Sports medicine is a relatively new and rapidly growing specialty for which, in most countries, there is not yet a recognised postgraduate training programme. Postgraduate education in sports medicine varies throughout the world from short term courses, such as the 40 hour team physician course offered by the International Federation on Sports Medicine, to long term specialty programmes, such as the five year higher specialty programme in Finland¹ and the four year course in Turkey.² In some countries, postgraduate courses in this field are offered as a Master of Science and Postgraduate Diploma (MSc/Dip) course (tables 1 and 2). These courses differ in their objectives, learning outcomes, and structures, especially in the United Kingdom.

As our knowledge and experience in sports medicine improves and the needs of professional and recreational athletes, clubs, and institutions involved in sports and society change, the curricula of sports medicine courses need to be developed. Specifying new learning outcomes is often the first phase of curriculum development.³

A learning outcome is defined as “a broad statement of what is achieved and assessed at the end of a course of study”.⁴ The National Committee of Inquiry into Higher Education in the United Kingdom (the Dearing Report, 1997)⁵ recommended that all institutions of higher education write learning outcomes for their courses. This study focused on learning outcomes as the first phase in the curriculum development of an ideal MSc course in sports and exercise medicine.

The specialty of sports medicine will be recognised in the United Kingdom in the near future.⁶ O’Brien and Mahony⁷ have suggested that a unified, well structured, and coordinated MSc course, offered by universities in the United Kingdom and Ireland, should be an integral part of this scheme. Reaching consensus among different universities that offer an MSc in sports medicine regarding the learning outcomes of an ideal MSc course would be a step in the right direction. It is the purpose of this study to report on the results of such a survey.

METHODS

Listed leaning outcomes

A literature search showed no previous work on defining learning outcomes for a sports medicine MSc course on which we could base our questionnaire. Therefore 29 learning outcomes were developed based on the following six basic areas, especially from current MSc courses (table 3).

• The aims, learning outcomes, and objectives of the current MSc/Dip courses in the United Kingdom.

• MSc/Dip in sports medicine and other postgraduate sports medicine courses in other countries.

• The syllabus of the examination for the Diploma in Sport and Exercise Medicine of Great Britain and Ireland run by the intercollegiate academic board of sports and exercise medicine in the University of Edinburgh.⁸ The syllabus of the examination of the diploma in sports medicine of the Society of Apothecaries of London.⁹

• Related data and articles that show policies and directions such as the “Sport and exercise medicine: policy and provision” published by the BMA.¹⁰

• Occupational standards in the field of sports medicine such as the “Team physician consensus statement”,¹¹ which is a statement of different important institutions involved in sports medicine in the United States, and “Doctors’ assistance to sports clubs and sporting events,” published by the board of science and education of the BMA.¹²

• Short term sports medicine courses in the United Kingdom.

Written learning outcomes are broad educational outcomes that cover the main points addressed in the above basic data. The phrase “sports and exercise medicine” instead of “sports medicine” was used because the latter may refer to only professional athletes, whereas the former covers all aspects and levels of physical activities and health. A total of 29 learning outcomes were defined, which included seven key and cognitive skills.

Attitude measurement

Subjects were asked to what extent they agreed that each listed learning outcome should be an outcome of an ideal MSc sports and exercise medicine course. A five point Likert scale was used: 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree. A “don’t know” choice was allowed for lack of knowledge or attitude towards the learning outcome. It was dealt with as missing data in the analysis.

Subjects

The opinion of teachers, experts in the field, and the needs of students can provide basic information for course development and the writing of learning outcomes.^3,13 Among experts in sports medicine, the attitudes of the directors of MSc/Dip sports medicine courses listed in tables 1 and 2 were sought. For the opinions of teachers and students, the teachers, graduates (graduated in 1999–2002), and current students of the course at the University of Nottingham were evaluated.

Email survey

Subjects were sent an email requesting their opinions of the learning outcomes and directing them to an on line questionnaire via a hyperlinked web address embedded in the email. In the case of non-response, an email was sent as a reminder two weeks later. A second reminder was sent by mail one week after the first reminder.

Analysis

The data were treated as ordinal data. Each subject’s total score, the sum of the scale scores of all items, was used to show the degree of agreement with the listed learning outcomes. Both “strongly agree” and “agree” were used as indicators of agreement. As a result, the sum of the percentages of “strongly agree” and “agree” was used to show agreement with each learning outcome and to perform a general ranking of them. Cronbach’s coefficient α was used to evaluate the reliability of our questionnaire and interitem correlation of learning outcomes.

RESULTS

Description of subjects and response rate

Graduates

There were 61 graduates (34 medical doctors, 21 physiotherapists, two osteopaths, two exercise therapists, and two chiropractors) who studied MSc/Dip in sports medicine at the University of Nottingham and graduated from 1999 to 2002. The response rate of graduates was 54%.

Teachers

There were 56 teachers on the course. There were 11 sports medicine specialists, 14 orthopaedic surgeons, nine physiotherapists, and 22 specialists in the other fields such as public health, anatomy, nutrition, physiology and metabolism, radiologist, ophthalmic surgery, rheumatology, and cardiovascular medicine. The response rate of teachers was 79%.

Students

There were 32 students studying the course, 20 doctors and 12 other professionals, mainly physiotherapists. The total response rate was 78%.

Course directors

The response rate of 20 course directors was 75%.

Results

Table 4 shows Cronbach’s coefficient α for different groups of subjects.

There are 29 items (learning outcomes) in the questionnaire, and the scores were given weights as follows: strongly disagree, 1; disagree, 2; neutral, 3; agree, 4; strongly agree, 5. Therefore the maximum possible score was 145, the minimum 29, and the central score 87. Attitudes between “agree” and “strongly agree” scored more than 116. All of the total scores of the subjects, except one teacher, were more than the midpoint of 87, and 93%, 66%, 64%, and 48% of total scores of course directors, teachers, graduates, and students respectively were more than 116.

Learning outcomes are ranked on the basis of the sum of the percentage of the “strongly agree” and “agree” (table 5). Median scores of different groups of subjects for different learning outcomes were 4 and 5, except the learning outcomes 19, which was 3 for all groups, and 20, which was 3 for teachers.

DISCUSSION

Correlations among learning outcomes

The values of Cronbach’s coefficient α for all groups shows good reliability (>0.8), which is based on high interitem correlations.¹⁴ It suggests that the learning outcomes are reasonably consistent and have good interitem correlations. It also shows the good reliability of the questionnaire.

Opinion of the subjects on the whole list of learning outcomes

The total scores of all the subjects, except one teacher, are above the midway point. It shows a positive attitude toward the idea that “the listed learning outcomes should be the learning outcomes of an ideal MSc in sports and exercise medicine”. It indicates that all subjects generally agree with all of the listed learning outcomes and there is a consensus among all groups of subjects.

A total score of 93% of course directors, 66% of teachers, 64% of graduates, and 48% of students of more than 116 shows a strong positive attitude or agreement towards the specified learning outcomes.

Final list of learning outcomes

As shown in table 5, except for learning outcomes 18 and 19, most course directors (>80%) agreed or strongly agreed with each of the other learning outcomes. Most of the other subjects also agreed or strongly agreed with nearly all of the learning outcomes. Subjects had a less positive attitude about the learning outcomes that are at the bottom of table 5. It seems that there is no recommended cut off point that could be used to decrease the number of learning outcomes based on the percentage of agreement (sum of “agree” and “strongly agree”). However, if agreement of two out of three (66.66%) subjects is used as a cut off point, the following learning outcomes have less agreement for different groups of responders:

• course directors: learning outcomes numbers 18 and 19.

• teachers: learning outcomes numbers 18, 19, and 20.

• graduates: learning outcomes numbers 19 and 20.

• students: learning outcomes numbers 11, 19, 20, and 21.

All groups agreed less with learning outcome number 19. With learning outcomes numbers 18 and 20, at least two groups of responders agreed less. Therefore, in this study, learning outcomes numbers 18, 19, and 20 could be omitted from the list. Also the medians of the scores support the assertion that the subjects agreed less with learning outcome number 19.

It seems that, on the basis of the opinion of the course directors, all of the listed learning outcomes, except numbers 18 and 19, should be included in an ideal MSc in sports and exercise medicine. On the basis of the opinion of all subject groups, all of the listed learning outcomes, except number 19 should be included in the course. If one widens the cut off, then it is suggested that learning outcomes 18, 19, and 20 could also be omitted.

It has been suggested that the optimal number of learning outcomes for a course is between 8 and 12,³ and the final list of learning outcomes identified here could be summarised to achieve that number.

Some other data are important in developing the learning outcomes for an ideal MSc course in sports and exercise medicine, such as the needs of athletes and society and the opinion of other experts such as teachers and graduates of other MSc courses, which was not addressed in this study. Also other factors can be important, such as the duration and entrance requirements of the course. The duration of MSc courses in the United Kingdom are one year and in Australia generally more than one year. The courses are restricted to doctors in some universities, commonly in Australia, but are not in others.

Despite this, all the course directors and nearly all of the other subjects are agreed that the listed learning outcomes should be included in an ideal MSc in sports and exercise medicine. We suggest that they could be useful to universities in designing new MSc courses in the future.