This week I got to interview Dr Farhan Shahid who I got to know when I popped in to see a friend of mine at her Covid clinic – only to find Farhan teaching her how to do one-legged squats during their break. He is a qualified GP and in his second year (ST4) of his four-year Sport and Exercise Medicine (SEM) training in London. Sports medics are a rare breed in the UK and I am aware that there is nothing globalGP about it but I definitely wasn’t going to waste this opportunity on finding out and sharing the information on how to become one.
The Faculty of Sport and Exercise Medicine (FSEM) was formed only in 2006, not long after London won the Olympic bid for 2012. The idea was to professionalise the speciality of SEM which, until then, was covered as a specialist interest by trained physicians, orthopaedic surgeons and GPs. It is such a young speciality and it is still carving its role out in the NHS. It reminds me of the family medicine movements in countries like Japan and South Korea where they are still in their infancy where there is a nervousness of an uncertain future but also the excitement that anything could happen. There is so little exposure to SEM at med school in the UK which means that it is not widely known and, even if does pique your interest, there is no established roadmap. Where do you get your information to even decide if it’s for you?
The sports medicine training is four years and requires a background in general practice (GPVTS), medicine (CMT/IMT) or emergency medicine (ACCS). During his SEM training, Farhan has already completed six months in emergency medicine, six months of exercise medicine, six months of general practice and had just started in his six-month rotation of public health. His third year will be at the Institute of Sports, Exercise and Health and his final year will be back in hospital in a combination of orthopaedic and SEM clinics at the Homerton hospital. During this time, he is also expected to organise his own sports placements which, so far, have included being the doctor for Brentford football team and the Lawn and Tennis Association (LTA). He also is the doctor for the under 16 national England Football team which he does outside his training. Excitingly, he also tells me that he will be working for the English Institute of Sport (EIS) as a sports placement which means that he may be treating some British Olympians in the near future!
I have real life-envy when I talk to Farhan about his day job. SEM bridges several specialities – the perfect combination of orthopaedics and medicine – to manage exercise performance through the knowledge of musculoskeletal anatomy and exercise physiology. This is reflected by the fact that the Royal College of Surgeons of Edinburgh manage the exams although the speciality lies under the auspices of the Royal College of Physicians. Despite being a relatively niche speciality, it is still competitive with approximately 100 people applying for the 11 registrar posts in the year that Farhan had applied.
In the UK, after qualification from medical school, all doctors are required to complete Foundation year one and two. During the second year, doctors apply for a speciality although it is increasingly popular to delay speciality training in order to do extra time studying, travelling or trying out different specialities (which has been nicknamed the ‘F3 year’). When Farhan finished his Foundation training, he was split between orthopaedics and general practice. Being very sporty, he loved the idea of sports medicine but didn’t know much about it or whether it existed but took it forward via a Masters in sports medicine. Although he loved the hospital environment, he opted for family medicine training because of the broad range of skills that he would have but also because he could branch into SEM as a specialist interest if he wasn’t successful in attaining an SEM training post.
During the three years of GP training, he spent time checking off requirements for entry into the SEM training programme. He attended the right conferences, looked at the right exams, the right courses. He started to speak the language of sports medicine. I have a lot of respect for Farhan here. I have always advised anyone applying for a role or a new job to check the person specifications and ensure that they have an example for each point in your application or interview. Farhan was doing this naturally in preparation for his application. Unsurprisingly, he was shortlisted for interview and got his top choice of a London training programme. Although he is incredibly humble about it, it is clear that this did not happen by chance and that he was an exceptional candidate.
So what can a Certificate in Completion of Training (CCT) from SEM get you? Obviously, most trainees will have an interest in elite sports which is predominantly private but there are opportunities within the NHS as well. There are hot spots of NHS MSK clinics in London but, unfortunately, it’s not widespread and the one that he worked for only received referrals from the MSK services in primary care and not directly from GPs. Farhan was trying to explain to me about Cardiopulmonary Exercise Testing (CPET) that he was involved with at the Hammersmith Hospital which looks at the CO2 and oxygen gas exchange. This has been used to calculate lactate thresholds when an elite athlete switches from aerobic to anaerobic respiration but has real implications for pulmonary and cardiac-related hypertension and especially in calculating pre-operative risk and the need for an ITU bed. He definitely lost me on some of the respiratory physiology but even I can recognise that this is cutting edge medicine.
So Farhan envisages a real mix to his daily practice once he qualifies. He wants to keep his GP license going but is also keen to manage high-performance athletes and mix this up with a few days in the NHS doing MSK clinics. He also plans to do a fellowship in the U.S or Australia – the world leaders in SEM practice alongside the UK. The really exciting thing is that because it is such a new speciality, he can create a bespoke service with the skills that he has acquired. So what is the future of SEM? None of us knows but there are so many endless possibilities.
Farhan’s life advice – what can medicine learn from sports?
One of the things that I love about talking with Farhan is his insane levels of positivity and how motivated I feel about life and work after a conversation with him. What was his secret? I know that the sports mindset is about growth, discipline and effort-over-outcome which is evident in our conversation which wanders off into our value sets and how to live our best lives. What I find interesting is that the lessons that Farhan learnt from SEM resonate with the lessons that I have learnt from international medicine.
When I give talks to medical students or junior doctors about international primary care, I often get asked about how to get to where I am. It breaks my heart sometimes where I hear that juniors are being told that they need to be wily or deceitful in order to get to the top. Farhan states the importance of having a value system and a set of principles that you want to adhere to which will give you the confidence to be comfortable with yourself and be positive about what you are trying to achieve. It’s much about the journey as it is about the outcome. We agree that, as doctors, we chronically undervalue ourselves and our skills – perhaps this is because of the learned helplessness that is instilled into us from being on a conveyor belt or due to being chronically undervalued by the NHS. We are a commodity and we have skills and a work ethic that is incomparable. The most important thing is to know what we are worth and then to appreciate the journey without being too attached to the outcome. I guess it’s tantamount to playing your best game but losing always feels better than winning when you didn’t deserve to. He finds that, when he studies successful people, the common thread is the notion of focusing on what is within your locus of control and then being stoical about what is not.
Another lesson I take from him is that it is better to be on the pitch than in the stands. Go to that conference or take the opportunity to work abroad because worst comes to worst, you’ll know it wasn’t for you and you’ll have a funny anecdote for the dinner table. This reminds me of Brenée Brown’s TED talk where she quotes Roosevelt about how the credit goes to the man in the arena, not to the critic who sits and points out how he falls and stumbles. I think for both of us, the arena has ended up being a very supportive space where everyone falls and stumbles all the time but actually we all help each other get back up again and some pretty amazing stuff happnens.
Following on from this, we discuss the importance of finding your tribe (which is my mantra). Farhan felt that he really stuck out like a sore thumb at his VTS because his peers didn’t quite understand his passion but it’s obvious that he has found his brethren now. We are creatures of community and social connection and it has never been easier to find your own tribe through the internet, zoom or teams. For me, I love the inspiration that my tribe brings me – from my friends who do quality improvement projects and system change in hospitals in Syria and Iraq to community health building in Zambia to saving albatrosses on a remote island in the Atlantic. I love hearing about their adventures and I love the support and encouragement we give each other to pursue these random dreams. For Farhan, it’s the inspirational talks from the coaches, the dedication he sees in his elite athletes and the support and passion that he feels from his peers. I was very struck by his advice if you wish to receive, you need to give first. When you are generous to others and bringing value to others, generosity will always come back to you. This is very true in the international committee where we are always passing opportunities and experiences to each other and help build each other when needed. By creating value, people are attracted to you and, if you don’t think you have any value, just be a nice person!
Finally, Farhan reminds me of a line from the poem by Rudyard Kipling, ‘If’ which is written above the player’s exit in the centre court at Wimbledon: ‘If you can meet with Triumph and Disaster and treat those two impostors just the same…” It’s a fine line between failing and succeeding and it is very important not to let yourself be defined by either.
You can follow Farhan on
Faculty of Sports and Exercise Medicine (FSEM) https://www.fsem.ac.uk/