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Since gaining independence from Malaysia in 1965, Singapore has become a financial and cultural hub in South East Asia. Four years after independence, the government decided to develop Sports Medicine, by sponsoring the first Sports Physician to train in the USA.1 The Sports Medicine and Research Centre (SMRC) was established along with the National Stadium in 1973, with a focus on managing national athletes. It also played a part in the ‘Sports for All’ programme, promoting regular exercise and establishing national physical fitness tests. This programme included the National Physical Fitness Award scheme, launched in 1982, for the general public, schools and uniformed personnel, including those of the military.
Over time, sports medicine was expanded to include biomechanics, nutrition, psychology, and strength and conditioning. Subsequently, it was formalised as a medical specialty in 2007, similar to the UK model, with the first specialist rotation established at Changi General Hospital.2 ,3
How does sports medicine differ from orthopaedics and primary care?
Musculoskeletal/exercise medicine education is often lacking in the undergraduate curriculum and junior doctors report a lack of confidence in managing conditions.4–6 Sports medicine traditionally brought together primary care physicians interested in musculoskeletal/exercise medicine and Orthopaedic surgeons interested in sport-related injuries. Since evolving into an independent medical specialty with a training programme, research and educational objectives, sports medicine in Singapore has produced clinicians who work alongside orthopaedics, rheumatology, rehabilitation and allied health colleagues.
In doing so, sports physicians in Singapore provide a specialist review of musculoskeletal and physical activity-related conditions, while also performing therapeutic interventions such as ultrasound-guided procedures and focused shockwave treatments. It benefits both primary care and orthopaedics by directing patients into a relevant secondary care clinic.
Why has sports medicine been successful in Singapore?
Within the region, Singapore is an affluent country with high expectations from its population. Sport forms an integral part of Singaporean life, with the 2011 National Physical Activity Survey reporting that 42% of Singaporeans regularly took part in sports activities; indeed, the ‘Run Society’ lists weekly running events and the Standard Chartered Marathon attracted 65 000 participants in 2011.7 ,8 In addition, with continued national service and regular reservist duties, there is an onus on Singaporeans to maintain physical fitness.
Given the population is currently 5.5 million, with a high percentage being actively involved in physical activity, sporting injuries are common. Where sports medicine has been particularly successful is its placement within the secondary care setting, managing common acute and chronic non-surgical musculoskeletal conditions. Indeed, situated between orthopaedics and rheumatology, sports medicine fills the gap that can be overlooked by healthcare and supports workflow distribution. Most public hospitals have a sports medicine specialist outpatient clinic as part of orthopaedics, and those without their own specialists either invite those from other institutions or are in the process of establishing this service.
With this secondary care presence, sports medicine has evolved from its early days focusing on elite athletes and research, to being available to the population at large. Two notable cohorts are the military and recreational athletes, who can access specialist assessments via primary care or emergency department referrals. By providing this pathway, it expedites treatment, enables non-surgical avenues to be explored and correctly identifies individuals requiring orthopaedic intervention so that they are referred after relevant investigations have been conducted.
Being in secondary care also fulfils an important exercise element. Obesity remains a significant risk in Singapore, but sports medicine is well placed to provide guidance to patients, educate external organisations and support the Exercise is Medicine Singapore programme.
There also remains a central role in team medicine and preparticipation screening of elite athletes. Indeed, with the SMRC evolving into the Singapore Sports Institute, based at the Sports Hub, the service continues to provide treatment to national athletes and is supported by hospital-based clinics through a national network; this also enables physicians in public hospitals to maintain links with a variety of sports.
What can other countries learn?
In many countries, sports medicine remains as an intermediate level specialty between primary and secondary care or, where present in the hospital or clinic setting, it is largely as a private entity. Where Singapore has been particularly successful is in the integration of sports medicine into public hospitals. In doing so, it has exposed the specialty to the population, so that they understand our role and we have become a primary destination to manage their conditions.
Equally, by working more closely with other specialists, the value that sports medicine brings to secondary care can be witnessed first-hand and there can be regular in-service education to inform others and develop innovative management pathways.
For those within sports medicine, we must continue to look forward, challenge preconceptions, and seek better ways of engaging colleagues and patients to secure our position as a specialty of value in Singapore.
Twitter Follow Dinesh Sirisena at @sport_med_doc
Collaborators Dr Chin Sim Teoh.
Contributors DS is the primary author and contributed significantly towards writing the article. SL, TKC and TCS contributed towards writing the article and editing it.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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