The NYC Rheumatology Objective Structured Clinical Examination (NYC-ROSCE) is held annually to assess fellow competencies. We recently redesigned our OSCE to better assess subspecialty trainee communication skills and professionalism by developing scenarios in which the patients encountered were psychosocially or medically complex. The objective of this study is to identify which types of verbal and non-verbal skills are most important in the perception of professionalism in the patient-physician interaction. The 2012-2013 NYC-ROSCEs included a total of 53 fellows: 55 MD evaluators from 7 NYC rheumatology training programs (Hospital for Special Surgery-Weill Cornell (HSS), SUNY/Downstate, NYU, Einstein, Columbia, Mount Sinai, and North Shore/Long Island Jewish (NSLIJ)), and 55 professional actors/standardized patients participated in 5 stations. Quantitative fellow performance assessments were made on the following: maintaining composure; partnering with the patient; honesty; professionalism; empathy; and accountability. Free-text comments were solicited regarding specific strengths and weaknesses. A total of 53/53 eligible (100 %) fellows were evaluated. MD evaluators rated fellows lower for professionalism than did the standardized patients (6.8 ± 0.6 vs. 7.4 ± 0.8, p = 0.05), suggesting that physicians and patients view professionalism somewhat differently. Fellow self-evaluations for professionalism (6.6 ± 1.2) were concordant with those of the MD evaluators. Ratings of empathy by fellows themselves (6.6 ± 1.0), MD evaluators (6.6 ± 0.7), and standardized patients (6.6 ± 1.1) agreed closely. Jargon use, frequently cited by evaluators, showed a moderate association with lower professionalism ratings by both MD evaluators and patients. Psychosocially challenging patient encounters in the NYC-ROSCE permitted critical assessment of the patient-centered traits contributing to impressions of professionalism and indicate that limiting medical jargon is an important component of the competency of professionalism.

Background Symptoms of dizziness, neck pain and headaches have previously been identified as risk factors for concussion. Clinical measures associated with these symptoms have not previously been evaluated as risk factors for concussion. Objectives To evaluate clinical measures of cervical endurance and strength as risk factors for concussion in elite youth ice hockey players. Design Prospective cohort study. Setting Community ice rinks and Sport Medicine Clinic. Participants Bantam (12-14 years) and Midget (15-17 years) male and female elite youth ice hockey players (n=466). Risk factor assessment Participants completed baseline clinical tests of cervical flexor endurance and cervical spine isometric strength at the beginning of the 2011-2012 season. Main outcome measurements Players with a suspected concussion (identified by team therapists) were referred to the study sport medicine physician for assessment (diagnosed as per the 3 rd International Consensus on Concussion in Sport Guidelines). Results Concussion incidence rate ratios were estimated using Poisson regression (adjusted for cluster by team and exposure hours). 466 elite youth ice hockey players completed clinical baseline tests at the start of the 2011-2012 hockey season. Players performing in the lowest 25 th percentile were not at an increased risk of concussion during the season of play [cervical strength right sided IRR=1.33 (95%CI; 0.98-1.83); left IRR=1.07 (95% CI; 0.64-1.78] or cervical flexor endurance [IRR=1.27 (95% CI; 0.74-2.20)]. Conclusion Clinical tests of cervical flexor endurance and isometric cervical strength were not predictive of concussion risk. Further evaluation of other baseline clinical measures is necessary to inform future development of prevention strategies for concussion in youth.

Background Participation rates in youth sport in Canada are high. Sport injury epidemiology studies in youth primarily focus on adolescents (ages 13–18). There is a paucity of literature examining sport injury risk in children where injury prevention practices require development and evaluation. Objective To examine sport participation and sport injury rates in elementary school students (ages 9–12). Design Cross-sectional study. Setting A survey was sent home with students in randomly selected Calgary (Canada) elementary schools (grades 4–6). Participants Elementary schools in Calgary (Canada) were randomly selected to participate (N=26 schools). A survey was completed by 540 children and parent/guardian. Risk factor assessment The primary risk factors of interest include age, sport of choice, and time spent participating in sport. Main outcome measures Sport injury was defined as any injury sustained in the previous year that required medical attention. Results Overall, 81% of participants reported participating in sport in the past year. The highest sport-specific participation was reported in soccer (18.9%), swimming (13.5%), and dance (10.8%). The overall injury incidence proportion (IIP) was 28.3 injuries/100 children/year. The medical attention IIP was 9.8 injuries/100 children/year for males and 11.4 injuries/100 children/year for females. The highest IIP for males occurred in soccer (26.0%), cycling (19.5%) and hockey (9.1%). The highest IIP for females occurred in basketball (10.6%), soccer (10.6%), and dance (9.1%). Conclusions The IIP (28.3%) and medical attention IP (10.6%) was lower than previously reported in adolescents (ages 12–18), suggesting less severe injuries in younger children. The greatest burden of sport injury occurred in soccer, cycling, and basketball. This study will inform the development of future targeted interventions within specific sports as well as within school-based curriculums to prevent sport injury in children.

BackgroundPediatric concussion risk factor identification will facilitate targeted injury prevention strategy development.ObjectiveTo examine risk factors for concussion and prolonged recovery amongst elite youth ice hockey players.DesignCohort study.SettingCommunity ice rinks and sport medicine clinic (2011/12 season).ParticipantsMale and female elite Bantam (13–14 years) and Midget (15-17 years) ice hockey players (n=780).Assessment of risk factorsBaseline age group, sex, previous concussion history and SCAT2 component scores [Total Symptom Score (TSS), Balance Error Score (BES) and Standardized Assessment of Concussion (SAC) score] were evaluated.Main outcome measurementsPlayers with a suspected concussion were referred to a sport medicine physician by team therapists/trainers (n=137). Concussions with time loss of >10 days were defined as prolonged recovery.ResultsConcussion incidence rate ratios (IRR) were estimated using multivariate (concussion) and univariate (prolonged recovery) Poisson regression analyses (cluster and exposure hours adjusted). Males were at greater risk than females [IRR=1.44 (95% CI: 1.09–1.90)]. In females with no concussion history, Bantam players were at greater risk than Midget players [IRR=4.04 (95% CI: 1.24–13.19)]. In Midget players, those with a history of concussion were at greater risk than those with no concussion history [IRR=2.68 (95% CI: 1.61–4.46)]. Players with baseline TSS in the lowest 25th%ile were at greater risk of concussion [IRR=1.50 (95% CI: 1.03–2.18)] and prolonged recovery [IRR=1.88 (95% CI: 1.18–2.99)]. Players with a history of concussion were at increased risk for prolonged recovery [IRR=2.02 (95% CI: 1.29–3.16)]. SAC and BES were not risk factors.ConclusionsAge group, sex, previous concussion history, and baseline symptom reporting affected the risk of concussion and prolonged recovery in elite youth ice hockey players. This study will inform the development of youth sport concussion prevention strategies.

BackgroundConcussion is a commonly encountered injury associated with potential long-term sequelae. No previous studies have evaluated dizziness, neck pain and headache as potential risk factors for concussion.ObjectiveThe objective of this study is to determine the risk of concussion in male youth hockey players with preseason reports of neck pain, headaches and dizziness.DesignThis study is a secondary data analysis of a prospective cohort study examining the risk of injury associated with body checking among paediatric ice hockey players.SettingYouth ice hockey in Alberta and Quebec, Canada.ParticipantsA total of 3902 11–14 year old males from 282 teams participated.Assessment of risk factorsEach participant completed a pre-season baseline demographic and injury history questionnaire. Preseason reports of neck pain, headache or dizziness were documented on the Sport Concussion Assessment Tool.Main outcome measurementsDiagnosed concussions were recorded during the season of play via a previously validated, prospective injury surveillance system.ResultsA total of 178 concussions occurred during the studies, with 11 players sustaining two concussions. Incidence rate ratios were calculated using Poisson regression, adjusted for exposure hours, cluster by team and potential covariates. Dizziness was not a significant predictor of concussion. Individuals reporting a headache or neck pain at the start of the season were 1.48 (95% CI 1.02 to 2.14) and 1.69 (95% CI 1.16 to 2.44) times more likely to suffer a concussion during the season than those not reporting these symptoms. Individuals reporting any two of dizziness, headache and neck pain were 1.99 (95% CI 1.20 to 3.32) times more likely to sustain a concussion.ConclusionMale youth athletes reporting headache or neck pain at baseline were at an increased risk of concussion during the season. From an injury prevention perspective, baseline testing may aid in identifying individuals at a higher risk for concussion.