Pediatric Sports Medicine
This rotation will revolve around outpatient clinics at various sites provided by one of the eight primary care sports medicine specialists/attendings. Learning conservative treatment management (i.e. rehabilitation through formal physical therapy, functional rehabilitation, and home exercise programs) as well as recognizing indication for surgical treatment will be emphasized in the curriculum. The fellow will be exposed to a wide range of diagnoses in pediatric musculoskeletal medicine ranging from sports injury, injury prevention education, and formulation of wellness programs for the prevention of disease and treatment of chronic disease (i.e. congenital heart disease, coronary artery disease, DM, COPD) in a variety of age ranges from childhood to adulthood. The fellow will become well versed in treating special needs athletic populations (i.e. Downs Syndrome/Special Olympics) and handicap athletes.
Adult Sports Medicine
This rotation revolves around outpatient clinics with Dr. Jeremy Mathis. The fellow will see a wide base of patients, in the adult setting, with acute and chronic musculoskeletal needs. Learning principles of conservative treatment management, becoming proficient in joint injection principles, as well as recognizing indication for surgical treatment will be emphasized in the curriculum. As in pediatric sports medicine rotations, the fellow will be exposed to a wide range of diagnoses in musculoskeletal medicine ranging from sports injury, injury prevention education, and formulation of wellness programs for the prevention of disease and treatment of chronic disease (i.e. coronary artery disease, DM, COPD).
The pediatric orthopedic rotation is supervised by our pediatric orthopedists. This rotation will expose the fellow to a wide array of orthopedic issues seen in pediatrics (i.e. SCFE, Legg-Calve’-Perthes disease, clubfoot, metatarsus adductus, outtoeing/intoeing, developmental dysplasia of the hip, aneurismal bone cysts to name a few). As well, the fellow will gain confidence in radiographic evaluation of fractures, reduction techniques in fracture care, casting/splinting, and overall management of fractures. This will be accomplished by rotating with our orthopedic specialists and doing shifts in the Emergency Department with the moonlighting orthopedic resident (seeing acute fractures) learning how to hone these skills.
Orthopedic Spine and Physical Medicine & Rehabilitation
During the hand rotation, the fellow will rotate with or our orthopedic hand specialists. The fellow will become proficient in treating hand and wrist injuries as well as fractures. The fellow will gain experience and confidence in recognizing injuries that require more specialized care or surgery revolving around entrapment neuropathies, sprains/strains, tendonitis/bursitis, common fractures and dislocations, Dupuytren’s contracture, soft tissue injuries, flexor tendon nodules, arthritis, and overuse injuries.
Orthopedic Foot and Ankle
This rotation will allow the fellow to spend time treating patients with foot and ankle injuries needing more specialized care or surgery. The fellow will be proficient in treating common foot and ankle conditions affecting athletes; including fractures, stress fractures, lisfranc injury, sprains, sesamoiditis/sesamoid dysfunction, cysts, neuromas, hallux rigidus, intoeing, outtoeing, tendon injury/dysfunction/tendonitis, Sprains/strains, dislocations, Tarsal Tunnel Syndrome, arthritis, diabetic foot, heel pain/plantar fasciitis, toe deformities, bunions, corns and calluses, metatarsalgia, soft tissue masses of the foot and ankle.
The fellow’s rheumatology rotation will help to round out their musculoskeletal knowledge while learning to diagnose and initiate appropriate treatment for common rheumatologic problems until rheumatologic consultation can be obtained. These disease processes will include but are not limited to: Juvenile Idiopathic Arthritis, Juvenile Ankylosing Spondylitis and Spondyloarthropathies, SLE,Juvenile Dermatomyositis/ Polymyositis, PMR and giant cell arteritis, Reactive Arthritis, Infectious vs. Post Infectious vs. Inflammatory Arthritis, Lyme disease, Fibromyalgia versus Pain Amplification Syndrome, Complex Regional Pain Syndrome/Reflex Neurovascular Dystrophy, Systemic Vasculitides, Polyarteritis Nodosa (PAN), and Sarcoidosis.
Cardiology Stress Testing and Voice Clinic Combination Month
During the cardiology rotation and throughout the year the fellow will become comfortable with the cardiovascular evaluation with specific emphasis on the pre-participation physical as well as screening questions proposed by ACSM and AHA. The bulk of clinical experience through Cardiology will come in the form of rotating through the exercise stress lab. The fellow will become comfortable with recognizing the epidemiology, diagnostic and screening tests, treatment options, and criteria for sports participation in relation to causes/etiologies of SCD. The fellow will come to understand recommendations for obtaining EKG and echocardiogram as well as these test’s limitations in preventing sudden cardiac death (SCD). The fellow will understand the phenomenon of Athletic Heart Syndrome and how to differentiate this entity from Cardiomyopathy. The fellow will become familiar and comfortable with utilization of the Bethesda Criteria for sports participation decisions concerning cardiac diseases. The fellow will become comfortable with recognition of abnormal blood pressure in a pediatric and adolescent population as well as understand the workup for secondary causes of elevated blood pressure in this patient population. As well, the fellow will be comfortable with initiation of proper treatment and chronic follow up for hypertension. The fellow will also become proficient at the workup for chest pain in an athlete while learning to use such diagnostic tools as cardiac and pulmonary stress testing.
The fellow will rotate through voice clinic during the same month as rotating through the cardiology stress lab. This clinical rotation experience will be utilized to garner experience in evaluating and diagnosing voice disorders with specific emphasis placed on vocal cord dysfunction. By the end of the rotation the fellow will be able to generate a differential diagnosis for patients presenting with signs and symptoms that could be consistent with vocal cord dysfunction (i.e. Exercise induced bronchospasm/asthma, cardiology disorders) and understand when referral for specialized testing is required to diagnose vocal cord dysfunction. The fellow will also become familiar with the specific tests utilized to diagnose vocal cord dysfunction and how these tests are preformed and interpreted.
This rotation will be spread throughout the academic year in order to allow the fellow the opportunity to learn and utilize radiographic exam skills throughout their entire year of training. In addition to reading all films in clinical musculoskeletal and orthopedic clinics; the fellow will garner experience with regular sessions, throughout the year, reading films with a radiology attending. In addition the fellow will meet monthly with sports medicine faculty and radiologists for radiology rounds/case conference. During sessions, the fellow will gain an appreciation for the various radiologic musculoskeletal diagnostic tests and understand their limitations, sensitivity, specificity, and indications in relation to musculoskeletal medicine. The fellow will garner awareness concerning the costs of various diagnostic modalities, their advantages and disadvantages. The fellow will also gain exposure to musculoskeletal pathology on plain films, CTs, MRIs, ultrasound, and bone scans and be able to correlate clinical findings of disease with radiographic abnormalities.
Primary Care Continuity Clinic
The fellow will spend one half day per week maintaining clinical competence in the fellow’s perspective primary field of primary care medicine. This may include pediatrics, family medicine, or internal medicine. The rotation may take place at one of the NCH primary care continuity care clinic sites or South High Street Internal Medicine and Pediatric Clinic. Continuity Clinic for Family Medicine trained fellows will occur either at the Northland Family Practice associated with Mt. Carmel Hospitals or the South High Street Internal Medicine and Pediatric Clinic.
For fellows, with primary certification in emergency medicine; special arrangements will be made to maintain clinical competence in the emergency department. For fellows with primary certification in Physical Medicine and Rehabilitation (PM&R); special arrangements will be made to maintain clinical competency through time spent in the PM&R Department.
Fellow Run Sports Medicine Clinic
The fellow will run, one half day per week, a designated Nationwide Children's Sports Medicine fellow’s clinic. This will be a fully functional referral clinic focused on managing musculoskeletal/sports related injuries and issues. One of the sports medicine faculty will precept the fellow in this clinic.