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Editor,—The article “Sports medicine training in the United States” was recently brought to our attention. We applaud the journal's interest in improving the public's understanding of this complex area, but we are concerned about a number of serious misstatements on orthopaedic sports medicine training.
Firstly, the author states that orthopaedic sports medicine fellowship programmes are not accredited and do not have curriculum requirements or standards for supervision. It is a point of public record by the Accreditation Council for Graduate Medical Education (ACGME)—the US entity responsible for accrediting fellowships in all specialty endeavours—that there are 53 accredited orthopaedic sports medicine programmes. This compares with 64 accredited primary care sports medicine programmes in emergency medicine, internal medicine, paediatrics and family practice, combined.2
All accredited programmes are required to meet the programme requirements as established by the ACGME residency review committee, which includes educational and personnel standards.3 Moreover, the AOSSM fellowship committee—a committee of the whole for fellowship programmes—has adopted a curriculum to ensure that fellowship education is appropriately thorough and consistent.4
Secondly, the author incorrectly characterises orthopaedic sports medicine training as generally teaching the surgical approach to sports medicine and not stressing the numerous other areas of athletic care. Although surgery is an important facet of orthopaedic sports medicine, it is a significant oversimplification to suggest that it is the only facet of the specialty. In fact, the aforementioned graduate medical education curriculum delineates what trainees should know with respect to basic science (anatomy, biomechanics, and biology of healing), evaluation (history, physical exams, and imaging), and management (operative and non-operative) for virtually every region of the musculoskeletal system. Equally important, the curriculum goes beyond the musculoskeletal system to cover other sports medicine topics, including medical (such as cardiac, dermatology, pulmonology, and infection), nutrition, drug testing, environmental exposure, exercise physiology, athletic populations, paediatric and adolescent issues, preventive sports medicine, trauma, protective equipment, team physician management issues, and more.
Thirdly, the author suggests that the training and practice of the orthopaedic sports medicine specialist is less involved in the team setting. Late in 1999, the society surveyed its membership to better ascertain their involvement in orthopaedic sports medicine.5 Some 91% indicated that they served as a team physician, 8% on the field coverage only, 6% office based consulting only, and 77% both on the field and office based consulting. The types of teams these orthopaedists served is also instructive: 74% served high school teams, 62% served university teams, 46% served community teams, 35% served professional teams, and 18% served Olympic or international teams. In total, sports medicine comprised 57% of their professional activities, divided between clinical care (42%), team service (7%), teaching/consulting (5%), and research (3%).
Finally, we think that the most significant hallmark of sports medicine in the United States is that it incorporates the expertise of many specialists in the care of athletes. Every area of specialisation—primary care and non-primary care—has inherent strengths and limitations which we believe are important to recognise in providing athletes with optimal care. For this reason, AOSSM, the American Academy of Family Physicians, the American Medical Society for Sports Medicine, the American College of Sports Medicine, the American Osteopathic Academy of Sports Medicine, and the American Academy of Osteopathic Sports Medicine developed a consensus definition of a team physician that focuses on qualifications and responsibilities and not just specialty degree.6 Implicit and explicit in this statement is the recognition that sports medicine is not the domain of any one specialty.
We hope that this brief elaboration provides a more complete appreciation of sports medicine training in the United States.