Educational curriculum

A well-defined educational curriculum has been established for the PM&R Sports Medicine Fellowship, including learning objectives, journal clubs, weekly educational conferences and an ongoing didactic board review 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 Clinical Anatomy Lab. You continually acquire additional ultrasound skills by participating in daily patient care activities in both the Sports Medicine Center and Musculoskeletal Clinic.

As a fellow, you have full access to the Mayo Medical Libraries, including more than 4,000 electronic journals with sophisticated literature search capabilities and vast research support.

Clinical training

The focus of the fellowship clinical training is 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, cardiology, 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.

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 procedures of the Sports Medicine Center and Mayo Clinic in general. You evaluate 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 the advancement of your clinical skills under a model of progressive supervision.

You 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 with ultrasound guidance). Throughout the remainder of the year, you are given progressive responsibilities based on your clinical progress.

The PM&R and orthopedic 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
• Evaluation and management of concussions as part of the Mayo Clinic Sports Medicine concussion program
• Appropriate use of modalities and scientific rationale
• Prescription of targeted stretching techniques
• 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
• Use of ultrasound for diagnosis of musculoskeletal and 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
  • Calcific tendon barbotage
  • Mechanical neo-vessel and nerve ablation (tendon scraping)
  • Needle tenotomy
  • Ultrasonic tendon and fascia debridement using the Tenex device
  • Soft tissue releases (fasciotomy, trigger finger, carpal tunnel)
  • Platelet-rich plasma preparation
  • Bone marrow aspiration and preparation of bone marrow concentrate
  • Microfragmented adipose tissue harvest/preparation

You learn the appropriate 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:

• Rochester Community and Technical College football coverage and weekly or biweekly training room
• Coverage of area high school football and hockey games
• Multiple-team 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, skin examinations and tournament coverage

Clinical training also includes specific clinical learning experiences with the sports medicine physical therapy and athletic training staff. During these experiences, you observe and participate in patient evaluation, movement analysis, orthosis prescription and therapeutic exercise prescription.

Rotation schedule

You are scheduled for the majority of your time in the Sports Medicine Center. In addition, you spend approximately one half-day each week in the PM&R Musculoskeletal Clinic.

Supplementary clinical rotations are scheduled during the 12-month fellowship and include:

• Pediatric orthopedic sports medicine
• Adult orthopedic sports medicine
• Sports Cardiovascular Clinic
• Sports performance (sports psychology, nutrition, and strength and conditioning)
• Vascular medicine
• Pulmonary

After the first three months of fellowship, you may also participate in various electives such as:

• Electrodiagnostic Laboratory
• Cast Room
• Sports trauma emergency room
• Hand Clinic
• Foot Clinic
• Pain Clinic
• Radiology
• Spine Center
• Mayo Clinic Square (Minneapolis) Sports Medicine Center

Call frequency

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 have at least a 24-hour period each week free from patient care duties.

Research training

You may 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. Throughout the year, fellows are also encouraged to attend Mayo Clinic workshops on manuscript and grant writing.

Didactic training

A weekly sports medicine conference occurs each Thursday morning. The format of this conference is typically case presentations, in which cases are presented and discussed by various sports medicine staff, including the trainee. You share the responsibility of organizing this weekly conference with the Minneapolis PM&R and Orthopedic sports medicine fellows.

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.

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 Mayo Clinic Sports Medicine staff, including physiatrists, orthopedic surgeons and other sports medicine physicians. As a fellow, you have access to the board review lectures on video.

As previously described, you 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, you interact directly with Mayo Clinic Sports Medicine staff, including supervising physicians, physical therapists and athletic trainers.

Other educational opportunities include:

• PM&R Department Journal Clubs
• Weekly PM&R Grand Rounds each Monday 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 PM&R, internal medicine, family medicine, pediatrics and rheumatology departments who rotate through the Sports Medicine Center
• Teaching learning objectives to PM&R residents weekly (after the first two to three months)
• Community teaching activities, such as lecturing at the local athletic clubs

Evaluation

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.