting. To perform the necessary medical procedures, the physician may have to ask the master to temporarily modify speed and course to provide better working conditions.
The conditions described above vary with regard to which trade the vessel is engaged in (fishing, merchant or naval), and to the sailing zones (temperate, tropical or polar). An on board physician must obviously be familiar with these conditions, as must the practitioner who is responsible for the fitness examination. This kind of knowledge is also essential for the physicians providing medical training to the seafarers who are in charge of medical care on board (according to the STCW 95), for the physicians in TMAS centres providing medical advice to ships, as well as for the physicians who provide port health care for disembarked seafarers who are ill or injured. In France, an introduction to occupational medicine and training in maritime medical skills are provided by the governmental health service and by the physicians at the maritime consultations centre (Toulouse based CMM).
Beside medical care, the 2006 ILO convention also identifies the importance of preventive medicine, through programs for the promotion of health and for health education, and by establishing international co-operation in these fields. The role of the human element as a major factor in prevention is also emphasized. Preventative actions need to be based on close observation of workers in their working environment. This is another argument for the physician engaged in preventive medicine to experience employment on ships and thus be a part of the working environment.
There are many arguments to support the demand for a significant maritime experience that can be best obtained by taking employment as physician on a ship. This pertains to all physicians interested in maritime medicine: to the maritime physicians performing fitness examination, to practitioners of occupational medicine, to physicians giving medical advice to ships and to those providing port health care.
Telemedicine has become an important part of maritime medicine. The transmission of ECG recordings, digital pictures and videos offer great help in the diagnoses of diseases and in the care and follow-up of patients. The maritime physician must be familiar with the continuing development of telemedicine and be able to take advantage of it.
Finally, a minimum of fluency in the English language is a necessity to be able to communicate with crews of different nationalities. English is also the official language used by radio stations, search and rescue centres and port services.