The sixth generic capability that a rehabilitation professional should have ensures that they pass on expertise, an activity that is central to all professions. The capability is to be “able to teach and to train both undergraduates and post-graduates, in two different spheres: about their professional practice; and about rehabilitation as an activity.” The features specific to rehabilitation expertise relate to the multi-professional team. Teaching must be directed not simply at other people in the same profession, but also at people from all professions involved in the team. The second feature applies to most clinical teaching. Although teaching is often seen as a separate activity from clinical work, an expert will educate while working. A MindMap showing the summary of this capability can be viewed here.
Professions have developed around unique expertise acquired by a group of people, be it law, teaching, healthcare, web design, or whatever. The precise nature of professionalism in healthcare is a matter of debate and discussion (see box below). Nevertheless, there are a great many professions focused on many different sets of knowledge and skill. Most professions have a code delineating expected behaviours, values, and attitudes. One expected behaviour is that a professional will pass on their expertise to others. Professions are also characterised by having a professional body or society, an organisation that sets and maintains standards. The professional body may also represent the profession politically, and in negotiations about financial matters.
The medical profession is one of the older professions (but not the oldest!). The Royal College of Physicians (London) has recently (2018) reviewed and published a document about advancing medical professionalism. This can be found here. This was developed after extensive consultation with others, including other professions, patients, and commissioning organisations.
The report identified seven key aspects of medical professionalism. They are that the doctor acts as a:
- patient partner
- team worker
- manager and leader
- learner and teacher
These roles will be present in most healthcare professions, whether stated explicitly or not. They would all apply to a rehabilitation professional. The fifth role is that of “learner and teacher.” It is interesting that learning and teaching are conjoined. It is my experience, and I am sure this has been shown in research, that the act of teaching someone else is associated with much learning on my behalf.
One of the current difficulties in rehabilitation is the lack of any unique, rehabilitation professional body. Rehabilitation has unique expertise, set out in these 14 capabilities. However, each expert already belongs to another profession. Only doctors have an officially recognised (by the General Medical Council) professional expertise in rehabilitation, as a branch of medical practice where doctors have unique expertise compared to all other doctors. At a senior level, after full training, each doctor has both a medical expertise and an additional, specialist medical, expertise. (This remark includes general practitioners.)
Rehabilitation is a multi-professional activity. It is not appropriate that only one profession within the team should have recognised expertise, and that other members, who often also have similar expertise, should not have it recognised. More importantly, the other team members need to know what expertise they need to acquire to become expert. Moreover, once rehabilitation is recognised as a separate professional expertise that is fully integrated into other aspects of the person’s professional expertise, then each profession will start to get a clear idea of their own, unique expertise that they add to a rehabilitation team. (here)
The importance of the last two paragraphs is to emphasise that someone who wishes to become a recognised, professional expert in rehabilitation must, as part of their professionalism, teach the expertise to people from all professions. Only in this way will clinicians fully appreciate and demonstrate their commitment to true multi-professional teamwork.
Last, though training is usually discussed and described as a separate activity, with a person either undertaking a clinical (or other) activity or teaching someone how to undertake the activity, teaching is much more effective if integrated into the activity being taught. Much healthcare training is integrated into day-to-day care. This is not always understood by managers, yet it is probably the most effective and most efficient way to teach, Equally, I suspect that training aimed to help someone be a good educator concentrates on formal teaching. I suspect that training people how to integrate teaching into everyday clinical work has a much lower priority. Yet, if this were to occur, the clinical environment would truly become a learning environment.
The key attitudes required for this capability are:
- embracing teaching as part of daily clinical work
- supporting learners, especially when giving feedback
- engaging patients (or others involved in the activity) in the teaching process
- being patient and giving time when teaching others
The behaviours needed all arise from an underlying commitment to educate and teach anyone, anywhere, whenever an opportunity arises. Anyone committed to education will appreciate both the importance of continuing to learn themselves and the importance both of giving and of receiving feedback on their own teaching from those being taught.
Demonstrating these behaviours also adds an element of modeling appropriate behaviours, the professional showing through their behaviour how those being taught should behave; they show that learners should not only ‘do as I say, but also ‘do as I do’. The same comment applies to the emphasis on teaching all professions. Many professionals say that they are committed to multi-professional teamwork, but their behaviours often belie this, not teaching other professions.
This capability is one where a snapshot of a person’s behaviour over a day will rapidly show whether the person is a keen and effective teacher. It would be a rare day indeed if no opportunity to teach arose.
The behaviours expected of a rehabilitation professional, indicating this capability, are that the professional:
- teaches people during daily clinical work, integrating training with clinical practice. This is probably the most important because (a) it indicates willingness to teach and commitment to education and (b) it is the behaviour most likely to educate others;
- integrates profession-specific expertise with rehabilitation expertise in all educational activities. In other words, does not separate the two areas of expertise.
- delivers effective teaching to undergraduate and post-graduate students, across a range of professions. This relates to more formal teaching, and it emphasises the multiprofessional nature of educating.
- supervises and trains less expert professionals in the team and more widely. Again note the implied focus on all professions, not just the person’s own profession.
- gives constructive, honest and clear feedback on performance to others. This is an essential behaviour, indicating good teaching technique.
- seeks feedback from those being taught on teaching delivered, and acts on it. This behaviour both helps improve the person’s own teach skills, and shows learners that teachers are also committed learners.
- plans programmes of teaching covering several or many sessions. Ths is more about organising, but again demonstrates a willingness to teach.
- organises educational events, open to different professions. This behaviour returns to the theme of teaching across all professions.
Knowledge and skills.
It is probable that the most important knowledge is not easily taught, though it can be learned. It is knowing when an opportunity to teach has arisen, and knowing how best to use it taking into account the situation, and the person to be taught. Most of the knowledge given here is itself teachable and can be learned from courses, or books, or in other ways.
For this capability, the expert rehabilitation professional knows:
- how to elicit feedback from those being taught. Thinking about what helps you, and how you like to receive feedback will greatly improve your own delivery of teaching and feedback.
- How to judge how competent or entrustable another professional is. Competence and entrustability are different – see here and here.
- how to give feedback to someone being assessed in training.
- How to deliver a teaching session (seminar, lecture).
- How to use teaching aids and equipment, including different media.
- How to evaluate the knowledge and skills of a trainee.
Teaching is another professional activity, that healthcare professionals need to learn as part of their own skill-set. It requires skills that can be learned. As with all skills, the real skill needed is a meta-skill, the ability to adapt whatever you have learned to the specific situation: who you are teaching, what you are teaching, and in what context.
For this capability, the rehabilitation professional needs to be able to:
- Identify a useful item to teach to a student or colleague in most clinical situations;
- Adapt teaching to the situation, and to the needs of the learner(s);
- Explain complex material in a way that learners can understand;
- Give feedback in a manner that supports a learner whilst emphasising further learning needed;
- Learn from feedback given, improving their own teaching skills;
- Put together a training programme with clear learning objectives.
This page has outlined generic capability six, the ability to teach professional and rehabilitation expertise to members of your own profession and, equally well, to members of other professions working in rehabilitation and wishing to acquire rehabilitation expertise. As with all work in rehabilitation, the professional needs to balance the undoubted unique professional expertise with the equally undoubted unique rehabilitation expertise. It also depends upon accepting the blurring of professional boundaries and sharing of professional expertise.