This blog post updates the BSRM debate on its name and whether we should change it. After two somewhat confrontational discussions, Jav Haider (consultant in the Major Trauma Centre, Cardiff) agreed to discuss the issues rather than debate them. It was an exciting and productive discussion, and this blog post records the main points. John Burn, President of the BSRM, chaired the meeting, and 14 people listened and participated via Teams. There were five participants in the room. This blog post considers the main discussion points, not necessarily in the order that they arose. This blog post was written jointly by Jav Haider, Derick Wade and John Burn.

The Discussion

The starting point for the discussion was that, as highlighted in the debate one week earlier, the proposal to hold a ballot on changing the name had stimulated considerable activity and engagement among members. The extent was difficult to measure.

I suggested that a few active members had devoted much time and attention to working on behalf of our Society for some years, for example, producing documents on standards. The cost was a lower level of attention to members. At the same time, I suggested that members had not actively volunteered for working parties or committees to spread the load. These two factors probably led to a loss of engagement in our Society.

We both agreed that since we undertook to implement the proposal for a ballot in 2020, members of our Society had been much more engaged and active. We also decided that the debate risked increasing polarisation and discord within our Society. The risk of worsening polarisation led us to have a discussion rather than a debate.

Jav’s first and significant argument was that the proposed name would give our Society international equivalence. We would join a large body of other Societies and become more recognised and, possibly, more like other similar Societies. As part of this, he felt that the new name would encourage existing members to be more engaged with our Society and possibly undertake a broader range of work.

His vision was that, in 10 years, members of our Society would be closer to members of societies in many other countries in terms of the scope of work undertaken. He reported that, during his training, he had felt disheartened by the lack of international equivalence.

I then outlined my vision of the Society in 20 years. I hoped our Society would be the ‘go to’ Society whenever someone wanted an opinion about some aspect of rehabilitation service. We would represent all professions involved in rehabilitation, not just doctors. I hoped that our Society would have, as full members:

• many doctors who were interested in and delivering rehabilitation, but who were not accredited in Rehabilitation Medicine, for example, psychiatric and paediatric rehabilitation.
• many people from other professions who were committed to rehabilitation.

I suggested that we would need a varied subscription rate, proportional to the mid-point salary of a member’s NHS post (or equivalent).

Jav pointed out, and I agreed, that few consultants from other specialities had joined and some BSRM members had left the Society. He asked me how I thought we could overcome the loss of members and failure to recruit from other specialities and whether a name change would affect us.

I replied that it required an active engagement by all members of our Society, something I had been advocating for for at least nine months. I suggested that a specific working party might help, organising coordinated actions such as attending meetings of specialist interest groups within other societies to attract them into our Society. JohnBurn suggested bringing in members of other Societies to work with us on specific projects and guidance within the auspices of a BSRM Special Interest Group (SIG).

I was concerned that an action plan was needed and would be needed whatever the result of the ballot. Jav agreed.

Jav stressed the importance of being in line with other international rehabilitation societies, mainly to achieve the number of consultants seen (pro-rata) in most other countries and to broaden the scope of rehabilitation. One audience member specifically advocated for an increase in musculoskeletal medicine with rehabilitation practice and hoped this would occur with the change of name proposed.

John Burn and Shigong Guo asked each of us similar questions about our opinions on the risks associated with a vote against our proposed option.

I feared that a vote to change the name might be seen as ‘a victory’ by its advocates, and a defeat by people who opposed the change, and that the divisions already apparent (though their size and strength are difficult to judge) might persist. I was equally concerned that, whatever the outcome, members of our Society would return to the previous low level of engagement with Society affairs.

I hoped that whatever the result, there would be continuing active engagement of all members of our Society with the running of the Society. They could participate in many activities streams – writing reports and other documents, attending (not just belonging to) special interest groups, voting when asked, and so on.

Jav was also concerned about the risk of division within our Society and was clear that he would not consider the result to be either a victory or a failure. He strongly agreed that a plan to take forward the changes already proposed was essential.

A trainee in the audience raised the issue of a change in the name of the speciality. Jav pointed out that the vote related entirely to the name of our Society. He said that, nevertheless, a change in the name of the speciality was a likely eventual goal. Changing the name of the speciality would depend on the outcome of discussions within our Society, more comprehensive discussions with many groups outside our Society, and eventually the attitude of the General Medical Council. Dr Melissa Rossiter in the audience reflected on the benefit to Emergency Medicine of the change in the name of their speciality and how others then perceived them. Dr Jenny Thomas, also in the audience, commented that an emphasis on Physical Medicine in the title might tend to point away from involvement in wider aspects of Rehabilitation.

Comments in ‘Chat’ on Teams.

During the discussion, various comments were made in the chat function. Some were purely practical about coming or going. A few were about the curriculum which was discussed first, but most concerned the name change discussion. They are given below, indicating the person making the comment. The only editing has been expanding abbreviations, correcting spelling errors, and putting all comments made by one person together. There was no sequential flow between the comments.

Curriculum comments in ‘Chat’ on Teams.

Ida Bakar

I understand form Dr Wade’s talk earlier that the duration spent on a syllabus item e.g. Respiratory Rehabilitation is more about the experience (e.g. Cystic Fibrosis MDTs) and not about the duration spent in such activity e.g. must do two weeks in respiratory rehabilitation.

DW. That is true

Name change comments in Chat on Teams

Manoj Sivan

• It is not about the philosophical meaning of the name – it is about international equivalence.
• None of us see two groups within the society
• We have only 1 MSK physician in RM for 67 million population. And he is retiring soon. Hence our workforce is 10 times less than any other country at par. ‘Physical’ bring back MSK back to where it belongs
• Curriculum change not likely to bring back MSK to the society as it now belongs to SEM. They are unlikely to engage with us unless there is a change in outlook/ rebranding
• Spinal cord injury will engage more in society with name change – I have heard this from many SCI colleagues
• MSK conditions are the biggest cause of disability in any population
• GOAL – grow our society, international equivalence, bring everything back to RM. Long Covid has shown us what is missing in our specialty
• VISBILITY = NUMBERS. Our workforce is 10 times less that overseas. Specialty has not grown in last 40 yrs when compared to other medical specialties. Average growth in other UK medical specialties has been 3 times (Cardio Rheum Neuro etc) in last 20 years but we are 0.3 times.
• Apologies I have to leave. Great debate. Thank you all

Julian Harriss

• Unless we take this first step, we can never hope to achieve international equivalence, with all the benefits (international portability).
• MSK may be introduced to the curriculum, but it is missing from the name

Sreedhar Kolli

• Neurophysiology are also part of our Rehabilitation Medicine in North America and India

Lenyalo King

• A thought on MSK
• Rehabilitation post major trauma:
• there is a significant amount of MSK (which I think rehab medicine training and curriculum needs to improve to reflect this) as well as TBI (which I can see neurologists have developed very keen interest in)
• Thoughts on profile of speciality
• We can perhaps learn from geriatrics/ frailty : their speciality has grown over the years from my time as a medical student to now

Ida Baker

• Agree with Julian Harriss.
• There is more to MSK rehab than spinal injuries and amputees. Yes, we need to be part of the international society (esp after Brexit!)

Conclusion

Please discuss the question on changing the name of our Society with your friends, colleagues and anyone else interested. You may comment on the BSRM Facebook page (here) or use the comment button below.

Then please vote. Whatever the outcome, the larger the ballot the more valid the result.