Sports Medicine Fellowship Curriculum

Pediatric Sports Medicine

This rotation will revolve around outpatient clinics at various sites provided by one of the nine 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 (Ortho Neuro), Dr. Kendra McCamey and Dr. Jim Borchers (The Ohio State University Primary Care Sports Medicine). 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).

Pediatric Orthopedics

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

This rotation is comprised of two parts.  The first part of the rotation will be focused on spinal conditions in orthopedics.  The fellow will participate in the care of a wide array of spinal issues revolving around scoliosis, complicated spondylolysis/spondylolisthesis, cervical injury, lumbar disk disease, Scheuermann’s disease, diskitis, and osteomyelitis.  This part of the rotation is supervised by orthopedic spine specialists.

The physical medicine and rehabilitation portion of the rotation will be two-fold, including:

1. Allowing the fellow to become familiar with Electromyelography/ Nerve Conduction Study (EMG/NCS) clinic in order to garner experience in how this procedure is performed.  While rotating through this clinic, the fellow should gain an appreciation for which patient problems/diagnoses EMG/NCS is appropriate to utilize so that they may generate proper referrals for this testing. This portion of the rotation is supervised through the Pediatric PM&R specialists.
2. The fellow will also rotate with the PM&R specialists at OSU specializing in adult back pain to garner experience in treating and managing adult back pain both conservatively and surgically.

Orthopedic Hand

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.

Rheumatology

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.

Sports Nutrition

The fellow will rotate during various times throughout the year in sports nutrition with the Sports Medicine Clinical Dietitian. This will be more of an observational experience. Specific emphasis will be placed on learning key components to a sports nutrition history assessing. This will include patient goals, restrictive behaviors, weight history, female menstrual history, binge/purge/other eating disorder behaviors, SCOFF questionnaire, eating behaviors, estimated nutritional needs, sports and exercise history. The fellow will also become comfortable with development of a nutrition diagnosis and with development of a nutrition intervention/plan.

Nationwide Childrens Hospital Sports Medicine Fellowship Ultrasound Training

Sports Ultrasound training at NCH revolves around an intense ramp up in the early months of fellowship starting in July and moving through August and September of the fellowship year.  The course is instructed by Sports Medicine faculty including both Drs. Duerson and Napolitano.  Training occurs every Wednesday afternoon from July to September focusing on both didactics and hands on learning while utilizing the ultrasound.  Resources guiding training and didactics include the 3r^d edition Fundamentals of Musculoskeletal Ultrasound by Jon A Jacobson and the Atlas of Ultrasound Guided Musculoskeletal Injections by Gerard Malanga.  Leading up to a specific didactic topic it is the responsibility of the fellow to review the corresponding AMSSM Ultrasound didactic video.  Starting in October the fellow will begin rotating with Drs. Napolitano and Duerson on Mon afternoons in Westerville (both share a pod) doing both diagnostic and procedural ultrasound scans.  This will continue through June of the academic year. As well the fellow will begin in October (2 half days per month) rotating with Dr. Oberle in pediatric rheumatology doing ultrasound scans to gain a different scanning perspective.  To complement their training, the fellows will attend the AMSSM Fellow Conference Ultrasound session in July/Aug of fellowship year as well as the AMSSM ultrasound pre-conference prior to the start of the annual meeting in April of the fellowship year.  To gauge fellow competence, the fellow will complete two Semi Annual Practical Evaluations. The final Semi-annual practical in May/June of the academic year; is utilized to determine the fellow’s competency to scan independently, with regard to future employment (Per NCH Sports Medicine Credentials), as a Focused Ultrasound Operator.

Ohio State University Sports Medicine Fellowship MSK Ultrasound Curriculum

The fellow is provided an opportunity to gain knowledge in musculoskeletal ultrasound (MSK US). This course is offered through The Ohio State University Sports Medicine Fellowship through an OSU sports medicine faculty preceptor certified in MSK US. The fellow will obtain an understanding of the terminology and basic physics of MSK US, appropriate applications of MSK US in a sports medicine setting, and be able to perform a basic ultrasound exam of the shoulder, elbow, wrist/hand, knee, ankle/foot, and hip. As the fellow proceeds through the course they will be able to collect ultrasound images to be used after fellowship for credentialing and will understand the coding and billing that is used when doing MSK US in a clinical setting. Successful completion of the course is accomplished through assigned reading, completion of 6 musculoskeletal ultrasound sessions throughout the academic year with a MSK US preceptor, successfully passing a musculoskeletal ultrasound practical exam at the end of the academic year, attendance at all cadaver sessions as set up by the MSK US preceptor, and completion of the ultrasound exam requirements for focused MSK US operator at the Wexner Medical Center.

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 also 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.

Musculoskeletal Radiology

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.

Physical Therapy and Functional Therapy

The fellow will rotate at various times throughout the year in the physical therapy and functional therapy departments and expand their knowledge within the field of rehabilitation medicine.  Specific emphasis will be placed on learning the various exercise and rehabilitative programs for injuries, including therapeutic exercise and functional progression.  The fellow will be expected to understand the following concepts and their contribution to rehab therapy.

• Range of motion

• Isometric exercise

• Progressive resistance exercises

• Eccentric exercise

• Isokinetic exercise

• Modalities available for the treatment of the injured athlete including Kin-com (Isokinetic equipment), ultrasound, galvanic electrical stimulation, iontophoresis, heat and cold therapy

It is our hope that the fellow will be able to devise a rehabilitative plan based on an athlete’s injury.

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.

Learn about additional experience including Event Coverage, Conferences, and Scholarly Activity/Research.