All about rehabilitation

Rehabilitation Matters

About all rehabilitation

Academic rehabilitation encompasses education, training, research, and continuing professional development. Academic rehabilitation is also concerned with developing theories that support and extend our understanding of rehabilitation, thus setting out the knowledge and skills needed to practice expert rehabilitation. These activities are not restricted to recognised academic rehabilitation departments in universities. Much ground-breaking research and thinking relevant to rehabilitation occur in other specialities. For example, a psychiatrist who drew on work in sociology, systems theory and many other specialities published the biopsychosocial model of illness. This section covers or will cover many of these areas. This page introduces the topic.

Table of Contents

History

Most academic specialities develop within an existing area of expertise and split off as the scope becomes large enough to warrant separation. Rehabilitation initially developed with hospitals and became associated with radiology before becoming a separate medical speciality. However, academic studies in healthcare are centred not only on areas of expertise defined by anatomy and physiology, such as cardiology or neurology, or areas of management expertise, such as radiology, but also by profession, such as nursing.

One central feature of rehabilitation now is its multi-professional team-based nature. Unfortunately, the development of rehabilitation as an area of specialist healthcare practice co-occurred with the development of different professions. Each new profession set up its academic departments: nursing, physiotherapy, psychology etc. Some medical rehabilitation departments developed, although not until after the Second World War in the UK. The medical departments mainly focused on the role of doctors within rehabilitation, not rehabilitation itself.

In other words, rehabilitation as an area of expertise did not grow within an existing disease-based speciality and then separate as it grew to form its own body of knowledge and skills with supporting theories and evidence. Instead, rehabilitation activity was associated with the evolution of new professions, and each new discipline wanted to identify what it was an expert in. Consequently, few departments are explicitly multi-professional with a focus on rehabilitation. Most departments referred to as academic rehabilitation departments are firmly embedded in a professional faculty. They may employ other professions, especially for a research project, but it is a profession-specific department.

Multi-professional specialist societies are also rare. In the US, the American Congress of Rehabilitation Medicine (ACRM) became a multi-professional group in 1966. The multi-professional Society for Research in Rehabilitation (SRR) was founded in the UK in 1978. The European Forum for Research in Rehabilitation (EFRR) was founded in 1983. These groups are all national or supranational, and almost all academic research is managed within a uni-professional setting.

Consequences

This persisting split of academic rehabilitation into a host of small departments focused on the work of a single profession has had severe consequences. Although most professions now accept the need for multi-professional teamwork, almost all educational and research activities focus on the profession. There is minimal research into aspects of collaboration or the nature of rehabilitation as an area of expertise. The departments are small, often dependent on one or two dynamic individuals, and lack the critical mass of curious people needed to generate long-term productive departments. The scope of the research endeavour within a department is limited.

Training and education are also almost entirely focused on professional knowledge and skills, with little discussion of rehabilitation. This was also true of medical training until 2021, when a new curriculum, developed from 2017-2021, came into force. To the best of my knowledge (which is limited), only doctors in the UK have set out to train in rehabilitation itself. They are the only profession with a validated, nationally recognised training programme in rehabilitation. I led the development and writing of the new 2021 curriculum and its associated syllabus. (here)

Most conferences are also led by a single profession, though there is an increasing trend for meetings open to many occupations; for example, many disease-based conferences, such as the UK Stroke Forum, are now targeted at all other professions, and conferences organised by a single profession will often target other disciplines. One of the best rehabilitation conferences I have attended was an international meeting organised by ACPIN, the Association of Chartered Physiotherapists in Neurology.

Despite the universal recognition and strong evidence that effective rehabilitation depends on a multi-professional team, this has not translated into multi-professional academic rehabilitation departments. Moreover, much education and post-graduate training are aimed at single professions. Employers rarely support a professional who wishes to attend a course or conference run for a different profession.

This website will cover academic rehabilitation rather than any specific profession, but it will draw on medical training for several reasons. I am a doctor, so I am most familiar with medical training. More importantly, only medical training has explicitly separated training in rehabilitation from the more traditional medical knowledge and skills associated with the profession. The guidance on matters such as training and continuing professional development is all applicable to all occupations.

 

Medical training

The name for the speciality used by the General Medical Council, Rehabilitation Medicine, is apposite because we are indeed dually trained in medicine and rehabilitation. Thus, as mentioned in the last paragraph, I am discussing medical training specifically for several reasons.

This country is woefully short of rehabilitation doctors; there is a complete curriculum that sets out training in rehabilitation, albeit focused on training doctors; this curriculum sets out entrustable high-level outcomes, Capabilities in Practice, that can readily be adapted for all professions. I am familiar with the guidance on training and education for doctors and believe that the principles apply equally to all occupations.

The medical training pages will give specific information about training in the UK and will cover why rehabilitation is an excellent speciality for any doctor interested in people. They also illustrate how professional training in medical matters can be combined with training in rehabilitation.

Professional training

This section expands and adapts the specific medical rehabilitation training curriculum to suit every profession, including medicine. The medical curriculum is regulated by the General Medical Council and will not change for years, but the similarity will be obvious. One day, a generic curriculum for rehabilitation training might be possible.

I will discuss the high-level training outcomes, which are the overarching abilities that characterise an expert in rehabilitation. Educational practice in healthcare has been concerned with competencies for many years, but competencies are constrained to specific tasks, and curricula have become huge with many competencies.

The proliferation of competencies leads to two problems. In practice, a practising expert will only use some of the range of competencies, which leads to a waste of effort in learning competencies that are not used.

More importantly, expertise in individual competencies is only a part of being an expert. Experts can use their experience to respond to new situations appropriately and have many managerial and personal skills in analysing and responding to complex problems. They can be trusted.

Assessing high-level skills is one way to overcome the weakness of only evaluating competency. I set out seven high-level Capabilities in Practice that will characterise an expert in rehabilitation from any profession and an additional seven Capabilities in Practice that all healthcare professionals should have, emphasising how they apply to rehabilitation.

Syllabus.

The focus on assessing high-level skills can be criticised because it does not specify the more specific knowledge and skills an expert should have. A professional should identify and undertake their own learning needs, but some guidance is required at the beginning of a professional career.

Many rehabilitation doctors were concerned that the curriculum did not specify any knowledge or skills required by doctors training in rehabilitation, and many also criticised the lack of competencies. Therefore, we developed a syllabus outlining 39 areas of competence that a trainee should consider, suggesting appropriate knowledge and skills for each.

However, we emphasised that the syllabus was guidance, and demonstrating competence in each domain was not required. As it is unlikely that a trainee could achieve the Capabilities in Practice without being competent in most of the syllabus areas, it was unnecessary to have a formal assessment.

This site does not cover all the possible knowledge and skills someone training in rehabilitation might need. No place or single source could do that. It suggests that the medical syllabus would be a helpful framework for any profession. When I have the time, I will add pages for each domain of the syllabus.

Continuing Professional Development.

The General Medical Council emphasises that doctors “… must remain competent and up to date in all areas of your professional practice.” The GMC also highlights that doctors “.. should look for developmental opportunities across all four domains and not confine your learning to the areas of your practice in which you feel most comfortable.

The four GMC Good Medical Practice domains referred to are:

  1. knowledge, skills, and performance
  2. safety and quality
  3. communication, partnership and teamwork
  4. maintaining trust.

The first domain is what most people focus on in their CPD. They attend professional meetings that discuss their area of clinical practice. This allows them to meet and make friends and usually confirms that they are up-to-date; occasionally, the person may learn something new, which is as likely to arise in conversation with a colleague as it is from formal teaching by a speaker.

The other three domains are less likely to be the focus of continuing professional development and, unfortunately, are less likely to be supported financially by an employer. Yet, these crucial behavioural and attitudinal aspects of professional practice distinguish the best professionals.

I will consider continuing professional development in the three generic domains on this website. Individual professional societies will focus on the first domain.

Research: theories and skills.

No site can cover and keep up-to-date information about all research undertaken in rehabilitation because so many relevant new research studies are published each year. The feed from the Clinical Rehabilitation website, available on this website, has mentioned about 200 interesting papers each year since 2018. That is a small proportion of all studies. Furthermore, rehabilitation research is published in a broad range of journals, with only a minority in rehabilitation journals.

In the research part of this website, I will concentrate on the less rapidly changing aspects of academic rehabilitation, the theories, frameworks, and methods that guide more specific aspects of rehabilitation. Some of these ideas are developed in blog posts, and these will be linked to the section.

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