Capability seven is that the professional is “Able to use their specific professional expertise to assess and treat individual patients, to teach other team professions about the strengths and limits of their professional expertise, and to help develop team protocols and procedures.” Many professionals believe that teamwork risks ‘dumbing down’ their own expertise, that they may lose professional identify, and that they cannot use all the expertise they have acquired. These are unjustified fears. Indeed, working within an expert rehabilitation team increases opportunities to use acquired expertise fully, and challenges the professional so that expertise increases. Of course other team members may question some suggestions, but this is this will help to avoid complacency and will ensure that expertise is maintained and improved. This page explores what capability seven means for an expert within any profession. A MindMap can be seen here.
When I was a medical student, we thought our goal was to learn facts. We were taught some practical skills, such as examining the nervous system, but teaching about the use of the facts was either absent, or so poor or limited that I have forgotten it. Yet, as a professional, it is the ability to use knowledge that differentiates between excellent and other professionals, not the depth of knowledge. This capability focuses on the use a professional makes of their professional expertise.
The capability takes the expertise for granted. It must be stressed, however, that maintaining and increasing expertise is essential. In medicine, and I am sure in all professions, there is a professional responsibility to do this. The first seven requirements of Good Medical Practice (after the preamble) concern professional knowledge and skills. (here)
The core of this capability is being able to use professional expertise to its maximum effect within context, working with and drawing on the professional, physical, cultural and organisational contexts encountered. This contrasts with simply continuing as if other factors did not matter at all, and also with acting as if one is the only professional present, ignoring the help that other professions might offer. It requires adaptation, compromise, collaboration and cooperation, so that the expertise is accepted and used as completely as possible.
The patient is the most important context. He or she will have personal wishes and expectations, likes and dislikes, strengths and weaknesses and so on, and all assessments, interventions, and other actions must be tailored to build on what the patient has and wants. This often means not doing what textbooks and training suggest; it may sometimes mean not doing what the evidence suggests. While compromise and adaptation must not be extended to allowing harm or exposing the patient or others to risk, not doing ‘what is best for the patient‘ is acceptable, after informed but respectful discussion.
Most professionals learn that this is so, once they have been in practice for a few days! Some resist it or give way grudgingly, generally making the patient feel uncomfortable, and neither of these responses is appropriate. Most professionals learn how to manage, and to take a longer and broader view.
The other important context is the team, most of whom will be from other professions. Generally, during training and early work, a professional works with and learns from other people from the same profession. They learn how to get on with colleagues socially. Generally the professional group will have similar areas of interest and expertise, one will rarely be in a position of disagreeing about the use of their shared knowledge and skills.
A multi-professional team is quite different from a uni-professional team working from a single department. Other people will have their own areas of expertise, some overlapping with your own expertise. Their culture is likely to be similar, but there will undoubtedly be differences. Thus, other professionals may disagree with or question core parts of a professional’s practice and knowledge. They will have different priorities. Their culture and approach may be different.
This difference between professions can be managed using two complementary approaches. The first is relatively straightforward and draws on universal social skills. It depends upon getting to know the other people, developing social relationships through shared areas of interest such as clinical matters outside either professional sphere, or a particular type of music.
The second is more difficult. It is coming to accept that other professions in general (not just a friend from another profession) will be as committed to their own expertise as you are to yours, will have as much expertise as you do, give the same priority to their professional opinion as you do to yours, and so on.
This then leads to an acceptance that questioning of your suggestions, techniques, advice and so on is reasonable, that adjusting or even abandoning an intervention can be reasonable, that following recommendations from another professional is acceptable, and so on. In return, you may question others and learn from them, you can ask others to take forward some of your actions, and others will sometimes abandon their interventions.
The third context is the large number of others who may ‘join the team’ for a patient, usually from other organisations and often from other professions. As with the ‘home team’, a rehabilitation professional must also work with them, adapting, compromising but also teaching and involving them in treatments.
The behaviours concern using and sharing professional expertise as a contributor to a multi-professional team providing patient-centred rehabilitation. In this context, t three complementary factors determine behaviour: professional standards, a responsibility to the team, and above all, a responsibility to the patient. There may rarely be situations where the three responsibilities are not concordant.
Members of a multi-professional team need to preserve and use their professional expertise, just as they keep and use their personal characteristics in all other interactions. The team is a blended mix of strong individual colours, not a murky brown mess.
Each profession needs to contribute their professional expertise with confidence, but also with humility, allowing others also to contribute. Each profession needs to question, in a constructive way, anything that they do not understand or agree with, and also needs to be receptive to being questioned. This mutual, constructive and critical sharing of expertise can lead to excellent decisions and plans. Each individual needs to be sufficiently self-confident in their professional identity, knowledge and skills to welcome debate and, when appropriate, admit that other plans are better.
A team needs to share expertise, and to share responsibilities. This sharing involves teaching others, and being prepared to learn. It requires planned attendance at meetings, seminar and training events run by and for other professions. This gives another professional great insight into the differences in professional practice and beliefs between different professions – and also probably some unexpected similarities. The professional needs to maintain his or her own expertise, and to learn about the expertise of others.
The behaviours expected cover three contexts. In many ways, the behaviours are similar across all three contexts. but separation emphasises and makes explicit and specific what is expected.
In the context of the patient’s team, including professionals from outside the core rehabilitation team, the professional should:
- collect profession-specific information from the patient;
- identify profession-specific interventions that might benefit the patient;
- share this information with other team members, providing explanation and justification when necessary or asked for;
- participate in the formulation of the situation in team meetings;
- explain and justify assessments used and interventions recommended;
- adjust, adapt or accept not to provide an intervention when a team rehabilitation plan is drawn up;
- educate team members about professional expertise, strengths and weaknesses;
- actively learns from other professions about their expertise.
In the context of the patient, and their family and friends, the professional should:
- Explain and interpret any findings, and the meaning and significance of any professional information;
- discover and confirm, or establish a patient’s goals, expectations and preferences;
- explain, justify, and give the risks and benefits of any interventions proposed, sharing decision-making with the patient as far they are able and willing to do so;
- educate the patient and, if appropriate and agreed, family and friends about self-management;
- tailor all professional activities to the patient’s situation.
In the context of their own profession, the professional should:
- maintain and develop their own professional expertise, through continuing professional development activities;
- acquire and maintain expertise needed to support team-wide patient-management policies;
- teach, train and support less experienced members of their own profession.
Knowledge and skills
The most important knowledge for this capability is the core and expert professional knowledge expected for the grade. There are some other pieces of knowledge.
The professional should have good knowledge of:
- what assessments and interventions are appropriate for the population of patients being seen by the team;
- when and how to adapt and/or adjust professionally recommended assessments or interventions to reach an agreed team bundle of care;
- when and how to tailor professionally preferred assessments and interventions to the circumstances of the patient;
- the evidence behind any assessment or intervention used or given;
- how to teach patients self-management of the problems within their professional remit;
- how and what to teach other professions in the team about own professional expertise.
Most of the skills needed are common to most other capabilities. There are some skills specific to this capability.
The professional should be able to:
- explain and discuss all matters of professional expertise used, to a patient and family in language and terms tailored to their understanding;
- explain and teach about matters of professional expertise to other team members without using professional jargon, in ways that they can understand;
- willingly share professional expertise with other professions;
- adapt and adjust all professional assessment and interventions to the patient’s circumstances and team’s overall treatment plan;
- justify all recommended decisions or actions, answering questions and clarifying as needed;
- ask questions about and disagree with decisions or recommendations of other team members in a constructive, non-judgemental manner.
The capability emphasises that each profession in a team has and needs to maintain at the highest standard its own knowledge and skills, so that the team can function at a high level. The capability stresses the need to use the professional expertise in a clinical context. The team member needs to use professional expertise in the context of an expert multi-professional rehabilitation team. This inevitably requires adaptation and compromise, but it offers increased opportunities both for patients to benefit from professional expertise and for the professional to increase his or her own expertise. Teamwork offers opportunities, not threats.