New Fellow Proficiency and Program Director Expectations in Primary Care Sports Medicine

New Fellow Proficiency and Program Director Expectations in Primary Care Sports Medicine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article New Fellow Proficiency and Program Director Expectations in Primary Care Sports Medicine Scott Klass, Javier Santana, Martin Weaver, Eduard Tiozzo, Timothy Tiu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8152681/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Sports Medicine (SM) fellowship can be pursued after residency in family medicine (FM), emergency medicine (EM), internal medicine (IM), pediatrics (PED), and physical medicine and rehabilitation (PM&R). Each specialty uniquely prepares its graduates for a SM fellowship, yet it remains unknown if all specialties are equally prepared and if knowledge or training gaps exist. Methods In 2019–2020, a survey based on the Accreditation Council of Graduate Medical Education (ACGME) milestones was sent to 175 fellowship program directors (PD) after the first quarter of training. 82 PDs, (47% response) rated their fellows’ skills and expected proficiency. A Kruskal-Wallis test was used to compare the median ranks of different specialties. Pairwise comparisons were tested for significant differences with using Bonferroni correction. Differences and overall scores were analyzed using ANOVA. Results Combined milestone analysis showed no overall difference between specialties. Individually, out of the twenty one domains assessed, there were nine significant differences between fellows regarding their proficiency in performing various sports medicine skills and academic requirements. In evaluating the minimal proficiency expectations of the PDs from their current fellows we found three significant differences between specialties. Conclusion There are no overall differences in proficiency between SM fellows from FM, EM, IM, PED, or PM&R. Primary Care Sports Medicine Education Fellowship training Figures Figure 1 Figure 2 Background Sports Medicine (SM) is a recognized specialty with Accreditation Council of Graduate Medical Education (ACGME) fellowship training, with eligible primary specialties (PS) being emergency medicine (EM), family medicine (FM), internal medicine (IM), pediatric medicine (PED), and physical medicine and rehabilitation (PM&R). 1,2 The Team Physician Consensus Statement clearly states that each meets an essential qualification to serve as team physician. 3 Despite this, some employers including organizations such as the National Football League (NFL) and National Basketball Association (NBA), have policies that render certain SM trained and board-certified physicians ineligible to fill this or similar roles based on their PSs, most notably PED and PM&R, thus challenging the credibility of the ACGME SM fellowship. 4 , 5 FM, IM, PED, and EM physicians have self-identified that their training in sports and musculoskeletal (MSK) medicine is insufficient. 6 – 8 In IM, less than 1% of total didactic and clinical education time involves MSK medicine. 9 For PED programs, 29% do not include MSK examination in their curriculum, 77% provide lecture-only education for SM, and 83% have less than 6 hours of SM lectures. 10 One study demonstrated that only 61% of EM physicians passed a validated MSK knowledge examination. 11 In contrast, PM&R residents have rigorous training in MSK medicine, with greater than 50% of programs having more than six months of MSK training and 85% of graduates feeling comfortable treating MSK conditions. 12 The purpose of this study is to identify differences in SM competencies between new fellows of the various eligible PSs. The primary objective is to evaluate for overall differences in proficiency of SM-related skills. The secondary objectives are to evaluate for differences in proficiency of individual aspects of SM, and to identify any differences in program directors’ (PDs’) expectations for new fellows. Methods Setting and participants This study was survey based. Eligible participants were all 175 ACGME SM fellowship PDs during 2019–2020, identified using the ACGME website and the American Medical Association Residency & Fellowship Database. Interventions Interventions We created a 50-question survey using Qualtrics (see supplemental data) that was developed for this study and not published elsewhere. The entire survey can be found in the supplementary files and is available upon request. The initial eight questions were demographic. The remaining 42 questions were made based on ACGME milestones. 2 , 13 21 questions asked PDs to rate each fellow’s ability in a specific milestone using a 5-point Likert scale (1-Strongly disagree, 2- Disagree, 3-Neither agree nor disagree, 4-Agree, 5-Strongly agree), and 21 follow up questions asked PDs to give their expected level of proficiency on these milestones on another 5-point scale (1-No proficiency, 2-Limited proficiency, 3- Moderate proficiency, 4-Advanced proficiency, 5-Complete proficiency). Individual links were sent to each PD by institutional email, to obtain consent to participate in the study. This occurred during the fourth month of the academic year. Two reminder emails were sent within two months. The University of Miami’s Institutional Review Board waived the need for ethical approval in our study, as the data collected remain anonymous and de-identified. Outcomes measured The primary outcome was overall differences in SM skills between PSs. Secondary outcomes were specific differences in SM skills between PSs, and between PDs’ expectations for SM fellows’ level of proficiency. Analysis of the outcomes Median and range were reported for all questions regarding fellow proficiency. Further, an independent Kruskal-Wallis test was used to compare the median ranks of different specialties. If significant differences were observed, pairwise comparisons were used to test for pair-by-pair significant differences with using Bonferroni correction. These data points were treated as continuous outcomes, summed scores were averaged for each specialty, and differences were analyzed using ANOVA. All statistical analyses were conducted using IBM SPSS Statistics 26. p value ≤ 0.05 was considered statistically significant. Results 82 PDs completed the survey (47% response rate). There were 60 (73%) FM PDs, 14 (17%) PM&R, 3 (4%) EM, 2 (2%) PED, 1 (1%) IM, and 2 (2%) “other”. Data was obtained about 133 fellows: 79 (59%) FM, 25 (19%) PM&R, 14 (10%) EM, 9 (7%) PED, 6 (5%) IM. There were no overall significant differences in a combined score between PSs (Fig. 1 , Table 1 ). Of 21 domains assessed, 9 had significant differences (Fig. 2 , Table 1 ). FM and EM fellows were more proficient than PM&R in non-MSK SM physical examination. PM&R fellows were more proficient than FM, IM, and PED in performing an MSK examination, while FM and EM were more proficient than PED. FM, EM, and PED fellows were more proficient than PM&R in managing non-MSK SM conditions (e.g., infectious mononucleosis). EM fellows were more proficient than PM&R, FM, and IM in managing SM emergencies. PM&R fellows were more proficient than FM in interpreting MSK magnetic resonance imaging (MRI) and in the basic theoretical principles of sports ultrasound, and more proficient than PED, FM, and EM in the basic practical principles of sports ultrasound. PM&R fellows have a more genuine interest in academic projects compared to FM. FM fellows were more knowledgeable in billing and coding than PM&R and EM. Table 1 Significant Skill Differences Between Fellows in Each Specialty and Median Total Scores The new fellow is able to: Total FM PM&R PED EM IM p value Significant differences # Conducts non-musculoskeletal physical examination, as it pertains to sports medicine 5 5 4 4 5 4.5 0.002 FM > PM&R EM > PM&R Performs a musculoskeletal examination, including the identification of anatomic landmarks 4 4 4 3 4 4 FM* PM&R > IM PM&R > PED* EM > PED FM > PED Managing non-musculoskeletal conditions relevant to sports medicine. Examples include rash and infectious mononucleosis 4 4 3 5 4 4 PM&R* EM > PM&R* PED > PM&R* Manage emergent injuries and conditions at sporting events, at the level expected of a sideline physician 4 4 4 4 4 3.5 0.02 EM > PM&R EM > FM* EM > IM Independent interpretation of musculoskeletal MRIs 2 2 3 2 3 2.50 0.03 PM&R > FM* Proficient in the basic theoretic principles of sports ultrasound, including understanding the sonographic appearance of normal and pathologic tissues 3 3 4 2 3 3.5 0.003 PM&R > PED PM&R > FM* PM&R > EM Proficient in the basic practical principles of sports ultrasound, and is able to visualize and identify normal anatomic structures. 3 3 3 2 3 2.5 0.02 PM&R > IM PM&R > FM* Has a genuine interest in academic projects. 4 4 4 4 4 4 0.02 PM&R > FM* Knowledgeable in billing and coding 4 4 3 4 3 3 0.04 FM > PM&R FM > EM Total median values by specialty 77 78 82 74.5 76.5 74.5 0.37 No difference Table 1-These are the nine statistically significant differences in our analysis. The values on the table represents the median. We used median instead of mean values for this analysis since our data was not evenly distributed. #We also performed a Kruskal Wallis to determine a pairwise comparison between primary specialties, the result of which is seen in the last column. For these nine significant differences, the specialty with the greater symbol pointing towards it indicates that a higher value was obtained. FM- family medicine (n=79), PM&R- physical medicine and rehabilitation (n=25), PED- pediatrics (n=9), EM- emergency medicine (14), IM-internal medicine (6) * Significant after the Bonferroni adjustment In analyzing the minimal proficiency expectations of the PDs, we found three significant differences (Table 2 ). FM PDs had higher expectations in the ability to manage non-MSK conditions compared to PM&R PDs. PM&R PDs had higher expectations for both knowledge of the basic theoretic principles of sports ultrasound, and independent interpretation of MSK MRI compared to FM PDs. Table 2 Significant Differences Amongst PD Expectations of Fellows Skills What is your minimal acceptable level in: FM PM&R PED EM p-Value Significant Differences # Proficiency in ability to manage non-musculoskeletal conditions 3 2 2.5 3 0.03 FM > PM&R * Knowledge of the basic theoretic principles of sports ultrasound, including understanding the sonographic appearance of normal and pathologic tissues 2 2 1.5 3 0.01 PM&R > FM PM&R > Other EM > Other Ability to perform an independent interpretation of musculoskeletal MRI 2 3 2 3 0.04 PM&R > FM Table 2-These are the three statistically significant differences based on the PDs' expectations of the fellows' skills. The value on the table represents the median. We used median instead of mean values for this analysis since our data was not evenly distributed. # We also performed a Kruskal Wallis to determine a pairwise comparison between primary specialties, the result of which is seen in the last column. For these three significant differences, the order in which the specialty appears in relation to others indicates that a higher value was obtained. FM- family medicine (n=60), PM&R- physical medicine and rehabilitation (n=14), PED- pediatrics (n=2), EM- emergency medicine (n=3). *Significant after the Bonferroni adjustment Discussion The results suggest that all PSs entering SM are equally prepared and skilled, and therefore should be equally qualified and capable of practicing SM after fellowship. This is important because organizations such as the NBA and NFL have placed limits on the scope of practice of both PED and PM&R SM physicians, excluding them from serving as head team physicians. Both the NFL and the NBA collective bargaining agreements state that for the medical team, each club shall have one lead orthopedic surgeon and one lead SM physician board-certified in IM, FM, or EM only. 4 , 5 In line with the AMSSM’s Sports Medicine Physician Scope of Practice document and Team Physician Consensus Statement, our study demonstrates no perceived superiority in skills or preparedness of any one PS over another. Therefore, residency specialty training should not be a limiting factor in SM job opportunities, regardless of the level of sport. 14 Individual training programs or the ACGME may consider perceived proficiency differences between PSs in specific SM domains as opportunities for revision in curricula or milestones; eg: FM and EM fellows are perceived to be more proficient in more general medical areas, and PM&R fellows are perceived to have more substantial mastery of MSK specialized topics within SM. One must further distinguish that these findings indicate perceived skills and not actual skills. It is therefore important for national SM organizations to be cognizant of these perceptions and assist in educating each other on the equal preparedness of all primary specialties that comprise SM clinicians. Limitations include a survey response rate of 47%, but that is greater than the average of 44% in education. 15 There is also a risk of bias from fellowship PDs, and we minimized this through anonymity. It is possible that some of the observed deficiencies in proficiency are due to individual fellow differences instead of residency. Lastly, some of our findings may be affected by small sample sizes of PED, EM, and IM specialties. Future studies should objectively evaluate for knowledge and training gaps. Additional studies can examine athletes’ and sports organizations’ perceptions of differences in SM care to better understand policy decisions. Conclusion There are no overall differences in proficiency between SM fellows from FM, EM, IM, PED, or PM&R. Abbreviations Sports Medicine (SM) Family medicine (FM) Emergency medicine (EM) Internal medicine (IM) Pediatrics (PED) Physical medicine and rehabilitation (PM&R) Accreditation Council of Graduate Medical Education (ACGME) Program directors (PD) National Football League (NFL) National Basketball Association (NBA) Musculoskeletal (MSK) Magnetic resonance imaging (MRI) Declarations Ethics approval and consent to participate The University of Miami’s Institutional Review Board waived the need for ethical approval in our study, as the data collected remain anonymous and de-identified. Informed consent to participate was obtained from all participants. This was all done in accordance with the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding No funding was received for this research Authors’ contributions SK gathered data, organized the team, and was a major contributor in writing and editing the manuscript. JS gathered data, analyzed data and was a major contributor in writing the manuscript. MW gathered data, and was a major contributor in writing the manuscript. ET analyzed data and was a major contributor in the tables, figures and assisted in editing the manuscript. TT originated the idea, organized the team, was a major contributor in writing and editing the manuscript. Acknowledgements The authors would like to thank the program directors from the various fellowships who participated in our study. References Asif IM, Stovak M, Ray T, et al. Primary care sports medicine fellowship: AMSSM Proposed Standards of Excellence. Clin J Sport Med. 2017;27(3):231–44. ACGME program requirements for graduation in sports medicine. Accreditation Council of Graduate Medical Education. 2022. https://www.acgme.org/globalassets/pfassets/programrequirements/116_sportsmedicine_2022.pdf . (Accessed 4/2023). Herring SA, Putukian M, Leclere LE, et al. The team physician consensus statement 2024 update. Med Sci Sports Exerc. 2025;57(5):1067–75. National Basketball League Players Association. Collective Bargaining Agreement [online]. 2023. https://imgix.cosmicjs.com/25da5eb0-15eb-11ee-b5b3-fbd321202bdf-Final-2023-NBA-Collective-Bargaining-Agreement-6-28-23.pdf . (Accessed 8/2023). National Football League Players Association. Collective Bargaining Agreement [online]. 2020. https://nflpaweb.blob.core.windows.net/website/PDFs/CBA/March-15-2020-NFL-NFLPA-Collective-Bargaining-Agreement-Final-Executed-Copy.pdf . (Accessed 5/2023). Christensen M, Christensen HK. Differences between family and emergency medicine training before sports medicine fellowship. Curr Sports Med Rep. 2015;14(3):191–3. Brennan FH, Rao AL, Myers RA, et al. Suggested curricular guidelines for musculoskeletal and sports medicine in family medicine residency training. Curr Sports Med Rep. 2020;19(5):180–8. Amoako AO, Amoako AB, Pujalte GG. Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States. Open Access J Sports Med. 2015;6:81–6. Liddle DG, Changstrom B, Senter C, et al. Recommended musculoskeletal and sports medicine curriculum for internal medicine residency training. Curr Sports Med Rep. 2021;20(2):113–23. Coleman N, Beasley M, Briskin S, et al. Musculoskeletal and sports medicine curriculum guidelines for pediatric residents. Curr Sports Med Rep. 2021;20(4):218–28. Chow YC, Waterbrook AL, Suffoletto HN, et al. Recommended musculoskeletal and sports medicine model curriculum for emergency medicine residency training. Curr Sports Med Rep. 2021;20(1):31–46. Yang AJ, Brakke RA, Boimbo S et al. Residency and beyond. Am J Phys Med Rehabilitation: 2016;Vol 95(2):152–7. ACGME milestones for sports medicine. Accreditation Council of Graduate Medical Education. 2022. https://www.acgme.org/globalassets/pdfs/milestones/sportsmedicinemilestones.pdf . (Accessed 4/2023). Sports Medicine Physician Scope of Practice. American Society for Sports Medicine Sports Medicine Physician Scope of Practice , . (Accessed 8/2023). Wu MJ, Zhao K, Fils-Aime F. Response rates of online surveys in published research: A meta-analysis. Computers Hum Behav Rep. 2022;7:100206. Additional Declarations No competing interests reported. Supplementary Files AnnexFullSurvey.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 09 Jan, 2026 Reviewers agreed at journal 02 Jan, 2026 Reviewers invited by journal 24 Dec, 2025 Editor assigned by journal 22 Dec, 2025 Editor invited by journal 03 Dec, 2025 Submission checks completed at journal 02 Dec, 2025 First submitted to journal 02 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8152681","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":565358429,"identity":"42eda4ee-6ee3-41a4-94f1-80c54f7848fb","order_by":0,"name":"Scott Klass","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDElEQVRIiWNgGAWjYDADCXYQWXGAh4GBB8RKwKeYseEASAsziH3mAA8PaVoY2w4wENQi3374+OMPDDYMks3Mjz/+nHdHxp797MEPH2rSGPilj1/ApsXgTFoi0JY0BmlmNjNp3m3PeHh48pIlZxzLYZDsyynAqkWCxxCo5TCDHDODGTPjtsM8PBI8Zsy8DRVA03iwuk5+BljLf6AW9s8ff84hQgvDDbCWA0CH8RhI8DbAteQAtbAfwOWXGWcMknkkm3nKpHmOAbWcyTEG+iWNR7KHB1eIHfhQUWEnJ3G8ffPHHzWH7dnbzxgCQyxZjp+H/QFWPRC7GDANBCUDA9xacAB8toyCUTAKRsEIAgAUNVb7OaUalwAAAABJRU5ErkJggg==","orcid":"","institution":"Dartmouth Health and Geisel School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Scott","middleName":"","lastName":"Klass","suffix":""},{"id":565358430,"identity":"4aeffbf1-fab5-4be5-8415-496d52fb9b78","order_by":1,"name":"Javier Santana","email":"","orcid":"","institution":"University Medicine Associates/University Health","correspondingAuthor":false,"prefix":"","firstName":"Javier","middleName":"","lastName":"Santana","suffix":""},{"id":565358431,"identity":"9925ac4d-0451-4365-ad21-753407a3aa78","order_by":2,"name":"Martin Weaver","email":"","orcid":"","institution":"Nova Southeastern University","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Weaver","suffix":""},{"id":565358432,"identity":"e283524c-0b59-43b8-a5e9-d6beb8081e66","order_by":3,"name":"Eduard Tiozzo","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Eduard","middleName":"","lastName":"Tiozzo","suffix":""},{"id":565358434,"identity":"07584e37-f946-4596-8747-4f051a16ba11","order_by":4,"name":"Timothy Tiu","email":"","orcid":"","institution":"University of Miami Miller School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Timothy","middleName":"","lastName":"Tiu","suffix":""}],"badges":[],"createdAt":"2025-11-19 08:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8152681/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8152681/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99221794,"identity":"92285f15-970c-4082-ac3d-4dce3a88cbb3","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":323220,"visible":true,"origin":"","legend":"","description":"","filename":"ProjectmanuscriptBMCEducationFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/afe79ad7d44f238ecb8f5410.docx"},{"id":99221785,"identity":"197c5b89-84cd-40ac-964e-4b2300be5300","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6966,"visible":true,"origin":"","legend":"","description":"","filename":"94f839e7e16446278379126d8e7722eb.json","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/440c49fa9d5dc10f6c7634de.json"},{"id":99317756,"identity":"601dadcd-f15d-4d90-a4dd-20d62a2a40b6","added_by":"auto","created_at":"2025-12-31 16:30:41","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15301,"visible":true,"origin":"","legend":"","description":"","filename":"AnnexFullSurvey.docx","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/3ac02e59f2f994757bf5b47a.docx"},{"id":99221791,"identity":"a92f95d5-99e2-4088-8f1c-7c843f0bb545","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59758,"visible":true,"origin":"","legend":"","description":"","filename":"94f839e7e16446278379126d8e7722eb1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/16a7325be1c263130d38a111.xml"},{"id":99317344,"identity":"b7ec92a1-b640-48c6-9579-5146bda1f9dc","added_by":"auto","created_at":"2025-12-31 16:30:03","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59461,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/97b0832e9f2cb178fbf9f712.png"},{"id":99221790,"identity":"3f70a274-5f7d-4f42-95e4-c58e331ab61d","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57095,"visible":true,"origin":"","legend":"","description":"","filename":"94f839e7e16446278379126d8e7722eb1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/9e23a2f13b41cdb9618bbab4.xml"},{"id":99318775,"identity":"eb75c18b-41f0-4d94-a1c3-436b056713a7","added_by":"auto","created_at":"2025-12-31 16:34:41","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68246,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/79b124caecf2fa2e21e90d0b.html"},{"id":99221784,"identity":"b5fbeafa-2817-42df-b61c-11665df4adb9","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32929,"visible":true,"origin":"","legend":"\u003cp\u003eTotal Scores\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTotal median scores obtained by the fellows according to their primary specialty. EM-emergency medicine (total score 76.4), FM-family medicine (total score 78), PED-pediatrics (total score 74.5), PM\u0026amp;R-physical medicine and rehabilitation (total score 82), IM-internal medicine (total score 74.5).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/f9a562eb2d18bb6116f7e048.png"},{"id":99317775,"identity":"bcfaf0b3-6bb3-47a9-b543-e7064f29ac48","added_by":"auto","created_at":"2025-12-31 16:30:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":266742,"visible":true,"origin":"","legend":"\u003cp\u003eDomains Assessed\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTwenty-one domains assessed in our survey. Our analysis revealed nine domains with significant differences between fellows specialties listed in red. Domains in green signify no observed differences between fellows specialties.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage142.png","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/c0b5806aedb148472a5b6e59.png"},{"id":100421849,"identity":"f2b8fdc7-a7a8-4f29-9d3e-2a4b42d5aa8c","added_by":"auto","created_at":"2026-01-16 13:55:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1321435,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/a7d7363e-6268-4927-be1e-a3eacc8ec931.pdf"},{"id":99221788,"identity":"c32c192a-881a-4141-9f15-52a685da0707","added_by":"auto","created_at":"2025-12-30 09:51:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15301,"visible":true,"origin":"","legend":"","description":"","filename":"AnnexFullSurvey.docx","url":"https://assets-eu.researchsquare.com/files/rs-8152681/v1/5208259ef4f55556e8280b1d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"New Fellow Proficiency and Program Director Expectations in Primary Care Sports Medicine","fulltext":[{"header":"Background","content":"\u003cp\u003eSports Medicine (SM) is a recognized specialty with Accreditation Council of Graduate Medical Education (ACGME) fellowship training, with eligible primary specialties (PS) being emergency medicine (EM), family medicine (FM), internal medicine (IM), pediatric medicine (PED), and physical medicine and rehabilitation (PM\u0026amp;R).\u003csup\u003e1,2\u003c/sup\u003e The Team Physician Consensus Statement clearly states that each meets an essential qualification to serve as team physician.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Despite this, some employers including organizations such as the National Football League (NFL) and National Basketball Association (NBA), have policies that render certain SM trained and board-certified physicians ineligible to fill this or similar roles based on their PSs, most notably PED and PM\u0026amp;R, thus challenging the credibility of the ACGME SM fellowship.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFM, IM, PED, and EM physicians have self-identified that their training in sports and musculoskeletal (MSK) medicine is insufficient.\u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e In IM, less than 1% of total didactic and clinical education time involves MSK medicine.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e For PED programs, 29% do not include MSK examination in their curriculum, 77% provide lecture-only education for SM, and 83% have less than 6 hours of SM lectures.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e One study demonstrated that only 61% of EM physicians passed a validated MSK knowledge examination.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In contrast, PM\u0026amp;R residents have rigorous training in MSK medicine, with greater than 50% of programs having more than six months of MSK training and 85% of graduates feeling comfortable treating MSK conditions.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe purpose of this study is to identify differences in SM competencies between new fellows of the various eligible PSs. The primary objective is to evaluate for overall differences in proficiency of SM-related skills. The secondary objectives are to evaluate for differences in proficiency of individual aspects of SM, and to identify any differences in program directors\u0026rsquo; (PDs\u0026rsquo;) expectations for new fellows.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting and participants\u003c/h2\u003e \u003cp\u003eThis study was survey based. Eligible participants were all 175 ACGME SM fellowship PDs during 2019\u0026ndash;2020, identified using the ACGME website and the American Medical Association Residency \u0026amp; Fellowship Database.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInterventions\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eInterventions\u003c/div\u003e \u003cp\u003eWe created a 50-question survey using Qualtrics (see supplemental data) that was developed for this study and not published elsewhere. The entire survey can be found in the supplementary files and is available upon request. The initial eight questions were demographic. The remaining 42 questions were made based on ACGME milestones.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e 21 questions asked PDs to rate each fellow\u0026rsquo;s ability in a specific milestone using a 5-point Likert scale (1-Strongly disagree, 2- Disagree, 3-Neither agree nor disagree, 4-Agree, 5-Strongly agree), and 21 follow up questions asked PDs to give their expected level of proficiency on these milestones on another 5-point scale (1-No proficiency, 2-Limited proficiency, 3- Moderate proficiency, 4-Advanced proficiency, 5-Complete proficiency). Individual links were sent to each PD by institutional email, to obtain consent to participate in the study. This occurred during the fourth month of the academic year. Two reminder emails were sent within two months. The University of Miami\u0026rsquo;s Institutional Review Board waived the need for ethical approval in our study, as the data collected remain anonymous and de-identified.\u003c/p\u003e\n\u003ch3\u003eOutcomes measured\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was overall differences in SM skills between PSs. Secondary outcomes were specific differences in SM skills between PSs, and between PDs\u0026rsquo; expectations for SM fellows\u0026rsquo; level of proficiency.\u003c/p\u003e\n\u003ch3\u003eAnalysis of the outcomes\u003c/h3\u003e\n\u003cp\u003eMedian and range were reported for all questions regarding fellow proficiency. Further, an independent Kruskal-Wallis test was used to compare the median ranks of different specialties. If significant differences were observed, pairwise comparisons were used to test for pair-by-pair significant differences with using Bonferroni correction. These data points were treated as continuous outcomes, summed scores were averaged for each specialty, and differences were analyzed using ANOVA. All statistical analyses were conducted using IBM SPSS Statistics 26. p value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e82 PDs completed the survey (47% response rate). There were 60 (73%) FM PDs, 14 (17%) PM\u0026amp;R, 3 (4%) EM, 2 (2%) PED, 1 (1%) IM, and 2 (2%) \u0026ldquo;other\u0026rdquo;. Data was obtained about 133 fellows: 79 (59%) FM, 25 (19%) PM\u0026amp;R, 14 (10%) EM, 9 (7%) PED, 6 (5%) IM.\u003c/p\u003e \u003cp\u003eThere were no overall significant differences in a combined score between PSs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of 21 domains assessed, 9 had significant differences (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). FM and EM fellows were more proficient than PM\u0026amp;R in non-MSK SM physical examination. PM\u0026amp;R fellows were more proficient than FM, IM, and PED in performing an MSK examination, while FM and EM were more proficient than PED. FM, EM, and PED fellows were more proficient than PM\u0026amp;R in managing non-MSK SM conditions (e.g., infectious mononucleosis). EM fellows were more proficient than PM\u0026amp;R, FM, and IM in managing SM emergencies. PM\u0026amp;R fellows were more proficient than FM in interpreting MSK magnetic resonance imaging (MRI) and in the basic theoretical principles of sports ultrasound, and more proficient than PED, FM, and EM in the basic practical principles of sports ultrasound. PM\u0026amp;R fellows have a more genuine interest in academic projects compared to FM. FM fellows were more knowledgeable in billing and coding than PM\u0026amp;R and EM.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSignificant Skill Differences Between Fellows in Each Specialty and Median Total Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe new fellow is able to:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePM\u0026amp;R\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSignificant differences\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConducts non-musculoskeletal physical examination, as it pertains to sports medicine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R\u003c/p\u003e \u003cp\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerforms a musculoskeletal examination, including the identification of anatomic landmarks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM* PM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;IM\u003c/p\u003e \u003cp\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;PED*\u003c/p\u003e \u003cp\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;PED\u003c/p\u003e \u003cp\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;PED\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eManaging non-musculoskeletal conditions relevant to sports medicine. Examples include rash and infectious mononucleosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePED\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eManage emergent injuries and conditions at sporting events, at the level expected of a sideline physician\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;FM*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;IM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndependent interpretation of musculoskeletal MRIs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2.50\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProficient in the basic theoretic principles of sports ultrasound, including understanding the sonographic appearance of normal and pathologic tissues\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;PED\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;EM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProficient in the basic practical principles of sports ultrasound, and is able to visualize and identify normal anatomic structures.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e2.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;IM PM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas a genuine interest in academic projects.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnowledgeable in billing and coding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;EM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal median values by specialty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e78\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e74.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e76.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e74.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eNo difference\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eTable 1-These are the nine statistically significant differences in our analysis. The values on the table represents the median. We used median instead of mean values for this analysis since our data was not evenly distributed. #We also performed a Kruskal Wallis to determine a pairwise comparison between primary specialties, the result of which is seen in the last column. For these nine significant differences, the specialty with the greater symbol pointing towards it indicates that a higher value was obtained. FM- family medicine (n=79), PM\u0026amp;R- physical medicine and rehabilitation (n=25), PED- pediatrics (n=9), EM- emergency medicine (14), IM-internal medicine (6)\u003c/p\u003e\n\u003cp\u003e* Significant after the Bonferroni adjustment\u0026nbsp;\u003c/p\u003e \u003cp\u003eIn analyzing the minimal proficiency expectations of the PDs, we found three significant differences (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). FM PDs had higher expectations in the ability to manage non-MSK conditions compared to PM\u0026amp;R PDs. PM\u0026amp;R PDs had higher expectations for both knowledge of the basic theoretic principles of sports ultrasound, and independent interpretation of MSK MRI compared to FM PDs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSignificant Differences Amongst PD Expectations of Fellows Skills\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhat is your minimal acceptable level in:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePM\u0026amp;R\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePED\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003cp\u003eDifferences\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProficiency in ability to manage non-musculoskeletal conditions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFM\u0026thinsp;\u0026gt;\u0026thinsp;PM\u0026amp;R *\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of the basic theoretic principles of sports ultrasound, including understanding the sonographic appearance of normal and pathologic tissues\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM\u003c/p\u003e \u003cp\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;Other\u003c/p\u003e \u003cp\u003eEM\u0026thinsp;\u0026gt;\u0026thinsp;Other\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbility to perform an independent interpretation of musculoskeletal MRI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ePM\u0026amp;R\u0026thinsp;\u0026gt;\u0026thinsp;FM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003e\u003cem\u003eTable 2-These are the three statistically significant differences based on the PDs\u0026apos; expectations of the fellows\u0026apos; skills. The value on the table represents the median. We used median instead of mean values for this analysis since our data was not evenly distributed. \u003csup\u003e#\u003c/sup\u003eWe also performed a Kruskal Wallis to determine a pairwise comparison between primary specialties, the result of which is seen in the last column. For these three significant differences, the order in which the specialty appears in relation to others indicates that a higher value was obtained. FM- family medicine (n=60), PM\u0026amp;R- physical medicine and rehabilitation (n=14), PED- pediatrics (n=2), EM- emergency medicine (n=3).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*Significant after the Bonferroni adjustment\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results suggest that all PSs entering SM are equally prepared and skilled, and therefore should be equally qualified and capable of practicing SM after fellowship. This is important because organizations such as the NBA and NFL have placed limits on the scope of practice of both PED and PM\u0026amp;R SM physicians, excluding them from serving as head team physicians. Both the NFL and the NBA collective bargaining agreements state that for the medical team, each club shall have one lead orthopedic surgeon and one lead SM physician board-certified in IM, FM, or EM only.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In line with the AMSSM\u0026rsquo;s Sports Medicine Physician Scope of Practice document and Team Physician Consensus Statement, our study demonstrates no perceived superiority in skills or preparedness of any one PS over another. Therefore, residency specialty training should not be a limiting factor in SM job opportunities, regardless of the level of sport.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndividual training programs or the ACGME may consider perceived proficiency differences between PSs in specific SM domains as opportunities for revision in curricula or milestones; eg: FM and EM fellows are perceived to be more proficient in more general medical areas, and PM\u0026amp;R fellows are perceived to have more substantial mastery of MSK specialized topics within SM. One must further distinguish that these findings indicate perceived skills and not actual skills. It is therefore important for national SM organizations to be cognizant of these perceptions and assist in educating each other on the equal preparedness of all primary specialties that comprise SM clinicians.\u003c/p\u003e \u003cp\u003eLimitations include a survey response rate of 47%, but that is greater than the average of 44% in education.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e There is also a risk of bias from fellowship PDs, and we minimized this through anonymity. It is possible that some of the observed deficiencies in proficiency are due to individual fellow differences instead of residency. Lastly, some of our findings may be affected by small sample sizes of PED, EM, and IM specialties.\u003c/p\u003e \u003cp\u003eFuture studies should objectively evaluate for knowledge and training gaps. Additional studies can examine athletes\u0026rsquo; and sports organizations\u0026rsquo; perceptions of differences in SM care to better understand policy decisions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere are no overall differences in proficiency between SM fellows from FM, EM, IM, PED, or PM\u0026amp;R.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSports Medicine (SM)\u003c/p\u003e\n\u003cp\u003eFamily medicine (FM)\u003c/p\u003e\n\u003cp\u003eEmergency medicine (EM)\u003c/p\u003e\n\u003cp\u003eInternal medicine (IM)\u003c/p\u003e\n\u003cp\u003ePediatrics (PED)\u003c/p\u003e\n\u003cp\u003ePhysical medicine and rehabilitation (PM\u0026amp;R)\u003c/p\u003e\n\u003cp\u003eAccreditation Council of Graduate Medical Education (ACGME)\u003c/p\u003e\n\u003cp\u003eProgram directors (PD)\u003c/p\u003e\n\u003cp\u003eNational Football League (NFL)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNational Basketball Association (NBA)\u003c/p\u003e\n\u003cp\u003eMusculoskeletal (MSK)\u003c/p\u003e\n\u003cp\u003eMagnetic resonance imaging (MRI)\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe University of Miami\u0026rsquo;s Institutional Review Board waived the need for ethical approval in our study, as the data collected remain anonymous and de-identified. Informed consent to participate was obtained from all participants. This was all done in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding was received for this research\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eSK gathered data, organized the team, and was a major contributor in writing and editing the manuscript.\u003c/p\u003e\n\u003cp\u003eJS gathered data, analyzed data and was a major contributor in writing the manuscript.\u003c/p\u003e\n\u003cp\u003eMW gathered data, and was a major contributor in writing the manuscript.\u003c/p\u003e\n\u003cp\u003eET analyzed data and was a major contributor in the tables, figures and assisted in editing the manuscript.\u003c/p\u003e\n\u003cp\u003eTT originated the idea, organized the team, was a major contributor in writing and editing the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the program directors from the various fellowships who participated in our study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAsif IM, Stovak M, Ray T, et al. Primary care sports medicine fellowship: AMSSM Proposed Standards of Excellence. Clin J Sport Med. 2017;27(3):231\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACGME program requirements for graduation in sports medicine. Accreditation Council of Graduate Medical Education. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acgme.org/globalassets/pfassets/programrequirements/116_sportsmedicine_2022.pdf\u003c/span\u003e\u003cspan address=\"https://www.acgme.org/globalassets/pfassets/programrequirements/116_sportsmedicine_2022.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (Accessed 4/2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHerring SA, Putukian M, Leclere LE, et al. The team physician consensus statement 2024 update. Med Sci Sports Exerc. 2025;57(5):1067\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Basketball League Players Association. Collective Bargaining Agreement [online]. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://imgix.cosmicjs.com/25da5eb0-15eb-11ee-b5b3-fbd321202bdf-Final-2023-NBA-Collective-Bargaining-Agreement-6-28-23.pdf\u003c/span\u003e\u003cspan address=\"https://imgix.cosmicjs.com/25da5eb0-15eb-11ee-b5b3-fbd321202bdf-Final-2023-NBA-Collective-Bargaining-Agreement-6-28-23.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (Accessed 8/2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Football League Players Association. Collective Bargaining Agreement [online]. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nflpaweb.blob.core.windows.net/website/PDFs/CBA/March-15-2020-NFL-NFLPA-Collective-Bargaining-Agreement-Final-Executed-Copy.pdf\u003c/span\u003e\u003cspan address=\"https://nflpaweb.blob.core.windows.net/website/PDFs/CBA/March-15-2020-NFL-NFLPA-Collective-Bargaining-Agreement-Final-Executed-Copy.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (Accessed 5/2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristensen M, Christensen HK. Differences between family and emergency medicine training before sports medicine fellowship. Curr Sports Med Rep. 2015;14(3):191\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrennan FH, Rao AL, Myers RA, et al. Suggested curricular guidelines for musculoskeletal and sports medicine in family medicine residency training. Curr Sports Med Rep. 2020;19(5):180\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmoako AO, Amoako AB, Pujalte GG. Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States. Open Access J Sports Med. 2015;6:81\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiddle DG, Changstrom B, Senter C, et al. Recommended musculoskeletal and sports medicine curriculum for internal medicine residency training. Curr Sports Med Rep. 2021;20(2):113\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman N, Beasley M, Briskin S, et al. Musculoskeletal and sports medicine curriculum guidelines for pediatric residents. Curr Sports Med Rep. 2021;20(4):218\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChow YC, Waterbrook AL, Suffoletto HN, et al. Recommended musculoskeletal and sports medicine model curriculum for emergency medicine residency training. Curr Sports Med Rep. 2021;20(1):31\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang AJ, Brakke RA, Boimbo S et al. Residency and beyond. Am J Phys Med Rehabilitation: 2016;Vol 95(2):152\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACGME milestones for sports medicine. Accreditation Council of Graduate Medical Education. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acgme.org/globalassets/pdfs/milestones/sportsmedicinemilestones.pdf\u003c/span\u003e\u003cspan address=\"https://www.acgme.org/globalassets/pdfs/milestones/sportsmedicinemilestones.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (Accessed 4/2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSports Medicine Physician Scope of Practice. \u003cem\u003eAmerican Society for Sports Medicine Sports Medicine Physician Scope of Practice\u003c/em\u003e, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.amssm.org/PhyScopeOfPractice.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. (Accessed 8/2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu MJ, Zhao K, Fils-Aime F. Response rates of online surveys in published research: A meta-analysis. Computers Hum Behav Rep. 2022;7:100206.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Primary Care Sports Medicine Education, Fellowship training","lastPublishedDoi":"10.21203/rs.3.rs-8152681/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8152681/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSports Medicine (SM) fellowship can be pursued after residency in family medicine (FM), emergency medicine (EM), internal medicine (IM), pediatrics (PED), and physical medicine and rehabilitation (PM\u0026amp;R). Each specialty uniquely prepares its graduates for a SM fellowship, yet it remains unknown if all specialties are equally prepared and if knowledge or training gaps exist.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn 2019\u0026ndash;2020, a survey based on the Accreditation Council of Graduate Medical Education (ACGME) milestones was sent to 175 fellowship program directors (PD) after the first quarter of training. 82 PDs, (47% response) rated their fellows\u0026rsquo; skills and expected proficiency. A Kruskal-Wallis test was used to compare the median ranks of different specialties. Pairwise comparisons were tested for significant differences with using Bonferroni correction. Differences and overall scores were analyzed using ANOVA.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eCombined milestone analysis showed no overall difference between specialties. Individually, out of the twenty one domains assessed, there were nine significant differences between fellows regarding their proficiency in performing various sports medicine skills and academic requirements. In evaluating the minimal proficiency expectations of the PDs from their current fellows we found three significant differences between specialties.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThere are no overall differences in proficiency between SM fellows from FM, EM, IM, PED, or PM\u0026amp;R.\u003c/p\u003e","manuscriptTitle":"New Fellow Proficiency and Program Director Expectations in Primary Care Sports Medicine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:51:42","doi":"10.21203/rs.3.rs-8152681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-01-09T22:57:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198466871670086198106055645278860061531","date":"2026-01-02T17:25:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-24T13:44:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-22T16:56:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-03T09:44:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T11:26:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-02T10:49:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2458047d-97d2-475b-b382-6a8455e835c8","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T09:51:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:51:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8152681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8152681","identity":"rs-8152681","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}