All about rehabilitation

Rehabilitation Matters

About all rehabilitation

A rehabilitation syllabus will give some specific areas of expertise needed by professionals who wish also to specialise in rehabilitation. The curriculum of any educational programme sets out what a person is expected to learn broadly and suggests the experiences and methods of learning needed. It will specify the anticipated outcomes but does not give details, which can be found in the syllabus. The rehabilitation syllabus sets out the range of topics to be covered within a course with guidance on methods of learning and standards expected.  This introductory page sets the scene for a series of pages that will cover when finished, a syllabus for anyone becoming an expert in rehabilitation.

Table of Contents

The rehabilitation syllabus pages

This section intends to set out some guidance on what an expert in rehabilitation needs to know. It will be based on personal experience, opinion, and evidence. It is incomplete now (November 2022) because it will take months or longer to work through the 39 items on the syllabus. It will always be incomplete because no book, online resource, or other information sources can hope to become and remain up-to-date and complete.

The plan is to work through the syllabus and expand on the written syllabus with more detailed information. The table at the end of this page will show links to available items on the site.

The Rehabilitation Medicine curriculum

The UK 2021 Rehabilitation Medicine curriculum sets out the primary education outcomes expected. It guides the experiences considered necessary to achieve these outcomes and the educational assessments suggested to measure achievement over the four-year programme.

Since completing the curriculum, I have adapted the outcome measures slightly to make them suitable for all professions. The primary educational outcomes applicable to all occupations, including doctors, have been given here. There are 14 capabilities: seven generic professional capabilities, where I highlight their adaptation to rehabilitation, and seven specialist rehabilitation capabilities.

The curriculum is not a syllabus, nor does it suggest one. However, educators and trainees might benefit from a structured syllabus to guide but not define the training programme.

Continuing Professional Development (CPD).

Over the last 70 years, people have recognised that professional activities and standards have evolved as knowledge increases, circumstances change, and the needs of patients change. Nobody can expect their initial education to be sufficient for the rest of their life. This is recognised in most professions, and continuing professional development is a growth industry with professional guidance mandating it.

The curriculum and syllabus are a reasonable starting point when planning continuing professional development because the general frameworks used when constructing them will remain applicable.

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:

  1. A contract, with the educator setting out in some detail what the student can expect to learn, when, and how. This contractual aspect is associated with it being:
    1. A guide, helping the student appreciate how each session fits into the whole.
    2. A communication between the educator and the student
  2. A permanent record documenting what the student has done and achieved. This is associated with it being:
    1. A learning aid, helping the student to structure their work over the duration of 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 new 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 needed 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 has generally been welcomed as offering a much better guide to training and a much broader approach to rehabilitation. Nevertheless, before it was implemented, some UK consultants were concerned by the absence of any more detailed information about the knowledge and skills required. Two blog posts (and here) written at the time discuss this in more detail. Eventually, we agreed on a syllabus for the UK training programme.

A rehabilitation syllabus.

I have used the syllabus associated with the UK training in Rehabilitation Medicine on this site. Why? I was closely involved with its development, leading a group of colleagues whose discussions and contributions moulded the final product. I am familiar with it, and I know no better rehabilitation syllabus. Further, the process was reasonably systematic and involved broad consultation and a review by people outside the development group. The people involved are listed here, and I acknowledge their contribution.

The syllabus covers seven general competency domains:

  1. Research and scholarship (self-directed learning).
  2. The process of rehabilitation.
  3. Competencies needed for generic capabilities.
  4. Required competencies for specialist capabilities.
  5. Across condition competencies – treatments
  6. Across condition competencies – problem management
  7. Condition-specific competencies

In total, there are 39 competencies. This diagram shows the inter-relationships between the curriculum, the competency domains and items, and the process of learning from experience leading to the desired outcome, a trusted expert in rehabilitation. The subsequent pages in this section will eventually expand on the 39 individual competencies shown in a Mind Map and a table at the end of the text. As pages on each competency are published, they will be linked to the table.

Conclusion

The rehabilitation 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. Being an expert requires wisdom, which will be covered in a post soon. Wisdom can be learned. Experiences help you learn, but a fixed syllabus will not.

A rehabilitation syllabus:
39 competencies in seven groups

NSection TopicComment
AResearch and scholarship (GPC 9)This is GMC Generic Professional Capability nine, which will be relevant throughout a medical career
1Finding information when neededThis 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.
BRehabilitation processThis section covers four vital rehabilitation skills needed in all areas of practice: every disorder, every setting, every age, and every patient encounter.
2Using the biopsychosocial modelA 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
3Clinical assessment of a patientThis covers the collection of clinical data holistically, to cover all important illness domains, which includes establishing or confirming the disease diagnosis.
4Full formulation of a patient’s situationUsing 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.
5Person-centred rehabilitation planningDelivering 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.
CGeneric capabilities in practiceThese 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.
6Obtaining funding (CiP 1)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
7Ensuring the best interests process is used (CiP 2)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.
8Undertaking quality improvement (CiP 4)How to identify need, plan, select and manage data etc. This is a vital part of training with its own formal assessment process.
9Delivering a teaching programme (CiP 6)How to identify a need, plan a programme of teaching, set learning objectives etc. More than just delivering a session of teaching.
DSpecialist capabilities in practiceThese are competencies that relate directly to specialist Capabilities in Practice, covering areas not specifically covered elsewhere.
10Use 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
11Refer appropriately to other organisations (CiP 7)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.
EAcross condition competenciesThese 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
Treatment
12Exercise (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
13Practicing activitiesPrinciples 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.
14Psychosocial interventionsCovering areas such as providing emotional support and practical support, and some knowledge of sociology/social psychology, stigma etc
15Education/self-managementCovering principles of educating and teaching patients, families and others, especially about self-management of their condition. “Learning how to learn and adapt”
16How to tailor specific interventionCovering 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
17Assistive technologyAdvances 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.
18Vocational rehabilitationThere are few specialist vocational rehabilitation services (from any source), and being able to advise patients and employers is important,
19Palliative/end-of-lifeMany 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.
Problem-management
20Bowel & bladder managementProblems with bowels and bladder occur in many conditions, and awareness of causes, assessments, and principles of management are needed.
21Chronic painPain, especially chronic pain, is a frequent accompaniment of a disabling illness. A high level of expertise is needed in day-to-day clinical work.
22Spasticity and its complicationsSpasticity is common in many neurological disorders, and it can be difficult to manage. It is associated with contracture and skin breakdown.
23Sexual dysfunctionSome 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.
24Swallowing/dysphagiaDifficulties with feeding, drinking, swallowing and maintaining adequate hydration and nutrition is common in many conditions, and expertise in diagnosis and management is vital.
25CommunicationCommunication 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.
26Cognitive dysfunctionCognitive dysfunction is most common in neurological disabilities, but it is present in many other areas of practice.
FCondition specific competenciesThese 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.
27Neurological rehabilitation – acuteAcute 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
28Neurological rehabilitation – long-termThe 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.
29Trauma rehabilitationSince 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.
30Musculoskeletal rehabilitationMusculoskeletal disorders are one of the commonest causes of disability, and it will also often be present and relevant in people with other disabilities.
31Spinal cord injury rehabilitationSpinal 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.
32Cardiac rehabilitationCardiac 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.
33Pulmonary rehabilitationPulmonary 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.
34Rehabilitation in elderlyFor 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.
35Paediatric rehabilitationRehabilitation 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.
36Burns/dermatological rehabilitationThe 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.
37Psychiatric rehabilitation (inc Learning Disability)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.
38Limb loss rehabilitationThis covers limb loss from all causes. Amputation is the commonest, but congenital limb abnormalities are the most challenging area, needing special expertise.
39Visual and auditory impairmentsThough 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.
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