TEMT Medicina do Trabalho common mistakes
TEMT Medicina do Trabalho · Understand the traps and how to avoid them.
Answering legislation questions from memory of the NR text instead of checking the current wording, and applying revoked or superseded rules (e.g., treating the old NR-7 quadros or the pre-2019 NR-1 risk inventory language as current).
NRs are amended frequently by portarias; study material and older courses reproduce outdated text, and candidates memorize the version they first learned without tracking updates.
What to do instead
Before the exam, build a one-page update log per NR listing the latest amending portaria and date for NR-1, NR-4, NR-5, NR-6, NR-7, NR-9, NR-15, NR-16, NR-17, NR-32 and NR-33; for any question citing a specific article, reason from the current consolidated text and flag items you cannot date confidently.
Confusing the PCMSO (NR-7) with the PGR (NR-1) and attributing to the physician obligations that belong to the employer, such as elaborating the risk inventory or signing the PGR.
Both documents are described together in study summaries, and candidates blur the roles of coordinator, employer, and physician.
What to do instead
Memorize a role matrix: employer elaborates and implements PGR and PCMSO; physician coordinates and executes PCMSO, performs clinical exams, and issues the ASO; the PGR feeds the PCMSO. When a question asks 'whose obligation', anchor on the verb in the NR and the responsible party named in the article.
Classifying a case as occupational disease or accident without explicitly building the causal chain (hazard exposure, dose, latency, biological plausibility, exclusion of non-occupational causes, temporal relationship).
Candidates jump to the diagnosis that 'sounds occupational' or, conversely, dismiss any condition in a worker as unrelated, skipping the structured nexus reasoning.
What to do instead
Use a fixed five-step template for every nexus question: identify the agent and exposure, verify dose/intensity and duration, check latency compatibility, exclude extra-occupational confounders, and state the conclusion with the applicable legal criterion (nexo técnico, nexo epidemiológico, or nexo por presunção in the listed disease tables).
Issuing or interpreting an ASO without verifying that it contains all mandatory elements (identification, exposure risks, exams performed with dates and results, conclusion with aptitude and restrictions, physician identification and CRM), and treating 'apto' as the only possible conclusion.
Routine practice reduces the ASO to a checkbox, and candidates forget that aptitude conclusions include apto com restrições, inapto, and the specific cases of change of function and return to work.
What to do instead
Memorize the ASO checklist as a fixed list and, for each clinical vignette, actively decide among the four conclusions, justifying restrictions by the functional limitation and the job demands. Practice rewriting a short ASO from a vignette until every element appears.
Answering ethics questions by personal opinion or workplace convenience rather than by the Código de Ética Médica and the relevant CFM resolutions, e.g., disclosing diagnosis to the employer, performing exams without consent, or signing reports outside one's competence.
Ethics is perceived as common sense, and candidates do not recall the specific articles on sigilo, atestado, auditoria médica, and independence of the physician.
What to do instead
Create flashcards pairing each principle with its article number and a concrete prohibited behavior (e.g., revealing diagnosis to the employer without consent, signing a report in an area outside specialty, accepting interference in the medical act). For each ethics question, name the article before choosing the alternative.
Misapplying the NR-15 exposure limits and the NR-16 activity classification, for example treating an insalubridade finding as automatically due to every exposed worker or confusing the qualitative criteria of annexes with quantitative limits.
The annexes are long, the criteria vary by agent (noise, heat, chemicals, biological), and candidates rely on general rules like 'above 85 dB is insalubridade' without checking the annex and the exposure time.
What to do instead
Build a summary table per annex: agent, criterion (quantitative limit or qualitative activity), measurement method, and required exposure condition. For each question, identify the agent, then the annex, then the criterion, and only then the conclusion, noting that NR-15 defines characterization while NR-16 defines the degree and the right to the additional.
Confusing incapacity for the usual work with incapacity for any work, and conflating the INSS benefit types (auxílio-doença, aposentadoria por invalidez, auxílio-acidente) with the occupational nexus categories (acidentário vs previdenciário).
The legal categories overlap in practice, and candidates do not distinguish the medical criterion (incapacity) from the legal criterion (nexus and benefit eligibility).
What to do instead
Draw a decision tree: is there incapacity? is it temporary or permanent? is there nexus with work? then map to the benefit. Practice with short vignettes where the worker is fit for another function, and state explicitly whether the conclusion changes with the nexus.
Missing the compulsory notification of occupational diseases and work-related injuries, or notifying the wrong instrument, e.g., failing to issue a CAT for a suspected occupational disease or omitting the SINAN notification for a confirmed case.
Candidates treat notification as administrative trivia and do not recall that suspected cases, including those without sick leave, also trigger CAT and that the list of notifiable events includes occupational diseases and severe accidents.
What to do instead
Memorize the rule that CAT is due for accident, commuting accident, and occupational disease, including suspected cases and those without leave, and that SINAN notification applies to confirmed and suspected occupational diseases on the national list. For each vignette, ask 'who notifies, with which form, within what deadline' before answering.
Approaching LER/DORT vignettes as pure diagnosis questions, ignoring the work organization and ergonomic analysis that the answer usually requires, and thus choosing clinical treatment alone or attributing the condition solely to individual factors.
Medical training emphasizes diagnosis and treatment, while occupational questions test the multifactorial model and the need for intervention in the work process.
What to do instead
For every musculoskeletal vignette, list the biomechanical and organizational risk factors, the need for an ergonomic analysis (AET) when indicated, the role of rest/rotation and return-to-work planning, and the differential diagnoses. Include the notification and CAT decision in the same answer.
Answering periodic and admission exam questions without considering the risk-based periodicity, the complementary exams required by the agent, and the timing rules (admission exam before starting work, periodic exam within the maximum interval, return-to-work and change-of-function exams).
Candidates memorize a single 'annual exam' rule and forget that periodicity depends on risk and age, and that specific agents require specific complementary tests.
What to do instead
Build a table of agent to required complementary exam to maximum periodicity, plus the special timing rules for admission, return to work, change of function, and dismissal. For each question, first identify the agent, then the required exam, then the interval, then the timing obligation.