Article Text
PDF
Statistics from Altmetric.com
A 21st century workforce
The increasing demand for physical activity for health has stimulated a growth of sport and exercise medicine (SEM), which is not reflected in undergraduate medical training.1 Currently programmes fail to provide health professionals with the skills to promote sleep, nutrition and active living, which will restrict clinicians’ ability to address key causes of non-communicable diseases and limit the transition to preventative healthcare.2
This global training issue is reported in North America, Europe, Oceania and the Middle East.3 4 Medical students in the USA are only required to take 8 hours of physical activity education, and in the UK, the total SEM teaching averages 4.5 hours over 5 years. Two-thirds of SEM fellows in the USA had not received instruction on exercise prescription, and a study of graduating doctors in the UK found only half felt comfortable giving physical activity advice.4 5 There has been little change since these findings were published, and there remains an urgent need for improvement.5
Undervaluing musculoskeletal medicine?
One-third of people experience musculoskeletal (MSk) complaints, which are a major cause of ill health and disability. They account for 30% of primary care and a large proportion of emergency department attendances, and 20% of sickness-related absence from work.1 Despite this health and economic burden, undergraduate MSk education is under threat. MSk teaching accounts for only 2% of curricula in the USA—the majority is theoretical rather than practical—and there is a similar pattern in the UK, where a significant minority of students experience no MSk module and only 21% were competent in MSk examination skills.6 7
The North American deficit has been attributed to an absence of standardisation across curricula, as well as a lack of mandatory MSk clerkships and poor integration with clinical specialties including orthopaedics, rheumatology and physical therapy.4 The erosion of MSk components in the UK can be attributed to managed recruitment in which a move away from specialty-based education is being adopted in the hope of addressing a workforce shortage in primary care and internal medicine.
Physical inactivity is driving the increasing problems of multimorbidity, obesity and frailty affecting people in community and hospital settings. It is more important than ever for doctors to promote physical activity, which is a cornerstone of the WHO goals for health promotion and disease prevention. Furthermore, considering the burden of MSk complaints in the community, it might be prudent to embed these components into the primary care modules of undergraduate and postgraduate training.
Increasing access to SEM
The inclusion of SEM principles—promoting health, prescribing activity, managing multimorbidity and guiding rehabilitation from illness and injury—into undergraduate training could be achieved via several approaches, but all are contingent on addressing the misconception that SEM is focused principally on high-performance sports rather than being relevant to the whole population.
SEM is unlikely to be introduced into curricula as a stand-alone component. Rather its principles could be incorporated as longitudinal themes within allied specialties including orthopaedics, emergency medicine, primary care and aspects of internal medicine focused on managing and preventing multimorbidity. Currently SEM is most frequently accessed through optional components on some undergraduate programmes, affording exposure to clinical and research-based SEM principles. There needs to be greater equity in the availability of these opportunities, and more work is required to promote the uptake by students and universities.
Peer-led education has a significant role in facilitating on-demand and self-directed learning, and SEM organisations have a responsibility to increase access to high-quality resources. We also advocate for SEM teaching to be multidisciplinary, to learn from nutrition, sleep, physiology, mental health and physical preparation experts, and to foster constructive interdisciplinary working that will serve a holistic approach to patient care.
Country-specific initiatives such as the UK-based Moving Medicine, and Italy’s preparticipation screening scheme, provide a framework to deliver safe activity-based healthcare, but a comprehensive internationally recognised education programme is yet to be established.8 Standardisation of SEM education could support the WHO global action plan on physical activity, which calls for more SEM clinicians, although care must be taken to ensure that any global curricula is adaptable to both high and low resource healthcare systems. Consensus has been sought by the International Syllabus in SEM Group, which developed a syllabus using Delphi methodology.9 The European Union of Medical Specialists expanded its multidisciplinary approach to joint committee governance and training requirements, and a group of international experts consolidated existing curricula into freely available Exercise Medicine and Physical Activity Promotion modules that can be integrated into undergraduate syllabuses without the need to develop material de novo (https://canvas.instructure.com/enroll/CY9TPG).10
Conclusion
The evolution of a preventative model of healthcare is a universal goal for modern medicine, but successful delivery must be underpinned by clinicians’ ability to promote positive health behaviours, manage multimorbidity and encourage healthy active living. Many services are well equipped to respond to illness; this is necessary, but not sufficient. Tomorrow’s health professionals need to be trained to prevent common causes of ill health including inactivity, obesity and degenerative MSk conditions, and to work constructively with allied specialties to reduce the burden of non-communicable disease.
Ethics statements
Patient consent for publication
Footnotes
Twitter @KatGreenslade, @docandrewmurray, @andrewhallortho
Contributors All contributors satisfy the ICMJE criteria for authorship. KG: conceptualisation, data acquisition and analysis, draft writing, final approval. JN: draft writing, final approval. AM: conceptualisation, draft writing, final approval. RM-R: draft writing, final approval. AJH: conceptualisation, draft writing, final approval, supervision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.