20 September 2019
Dr David Humphries FACSEP
As Australasian SEM physicians know, the path to gaining the FACSEP is not an easy one. The minimum time from starting medical school to getting the big tick is 12 years, and not everyone travels the direct route. We are justifiably proud of our system of training and accreditation, but it is worth reflecting that it is not the only system out there. It is not entirely clear how many countries around the world recognise SEM as a specialist area of medicine, and how a specialist area is defined also varies. A figure commonly quoted is that 26 countries recognise it as a distinct medical specialty. Interestingly some countries that are powerhouses in SEM research do not recognise it as a medical speciality, an example being Sweden.
Having facilitated a Delphi group of international sports physicians for the past 4 years, I have been learning about the different paths to SEM specialisation in various parts of the world. In a very general sense, they can be broken down into three categories, the adjunct training path, the academic path, and the medical college path. Each has its own merits and potential pitfalls.
In regard to the adjunct training path there are several variations. In Canada there is are 2 possible pathways to achieve accreditation in SEM, each taking a year and being an adjunct to a qualification as a family physician, but SEM is not regarded as a stand-alone medical specialty. In Switzerland a year is added to general physician training and it is regarded as a medical specialty.
The academic model is typically associated with the award of a Master’s qualification from a University and may be the standard model of specialisation in that country. For example, in Malaysia each speciality takes PGY4 trainees into a Master’s program, which takes 4 years to complete and confers specialist status. Interestingly in the Malaysian system specialist training must be completed within 7 years of starting. Turkey has a 4year training program, with a PhD equivalent thesis to be presented at the end of specialist training. Specialisation in all disciplines in Turkey is determined by the Ministry of Health and can commence in PYG1.
The medical college path is very familiar to ACSEP registrars and fellows, a similar model exists in the United Kingdom however funding for registrar positions is determined by area health services and is dependent on the perceived need for the specialty in that geographical area. A variation on this theme would be the 4 year training program that runs in Romania. Here, after 6 years of medical school and a residency, specialty training takes place over 4 years, the system in the Netherlands is similar.
For more reading-
Humphries D, Jaques R, Dijkstra HP on behalf of the International Syllabus in Sport and Exercise Medicine Group (ISSEMG)
A Delphi developed syllabus for the medical specialty of sport and exercise medicine
British Journal of Sports Medicine 2018;52:490-492.
Infographic - SEM International Syllabus