Dr Aideen Henry writes about the growing medical specialty of sports and exercise medicine and outlines the undergraduate and postgraduate study programmes in NUI Galway
Sports and exercise medicine has become a rapidly growing medical specialty around the world, as it is realised that the practice of sports and exercise medicine requires the application of special skills, sensitivities and knowledge that is multidisciplinary.
Sports and exercise medicine is a discipline that draws upon basic and applied biomedical and clinical sciences with the knowledge to ensure best practice in the prevention, diagnosis and management of sports and exercise-related clinical problems. This discipline is relevant to the whole population and seeks to promote health, to prevent disease and injury, to apply optimum treatment and to measure outcomes.
In practical terms, the services that can be provided by doctors fully trained and qualified in sports and exercise medicine are very wide-ranging and include the assessment of musculo-skeletal injury in both athletes and the active population.
They also include exercise prescription appropriate to health and disease (including obesity, asthma, diabetes and heart disease), medical cover of mass participation events (such as marathons), pre-participation medical assessment, team doctor responsibilities (both at home and travelling abroad with teams or squads) and involvement in education training and research in this important aspect of healthcare.
Training in sports and exercise medicine also provides doctors with specialist knowledge important for dealing with problems relating to diving medicine, exercise in stressful environments (e.g. extreme heat or cold) or at high altitude.
Situation in Ireland
With support from the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland, a joint Faculty of Sports and Exercise Medicine was established in 2001. The Faculty of Sports and Exercise Medicine (RCSI and RCPI) was formally launched by the Minister for Arts, Sports and Tourism John O’Donoghue in September 2002.
In 2004, the Medical Council recognised sports and exercise medicine as a specialty and the Faculty is now the recognised body in the State for the purpose of granting evidence of satisfactory completion of specialist training in sports and exercise medicine. The Faculty currently has almost 500 members and fellows in Ireland and overseas.
NUIG: undergraduate medical education
A central aim of the Faculty of Sports and Exercise Medicine is the promotion of undergraduate medical education. NUI Galway has developed a five-year modular, systems-based, integrated undergraduate programme. Special study modules (SSMs) form an important element of this curriculum.
The concept of SSMs arose as a response to the recommendations of the General Medical Council to medical schools in the United Kingdom. Optional modules that allow the student to spend more time studying subjects of particular interest to them in more depth represent ‘the most exciting and significant development in medical education thinking in recent years’.
The SSMs in Sports Psy-chology, High-Altitude Medicine and Exercise Physiology have been developed at NUI Galway with the aim of implementing these recommendations and introducing topics from the specialty of sports and exercise medicine to the undergraduate medical curriculum.
a) SSM in Sports Psychology
This introduces students to the principles involved in mental preparation for optimal performance in sport, which includes learning about imagery techniques, focus and concentration, managing anxiety, motivation and goal-setting. Students are assessed on their assignments and group work.
This SSM is honoured to have the involvement of Paul Hession, Olympian sprinter and holder of the Irish national records for 100 metres and 200 metres, who shares his unique experience in this area and tutors students on this module.
b) SSM in High-Altitude Medicine
This introduces students to the pathogenesis, diagnosis and management of high-altitude illness, with an emphasis on the prevention of this condition in trekkers and mountaineers. A lecture series is complemented by case-study discussion sessions and practical training in the use of a portable hyperbaric chamber.
Students are assessed by means of assignments, a group project and viva examination. Dr Gerard Flaherty, Fellow of the Faculty of Sports and Exercise Medicine/Member of the Education Committee of the European College of Sport and Exercise Medicine, designed and delivers the module.
c) SSM in Exercise Physiology
Students are introduced to the physiologic responses and adaptations that occur with exercise, the concept of training and the principles of fitness assessment. Students join the Masters in Sports and Exercise Medicine students in attending relevant lectures and practical classes in fitness assessment.
Practical laboratory sessions involve the measurement of various indices of flexibility and strength in a group of local schoolchildren. This group laboratory project is assessed by means of a poster presentation.
d) Future SSMs being developed
SSMs in Sports Nutrition, Exercise Prescription and Musculoskeletal Examination in Sports Injuries are being developed and these will help broaden the knowledge base for medical students with an interest in this specialty.
NUIG: postgraduate medical education
In 2005, the Masters in Sports and Exercise Medicine commenced at NUI, Galway in response to the increasing need for higher training and qualifications for medical doctors working with recreational and elite athletes and with the increasing role of physical activity in the prevention and treatment of disease.
Many of the professional sporting organisations require team doctors working with them to have a Masters in Sports and Exercise Medicine qualification. This is a two-year, part-time programme, modular in structure made up of two semesters per year and two modules per semester.
Each module has 30 hours’ contact time (lectures/laboratories/clinical teaching) and 90 hours’ study time (including working with teams).
The programme runs from September to April, and students complete their dissertation over both summer breaks.
The MSc has attracted applications from medical doctors in many different specialties including general practice, orthopaedics, emergency medicine, rheumatology and anaesthetics, which reflects the wide sweep of specialties where sports and exercise-related problems present.
Studies have demonstrated that between 12 per cent and 18 per cent of patients presenting to emergency departments are suffering from a sports injury and that between 10 per cent and 12 per cent of primary care consultations are related to musculoskeletal complaints – of which a large proportion can be ascribed to sports injuries.
The MSc programme provides doctors with:
-The necessary scientific background knowledge to appreciate the issues arising in the field of sports and exercise medicine;
-The necessary skills and knowledge to provide advice on the prevention of sports injuries;
-Up-to-date training in modern methods of assessing, diagnosing and treating sports injuries including emergency care;
- Opportunities to learn about the theory and application of sports psychology, podiatry, biomechanics, sports nutrition, sports pharmacology, exercise physiology, fitness assessment and ethical issues within sport;
-An opportunity to learn about the medical applications of exercise in health and in disease;
-An introduction to research appropriate to sports and exercise medicine.
Lecturers within NUI Galway, from University College Hospital Galway, Merlin Park Hospital, Mayo General Hospital and the Galway Clinic contribute to the programme. Visiting lecturers from the Society of Orthopaedic Medicine and general practitioners with an involvement in team sport also contribute their knowledge and expertise.
As the MSc in Sports and Exercise Physiotherapy runs concurrently with the MSc in Sports and Exercise Medicine, chartered physiotherapists also contribute to the teaching programme. Former Olympians such as Éadaoin Ní Challaráin (kayaking) and Patrice Dockery (wheelchair athlete) and elite coaches from different sports also share their experiences with the students. Students also visit the Exercise Physiology Department at University of Limerick and Dublin City University.
The use of special study modules is an educationally desirable and effective vehicle for introducing sports and exercise medicine to the undergraduate medical curriculum. The Masters in Sports Medicine enables doctors already in clinical practice to increase their knowledge across sports and exercise medicine and to learn further skills necessary to put this knowledge into practice.
References on request.
Dr Aideen Henry, Director, MSc in Sports and Exercise Medicine, MSc in Sports & Exercise Physiotherapy, NUI Galway. Foundation Fellow and former Honorary Secretary to the Board of the Faculty of Sports and Exercise Medicine, RCPI and RCSI. Former National Medical Screening Co-ordinator for Olympic Athletes for the National Coaching and Training Centre, University of Limerick.