Should SEM have greater prominence in undergraduate curricula?

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

By Daniel Mauro

Launched in 2006, the Faculty of Sport and Exercise Medicine (FSEM) confirms the growth of the SEM speciality in the UK [1]. Every day, clinicians see illness related to physical inactivity. SEM is not just about elite athletes and sports injuries, it incorporates various areas including musculoskeletal medicine, exercise testing and prescription, developing population health and physical activity programmes and working with athletes individually or within teams [2]. Another recently developing area of medicine is ‘lifestyle medicine’. The British Society of Lifestyle Medicine has taken a lead on this, aiming to promote health and wellbeing in hope of preventing avoidable lifestyle related diseases [3]. It can be argued that despite SEM being a distinct speciality, there is insufficient teaching at the undergraduate level. Should there be dedicated teaching at an undergraduate level? What are the perceived benefits?

Medical students unaware of latest physical activity guidelines

Only 39% of men and 29% of women in the UK achieve minimum physical activity recommendations subjectively. This drops to just 5% of people when measured objectively [4]. This is an obvious issue that can be remedied through health promotion. Alarmingly, many final year medical students are not aware of current physical activity guidelines, with just 52% stating that they are confident delivering physical activity advice to patients [5]. These are the future clinicians best placed to provide such advice, and education in exercise medicine will provide them with principles and confidence to encourage patients to lead a more active lifestyle. Unfortunately, similar sentiments are felt from practicing clinicians. In primary care, many obstructions to promoting physical activity exist, including time constraints, lack of knowledge and once again, lack of confidence [6]. Incorporating SEM into undergraduate curricula could certainly improve future clinicians’ confidence to prescribe physical activity to their patients. Public health promotion and societal changes are needed to tackle the growing crisis related to obesity and inactivity. However, if those entering medicine now and in the future, are confident to address these issues, it will become the beginning of a solution to address this increasing health burden.

Currently, for many students, opportunities are only available via student selected modules, electives and intercalated degrees. A base knowledge level of SEM is expected of current and future graduates. A recent survey reported in the British Medical Journal [7], shows major differences within curricula regarding delivery of SEM. 76% have a direct focus on musculoskeletal medicine with only 40% focusing on SEM specifically. There is an even smaller number of UK medical schools directly assessing SEM knowledge. King’s College London has integrated a vertical stream of SEM lectures into their undergraduate curriculum, with SEM specific questions included in their exam question bank [8]. Many may argue that including SEM in the general medical curricula is impossible due to the breadth of topics needing to be covered. However, steps such as those at King’s College prove that there is a place for SEM at undergraduate level, in all areas rather than selective student modules.

What are the benefits of teaching SEM at the undergraduate level? 

Physical inactivity is a common contributor to major diseases, increased physical activity can lead to a 30% to 50% reduction of risk in developing conditions including cancer, ischaemic heart disease, diabetes, obesity, depression and dementia.4 It is estimated that NHS costs attributable to overweight and obesity will double to £10 billion per year by 2050 [9]. This is unsustainable in any financial market, particularly the current NHS. SEM can offer the NHS many different benefits such as preventing debilitating diseases, improving rehabilitation from these conditions and preventing co-morbidity. In addition to the direct benefits that can be reaped from helping to prevent and reduce musculoskeletal injuries – a large cost burden on the NHS.

Whilst it may be difficult to include some aspects of SEM into the current medical school curricula, an overview of exercise promotion and the risk of physical inactivity may stimulate doctors of the future to actively encourage healthy lifestyles. We see that all students passively know and acknowledge its benefit, however, an understanding of the underlying principles and reasons for health promotion are a starting block for such discussions.

It’s time to stop considering SEM as a subspecialty or niche that only those interested in should pursue. The inclusion of SEM in the undergraduate curriculum will not only promote the specialty but could benefit the NHS and population as a whole. SEM is a broad specialty which due to time and curricula constraints will not have a large focus of undergraduate teaching but surely deserves some attention in the ongoing battle against physical inactivity and obesity. It is time that SEM be considered an essential part of undergraduate education. It has a clear impact on a wide range of debilitating medical conditions and some medical schools have added this to their curricula, successfully. Other medical schools need to learn from these advancements and begin to integrate aspects of SEM into their wider curricula.

Daniel Mauro is a Foundation Year 1 doctor at the University Hospital of Wales, Cardiff. With a keen interest in Sport and Exercise Medicine and Medical education. Having not received formal education within Sport and Exercise Medicine during his undergraduate training he is interested to explore this. 

References

[1] Faculty of Sport and Exercise Medicine. About us. [online] Retrieved 08/11/17 http://www.fsem.ac.uk/about-us.aspx.

[2] Faculty of Sport and Exercise Medicine. Specialty training curriculum in Sport and Exercise Medicine. Joint Royal Colleges Physicians Training Board, 2006.

[3] British Society of Lifestyle Medicine. Welcome to the BSLM. [online] Retrieved 08/11/17 https://bslm.org.uk/.

[4] NHS Sport and Exercise Medicine Services. Sports and Exercise Medicine, A Fresh Approach. NHS North West, 2011.

[5] Dunlop M, Murray AD. Major limitations in knowledge of physical activity guidelines among UK medical students revealed: implications for the undergraduate medical curriculum. Br J Sports Med 2013; 47(11): 718-720.

[6] Hébert ET, Caughy MO, Shuval K. Primary care providers’ perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med 2012; 46: 625–631.

[7] Oluwajana F, Rufford C, Morrissey D. Exercise, sports and musculoskeletal medicine in UK medical school curricula: a survey Br J Sports Med 2011; 45: e1.

[8] Brooks J, 2013. Faculty of Sport and Exercise Medicine Annual Scientific Meeting. Undergraduate Teaching in SEM. [PowerPoint slides] Retrieved 09/11/17 http://www.fsem.ac.uk/media/25082/131024-fsem-presentation-john-brooks-nn.pdf.

[9] Government Office for Science. Foresight, Tackling Obesities: Future Choices – Project report. Department of Innovation Universities and Skills, 2007.

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