For many years there has been a grumbling level of dissatisfaction with training in Rehabilitation Medicine within the UK. Having just finished my fifth or sixth meeting about training in the UK within the last four weeks, I recognise that the coincidence of a new curriculum being introduced in August 2021 and the major effect that Covid 19 has had upon the ability to deliver training has led to serious discussion about rehabilitation medicine training programs. I hope these discussions will lead to considerable change and improvement. This blog brings trainees and others up-to-date.
The long-standing problems and their causes were fairly well recognised. There are relatively few trainees in any particular deanery or region. In order to assemble a group of trainees of sufficient size to attract speakers on a regular basis, you would need to be covering four or five deaneries. This was rarely possible, given the time it took to travel the distances. Local and regional meetings were notable by either not occurring, or occurring infrequently.
A second, less openly discussed problem, is the difficulty in engaging local consultants, both those in Rehabilitation Medicine and those in associated relevant specialties such as neurology in the training sessions. One important reason for this was that a consultant would put in several hours of preparatory work and several more hours of work, to train to trainees who he or she met on a regular basis (and maybe one other trainee). Some consultants work single-handed, many are over-worked, and perhaps teaching has a lower priority.
A third, also less openly discussed problem, was the variation in the standard of training and the content of training around the country. With relatively few consultants in any particular area, it is difficult to access consultants with specific interest and expertise in each of the many areas of rehabilitation medicine. For example there are some deaneries that do not have a local spinal cord injury centre within them. Trainees in that area will not be exposed to spinal cord injury rehabilitation as part of general training events.
Some 10 to 12 years ago an attempt was made to remedy this by producing a CD with pre-recorded lectures on most of the topics in the 2010 curriculum. The intention was that local trainers would use the slides to teach. I do not think that this was used very much, and it did not prove easy to update it despite valiant efforts by one or two consultants to update the whole series.
Covid 19, and new curriculum
The arrival of Covid 19 has precipitated some parts of the country into producing online seminars, lectures and other teaching materials. Some if not many of these are accessed by trainees from further afield, and at least some trainees feel that this has already improved the quality of their training, through being able to access teaching from a much wider range of consultants. It is very ad hoc, and not particularly structured around the existing curriculum.
The new curriculum has also stimulated an increased awareness of the lack of any specific syllabus, by which I mean a list of core competencies, knowledge, and skills that a trainee should acquire over their four years of training. The training output is defined in the new curriculum. The curriculum also states what experiences are likely to enable a trainee to acquire the 14 Capabilities in Practice. The curriculum does not state what its component parts are. In other words there is a gap between the range of experience needed to acquire the capabilities, and gaining the capabilities.
This gap will be closed through some current work being undertaken to develop a syllabus. The exact structure and nature of this has yet to be defined, but it is likely to include somewhere between 30 and 45 specific topic areas, and for each of those it is likely to show indicative areas of knowledge that will be needed and at what level, and skills that will be needed and at what level.
This syllabus will recommend what trainees will, by and large, need to learn. It will not be a definitive list of everything that has to be learned, nor will achieving everything on the syllabus necessarily be sufficient to acquire all 14 Capabilities in Practice. It is a guideline, no more and no less.
The syllabus will possibly inform the structure of the revised e-portfolio. The syllabus will suggest how different topics relate to capabilities. The syllabus will help both trainers and trainees to identify what needs to be learned, and whether the learning is sufficient. It will enable meaningful discussion on neutral ground.
There is currently a working party set up by Dr Anna Brain, one of the two British Society of Rehabilitation Medicine (BSRM) trainee representatives on the education subcommittee of the BSRM, and also on the Specialist Advisory Committee. A recent meeting came to some provisional conclusions:
- there was a need for a structured programme of teaching and learning, matched to the topics identified in any syllabus;
- this could only realistically be supplied on a national basis, and that it will therefore necessarily be provided online;
- online material could only ensure that the trainee new the facts,
- additional means of training would be needed to develop that learning so that it was fully embedded and understood, and able to be used constructively in day-to-day clinical practice.
Further exploration and discussion will be carried out, for example determining where an online system might be hosted, and how much it would cost and how it would be paid for.
One proposed model is as follows. There would be:
- a monthly online training talk or seminar possibly with some interaction using chat function, covering one (or possibly two) topics within the syllabus over one or two hours;
- this would be followed, approximately one week later, by a training after they held in a region or supra-regionally. Once Covid 19 restrictions are lifted, they would be in person but initially they will be online also;
- the regional follow-on session would be chaired and organised by a training programme director or a nominated individual for a particular topic;
- every regional trainee would attend, and it would be a required part of training, in practice if not in any legal way;
- trainees would be given work related to the topic to undertake over and above watching the seminar prior to the regional meeting. The nature of this work would be determined by the local organiser.
If any trainee, or indeed any other person reading this wishes to learn more or to give feedback, then they should do so by contacting Dr Anna Brain using the form below: