Medical management of the professional rugby player

I wanted to take the opportunity to practice medicine in a different environment to that which I have experienced in medical school so far. Ideally I wanted to study in a country culturally different to the UK but also wishing to experience medicine that lies outside of conventional primary or tertiary services.
 
My desired field of study for my elective was sports medicine. As there are many different sides to sports medicine I thought it best to narrow my experience to one sport so I chose rugby. Not only as it is a sport that I have loved since a small age, but also because it is a high impact sport with an abundance of diverse injuries. As New Zealand is the country that adapted to the professional era of rugby the quickest, this seemed the obvious choice of destination. The timing of the elective period also coincided with the start of the domestic season in New Zealand, which also influenced my decision.
 
The rugby union that I eventually chose to apply to was Auckland as the team were the current champions of the domestic competition, and have a highly experienced medical team and they are also involved in the management of the New Zealand 19’s side.
 
The union manager agreed with my proposal, after requesting my CV and after consulting with members of the management. I then made contact with the team doctor who agreed to be my tutor during my time with the team. I then proceeded to organise with him appropriate dates for my elective period and outlined what I hoped to achieve during this period.

At this point my tutor informed me that he also worked part time as a GP in the Auckland area (2/3 days per week) and that I would also be most welcome to accompany him to his practice on days where I was not involved with the rugby team.
 
To organise transport to/from Auckland I booked appropriate flights keeping in mind factors such as cost and allowing time to overcome jet lag. I also organised coach transport to/from London for the respective days of departure/arrival and checked with the New Zealand Immigration Service whether I required a VISA for entry into New Zealand.
 
I was fortunate to be offered accommodation by my tutor at his home for the duration of my elective. I did however search for possible alternatives in the event that further accommodation would be necessary. For periods where the team would be away from Auckland my accommodation and transport would be provided for by the Auckland Rugby Union wherever possible or would otherwise be funded and organised by myself.

While on my elective period my time was with the team doctor and physiotherapist.

Each Monday an injury clinic was held at the teams training venue. The clinic involved assessing players with injuries from the previous games or training. Both players with new injuries and players with longstanding problems were seen. At these clinics I was able to assess both common and some uncommon injuries, which helped to improve my examination technique and diagnostic skills.
 
Whilst with Auckland Rugby I accompanied the team to seven Air New Zealand Cup Matches. Before each game and under supervision I was involved in applying appropriate supportive strapping, sports massage and sometimes giving local anaesthetic or intra-articular corticosteroid injections. During each game I was permitted to attend to any injured players at the sideline with my tutor. This involved making an initial assessment on the type and severity of injury and applying initial treatment (e.g. ice therapy, appropriate strapping or suturing lacerations). I feel this showed me how important thorough initial assessment can be and the necessity to take simple and appropriate first-aid measures in acute situations.
 
During my elective I was also set a number of tasks, which involved performing a literature-based search on chosen topics and then giving an oral presentation of the information found.
 
I was also required to give a more in depth presentation to the medical staff of the team on appropriate management of pectoralis major tears, outlining the differences between surgically and conservatively managed patients and describing whether a delay in surgery resulted in a poorer outcome.
 
These tasks helped guide my learning about sports medicine, gave me more experience in evaluating medical evidence and helped improve my presentation skills.
 
Whilst at the GP practice I was able to sit in on consultations and also saw patients alone before presenting my findings and discussing the case with my tutor. During my time at the practice I was able to see a wide variety of cases.
 
The experience allowed me to practice my history and examination skills, particularly in areas of previous limited experience.
 
I was also able to carry out minor procedures such as ear syringing, cryotherapy to skin lesions and assisting in some minor surgery with another practice doctor (e.g. ellipse excision of basal cell carcinoma). My involvement in these procedures has given me both the confidence and experience to feel comfortable in assisting or performing such procedures in the future.
 
During my elective there were several things that I learnt from the experience. I now appreciate the importance of initial assessment, particularly in the acute setting. In sports medicine decisions taken from initial assessment and the ability to identify serious injuries from the more minor injuries is vital.
 
There are differences in the way medicine is practised as a team doctor compared to hospital or primary care medicine. Within a team environment it is often the case that you are in much closer contact and have a greater knowledge base about your patients. Trust is important along with having good lines of communication with the players, management and other healthcare professionals involved in the medical care of players.
 
The experience of presenting findings from relevant literature searches also greatly improved my confidence in public speaking and presentation skills and also aided my learning.
 
One challenge that I faced during my elective was to become integrated into a tight group of players and management staff midway through their season. It was important for me to do this in order to earn trust and respect, enabling me to make the most of my learning experiences.

 A further challenge came not in the field of medicine but in the field of life. By staying with my tutor, I was also living with his family, including his children (twin girls [6], a son [11]). Having had limited experience with young children in the past this gave me a good opportunity to become comfortable in this environment by taking part in family life.
 
From my primary care experience there was a greater emphasis on treating patients within primary care in New Zealand with fewer cases being referred to secondary care. I thought that this more “hands on” approach could be a benefit to the patients as the majority of their care would be organised and carried out by one doctor, making the health system more accessible.
 
Overall the experience has definitely made me think of sports medicine as a possible career as it is such an exciting and also flexible career, which can be combined with work in other fields (e.g. general practice).
 
The cultural aspect of living in New Zealand was also a fantastic experience where it was interesting to witness such a dynamic and diverse population and observe how this has a bearing on the range of presenting medical problems.
 
There are few things that I would have changed if I were to repeat the elective period. I would have benefited from a longer period of time in order to learn more about this branch of medicine. I would also have ideally arranged my elective period to join the team at the beginning of their season. It may also have been interesting to follow-up particular injuries more extensively by observing relevant surgery and hospital or specialist referrals, which is something I could hope to do on another occasion.
 
From my elective I feel I have a real insight into sports medicine. I hope to take the knowledge, experience and skills learnt and apply them in my future career.



This guidance was correct at publication 18/09/2007. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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