The curriculum for the orthopedic sports medicine fellows include a very busy clinical experience:
- The fellow participates in approximately 1,000 operative cases during the year.
- The fellow actively sees patients in the clinical setting under the guidance of an attending. The fellow is the first person to see new patients and is responsible for taking a thorough patient history, performing a physical exam, reviewing imaging modalities and coming up with a treatment plan for each patient seen.
- The fellow then reviews the patient's case with the appropriate attending and a management plan is decided upon. The attending then personally sees and examines all patients in the presence of the fellow and reviews pertinent exam findings while discussing the management plan with the patient.
- In pediatric sports medicine in particular, many problems are managed with non-operative interventions such as physical therapy, orthotics, activity modification or bracing. The opportunity to see a young gymnast or soccer player at their first presentation of sports related pain and follow them through the entire sequence of their diagnosis, assessment and management is particularly important. We also see many pediatric patients with non-traumatic etiologies of the pain including tumor, reflex sympathetic dystrophy or pauciarticular rheumatoid arthritis.
- 90% of the clinical experience of the fellows in the clinic setting is related to the care of children and adolescents involved in sports. Attending faculty also provide care to physically active adults. Many of these patients are surgical consultations (often referred from other faculty members) which leads to a higher operative rate in these patients.
- Although we expect the fellow to be particularly well versed in the care and management, including operative management, of pediatric and adolescent athletes, we feel there is very adequate exposure to adult surgical interventions including arthroscopic procedures of the knee, shoulder, elbow, ankle and hip.
The clinical experience the fellow receives will allow the fellow to achieve competence in:
- Obtaining a detailed history from the patient, often involving questioning the parents as well which identifies pertinent positive and negative findings related to possible diagnoses.
- Performing a physical exam on the areas of interest including provocative maneuvers which often indicate specific pathology.
- Identifying physical exam abnormalities as well as normal variants.
- Reviewing radiographs, MRIs, CT scans, bone scans of the pertinent body parts.
- Reviewing all available medical records and pertinent laboratory tests.
- Understanding when further imaging or blood work is indicated.
- Synthesizing all above information to create a differential diagnosis and formulating a leading diagnosis based on the above data.
- Deciding on a management plan for both operative and non-operative problems, including when the patient should be seen for follow-up and what should be expected at follow-up.
- Counseling and educating the patients on their diagnosis and management options, and answering patient questions regarding non-operative and operative interventions.
- If surgical intervention is planned, discussing the surgery with the patient and family including describing the procedure and the expected pre-oprerative and postoperative course.
- When physical therapy is ordered, understanding the role for physical therapy modalities such as ultrasound, iontophoresis, water therapy and electrical stimulation.
- Understanding when consultation with other services is indicated including infectious disease, acute pain service, rheumatology and endocrinology.
- Reviewing the pertinent medical literature related to specific unique diagnoses seen during clinic.
- Following-up on patient testing and imaging ordered and reviewing results with the attending physician.