Rehabilitation is unusual. Within healthcare, most areas of specialist knowledge and skill are associated with an associated profession: speech and language therapists specialise in communication and swallowing; physiotherapists in muscles and movement; doctors in disease, and so on. In contrast, rehabilitation is a specialist area of knowledge and skill that is not confined to any single healthcare profession. Indeed it is relevant to almost all professions, but at present only doctors have an officially recognised training and qualification in rehabilitation.
Specialism implies a greater level of knowledge, skill and experience in something, compared with the bulk of other people in the same group. Most post-graduate education or training focuses upon increasing the depth of expertise in one part of the person’s basic professional training. For example, a surgeon will increase his or her knowledge of anatomy, skills in making surgical diagnoses, ability to use tools and equipment needed to perform surgery and so on, and a hepatologist will increase their understanding of liver structure and function and how it goes wrong.
Therefore, as they specialise, most professionals are simply learning more within the same framework they trained in. Almost all professions train within the biomedical framework (described here), the culturally dominant model of illness used by almost everyone in most economically advanced countries. The model is based on a scientific, reductionist approach to illness, which focuses on identifying a single specific cause for the illness, and giving a specific curative treatment.
Rehabilitation is set in a different framework, the biopsychosocial model of illness. This model is not widely known, and is quite different from the biomedical model which almost everyone uses at all times. Consequently, rehabilitation training has to start by inculcating a different analytic approach, one where there are no single causes or treatments, but a multitude of relevant influencing factors with non-linear relationships. Some other medical specialities also need to install a different view of illness. Psychiatry and general practice are two obvious examples.
Only doctors have a specific curriculum for training in rehabilitation as an area of specialist knowledge and skills. Completion of training over four years allows them to be on the specialist medical register with the General Medical Council (GMC). The GMC is determines the structure and the standard of all medical curricula. It has recently moved to requiring “higher level outcomes” from training, in contrast to previous medical curricula and the majority of all other curricula which focus on acquiring a large number of competencies. The focus of training in the process of rehabilitation causes some doctors concern, until they understand the nature of their expertise.
“But when I go to a multidisciplinary team meeting, I need something special I can contribute”. (doctor in training)
I was asking a trainee in his third year why he wanted to attend a course about a skill he was not likely to need, because other services usually did the activity. The quotation above was his reply.
I asked what he thought a doctor in rehabilitation offered the team and he could not give any clear answer. I was concerned that, after three years of specialist training, he could not identify anything special that he had learned about rehabilitation. He saw specialist training in terms of acquiring skill in specific practical activities. His examples of the contribution of other professions were all phrased in terms of practical skills.
In other words, he was training to be a doctor who worked in rehabilitation, not training to be a specialist in rehabilitation who was also a highly skilled doctor. He ‘saw the light’, went on to be an excellent consultant.
There should be a distinction between a person’s professional knowledge and skills, and their team or service knowledge and skills. In this analysis, one would expect the doctor to develop their professional aspects to meet the requirements imposed by the medical aspects of their clinical work. This would apply to any other profession. They need to develop expertise in the team activity, rehabilitation.
For example, a nurse specialised in oncology would be expected to have (a) good professional knowledge and skills relevant to oncology as well as (b) specialist knowledge about oncology over and above, and outside the scope of, any professional nursing expertise. At present only doctors can demonstrate that with a recognised qualification.
Given the important of rehabilitation teamwork, it seem important for all professions involved to acquire special knowledge and skills about rehabilitation to complement and extend the use of their professional knowledge and skills. Some core capabilities (high-level outcomes) that could characterise a someone specialised in rehabilitation from any profession (including, I think, managers) has been published.
The detailed pages in this section of the website covers a variety of training and educational matters relevant, I hope, to any profession (and even patients and their families?). Because doctors are the only profession who have to undertake specialist training in rehabilitation, it will have more about medical training. Nevertheless, I hope an increasing amount of its content will be relevant to all professions: