Educating the next generation in sport and exercise medicine: A cross sectional survey

KATHERINE ROSE MARINO; DANIEL FITZPATRICK; DANE VISHNUBALA

doi:10.37532/1897- 2276.2022.17(12).72

Katherine Rose Marino¹^*, DANIEL FITZPATRICK² and DANE VISHNUBALA³

¹ British Association of Sport and Exercise Medicine, UK, Email: Kathierino@live.co.uk
² University of Brighton, England
³ Hull York Medical School, University of York, England

^*Correspondence: Katherine Rose Marino, British Association of Sport and Exercise Medicine, UK, Email: Kathierino@live.co.uk

Received: 05-Dec-2022, Manuscript No. jotsrr-22- 82934; Editor assigned: 06-Dec-2022, Pre QC No. jotsrr-22- 82934(PQ); Accepted Date: Dec 28, 2022 ; Reviewed: 18-Dec-2022 QC No. jotsrr-22- 82934(Q); Revised: 25-Dec-2022, Manuscript No. jotsrr-22- 82934(R); Published: 03-Jan-2023, DOI: 10.37532/1897- 2276.2022.17(12).72

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Abstract

Background: Sport and Exercise Medicine (SEM) is a relatively new specialty, and it is not well incorporated into undergraduate medical education.Previous studies have highlighted that medical students would benefit from increased teaching on SEM, and that students would like more SEM teaching. The aim of this project is to establish which SEM- related topics are deemed to be most important to incorporate into undergraduate medical education and confirm whether medical students would benefit from increased SEM exposure.

Methods: An online survey was distributed to all members of the British Association of Sport and Exercise Medicine (BASEM) via email, and it was shared on Twitter via BASEM and the research team.

Results: A total of 126 responses were analysed. The majority of respondents works in SEM, or were interested in pursuing a career in SEM. Musculoskeletal (MSK) examination skills, exercise to prevent and manage disease, and MSK injuries and conditions were deemed to be the most important SEM-related topics to teach medical students. Use of social media and pitch side case were deemed the least important. Respondents thought medical students do not receive enough SEM teaching at medical school and could benefit from increased SEM exposure.

Conclusion: This study supports the opinion that medical students would benefit from increased SEM exposure. This survey is the first to determine how important it is that specific SEM-related topics are taught to medical students. In response to this survey a Delphi study is being conducted in the UK to establish a consensus undergraduate SEM curriculum for medical students.

Abbreviation:

KM and DF conceived the design of the study, contributed to the collection of the data, KM, DV and DF both performed statistical analyses of the data. All authors (KM, DF and DV) contributed to the manuscript writing and approved the final version applicable

Keywords

Shoulder arthroscopy; glycine effect; electrolytes imbalance; complications; fluid overload

Introduction

Sports and Exercise Medicine (SEM) is a recognized specialty with its own higher specialist training program and increasing numbers of SEM departments are becoming established in the National Health Service (NHS) [1]. In keeping with this increased opportunity for SEM in postgraduate training, there is an increasing need to develop interest and knowledge among junior clinicians and students [2]. For students and junior clinicians interested in SEM there are limited options available to learn more about the specialty, with few resources aimed at this level of training [3]. There have been several research papers and editorials published in recent years calling for an increase in SEM in the undergraduate medical curriculum [3–8]. However, none report novel data to directly support their conclusions.

The primary objective of this study is to establish which SEM-related topics are deemed most important to be taught as part of undergraduate medical education in the United Kingdom (UK). Secondary objectives include determining how often SEM is taught at medical school and understanding thoughts on whether students would benefit from more SEM teaching.

Method

An online survey was created using Google Forms (Google Inc. USA). All members of the British Association of Sport and Exercise Medicine (BASEM) were emailed a link to the survey in June 2018. Participants responded over a three-month period. The survey was also shared via BASEM’s Twitter account and by the Twitter accounts of the research team (KM and DF). Informed written consent was obtained via a compulsory question at the start of the questionnaire. This was an internal organization survey conducted with permission from said organization. Due to this and no identifiable information is collected, ethical approval was not sought. This is in line with the Declaration of Helsinki on ‘Ethical Principles for Medical Research Involving Human Subjects’ created by The World Medical Association, Inc. [9–11].

Participants were eligible to complete the survey if they were UK medical students or qualified doctors. The questionnaire aimed to explore several elements of SEM teaching at the undergraduate level and is given in Appendix 1.Where appropriate, data were divided into 2 subgroups of juniors (medical students and pre-registrar doctors), and seniors (Consultants, General Practitioners and Registrars) for comparison between groups. In addition, where appropriate seniors were separated into those that worked or trained in SEM or not to establish differences of opinion. Statistical analysis was performed using Microsoft Excel. Where median values are given, they are reported as median and inter-quartile range. Where appropriate, data were assessed for normality using Shapiro-Wilcox and the Mann-Whitney U test was used to determine differences between groups. Statistical significance was set at p < 0.05.

Results

The survey received 136 responses. Eight participants were not eligible due to not being a doctor or medical students. Incomplete surveys (n = 2) were removed, leaving 126 responses.Consultants made up 34% of participants, 25% were General Practitioners, 10% were registrars, 13% were pre-registrar level doctors, and 19% were medical students.

72% of senior clinicians were working or training in SEM. 69% of juniors were interested in pursuing a career in SEM. 66% of all respondents had an additional degree in SEM.

IMPORTANCE OF SEM RELATED TOPICS

Participants were asked to rank how important it is that various SEMrelated topics are included in undergraduate medical education.There were statistical differences between responses from juniors compared with seniors for the topics of nutrition, exercise physiology, working as a team doctor, and pitch side care. In each case, juniors deemed them to be more important than seniors. The results are given in Table 1

Table 1. Participants were asked to rank how important it is that each topic is included in undergraduate education. 1 = not important at all, 10 = very important. P value is given for comparing responses from juniors, with responses from seniors. Statistically significant p values are in bold.

Topic	Median (IQR)	Median (IQR) for juniors	Median (IQR) for seniors	P value
Musculoskeletal Examination Skills	10 (10 - 9)	10 (10 − 9)	10 (10 − 9)	0.934
Exercise to prevent and manage disease	10 (10-9)	10 (10 − 9)	10 (10 − 9)	0.465
MSK injuries and conditions	9 (10 − 8)	8 (10 − 8)	9 (10 − 8)	0.516
Nutrition’s	8 (9 −6)	8 (10 − 6)	7 (9 − 6)	0.024
Rehabilitation	8 (9 −6)	8 (9 − 6)	7 (9 − 6)	0.126
Exercise Physiology	7 (8 −6)	8 (9 − 6)	7 (8 − 5)	0.005
SEM in specialist groups ( eg disability, women, older athletes, children’s)	7 (8 −5)	7 (8 − 5)	7 (8 − 5)	0.151
Biomechanics	6 (8 −5)	7 (8 − 4)	6 (8 − 5)	0.624
Drugs in sport	5 (7 −4)	6 (8 − 4)	5 (7 − 3)	0.346
Sport Psychology	5 (7 −3)	6 (8 − 4)	5 (6 − 3)	0.065
Working as a team doctor	5 (7 −2)	6 (8 − 3)	4 (6 − 2)	0.004
Sports Ethics and law	5 (6 −3)	5 (7 − 3)	5 (6 − 2)	0.338
Pitch side care	5 (6-2.25)	5.5 (8 − 3)	5 (6 − 2)	0.016
Use of social Media	5 (6 −2)	5 (6 − 2)	4.5 (6 − 1)	0.181

THOUGHTS ON AMOUNT OF SEM TEACHING

All juniors were asked how often they had been exposed to SEM during medical school. The majority had either never been exposed to SEM during medical school (60%) or had been exposed to it 1–2 times a year (37%). The remaining 3% were exposed to SEM 1–2 times a month (Figure 1).

Figure 1: Responses when participants were asked if they agree or disagree with the statement ‘Medical students receive enough teaching on SEM at medical school

In this figure the results given when participants were asked whether medical students receive enough teaching on SEM. The median score for seniors was 2(3 − 1) and for juniors was 1(2 − 1). There was a statistically significant difference between the two groups (p = 0.004). There was no statistically significant difference between those seniors working or training in SEM and those that are not (p > 0.05) (Figure 2).

Figure 2: Responses when participants were asked if they agree or disagree with the statement ‘Medical students would benefit from increased teaching or resources on SEM at medical school

Figure 2 shows that participants think students would benefit from increased teaching or resources on SEM at medical school. There was no statistically significant difference in opinion between juniors and seniors (p = 0.908). Senior clinicians thought it was important for all medical students to have increased teaching or resources on SEM (median of 9 (7–10)), as well as those specific medical students interested in pursuing SEM (median of 10 (8–10)). There was a statistically significant difference between those seniors working or training in SEM and those that are not, with those working in SEM believing more strongly that medical students would benefit from increased SEM teaching or resources. The median for SEM professionals was 9(10 − 8) and the median for nonSEM professionals was 8(10 − 7) (p = 0.005).

Discussion

THE MOST RELEVANT SEM RELATED TOPICS

The key findings of this study are that MSK examination skills, exercise to prevent and manage the disease, and MSK injuries and conditions are deemed to be the most important SEM-related topics to teach to undergraduates. Social media use and pitch side care were deemed the least important. This survey is the first to determine how important it is that specific SEM-related topic are taught to medical students. The findings of this study are important because they will determine how best we move forward in terms of the education we provide to undergraduate level The majority of research thus far around incorporating SEM into medical curricula has been focused on exercise medicine [12] Aside from exercise medicine, as far as the research team is aware, there are no SEM-focused resources aimed at the level of medical students. In addition, there is no SEM syllabus for medical students and new clinicians outlining what SEM they should know for their level in training.

BEING AN SEM DOCTOR- MORE THAN BEING PITCHSIDE

The difference of opinion between juniors and senior clinicians on the topics of working as a team doctor and pitch side care is of particular interest. It is a controversial topic within the SEM community that SEM doctors only work with elite athletes and sports teams, and the importance of highlighting that SEM is much broader than this has been highlighted previously [13]. Anecdotally, the authors acknowledge that the MSK medicine and exercise medicine aspects of SEM are often overlooked by those with limited experience in the specialty. Arguably these are the aspects of SEM that can best be utilized in several different specialties throughout the NHS. It may therefore be valuable for students and new clinicians to have some knowledge of SEM that will be valuable in a variety of different clinical settings.

THE BENEFITS OF MORE SEM EDUCATION

The survey findings suggest that students and clinicians of all grades think that medical students would benefit from having more exposure the SEM during medical school, an opinion expressed previously [14–16]. However, limited data is supporting this theory, which is an important finding of this study. In addition, this study found that seniors believe increased SEM teaching would be beneficial for all students, not just those interested in pursuing a career in SEM. There are potentially several reasons for this. Firstly, the lack of exposure to SEM results in a lack of awareness of what is involved in SEM, including its place in health service provision [17]. A lack of awareness of the specialty of SEM has been demonstrated among the medical profession [18, 19]. This may mean that SEM NHS services are not being utilized due to lack of awareness of these services existing, resulting in patients not benefitting from referrals to SEM departments.

Secondly, inactivity is a significant risk factor for disability and death and to combat this as a society promoting physical activity as a form of medicine is of paramount importance [20]. If we are encouraging more people to be active, it follows that more people will suffer from sportsrelated injuries. We need our doctors of the future to be prepared and confident to deal with the MSK injuries that will potentially increase as a result of this. Furthermore, aspects of the SEM curriculum are applicable in many parts of medicine [21]. For example, both exercise and musculoskeletal medicine are relevant in General Practice, whilst exercise physiology is important in Anesthetics.

STRENGTH AND LIMITATIONS

This survey is the first to determine how important it is that specific SEM-related topic are taught to medical students. Views were collated from individuals in a variety of stages in their careers to order to compare differences between sub-groups.

A limitation of this study is that most participants have an existing interest in SEM. The majorities of participants were working in, or interested in working in, SEM and therefore are potentially biased towards feeling more SEM exposure would be of benefit. Further research should aim to gain the opinions of non-SEM doctors, and students and juniors not interested in pursuing SEM, to establish how applicable SEM skills and knowledge is to the wider medical profession. Furthermore, as the survey was shared on social media, a response rate cannot be calculatedp[22].

Conclusion

This study has found that MSK examination skills, exercise to prevent and manage disease, and MSK injuries and conditions were deemed the most important SEM-related topics to include in medical student education. Use of social media, pitch side cases, sports ethics and law, and working as a team doctor were deemed the least important SEMrelated topics for undergraduate education. Respondents thought medical students do not receive enough SEM teaching at medical school and could benefit from increased SEM teaching/resources, which supports previous research findings. In response to the findings of this survey, a Delphi study is being undertaken to further clarify an SEM undergraduate syllabus. In addition, educational SEM & musculoskeletal resources have been created specifically aimed for the level of medical students and junior clinicians.

Declarations

Ethics approval and consent to participate: This was an internal organization survey conducted with permission from said organization. Due to this, and no identifiable information is being collected, ethical approval was not sought. This is in line with the Declaration of Helsinki on ‘Ethical Principles for Medical Research Involving Human Subjects’ created by The World Medical Association, Inc. Informed written consent was obtained via a compulsory question at the start of the questionnaire, and all participants were over the age of 18. All methods were carried out by relevant guidelines and regulations.