Sports and exercise medicine

Are you a "go getter" looking for a new and energetic specialty? Bryan English explains how to get on in sports and exercise medicine

Sports and exercise medicine should be one of the United Kingdom's greatest investments for the future. With an escalating incidence of heart disease and obesity (especially in children) the potential impact of the specialty on public health is massive. Sadly, it is still not a fully recognised specialty in the United Kingdom, but exciting news is on the horizon.

Training today

There are already plenty of one year training programmes to suit both the specialist and the doctor with just an interest in sports and exercise medicine. Masters and diploma courses in sports medicine are available all over the United Kingdom. These range from a full time course consisting of 24 weeks' work spread over a year (the diploma/MSc course at the Royal London Hospital) to a diploma which requires no course and no training (the UK diploma taken in Edinburgh). The former is a genuine attempt to educate and train people in sports and exercise medicine and if you have the time it is the course that I would recommend. If you are after a certificate to demonstrate competence to be a touch line doctor then the examination in Edinburgh may be the one for you. However, as this is a "career focus" and not a "passing interest" article I do not recommend this route if you wish to specialise. Take some time out to learn in an educational environment.

Many other good sports and exercise medicine courses exist, including ones in Bath, Cardiff, Nottingham, Glasgow, and London. Take your pick and see what fits your timetable. Some excellent lecturers and training programmes are available on these courses, which you could incorporate into a four year training programme.

Interest or specialty?

After you gain your medical qualification it is a good idea to pursue your general medical training. Sports and exercise medicine is a specialty for a physician so if you are going to be a surgeon then you have to face the fact that sports medicine will be your interest, not your specialty. A general practitioner may become very adept at working within sport, but he or she should spend at least half their time dedicated to sports and exercise medicine if they are to be competent within the field. In my opinion it is not satisfactory to get your diploma, work full time in general practice, and then claim to be a sports medicine specialist. This makes a mockery of the subject, which is why we need formal recognition via the UK Sport working group to set standards (see below).

Stay out of trouble

Lots of doctors do commendable voluntary work for our amateur athletes. This is all very well, but our defence unions now state that any doctor working in sport should have the necessary training to deal with any eventuality. So the message is get yourself trained, otherwise you could be in trouble--even if it is the local under 8s football team that you are looking after.

The route to specialisation

With these guidelines in mind, start to create your own four year training programme that will hopefully be recognised, in part or in full, retrospectively. Any career in sports and exercise medicine will consist of general medicine, accident and emergency medicine, and general practice as well as optional subjects such as rheumatology and orthopaedic surgery. However, the most important training (apart from sports and exercise medicine training) will be in learning the art and science of musculoskeletal medicine. Musculoskeletal examination is often the Achilles' heel of the sports and exercise medicine specialist. I think it is highly unsatisfactory for doctors to be usurped by the physiotherapy profession in this regard.

I did senior house officer jobs in orthopaedics and rheumatology and did not learn good quality examination of anything other than the peripheral joints. The courses run by the British Institute of Musculoskeletal Medicine (www.bimm.org.uk) filled the gaps in my training, along with spending time with senior colleagues. This taught me how to palpate, examine, and treat the soft tissues (the dynamic aspect of the locomotor system) and, most importantly, how to make the diagnosis.

Jobs for the boys and girls

The old boy/old girl network can be a source of great frustration for newly qualified sports and exercise medicine doctors. Some doctors looking after national sports teams have been in place for decades. I think that this is wrong unless, as is the case with some sports, the post is purely honorary. A rotation policy should exist. I hope that in future there will be formal application procedures and interviews for these posts (as recently was the case with cricket and rugby union). Another exciting development has been the recently established institutes of sport set up around the country. These institutes have been employing some of our top sports medicine doctors to look after the lottery funded athletes across the UK. This is the elite end of sport where some doctors choose to work (probably because they get paid in these posts).

Training tomorrow

There has been a recent surge in political will to make sports and exercise medicine a recognised specialty. In 2000, the Irish colleges of medicine and surgery created a Faculty of Sport and Exercise Medicine in Ireland; how long will it be before the colleges in England, Scotland, and Wales follow suit? A working group has been created by UK Sport and the sports minister, Richard Caborn, to take this issue directly to the Department of Health. If this group's work is successful then a four year higher specialist training programme will be created in line with that of any other specialty. This will surely then get college support, which to date has been sadly lacking.

The four year programme

Entry into this programme will probably require four years of basic medical training at a postgraduate level. The programme itself is likely to be flexible (see box 1) and based across a range of sites:

• NHS--primary care trusts and hospitals
• Universities
• Home country sports institutes
• National governing bodies of sport
• Private sector.

Go get

Sports and exercise medicine is a great specialty to be involved with (see box 2). Most of the practitioners are go getters as they have had to fight their corner in protecting and creating this form of medicine. The hours can sometimes be unsociable, but that depends on which sport you choose to be associated with.