The coming of age of sports medicine

Growing demand must be matched by specialist accreditation and recognition

Recent proposals are set to change the way sports medicine is perceived and practised in Britain. Sports medicine is not new but has been practised away from mainstream medicine as a hobby or in the domains of private practice and physiotherapy. There has been no formal accreditation or recognition of the specialty and little or no provision for sports medicine within the NHS. Its Cinderella status in Britain reflects the struggles of an emerging discipline within the confines of the traditional medical paradigm. But this position is not universal. Other countries have successfully produced models of education and practice of sports medicine to suit their own healthcare systems.

The term sports medicine is emotive as it has connotations of care limited to the sporting elite. This is wrong. More accurately described as sport and exercise medicine, the specialty covers the entire spectrum of human performance and reflects the total medical care of people who exercise.1 The continuum of care ranges from high level athletes seeking to optimise their performance to people exercising to aid recovery after physical and psychological illness or injury. These populations typically receive uncoordinated, inconsistent, and regionally variable care, providing a strong case for making primary care a cornerstone of this emerging specialty. This argument is strengthened by the numerically largest group of exercisers–the population at large exercising for health.

There are many reasons why the development of sports medicine has failed to progress in Britain. Specifically, there has been no single respected voice to coordinate education, research, service provision, and accreditation. Britain is now behind North America, Australasia, the Far East, and much of Europe, where accreditation systems have emerged with specialist recognition. In the United States, four boards of primary care specialties (emergency medicine, family medicine, internal medicine, and paediatrics) offer a certificate of added qualification in sports medicine on the basis of a written examination.

Canada, with its Royal medical college, has a medical system more analogous to Britain's. The Canadian Academy of Sports Medicine has taken on the role of academic development through its journal and the development of a diploma examination. However, despite an organised and expanding educational fellowship system for sports medicine, the academy has yet to receive specialist recognition from the Royal College of Physicians and Surgeons of Canada.1

In Australia specialist recognition is on its way after the establishment of the Australian College of Sports Physicians in 1985. The college's primary aims are establishing curricula and setting standards through examination and supervision of training programmes. Their fellowship examination is in two parts separated by three years of dedicated fellowship training.

Similar systems of training and accreditation exist with specialist accreditation in five European countries. In Finland, where specialist recognition occurred in 1986, training posts in sports medicine exist with emphasis on research and the health benefits of exercise. In the Netherlands, specialist recognition arrived in 1987, based on a four year training scheme. Considerable importance is placed on the public health aspects of sport and exercise, and registration occurs under a category of social and preventive medicine.

Britain is entering a critical phase in the development and recognition of sport and exercise medicine. We now need a process of accreditation and specialist recognition. This will require an intercollegiate board for sport and exercise medicine to be established under the auspices of the Academy of Medical Royal Colleges. The board should be accountable to the medical Royal colleges, and its constitution should allow curricular development, examination, and accreditation, with an initial emphasis in primary care. Parallel development of higher specialist training as a subspecialty year for other medical or surgical specialties and a full programme for primary care should be developed, with the award of a certificate of completion of specialist training consistent with the Calman recommendations. As has happened in the United States, subsequent development of the undergraduate medical curriculum should reflect the growing interest in this aspect of medical practice.2

The government has raised the profile of sports medicine through its encouragement of sport for health and the development of a British Academy of Sport.3 4 The BMA, through its publication Sport and Exercise Medicine: Policy and Provision, has widely endorsed these views and set out clear recommendations for the development of sport and exercise medicine.5 Sport and exercise medicine should now be recognised as a specialty based on the relevant basic sciences and clinical practice. Much of the educational programme exists, and the time is right for accreditation and the development of independently assessed training programmes, established on the basis of similar developments in other fields of clinical practice.