The 21 February 2005 proved to be a red letter day for sport and exercise (SEM) medicine in the United Kingdom, as the Department of Health announced that it was approving the application for specialty status submitted in early 2004. This ended a process that began in 1998 with the formation of the Intercollegiate Academic Board of Sport and Exercise Medicine (IABSEM), under the auspices the Academy of Medical Royal Colleges. Progress was slow until early 2003, when the intervention of the Minister of Sport led to an educational forum and the subsequent formation of a working party tasked with developing the application. The working party consisted of medical professionals, representatives of UK Sport, the Department of Culture, Media and Sport, and the Department of Health. The application had to clearly establish that the creation of a new medical specialty was the best and most effective way of answering a service need, or exceptionally a national need. The working party were able to argue for the recognition of SEM on both counts, and furthermore make a case based on the other 11 principles for new specialties as set out in the 2001 Department of Health document, “Developing specialties in medicine”.

The timing was favourable, as the government was increasingly turning its attention to strategies to defuse the public health time bomb posed by spiralling national levels of physical inactivity and obesity.^1–,⁴ This, coupled with London’s bid to host the 2012 Olympic Games, of which the NHS is a key supporter, provided the perfect backdrop highlighting the relevance of SEM to all levels of society. The new specialty was thus founded on a holistic approach to addressing illness and injury in those who exercise, injury prevention, and the safe use of physical activity in the treatment and prevention of illness with encouragement of wellbeing through exercise and physical activity.

The Department of Health accepted the reasoning that SEM practitioners would be ideally placed not only to provide timely and expert treatment of musculoskeletal injuries which were estimated to cost the NHS some £590 million per annum, but also to coordinate a range of initiatives that would promote physical activity as an effective intervention and prevention tool for a wide spectrum of health problems.

This announcement is undoubtedly a huge breakthrough for SEM, making the UK one of several EU countries to accept SEM as a stand alone medical specialty, some with four year programmes of higher specialty training (HST). However, as the dust settles and we get over the initial euphoria, we must now turn our attention to ensuring that SEM effectively delivers better health for our patients and behaves in a manner consistent with other medical specialties.

WHERE NEXT?

The immediate need is to refine our detailed training curriculum, approve training regions, and identify appropriately qualified trainers. The Specialist Training Authority (STA) or Postgraduate Medical Education and Training Board (PMETB), who will assume the role of the STA later this year, is likely to devolve this task to the IABSEM, who may assume the role of a faculty. A number of committees with responsibility for training (Specialty Advisory Committee), examination, appraisal, and revalidation of SEM doctors will be set up, drawing on the knowledge and experience of doctors from both SEM and other disciplines. The tasks undertaken will include defining the criteria for the retrospective award of a Certificate of Specialist Training (CST) and assessing those doctors currently working in the area to determine if they fulfil the criteria for inclusion on the specialist register.

With an agreed national curriculum, trainers, and training regions (postgraduate deaneries and budgets) identified, the process of enrolling trainees into HST can begin. In the first instance, there are likely to be a number of doctors who have a considerable amount of relevant experience without fully meeting the criteria for the award of a CST; there will be a mechanism to have this recognised and these doctors will be able to enter HST at year two or three as appropriate. There will continue to be opportunities for doctors in other medical specialties to develop SEM as a subspecialty interest by undertaking a one year subspecialty training programme.

It is envisaged that a relatively small number of trainees will gain entry to the regionalised HST programmes, and that competition for places will be intense. Trainees will become eligible to apply for HST after foundation training, and at present it is likely that MRCGP, MRCP, MRCPCH or MRCS and a Diploma, or MSc in SEM will be essential entry criteria. The training programme will be of four years duration, flexible, and consistent with the aims of existing training and “modernising medical careers”. At the end of this programme, the future SEM specialist should have the knowledge and competencies to manage a wide range of exercise related conditions, advise on the therapeutic use of exercise, and provide medical support to athletes at all levels of participation. The future SEM specialist will be expected to integrate with community and primary care services to help promote physical activity strategies that will target those most in need and develop seamless care pathways for those with exercise related injury.

THE CHALLENGES

Our strengths lie in our multidisciplinary approach and the “broad church” of our specialty. To date SEM doctors in the UK have largely worked in isolation, and much of our accepted practice has been based on expert opinion rather than rigorous science. We are now faced with the challenge of demonstrating that our specialty can stand comparison with other conventional specialties by clearly showing that we are prepared to methodically examine what we do, and reject what does not stand up to the closest of scrutiny. Accordingly we must embrace the need for properly conducted research and develop an evidence based practice through the conscientious, explicit, and judicious use of current best knowledge. To this end, research will be integral to HST programmes, and trainees will be encouraged to submit their work for peer review and publication. All trainees should aspire to undertake a higher degree, as is the accepted norm in other specialties.

Ultimately we will be judged on our results: has the introduction of SEM led to a healthier population as seen in lower cardiovascular mortality and morbidity, lower rates of obesity and diabetes, less work absenteeism, etc? We wish to see and encourage a Department of Health (not unhealth) and a service of truly National Health. We will need to be given time to demonstrate our worth—Rome wasn’t built in a day and we cannot be expected to transform a nation of couch potatoes into a nation of athletes overnight. Furthermore, it should be appreciated that the problems of unhealthy living, obesity, and lack of physical activity are not solely the problems of SEM but societal issues. It has taken 25 years to produce a significant change in our smoking habits (and there were considerably fewer smokers than inactive people). It will take at least this period of time and appropriate funding if we are to see similar results with respect to activity levels and improved health.