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Exercise medicine resources launched for health and social care students

18 Nov, 16 | by BJSM

*Media Release*

Working with the Council of Deans of Health, Exercise Works! has launched the latest update of its physical activity and health resources designed specifically to support teaching in undergraduate health programmes. The “Movement for Movement” resources equip health and social care students to promote physical activity in the prevention and treatment of disease.

The resources on exercise medicine and health for undergraduate education were endorsed by the Council of Deans of Health when they were first launched in 2015. The revised version contains the latest evidence for future health professionals to use in discussing lifestyle medicine with their patients and deliver safe and effective exercise advice.

Ann Gates, Director of Exercise Works! said:

“I’m delighted to be able to launch these updated resources that address one of the most pressing public health challenges of our time. I look forward to seeing how universities use them to strengthen teaching about exercise in their programmes.”

Read more about Movement for Movement in this:

BJSM blog: A Movement for Movement: what’s art got to do with it? A lot. and;

BJSM Editorial: Movement for movement: exercise as everybody’s business?

movement-jpeg

For more information: Contact Ann Gates @exerciseworkshttp://www.exercise-works.org/

 

MOOCs: Marvellous or Moot for Exercise Medicine and Physical Activity?

8 Nov, 16 | by BJSM

By Chris Oliver @CyclingSurgeon, Mairi Buchan, and Jo Hilton

Massive Open Online Courses (MOOCs) have become increasingly popular over the past few years. Especially after successful early MOOCs such as “Circuits and Electronics” by American Universities, Harvard and MIT [1]. In their simplest form MOOCs are vehicles for delivering information on a topic to an enormous number of people at any one time. Recent additions to the MOOC portfolio include MOOCs that offer education in Exercise Medicine and Physical Activity. For example, McGill University’s MOOC “Exercise is Medicine” was “created to provide the public with a reliable source of information and exposure to experts in the field” [2]. Whilst there are many positive aspects of these programmes, there are important considerations related to the benefits, challenges, and implications that these innovative e-learning programmes have for the sports and exercise medicine community, and the world at large. In this blog, we introduce some key themes of this debate.

moocoliver

Image courtesy of Chris Oliver

MOOCs: The positive story

An ancient Chinese proverb states “if you are planning for a year, sow rice; if you are planning for a decade, plant trees; if you are planning for a lifetime, educate people”[3]. Free access to education is a hot topic and in modern-day society. As we are increasingly aware of inequalities in all aspects of our lives, we want to allow everyone, regardless of background, access to this basic human right [4]. Some MOOCs have been created in order to bridge the access gap for populations from more socioeconomically deprived regions [5]. There are a plethora of positives surrounding MOOCs, particularly the focus on the appeal to human curiosity and a more relaxed approach to learning. Individual choice in study topic over a given timeframe is key in developing and maintaining an intrinsic motivation to learn. Many education critics believe intrinsic motivation is often lacking in formal educational settings [6].

What are the educational themes and why are these important?

Despite advantages of MOOCs, the accompanying educational themes are worthy of further investigation. Firstly, yes, the whole idea behind these projects is that they provide equal access opportunity to education by breaking down financial and infrastructural barriers; however, in general, the evidence so far is that people accessing these courses tend not to be from more socioeconomically deprived demographics [7]. Many of the MOOC participants are university-educated with a desire to further their knowledge and advance in their current careers [8].

Another inherent glitch is catering to the huge number of students. Some courses have had many tens of thousands of participants. In a formal education setting, physical or online, hundreds of tutors are required to cater to each student’s needs. The number of tutors involved in MOOCs is often very small and may struggle to match the personalised educational experience, expected in formal education [8]. In addition, the lack of funding to employ a greater number of tutors to support participants and to develop educational materials provides yet another challenge to the success of MOOCs [9].   The long-term economic sustainability of MOOCs will rely on a clear business case. The impact of use of intellectual property by MOOCs has still to be widely debated.

Whilst many people enjoy the experience of engaging in a MOOC, there are challenges for participants. Embarking upon a MOOC can be intimidating for those new to this style of learning [6]. Lists of recommended reading, participation in discussion groups and completion of weekly assignments may cause information overload issues. Some participants may not know where to begin or how to manage their time accordingly. The student may also be left to rely on guidance from connecting with other MOOC participants and gaining advice from their previous experiences. There is an assumption that students will be proactive and enthusiastic learners. However, if no-one contributes to discussions on a regular basis, the onus is on the individual to find their own way around the MOOC [6].

Future implications of MOOCs for modern-day higher education

Access to educational materials produced by highly-rated universities, can contribute to facilitating the economic, political, and social growth of developing countries. It would appear that MOOCs combine local access to e-learning that can be applied to practice in the field of sports and exercise medicine. Nevertheless, despite the access ideals behind MOOCs, it seems that one group may be benefiting more than the other from these courses: the developed world. This is likely in direct relation to evidence that suggests there is an early uptake effect of MOOCs by those who already have already experienced higher education.

Although initial subscription to and enthusiasm towards MOOCs is often high, the attrition rate is higher than that of conventional higher education settings [10]. The impact of low staff-to-student ratios, the relatively low personal investment and the high intrinsic motivation necessary to learn may all contribute to a high drop-out rate.

MOOCs are still valuable despite their limitations. However, they should not be viewed as the sole solution, or as a replacement for other initiatives that seek to increase access to quality education in developing countries. MOOCs may be best viewed as complementary to rather than competing with the traditional education setting, physical or online.

The inherent issues of financial and time resource constraints as well as the challenges MOOC participants face, need to be held in mind by all stakeholders with an interest in quality, low-barrier education opportunities.

In the field of exercise and physical activity, MOOCs appear to be here to stay. A next-step to collectively consider is the challenge of measuring their social, educational and financial impact long-term.

References

  1. Breslow L, Pritchard DE, DeBoer J, Stump GS, Ho AD, Seaton DT. Studying Learning in the Worldwide Classroom: Research into edX’s First MOOC. Res Prac Ass. 2013; 8: 13-25. Available from: http://files.eric.ed.gov/fulltext/EJ1062850.pdf [Accessed 10 October 2016].
  2. Griffin S, Shrier I. University of McGill massive open online course: pioneering sport and exercise medicine education. Br J Sports Med 2016;50:1101-1102. http://bjsmbeta.bmj.com/content/50/18/1101.info [Accessed 30 October 2016]
  3. Chinese Proverbs http://www.rodneyohebsion.com/chinese-proverbs.htm [Accessed 10 October 2016].
  4. The Universal Declaration of Human Rights. United Nations. http://www.un.org/en/universal-declaration-human-rights/ [Accessed 10th October 2016].
  5. Kay J, Reimann P, Diebold E, Kummerfeld B. MOOCs: So many learners, so much potential. 2013; 52(1):49-67.
  6. Kop R. The challenges to connectivist learning on open online networks: Learning experiences during a massive open online course. The International Review of Research. In Open and Distributed Learning. 2011 Jan 13; 12(3):19-38.
  7. Christensen G, Steinmetz A, Alcorn B, Bennett A, Woods D, Emanuel EJ. The MOOC phenomenon: who takes massive open online courses and why? 2013. http://dx.doi.org/10.2139/ssrn.2350964 [Accessed 10 October 2016].
  8. Laurillard D. Five myths about MOOCs. Times Higher Education. 2014 https://www.timeshighereducation.com/comment/opinion/five-myths-about-moocs/2010480.article [Accessed 10 October 2016].
  9. Hollands F, Tirtahli D. Resource requirements and costs of developing and delivering MOOCs. The International Review of Research in Open and Distributed Learning. 2014 5 October; 15(5). http://www.irrodl.org/index.php/irrodl/article/view/1901/3069 [Accessed 10 October 2010]

Thoughts and impressions midway through the FIFA Sports Medicine Diploma

4 Sep, 16 | by BJSM

By Nash Anderson

I first heard about the FIFA Sports Medicine Diploma in 2015 and was impressed to hear that a free course existed from the sporting organisation body FIFA.1 I started the course in June 2016 for two reasons. Firstly, I had more free time this year and I was curious to see this new course created by world leading clinicians. Secondly, I have worked on the sideline for various sporting codes over the years however never football specifically. I hoped this course would help me to develop my knowledge and confidence in football medicine for not only any potential sideline work in football but also for dealing more proficiently with my football playing patients. Below I share some pertinent information and my personal experience thus far.

ref standing footballWhat is the FIFA Sports Medicine Diploma?

The Diploma is a free course by FIFA covering major medical and musculoskeletal issues in football. It also covers ‘special topics’ including: event planning, team travel, female athletes, anti-doping and more. More modules are added regularly. The aim is to provide a total of 42 modules, one from each of the FIFA Medical Centres of Excellence. 1

The course shares clinical experience and evidence from lead researchers as well as the theoretical knowledge amassed by F-MARC over the last 22 years.

Who is F-MARC?

The FIFA Medical Assessment and Research Centre (F-MARC), established in 1994, is a prestigious independent research body of FIFA uniting an international group of experts in football medicine.2 They are world leaders in football medicine and have produced hundreds of publications in peer-reviewed journals. 3

Besides research and educational courses,3 they have been involved in many initiatives including: improved screening for sudden cardiac arrest; the FIFA Sudden Death Registry;4 5 the FIFA 11+, an effective programme to prevent football injuries in various player groups worldwide; 6 as well the FIFA 11 for Health program. 7 The FIFA 11 for Health program illustrates the health benefits of football for population groups. One such recent example is that small-sided football in schools and leisure-time sport clubs improves physical fitness, health profile, well-being and learning in children. 8

Why is the FIFA Sports Medicine Diploma essential to clinicians interested in football medicine?

“Education is the key to prevention and therefore FIFA supports the “Diploma in Football Medicine” for doctors, physiotherapists and paramedical staff”

– Prof Jiří Dvořák. FIFA Chief Medical Officer & F-MARC Chairman.1

After completing these modules, participants will be better able to identify and treat injuries and illnesses as well as be more aware of injury and illness-prevention programmes. Due to the great breadth of topics there is something to learn even for the most experienced football medicine clinicians.

The FIFA Sports Medicine Diploma is essential to create an education platform for multidisciplinary cooperation. In turn, football will become a more safe 6 and rewarding pursuit for patients, athletes, clinicians and football associations.

I have currently completed a number of modules. Here are some of thoughts thus far:

Pros

  • Free. A free resource from a leading sports medicine organisation.
  • Comprehensive resource. This course covers a variety of topics. This is not just a course but also a brief online sports encyclopaedia.
  • All-star line up. In addition to up to date topics, modules are written by international experts with a wealth of practical and academic experience. The curriculum also includes insights from high-profile players.
  • Multidisciplinary depth of topics. MSK topics are generally broken down into initial presentations, radiological investigations, physical therapies, reasons for referral and surgical options. This helps to establish clear roles for football organisations and clinicians.
  • Excellent testing and feedback. Knowledge is tested using multiple-choice questions; however, if you do not select the correct answer, it prompts constructive feedback.
  • Web based course. Being entirely web based, participants can engage in content through multiple platforms, such as PCs and smartphones. There is also synchronisation between devices.
  • There are no deadlines! The course can be completed online at your own pace.

Constructive feedback

  • Technical. I have thoroughly enjoyed the depth of the content. Although one website comment suggested that the course was for “anyone with an interest in sports medicine”. I believe that may be a stretch. The original target audience was sports physicians and, although somewhat simplified, it is still very technical for “anyone with an interest”.
  • Where to go for practical skill growth? Although this course is very accessible and the practical assessment videos hugely helpful, I am interested to see what steps or courses FIFA recommends for clinicians for further practical skill development beyond the FIFA Sport Medicine Diploma, the FIFA Sports First Aid and their FIFA Nutrition Course.
  • Football Medicine Manual, web version please! 9
  • The key resource for this course is currently only in PDF form. On smaller devices it is difficult to read. A web enabled version would enable enhanced readability on all mediums such as PC and smartphone. This is, however, only a criticism to user friendliness of the manual and not its content.

Thank you to the F-MARC Team for producing an excellent and free resource. Kudos in particular to Dr Mark Fulcher, the New Zealand team doctor and editor-in-chief of the project. I look forward to viewing more modules in the future including as of yet unreleased modules.

I would also like to thank Dr. Reidar Lystad @RLystad for his assistance with this blog and the support of the BJSM @bjsm_bmj dream team for letting me share my thoughts.

FURTHER INFORMATION

For further information and to sign up for the course please visit: http://f-marc.com/footballdiploma/

You can download the Football Medicine Manual from here: http://f-marc.com/footballdiploma/cdn/FMM_Medicine%20Manual_FINAL_E.pdf

Also here you can also read the BJSM Course review on The FIFA Sports Medicine Diploma from Adam Culvenor. 10 http://bjsm.bmj.com/content/early/2016/08/23/bjsports-2016-096662.short?rss=1

 

******************

Nash Anderson is a Chiropractor in private practice in Farnham. He has a special interest in sideline care, sports medicine and created sportmednews.com, an open access health and sports medicine resource for clinicians and the public. He enjoys working pitch side and has recently finished up with the Farnham Knights American Football team but still works to provide care at cycling events with @roadsideteam. You can follow him on Twitter (@sportmednews).

 

REFERENCES

  1. F-MARC. Football Medicine Diploma | FIFA Diploma in Football Medicine 2016 [Available from: http://f-marc.com/footballdiploma/
  2. Excellence FMCo. FIFA Medical Centre of Excellence – FIFA & F-MARC: FIFA Medical Centre of Excellence; 2016 [Available from: http://www.footballmedicinecentre.com/about/fifa-f-marc/.
  3. F-MARC. FOOTBALL MEDICINE the complex medico-social milieu 2016 [Football Medicine Courses provided]. Available from: http://f-marc.com/football-medicine/.
  4. Kramer EB, Dvorak J, Schmied C, et al. F-MARC: promoting the prevention and management of sudden cardiac arrest in football. Br J Sports Med 2015;49(9):597-8.
  5. Scharhag J, Bohm P, Dvorak J, et al. F-MARC: the FIFA Sudden Death Registry (FIFA-SDR). Br J Sports Med 2015;49(9):563-5.
  6. Bizzini M, Dvorak J. FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide-a narrative review. Br J Sports Med 2015;49(9):577-9.
  7. F-MARC. FIFA 11 for Health 2016 [Available from: http://f-marc.com/fifa-11-for-health/.
  8. Krustrup P, Dvorak J, Bangsbo J. Small-sided football in schools and leisure-time sport clubs improves physical fitness, health profile, well-being and learning in children. Br J Sports Med 2016.
  9. (FIFA) FIFA. Football Medicine Handbook. In: FIFA Medical Assessment and Research Centre (F-MARC) FMOc, Production F, eds.
  10. Culvenor AG. FIFA Diploma in Football Medicine: free knowledge from expert clinicians to improve sports medicine care for all football players (continuing professional development series). Br J Sports Med 2016.

 

Physical Inactivity and the Clinical Champions Programme

4 Jan, 16 | by BJSM

Sport and Exercise Medicine: The UK trainee perspective – A BJSM blog series

By Dr Dane Vishnubala @danevishnubala

Earlier this year, Public Health England (PHE) put out a job advert for GP Clinical Champions. The job involved educating clinicians on: (i) the benefits of physical activity in primary and secondary prevention of disease and (ii) the harms of inactivity.

As I was just finishing GP training and about to embark on Sport and Exercise Medicine training, the idea of teaching and talking about exercise and health sounded perfect. So I applied and got the role as a Clinical Champion.

The clinical champion network is definitely an interesting initiative and one worth sharing with you.

So lets start at the beginning- why is there a need for the physical activity champions network?

Inactivity in the UK

Inactivity is a major problem in the UK. The statistics do not paint a pretty picture. As well as GPs, this is a great opportunity for the SEM community to make a difference and show a different side to our specialty.

Key facts

* I have taken most of the statistics from the Every body Active, Every day document by PHE that is well worth a read.

1 clinical champion

45% of women are not active enough for good health

 

2 clinical champion

19% of men and 26% women are physically inactive.

We also know that as well as females, ethnic minorities and those who identify as lesbian, gay or transgender are all likely to be less active. As you can see inactivity is a major issue and we must look at ways of tackling this whilst ensuring we also involve these harder to reach subsections of the populations.

Graph in terms of risk to mortality:

3 clinical champion

How do we compare to other countries?

4 clinical champions

Poorly would be the answer! *Note the definition of inactivity in this study is different to the one used previously.

 

Here is the recent info graphic launched in England at the last PHE conference to get across the key messages of the UK CMOs’ guidelines. An infographic for children 5-18 years is currently under development.

5 clinical champion

The Clinical Champion Programme

Aims

We know from research that we as clinicians in all specialties can make a bigger impact. We have a lot of patient contacts and opportunities to change behaviour.

The aim of the Clinical Champion Programme is to educate clinicians around the following:

  • Physical activity and it’s benefits
  • Risks of inactivity
  • Current inactivity statistics.
  • Exercise physiology in primary and secondary prevention
  • Making every contact count
  • Motivational interviewing
  • Local provisions for physical activity

To do this PHE decided to recruit GPs in various areas with an interest in physical activity to deliver the education. GPs were selected after an interview process which including assessing their teaching and presentation skills.

Here is our promotional flyer:

 5 clinical champion

Training

As part of the role, I attended a two day training session, which brought the Champions together for sessions on teaching skills and to review, discuss and practice the materials; it also provided the opportunity to gel as a cadre of professionals. In addition the Champions all attend a national PHE physical activity conference.

The physical activity champions

It was great to see the range of Clinicians in the GP Clinical champion team. As well as the Public Health England team, we have a range of GPs with considerable physical activity experience, some with an MSc in Sport and Exercise medicine, others dually trained in SEM and GP, and even RCGP Physical Activity leads. This range of people has led to some interesting discussions on our team forum and further in team education. I have learned a lot about the public health side of this problem since joining the initiative, as much from the other champions as well as the training.

Delivery Experience

The education has been tailored to be either 30min to 2-3 hours approximately. I have delivered to VTS groups, GP groups, hospital specialty and trainee groups and grand rounds amongst others so far. The variety of specialties and the length of time can be a challenge however PHE has presentation and lesson plans for different groups. There has been some travelling to do and I have delivered in Yorkshire, Lancashire region and even one in London. The general feedback from the physical activity champions is that the training has been well received and that we are providing education in an area not provided at medical school or usually further training unless you happen to be a sport and exercise medicine or public health trainee!

Top 5 tips for clinicians

  1. Understand the patient, their motivations and barriers- softer GP skills are definitely useful here.
  2. Motivational interviewing or elements of it can be helpful in behaviour change.
  3. Understand local provisions so that you can signpost appropriately for that individual.
  4. Remember that even if you don’t make a change today, you may cause a change later- don’t underestimate the impact we can have.
  5. MAKE EVERY CONTACT COUNT! Prevention is always better than finding a cure!

Further resources

  1. PHE- Clinical Champion Teaching session– Contact physicalactivity@phe.gov.uk
  2. Motivational interviewing- BMJ http://learning.bmj.com/learning/module-intro/.html?moduleId=10051582
  3. BMJ Learning Modules. http://learning.bmj.com/learning/course-intro/physical-activity.html?courseId=10051913
  4. Intelligent health http://www.intelligenthealth.co.uk
  5. Motivate to Move: http://gpcpd.walesdeanery.org/index.php/welcome-to-motivate-2-move
  6. Exercise Works http://www.exercise-works.org

Can you help?

Can you help us spread the message? If you feel any groups of clinicians, you are involved with would benefit from the session then…email us to get a free education session booked in and delivered by one of our Physical Activity Clinical Champions. Contact us at physicalactivity@phe.gov.uk

**************************

Dr Dane Vishnubala MBBS PGCME MRCGP FHEA, is a Sport and Exercise Medicine Registrar in Yorkshire, GP and part time lecturer at Leeds Beckett University in Physical Activity and Health. He has a strong interest in exercise medicine and still actively works in the Exercise Referral industry as a BASES/REPs Level 4 Certified Exercise Professional.

Twitter: @danevishnubala

Email: dane.vishnubala@nhs.net

Farrah Jawad is an ST5 doctor in Sport and Exercise Medicine in London.  She co-ordinates the BJSM Trainee Perspective blog.

Clinical Reasoning in Exercise and Performance Rehabilitation (February and March 2016), registrar now!

13 Dec, 15 | by BJSM

ACPSEM Course – Clinical Reasoning in Exercise & Performance Rehabilitation

 

Part 1- 6th & 7th February 2016

Part 2- 12th & 13th March 2016

  • This course is open to qualified physiotherapists
  • The tutor team will be: Dr Nicola Phillips, Tim Sharp, Lynn Booth, Dr Phil Glasgow, Chris McNicholl and Caryl Becker. Each of our tutors have many years of elite sports experience and teaching practice.

See more details on poster below and/or check out:  www.physiosinsport.org

Registration open now!
aspem

Undergraduate Physiotherapists at Sheffield Hallam University use Interdisciplinary Exercise Medicine Resources

14 Nov, 15 | by BJSM

By Anna Lowe

In 2014 Exercise Works! (an organisation that promotes the prevention and treatment of non-communicable diseases) made huge steps forward to enhance the exercise-related content of medical undergraduate curricula. The project “Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients” (Tomorrow’s Doctors), funded by Public Health England, led to the development of exercise medicine and chronic disease resources for all UK undergraduate medical degrees.

sheffald

Following on from the success of “Tomorrow’s Doctors”, these resources have been revised and made available for all undergraduate nursing, midwifery and Allied Health Professions courses internationally.

At Sheffield Hallam University we have approximately 300 undergraduate physiotherapy students and we are delighted to be using the resources to support our training of “Tomorrow’s Physiotherapists”.  Our physiotherapy approaches must evolve to keep up with a changing and growing population.  Exercise medicine is a core part of our undergraduate curriculum, in view of the rise of long-term conditions and the ageing population, the need for exercise prescription skills is greater than ever before.  The resources are a selection of PowerPoint presentations on subjects ranging from “Mental Health & Exercise” to “Physical Activity Leadership”.  We will evaluate staff and student perspectives and promote the resources to other health courses within the University.

Sheffield has a rich history of physical activity and it has recently claimed the title of The Outdoor City.  It borders the Peak District and benefits from an abundance of green space and beautiful landscape; something that brings many students to the city and keeps them here long after their studies finish.  With the help of Olympic Legacy projects such as Move More (a city-wide physical activity strategy) and the National Centre for Sports and Exercise Medicine the physical activity infrastructure continues to grow and physical activity is becoming firmly embedded in the personality of the city.

Despite this, Sheffield is a city of contrast with large geographic variations in health and disability. Contemporary health education requires a deep understanding of the wider determinants of health, particularly in relation to health behaviours.  Every patient contact is an opportunity to impact, not only on the presenting complaint, but also on overall health & wellbeing.  A physiotherapist may see up to half a million patients in their career, many of these patients will have long-term conditions and will therefore be at risk of disability and early death.  As a profession we must ensure that we keep exercise at the heart of everything we do and that no opportunity is wasted!

******************

Anna Lowe is a Senior Lecturer in Physiotherapy at Sheffield Hallam University

@annalowephysio a.lowe@shu.ac.uk

Ann B Gates is founder of Exercise Works!

@exerciseworks  ann@exercise-works.org

Highlights from the BASEM Exercise in Health and Disease Course

4 Nov, 15 | by BJSM

By Manroy Sahni (@manroysahni)

Unfortunately, the vast majority of medical schools dedicate very little teaching time to the health benefits of physical activity and how to deliver lifestyle advice to patients that would profit. As such, this course stood out as an opportunity to gain some background knowledge and learn practical tips from the experts on how to get patients MOVING MORE and SITTING LESS- and it definitely didn’t disappoint!

The course provided a solid base of underpinning evidence for promoting exercise in patients suffering from a multitude of chronic illnesses including diabetes, cardiovascular disease, arthritis, osteoporosis and cancer. Especially interesting for me were the talks outlining practical strategies to get patients moving. Topics included brief interventions during consultations, tips to motivate patients in general practice and breaking down common barriers. We even had a chance to try Nordic walking!

I learned valuable points and tips that I will use to encourage physical activity and lifestyle optimisation when talking with patients.

gear shiftFor example an interesting analogy was that getting people motivated and doing more physical activity is like driving. When you’ve been stationary and want to get the car moving what gear do you go in to? First gear. So people who have been inactive should initially go into first gear by trying something easy- like standing more instead of sitting. If they try to go straight into 4th gear (e.g. a marathon) they will stall. Therefore when promoting physical activity we should encourage patients to take it slowly and go through the gears- this way they will be less likely to stall.

Health care professionals are now very good at smoking cessation advice, with many aware of the ASK, ADVISE and ACT intervention to identify patients at risk and point them in the right direction for help. Similar brief interventions were outlined to promote the benefits of physical activity and motivate patients to make lifestyle changes. Utilising these strategies, we as health care professionals can make every patient contact count.

prev medicineThe importance of working an exercise history into each standard medical history was also reinforced. This is a topic that is again relatively neglected in undergraduate training and something that should be stressed considering the increasing burden of (potentially preventable) chronic disease gripping the nation. After all it’s easier to turn off the tap than to mop the floor.

 

 

*****************************

Manroy Sahni is a fourth year medical student at the University of Birmingham. He is co-president of the Birmingham University Sports and Exercise Medicine Society and involved in promoting healthy living and lifestyle change. 

Expedition medicine’s role in sports and exercise medicine training

16 Oct, 15 | by BJSM

By Phil Clelland

Sport and Exercise Medicine: The UK trainee perspective – A BJSM blog series

This summer, I worked for British Exploring as the senior medic on their Project New Horizons expedition and provided medical cover for 67 participants during a three week trip to North West Iceland. This expedition aimed to inspire young people who are not in employment, education or training through adventurous physical activities including trekking and white water rafting.

My return to the UK and subsequent sports and exercise medicine (SEM) training, prompted me to reflect upon the crossover of skills, knowledge and behaviours between SEM and expedition medicine. This link is well documented in the sports medicine literature1, 2, 3 (and in a  BJSM podcast with Dr Russell Hearn and  BASEM today article featuring Dr Dan Roiz de Sa).

Below I build off this knowledge base, and reflect on my own experience to address the role of expedition medicine in sports and exercise medicine training.

The rise of expedition medicine

Expedition medicine has recently increased in prominence. This is in part due to the popularity of adventure travel/endurance events, the ease and affordability of international flights, and a plethora of fundraising treks and sustainable development projects.

The growth in demand has been met by a degree of formalisation in expedition medicine training. Multiple companies offer courses of varying length in a range of locations from the Brecon Beacons to Costa Rican jungles. A postgraduate diploma in expedition and wilderness medicine is now delivered by the Royal College of Physicians and Surgeons of Glasgow and doctors can seek fellowship accreditation through the Royal Geographical Society or the Academy of Wilderness Medicine.

Each expedition is different in terms of its objectives, size, location and level of organisation. However, my experiences over several trips suggest that each follows a similar format which lends itself well to coverage of aspects of the SEM curriculum.

Selection

Organisations require submission of a CV or application form and seek a broad medical background. Expedition practice typically includes emergency medicine, sports medicine, general practice, tropical medicine and pre-hospital care, thus qualifications in these areas are desirable. Personally, I’ve completed diplomas in tropical medicine and SEM as well as pre-hospital care and expedition medicine courses.

Subsequently, programs require a face to face meeting which can take the form of an interview or an assessment weekend. The latter is more intense and test’s the applicant’s ability to work effectively in a team, practice independently, manage emergency scenarios and cross an icy river in just their underwear whilst still smiling.

Motivation phil mountain

Medics require a variety of additional skills and often play a supportive, pastoral role.

Pre-expedition planning and training

Pre-expedition planning and training draw the strongest parallels to an SEM team physician 4. These elements are as essential to a successful and safe expedition as to sporting event cover5. Similar responsibilities include:

  • medical screening of participants,
  • determining the necessary medical equipment to take, sourcing and transportation,
  • advising on potential health issues,
  • casualty evacuation planning,
  • teaching first aid/preventative health
  • developing nutritional strategies.

Risk assessment plays a large part and not at all mundane when the process involves snakes and machetes. Also essential, is ensuring adequate personal, professional indemnity.

DCIM100GOPRO

Expedition risk assessment

On expedition

The doctor will often be part of a small advance party. This helps establish rudimentary medical facilities at a base camp, confirmation of evacuation plans, communication systems, adequate local medical facilities and more glamorous tasks such as digging a hole for the long drop toilet.

base camp iceland phil

Iceland base camp and medical facilities within white tentBase camp

 

The main party’s arrival signals the start of the incredibly diverse clinical work. Geographical location, objectives of the expedition and demographics of the individuals all influence the scope of roles. Conditions encompass anything from medical emergencies to psychological problems but musculoskeletal complaints often predominate. Management of environmental related illness is also common.  All of these can be complicated by occurring in challenging, isolated situations. Examining for corneal abrasions in a land of 24 hour sunlight requires some improvisation.

eye examination phil

Eye examination

Training may also involve a research or audit project. The premise of many expeditions is personal development through adventurous, physical activities. Whilst in Iceland, I conducted a study using serial psychological assessments to determine the impact of these activities upon the participants, several of whom had pre-existing depression or anxiety. Much like in SEM, the quality and range of future research investigations will in part determine the progress of Expedition Medicine.

Post expedition

A doctor’s post expedition medical report includes critical incidents and detailing all significant medical issues. They also make governance and quality control recommendations based on reflective practice. Following my recent expedition, suggestions included mandatory pre-expedition dental checks, trauma and resuscitation training for leaders and emergency protocol flash cards in medical kits. Handover letters to GPs regarding major or on-going problems are also written to ensure continuity of care. These elements are all similar to an SEM practitioner.

So what are the benefits as part of SEM training?

The SEM trainee’s education may benefit by undertaking expedition work and their skillset lends itself perfectly to the role. It is a complementary experience to an already diverse and interesting career. Expedition Medicine frequently tests effective teamwork, leadership, managing uncertainty and professionalism. The co-ordination of a casualty evacuation that had fallen into a glacial river, fractured their scaphoid and developed hypothermia is one such example from this summer.  Building the skills to respond to and manage this scenario effectively will strengthen anyone’s skills as a SEM practitioner.

To end on a personal note, expeditions have impacted me significantly. They have provided the same (albeit based in very different contexts) satisfaction, enjoyment, inspiration and memories as working at sporting events. Playing a small part in helping others achieve their goals and witnessing the resulting personal development is very rewarding.

********************************************************

Phil Clelland is an ST3 in Sports and Exercise Medicine in the North West Deanery. He has a background in hospital medicine and general practice. He enjoys all sports but has an interest in endurance and adventure sports and completed his first ultra-marathon this year. He plans to raise money to support future British Exploring expeditions by racing a dug-out sailing canoe along the coast of Zanzibar next summer.

References

  1. Heggie TW. Paediatric and adolescent sport injury in the wilderness. Br J Sports Med 2010;44:50-55
  2. Buckler DGW, O’Higgins F. Medical provision and usage for the 1999 Everest marathon. Br J Sports Med 2000;34:205-209
  3. Maruff P, Snyder P, McStephen M, et al. Cognitive deterioration associated with an expedition in an extreme desert environment. Br J Sports Med 2006;40:556-560
  4. Brukner P. Surviving 30 years on the road as a team physician. Br J Sports Med 2013;47:610
  5. Tillett E, Loosemore M. Setting standards for the prevention and management of travellers’ diarrhoea in elite athletes: an audit of one team during the Youth Commonwealth Games in India. Br J Sports Med 2009;43:1045-1048

Passionate about proactive healthcare? Look no further…#MET2015

14 Oct, 15 | by BJSM

Move Eat Treat is a movement to equip all healthcare practitioners with the skills to positively influence their patients’ lifestyle choices, fostering a healthy and happy Great Britain.

move eat treat Updated_Logo_Pill_OnlyAs follow-up from our groundbreaking inaugural summit in 2013, we invite you to join us at the Institute of Sport Exercise and Health (ISEH) in London on Wednesday 18th November. We will critically discuss the recent progress and future of integrating lifestyle teaching into medical education. Our overarching aim is to encourage a more proactive healthcare system.

Talks will address important lifestyle issues such as nutrition, physical activity and positive psychology, and feature keynote talks from:

  • Dr Aseem Malhotra,
  • Dr Richard Weiler,
  • Dr Mike Loosemore
  • and Dr Tim Anstiss; amongst others.

There will be multiple panel discussions throughout the day to encourage dialogue and collaboration. Our last summit was an enthusiastic mix of those working in the healthcare profession, politicians, industry leaders as well as members of the media – this diverse audience made for rich conversation. We hope to replicate and build off of this diversity, and as thus, ask for your help to spread news of the summit!

And of course if proactive healthcare is something you’re passionate about, we would love for you to join us.

If you are unable to attend on the day, still get involved in the discussion on social media by using the hashtag #MET2015.

For tickets, visit this link: http://www.eventbrite.co.uk/e/move-eat-treat-summit-2015-tickets-17733522443

For more information about Move Eat Treat, you can visit the website www.moveeattreat.org or follow us on twitter @moveeattreat

 

TE(D)rrific talks (and a chance to win a prize)

13 Jun, 15 | by BJSM

tedThe internet – not only does it provide countless videos of animals doing funny things, it also contains a rich stock of fantastic educational resources, meaning that you can learn from world-experts in a variety of fields from the comfort of your home – all for absolutely free. One organisation that is universally regarded as a leader in providing high quality and reliable online teaching is TED, a non-profit committed to spreading ideas through video-recorded talks. Due to the success of the recently published blog centred around Dr Sarah Hallberg’s TED talk on tearing up the guidelines in treating Type 2 diabetes, the BJSM editorial team brainstormed to produce a list of favourite TED talks, covering issues from SEM staples on the basis of pain to the power of body language in success. Let us know if you find these helpful!

  1. Challenging Beliefs. Tim Noakes http://bit.ly/1H7nN86

This 15-minute talk is a whistle-stop tour of Prof Tim Noakes’ (author of the recent BJSM editorial on exercise in obesity which made headlines around the world) lifetime of research in SEM. Covering everything from exercise-induced hyponatraemia to his now infamous advocacy of a #LCHF diet, this talk is worth watching not only for the countless educational nuggets, but also to learn from someone who has never been afraid of swimming against the tide.

  1. Are athletes really getting faster, better, stronger? David Epstein http://bit.ly/1FYOw4x

This thought-provoking talk by David Epstein questions whether human evolution is truly at the heart of athletic improvement, and suggests that we may want to lay off the self-congratulation. Great talk for anyone interested in sporting performance and it provides a view rarely considered or advocated in the public domain.

  1. Sugar – the elephant in the kitchen. Robert Lustig http://bit.ly/1H7tjY4

A talk on sugar in relation to the obesity & diabetes pandemic by one of the world’s most respected authorities on the matter had to make the list. With nearly 200,000 views, this talk by Dr Robert Lustig reinforces the growing message regarding the dangers associated with high sugar intake, providing real food-for-thought.

  1. Why things hurt. Lorimer Moseley http://bit.ly/1FYU5zN

This fantastic video explains the rarely-taught basis of pain, and the role of the brain in the pain response. It provides an insight into some ground-breaking experiments that demonstrate astonishing results, more of which can be found in this BJSM podcast with the same speaker! http://bit.ly/1FZ177G

  1. Your body language shapes who you are. Amy Cuddy http://bit.ly/1H7CibQ

Something that although not SEM related, is infinitely useful whether you’re plucking up the courage to ask a question at a conference or whether you’re going for that dream job in SEM. It’s not about faking it ‘til you make it, fake it until you become it.

That’s just some of the fantastic resources available online – now we want to hear from you. For a chance to win a copy of Brukner & Khan’s Clinical Sports Medicine, share using the hashtag #TED4BJSM and comment on the Facebook stream (pinned post)  to let us know which TED talk you would recommend to others in SEM or one that has made an impression on you. As always, you can let us know your thoughts on Facebook, Twitter (@BJSM_BMJ) or Google +, we look forward to hearing from you!

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