tional physicians. Occup Environ Med 2003; 60: 1–2.25. Cashman C, Slovak A. The occupational medicine

agenda: routes and standards of specialization in occu-pational medicine in Europe. Occup Med 2005; 55:308–311.

26. Kolb S, Reichert J, Hege I, et al. European dissemina-tion of a web- and case-based learning system for occu-pational medicine: NetWoRM Europe. Int ArchivOccup Environ Health 2007; 80: 553–557.

27. Braekman L, Fieuw A, Bogaert H Van. A web- and case-based learning program for postgraduate students inoccupational medicine. Int J Occup Environ Health2008; 14: 51–56.

28. Burgess G, Holt A, Agius R. Preference of distancelearning methods among post-graduate occupationalphysicians and hygienists. Occup Med 2005; 55:312–318.

29. All about workplace-based assessments. In: Specialtytraining in occupational medicine: Questions andAnswers. London: Faculty of Occupational Medicine,Royal College of Physicians, www.facoccmed.ac.uk/library/docs/t_qa1_wba.pdf.

30. ASSESSMENT BLUEPRINT MATRIX MAPPEDAGAINST COMPETENCY RECOMMENDATIONS. Lon-don: Faculty of Occupational Medicine, Royal College ofPhysicians,http://www.pmetb.org.uk/fileadmin/user/QA/Curricula/ASSOCIATED_ASSESSMENT_SYSTEM/Occupational_Med/Assessment_Blueprint_Matrix_Faculty_of_Occupational_Medicine_response_from_the_College_25_Sep_07.pdf.

31. Norcini J. Work based assessment. ABC of learningand teaching in medicine. BMJ 2003; 326: 753–755.

32. Carr S. Assessing clinical competency in medical sen-ior house officers: how and why should we do it?Postgrad Med J 2004; 80: 63–66.

33. ATOM Assessment tool for occupational medicine.Healthy Working Lives Group, University of Glasgow,www.hwlresearchgroup.org/display.asp?pid=22.

34. Baker B, Katyal S, Greaves I, et al. OccupationalMedicine Residency Graduate Survey: Assessment oftraining programmes and core competencies. J OccupEnviron Med 2007; 49: 1325–1338.

35. Downie R. Professions and professionalism. J PhilosEduc 1990;24:2.

36. Roberts T. Is professionalism changing? In: ASME con-ference, 2005, http://www.asme.org.uk/conf_courses/2005/docs_pix/04_28_roberts.pdf.

37. International code of ethics for occupational healthprofessionals.www.icohweb.org/core_docs/code_ethics_eng.pdf.

38. Philipp R, Goodman G, Harling K, Beattie B. Study ofbusiness ethics in occupational medicine. Occup Med1997; 54: 351–356.

39. Leung W-C. Competency based medical training:review. BMJ 2002; 325: 693–696.

40. Zook A. Military competency-based human capitalmanagement: a step toward the future. CarlisleBarracks, PA: U.S. Army War College, 2006.

ABOUT THE AUTHOR

John Harrison is a consultant in occupational medicine

and clinical director for organizational health and wellbe-

ing in Imperial College Healthcare NHS Trust, in London.

He was Senior Lecturer in occupational medicine at the

University of Newcastle upon Tyne and was appointed

Professor (Associate) in Clinical Organizational Develop-

ment at the Business School of Brunel University in

November 2005. He was Academic Dean of the Faculty of

Occupational Medicine (1999–2007) and led the develop-

ment of a new national training curriculum for occupa-

tional medicine. He is immediate past-chairman of

EASOM (European Association of Schools of Occupational

Medicine). He is the UK national secretary and a board

member of the International Commission for Occupa-

tional Health (ICOH).

CORRESPONDENCE ADDRESS

Prof. John Harrison, Imperial College Healthcare NHS

Trust / Brunel University, Du Cane Road, London W12

0HS, United Kingdom.

Email: John.Harrison@imperial.nhs.uk.

444 TBV 16 / no. 10 / December 2008

Cognitive impairment in patients with anxiety, depression

and bipolar disorder

Patients with anxiety, depression, and bipolardisorder are known to be impaired relative tohealthy controls on neurocognitive tests, but thedegree of impairment may be obscured if thedata are analyzed in terms of group means.Patients and controls were administered a com-prehensive neurocognitive assessment thatmeasured performance in memory, psychomotorspeed, reaction time, attention, and cognitiveflexibility. There were small differences between patientsand controls, but comparisons of results in termsof the frequency with which patients and con-trols fell below certain cutoff scores amplified

the importance of these differences. Only 4% of controls fell below a standard scoreof 70 (two standard deviations below the mean)on two or more cognitive domains, but 19% ofanxiety patients, 21% of depressed patients, and30% of bipolar patients fell below the standardscore. Substantial numbers of patients with anxiety,depression, and bipolar disorder are cognitivelyimpaired. A score that is two standard deviationsbelow the mean is usually clinically important,and two domain scores in that range is cause forserious concern. Source: The Journal of Clinical Psychiatry, July 2008

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