Retrospective analysis of challenging cases for medical examiners of diving.

Introduction: Assessing a diver's fitness to dive enhances diving safety, with medical examiners of diving (MED) being entrusted with this responsibility. However, the effectiveness of MED training in preparing physicians for this task remains underexplored. In the Netherlands, where any physician can pursue MED qualification, challenging cases can be presented to a board of experts. Methods: This retrospective analysis included all cases presented to a board of experts in the period 2013-2023. Aside from baseline information, cases were coded using the International Classification of Diseases 11th Revision (ICD-11). Additionally, the type of advice given by the board was also recorded. Results: A total of 291 cases could be included, 62.5% were male divers with a median age of 47 years old (interquartile range 29-55). Circulatory (20.9%), respiratory (16.2%), neurologic (14.4%), psychiatric (9.6%) and endocrine (6.5%) disease comprised more than two-thirds of all presented cases. Problems for the MED included multimorbidity, knowledge of guidelines and interpretation of diagnostic data. Conclusions: These results could be used to improve MED courses or serve as a topic for continuing medical education for MEDs, however, further research into generalisability is required.