A well-defined educational curriculum has been established for the PM&R Sports Medicine Fellowship, including learning objectives, journal clubs, weekly educational conferences and an ongoing didactic board review discussion series.
The fellowship also includes formal training in diagnostic and interventional musculoskeletal ultrasound. Fellows complete reading assignments, participate in hands-on instruction and attend teaching sessions at the Mayo Clinic Procedural Skills Laboratory (anatomy lab). Fellows continually acquire additional ultrasound skills by participating in daily patient care activities in both the Sports Medicine Center and Musculoskeletal Clinic.
Fellows have full access to the Mayo Medical Libraries, including more than 4,000 electronic journals with sophisticated literature search capabilities and vast research support.
The focus of the fellowship's clinical training is on the evaluation and management of sports-related injuries and musculoskeletal problems that adversely affect a patient's ability to compete, exercise or maintain general fitness. Although the clinical focus is musculoskeletal, all aspects of a general sports medicine practice are encountered, such as exercise physiology, neurology, endocrinology, pulmonary and other medical aspects of sports. In general, these patients are seen in the Sports Medicine Center from 8 a.m. to 5:30 p.m., Monday through Friday.
Throughout the year, fellows rotate with sports medicine physicians from a variety of backgrounds, including physical medicine and rehabilitation (PM&R), pediatrics, emergency medicine and orthopedic surgery consultants. During the first several months of the fellowship, fellows work only under the direct supervision of consultants and are introduced to procedures of the Sports Medicine Center and Mayo Clinic in general. Fellows evaluate patients of the consultant with whom they are rotating. The consultant reviews the history and physical exam findings and staffs the patient with the trainee.
As fellows progress in clinical competency, they begin their own continuity clinic several half-days each week, working under indirect supervision with immediate consultant availability. The clinic schedule and types of procedures are progressed during the year based on the fellow's clinical competency. This facilitates the advancement of trainee clinical skills under a model of progressive supervision.
Fellows receive instruction on sports injury history-taking, physical exam findings and techniques, the use and interpretation of appropriate diagnostic imaging and related testing, and therapeutic injections (including ultrasound guidance). Throughout the remainder of the year, trainees are given progressive responsibilities based on clinical progress.
The PM&R and orthopedic sports medicine staff instruct and assist fellows in developing differential diagnoses as well as sport- and patient-specific treatment plans for common complaints and injuries.
Aspects covered in the treatment plan include:
- Indications for operative and nonoperative treatment of injuries
- Evaluation and management of concussions as part of the Sports Medicine Center concussion program
- Appropriate use of modalities and scientific rationale
- Prescription of targeted stretching techniques
- Prescription of specific strengthening techniques:
- Isometric, isotonic, isokinetic and more
- Concentric and eccentric
- Open kinetic chain and closed kinetic chain
- Proprioceptive and neuromuscular control retraining
- Principles of functional progression:
- Treatment plan modification
- Return-to-play criteria
- Indications for additional objective testing, such as KT2000, Cybex and gait analysis
- Prescription of various orthoses
- Use of ultrasound for diagnosis of musculoskeletal and sports medicine conditions
- Compartment pressure testing
- Appropriate use of diagnostic and therapeutic injections pertinent to sports-related injury
- Ultrasound-guided procedures:
- Peripheral joint and bursa injections
- Perineural injections and blocks
- Calcific tendon barbotage
- Percutaneous mechanical neo-vessel and nerve ablation (tendon scraping)
- Percutaneous needle tenotomy
- Percutaneous ultrasonic tendon and fascia debridement using the Tenex device
- Percutaneous releases
- Platelet-rich plasma preparation
- Bone marrow aspiration and preparation of bone marrow concentrate
Fellows learn the appropriate indications for consulting specialists in sports psychology (and through this interaction, the psychological impact of sports injuries), neuropsychology, brain injury, sports nutrition, as well as other medical and surgical specialists.
Fellows also participate in:
- Rochester Community and Technical College football coverage and weekly/biweekly training room
- Coverage of area high school football and hockey games
- Multiple-team local tournaments
- National and regional sporting events that regularly occur in Rochester
- The annual Med City Marathon, Rochester Half Marathon and Rochester Triathlon
- Pre-participation examinations of local high school students and Rochester Community and Technical College students
- High school wrestling weight certification, skin examinations and tournament coverage
Clinical training also includes specific clinical learning experiences with the sports medicine physical therapy and athletic training staff. During these experiences, the fellow observes and participates in patient evaluation, movement analysis, orthosis prescription and therapeutic exercise prescription.
Fellows are scheduled for the majority of their time in the Sports Medicine Center. In addition, trainees spend approximately one half-day each week in the Musculoskeletal Clinic.
Supplementary clinical rotations are scheduled during the 12-month fellowship and include:
- Pediatric orthopedic sports medicine
- Adult orthopedic sports medicine
- Cardiovascular Health Clinic
- Sports performance (sports psychology, nutrition, and strength and conditioning)
In addition, following the first three months of fellowship, trainees may also participate in various electives such as:
- Electrodiagnostic Laboratory
- Cast Room
- Hand Clinic
- Foot Clinic
- Pain Clinic
- Spine Center
- Mayo Clinic Square (Minneapolis) Sports Medicine Center
There is no call schedule. However, fellows are required to participate in sporting event coverage and pre-participation examinations as previously described. As implied, many of these activities occur outside of normal working hours. However, in compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements, patient care duties, including athletic coverage, will not exceed the 80-hour-a-week limit, and fellows will have at least a 24-hour period each week free from patient care duties.
Fellows may participate in a research training course for clinicians, which is coordinated through the Center for Clinical and Translational Science (CCaTS) at Mayo Clinic. This is typically scheduled in the fall.
A weekly sports medicine conference occurs each Thursday morning. The format of this conference is typically case presentations, in which cases are presented and discussed by various sports medicine staff, including the trainee. The fellow shares responsibility of organizing this weekly conference with the orthopedic sports medicine fellow.
An all-staff Sports Medicine Center Journal Club occurs quarterly, supplemented by a monthly Sports Medicine Journal Club held by the program director, associate program director, fellow and rotating PM&R residents. The fellow is responsible for organizing the Sports Medicine Center Journal Club sessions.
A comprehensive didactic curriculum is scheduled throughout the year, covering all primary care and orthopedic sports medicine topics relevant for the practice of primary care sports medicine. Didactic sessions are held weekly and are facilitated by Mayo Clinic Sports Medicine staff, including physiatrists, orthopedic surgeons and other sports medicine physicians. Fellows have access to the board review lectures on video.
As previously described, fellows complete an in-depth didactic experience in diagnostic and interventional musculoskeletal ultrasound, consisting of reading assignments, weekly scanning sessions, and seven or eight cadaveric sessions throughout the 12-month fellowship.
During the day-to-day activities of the fellowship, the fellow directly interacts with Mayo Clinic Sports Medicine staff, including supervising physicians, physical therapists and athletic trainers.
In addition to the above, the sports medicine fellow is provided with these educational opportunities:
- PM&R Department Journal Clubs
- Weekly PM&R Grand Rounds each Monday at noon
- Department of Orthopedic Surgery Grand Rounds each Monday morning, during which general orthopedic topics are discussed
- Participation as a teaching assistant during the annual PM&R Resident Musculoskeletal Course (five months of weekly anatomy, physical examination and ultrasound instruction sessions)
- Teaching of medical students and residents from the PM&R, internal medicine, family medicine, pediatrics and rheumatology departments who rotate through the Sports Medicine Center
- Teaching learning objectives to PM&R residents weekly (after the first two to three months)
- Community teaching activities, such as lecturing at the local athletic clubs
The program directors and all consultants with whom the trainee rotates provide a quarterly review of the fellow's performance. A final year-end review also is completed.