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27 CONCLUSION Primary care physicians are inadequately prepared to respond to the growing need for clinical services that address the real and perceived problems of occupational and environmental illness. A recent community-based survey identified physicians as one of the most trusted but least knowledgeable sources of information about chemical risks. 23 This gap between trust and knowledge must be narrowed. Significant changes in medical education are needed at the unclergraduate level as well as in the training of clinicians, teachers, and researchers in occupational and environmental medicine. In specific, the Institute of Meclicine recommencis (i) increasing interest in the fie~cl of occupational and environmental medicine among students and trainees, (ii) establishing a cohort of centers of excellence to train future teachers, researchers, and leaders, (iii) integrating environmental medicine with occupational medicine training and research programs, (iv) increasing funding for faculty development, (v) supporting residency and fellowship

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28 training, and (vi) exploring, refining, and adopting new pathways to certification and accreditation in occupational and environmental medicine. Taken together, these six measures can alleviate the pressing shortage of physicians in occupational and environmental medicine.