Frequently Asked Questions: Sports Medicine

7/2024

Review Committees for Emergency Medicine, Family Medicine, Pediatrics,

and Physical Medicine and Rehabilitation

ACGME

Question

Answer

Introduction

Can a fellowship program last more than

one year?

[Program Requirement: Int.C.]

The Review Committees accredit only 12 months of education in sports medicine. All

accreditation requirements must be met within this 12-month period. If fellows complete

more than 12 months of education in a sports medicine program, that time is

considered unaccredited. If a program offers more than 12 months of education in total,

those experiences will not be reviewed by the Committee.

Can fellows complete their education part-

time, that is, take two years to complete the

fellowship instead of one?

[Program Requirement: Int.C.]

The program must be structured as a full-time undertaking. Individual applicants who

wish to complete the sports medicine fellowship over the course of two years (as part-

time fellows) will need discuss and receive approval from the relevant certifying Board.

Must the 12 months of fellowship education

be completed consecutively?

[Program Requirement: Int.C.]

Yes. It is expected that the fellowship take place within 12 consecutive months.

Institutions

If an applying program's sponsoring

institution does not have an accredited

program in one of the four indicated

specialties (emergency medicine, family

medicine, pediatrics, or physical medicine

and rehabilitation), what are its options?

[Program Requirement: I.B.1.a.)]

A sports medicine fellowship application will not be considered for accreditation unless

its sponsor also sponsors an ACGME-accredited core program in one of the four

specialty areas identified in the Program Requirements.

7/2024

Question

Answer

What relationship does the sports medicine

program need to have with its ACGME-

accredited residency program?

[Program Requirement: I.B.1.a.).(1)]

The sports medicine program must demonstrate for the Review Committee that it exists

in conjunction with, and is an integral part of, one core ACGME-accredited residency

program (in emergency medicine, family medicine, pediatrics, or physical medicine and

rehabilitation). This can be done a number of ways: (1) faculty members of the core

program are involved in teaching sports medicine fellows (e.g., by lecturing or

supervising a rotation); (2) faculty members of the sports medicine program are

involved in teaching residents from the core program; or (3) fellows are involved in

teaching and providing education to core residents.

What are the expectations for compliance

with availability to imaging and

rehabilitation services?

[Program Requirements: I.D.1.a).(1)]

Required imaging in the sports medicine clinic includes MRI, CT, and plain imaging

(digital or silver film). Required rehabilitation services include functional rehabilitation,

including the services of physical and occupational therapists, athletic trainers, and

coaches.

How is compliance determined with

regards to the requirement for an acute

care facility?

[Program Requirement: I.D.1.c).]

The expectation is that the program has a licensed acute care hospital with an average

occupancy of at least 135 beds, or an acute care facility with comparable

characteristics. Comparable characteristics include access to a broad range of medical

and surgical conditions that require an inpatient intensity of service, as well as an active

medical staff that includes surgical and non-surgical physicians. The hospital or facility

should be within 30 miles of the primary sports medicine center where the fellows learn

sports medicine.

How are programs expected to

demonstrate that they have access to a

broad patient population of adequate size

and variety?

[Program Requirement: I.D.1.d)]

Programs will describe their patient population in the application. For example, the

response might indicate that a

t a minimum, at least 10% of the patient population in the

sports medicine clinic should be pediatric (18 years of age or younger), and, in addition,

at least another 10% should be adults aged 51 years or older. An “adequate number” of

patients is as many as is necessary to allow fellows to acquire knowledge and/or

competence in the evaluation or management of a particular disease/condition or to

perform a procedure. Whether a program has a patient population that is “adequate in

number and variety” will be verified in interviews with faculty members and fellows at

the time of a site visit.

Program Personnel and Resources

Does every sports medicine faculty

member need to be identified in the

Accreditation Data System (ADS)?

[Program Requirement: II.B.)]

Each sports medicine faculty member (in addition to the program director) that is

responsible to fulfill supervisory and teaching responsibilities must be listed in ADS.

7/2024

Question

Answer

How does the Committee define "qualified"

for staff members from other identified

disciplines who must be available to

provide consultations and assist with

teaching fellows?

[Program Requirement: II.D.2.]

Examples of acceptable qualifications for each staff members include:

• Nutrition: is a registered dietician, or holds a bachelor's degree in nutrition

• Exercise Physiology: holds a bachelor's degree in exercise physiology, or is

certified by the American Society of Exercise Physiology to practice exercise

physiology, or has a doctorate with an academic degree or emphasis in

exercise physiology from an accredited college or university

• Physical Therapy: is a licensed and practicing physical therapist

• Behavioral Science: is an American Board of Medical Specialties (ABMS)-

certified psychiatrist, or is a licensed clinical, counseling, or educational

psychologist, or is a licensed clinical social worker

• Clinical Imaging: is an ABMS-certified radiologist

If a program does not have individuals with these qualifications, the program will need

to describe the comparable qualifications of staff members in these areas.

7/2024

Educational Program

Question

Answer

Which medical and surgical specialties and

subspecialties must be available?

[Program Requirement: II.D.2.b)]

Medical and surgical specialties and subspecialties must be available to sports

medicine clinic patients for serious sports medicine injuries. These specialties include:

• Cardiology

• Dentistry

• Emergency medicine

• General surgery

• Neurology

• Ophthalmology

• Orthopaedic surgery

• Otolaryngology

• Urology

What documentation does the Review

Committee suggest ensuring adequate

clinical experience in determining

competency for diagnostic and procedural

ultrasound?

[Program Requirement: IV.B.1.b).(1).(c)]

It is recommended that fellows maintain case logs as a means of collecting and

monitoring their experiences in diagnostic and procedural ultrasound of the shoulder,

elbow, wrist, hand, hip, knee, ankle, and foot. These logs are to be maintained at the

local institutional level and not through the ACGME Case Log System.

What are examples of exercise programs

for school-age children?

[Program Requirement: IV.B.1.c).(2).(q)]

Examples of exercise programs for school-age children considered acceptable by the

Review Committee include in-school physical education programs, t-ball, and pee-wee

soccer.

What are considered the basic principles of

sports ultrasound?

[Program Requirement: IV.B.1.c).(3)]

The basic principles of sports ultrasound include ultrasound physics, the benefits and

limitations of ultrasound, and image acquisition, optimization, capture, labeling,

archival, and reporting.

What are expectations for conferences and

workshops in

which sports medicine fellows

must participate?

[Program Requirement: IV.C.3.a)]

Conferences, seminars, and workshops must be specifically designed to augment the

clinical experiences of sports medicine fellows. Attending a sports medicine lecture

given by a core program is not adequate in that it is geared toward resident education

and not the education of sports medicine fellows specifically.

7/2024

If a program accepts a physician(s) from a

qualified specialty and the Sponsoring

Institution does not have a residency

program in that specialty, where may the

fellow(s) practice to maintain their skills in

their primary specialty?

[Program Requirement: IV.C.3.c)]

The program, in partnership with the Sponsoring Institution, may allow the fellow(s) to

temporarily work in a community practice or with an appropriate hospital service

depending on the primary specialty. It may also be possible to create a temporary

outpatient clinic for the specialty, within the sports medicine continuity clinic space.

Which outpatient non-operative

interventional procedures are considered

clinically relevant to the practice of sports

medicine, and fulfill the requirement for

experiences with which fellows must assist

or which they must observe?

[Program Requirements: IV.C.4.b).(1)-(2)]

The program is encouraged to allow fellows to have experience with non-operative

procedures, including reduction of dislocation, splinting, casting, soft tissue and joint

injection, arthrocentesis, management of simple uncomplicated fractures, and cervical

spine immobilization.

What are the expectations regarding the

extent to which fellows must assist with

and/or observe inpatient and outpatient

operative musculoskeletal procedures?

[Program Requirements: IV.C.4.b).(1)-(2)]

The intent of the requirement is that fellows must have active involvement with

operative procedures, though the requirement is written with flexibility (“must assist

and/or observe”). Programs will be cited if it is not evident that fellows have the

opportunity to assist with or observe such operative procedures relevant to sports

medicine.

What are the expectations for continuity in

the sports medicine clinic?

[Program Requirement: IV.C.4.c).(2)]

To ensure a continuity relationship (i.e., one clinic/patient panel followed over a long

period of time on a weekly basis), it is essential that fellows spend at least one day per

week for 10 months in a single sports medicine clinic. If the same patients cannot be

followed over the time noted, the Committee will not consider this requirement fulfilled.

How does the Review Committee define

the difference between “urgencies” and

“emergencies,” and can you provide

examples of both?

[Program Requirement: IV.C.4.d.(3)]

"Urgencies" require care within 24-48 hours. “Emergencies” uniformly require care in

less than 24 hours.

An urgency could be casting/splinting for follow-up with an orthopaedic surgeon on a

Monday for an injury sustained on a Saturday night.

An emergency would be a cervical collar and backboard for immediate transport to a

spine center for a spine injury.

7/2024

How many faculty members must

participate in scholarly activity?

[Program Requirement: IV.D.]

At least one sports medicine faculty member must participate in each of the following:

organized clinical discussions, rounds, journal clubs, and conferences.

Evaluation

How is the required Board pass rate

measured for programs with a small

number of fellows?

[Program Requirement: V.C.3.]

Fellows who graduate from ACGME-accredited sports medicine programs are

expected to take and pass the ABMS and if applicable, AOA-certifying exam in sports

medicine. Most sports medicine programs have only one or two fellows per year. As

such, the requirements were written so that compliance is determined using a five-year

timeframe.

Fellow Duty Hours in the Learning and Working Environment

Are there situations when fellows may be

supervised by licensed independent

practitioners?

[Program Requirement: VI.A.2.a).(2)]

While there is an expectation that fellows and faculty members have ultimate

responsibility for the overall care of each patient, there may be circumstances where a

licensed independent practitioner or physician extender may also be involved in a

supervisory role for the fellow. In such instances, the non-physician is expected to

provide that supervision within the legal limits of his or her particular license.

What is an optimal clinical workload?

[Program Requirement: VI.E.1.]

The program director must ensure fellow patient loads are appropriate. The optimal

case load allows each fellow to see as many cases as possible, without being

overwhelmed by patient care responsibilities, and without compromising a fellow’s

educational experience.

Who should be included in the

interprofessional teams?

[Program Requirement: VI.E.2.]

Physicians, advanced practice providers, case managers, certified athletic trainers,

child-life specialists, coaches, emergency medical technicians, nurses, pain

management specialists, paramedics, pastoral care specialists, pharmacists, physician

assistants, psychiatrists, psychologists, rehabilitative therapists, respiratory therapists,

and social workers are examples of professional personnel who may be part of

interprofessional teams.

Other

Does biographical information need to be

provided on every faculty member?

No. Programs should provide a one-page curriculum vitae (CV) for each sports

medicine physician faculty member, as well as the full CVs of any other subspecialists

who are not ABMS-certified.