A rehabilitation syllabus
Last updated: March 9, 2025
This page introduces a large section of the website, which covers expertise anyone specialising in rehabilitation may need. It is derived from the Rehabilitation Medicine Syllabus published in 2021 to accompany the Rehabilitation Medicine Curriculum for doctors in the speciality. However, all team members need rehabilitation expertise as a crucial addition to their professional expertise. Therefore, though the content will inevitably be biased towards doctors, the principles should be relevant to all professions; the specific knowledge and skills will vary between professions. The original pages were written in 2022-23, and I reflected on what I learned writing the pages when I completed the task. I am updating them to broaden their relevance and improve their content.
The content of this section is not intended to be a textbook. It does not cover all the basic and advanced knowledge needed. My goals are to:
- Introduce the reader to some publications that will give a reasonable entry into the topic;
- encourage the reader to question some accepted wisdom, for instance, by suggesting a different way of looking at a topic
- Understand enough about the topic to cope when faced with a patient with the condition discussed.
Table of Contents
Introduction
Schooling in the UK is dominated by learning facts even though success in life, especially in work, essentially depends on interpersonal skills, flexibility, and the ability to adapt to circumstances. Higher, professional education also still primarily relies on knowledge tests, even though professionals must have and use many other skills.
Acquiring a body of specific knowledge attracts the learner because it delineates what they must do: ” Learn facts alpha to omega, and you’ll be OK.” Testing specific knowledge also attracts trainers and those responsible for professional standards because the results are generally unambiguous and leave little room for dispute. This has led to a focus on competencies in healthcare: Can the person demonstrate that they undertake a specified activity safely and effectively?
The number of competencies required by healthcare professionals expanded rapidly, considerably burdening trainees and examiners. Moreover, most complaints and examples of poor professional practice concerned limited interpersonal skills and judgment, not inadequate competence.
This led bodies responsible for professional standards, such as the General Medical Council, to focus on a few high-level speciality-training outcomes and high-level indicators of general professional performance. These were formalised in the curriculum, but they abandoned mandatory competence assessments. The curriculum did not delineate required knowledge and competencies.
What is a syllabus?
There are many definitions of a syllabus, descriptions of what a syllabus contains, and statements concerning the purpose of a syllabus. Queens University in Canada suggests five facets, which are likely to differ in importance in different circumstances:
- A contract, with the educator describing what the student can expect to learn, when, and how. This contractual aspect is associated with it being:
- A guide, helping the student appreciate how each session fits into the whole.
- A communication between the educator and the student
- A permanent record documenting what the student has done and achieved. This is associated with it being:
- A learning aid helps the student structure their work throughout the course.
Alternatively, one can consider a syllabus as the link between the overall goals of an extended education period and the detailed daily work undertaken; it is the intermediate level. It helps the student achieve the desired educational outcome, such as a professional qualification.
The emergence of the UK Rehabilitation Medicine syllabus illustrates this function. The 2021 curriculum was developed in line with the General Medical Council’s wishes to have a small number of high-level outcomes assessed after speciality training lasting 4-6 years. They also wanted to avoid regular changes in the official curriculum as medical practice changed, with new treatments emerging and other competencies becoming redundant. This approach was a dramatic contrast to all earlier curricula, where the result was evaluated on many specific medical competencies.
The new Rehabilitation Medicine curriculum was generally welcomed as offering a much better training guide and a broader approach to rehabilitation. Nevertheless, before it was implemented, some UK consultants were concerned that it did not provide more detailed information about the required knowledge and skills. After discussion, we agreed to develop a syllabus for the UK training programme, identifying suggested areas of knowledge and skills needed to be competent in various rehabilitation fields.
I must stress that the syllabus is not mandatory and has not been reviewed or approved by any organisation. Potential indicators of competence are given but they have not been validated. No practicing consultant (equivalent to a certified specialist in other countries) will ever need or use all 40 competencies.
A rehabilitation syllabus.
This site’s suggested syllabus is based on the UK Rehabilitation Medicine syllabus. I led the group in developing it and translated the outcome of our discussions into a written document. Some working party members contributed one or more competencies, and I acknowledge their contributions. When writing this site’s version, I realised we had omitted competency in assessment, so I wrote a blog post about it.
The syllabus covers seven general competency domains with 40 competencies:
- Research and scholarship (self-directed learning).
- The process of rehabilitation.
- Competencies needed for generic capabilities.
- Required competencies for specialist capabilities.
- Across condition competencies – treatments
- Across condition competencies – problem management
- Condition-specific competencies
The 40 individual competencies are shown in a Mind Map below (only readable on a desktop) and a table at the end of the text.
Each item has a downloadable guidance document that sets out:
- The competency
- Behaviours indicating the trainee has the competency
- Knowledge indicating the trainee is competent
- Skills a competent trainee will have
- Other evidence a trainee might collect
- References relevant to the competency
A rehabilitation curriculum
The UK 2021 Rehabilitation Medicine curriculum sets out the primary education outcomes expected for doctors training in Rehabilitation Medicine. The curriculum suggests but does not mandate the range of clinical experience needed before becoming entrusted. It also outlines some educational assessments to measure achievement over the four-year programme.
This diagram shows the interrelationships between the curriculum, the competency domains and items, and the learning process from experience, leading to the desired outcome: a trusted expert doctor in rehabilitation.
Each profession involved in rehabilitation, and many professions are, will have its professional high-level outcomes for professional standards. If a professional wants to be accredited with expertise in rehabilitation, they would need a similar approach to that used in medicine, showing high-level capabilities in rehabilitation.
I have slightly adapted the medical capabilities to make them generally applicable to any profession. There are 14 capabilities: seven generic professional capabilities, which I highlight as being adapted to rehabilitation, and seven specialist rehabilitation capabilities. I have also published this proposal in Clinical Rehabilitation.
Doctors may work in any field and require a wide range of competencies, but some professions may not need to cover them all.
Continuing Professional Development (CPD).
A crucial aspect of professionalism is ensuring that one’s knowledge and skills are appropriate for the work undertaken. This means staying up-to-date, continuing to learn from experience, and developing one’s expertise further. The professional standard reached when finally registered as an independent practitioner is nowhere near the expertise one should have ten years later.
Nobody can expect their initial education to be sufficient for the rest of their lives. This is recognised in most professions, and continuing professional development is a growing industry with professional guidance mandating it. The curriculum and syllabus provide a reasonable initial standard for safe, effective care in most situations, but not more. The syllabus might also help someone whose job changes and needs to relearn competencies in a new field.
Using the rehabilitation syllabus.
The syllabus is a guide. It maps out some individual aspects of rehabilitation. However, it does not cover the whole of rehabilitation, the areas in between, or how the components relate. You should use it to help you but not allow it to direct you.
You will gain most from an item if you use it when involved clinically with the content. Consequently, each user will undertake items in a different order. You may read an item to prepare for a new training area, reading it just before starting. You will unlikely benefit from reading items when not clinically active in the competency concerned. You should not simply start at the beginning and read through the items.
Each page will give you some references to help you into the field. They tend to be systematic reviews or well referenced guides. My goal is to encourage critical thinking; some references give an alternative view of the competency. You should not accept any competency pages as correct; each puts forward a reasonable, defensible point of view. You must draw your conclusions.
Last, you must always retain a holistic perspective. Look for commonalities between the competencies and consider what can be learned from one that applies to others. Remember that your expertise arises not from what you know but from how you use that knowledge, along with all other information, to help your patients. A syllabus is not a recipe to be followed; it is just a list of ingredients.
Conclusion
The goals for someone training to be a rehabilitation expert are given in a rehabilitation curriculum. The curriculum does not specify what must be learned or how the trainee acquires the expertise. Its concern is the professional’s ability to perform their role safely and effectively. The syllabus outlines a path to becoming an expert in rehabilitation. Still, you must realise that knowing the whole syllabus cannot alone make you an expert and that an expert is unlikely to know the entire syllabus. Moreover, there may be other ways to achieve the goal. An expert can make sound judgments and decisions, holistically balancing competing factors. Over time, a professional may acquire wisdom. The curriculum and syllabus can provide a strong base, but do not guarantee expertise or wisdom.
A rehabilitation syllabus: Table of the 40 competencies
The table below shows the 40 syllabus competencies, divided into seven groups; the links (red text) take you to the competency’s page.
| N | Section Topic | Comment |
|---|---|---|
| A | Research and scholarship (GPC 9) | This is GMC Generic Professional Capability nine, which will be relevant throughout a medical career |
| 1 | Finding information when needed | This competency is vital within rehabilitation, because the range of possible diseases, conditions, problems and solutions that may be encountered is huge, and the need to find information will arise frequently, almost daily, throughout a career. |
| B | Rehabilitation process | This section covers four vital rehabilitation skills needed in all areas of practice: every disorder, every setting, every age, and every patient encounter. |
| 2 | Using the biopsychosocial model | A good understanding of the biopsychosocial model is essential. It underlies all effective rehabilitation. The competency includes not only using it in all clinical contexts, but in other contexts such as service management, quality improvement and research |
| 3a | Assessing a patient | This covers the collection of clinical data holistically, to cover all important illness domains, which includes establishing or confirming the disease diagnosis. |
| 4 | Full formulation of a patient’s situation | Using collected data to analyse the clinical situation, to identify the major areas of importance influencing the situation, and to suggest management options. It is a key analytic skill. |
| 5 | Person-centred rehabilitation planning | Delivering a rehabilitation programme tailored to a person’s needs, wishes and situation can only happen if the planning process is thorough, and person centred. Many skills are needed. |
| 6 | B-6 Evaluation competency | “Has my intervention achieved the goal we set? Are there side effects, and are they worse than the benefit? What should we do now?” Answering these questions is the last step in the rehabilitation cycle; the evaluation determines the next plan. |
| C | Generic capabilities in practice | These competencies relate to the generic Capabilities in Practice, and cover areas that are not in the generic standards given but are particularly important areas within rehabilitation. |
| 7 | Obtaining rehabilitation funding | An important area of work, this has to do with understanding commissioning within the NHS, and how resources are allocated to a patient, both within and from outside the NHS |
| 8 | Ensuring the best interests process is used | Focuses on Mental Capacity Act and ethical aspects of best interests, use of the ReSPECT approach, etc. Not just as applied to prolonged disorders of consciousness and gastrostomy feeding. Part of daily clinical practice for most consultants. |
| 9 | Undertaking quality improvement | How to identify need, plan, select and manage data etc. This is a vital part of training with its own formal assessment process. |
| 10 | Delivering a teaching programme | How to identify a need, plan a programme of teaching, set learning objectives etc. More than just delivering a session of teaching. |
| D | Specialist capabilities in practice | These are competencies that relate directly to specialist Capabilities in Practice, covering areas not specifically covered elsewhere. |
| 11 | Use drugs appropriately for common problems (CiP 6) | The ability to use drugs correctly and the ability to review and stop drugs are both vital as many patients accumulate drugs without review. Covering pain, emotional distress, epilepsy and other common medial problems |
| 12 | Refer appropriately to other organisations | Understanding the roles of Department of Work and Pensions, Employment, Housing, Social services, voluntary organisations etc. Additionally, stresses the need to appreciate their individual cultures, and priorities and processes. |
| E-1a | Across condition competencies | These are competencies arising in many different areas of rehabilitation, are not confined to a particular disease or condition. The first eight are generic rehabilitation treatment competencies; the remaining seven are generic problem-management competencies |
| 13 | Exercise (being physically active) | Exercise with cardio-respiratory consequences is a vital treatment. Knowledge of exercise physiology/types and principles relating to exercise and its benefits |
| 14 | Practicing activities | Principles of learning how to undertake activities, both practical and neurophysiological. This is necessary because the patient’s ability to learn how to undertake an activity is a central feature of rehabilitation. |
| 15 | Psychosocial interventions | Covering areas such as providing emotional support and practical support, and some knowledge of sociology/social psychology, stigma etc |
| 16 | E-16 patient self-managementEducation/self-management | Covering principles of educating and teaching patients, families and others, especially about self-management of their condition. “Learning how to learn and adapt” |
| 17 | E-17 Tailoring rehabilitation | Covering not the 100s of different treatments but how to select and how to monitor the success or otherwise of individual treatments. Requires knowledge of measurement |
| 18 | E-18 Assistive Technology | Advances in technology has transformed the lives of disabled patients, and the advances will continue to do so. A good awareness of how assistive technology can help, and matching patients to technologies is important. |
| 19 | E-19 Vocational Rehabilitation | There are few specialist vocational rehabilitation services (from any source), and being able to advise patients and employers is important, |
| 20 | E-20 Palliative care | Many patients have progressive disabling disorders that culminate in an early death, and being able to recognise when end-of-life planning is appropriate, and to set out a plan is a necessary expertise. |
| E-2 | E-2 cross-condition problem management | These seven problem-management competencies apply in most conditions |
| 21 | E-21 Bowels and Bladder | Problems with bowels and bladder occur in many conditions, and awareness of causes, assessments, and principles of management are needed. |
| 22 | E-22 Chronic pain | Pain, especially chronic pain, is a frequent accompaniment of a disabling illness. A high level of expertise is needed in day-to-day clinical work. |
| 23 | E-23 Spasticity management | Spasticity is common in many neurological disorders, and it can be difficult to manage. It is associated with contracture and skin breakdown. |
| 24 | E-24 Sexual dysfunction | Some disabling conditions directly affect sexual function, and disability itself can affect both sexual function and also forming or maintaining sexually intimate relationships. Being competent at recognising and managing these it important. |
| 25 | E-25 swallowing and dysphagia | Difficulties with feeding, drinking, swallowing and maintaining adequate hydration and nutrition is common in many conditions, and expertise in diagnosis and management is vital. |
| 26 | E-26 Communication | Communication is part of everyone’s life, but some patients can develop major problems with it. Good ability to analyse the cause of poor communication is important in many conditions. |
| 27 | E-27 cognitive deficits | Cognitive dysfunction is most common in neurological disabilities, but it is present in many other areas of practice. |
| F | F-0 condition-specific rehab | These are competencies relating to medically categorised groups of patients, reflecting the reality of the organisation of other services and the likelihood that patients in a disease-defined group will have many problems in common. |
| 28 | F-28 Acute neurological disorders | Acute neurological conditions have formed the main area of growth in rehabilitation since about 1970, and is now a significant part of the total inpatient workload |
| 29 | F-29 Chronic neurological conditions | The importance of rehabilitation for long-term and often progressive disorders has only been recognised since about 2000; it is now also a significant part of the workload in many services, usually on an out-patient basis. |
| 30 | F-30 Trauma rehabilitation | Since 2013 all major trauma centres are supposed to have input from consultants in rehabilitation medicine to provide acute (within two days) assessment and advice and to ensure a full Rehabilitation Prescription is issued on transfer out of patients of all ages. |
| 31 | F-31 Musculoskeletal rehabilitation | Musculoskeletal disorders are one of the commonest causes of disability, and it will also often be present and relevant in people with other disabilities. |
| 32 | F-32 Spinal Cord Injury rehabilitation | Spinal cord injury rehabilitation is currently focused on specialist in-patient units, but in practice some patients never reach the specialist unit, and long-term support may well be a local responsibility. Every consultant needs to be competent in this. |
| 33 | F-33 Cardiac rehabilitation | Cardiac rehabilitation has been and still is run independently of other rehabilitation services. Nevertheless, cardiac problems are seen in many patients seen with other conditions, and complex cardiac rehabilitation problems may need expert rehabilitation advice. |
| 34 | F-34 Pulmonary rehabilitation | Pulmonary rehabilitation has also been and still is run independently of other rehabilitation services, but it may become part of rehabilitation services particularly as patients with Covid-19 will need more than pulmonary rehabilitation alone. |
| 35 | F-35 Geriatric rehabilitation | For many years in the UK, geriatrics was the major rehabilitation service; it was and still is closely involved in much rehabilitation for example with stroke, and Parkinson’s disease. And the majority of disabled people are aged over 65 years or even 75 years. |
| 36 | F-36 Paediatric rehabilitation | Rehabilitation for children is a sub-speciality within paediatrics, but rehabilitation specialists will have much to offer because of their rehabilitation expertise, working collaboratively with the paediatric services. |
| 37 | F-37 Dermatological and burns rehabilitation | The development of trauma rehabilitation has drawn attention to the need for active rehabilitation input into services managing patients with burns. Rehabilitation expertise could also assist people with other skin disorders. |
| 38 | F-38 Psychiatric rehabilitation | This competency covers two related problems: diagnosis and management of emotional distress and disorders; and diagnosis and management of people with challenging behaviours. These problems arise in all areas of rehabilitation.. The causes include psychoses, emotional disturbance and cognitive problems, and learning a structured way to think about behavioural analysis helps in all rehabilitation. |
| 39 | F-39 Amputee rehabilitation | This covers limb loss from all causes. Amputation is the commonest, but congenital limb abnormalities are the most challenging area, needing special expertise. |
| 40 | F-40 Auditory and visual rehabilitation | Though in many ways visual and auditory losses are quite different, for many years ‘sensory impairment services’ have covered both and often have close links with Social Services. Visual and hearing impairments are common, and are seen in many people with other conditions. |