"Committed to Educate, Not Just Rehabilitate"
Sports Medicine Fellowship Programs in Canada

There are currently seven formal Sports Medicine Fellowship programs in Canada at the following universities: University of British Columbia, University of Calgary, University of Manitoba, University of Western Ontario, University of Toronto, McMaster Health Sciences, and McGill University. There are very strong training selectives in Sports Medicine in Edmonton, Alberta and Dalhousie, Nova Scotia. A Fellowship program is developing in Halifax, Nova Scotia. For further information of these programs, please contact Ms. Jacqueline Burke at the Canadian Academy of Sport Medicine in Gloucester, Ontario. Her contact information may be found under the directory heading of C.A.S.M. (Canadian Academy of Sport Medicine).

Toronto Primary Care Sports Medicine Fellowship program is meant to be an all encompassing training program in Sports Medicine for the postgraduate resident in Family Medicine (or related discipline). The essence of the experience will emphasize the primary care nature of this recognized subspecialty of Family Medicine and will offer the means to gain this knowledge. Sports Medicine is a very diversified subspecialty dealing with the musculoskeletal system, nutrition, general medicine, paediatrics, female medicine, geriatrics, exercise medicine, health promotion and prevention issues, sports bracing, podiatry, event coverage, and athletic emergencies. This list is really just touching the surface of the in depth knowledge required to be an excellent sports medicine physician. The sports medicine practitioner is constantly updating him/herself to be and remain ontop of his/her subspecialty.

Sport is a great vehicle to achieve an optimal level of health, but it is significant to realize that there are many people who are not involved in sport, but still require the same attention as those athletes (recreational/elite) that we treat on a regular basis. As mentioned above, part of the sports medicine physician's duty is to promote good health. This philosophy applies to any patient regardless of his/her athletic prowess. People are quite intimidated by the term "Sports" in front of the word "medicine" and it is one of our inherent commitments to dispel the myth that we only treat "athletic" patients.

The year will consist of multiple rotations in Adult Sports Medicine, Family Medicine, Paediatric Sports Medicine, Orthopaedics, Sports Nutrition, Physical Rehabilitation, Sports Bracing, Biomechanical Analysis, Cardiac Stress Testing, On Field Event and Team Coverage, Podiatry, Sports Psychology, Doping Control Procedures, Internal Medicine, Dermatology, ENT, Dentistry, Ophthalmology, and other areas of interest to the sports medicine practitioner.

There will be available one half day per week that will be designated as research time if the fellow would like to pursue a research paper in sports medicine by the end of the clinical year. This paper could be presented at either the C.A.S.M. General Meeting or the O.M.A.'s Sport Med in the following year (or both meetings if the fellow wishes).

The fellow will spend three half days per week practicing adult sports medicine in two designated sports medicine clinics in the city. The fellow will also spend one to two half days per week practicing family medicine with a sports medicine practitioner. This will make up a total of five to six half days per week throughout the year.

There will be three half days per week that will be reserved for exposure to the "specialty areas" of sports medicine. These will include such areas as nutrition, orthopaedics, paediatric sports medicine, podiatry, exercise medicine, event coverage, etc..

The Toronto Primary Care Sports Medicine Fellowship Committee has set out the following criteria for a candidate to possess in order to apply for the fellowship position . . .

1. Must be a member and in good standing with the C.M.P.A. (Section 64).
2. Must be a member and in good standing with the C.P.S.O. or equivalent.
3. The candidate must hold a general license to practice medicine in the province of Ontario.
4. The candidate requires 3 letters of reference (preferably 1 sports medicine reference).
5. Must send in a Certificate of Conduct from the C.P.S.O..
6. Must send in an updated Curriculum Vitae.
7. Must send in a short essay outlining the fellow's goals for the year (approximately 250 words).
8. The candidate should also send a letter of intent.
9. It is preferable that the candidate be an existing member of the C.A.S.M.

The fellow will have a clinical supervisor at each site where he/she is seeing patients. There will be a designated clinical supervisor at the places of adult sports medicine, family medicine, and each respective specialty clinic. As well, the trainee will have been selected a preceptor for the research paper that he/she has the option to pursue during the clinical year.

The year will be evaluated in many different forms. The following list outlines these methods.

• The on-going direct supervision of the doctor/patient contact.
• The on-going chart reviews.
• Quarterly evaluations completed by the adult sports medicine and family medicine clinical supervisor.
• Specialty rotation evaluations at the end of each rotation.
• Exit examination (written) for those who do not sit the C.A.S.M. Diploma examination during the same clinical year..
• Evaluation of the fellow's research study for those who are able to complete his/her study during the clinical year.

The fellow is expected to complete an evaluation of the supervisor at the end of the time that the fellow spends with that particular sports medicine faculty member. The year will be considered `not complete' until these evaluations are returned to the Program Director/Fellowship Committee.

The Toronto Primary Care Sports Medicine Fellowship year is broken down into both a clinical component and a research component. Both of these areas of sports medicine are as equally important and contribute to the overall success of the fellow during his/her year. The following criteria must be met before a fellow is considered to be worthy of acceptance of the Diploma in Sports Medicine from The Toronto Primary Care Sports Medicine Fellowship Committee.

1. Quality Assessment:
   • The Fellow should have a favourable review from greater than seventy-five percent of his/hers supervisors evaluations.
   • The Fellow should show behaviour that is exemplary and befitting his/her profession.
   • Any and all complaints made against the fellow by a patient shall be reviewed by The Toronto Primary Care Sports Medicine Fellowship Committee ("TPCSMFC") and a decision shall be made in respect to the fellows conduct.
   • The Fellow shall always be given the opportunity to explain his/her actions for review by the aforementioned TPCSMFC.


2. Quantitative Assessment:
   • There shall be a clinical mark, a written examination mark (where applicable), a critical appraisal mark, and a mark for the research paper.

The clinical component is a quantitative evaluation that is based on the average of the supervisor's evaluations from throughout the year. This is weighted at 25 %.

This 25 % is represented by a written examination that will be written by the Fellow (if the Fellow has not registered for the C.A.S.M. Diploma Examination during the Fellowship year) in the third week of June of the Fellowship year. Further details about the examination will be given later on in the year. The passing mark on the written examination is set at >70%.

This assignment will follow the years learning of Sports Medicine Critical Appraising of research papers reviewed with Dr. Lawrence Hart. There will be a number of papers reviewed during the year and discussed with Dr. Hart. There will be one paper given to the Fellow to review for marking in May of the academic year.

The research expected of the Fellow is to be involved in an on-going study or to develop a study under the supervision of one of our faculty members. The goals and objectives for this component will be thoroughly reviewed with the Fellow in the weeks leading up to the start of the Fellowship year (between January and July). The Fellow's performance will be evaluated in June of the academic year. Further details to be discussed.

Please note that there are some exceptions to the sitting of this examination. If the Fellow has been accepted to sit the CASM Diploma Examination, then this will form the basis of the Fellow's written examination evaluation. Once the Fellow has decided to sit the CASM Diploma Examination and is accepted, he/she will be committed to this examination. There will be no further written examination that the Fellow will be responsible for. If the Fellow is not successful in being accepted to sit the examination, then the Fellowship's Written Examination will then form the basis of the evaluation process for this component. If the Fellow is not successful in passing the CASM Diploma Examination, then the Fellow will have been considered to have "Failed" this component of the evaluation process. Discussions between the Fellow and the Program Director will take place through the year to help make the appropriate arrangements. The cost for sitting the CASM Diploma Examination will be the sole cost of the Fellow. The Fellow will be expected to forward his/her results to the Program Director as soon he/she receives them. The results of the examination will help form 25 % of the evaluation for the Fellow for the year.

The U of T Sports Medicine Fellowship is a fellow generated funded position. The position is advertised as a non-funded position. This is not a government funded residency position, but rather, is funded by a percentage of a fee generated by the fellow paid to the Toronto Primary Care Sports Medicine Fellowship. The five to six half days spent training at the sports medicine and family medicine clinics will generate the years earnings for the fellow. The time spent doing the specialty rotations and the research time will be considered as "non-income" producing time. The fellow will be paid 70 % of all the income generated at the clinic sites (where agreed upon). The "fees generated" includes all fees for services provided. All insurance forms, WCB forms, and all other miscellaneous items that are completed by the Fellow shall be paid in full to the Fellow. The Fellow (depending on the availabiity of private funding). The T.P.C.S.M.F. Committee will also attempt to pursue additional private companies for financial support to help secure the funding of the fellow.

There will be some additional assistance for the Fellow (provided sponsorship money has been received for the current academic year) in the following forms . . .

This money will be considered as a grant and will not be repayable by the Fellow.

The clinical year shall run from July 1st to June 30th of the following year. This period is in parallel with The Department of Family and Community Medicines residency training years.

The Fellow will be allowed two weeks of conference time during the clinical year of which one will have a sports medicine theme and the other will have a family medicine theme. The proposed conferences will require the approval of the Program Director and/or The TPCSMFC. The Fellow may choose to attend additional conferences, but these will have to occur during the Fellows own vacation time. The Fellow will have at his/her disposal $ 750.00 for expenses towards his/her chosen conferences.

The clinical year is 52 weeks long with two weeks conference time and an additional four weeks vacation time. Religious/Statutory holidays will be considered separate from the four weeks designated as vacation time. The four weeks vacation time is not to be taken in bulk. The fellow can take a maximum of two weeks at a time separated by at least two months as this could severely interfere with the rotations scheduling time. The Fellow must present the proposed vacation time to the Program Director at least three months in advance of the anticipated vacation time for approval so as to disrupt the planned clinical year as little as possible.

In addition to the previously mentioned responsibilities, the Fellow shall have the following additional responsibilities . . .

• Teaching of Clerks and F.M. Residents.
• Presenting of a lecture at both Family Medicine and Sports Medicine rounds (if applicable).
• On-Field Emergency Care Log.
• Attendance at Sports Medicine Rounds (where applicable).

Based on the nature of the funding, the Fellow will be expected to sign a letter of agreement with The Toronto Primary Care Sports Medicine Fellowship Program that he/she understands that the Fellow will be generating his/her own income and that The U of T/DFCM or any other body is not responsible for making up any part of the Fellow's income should it fall below the predicted $ 20,000.00-$ 40,000.00 range. As well, the TPCSMFC will work hard to provide the funding mentioned earlier (ie/ conference account, book expenses account, and the research account), but that this money is not guaranteed as funding for these categories will always depend on the budgets from year to year as sponsorship dollars do fluctuate.

At the "successful" (see the definition of "successful" under the heading entitled EVALUATIONS) completion of The Toronto Primary Care Sports Medicine Fellowship year, a diploma shall be presented to the fellow stating that he/she has successfully completed a year of clinical sports medicine at The U of T. No diploma shall be granted if the stated criteria (as outlined under EVALUATIONS) is not met.

The curriculum goals are the following . . .

1. To provide basic knowledge of sports medicine as it relates to family medicine.
2. To help the candidate to understand the role of exercise in health promotion.
3. To teach the management of both acute and chronic sports related injuries and to identify injury prevention issues.
4. To teach the candidate what knowledge and skills are necessary to perform as a team physician.
5. To provide additional training in family medicine.

This clinical year in Sports Medicine at The U of T will have as its final goal to prepare the prospective Fellow for the Canadian Academy of Sport Medicine Diploma Examination. This examination will be the culmination of the training program. The examination cost at the time of this printing is $ 750.00. The fee to sit this examination will be the responsibility of the Fellow. It will be the right of The Toronto Primary Care Sports Medicine Fellowship Committee to have access to the result of the Fellow's examination. This information will enable us to identify our weaknesses and provide some direction for The Fellowship Committee to improve the quality of its program, both in content and in its delivery.

The Toronto Primary Care Sports Medicine Fellowship is a twelve month academic Fellowship year for Primary Care physician's who are committed to the practice of Sports Medicine. The year has many various goals for the Fellow, our Faculty, and the Program, but there will be a very strong emphasis on teaching, the improvement of the Fellow's clinical skills, and the development of original research in the area of Sports Medicine. The year is not meant to be a twelve month elective in Sports Medicine. This Fellowship program is reserved for candidates who already have shown a strong commitment towards Sports Medicine and who want to build on this stable foundation.

If you are interested in applying for the position of Fellow for The Toronto Primary Care Sports Medicine Fellowship, the advertisement for this position is usually seen in the late summer for the following summer's start up date. If you require any further information about the program, please do not hesitate to contact me at the address given below.

1. "Sports Injury Assessment And Rehabilitation"-David C. Reid
2. "Sports Medicine"-Roy/Irvin
3. "Sports Medicine"-Strauss
4. "The Team Physician's Handbook" - Mellion/Walsh/Shelton
5. "Paediatric Orthopaedics In Primary Care" - Tolo/Wood
6. "Exercise In Health And Disease"- 2nd Edition - Pollock/Wilmore
7. "Common Problems In Paediatric Sports -Medicine"-Nathan J. Smith
8. "Eat To Compete"-Peterson/Peterson
9. "The Foot Doctor"-Copeland
10. "Resource Manual For Guidelines For Exercise Testing And Prescription - A.C.S.M.

1. Clinical Journal Of Sports Medicine
2. The Physician And Sports Medicine
3. Clinics In Sports Medicine
4. Canadian Family Physician
5. American Journal Of Sports Medicine
6. Other Family Practice Publications

This Fellowship year has the following goals . . .

1. To develop expertise in practicing Sports Medicine.
2. To prepare the fellow to write the C.A.S.M. (Canadian Academy of Sports Medicine) O.S.C.E. Examination the following year.
3. To produce excellent original Sports Medicine research (something that has been seriously lacking from this city in comparison to some other major Sports Medicine universities).
4. To develop a more expanded teaching system for future family practice residents who plan to do 1 month elective/selectives in Sports Medicine.
5. To raise the level of academic standards for teaching faculty in Sports Medicine at both a clinical and research level at U of T.
6. To be seen as the "gold standard" by other universities world wide as to how to create an excellent Sports Medicine Fellowship program (that deals with much more than just sports injuries).
7. To create an expanded forum for learning in the form of Sports Medicine rounds/conferences for the many G.P./F.P.'s in the city.
8. To further the already excellent reputation of the D.F.C.M. and The U of T.
9. To help promote the philosophy of health promotion and disease prevention in the community.
10. To help stress the concept of teamwork when it comes to caring for a patient. This philosophy is no better seen than in Sports Medicine.

We have an impressive faculty which makes up our Fellowship Committee.

As you can see we have some of the very best Sports Medicine physicians in the city. As well, we have recruited a number of other faculty to help round out the staff to assist with the training of our fellow. I hope this information has been of use to you in forming your own image of what our mission is in developing this Fellowship program. It is long overdue, but maybe the time it has taken to develop such a program was necessary in order to allow us to reflect on what was important to include to develop the best program in the country. The challenge is a great one, but the effort is tremendously worthwhile.

The application process takes place in the fall of the year preceding the academic year of application. That is, if you are applying to enter the 2001 academic year, one would apply in the Fall of 2000. Application forms may be obtained from the Innovative Programs representative in the Department of Family & Community Medicine, U of T.

This Representative can be reached at the following telephone number . . .

The application is considered complete when the candidate has successfully delivered the following . . .

1. A completed application form (available through the DFCM office/Dr. H. A. Winston; CHSMTO.COM Web site-soon to be available).
2. 3 letters of reference.
3. Certificate of Conduct (CPSO/equivalent).
4. Short Essay Outlining the Candidates Objective for the Fellowship year.

All of the above documents MUST be received no later than 5:00 pm on the first Friday in December of the year preceding the academic year of application.

For further information you may call the Program Director's office at the following:

The application is due the first Friday in December prior to the commencement of the Fellowship year (July 1st), which deadline is strictly enforced. Notices of advertising for the Fellowship position will be released in October of the year preceding the academic year.

The TPCSMF is located in Toronto, Ontario, Canada. The Fellow will be attending multiple facilities in Toronto proper and some of its surrounding areas. It would be considered an asset to own a car, but clearly, not a prerequisite. The candidate will be registered as a Post Graduate student with the University of Toronto and will be afforded all the same privileges as any other Post Graduate student. The registration process must take place by no later than mid-June of the academic year.

The Fellow is responsible for the registration fee with the Post-Graduate office.

The prospective candidate should be aware that he/she may be asked to attend an interview, in Toronto, within two weeks of the application deadline date in December. Please make sure that your schedules are clear for this two week time period for a possible interview.