Generic capability 7

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 both 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. Just as, in the UK, a doctor is trained in Rehabilitation Medicine, a nurse would be trained in Rehabilitation Nursing, or a speech and language therapist would be trained in Rehabilitation Speech and Language Therapy. There may be other ways of naming the joint professional expertise, but the principle is simple – the person has and must maintain both expertise in their profession, and expertise in rehabilitation. This needs to 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 and downloaded here.

Context

Almost all health services are delivered by one or more teams. Only private out-patient practice continues, to a greater or lesser extent, to deliver health care through single-handed, single-profession services. All hospital practice, most general practice (family doctor) healthcare, much community, and some care home practice 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 members of the team contribute information towards the eventual ‘diagnosis’, more accurately termed the formulation. (here) All members of the team contribute their own clinical actions to the overall plan made. And, generally, the team is involved with the patient for a much longer time. In management terms, it is a much flatter team structure, with no obvious leader. This is in contrast to, 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 role. In many instances, the amount of knowledge and skill needing to be shared is relatively 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 important that each team member has a much greater amount of the team’s expertise, rehabilitation. This leads to the need for specified rehabilitation capabilities, as being developed on this site.

However, the focus on rehabilitation carries a risk that the professional loses the professional expertise which, ultimately, will reduce the effectiveness of the team. In addition, some people, perhaps particularly doctors (in my experience), feel that their (medical) expertise is not wanted or not appreciated, and so they do not bother or appreciate the importance of maintaining their professional expertise.

The need for a high level of professional expertise arises specifically 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.

Attitudes

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, able to judge which areas of professional expertise need reinforcing or further development.
  • being personally responsible for self-improvement of expertise

Behaviours

The behaviours associated with this capability indicate that the person is always curious, interested in learning more. They also indicate that the person has reasonable self-awareness of areas of professional strength and weakness, and takes personal responsibility for reducing areas of low knowledge and/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 be less appropriate for maintaining knowledge and skill.

A better approach is to incorporate learning into everyday activities, for example searching for answers to questions that arise 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 with learning, and often search for resources to assist learning.

Another good approach is for the rehabilitation expert to attend conferences or educational events that are outside their own specific area of interest, outside their own ‘comfort zone’. This may be quick 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, often some other, apparently unrelated service may face exactly the same problems as faced by 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 practice 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
  • always 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.

The knowledge needed for this capability relates to knowing how to identify areas where further learning is needed and how to find and use the resources needed to learn. In many ways the knowledge needed is similar to that needed for capability 6, training others (here), except it is applied to the professional him or herself.

The expert rehabilitation professional knows:

  • that there is alawys more to learn. He or she never thinks that they know all that 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 must be met by members of their profession.
  • what is considered mandatory training in their profession and/or by their employin authority.

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

The expert rehabilitation professional is able to:

  • identify, as part of any clinical activity, when they need to or should learn more
  • identify, set and evaluate targets or objectives for their own 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 own expertise critically, identifying educational/training needs

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 abilities, and rehabilitation excellence cannot be achieved and maintained without professional excellence.

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