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Learn Something – Hazardous Substance Continuing Education

Categories: Agency for Toxic Substances and Disease Registry (ATSDR), Toxic Substances


Arsenic. Lead. Asbestos. Want to learn more about how these and other hazardous substances affect human health? No need to go back to school—you can increase your knowledge in a wide range of these topics easily via ATSDR’s accredited Case Studies in Environmental Medicine (CSEMs).

What Are They?

CSEMs are self-instructional, continuing-education courses written for health care providers. They are available online at no cost to the learner. These courses also can be informative and interesting to those outside of health care. Here’s a key concept about beryllium: “Chronic beryllium disease may be misdiagnosed as sarcoidosis.” Another, about lead: “Blood lead levels once considered safe are now considered hazardous.” Key concepts are listed in each CSEM chapter to aid in learning.

Twenty-four topics are available, including chromium, cadmium, cholinesterase inhibitors, ethylene/propylene glycol, and nitrate/nitrite. CSEMs help those taking the courses to increase their knowledge of hazardous substances and also to evaluate potentially exposed patients. Each includes registration, instructions on how to apply for continuing education credit, a posttest, course overview, and materials.

How Are They Used?

Exposure to arsenic remains a problem. For example, it is sometimes found in drinking water wells. To prepare for treating persons who have been exposed, primary health care providers can use the arsenic CSEM to learn how to take an appropriate exposure history, consider environmental factors in diagnosis, take appropriate public health actions, and provide patient education and counseling. This knowledge enables healthcare personnel to diagnose, treat, counsel, and manage their patients more effectively.

The Karmanos Cancer Institute’s Environmental Cancer Program and Blue Cross-Blue Shield (BC-BS) of Michigan partnered with ATSDR to offer BC-BS physicians an incentive to address exposure risk to asbestos, arsenic, and radon. More than 700 physicians took the asbestos, arsenic, and radon CSEMs and the “Taking an Environmental Health History” CSEM. As a result, preventive environmental health services have been delivered, exposure histories have been taken, and screening and counseling have been provided. Participating physicians reported that they identified and addressed 13 radon exposures, 64 asbestos exposures, and 5 arsenic exposures.

Across the nation, over 15,000 health care providers have completed CSEMs.

High Praise


Dr. Pam Tucker, who led development of the “Principles of Pediatric Environmental Health CSEM,” recently learned that her course is among the top ten e-learning courses across CDC/ATSDR. It will be highlighted as part of CDC’s Primary Care and Public Health Initiative. Dr. Tucker’s CSEM is designed to help pediatricians and others who care for children understand children’s special susceptibilities to toxicant exposure.

More Information

To learn more about CSEMs, visit

Check out Dr. Tucker’s CSEM at .

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