A well-defined educational curriculum has been established for the fellowship, including learning objectives, journal clubs, weekly educational conferences, and an ongoing didactic 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.
The Sports Medicine Library is housed in the Sports Medicine Center to complement the learning experience. This library is stocked with the latest sports medicine texts, instructional videos, models to practice peripheral injection techniques, and recent sports medicine journals. In addition, fellows have full access to the Mayo Medical Libraries, including over 1000 electronic journals and sophisticated literature search capabilities.
Clinical training focuses 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 will be encountered (i.e., exercise physiology, neurology, endocrinology, pulmonary and other medical aspects of sports). In general, these patients will be seen in the Sports Medicine Center from 8 a.m. to 5:30 p.m., Monday through Friday.
Fellows rotate with Physical Medicine & Rehabilitation (PM&R) and Orthopedic Surgery consultants during the first two to three months of the fellowship. During that time, fellows 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 fellow. 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, fellows are given progressive responsibilities based on clinical progress.
The PM&R and Orthopedic sports medicine staff instruct and assist fellows in developing differential diagnoses and sport-and patient-specific treatment plans for common complaints and injuries. Aspects covered in the treatment plan will include:
- Indications for operative and nonoperative treatment of injuries
- Appropriate use of modalities and scientific rationale
- Prescription of targeted stretching techniques
- Evaluation and management of concussions, as part of the Sports Medicine Center Concussion Program.
- Prescription of specific strengthening techniques
- Isometric, isotonic, isokinetic, etc.
- Open kinetic chain/closed kinetic chain
- Proprioceptive/Neuromuscular control retraining
- Principles of functional progression
- Treatment plan modification
- Return to play criteria
- Indications for additional objective testing (i.e. KT2000, Cybex, gait analysis)
- Prescription of various orthoses
- Appropriate use of diagnostic/therapeutic injections pertinent to sports-related injury
- Use of ultrasound for diagnosis of musculoskeletal conditions
- Ultrasound-guided injections
- Fellows also learn the appropriate indications for consulting specialists in sports psychology (and through this interaction, the psychological impact of sports injuries), neuropsychology/concussion, and sports nutrition, as well as other medical and surgical specialists.
Fellows also participate in:
- Coverage of area high school football and hockey games
- Multi-team local tournaments
- National and regional sporting events which regularly occur in Rochester
- The annual Med City Marathon
- Pre-participation examinations of local high school students and Rochester Community and Technical College
- High school wrestling weight certification/skin examinations
Clinical training will also include specific clinical learning experiences with the Sports Medicine Center 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.
The fellow is scheduled for the majority of his or her time in the Sports Medicine Center. In addition, fellows spend approximately one-half day each week in the Musculoskeletal Clinic and one-half day every other week in the Electrodiagnostic Laboratory. Supplementary mandatory clinical rotations are scheduled during the 12-month fellowship and include Pediatric Orthopedic Sports Medicine, Adult Orthopedic Sports Medicine, Cast Room, Cardiovascular Health Clinic, and Sports Psychology. In addition, following the first three months of fellowship, fellows may also participate in various electives such as:
- Hand Clinic
- Foot Clinic
- Pain Clinic
- Spine Center
A weekly sports medicine conference occurs each Friday morning. The format of this conference is typically case presentations, in which cases are presented and discussed by various Sports Medicine Center staff, including the fellow.
An all-staff Sports Medicine Center Journal Club occurs quarterly, supplemented by a monthly Sports Medicine Journal Club held by the program director, assistant program director, fellow, and rotating PM&R residents. The fellow is responsible for the organization of the cases conferences as well as the Sports Medicine Center Journal Clubs.
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 bi-weekly and are facilitated by sports medicine center staff, including physiatrists and orthopedic surgeons.
As previously described, fellows will complete an in-depth didactic experience in diagnostic and interventional musculoskeletal ultrasound, consisting of reading assignments, weekly scanning sessions, and 7-8 cadaveric sessions throughout the 12-month fellowship.
During the day-to-day activities of the fellowship, the fellow directly interacts with Sports Medicine Center staff, including supervising physicians, physical therapists, and athletic trainers.
The fellow also attends monthly Sports Medicine Center Rehabilitation Discussion Group, during which physicians, therapists, and athletic trainers meet to specifically discuss one or more aspects of sports rehabilitation.
In addition to the above, the Sports Medicine Fellow is provided with the following educational opportunities:
- PM&R Department Journal Clubs.
- Weekly PM&R departmental educational conferences, each Friday at noon.
- Department of Orthopedic Surgery Grand Rounds each Monday AM, during which general orthopedic topics are discussed.
- Participation as a teaching assistant during the annual PM&R Resident Musculoskeletal Course (5 months of weekly anatomy, physical examination, and ultrasound instruction sessions).
- Teaching of medical students and residents from the departments of PM&R, Internal Medicine, Family Medicine, Pediatrics, and Rheumatology who rotate through the Sports Medicine Center.
- Teaching learning objectives to PM&R residents weekly (after the first three months)
- Community teaching activities, such as lecturing at the local athletic clubs.
Fellows participate in a research training course for clinicians, which is coordinated through the Center for Translational Science Activities (CTSA) at the Mayo Clinic. This is typically scheduled in the Fall.
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 will occur outside of normal working hours. However, all of your patient care duties, including athletic coverage, will not exceed the 80-hour/week limit.
Fellows sit on both the Research and Education Committees at the Sports Medicine Center.
The program directors and all consultants with whom the fellow rotates will provide a quarterly review of the fellow's performance. A final year-end review will also be completed.