【文献Abstract】家庭医療領域でのスポーツ医学研修

〈要点〉

家庭医療領域でのスポーツ医学研修のコンピテンシー

・家庭医は、正確な筋骨格系の病歴と身体診察を行うことができなければなならない。これには、筋骨格系の愁訴に対する鑑別診断、診察、初期治療、専門紹介が含まれる。

・家庭医は参加前診察（PPE）を行う。 PPEはプライマリケアプロバイダーと地域社会およびそのスポーツと健康関連の問題を結びつける役割を果たす。

・家庭医療研修では、大会救護やチームドクターとして医療を提供できる環境があることが望ましい。これらは、救急医療スキルを磨くことやコミュニティとのつながりを築くための手段となる。

・家庭医はスポーツに関わるさまざまな患者と効果的にコミュニケーションができる必要がある。これには、家族、コーチ、学校の管理者や医療関係者、雇用主とのコミュニケーションも含まれる。

・家庭医は運動処方を策定できる必要があり、このプロセスでは動機付け面接のスキルが重要となる。社会経済的状況を認識しながら、コミュニティや病院システム内のリソースを認識しこれらの問題に対処できるようになる必要がある。また、他の医学的問題と心理社会的要因について鑑み、必要に応じて治療する必要がある。

・最後に、居住者が筋骨格系およびスポーツ医学関連のケアと照会のアウトカム指標に関連するデータを理解することが重要である。この情報は、患者集団に最善のケアを提供するための品質改善に利用する必要がある。

〈雑感〉

・個人的にはやはりスキルアップ＆維持していくためには「現場」が必要。今年中に動こう！「現場」じゃない学びの場も必要なので、コミュニティも作ってみよう！

〈文献〉

Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Family Medicine Residency Training

Abstract
Patients often seek care from a family physician when they have a musculoskeletal injury or sport-related ailment. Family physicians must be adequately trained to provide this care. While general guidance is provided by the Accreditation Counsel for Graduate Medical Education (ACGME) it is left up to the individual programs to develop, implement, and execute their orthopedic and sports medicine curriculums. The American Academy of Family Physicians' (AAFP) Recommended Curriculum Guideline for Family Medicine Residents — Musculoskeletal and Sports Medicine provides a basic outline format for curriculum content and reference resources. The aim of this article is to elaborate on those training requirements and help programs to develop a curriculum implementation plan that will deliver a baseline level of competence for family medicine trainees.

（内容）Competencies
The ACGME expects family medicine residents to achieve “milestone” Level 3 competency in patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice (3). It is imperative that family medicine residents develop these competencies in musculoskeletal and sports medicine during their training.

First, residents should be able to perform a precise musculoskeletal history and physical examination. This includes formulating a differential diagnosis for musculoskeletal complaints, determining applicable diagnostic tests, recommending initial treatment, and understanding when specialty referral is necessary. They should have an awareness of how mechanism of injury and knowledge of anatomy can lead to the correct diagnosis. Systemic and psychological conditions may present as a musculoskeletal complaint. Young clinicians must be aware of this concept.

Family physicians often perform preparticipation examinations (PPE). The PPE provides an opportunity for the family physician to interact with younger members of his or her community while gaining an understanding of relative health risks and sport-specific concerns. By providing this service, the PPE can serve to connect primary care providers with local communities and their sport and health-related issues (6). Residents must be able to perform evidence-based, age-appropriate, and activity-specific PPEs by the end of their training. They should understand the limitations of the current evidence associated with PPEs.

Resident physicians should be encouraged to provide medical care at mass participation events (e.g., treating patients in a marathon medical tent) and sideline events (e.g., a high school football game). These events are a forum to refine their acute care skills and a means to make a connection with their community through service.

Resident physicians should be able to care for athletes involved in competition within the context of a multi-disciplinary team. Learning how to obtain background information on the athlete's specific training and competition circumstances is essential. Care for the athlete includes performing a risk assessment, providing medical services, collaborating with other team members (athletic trainers, physical therapists, nutritionists, etc.), and following up with injured athletes after an event to then recommend postevent treatment modalities for injury and recovery.

Because a variety of patients, active and sedentary, will present to their primary care physician with musculoskeletal and other sports medical complaints, residents must be able to communicate effectively with a wide array of patient populations. This also may involve concise communication with their family, coaches, school administrators or medical personnel, and employers.

Given the high rates of obesity and related medical comorbidities (e.g., diabetes, hypertension) in the United States (7), residents should understand how regular exercise impacts these disease states and how getting patients more active affects their health. For patients who are not exercising, the resident should be able to formulate an individualized exercise prescription. Skills in motivational interviewing are important in this process (8). Residents should be aware of the resources within their community and/or hospital system to help address these issues while being cognizant of the patient's insurance and socioeconomic status.

Residents must understand the importance of taking a holistic approach to athlete care. Even if the only complaint is musculoskeletal in nature, they should inquire about other underlying medical issues and psychosocial factors and treat as necessary.

Finally, it is important for residents to have an understanding of data related to outcome metrics for musculoskeletal and sports medicine related care and referrals. This information should be utilized for quality improvement initiatives to provide the best possible care for their patient population.

Copyright © 2020 by the American College of Sports Medicine