Fellowship Director Jonathan T. Finnoff, D.O., performing an ultrasound
Clinical training focuses on the evaluation and management of sports-related injuries and musculoskeletal problems that adversely affect a patient's ability to participate in 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 p.m., Monday through Friday.
Throughout the year, you rotate with sports medicine physicians from a variety of backgrounds, including PM&R, pediatrics, emergency medicine and orthopedic surgery consultants. During the first several months of the fellowship, you work only under the direct supervision of consultants and are introduced to the procedures of the Sports Medicine Center and Mayo Clinic in general. You evaluate the patients of the consultant with whom you are rotating. The consultant reviews the history and physical exam findings and staffs the patient with the fellow.
As you progress in clinical competency, you begin your 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 your clinical competency. This facilitates advancement of your clinical skills under a model of progressive supervision.
You receive instruction on sports injury history-taking; physical exam findings and techniques; use and interpretation of appropriate diagnostic imaging and related testing; and therapeutic injections, including ultrasound guidance. Throughout the remainder of the year, you are given progressive responsibilities based on your clinical performance.
The sports medicine staff members instruct and assist you 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
- Exercise prescription
- Evaluation and management of sports concussions
- Principles of functional progression
- Treatment plan modification
- Return-to-play criteria
- Indications for additional objective testing, such as Cybex and gait analysis
- Prescription of various orthoses
- Use of ultrasound for diagnosing 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
- Percutaneous mechanical neo-vessel and nerve ablation (tendon scraping)
- Percutaneous needle tenotomy
- Percutaneous tenotomy and fasciotomy using the Tenex device
- Releases, such as carpal tunnel release and fascial release
- Platelet-rich plasma injection
- Bone marrow aspirate concentration (BMAC) injections
- 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
You also participate in:
- Coverage of training rooms and basketball games for the Minnesota Timberwolves (NBA) and Minnesota Lynx (WNBA)
- Coverage of a U.S. Ski Team event
- Coverage of area sports teams
- Coverage of disabled sports events
- Local tournaments and events
- The annual Med City Marathon and Twin Cities Marathon
- Pre-participation examinations for Rochester high school students
Clinical training also includes specific clinical learning experiences with the Sports Medicine Center physical therapy, athletic training and sports performance (coaches, sports nutritionists, sports psychologists) staff. During these experiences, you observe and participate in patient evaluation, movement analysis, orthosis prescription and therapeutic exercise prescription.
Basketball court at the Sports Medicine Center in Minneapolis
You spend the majority of your time in the Sports Medicine Center in Minneapolis. One day a week is spent in Rochester, where half of the day is in a primary specialty clinic (such as the Musculoskeletal Clinic or PM&R Regenerative Medicine Clinic) and the other half of the day involves rotating in the Rochester-based Sports Medicine Center or with other specialists in areas such as Pediatric Sports Medicine, Emergency Medicine, Adult Orthopedic Sports Medicine, Radiology, Cardiovascular Health Clinic, Pulmonary Medicine Clinic, Cast Room and Sports Performance Program (Sports Psychology, Nutrition, and Strength and Conditioning).
After the first two to three months of the fellowship, you may also participate in various electives, such as:
- Electrodiagnostic Laboratory
- Hand Clinic
- Foot Clinic
- Spine Center
- Pain Clinic
There is no call schedule, but you 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 you will have at least a 24-hour period each week free from patient care duties.
The fellow participates 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 well-defined educational curriculum has been established for the PM&R Sports Medicine Fellowship in Minneapolis, including learning objectives, journal clubs, weekly educational conferences and an ongoing didactic board review discussion series. Many of the fellowship didactics are performed jointly with the Mayo Clinic PM&R Sports Medicine Fellowship based in Rochester.
A comprehensive didactic curriculum is scheduled throughout the year, covering all primary care and orthopedic sports medicine topics relevant to the practice of primary care sports medicine. Didactic sessions are held on Wednesday mornings and are facilitated by the Sports Medicine Center staff.
The fellowship also includes formal training in diagnostic and interventional musculoskeletal ultrasound and regenerative medicine techniques. You have reading assignments, weekly scanning sessions on Tuesday mornings, and seven or eight cadaveric sessions in the Mayo Clinic Procedural Skills Laboratory (anatomy lab) throughout the 12-month fellowship. You continually acquire additional ultrasound skills by participating in daily patient care activities in the Sports Medicine Center.
You have full access to the Mayo Clinic Libraries, including more than 4,000 electronic journals with sophisticated literature search capabilities and vast research support. You have the opportunity to attend the annual Mayo Clinic Symposium on Sports Medicine, a two-day national conference that takes place each fall in Rochester, and the Comprehensive Sports Medicine Update and Board Review Course that takes place each June in Minneapolis.
In addition, you are sent to the Medical Emergencies in Skiing and Snowboarding Course held annually in Vail, Colorado. This conference was created by the U.S. Ski and Snowboard Association to prepare physicians to cover ski and snowboard events for the U.S. Ski Team and U.S. Snowboarding.
Other educational opportunities include:
- Weekly PM&R Grand Rounds each Monday at noon
- 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 Department of Physical Medicine and Rehabilitation who rotate through the Sports Medicine Center
- Community teaching activities, such as lecturing at local athletic clubs
Training area at the Sports Medicine Center in Minneapolis
A weekly sports medicine conference involving the Sports Medicine Center staff in both Minneapolis and Rochester occurs each Thursday morning via videoconference. The format of this conference is typically case presentations, in which cases are presented and discussed by various Sports Medicine Center staff, including fellows. You share the responsibility of organizing this weekly conference with the PM&R and orthopedic sports medicine fellows in Rochester.
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. You are responsible for organizing the Sports Medicine Center Journal Club sessions.
During the PM&R Sports Medicine Fellowship, your program directors and all consultants with whom you rotate provide a quarterly review of your performance. A final year-end review also is completed.