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Establishing a new medical discipline in the United Kingdom must meet a series of criteria laid down by the European Medical Specialist Qualification Order, the General Medical Council, and the Specialist Training Authority (STA). Enthusiastic practitioners of sport and exercise medicine must meet the demands of these bodies before the National Health Service medical education unit will recommend that the secretary of state for health should amend schedule 2 of the Specialist Medical Order.
There is a reluctance in the STA to increase the number of specialties. Any proposal to support the recognition of sport and exercise medicine will need to be soundly based and closely argued, demonstrating that an identified need for the specialty can be met by appropriately trained doctors.
Postgraduate medical training in the United Kingdom is based on doctors spending one year as a preregistration house officer followed by a minimum of two years general professional/basic specialty training giving a breadth of experience before the doctor chooses a higher specialty training programme. These supervised programmes vary from a minimum of one year in general practice to four to six years in hospital based or community medicine specialties. Thereafter, the doctor applies to the STA for recognition that his/her training has been completed. This entitles the doctor to have his/her name added to the specialist medical register with an agreed suffix acknowledging the specialty.
This is the background against which the Intercollegiate Academic Board for Sport and Exercise Medicine was established with the support of the Academy of Medical Royal Colleges in April 1998. The board's first priority has been to develop a diploma examination, building on the experience of the Scottish Royal Colleges, which will set the minimum standards of knowledge and “touch line skills” for doctors practising sport and exercise medicine. This examination is pitched at a similar standard to the membership examinations in medicine and surgery, and acknowledges the completion of basic specialty training. In due course, the examination will be an entry requirement for higher specialty training in sport and exercise medicine.
The first part of the examination consists of a multiple choice question paper (two hours duration), of which about one third of the questions cover the basic sciences, and three short essay questions (one hour). Candidates must pass part I before they enter part II, which consists of a 30 minute oral followed by two 30 minute objective structured clinical examinations designed to assess core and clinical skills.
The board has issued a syllabus and reading list to help the candidates, who come from a wide range of backgrounds, to prepare for the examination. Details of suitable educational courses run by the British Association of Sport and Exercise Medicine and several universities can be obtained from the National Sports Medicine Institute.
The board has clarified the steps that need to be put in place to establish higher specialty training programmes in sport and exercise medicine. Individual specialty advisory committees supervise and accredit training programmes, trainers, and trainees before recommending a successful trainee to the STA. A common feature of all specialties is that trainees can apply for a flexible year to undertake additional relevant training or research. Rehabilitation medicine currently allows trainees to spend a year in sport and exercise medicine. The Intercollegiate Board of Sport and Exercise Medicine hopes to persuade more specialty advisory committees, ranging from orthopaedics and trauma to rheumatology, occupational medicine, or public health to view sport and exercise medicine as a suitable flexible training year.
Developing a four year full time higher specialty training programme in sport and exercise medicine that will meet the requirements of the STA, as outlined above, will require an enormous commitment, looking at European, North American, and Australasian experience as well as coordinating clinical and educational opportunities. The number of centres able to offer a full programme will be limited. The Intercollegiate Academic Board of Sport and Exercise Medicine would welcome approaches from centres who would be prepared to develop suitable programmes for what will initially be a small number of trainees to meet the requirements of Great Britain and Ireland. The momentum to develop one year and four year higher specialty training programmes has recently been accelerated by correspondence between Ms Kate Hoey, MP, Minister for Sport and the Chairman of the Academy of Medical Royal Colleges which accepts that sport and exercise medicine is ready to develop along these lines.
The board is also considering how best to recognise the continuing competence of doctors practising sport and exercise medicine. The procedures to document the appraisal, revalidation, continuing medical educational requirements, and professional development of doctors in Great Britain and Ireland is still in its infancy. The Intercollegiate Academic Board of Sport and Exercise Medicine expects to make a positive contribution to the debate as well as supporting doctors practising sport and exercise medicine as a specialty interest or on a full time basis. The board will be available, as the professional body responsibility for standards in sport and exercise medicine, to advise colleges, postgraduate deans, and regional advisers in general practice on the quality of programmes suitable for continuing medical education credits or postgraduate educational allowances. The board may also act as the body that will record the portfolio of doctors who do not naturally fall under the umbrella of one of the more established colleges or faculties.
In summary, the programme being pursued by the Intercollegiate Academic Board of Sport and Exercise Medicine is designed to:
recognise basic specialty training in sport and exercise medicine;
promote one year flexible training opportunities in a wide range of higher specialty training programmes;
develop a four year higher specialty training programme in sport and exercise medicine;
gain recognition for the new specialty by the STA;
establish a system to recognise the continuing competence of doctors practising sport and exercise medicine.
The Intercollegiate Academic Board of Sport and Exercise Medicine must report its progress and plans for future development to the Academy of Medical Royal Colleges in July 2000. The plans summarised above will be the basis of the submission that will hopefully be approved and give further momentum to the eventual recognition of sport and exercise medicine as a fully fledged specialty in Great Britain and Ireland.