Sports medicine is a study of medicine that deals with physical fitness and the treatment and prevention of fractures related to games and exercise. Games and exercise medicine physicians are specialist doctors who have completed medical school, appropriate residency training and then specialize further in sports medicine. Specialization in sports medicine may be a doctor's first specialty. It may also be a sub-specialty following a specialization such as orthopedic surgery and psychiatry. The various approaches reflect the medical culture in different countries.