All Aboard! The future of Sport and Exercise Medicine awaits.

By Justin Carrard @CarrardJustin, Stephen McMahon @SteveMcMahon855, Steffan Griffin @SteffanGriffinand Liam West @Liam_West

The benefits of incorporating Sport and Exercise Medicine (SEM) into the undergraduate curriculum are known, but we rarely see it in practice (1-4). We are therefore proud to highlight that SEM is now a part of the undergraduate medical curriculum in Nottingham (UK), South Carolina (USA) and Tehran (Iran) (5-7). Irrespective of these initiatives, the vast majority of medical students globally have limited or no contact with SEM consultants during their medical education. In fact, many medical students are still unaware that SEM exists as a discipline or specialty pathway. Fortunately, evidence suggests that medical students want to learn more about physical activity for health (8).

Medical education differs both within and between countries. In most cases it follows a top-down approach in which a national body decrees a teaching programme, which is then applied and adapted by universities. We propose a lobbying strategy (inclusive of both top-down and bottom-up approaches) that the SEM community could use to implement SEM into undergraduate curriculum as illustrated in Figure 1 below.

Figure 1: Top-down and bottom-up lobbying approaches. Wide arrows represent the traditional top-down approach usually used to elaborate undergraduate medical teaching programme. Narrow arrows represent the two suggested lobbying approaches. Arrowheads indicate the recommended direction of communication.

 

SEM should be taught at all medical schools worldwide by specialist SEM Physicians, Sport & Exercise Physiotherapists and Accredited Exercise Physiologists.

We therefore call the SEM community to lobby to national medical education bodies and universities to engage and recruit SEM professionals into medical schools to teach this content. This represents the traditional top-down lobbying approach.

We expect a time delay before SEM teaching can be effectively implemented at an undergraduate level, we propose a simultaneous bottom-up approach in which the SEM community actively and immediately seeks contact with medical students. This can take the form of extracurricular lectures, workshops, placements, mentoring programs or establishing undergraduate SEM associations.

Step 1: Start with a SEM Association!

In our opinion, SEM Associations are how we can fill the current void created by a deficiency of SEM teaching at the undergraduate level. These associations organise local and national events to draw students’ attention to the solutions that SEM can help with e.g., managing non-communicable diseases (NCD) and musculoskeletal (MSK) pathologies. These Associations are well positioned to lobby to expand the SEM content in the undergraduate curriculum. SEM student associations also provide valuable networking opportunities, like-minded communities and the possibility to share a passion with peers.

In the United Kingdom, the first undergraduate Sport and Exercise Medicine (SEM) Society was initiated in 2010 at the Cardiff University. Currently, to satisfy the growing interest in SEM, there are 27 similar student societies across the UK. To our best knowledge, there are also three national SEM associations across the world dedicated to both undergraduate and newly graduated medical / physiotherapy students interested in pursuing a career in SEM. These are the UK Undergraduate Sport & Exercise Medicine Society (USEMS); the Australian Sports & Exercise Medicine Students’ Association (SEMSA); and the Swiss Students & Junior Doctors SGMS/SSMS. We believe that there is potential for similar associations in numerous countries around the world and would be pleased to facilitate their development. Given this, we also call all national SEM Societies, Colleges, Faculties and SEM Consultants to assist, encourage and support motivated students to establish SEM associations in your respective countries. The authors of this paper are very happy to help – please reach out to us to kick-start your local undergraduate SEM revolution!

SEM has an essential clinical role and important disease prevention and mitigation role in current and future healthcare climates. Basic SEM knowledge and skills would be of great benefit to prevent and alleviate the growing NCD and MSK burden of disease. We must provide all future medical doctors with core SEM knowledge and skills in order to confront this global health crisis – not just those physicians who formally specialize in SEM. To attain this goal, we implore the SEM community to advocate on our behalf to include adequate SEM teaching at the undergraduate level, to support students establishing undergraduate SEM associations and finally to support students embarking on their initial first steps of their SEM career journey. We believe that you, the reader, could really help us with the bottom-up approach and improve the visibility and imprint of SEM globally.

***

Justin Carrard @CarrardJustinis a resident and researcher at the Division of Sports & Exercise Medicine, Department of Sports, Exercise and Health, University Basel. In addition, he is a SGSM/SSMS board member and the President-Founder of Students & Junior Doctors SGSM/SSMS. As a former competitive swimmer, he has a keen interest for endurance sports and regularly practices them with passion. Email Justin.carrard@unibas.ch

Stephen McMahon@SteveMcMahon855is final year medical student at University of Notre Dame Australia, Ballarat Rural Clinical School and SEMSA President (Sports & Exercise Medicine Students Australia). Previous careers as an Exercise Physiologist and Biology/Physical Education Teacher. As a Level 4 Athletics Distance Coach, appointed Team Manager/Coach to both Victorian & Australian Schools Teams and personally coached the 2010 World Schools Cross Country Champion & Team Silver medalists in Slovakia. Former national level senior & junior distance runner (Australian Junior, Australian Universities & Victorian Open Champion and Australian Open Medallist) who has competed in Ireland and UK. Email: stephen.mcmahon1@my.nd.edu.au

Steffan Griffin @SteffanGriffinis a junior doctor working in Central London, developing the skills to work in SEM. He is a member of the BJSM Editorial Team, a board member of the ISEM, and is gaining clinical experience within various SEM settings. He has an active interest in emergency medicine, rugby medicine and concussion in particular. Email steffangriffin@gmail.com

Dr. Liam West @Liam_Westis a Sports & Exercise Medicine Registrar at Olympic Park Sports Medicine Centre (OPSMC), Melbourne Australia but also spends time providing medical services within elite sport. Prior to coming to Australia he founded both the UK and European student / junior doctor SEM societies. Email liamwestsem@hotmail.co.uk

Acknowledgements We thank Daniel Phillips (University Hospital of Wales) for his intellectual input.

References

  1. Dacey ML, Kennedy MA, Polak R, et al. Physical activity counseling in medical school education: a systematic review. Medical Education Online. 2014;19:24325-.
  2. West LR. Sport and exercise medicine in the undergraduate curriculum. Are we inspiring the next generation of sport and exercise medicine doctors and helping them overcome the barriers they face getting into the specialty? British Journal of Sports Medicine. 2013;47(11):664-5.
  3. Pandya T, Marino K. Embedding sports and exercise medicine into the medical curriculum; a call for inclusion. BMC Medical Education. 2018;18(1):306.
  4. Kordi R, Moghadam N, Rostami M. Sports and exercise medicine in undergraduate medical curricula in developing countries: a long path ahead. Medical Education Online. 2011;16:10.3402/meo.v16i0.5962.
  5. Noormohammadpour P, Halabchi F, Mazaheri R, et al. Designing and implementing a curriculum for Sports and Exercise Medicine elective course for undergraduate medical students of Tehran University of Medical Sciences. British Journal of Sports Medicine. 2018.
  6. Trilk JL, Phillips EM. Incorporating ‘Exercise is Medicine’ into the University of South Carolina School of Medicine Greenville and Greenville Health System. British Journal of Sports Medicine. 2014;48(3):165-7.
  7. Gates AB. Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients. British Journal of Sports Medicine. 2015;49(4):207-8.
  8. Osborne SA, Adams JM, Fawkner S, et al. Tomorrow’s doctors want more teaching and training on physical activity for health. British Journal of Sports Medicine. 2017;51(8):624-5.

 

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