Generic capability 7

Rehabilitation is an unusual speciality. It should be significant because most patients have some disability associated with their illness needing at least advice and some specific input. Despite this, there is no profession of ‘rehabilitationists’, no professional body representing rehabilitation, and only doctors can gain a recognised professional qualification in addition to their medical professional qualification. For all other professions, rehabilitation is additional professional expertise acquired but not recognised. One day, I hope, we will see nurses trained in Rehabilitation Nursing, speech and language therapists trained in Rehabilitation Speech and Language Therapy, and so on. However, the qualification is additional to the first profession, and each discipline with rehabilitation expertise must maintain and increase its professional expertise. This is in addition to developing and preserving rehabilitation expertise. This capability focuses on a person’s unique professional knowledge and skills and must be considered in the context of the other six generic capabilities (here) and the seven rehabilitation capabilities. (here) A MindMap of this capability can be seen below and downloaded here.

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Maintain professional expertise capability 7

Generic capabilty 7: maintain professional expertise

The seventh generic capability achieved by an expert on rehabilitation is to be “able to maintain their professional expertise and to use it effectively within the context of a multi-professional team, contributing to team decisions and actions, adapting practice to the patient’s benefit.” Generic capability 7 recognises that an expert in rehabilitation will also have training in a specific profession and that the professional expertise is integral to their rehabilitation expertise.

Context: multi-professional teamwork

One or more teams deliver almost all health services. Private out-patient practice continues, to a greater or lesser extent, to provide health care through single-handed, single-profession services. All hospital practice, most general practice (family doctor) healthcare, much community, and some care home activities are based around multi-professional teams. This is increasingly accepted as ‘best practice’ and is part of the planned UK development of care homes. (here)

Rehabilitation is relatively unusual in healthcare. All team members contribute information towards the eventual ‘diagnosis’, more accurately termed the formulation. (here) All team members contribute their own clinical actions to the overall plan. And generally, the team is involved with the patient for much longer. In management terms, it is a much flatter team structure with no prominent leader. This contrasts with, for example, a surgical team, where the surgeon operating is the focus.

In all teams, there must be a shared body of knowledge and skill to allow the team members to communicate efficiently and to allow individual team members to understand their roles. In many instances, the amount of knowledge and skill to be shared is limited, and some may well have been given as part of general professional training.

In this situation, where sharing of expertise and greater role flexibility is often present, it is much more critical that each team member has a significant amount of the team’s expertise, which is rehabilitation. This leads to the need for specified rehabilitation capabilities developed on this site.

However, the focus on rehabilitation carries a risk that the professional loses the professional expertise, ultimately reducing the team’s effectiveness. In addition, some people, perhaps particularly doctors (in my experience), feel that their (medical) expertise could be more wanted and appreciated by the team. Sometimes, team members do not recognise the importance of maintaining their professional expertise, to the group’s detriment.

The need for a high level of professional expertise arises precisely because of the need to be able to undertake professional assessment, diagnosis, and treatment whilst, at the same time, also being able to work as part of a multi-professional team. The team relies upon individual members retaining a very high level of expertise.

Thus this capability is of central importance to a successful team’s functioning.


The attitudes required for this capability are:

  • self-confidence, recognising and believing in the need to maintain professional skills.
  • sense of proportion, being willing to think about and determine the allocation of time on different areas of expertise.
  • being self-critical and able to judge which areas of professional knowledge need reinforcing or further development.
  • being personally responsible for self-improvement of expertise

Behaviours for generic capability

The behaviours associated with this capability indicate that the person is always interested in learning more. They also suggest that the person has good self-awareness of areas of professional strength and weakness and takes personal responsibility for reducing areas of insufficient knowledge or skill.

The traditional means for maintaining and improving professional knowledge and skills is through attending courses, seminars, or other organised educational events, thereby collecting the required Continuing Professional Development (CPD) points. There is undoubtedly a place for such events, particularly when acquiring a new skill. They may need to be more appropriate for maintaining knowledge and skill.

A better approach is to incorporate learning into everyday activities, such as searching for answers to questions arising from a clinical encounter. The process of reflective practice (here) is one way of maintaining professional standards, provided that any reflection is accompanied by or followed by learning, and often search for resources to assist learning.

Another good approach is for the rehabilitation expert to attend conferences or educational events outside their specific area of interest, outside their own ‘comfort zone’. This may be quite far removed. It helps in several ways. It will increase general healthcare knowledge, giving an insight into the work of other teams, which may assist when next seeing a patient from that team.

More importantly, some unrelated services may face the same problems as the rehabilitation service. They might also have found a way of overcoming the difficulty, a way that the rehabilitation professional may then use. Last, and conversely, the rehabilitation professional may be able to help by offering a solution to a problem faced by another team.

The behaviours indicative of this capability are that the rehabilitation expert

  • participates in a yearly review of their practice, an appraisal, to set learning goals
  • recognises or identifies areas of professional training they need to learn or improve in their performance
  • attends educational activities relating to their professional expertise
  • regularly looks for further information about a clinical matter encountered in their work
  • keeps a record of their formal and informal continuing professional development activities
  • uses feedback from colleagues, team members and patients to identify areas where they need more knowledge or skill
  • continually strives to learn from both successes and failures or difficulties
  • Attends meetings or educational events that are outside their own ‘comfort zone.’

Knowledge and skills needed to maintain expertise

The knowledge needed for this capability relates to identifying areas where further learning is required and finding and using the resources necessary to learn. In many ways, the knowledge needed is similar to that required for capability 6, training others (here), except it is applied to the professional him or herself.

The expert rehabilitation professional knows:

  • that there is always more to learn. They always think that they know only some of what is needed.
  • the most appropriate learning opportunities and resources for their profession.
  • that learning as part of clinical practice in response to clinical problems is the best educational approach.
  • the required clinical standards that members of their profession must meet.
  • what is considered mandatory training in their job and by their employing authority.

The skills needed by an expert rehabilitation professional to become entrustable in this capability are similar to those required for generic capability six, as both involve learning.

The expert rehabilitation professional can:

  • identify, as part of any clinical activity, when they need to or should learn more
  • identify, set and evaluate targets or objectives for their learning
  • appreciate what can be learned from education and experience outside own personal ‘comfort zone.’
  • admit lack of knowledge or skill openly, and actively work to reverse the lack
  • assess their expertise critically, identifying educational/training needs

Conclusion - professional expertise

This seventh and last generic capability ensures that all professionals working in rehabilitation recognise the importance of achieving and maintaining excellent professional abilities. Excellence in rehabilitation is built on a foundation of excellent professional skills, and rehabilitation excellence cannot be achieved and maintained without professional excellence. The capability’s main features are shown in the figure below,

Maintaining professional expertise
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