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 more than 4,000 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 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.
Fellows rotate with Physical Medicine and 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 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
- 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 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
- Appropriate use of diagnostic and therapeutic injections pertinent to sports-related injury
- Use of ultrasound for diagnosis of musculoskeletal conditions
- Ultrasound-guided procedures, such as injections including platelet-rich plasma, percutaneous tenotomy and calcific tendinitis aspiration
Fellows also learn the appropriate indications for consulting specialists in sports psychology (and through this interaction, the psychological impact of sports injuries), neuropsychology and 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
- Multiteam 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 and skin examinations
Clinical training also includes 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. Supplementary mandatory clinical rotations are scheduled during the 12-month fellowship and include the Electrodiagnostic Laboratory, 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 weekly and are facilitated by Sports Medicine Center staff, including physiatrists and orthopedic surgeons.
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 Sports Medicine Center 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 departmental educational conferences each Friday 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 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 Clinical and Translational Science (CCaTS) at 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 occur outside of normal working hours. But all of your patient care duties, including athletic coverage, will not exceed the 80-hour-a-week limit.
Fellows sit on the Sports Medicine Center Medical Education Committee.
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.