Curriculum developments

On the 18th of November 2020 a Training Advisory Group met to discuss the new Rehabilitation Medicine training curriculum and how it can be translated into a more specific syllabus. This meeting arose from a groundswell of disquiet and dissatisfaction about the lack of specific, objective criteria within the curriculum. This lack of detail leaves trainers in a difficult position when assessing a trainee’s progress and level of knowledge, skill, and competence. It also leaves trainees in a difficult position, because it is not immediately apparent what they should be reading about and trying to learn. The Rough Guide to the curriculum does not help.

The meeting attracted about 15 people when first announced. Although only four weeks’ notice was given, 17 people (at least) logged in for one hour 15 minutes to discuss, on Zoom, their concerns and how they might be addressed. The meeting was chaired excellently by Dr Elizabeth Stoppard, chair of the British Society of Rehabilitation Medicine’s education sub-committee who managed hands up, thumbs up, and chat functions as if she had been doing it for years.

Our main conclusions were that:

  • a syllabus was definitely needed to allow trainees and trainers to
    • assess the level of competence (knowledge and/or skills) in specific important rehabilitation activities
      • including both doing less well than expected and being at a higher level than expected
    • know what specific areas of competence were needed in order to achieve the higher-level capabilities
    • identify when additional learning was needed
  • the degree of granularity needed careful consideration, steering between
    • too much focus on multiple small areas of practice, and
    • too little specification.

Other interesting ideas arose. Several contributors emphasised that rehabilitation doctors were “specialists at being generalist“, with a particular comparison with training in general practice. In the same vein, the trained doctor was described as “an expert generalist“. These expressions highlight the holistic approach that is central to rehabilitation, based on the biopsychosocial model of illness. They also reflect the fact that rehabilitation training can be entered from almost all post-qualification core training programmes:

  • Internal Medicine Training stage one (two years),
  • ACCS-Acute/Internal Medicine (three years),
  • Level 1 Paediatrics training (three years),
  • Core Surgical Training (two years),
  • Core Level Training in Anaesthetics (two years),
  • Core Psychiatry Training (three years),
  • Basic (ST1 and ST2) Obstetrics and Gynaecology training (two years),
  • ST1 and ST2 of Ophthalmic Specialist Training (two years), or
  • completion of a General Practice specialty training programme (three years)

We meet again in two weeks.

Derick Wade. November 20th 2020

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