The new, significantly changed, and improved 2021 Rehabilitation Medicine training curriculum for doctors became active on August 1st 2021. This page introduces the new curriculum and its associated documents and discusses how the training programmes have been adapted. In the UK, Rehabilitation Medicine (but not the practice of rehabilitation generally) has previously had a limited scope, reflecting its history. The 2021 curriculum is a dramatic and radical break from the past. It recognises and emphasises that rehabilitation expertise can and should be applied throughout all health conditions. The need for this much broader scope has been highlighted by the longer-term problems arising from Covid-19; it was also highlighted in relation to trauma in 2013 but the change was slow. We can thank the General Medical Council for precipitating the change because they required completely new curricula for all medical (including surgical) curricula.
A brief history
History is important. Rehabilitation as a process has been practised since Roman times at least, returning wounded men to fighting. It entered civilian practice in the 1800s and became more prominent during and after the First World War. Its initial focus was on men with acute injuries needing to return to employment, and its initial approach was through exercise and technology, especially electricity. The success of rehabilitation transformed the lives of people with spinal cord injuries in the 1940s-1950s and those left with the effects of polio. Advances in the technology of prosthetic legs increased awareness of rehabilitation.
In the UK, rehabilitation was first a speciality in the 1930s but disappeared from about 1970 to 1984. At the same time, in the 1970s, the speciality of geriatrics was growing fast and took on rehabilitation for stroke and all problems associated with older people.
In 1984 a new specialist society was founded (Medical Disability Society), but the speciality was only recognised by the General Medical Council in about 1997. At that point, the speciality came into being, with several quite disparate groups of doctors amalgamating to form the speciality: civil service doctors responsible for prosthetics and wheelchairs; consultants in spinal injury rehabilitation; some rheumatologists who remained interested in rehabilitation; and some neurologists who had become interested in rehabilitation.
The first curriculum was published in 1997 followed by a second curriculum in 2001. I have not found any copies. The third curriculum was published in 2007, and anyone interested can download it here. The fourth version was published in 2010, available for download here. These curricula all reflected the historical development of rehabilitation in the UK, and the training fell into four subspecialties:
- Neurological rehabilitation
- Spinal cord injury rehabilitation
- Musculo-skeletal rehabilitation
- Amputee rehabilitation
The 2010 curriculum stated, “Basic requirements include at least 12 months in Neurorehabilitation, 6 months in musculoskeletal medicine, 3 months in spinal injuries, 3 months in prosthetics, orthotics, special seating. The remaining 24 months is spent in a range of rehabilitation environments addressing both generic and specialist training requirements across the curriculum.“
In 2013, the recognition that rehabilitation was not available for people with problems after trauma precipitated a change in rehabilitation training, which had not reached fruition by the end of 2016 when a fifth curriculum was ready for publication. However, in January 2017 the General Medical Council required all curricula to change, moving from focusing on the achievement of multiple competencies to focusing on a few higher-level outcomes. The next four years were devoted to writing a completely new curriculum.
This requirement by the General Medical Council for a revised style of curriculum allowed the general dissatisfaction with the continued restricted scope of Rehabilitation Medicine to be resolved when designing the new curriculum. The major changes were:
- allowing entry into the specialist training programme of any doctor with post-graduate accredited core training in almost all clinical specialities;
- broadening the scope of training to cover all ages, all settings, all conditions (including mental health), all interventions, and all stages of an illness from onset to end-of-life care.
The training is described in three major documents, all available on the Joint Royal Colleges Physician Training Board (JRCPTB) website here (expand ‘curriculum’ at the bottom):
- the curriculum, the definitive document
- the Rough Guide to the curriculum, which adds explanation to and clarification of the curriculum, and its implementation
- the syllabus, which provides guidance on the clinical areas that will need to be covered.
The curriculum is now available online here. It became the required curriculum in August 2021. Any trainee in their last year of training at that point may still obtain their Certificate of Completion of Training (CCT) using the 2010 curriculum until 2022. The GMC have recently issued new guidance suggesting that some trainees may be able to gain a CCT on the 2010 curriculum for two years. (here). If you wish to do this, you should discuss it with your educational supervisor immediately, set out the reasons and then approach the training programme director.
Three MindMaps summarise the training. The first shows the 14 Capabilities in Practice (high-level training outcomes) given in the curriculum that trainees will acquire. (here) The second shows the 39 competencies that are outlined in the syllabus. (here) The third, which is derived from the curriculum, summarises the programme of training. (here)
The Rough Guide to the curriculum is on the JRCPTB website here. The main purpose of the Rough Guide is to help trainers and trainees implement the curriculum. It clarifies, where necessary, what the curriculum means. It suggests ways that the goals can be achieved. It is supposed to answer questions but the first version was written without any questions as the curriculum had not been activated. If you as a reader, trainee, or trainer have a question about the curriculum that the Rough Guide does not help with, please email the chair of the Rehabilitation Medicine Specialist Advisory Committee at the JRCPTB.
The syllabus is also on the JRCPTB site here. The main purpose of the syllabus is to illustrate the areas of clinical expertise that are likely to be needed to achieve the capabilities, especially the eight specialist Capabilities in Practice. For each area, it outlines the expected observable behaviours, knowledge, and skills that a trainee will need to acquire. There is also a system for grading expertise.
The document stresses that this is guidance only. It has also been written before the new training started, so is very likely to need improvement. If anyone has any questions, comments, or suggestions for improvement (adding, subtracting, changing), please email the chair of the Rehabilitation Medicine Specialist Advisory Committee at the JRCPTB.
For anyone interested, further discussion about the need for and nature of a syllabus can be seen here. The syllabus gives 39 competencies, and anyone interested in competencies can read more here.
The training programmes also needed adjustment and this has been achieved. Over time, as the nature of the work evolves and as needs become more apparent, there will no doubt be changes in training programmes – but that happens anyway.
The new curriculum came into force at an exciting and challenging time for rehabilitation. The need for expert rehabilitation services able to cover a very wide range of problems has been brought into sharp focus by Covid-19. The curriculum is designed exactly to train consultants who can meet those needs. There are several challenges. The resources devoted to rehabilitation need rationalisation and also need to be increased. (here) Existing consultants will need rapidly to learn how to assess and manage the new problems arising from Covid-19. Trainees will often need to help improve services, and to learn with their consultant trainers. In ten years’ time, we could have excellent and better-resourced expert rehabilitation services.