Doctors in rehabilitation – 1
“But what do doctors do in rehabilitation? “I have been asked this question since I became interested in rehabilitation. Many healthcare professionals, including managers, worryingly state, “We don’t need...
Education and training
Rehabilitation is an area of clinical work that depends on rehabilitation expertise from all team members, yet only doctors are required to have training in rehabilitation. All other professions are expected to know and to have the skills. Someone with a professional qualification in medicine who has undertaken at least five more years of post-qualification training is scheduled to launch into another four years of training in rehabilitation. Why is specific training in rehabilitation not needed for any therapist, clinical psychologist, or nurse? Many pages on this website are devoted to the particular knowledge and skills required by any professional working in a rehabilitation team. Indeed, one of my reasons for setting up this site was to draw attention to the generic knowledge and skills needed by every team member. The posts in this category inevitably draw on experience training doctors because only doctors are taught rehabilitation to a validated level of capability. Nonetheless, they are written for all professions, hoping other professionals will acquire rehabilitation expertise.
Table of Contents
Introduction
Healthcare specialities are based on the biomedical model of illness. They focus on diseases, usually classified by the organ system involved, for example, neurology or haematology. Further subclassification occurs, such as neurology, neurosurgery, and neurophysiology. Two specialities are based on age – paediatrics and geriatrics – and some are based on other disease-related phenomena such as further investigations (e.g. radiology) or specialist treatments (e.g. oncology, radiotherapy). Mental health services are fitted into this system.
The main exceptions are palliative care services, primarily concerned with the end-of-life and associated relief of pain and distress, and rehabilitation services.
Most professional training is centred on the biological aspects of sickness. Education concerns some broader aspects of ill health and healthcare, but the critical professional clinical knowledge and skills involve bodily structures and functions. Medical training for doctors in Palliative Medicine and Rehabilitation Medicine requires an extra four years after completing core training over five or six years. Doctors acquire knowledge and skills about palliative care or rehabilitation as specified by the palliative medicine or rehabilitation medicine curriculum.
One of my goals is to encourage all other team members to learn about rehabilitation. The posts in this category are part of my mission.
Inculcating a broader perspective of training.
Rehabilitation takes a holistic approach to each patient, setting their diseases, symptoms, and signs in the much bigger context of their life – their ability to look after themselves, work, pursue hobbies, make friends, etc. Ultimately, we need to facilitate the patients in satisfying their own goals in the five areas of human needs set out in Maslow’s theory of human motivation. There are other ways to identify a person’s aspirations, but they all require the healthcare service to take a broad view of the patient.
Therefore, the first and most important purpose of education and training in rehabilitation is to help a biomedically-trained professional recognise that there is more to a patient’s life than their disease or disorder. Many doctors and other professionals find this challenging because most of their education has stressed expertise in bodily function.
This change is achieved using the biopsychosocial model of illness, and a separate category of posts covers models of illness.
The posts in this category cover a broad spectrum of topics loosely centred on learning about rehabilitation. Some concern educational assessment during training, such as the recent use of capabilities and entrustment rather than a competency-based approach. This, too, reflects a broader view of professional expertise. A good professional should not only be able to undertake some skilled process. They must know when to perform a procedure, how to explain this to the patient, share decision-making, etc.
Other posts are more educational, for example, setting out how to use the Mental Capacity Act. Education and training should include learning about research. What is it, how does one evaluate and use research, and how can one learn about it? These are also encompassed within this category of posts.
Rehabilitation education and training.
I dream that every professional working within a rehabilitation team as a team member will have a recognised, validated qualification in rehabilitation in addition to their professional qualification. The nature and extent of their extra learning are open to debate, and I am not expecting every professional to undertake four years of training in rehabilitation!
This dream is some years away. The posts in this category and the pages elsewhere on the site will allow anyone to start training themselves. Self-directed learning is an excellent way of acquiring expertise; the expertise gained still needs to be validated.
The posts
The most recent eight posts on education and training are below; more can be loaded using the button at the end.
Rehabilitation team leadership
At a recent meeting in Genoa of RIMS (Rehabilitation in Multiple Sclerosis), Dr Carlotte Kiekens discussed the leadership of the rehabilitation team, providing some challenging evidence and ideas to...
Assessment competency
At 02.00 hrs on November 29th, I had an epiphany, “a moment of sudden and great revelation or realisation”. [OED] For many years, I have emphasised a distinction between...
Wisdom in rehabilitation
In May 2021, Dr Sabena Yasmin Jameel published her University of Birmingham PhD thesis on Enacting Phronesis in General Practitioners. John Launer wrote about it on November 2nd, and...
2021 Rehabilitation Curriculum
The new, significantly changed, and improved 2021 Rehabilitation Curriculum for training doctors in rehabilitation became active on August 1st 2021. This page introduces the new curriculum and its associated...
Rehabilitation thinking
“Rehabilitation is a way of thinking, not a way of doing.” I have written two editorials extolling this approach, but I have recently realised that I have not explained the specific...
Assessing Entrustment in Rehabilitation.
Trust is central to all healthcare. A patient trusts the doctor’s diagnosis and recommendations. The doctor relies on a radiologist to read the image correctly. When the doctor refers...
Why are research papers rejected?
Clinical Rehabilitation, the journal I have edited from 1994 to 2021, rejects about 88% of all submissions. Rejections fall into two groups. Many papers are not worth publishing or...