At the end of this two week rotation and after completing the three year longitudinal curriculum, the resident will develop the skills necessary to serve as health advisors and motivators for all ages.  Moreover, the resident will be able to recognize, assimilate, and master those aspects of orthopedic problems and medical diseases that are specific to the care of the athlete.  This will include provision of pre-participation physical evaluations and plans as well as assessment and care of the injured athlete.  At the conclusion of this training the resident will have the knowledge and skills to manage the majority of medical issues, concerns and injuries seen by a family physician and recognize those conditions or problems that require appropriate referral on consultation.  These skills will be obtained in several settings including the orthopedic/sports medicine specialist's office practice, the FMC, the hospital, emergency room and didactic lectures.

Goal I: To gain the knowledge and skills to manage the orthopedic problems and medical diseases of the athlete commonly seen by Family Physicians.

 Goal II: Recognize the need for proper referral and consultation to a specialist for those orthopedic problems and medical diseases of the athlete that are beyond his/her capabilities.

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.  Residents are expected to:

Competencies

• Correctly apply taping, strapping and bracing, for joint protection.
• Correctly apply splints or casts for joint immobilization.
• Correctly administer a joint injection.
• Assist in the surgical care of an athlete.
• Correctly interpret an orthopedic x-ray.
• Correctly perform pre-participation physical evaluations

Objectives

The resident will

• Observe, discuss, and learn the proper application of a patient appropriate brace, splint, or cast.

• Observe, discuss, and learn the approach to orthopedic x-ray evaluation.
• Learn appropriate use of MRI, CT and bone scanning
• Observe, discuss, and learn to perform appropriate joint injection and soft tissue injection based on anatomic site.
• Surgically assist the preceptor in the surgical management of sports medicine problems.
• Learn the importance of a thorough pre-participation physical evaluation of an athlete.

Goal

Residents must integrate sports medicine knowledge and the Family Medicine, patient-centered philosophy of practice.  Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and behavioral sciences as they pertain to the care of the athlete. Residents are expected to:

Competencies

• Be able to assess/evaluate the athlete with joint pain.
• Be able to assess/evaluate the athlete with extremity pain.
• Be able to assess/evaluate the athlete with an acute musculoskeletal injury.
• Be able to assess/evaluate the athlete at risk for eating disorders.
• Be able to assess/evaluate the athlete in need of rehabilitation.
• Be able to assess/evaluate the athlete abusing substances such as steroids.
• Be able to assess/evaluate the acute problems in athletes with concomitant chronic diseases.

 Objectives

The resident will:

• Discuss the proper approach to joint pain and extremity pain with his/her sports medicine preceptor and develop appropriate examination techniques, differential diagnoses, and treatment plans.
• Discuss the appropriate approach to the athlete with an acute injury with his/her preceptor and develop necessary differential diagnoses and treatment plans to ensure proper patient care.
• Discuss with his/her preceptor and develop appropriate treatment plans for athletes with eating disorders and substance abuse problems.
• Discuss with his/her preceptor and the appropriate evaluation and selection of rehabilitation plans for the injured athlete.
• Discuss the proper approach to athletes with concomitant diseases with the preceptor.

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.  Residents are expected to:

Competencies

• Identify strengths, deficiencies, and limits in one's knowledge and expertise
• Locate, appraise, and assimilate evidence from scientific studies that relate to the health problems of their patients/athletes.
• Evaluate their clinic panels for quality measures in the care of athletes.

Objectives

• The resident will understand the need for appropriate referral or consultation for complex problems with the athlete.
• The resident will understand how medical knowledge with regard to care of the athlete changes over time and how evidence based practice techniques will help assure that the care of the athletes remains up to date.
• The resident will understand how quality health care of the athlete depends on evaluation of his/her performance compared to established treatment guidelines and techniques to improve his performance through a process of quality improvement.

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.  Residents are expected to:

 Competencies

• Work effectively in various health care delivery settings and systems relevant to their clinical specialty.
• Coordinate patient care within the health care system relevant to their clinical specialty.

 Objectives

• The resident will gain an understanding of the delivery of care to the athlete regardless of in-patient or out-patient setting
• The resident will learn to coordinate in-patient and out-patient care of the injured athlete including but not limited to: physical therapy, occupational therapy, rehabilitation medicine, wound care, etc.

• Advocate for quality patient care and assist patients in dealing with system complexities

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.  Residents are expected to demonstrate:

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

 Objectives

• The resident will encounter a vastly diverse group of athletes based on exposure to the private sports medicine clinic, hospital and emergency room.

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates.  Residents are expected to communicate effectively with other physicians, staff, patients and families.

Direct preceptor/resident interaction in the inpatient and outpatient settings. 

At the conclusion of each resident rotation, the residency coordinator sends a formative-type, rotation-specific performance evaluation form to the rotations' supervising physician.  When the completed evaluation is returned, the resident physician and the resident's faculty advisor review the evaluation and attest to reviewing it by signing/initialing the form.  Next, the program director reviews and attests to the document.  Once all three have reviewed and attested the evaluation, it is included in the resident's permanent file. 

 Each resident is asked to evaluate the rotation and supervising physician(s) at the end of the rotation.  The resident's faculty advisor and program director review the evaluation and attest to reviewing it by signing/initialing the form. These evaluations are filed together by resident year.

The resident is under the direct supervision of the assigned sports medicine preceptor. 

RESOURCES DISTRIBUTED FOR ROTATION:

 REQUIRED:

American Academy of Family Physicians et al:  Preparticipation physical evaluation (PPE):  A joint publication.  American Academy of Family Physicians et al, Kansas City, MO., 2^nd edition.

 SUPPLEMENTAL:

Maron BJ, et al:  Cardiovascular preparticipation screening of competitive athletes.  Circulation.  94:850-856.

Himes JE, Campbell DC:  Sports medicine. Textbook of family practice. Ed.  Robert Rakel.  5^th Edition.  891- 914.

Scarpinato L:  Clearing athletes for sports participation.  Hosp Prac, 120-121.

Marron JT, Tucker JB:  The preparticipation health inventory.  Sports medicine for the primary care physician.  Ed. Richard Birrer. 2^nd Edition.  15-26.

Grafe, MW, Paul GR, Foster TE:   The preparticipation sports examination for high school and college athletes.  Clinics in Sports Medicine, 569-591.

Bratton RL, Agerter DC:  Preparticipation sports examinations.  Postgraduate Medicine, 123-132.

Garrick JG:  Orthopedic preparticipation screening examination.  Pediatric Clinics of North America. Vol. 37. No. 5: 1047-1057.

Fields KB, Delaney M:  Focusing the preparticipation sports examination.  Jour Fam Prac. Vol. 30, No. 3:  304-312.

Rifat SF, Ruffin MT, Gorenflo DW:  Disqualifying criteria in a preparticipation sports evaluation.  Jour Fam Prac. Vol. 41, No. 1:  42-50.

Group on Science and Technology, American Medical Association.  Athletic preparticipation examinations for adolescents:  report of the Board of Trustees.  Arch Pediatr Adolesc Med., 148:93-98.

Faber KJ, Singleton SB, Hawkins RJ:  Rotator cuff disease:  diagnosing a common cause of shoulder pain.  Journal of Musculoskeletal Medicine.

Woodward TW and Best TM:  The painful shoulder:  part 1. clinical evaluation.  American Family Physician,; Vol. 61, No. 10:  3079-3088.

Woodward TW and Best TM:  The painful shoulder:  part 2.  Acute and chronic disorders.  American Family Physician, Vol. 61, No. 11:  3291-3299.

On Line resources:

UpToDate and DynaMed