PDF File in APA Format of a Sports Medicine Team

PDF File in APA Format of a Sports Medicine Team

Question Description

I’m working on a health & medical question and need a sample draft to help me learn.


use this knowledge to build the sports medicine team for the New Orleans Krewe.

Upon selection of the members of the sports medicine team, you will provide a visual organizational chart for the Krewe.

The visual organization chart must include the following items:

Position titles

Position descriptions

Justifications for why the position is necessary to the success of the organization

  • How the position will be utilized

Clin Sports Med 26 (2007) 173–179 CLINICS IN SPORTS MEDICINE Building a Sports Medicine Team Freddie H. Fu, MD, HDSc*, Fotios Paul Tjoumakaris, MD, Anthony Buoncristiani, MD Department of Orthopaedic Surgery, Center For Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203, USA B uilding a winning sports medicine team is equally as important to the success of an athletic organization as fielding talented athletes. Acquisition of highly qualified, motivated, and hard-working individuals is essential in providing high quality and efficient health care to the athlete. Maintaining open paths of communication between all members of the team is the biggest key to success and an optimal way to avoid confusion and pitfalls. There have been a growing number of participants in high school and collegiate athletics in recent years, placing ever-increasing demands on the sports medicine team. With tremendous advances in athletic medicine and the specialization of medical care increasing in the United States, a wide array of specialists are now deemed necessary to care for athletes. Questions arise as to who should serve as part of the sports medicine team, which care provider should serve as the coordinator, what are the defined roles of each member, and how can a coordinated approach be maintained to best care for the athlete? The answers to all of these questions have been hotly debated over the years [1]; however, some agreement exists as to the importance of each member to create a coordinated and comprehensive approach to medical coverage, providing optimal care for the athlete [1]. This article outlines the importance of each member of the sports medicine team and provides a guideline for sports medicine physicians on how to assemble the optimal team of specialists in order to provide the best medical care for the athlete. Defining which members warrant inclusion and how care is administered are discussed. OBJECTIVES OF THE SPORTS MEDICINE TEAM Before any process of assembling the proper players for the team can begin, a basic paradigm or mission statement is critical to defining the objectives of the sports medicine team. This technique is often used in corporations to clearly identify the objectives of the corporation, the consumers that it serves, *Corresponding author. Center for Sports Medicine, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA 15203. E-mail address: ffu@upmc.edu (F.H. Fu). 0278-5919/07/$ – see front matter doi:10.1016/j.csm.2006.12.003 ª 2007 Published by Elsevier Inc. sportsmed.theclinics.com FU, TJOUMAKARIS, & BUONCRISTIANI 174 and the employees who achieve its end [2]. The same basic paradigm can be applied to the sports medicine team. The health team must identify the objectives that it must achieve, provide a quality product to the athlete, and provide the providers with a sense of contribution. In the year 2000, the team physicians’ consensus statement was outlined from collaboration among six sports medicine and medical societies [3]. Within this statement lies an excellent outline for the objectives of the sports medicine team:  Coordinate pre-participation screening, evaluation, and examination.  Manage injuries on the field.  Provide for medical management of injury and illness.  Coordinate rehabilitation and return to participation.  Provide for proper preparation for safe return to participation after an illness or injury.  Integrate medical expertise with other health care providers, including medical specialists, athletic trainers, and allied health professionals.  Provide for appropriate education and counseling regarding nutrition, strength and conditioning, ergogenic aids, substance abuse, and other medical problems that could affect the athlete.  Provide for proper documentation and record keeping. This paradigm of care, in effect, is our mission statement. When assembling the team, it is paramount to ensure that all aspects of this mission are achieved through the use of our players in an appropriate fashion. The following is an example of a clear and inclusive mission statement from the James Madison University Sports Medicine Team that sets objectives and outlines a multidisciplinary approach to the care of the athlete: ‘‘The Department of Sports Medicine aspires to be a leader in providing quality healthcare services to all student-athletes. A team of multi-skilled professionals, utilizing current research, educational knowledge, and state-of-the-art equipment and technology, strives to provide a comprehensive and progressive approach to assuring the holistic well being of each student-athlete.’’ WHO MAKES THE CUT? The first decision that must be made in the overall assembly of our team is to identify which care providers are essential players and which can be used more in an ancillary capacity. Although it may at first glance seem best to apply an all-inclusive approach to this question, requesting the help of a multitude of providers from various disciplines, a more careful analysis of this question shows that a ‘‘less is more’’ doctrine may provide for clearer communication, less confusion for the athlete and personnel, and more efficient delivery of health care. The ‘‘gatekeeper’’ of the sports medicine team and the provider on the ‘‘front lines’’ of this process is the certified athletic trainer. Not only is this person the most likely first contact for the athlete with a medical concern, this individual is often intimately involved with the athlete on a personal level, and should an BUILDING A SPORTS MEDICINE TEAM 175 injury warrant treatment, the certified athletic trainer is often the provider administering the treatment program. Most athletic injuries occur during practice, not during the game when physician supervision is often present. The certified athletic trainer is perfectly suited to address injuries in this setting. In addition, data from high schools suggests that one in five high school athletes will sustain an athletic injury during their careers [4]. This large volume of injuries warrants a front line manager who can diagnose, examine, triage, refer, and treat patients appropriately. The sports medicine physician is the next critical player in the starting lineup. The sports medicine physician must meet certain criteria to qualify for this position:  Have an MD or DO degree with an unrestricted license to practice medicine.  Possess fundamental knowledge of providing emergency care for sporting events.  Be trained in CPR; assistance with emergency medical services (EMS) for cer- tain events may be warranted (eg, football).  Have a working knowledge of trauma, musculoskeletal injury, and medical conditions affecting the athlete [3]. Additional desirable but not always possible requirements for the sports physician are: specialty board certification, continuing education in sports medicine, fellowship training in sports medicine, significant practice contribution to the care of athletes, and membership and participation in a sports medicine society. Vital players of the team are the coach and coaching staff of the injured athlete—from the head and assistant coaches to the strength and conditioning coach for the team. A strong working relationship with open communication is necessary between the medical staff and the coaches to optimize care for the athlete. It should be clear to all parties that they share a common objective: the safe return to play of the injured athlete. Several studies have documented the ethical dilemma inherent in this relationship between medical personnel and coaching/ownership staff; however, with open communication and clear understanding of this fundamental objective, this dilemma can be minimized [5]. The strength and conditioning coach can be employed as part of the treatment program, allowing the athlete to continue to feel part of the team during a long rehabilitation process. In addition to the certified athletic trainers, physician, and coaching staff, it is helpful to view the athletes’ parents (for collegiate and high school athletics) as parts of the team as well. These emotional supporters of the athlete are crucial to the successful treatment of injured players. The entire emotional support network from teammates, family, and friends cannot be underestimated. Shared experiences and encouragement during rehabilitation provide much needed support, and are often as valuable as the medical treatment itself. This basic setup of the sports medicine team is an adequate beginning to caring for the injured athlete; however, it is only the beginning. This foundation is just that, a place to start. Several more providers are necessary for the 176 FU, TJOUMAKARIS, & BUONCRISTIANI comprehensive care of the athlete. The sports medicine physician should have access to an array of medical and ancillary providers, all adept at treating injured athletes. This access should be expedient, providing competent and quick decision-making. If the physician is a primary care sports medicine provider, a close working relationship with an orthopedic surgeon (preferably trained in sports medicine) is paramount. The reverse is true if the primary medical provider is an orthopedic surgeon. The physician should have quick access to specialists in the fields of hand surgery, foot and ankle surgery, neurosurgery/neurology, ophthalmology, internal medicine, general surgery, dentistry, and radiology. Ancillary providers such as sports specific physical therapists, nutritionists, and sports psychologists round out the medical team, providing the most comprehensive care in the best of scenarios. Game coverage by EMS is also important to stabilize critically injured athletes on the field of play. Fellows, residents, and athletic training students undergoing training in sports medicine often play an integral role in facilitating prompt care when access to the senior staff is difficult. Often times the athletic director is involved in coordinating and organizing the team in coordination with a designated team physician and athletic trainer. The budget allocated to the care of athletes will ultimately determine which providers are included or excluded from participation. COORDINATION OF CARE As mentioned previously, there has been significant debate in the medical community regarding who is best suited to be the sports medicine director of the medical team. Rather than contribute to this debate, the authors find it best to give parameters by which to judge a suitable candidate. First and foremost, it must be recognized that the true ‘‘coordinator’’ of care for athletes is the certified athletic trainer. This position requires an individual who is not only skilled in the ability to diagnose and treat musculoskeletal conditions, but who possesses excellent organizational and communication skills. The certified athletic trainer is responsible for coordinating pre-participation examinations, training room evaluations, referrals to the physician, and accurate record keeping for the athlete’s medical record, including health care insurance coverage and payment. A study on the perception of certified athletic trainers by student athletes demonstrated that, overall, student athletes had a very good perception of their certified athletic trainers [6]. This perception places the certified athletic trainer in a key role as athlete advocate and practitioner. As if this task weren’t daunting enough, the certified athletic trainer often serves as the liaison between the coaches and physicians and between athletes and their parents, which requires tremendous interpersonal and communication skills. The overall director of medical care should be an individual who possesses many of the same qualities as the certified athletic trainer. At the very core of these qualities is a significant level of competence in the field of musculoskeletal medicine. A recent study performed on intercollegiate athletes at a Division I University demonstrated that 73% of all training room visits by athletes BUILDING A SPORTS MEDICINE TEAM 177 were for a musculoskeletal complaint [7]. The visits for musculoskeletal injuries among athletes were much more likely to require repeat evaluation, whereas visits for common medical diagnoses (respiratory tract infection and so forth) were not. In addition, 4% of all musculoskeletal injuries ultimately required some form of surgical intervention. For this reason, it is critical that the medical director of the sports medicine team be an individual who is trained in musculoskeletal medicine. The roles of the director include  Establish and define the relationships of all parties.  Educate athletes, parents, coaches, administrators and other parties of con- cern regarding the athletes.  Develop a chain of command.  Plan and train for emergencies during games and practice.  Address equipment and supply issues.  Provide for proper event coverage.  Assess environmental concerns and playing conditions.  Provide oversight for clinical policies and procedures, (concussion manage- ment, dehydration, and so forth) [3]. Several schools and professional teams may often request that this individual be a sports medicine-trained orthopedic surgeon, because decisions regarding surgical intervention are often made on a continual basis. This may be necessary at certain levels of competition; however, in some instances a well-trained primary care sports medicine specialist may be sufficient. The important point is that this individual must have open paths of communication and demonstrate superior leadership qualities. AVOIDING PITFALLS, CONFUSION, AND CONFLICTS When assembling the team, it is important that all parties recognize their roles in the chain of command to avoid confusion and overlap between the players. The sports medicine physician sets the tone and must clearly communicate to all parties what is expected of them. Having a written outline documenting the responsibilities of each individual can significantly reduce the amount of overlap between different providers, and can help to avoid conflicts when they arise. An example of such a scenario may be that the internal medicine consultants relegate themselves to decision-making regarding non-musculoskeletal issues (asthma, heart conditions, and so forth), whereas the orthopedic consultants focus solely on that topic. Providers must be given a certain level of autonomy in the decision-making process in order to feel as if they are contributing to the overall care of the athletes. Confusion arises when several parties are rendering differing opinions on the care of the athlete and a clear rehabilitation program is not outlined. This could have an adverse impact, especially with respect to return-to-play expectations of athletes and coaches. Primary care sports medicine specialists may have anticipated being an integral part of the musculoskeletal decision making process, only to find that they are being used in a capacity more suitable for a medical internist. Asking 178 FU, TJOUMAKARIS, & BUONCRISTIANI pertinent questions when being asked to be a member of the team can help avoid this potential conflict of objectives. In addition, orthopedic surgeons and their primary care colleagues may have differing views on the optimal management of some common nonoperative injuries. Meeting regularly to discuss these issues can help the team come to a protocol for the optimal delivery of health care in these instances. Having a well-qualified, certified athletic trainer cannot be underestimated in avoiding several conflicts. It should be clear to the certified athletic trainer which injuries warrant bumping up to the next level in the chain of command. The medical director may decide that nonoperative injuries (sprains, contusions, and so forth) be evaluated by members who do not perform surgery, and that more serious injuries should be evaluated by the surgeon. Whichever decision is made, a certain level of autonomy must be given to the treating individual when evaluating these patients and coordinating a treatment plan. The inclusion of specialists into the treatment algorithm should flow through the sports medicine director. The director should have clear communication with the specialists, whether they are being used to render treatment or a medical opinion. Obviously, the athlete has certain rights in this regard, but usually defers to the medical staff for the coordination of care. All members of the team should meet regularly, both during the season and in the off-season, to discuss various issues that arise regarding conflicts, difficult cases requiring high level decision-making, and any overlap that may be hindering efficient delivery of care. Regularly scheduled training room sessions in which athletes are evaluated are an integral part of this efficient delivery. Staffing of these sessions is the responsibility of the director and the certified athletic trainer. The use of e-mail can serve as a useful adjunct, and can be used to determine if patients warrant radiographs or other diagnostic tests before being seen by the physician. E-mail also allows all members to discuss issues regularly, and is essential in keeping the lines of communication open. The physician and certified athletic trainer should meet with the coach on a regular basis to discuss all injuries and their responses to treatment. Parents should be introduced into the equation as quickly as possible, and having one spokesman in this regard is essential to avoid confusion and allay fears. Signed releases allowing the team to release information to parents for athletes over the age of 18 is required to involve family in the decision-making process. ESTABLISHING A WINNING TEAM The sports medicine team does not have the benefit of a lackluster season, nor can a ‘‘rebuilding’’ phase be accommodated. It is essential that all members of the team are on their ‘‘A’’ game at all times. Obviously, as members of the team work together longer and solidify strong working relationships, the team will only get stronger and more efficient. The key to success in this regard is to never surrender the strong foundation of availability, affability, and ability. All personnel should be available to the athlete and to each other for rendering BUILDING A SPORTS MEDICINE TEAM 179 of care. All parties should recognize that each has something to contribute and should respect the opinions of all stakeholders. All parties should also be qualified to render medical care in the highest capacity possible. Regular attendance at courses and continuing medical education is required to render the best treatment that science has to offer. The component of trust among team members is important to create the optimal atmosphere for patient care. All members of the team should feel confident in their own ability as well as the coordinated ability of the staff to provide the most current and appropriate medical care. Attendance at conferences by all parties and cross-disciplinary education is essential to create this atmosphere. Certified athletic trainers should be offered opportunities to observe surgery on athletes, and physicians should be encouraged to attend athletic training conferences and symposia. In this fashion, all members of the team create an appropriate check-and-balance situation to ensure the highest degree of trust and confidence among stakeholders. The essential component to sustaining a winning team is communication. The importance of this concept cannot be emphasized enough. As long as open lines of communication are continually maintained, all conflicts can be resolved and all shareholders can be accommodated. The old adage ‘‘There is no ‘I’ in team’’ is appropriate when caring for the athlete. Recognition of a coordinated approach to athletic care is imperative to sustain the best possible working relationship. Our focus as practitioners of health care should be on the patient as much as possible, with sound protocols in place that support our objectives of competent, efficient delivery of care. Laying a strong foundation from the beginning will pay dividends when game time approaches. References [1] Matheson G. Orthopaedics vs. primary care: time for a cease-fire [editorial]. Phys Sportsmed 2002;4–8. [2] Covey SR. Universal mission statement. In: Covey SR. Principle centered leaderhip. New York: Free Press; 1990. p. 295–302. [3] AOSSM. Team physician consensus statement. Am J Sports Med 2000;28:440–2. [4] Lyznicki JM, Riggs JA, Champion HC. Certified athletic trainers in secondary schools: report of the council on scientific affairs. American Medical Association. J Athl Train 1999;34(3): 272–6. [5] Tucker AM. Ethics and the professional team physician. Clin Sports Med 2004;2:227–41. [6] Unruh S. Perceptions of athletic training services by collegiate student-athletes: a measurement of athlete satisfaction. J Athl Train 1998;33(4):347–50. [7] Steiner ME, Quigley B, Wang F, et al. Team physicians in college athletics. Am J Sports Med 2005;33(10):1545–51.