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In the academic game, a higher degree is the qualifying standard, and every paper is a personal best
  1. Domhnall Macauley
  1. Editor, British Journal of Sports Medicine

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    University departments of sports medicine are no longer a dream. Their expansion brings changes to the way sports medicine is perceived, thrusts new leaders into the spotlight, and changes the relationship between sports medicine, medical royal colleges, and sports organisations. Academic interest in sport and exercise medicine is being driven by many factors. Sport attracts money, a commodity that universities lack, and they see financial opportunity in the increasingly commercial world of academia. Sport attracts publicity and universities are waking up to the marketing potential of high level sport. Sport attracts students and, in this new commercial world of education, student numbers have a major impact on income. Increasing demand and a clear role for academic sports medicine mean that the discipline is ripe for expansion.

    Universities are aware of this growing potential and every year we see increasing integration of sport and exercise medicine into undergraduate and postgraduate curricula. With increasing teaching commitment, the demand for sports medicine education will soon exceed the expertise available. At present it is often taught by an enthusiast within one of the traditional clinical specialties—such as, cardiology, orthopaedics, or rheumatology. Gradually the tension between their core duties and the additional demands of teaching sport and exercise medicine will become excessive, and we will then see the creation of new posts which are specially designed to develop sport and exercise medicine. We will need a new type of leader with particular skills and expertise for this role.

    Academia is often portrayed as a rather archaic club with its own peculiar rules and regulations. But, if sports medicine is to survive in this environment, our new leaders must be able play by these rules and work in the same currency as other members of this club. Clinical skills are of considerable importance but academic credibility is gained only through the achievement of higher degrees and academic publication. As clinicians, we know that good clinical care is much more important than any published paper but this does not necessarily carry weight in the academic environment. To negotiate for resources, apply for funding, and gain curriculum time, sport and exercise medicine must be able to compete as an equal. We have some way to go.

    There are established criteria in appointing senior academics to university posts and these are the standards to which future leaders should aspire. A chair would normally have a higher degree, a track record in quality research, and evidence of leadership skills. A senior lecturer would usually have a higher degree but applicants would, at the very least, have experience in research and evidence of publications. In sports medicine, few measure up to these criteria. We have a small number of doctors working full time as sports medicine physicians yet these pioneers, who have contributed greatly to the profession, would not be rated in the academic world. Few sports medicine physicians possess a higher degree and many have no quality peer reviewed publications. These pioneers are unlikely to be among the new leadership.

    But there are people associated with sport and exercise medicine who do meet academic criteria. Many orthopaedic surgeons have a higher degree. Indeed, before specialist training it would have been very difficult to progress without a higher degree, research experience, and publications. Others, including rheumatologists, physicians, general practitioners, and public health physicians may have higher degrees and research publications, although they may not work exclusively in the field of sport and exercise medicine. Sports science has evolved much more quickly as an academic discipline and our sports science colleagues are more likely to possess higher degrees, publications, and experience of working in an academic department. We could learn a lot from them.

    Universities have a choice. They could choose appoint a leading clinician who has worked hard for the specialty, taught on courses, contributed to committees, and who is recognised for high quality medical care. However, it is more likely that they will opt for someone who has achieved academic excellence. Universities have to make difficult decisions when establishing academic departments. We all know of the importance of research assessment and that funding follows academic excellence. It is a harsh competitive environment. Established sports medicine physicians might have an opportunity to move into some of the first wave of academic posts, but future generations will have to tread the traditional paths to academic excellence. Those who aspire to an academic career should begin to prepare themselves to compete in this environment.

    We have a choice. Future leaders in our discipline will plan their career to have the correct blend of general professional experience, higher specialist training, and academic achievement. A higher research degree—for example, an MD or PhD, will be essential, as will quality publications. Those who set off on their sports medicine career in the recent past may find this vision of the future radical, challenging, and very different from that which they imagined. But, as we read this we may already be one of yesterday's men or women. There will soon be a new generation of young lions snapping at our heels.

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