Undergraduate perspective on Sports & Exercise Medicine – a BJSM blog series

 By Liam West (@Liam_West) & Dr. Peter Brukner (@PeterBrukner)

The second of this two part interview series exploring the field of Sport & Exercise Medicine (SEM) is with Dr. Peter Brukner (PB). He is a world renowned name in SEM, co-authors Clinical Sports Medicine (for many the “SEM Bible”), hosts a fantastic SEM website and helped set up the prestigious Olympic Park Sports Medicine Centre in Australia.

LW: Hi Dr. Brukner. Could you start by describing what is involved in sports medicine for the undergraduate readers?

PB: It is a very broad field. The core is musculoskeletal medicine concerning injuries categorised into acute, chronic or acute-on-chronic injuries. As a sports medicine physician you need be able to diagnose these conditions from a comprehensive history, clinical examination and often imaging techniques. Then you must decide the management plan which may be physiotherapy rehabilitation, injections, surgery etc. You should have a good understanding of all these areas, even ones you may not be directly overseeing such as the rehab, as ultimately you will be running the show! At the end of the day, the patient is your responsibility.

LW: A great overview. What other skills do students need to acquire to be successful in sports medicine?

PB: Competency with clinical skills and underlying knowledge of radiological skills, rehabilitation protocols, recovery and available treatments is fundamental to success in sports medicine. Increasing performance, rehabilitation and prevention is at the heart of everything we do. Good research is out there with which we can reduce the risk of certain injuries – you will need a good understanding of this. As well as all these medical factors you must have an understanding of training, sport and biomechanics, nutrition and psychology which are all components of sports medicine.

There are also the challenges of looking after a team on a day to day basis. Screening, travel and its associated issues (jetlag effects etc), doping and dealing with the media can all prove difficult. You must be source of education for players as to the dangers of certain performance enhancing practices. It is much broader than running on to the football pitch with the magic sponge! I think this is what people don’t understand about sports medicine.

LW: If you could only say one thing to a student that is trying to weigh up a potential career in sports medicine with a more traditional medical speciality what would it be?

PB: One of the big differences with sports medicine and other medical specialities is the multi-disciplinary approach. Once students start clinical attachments they will soon realise that consultants often treat their physiotherapists like third rate citizens! We really must work as equals in a team. If you think you know a whole load more than physios, don’t get into sports medicine! Be an orthopaedic surgeon, sounds like you have the right personality for that! I have learnt more sports medicine from physiotherapists than from doctors.

LW: That sounds very appealing. So what jobs can we get into in sports medicine?

PB: A huge range is on offer. You can become a consultant in the NHS or private practise managing musculoskeletal injuries or exercise related problems. You could be working at one of the multi-disciplinary sports medicine centres popping up around the UK. You can get involved with university jobs based in research or teaching. Then there is obviously involvement with team sports or professional sporting organisations. Most do a combination of these.

Sports physicians also have to become the world leaders in exercise prescription and dealing with the effects of exercise on patients with various chronic health problems. Something you have spoken to Dr. Mike Loosemore about.

LW: Any advice for medical students wanting to get involved in sports medicine?

PB: Go and look after your local sports team. Most amateur or semi-professional teams are dying to get people that can come and help them. You obviously need some simple skills and to act under proper guided supervision. Completing sports strapping / taping, first aid or pitch side trauma management courses can make you a valuable member of the medical team. Look to cover sports that guarantee carnage! Rugby, football or hockey are perfect and you will learn lots just from being around acute pathology and their subsequent management.

Get your foot in the door with sports medicine by volunteering. As well as your local sports team, marathons and triathlons are always looking for volunteers to help out with the medical teams. These are great opportunities to gain experience and this is what you need to do as an undergraduate. When I interview people for sports medicine jobs I always ask about their relevant volunteer experience. If they say they have only just come across the field, I immediately think “so you failed your application for orthopaedics then…” The genuine sports medicine enthusiast normally has longstanding interest.

Once you graduate, carefully pick your clinical rotations. Emergency medicine, orthopaedics, rheumatology, cardiology and respiratory medicine are all very helpful for a future sports medicine career. Then you might like to undertake a masters degree to further your interest.

You have got to love sport. You have got to appreciate sportsmen and women. You must understand that your regular Sunday league footballer wants to get back to playing after an injury just as much as Wayne Rooney does. You can’t just tell him to rest for 6 weeks and expect him to listen to you! You may think you are pretty hot stuff as you are a medical student but you quickly need to swallow a big slice of humble pie and not be too proud to learn off any member of the sports medical team. You need to be a sponge.

LW: There are some great take home messages for students in there. Can you finally comment on the role that the media plays in sports medicine?

PB: The public know very little about sports injuries and what we as sports medicine doctors actually do. The media can be used as a very powerful vehicle to educate the public on sports medicine. In Australia, sports injuries are openly discussed in the media and in quite a lot of detail, so the average sports fan is quite knowledgeable on the subject. That doesn’t happen here in the UK. I think we should get out there and talk more to the media and break down this culture of secrecy in sport regarding injuries. The average punter knows what an orthopaedic consultant or cardiologist does but they have no idea what a sports physician does. We need to sell our profession.

A perfect example is the case of Fabrice Muamba. Two club doctors did an absolutely sterling job of keeping this guy alive but the sole media attention was that the cardiologist jumped the fence and played no role in the immediate resuscitation. We need to ensure credit is given where credit is due!

LW: I think we will leave it there with that powerful success story. Thanks for your insights into sports medicine Dr. Brukner.

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Dr Peter Brukner (@PeterBrukner) is an Associate Editor of BJSM and an Australian sports medicine physician, author and media commentator living in Liverpool, UK. Currently working with Sky Sports News and one of the sports physicians working with the Australian cricket team. He runs his own website,www.peterbrukner.com which is a site for provocative and insightful sport & exercise medicine columns.

 

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.