- Email: [email protected]
Sports medicine in physical medicine and rehabilitation residency programs
230
Sports Medicine in Physical Medicine and Rehabilitation Residency Programs Gregory W. Stewart, MD, Randolph L. Roig, MD ABSTRACT. Stewart GW, Roig RL. Sports medicine in physical medicine and rehabilitation residency programs. Arch Phys Med Rehabil 1995;76:230-3. • Because sports medicine is a rapidly expanding field within many specialties, it is important to gauge how active physiatrists have become in this arena. A nationwide survey of program directors and chief residents of physical medicine and rehabilitation residency programs was conducted to determine such prevalence. For the purposes of this study, sports medicine was defined as the routine care of athletes involved in organized sporting activities at any level of competition. Questionnaires were mailed to program directors and chief residents with response rates of 79.7% each. Overall, correlation of the answers between groups was high. The level of interest of residents was rated at 46%. Data was also obtained regarding research, clinical rotations, lectures, fellowships, association with academic departments of other specialties, and affiliations with professional sports medicine organizations. The actual level of educational opportunities available was much lower than might be expected given the high level of interest expressed. It is reasonable to conclude that more opportunities should exist for education in sports medicine.
© 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Sports medicine is a rapidly expanding field that exists within many specialties of medical practice. Presently, most sports medicine activity is concentrated within six areas of specialization: orthopedic surgery, family practice, pediatrics, internal medicine, emergency medicine, and physical medicine and rehabilitation (PM&R). 1'2 DeLisa 3 mentioned that sports medicine has been identified by residents as the area of greatest subspecialty interest among those residents interested in fellowship training. In fact, the percentage of residents interested in sports medicine fellowship training was higher than the next four most popular choices combined: clinical neurophysiology, spinal cord injury, pediatrics, and brain injury. The implication is that interest in sports medicine by all residents is high; it would be useful to know how high this interest level is. Once this level is quantified, comparisons can be made to resident education and fellowship availability. No information from previous studies regarding these variables could be found. Data for the variables would be of value in tailoring residency training programs to address the needs and desires of their residents. Preparing physiatry residents to practice sports medicine is important, because physiatrists--with their extensive backgrounds and experience in musculoskeletal medicine--are ideally suited to meet many of the demands of sports medicine. It has been postulated that interest in sports medicine among residents is relatively high when compared with interest among their corresponding faculty members. This study From the Section of Physical Medicine and Rehabilitation, LSU Medical Center, New Orleans, LA. Submitted for publication June 6, 1994. Accepted in revised form September 2, 1994. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. No reprints available. © 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/95/7603-310053.00/0
Arch Phys Med Rehabil Vol 76, March 1995
assesses the level of resident interest and faculty recognition of this interest and examines whether resident desires are being met with appropriate educational opportunities. METHODS
A sports medicine survey containing 15 questions, some with subsections, was mailed to the chief residents (CRs) and program directors (PDs) of the 74 PM&R residency programs that existed in the winter of 1992. These individuals were considered best qualified to indicate the sports medicine interest and training opportunities available in their programs. Approximately 3 months after the first mailing, repeat questionnaires were sent to all individuals who had not responded. We defined sports medicine as the routine care of athletes involved in organized sporting activities at any level of competition. This definition also included exercise medicine and athletic trauma. RESULTS
The survey response rate was 79.7% (118/148). Coincidentally, the same number of forms was returned by CRs as PDs (59 of 74). As anticipated, resident interest in sports medicine, as reported by CRs, was high (46.3%). Faculty gauged this level of interest at 50.5% of all residents (fig 1). The number of residents actually involved in sports medicine was much lower. Program directors indicated that 9.5% of residents served sports teams; CRs reported the percentage to be 9.9%. When residents did provide team coverage, it was most often at a high school level; approximately 15% of physiatry residents are involved in such activity according to PDs and CRs. Less frequently, residents cover college (10%), junior high school (6%), or professional (3%), sporting events (table). Figure 2 illustrates resident and faculty coverage of teams, clinics, and research involvement. According to PDs, 28.8% of residency programs offered no sports medicine rotations,
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart 100 -
slightly shorter. Lectures in sports medicine were offered by almost all programs. Only 5.7% did not offer lectures, according to the PDs, 10.5% according to CRs. The average number of lecture hours per year was 7.7 hours per residency program according to PDs, and 9.3 hours according to CRs. Of responding PDs, 8.5% offer fellowships in sports medicine (6.8% according to CRs). PDs report that 4.4% of faculty belong to professional sports medicine associations (4.2% according to CRs). Physical medicine and rehabilitation sports medicine affiliations existed with orthopedic surgery programs (45.9% PDs and 32.8% CRs) and to a lesser extent with family practice (4.9% PDs and CRs). However, most programs maintain no formal affiliations with other academic departments. Pearson correlation coefficients (PC) were calculated to compare the results of the individual questions of the survey. Not surprisingly, within a residency program, resident interest correlates directly with faculty interest (PC > 0.40, p < .01). Resident activities correlated very highly with faculty activity. For example, resident sports team coverage correlated with faculty team coverage (PC > 0.41, p < .0001) but did not correlate as highly with faculty research or faculty clinic coverage. Resident research correlated highly with faculty research (PC > 0.37, p < .0001). Resident clinic coverage showed a relationship only with faculty clinic coverage (PC > 0.21, p < .03).
80 i 60 50.5
40
20 -
1"t:5
0
j Faculty Interest
Resident Interest Legend Program Directors m
231
Chief Residents
Fig 1--Resident and faculty interest in sports medicine.
15.3% required a sports medicine rotation, 54.2% offered one as an elective, and 1.7% offered both. CRs reported these numbers as 39.0%, 5.1%, 39.0%, and 16.9% respectively. The average length of these rotations was approximately one and one-half months with elective rotations being
Number of Programs That Provide Team Coverage at Athletic Events According to Program Directors and Chief Residents Recreational
Men's Athletics Ballet Baseball Basketball Cross country ski Football Golf Gymnastics Ice hockey Musicians Rugby Soccer Swimming Tennis Track & field Volleyball Weight lifting Wheelchair basketball Wrestling Women's athletics Ballet Baseball Basketball Golf Gymnastics Field hockey Musician Soccer Softball Swimming Tennis Track & field Volleyball
Jr. High
Sr. High
Jr. College
College
Semi-Pro
Professional 1 (3)
(1) ( 1)
(1) (1)
1 (3)
1 (4)
ll (12)
(1) (1)
1 (3)
3 (3) 3 (3)
1 1
(1) (1) (1)
(1)
(4) 1
1
3 (4) 1 1 (1) (1)
1 (1)
1 (l)
(1)
(2) 1 (1)
(1)
( 1) (1) (2) (1)
(1) (1) 2 (4) (2)
1 1 1
2 (1)
2 (2) 1 (1) (1)
(1) ( 1)
2 (4)
( 1) (1)
(1) 1 (2)
3 (6)
( 1)
(3)
1 1 (1) 1
1 (3)
(2)
(1) (1) ( 1)
1 (1)
(1) (1) (1) (1)
(1) (l) 2 (4) (2)
1 (1) 1 1
2 2 (2) 2 (3)
Total of 59 responses. The Chief Resident responses are in parentheses.
Arch Phys Med Rehabil Vol 76, March 1995
232
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart
Residents Covering Sports Clinics
Faculty Coveting Sports Clinics
Residents Active in Sports Research
FacuRy Active in Sports Research
Residents Covering Sports "Teams
Legend [] []
Chief Residents (%) Program Directors (%)
Faculty Covering Sports Teams
0
2
4
6
8
10
Fig 2--Program director and chief resident responses for team coverage, research, and clinic coverage.
The number of lecture hours highly correlated with faculty interest (PC > 0.23, p < .02) and very highly correlated with faculty participation (PC > 0.64,p < .0001)and faculty membership in professional sports medicine organizations (PC > 0.51, p < .0001). Interestingly, the hours of sports medicine lectures correlated with resident participation (PC > 0.43, p < .0001 for sports team coverage) but not with resident interest (PC > 0.09, p < .35). DISCUSSION The survey response rate was high and represents 68 of 74 residency programs. An important finding was the high degree of correlation between PDs and CRs responses in individual question categories. This validates the answers of both groups because the surveys of each group were performed independently of the other. Both PDs and CRs report a large number of residents interested in sports medicine. This is not surprising given the results of the DeLisa study, in which 45.9% of residents said that a sports fellowship would be their first choice for postresidency education. 3 This is of even greater significance because only eight programs indicated that they offer fellowships in this area. With almost half of the residents expressing an interest in sports medicine, this seems to support the trend in physiatry toward out-patient physical medicine. 4 The low number of fellowships and lower faculty than resident interest might indicate that currently practicing academic physiatrists have less interest or expertise in sports medicine. Resident activity in sports medicine was much lower than might be expected considering the high interest level. Factors causing this disparity include low rates of faculty interest and activity and inadequate educational opportunities such as lectures and rotations. However, even in programs that provided for resident interest, overall participation was low. This may be partially a result of the time commitment required for coverage of sporting events and visits to training rooms. One author spends up to 30 hours a week in these activities during football season. Arch Phys Med Rehabil Vol 76, March 1995
Faculty interest was one-third that of residents, although faculty involvement in research and clinics was on an equal percentage basis with residents. The ratio of physiatrists coveting sports teams is one faculty to three residents. Increasing the number of faculty members supervising residents coveting sports teams may be the most effective way to maximize resident activity in clinical sports medicine. Clinical exposure, especially in the area of sports medicine, is important. However, the necessity of academic support cannot be overlooked. Clinical rotations and lectures are vital. In 1989, a physical medicine and rehabilitation residents' educational needs assessment was performed. 5 Residents who responded to the survey indicated that they wanted more clinical and didactic sports medicine than they receive in their training. The current study supports this position. Many residency programs offer rotations, but 28.8% of programs have no rotations in sports medicine. This is too high a percentage given such elevated levels of resident interest. However, the situation is vastly improved from 1986, when only eight (18.6%) of 43 chief residents reported resident exposure to sports medicine, with an average rotation of 2.2 weeks. 6 Also, the hours of lectures provided are low (7.7 per year) in relation to residents' apparent enthusiasm to acquire information in the area. Finally, professional sports medicine organizations can be excellent avenues for the latest academic information to directly enter residency programs. Faculty members who practice sports medicine are frequently members of such organizations, but this accounts for only 4% of all faculty members. Resident interest in sports medicine correlated directly with faculty interest. The same was true of resident and faculty activity in sports medicine. These correlations serve to stress the importance of faculty interest and activities in meeting resident desires for the same. Also, there may be a selection bias present. Potential residents with an interest in sports medicine will select programs that provide educational opportunities in this area. Increased faculty interest and activity would meet the educational needs of the large numbers of residents currently interested in sports medicine. It would also encourage more residents to enter the sports medicine arena, and could be used as an effective resident recruiting tool. Gonzalez 4 has declared that the perceived educational needs of residents should be addressed relative to sports medicine. Attempts to accomplish this have been initiated by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) by including sports medicine as one of the 15 topics in the third edition of the Self-Directed Medical Knowledge Program and keeping it as one of the 10 topics in the new fourth edition. 7-12 Sports medicine has also been identified by the AAPM&R as an area for subspecialization. 13 Yet with all of this interest by physicians in general, and physiatrists in particular, only 30% of high schools in Louisiana have a team physician (unpublished data). More training in sports medicine needs to be provided to PM&R residents to fill their perceived need for education and the need for sports medicine physicians in the community. SUMMARY
Subspecialization in sports medicine occurs in many fields. Many specialties are forming alliances in the area of
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart
sports medicine to facilitate sharing knowledge and perspectives unique to their expertise. If PM&R residents are to practice sports medicine effectively in the present complex and competitive environment, then physiatry residency programs must provide for this education. Programs must adjust their curricula to meet the needs of the large number of residents who are interested in sports medicine. Increasing the numbers of faculty who actively practice sports medicine would enable more residents to become involved in all aspects of this field. Acknowledgment: The authors would like to acknowledge the editorial assistance of Bonnie Johnson Stewart, PT, and the statistical analysis of Karl Cambre. References 1. DeHaven KE. Where do we go from here? Am J Sports Med 1992; 20:630-3. 2. McKeag DB. Sports medicine: the times, they are a-changin'. J Fam Praet 1991;33:573-4.
233
3. DeLisa JA. Resident interest in physical medicine and rehabilitation fellowships. Am J Phys Med Rehabil 1991;70:290-3. 4. Gonzalez EG. Physiatric subspecialization: elements of time. Arch Phys Med Rehabil 1994;75:237-42. 5. Kerrigan DC, Janes WW, Martin WA, Roe TJ. Physical Medicine and Rehabilitation residents' educational needs assessment. Arch Phys Med Rehabil 1993;74:687-90. 6. Anderson JM, Felsenthal G. Residency training in physical medicine and rehabilitation I: Clinical and didactic experience. Arch Phys Med Rehabil 1990;71:372-5. 7. Geiringer SR, Bowyer BL, Press JM. Sports medicine. 1. The physiatric approach. Arch Phys Med Rehabil 1993;74:$428-32. 8. Bowyer BL, Gooch JL, Geiringer SR. Sports medicine. 2. Upper extremity injuries. Arch Phys Med Rehabil 1993;74:$433-7. 9. Gooch JL, Geiringer SR, Akau CK. Sports medicine. 3. Lower extremity injuries. Arch Phys Med Rehabil 1993;74:$438-42. 10. Akau CK, Press JM, Gooch JL. Sports medicine. 4. Spine and head injuries. Arch Phys Med Rehabil 193;74:$443-6. 11. Press JM, Akau CK, Bowyer BL. Sports medicine. 5. The physiatrist as team physician. Arch Phys Med RehabiI 1993;74:$447-9. 12. Maly BJ. Foreword: the third edition: self-directed medical knowledge program (SDMKP) 1994. Arch Phys Med Rehabil 1994;75:S1-2. 13. Academy Board Votes to Support PM&R Subspecialization. Physiatrist 1992;8:6-7.
Arch Phys Med Rehabil Vol 76, March 1995
Sports Medicine in Physical Medicine and Rehabilitation Residency Programs Gregory W. Stewart, MD, Randolph L. Roig, MD ABSTRACT. Stewart GW, Roig RL. Sports medicine in physical medicine and rehabilitation residency programs. Arch Phys Med Rehabil 1995;76:230-3. • Because sports medicine is a rapidly expanding field within many specialties, it is important to gauge how active physiatrists have become in this arena. A nationwide survey of program directors and chief residents of physical medicine and rehabilitation residency programs was conducted to determine such prevalence. For the purposes of this study, sports medicine was defined as the routine care of athletes involved in organized sporting activities at any level of competition. Questionnaires were mailed to program directors and chief residents with response rates of 79.7% each. Overall, correlation of the answers between groups was high. The level of interest of residents was rated at 46%. Data was also obtained regarding research, clinical rotations, lectures, fellowships, association with academic departments of other specialties, and affiliations with professional sports medicine organizations. The actual level of educational opportunities available was much lower than might be expected given the high level of interest expressed. It is reasonable to conclude that more opportunities should exist for education in sports medicine.
© 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Sports medicine is a rapidly expanding field that exists within many specialties of medical practice. Presently, most sports medicine activity is concentrated within six areas of specialization: orthopedic surgery, family practice, pediatrics, internal medicine, emergency medicine, and physical medicine and rehabilitation (PM&R). 1'2 DeLisa 3 mentioned that sports medicine has been identified by residents as the area of greatest subspecialty interest among those residents interested in fellowship training. In fact, the percentage of residents interested in sports medicine fellowship training was higher than the next four most popular choices combined: clinical neurophysiology, spinal cord injury, pediatrics, and brain injury. The implication is that interest in sports medicine by all residents is high; it would be useful to know how high this interest level is. Once this level is quantified, comparisons can be made to resident education and fellowship availability. No information from previous studies regarding these variables could be found. Data for the variables would be of value in tailoring residency training programs to address the needs and desires of their residents. Preparing physiatry residents to practice sports medicine is important, because physiatrists--with their extensive backgrounds and experience in musculoskeletal medicine--are ideally suited to meet many of the demands of sports medicine. It has been postulated that interest in sports medicine among residents is relatively high when compared with interest among their corresponding faculty members. This study From the Section of Physical Medicine and Rehabilitation, LSU Medical Center, New Orleans, LA. Submitted for publication June 6, 1994. Accepted in revised form September 2, 1994. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. No reprints available. © 1995 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003-9993/95/7603-310053.00/0
Arch Phys Med Rehabil Vol 76, March 1995
assesses the level of resident interest and faculty recognition of this interest and examines whether resident desires are being met with appropriate educational opportunities. METHODS
A sports medicine survey containing 15 questions, some with subsections, was mailed to the chief residents (CRs) and program directors (PDs) of the 74 PM&R residency programs that existed in the winter of 1992. These individuals were considered best qualified to indicate the sports medicine interest and training opportunities available in their programs. Approximately 3 months after the first mailing, repeat questionnaires were sent to all individuals who had not responded. We defined sports medicine as the routine care of athletes involved in organized sporting activities at any level of competition. This definition also included exercise medicine and athletic trauma. RESULTS
The survey response rate was 79.7% (118/148). Coincidentally, the same number of forms was returned by CRs as PDs (59 of 74). As anticipated, resident interest in sports medicine, as reported by CRs, was high (46.3%). Faculty gauged this level of interest at 50.5% of all residents (fig 1). The number of residents actually involved in sports medicine was much lower. Program directors indicated that 9.5% of residents served sports teams; CRs reported the percentage to be 9.9%. When residents did provide team coverage, it was most often at a high school level; approximately 15% of physiatry residents are involved in such activity according to PDs and CRs. Less frequently, residents cover college (10%), junior high school (6%), or professional (3%), sporting events (table). Figure 2 illustrates resident and faculty coverage of teams, clinics, and research involvement. According to PDs, 28.8% of residency programs offered no sports medicine rotations,
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart 100 -
slightly shorter. Lectures in sports medicine were offered by almost all programs. Only 5.7% did not offer lectures, according to the PDs, 10.5% according to CRs. The average number of lecture hours per year was 7.7 hours per residency program according to PDs, and 9.3 hours according to CRs. Of responding PDs, 8.5% offer fellowships in sports medicine (6.8% according to CRs). PDs report that 4.4% of faculty belong to professional sports medicine associations (4.2% according to CRs). Physical medicine and rehabilitation sports medicine affiliations existed with orthopedic surgery programs (45.9% PDs and 32.8% CRs) and to a lesser extent with family practice (4.9% PDs and CRs). However, most programs maintain no formal affiliations with other academic departments. Pearson correlation coefficients (PC) were calculated to compare the results of the individual questions of the survey. Not surprisingly, within a residency program, resident interest correlates directly with faculty interest (PC > 0.40, p < .01). Resident activities correlated very highly with faculty activity. For example, resident sports team coverage correlated with faculty team coverage (PC > 0.41, p < .0001) but did not correlate as highly with faculty research or faculty clinic coverage. Resident research correlated highly with faculty research (PC > 0.37, p < .0001). Resident clinic coverage showed a relationship only with faculty clinic coverage (PC > 0.21, p < .03).
80 i 60 50.5
40
20 -
1"t:5
0
j Faculty Interest
Resident Interest Legend Program Directors m
231
Chief Residents
Fig 1--Resident and faculty interest in sports medicine.
15.3% required a sports medicine rotation, 54.2% offered one as an elective, and 1.7% offered both. CRs reported these numbers as 39.0%, 5.1%, 39.0%, and 16.9% respectively. The average length of these rotations was approximately one and one-half months with elective rotations being
Number of Programs That Provide Team Coverage at Athletic Events According to Program Directors and Chief Residents Recreational
Men's Athletics Ballet Baseball Basketball Cross country ski Football Golf Gymnastics Ice hockey Musicians Rugby Soccer Swimming Tennis Track & field Volleyball Weight lifting Wheelchair basketball Wrestling Women's athletics Ballet Baseball Basketball Golf Gymnastics Field hockey Musician Soccer Softball Swimming Tennis Track & field Volleyball
Jr. High
Sr. High
Jr. College
College
Semi-Pro
Professional 1 (3)
(1) ( 1)
(1) (1)
1 (3)
1 (4)
ll (12)
(1) (1)
1 (3)
3 (3) 3 (3)
1 1
(1) (1) (1)
(1)
(4) 1
1
3 (4) 1 1 (1) (1)
1 (1)
1 (l)
(1)
(2) 1 (1)
(1)
( 1) (1) (2) (1)
(1) (1) 2 (4) (2)
1 1 1
2 (1)
2 (2) 1 (1) (1)
(1) ( 1)
2 (4)
( 1) (1)
(1) 1 (2)
3 (6)
( 1)
(3)
1 1 (1) 1
1 (3)
(2)
(1) (1) ( 1)
1 (1)
(1) (1) (1) (1)
(1) (l) 2 (4) (2)
1 (1) 1 1
2 2 (2) 2 (3)
Total of 59 responses. The Chief Resident responses are in parentheses.
Arch Phys Med Rehabil Vol 76, March 1995
232
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart
Residents Covering Sports Clinics
Faculty Coveting Sports Clinics
Residents Active in Sports Research
FacuRy Active in Sports Research
Residents Covering Sports "Teams
Legend [] []
Chief Residents (%) Program Directors (%)
Faculty Covering Sports Teams
0
2
4
6
8
10
Fig 2--Program director and chief resident responses for team coverage, research, and clinic coverage.
The number of lecture hours highly correlated with faculty interest (PC > 0.23, p < .02) and very highly correlated with faculty participation (PC > 0.64,p < .0001)and faculty membership in professional sports medicine organizations (PC > 0.51, p < .0001). Interestingly, the hours of sports medicine lectures correlated with resident participation (PC > 0.43, p < .0001 for sports team coverage) but not with resident interest (PC > 0.09, p < .35). DISCUSSION The survey response rate was high and represents 68 of 74 residency programs. An important finding was the high degree of correlation between PDs and CRs responses in individual question categories. This validates the answers of both groups because the surveys of each group were performed independently of the other. Both PDs and CRs report a large number of residents interested in sports medicine. This is not surprising given the results of the DeLisa study, in which 45.9% of residents said that a sports fellowship would be their first choice for postresidency education. 3 This is of even greater significance because only eight programs indicated that they offer fellowships in this area. With almost half of the residents expressing an interest in sports medicine, this seems to support the trend in physiatry toward out-patient physical medicine. 4 The low number of fellowships and lower faculty than resident interest might indicate that currently practicing academic physiatrists have less interest or expertise in sports medicine. Resident activity in sports medicine was much lower than might be expected considering the high interest level. Factors causing this disparity include low rates of faculty interest and activity and inadequate educational opportunities such as lectures and rotations. However, even in programs that provided for resident interest, overall participation was low. This may be partially a result of the time commitment required for coverage of sporting events and visits to training rooms. One author spends up to 30 hours a week in these activities during football season. Arch Phys Med Rehabil Vol 76, March 1995
Faculty interest was one-third that of residents, although faculty involvement in research and clinics was on an equal percentage basis with residents. The ratio of physiatrists coveting sports teams is one faculty to three residents. Increasing the number of faculty members supervising residents coveting sports teams may be the most effective way to maximize resident activity in clinical sports medicine. Clinical exposure, especially in the area of sports medicine, is important. However, the necessity of academic support cannot be overlooked. Clinical rotations and lectures are vital. In 1989, a physical medicine and rehabilitation residents' educational needs assessment was performed. 5 Residents who responded to the survey indicated that they wanted more clinical and didactic sports medicine than they receive in their training. The current study supports this position. Many residency programs offer rotations, but 28.8% of programs have no rotations in sports medicine. This is too high a percentage given such elevated levels of resident interest. However, the situation is vastly improved from 1986, when only eight (18.6%) of 43 chief residents reported resident exposure to sports medicine, with an average rotation of 2.2 weeks. 6 Also, the hours of lectures provided are low (7.7 per year) in relation to residents' apparent enthusiasm to acquire information in the area. Finally, professional sports medicine organizations can be excellent avenues for the latest academic information to directly enter residency programs. Faculty members who practice sports medicine are frequently members of such organizations, but this accounts for only 4% of all faculty members. Resident interest in sports medicine correlated directly with faculty interest. The same was true of resident and faculty activity in sports medicine. These correlations serve to stress the importance of faculty interest and activities in meeting resident desires for the same. Also, there may be a selection bias present. Potential residents with an interest in sports medicine will select programs that provide educational opportunities in this area. Increased faculty interest and activity would meet the educational needs of the large numbers of residents currently interested in sports medicine. It would also encourage more residents to enter the sports medicine arena, and could be used as an effective resident recruiting tool. Gonzalez 4 has declared that the perceived educational needs of residents should be addressed relative to sports medicine. Attempts to accomplish this have been initiated by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) by including sports medicine as one of the 15 topics in the third edition of the Self-Directed Medical Knowledge Program and keeping it as one of the 10 topics in the new fourth edition. 7-12 Sports medicine has also been identified by the AAPM&R as an area for subspecialization. 13 Yet with all of this interest by physicians in general, and physiatrists in particular, only 30% of high schools in Louisiana have a team physician (unpublished data). More training in sports medicine needs to be provided to PM&R residents to fill their perceived need for education and the need for sports medicine physicians in the community. SUMMARY
Subspecialization in sports medicine occurs in many fields. Many specialties are forming alliances in the area of
SPORTS MEDICINE IN PM&R RESIDENCIES, Stewart
sports medicine to facilitate sharing knowledge and perspectives unique to their expertise. If PM&R residents are to practice sports medicine effectively in the present complex and competitive environment, then physiatry residency programs must provide for this education. Programs must adjust their curricula to meet the needs of the large number of residents who are interested in sports medicine. Increasing the numbers of faculty who actively practice sports medicine would enable more residents to become involved in all aspects of this field. Acknowledgment: The authors would like to acknowledge the editorial assistance of Bonnie Johnson Stewart, PT, and the statistical analysis of Karl Cambre. References 1. DeHaven KE. Where do we go from here? Am J Sports Med 1992; 20:630-3. 2. McKeag DB. Sports medicine: the times, they are a-changin'. J Fam Praet 1991;33:573-4.
233
3. DeLisa JA. Resident interest in physical medicine and rehabilitation fellowships. Am J Phys Med Rehabil 1991;70:290-3. 4. Gonzalez EG. Physiatric subspecialization: elements of time. Arch Phys Med Rehabil 1994;75:237-42. 5. Kerrigan DC, Janes WW, Martin WA, Roe TJ. Physical Medicine and Rehabilitation residents' educational needs assessment. Arch Phys Med Rehabil 1993;74:687-90. 6. Anderson JM, Felsenthal G. Residency training in physical medicine and rehabilitation I: Clinical and didactic experience. Arch Phys Med Rehabil 1990;71:372-5. 7. Geiringer SR, Bowyer BL, Press JM. Sports medicine. 1. The physiatric approach. Arch Phys Med Rehabil 1993;74:$428-32. 8. Bowyer BL, Gooch JL, Geiringer SR. Sports medicine. 2. Upper extremity injuries. Arch Phys Med Rehabil 1993;74:$433-7. 9. Gooch JL, Geiringer SR, Akau CK. Sports medicine. 3. Lower extremity injuries. Arch Phys Med Rehabil 1993;74:$438-42. 10. Akau CK, Press JM, Gooch JL. Sports medicine. 4. Spine and head injuries. Arch Phys Med Rehabil 193;74:$443-6. 11. Press JM, Akau CK, Bowyer BL. Sports medicine. 5. The physiatrist as team physician. Arch Phys Med RehabiI 1993;74:$447-9. 12. Maly BJ. Foreword: the third edition: self-directed medical knowledge program (SDMKP) 1994. Arch Phys Med Rehabil 1994;75:S1-2. 13. Academy Board Votes to Support PM&R Subspecialization. Physiatrist 1992;8:6-7.
Arch Phys Med Rehabil Vol 76, March 1995