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The article "Sports Medicine Training in the United States" (Br. J. Sports Med. 2000; 34: 410-412) was recently referred to our attention. We applaud the Journal's interest in improving the public's understanding of this complex area, but we are distressed over a number of serious misstatements related to orthopaedic sports medicine training.
First, the author states that orthopaedic sports medicine f...
First, the author states that orthopaedic sports medicine fellowship programs 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 endeavors - that there are 53 accredited orthopaedic sports medicine programs. This compares to 64 accredited primary care sports medicine programs in Emergency Medicine, Internal Medicine, Pediatrics and Family Practice, combined.
All accredited programs are required to meet the program requirements as established by the ACGME Residency Review Committee, which includes educational and personnel standards. Moreover, the AOSSM Fellowship Committee - a committee of the whole for Fellowship Programs -- has adopted a curriculum to ensure fellowship education is appropriately thorough and consistent.
Second, the author incorrectly characterizes orthopaedic sports medicine training as generally teaching the surgical approach to sports medicine and not stressing the numerous other areas of athletic care. While surgery is an important facet of orthopaedic sports medicine, it is a significant oversimplification to suggest that surgery 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, pediatric and adolescent issues, preventive sports medicine, trauma, protective equipment, team physician management issues and more.
Third, 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. 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 also is instructive: 74% served high school teams, 62% served university teams, 46% served community teams, 35% served professional teams and 18% serve 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 specialization - primary care and non-primary care -- has inherent strengths and limitations that we believe is important to recognize 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. 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 for sports medicine training in the United States.
Walton W. Curl, MD
(1) www.acgme.org , Accreditation Council for Graduate Medical Education, Chicago, IL, 2001
(2) Graduate Medical Education Directory, 1999-2000, American Medical Association, Chicago, IL, 1999, Pages 176-179
(3) Noyes, Frank R. and Farmer, James A., Orthopaedic Sports Medicine Fellowship Curriculum and Structure, American Orthopaedic Society for Sports Medicine, Rosemont, IL, Revised June 2000
(4) 1999 Sports Medicine Survey Final Report, American Orthopaedic Society for Sports Medicine, Rosemont, IL, March 2000, Pages 11-15
(5) Team Physician Consensus Statement, Spring 2000, American Academy of Family Physicians, Leawood, KS; American Academy of Orthopaedic Surgeons, Rosemont, IL; American College of Sports Medicine, Indianapolis, IN; American Medical Society for Sports Medicine, Overland Park, KS; American Orthopaedic Society for Sports Medicine, Rosemont, IL; American Osteopathic Academy of Sports Medicine, Middleton, WI. (Available at www.sportsmed.org under Sports Medicine Update, Spring 2000)