We invited Dr Fariz Ahamed to share his perspective on Sport and Exercise Medicine (SEM) in his home country, Sri Lanka.

 

 

Tell us more about yourself

I am a SEM Physician and a Co-Editor of the Sri Lankan Sports Medicine Association (SLSMA). I’ve served as an executive committee member of the SLSMA since 2010 and worked for two decades in the fields of SEM, general surgery, and orthopedics in both Sri Lanka and overseas. At present, I work within the SEM Department of the National Hospital of Sri Lanka.

I completed my post-graduate Diploma in Sports Medicine in 2009 at the University of Colombo and was the first practicing sports medicine specialist to be registered in the Ministry of Health (Sultanate of Oman) following successful Oman Medical Specialty Board (OMSB) examination in 2011. Later in 2017, I was selected to study the newly developed Doctor of Medicine in SEM (MD-SEM) programme at the Post-Graduate Institute of Medicine at the University of Colombo (completed: 2021). Upon completion of my post-MD overseas training, I will become the first consultant SEM in Sri Lanka.

During my career and post-graduate training, I have participated in several national and international sporting events and athletic championships as a sports physician. Moreover, I have contributed to several SEM symposia and helped form the Sri Lankan national guideline for exercise prescription for the management of hypertension. I also aided in establishing the National SEM Center at the National Hospital of Sri Lanka. My research focuses on orthopedic sports medicine, and I am currently exploring outcomes of arthroscopic Bankart repair for anterior shoulder instability among Sri Lankan athletes.

 

 

What is the path to become a sport and exercise physician/physio/scientist in Sri Lanka, and what are the main hurdles on this path?

SEM as a speciality is relatively new in Sri Lanka with many enthusiastic young doctors and physiotherapists keen to commence training in this space. Successful SEM specialists have the opportunity to work in SEM units at hospitals, as part of the Ministry of Health, as well as at the Institute of Sports Medicine (Ministry of Sports).

To embark on SEM training as a speciality, it is mandatory to have MBBS and completion of an internship as a primary qualification. Study pathway to obtain qualification as a board-certified SEM consultant includes:

1. Being one of the 12 candidates per year, on average, chosen based on merit following the selection examination of the post-graduate Diploma in SEM conducted by Post-Graduate Institute of Medicine, University of Colombo.
2. Completion of the post-graduate Diploma in Sports Medicine, which is a one-year program with lecture modules and clinical placement at sport facilities and hospitals.
3. Chosen based on merit following the selection examination for the MD-SEM degree.
4. Completion of the MD-SEM degree, which involves being a registrar in SEM for 30 months with multiple clinical rotations at hospitals and sports institutions.
5. Completion of the MD-SEM exit exam, which includes a research component and one-year post-MD local training at hospitals and sports institutions.
6. Completion of a one-year post-MD overseas training.
7. Successful application and board certification as a consultant (SEM).

Sports physiotherapy does not have an associated Master degree and is currently based on undergraduate study in physiotherapy with a major in sports. However, new proposals have recently been approved for a Master of science (Sports Physiotherapy). Unfortunately, Sri Lanka is yet to establish an accredited strength and conditioning training program, which tends to force those interested in these qualifications to complete short courses at institutions abroad.

Notable hurdles on the path to becoming an SEM-based clinician include, yet are not limited to:

1. Most national-level athletes in Sri Lanka are from lower socioeconomic backgrounds. Being a developing country, it is difficult to find insurance systems to cover athlete financial burden, which heavily influences the uptake of SEM.
2. SEM involves many advanced technologies such as those associated with MSK imaging, sport biomechanics, podiatry, exercise physiology, sports psychology, and speciality training. Inadequate training facilities, logistics and human resources are therefore rate-limiting factors.

• Overseas SEM training and financial support is currently lacking in Sri Lanka, and this would aid in the advancement of the SEM field within Sri Lanka.

 

How developed is collaborative work in SEM in Sri Lanka?

Collaboration is common among orthopedic surgeons, radiologists, rheumatologists, clinical nutritionists, and general physician. Moreover, most physiotherapists attached to the national-level rugby, cricket and athletic teams tend to have a greater rapport with SEM physician working at hospitals and the Institute of Sports Medicine. However, collaboration is less common among exercise physiologists, podiatrists, kinesiologists, and sports scientists due to the aforementioned hurdles in the SEM field.

 

Are exercise physiologists/scientists integrated into your healthcare system, and does health insurance cover for their services?

Unfortunately, Sri Lanka does not currently have the established pathways to integrate these professions within the healthcare system. Talks are currently underway to overcome this limitation, yet until this is addressed, healthcare in these spaces will remain suboptimal. Much of this stems from the aforementioned hurdles in the field.

 

What is done in Sri Lanka to promote SEM among students and young professionals regarding research and clinical opportunities?

The SLSMA was established in 1992 as the professional body to represent medically qualified doctors with special interest and post-graduate training in sport medicine. This has led to several national and international congresses to promote sports medicine awareness among medical professionals and the general public. Following these efforts, SEM was initially recognised by the Post-Graduate Institute of Medicine as a speciality in 2007 and eight student cohorts have since completed training. The first cohort of MD-SEM completed in January 2021 and currently two cohorts are in training. These trainees will have to assume duties as acting consultants at the end of post-MD overseas training. Additionally, SLSMA frequently conduct CPD programs and annual conferences with pre-congress workshop and courses in sports medicine, anti-doping, MSK imaging, athletic taping and post graduate teaching.

Both the Post-Graduate Institute of Medicine and SLSMA have worked tirelessly with the Ministry of Health and Ministry of Sports to establish cadre positions for SEM trainees and consultants in major hospitals throughout Sri Lanka to expand the clinical opportunities for aspiring specialists. Research has been introduced as a compulsory requirement for MD-SEM exit exam and board certification as a consultant. This has recently prompted many trainees in SEM to focus on research and evidenced based SEM.

 

Finally, if you were Harry Potter, what would you change to SEM in Sri Lanka?

Harry Potter!!!

From fantasy novels to novel approaches, I would first promote SEM in Sri Lanka. Focusing on a nationwide awareness program on SEM from pre-school to multi-sector public and private institutions would be a great start. This could be achieved by incorporating sports medicine in medical school curricula and undergraduate levels.

The aforementioned SEM professions that are less integrated into the healthcare system would benefit from further integration. There is a need to establish better referral pathways, which should form part of national guidelines and position stands. Only with appropriate collaboration can we expect benefits from sports and exercise at the population-level.

Finally, insurance policies regarding SEM in Sri Lanka needs an overhaul. This is currently a rate-limiting factor across the field and without financial support, we cannot expect to overcome the myriad hurdles facing the advancement of the SEM field in Sri Lanka.