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rehabilitation

What is Rehabilitation Medicine?

Rehabilitation medicine (RM) is the medical specialty with rehabilitation as its primary strategy. The primary aim is to enhance recovery after disabling illness or injury and to enable people with disabilities to achieve and maintain a high level of physical, psychological and social well-being.

Patients frequently present with a diverse mixture of medical, physical, sensory, cognitive, communicative, psychological, social and environmental problems which require specialist input from a wide range of disciplines working together as a coordinated team. Accredited RM specialists
therefore work in multidisciplinary teams across the range of healthcare, both in acute and community settings.
Rehabilitation medicine covers a large number of disabling conditions, including:

  • Sudden onset conditions - such as  brain injury, stroke, spinal cord injury, Guillain Barre Syndrome, limb loss and multiple trauma.
  • Progressive conditions  -  such as multiple sclerosis, motor neurone disease, rheumatoid arthritis
  • Stable conditions - such as cerebral palsy, post-polio, muscular dystrophies and limb deficiency, will continue into adulthood and require ongoing support, advice and assistance.

RM services in the UK are broadly divided into two main areas:

  • Neurological rehabilitation - serving those with neurological disabilities,
  • Amputee, trauma and musculoskeletal (MSK) rehabilitation - serving those with Iimb loss and other musculoskeletal impairments.

In addition to in-patient rehabilitation, RM physicians support specialist community rehabilitation teams in the management of patients with complex disability, and provide specialist RM input for specialist nursing homes - for example to provide neuropalliative rehabilitation, and to interface with palliative care teams regarding treatment/ care and end of life decision-making.
 

Why is Rehabilitation Medicine an attractive option for trainees?

Rehabilitation Medicine offers a number of different of career patterns.

  • If you enjoy the cut-and-thrust of acute medicine, working in the acute step-down rehabilitation services (which take patients direct from neurosurgery, major trauma centres, intensive care settings or the hyper-acute stroke units) provides a challenging and varied array of acute medical, surgical and orthopaedic problems in patients who are not yet medically stable. Trainees will gain confidence in dealing with a wide range of diagnoses and ill patients.
  • On the other hand, if you are looking for a more flexible programme RM also includes a wide range of elective services with offer an attractive career option for those who wish to balance work commitment with child care and family life.  The absence of acute medical and on-call commitments in these services also allows time to pursue research, non-clinical and managerial roles.

RM will be attractive to those doctors who:

  • enjoy working in a multidisciplinary team and taking an individualised problem-solving approach to treatment.
  • like to get about and about in the community as well as working in hospital settings.
  • like to take a holistic approach to medicine, considering not only the pathological diagnosis, but its wider impact on the lives of the patient and their families.
  • have excellent communication skills and enjoy using these to explore and manage the physical, emotional and behavioural aspects of disabling illness.
  • enjoy the longer term doctor-patient relationship, providing continuity of care over a period of months / years.
  • are seeking a specialty with a wide range of interest and an ever-stimulating array of unique clinical conundrums

Read a trainee’s perspective on training in RM in London

A BMJ Careers article on Rehabilitation Medicine is available

What are the core skills/competencies in Rehabilitation Medicine?

Rehabilitation medicine physicians are part of the multidisciplinary team and have responsibility for the medical aspects of rehabilitation. This includes establishing a diagnosis and prognosis, appropriate medical management of disease, health promotion and prevention of secondary damage and complications. They use specific diagnostic assessment tools and carry out treatments including pharmacological, physical, technological, educational and vocational interventions. Because of their comprehensive training, they are best placed to be responsible for the activities of the multidisciplinary team in order to achieve optimal outcomes in the treatment of the whole patient and also to provide leadership for the Team.

The London Training Scheme in Rehabilitation Medicine

The 4 year clinical rotation in London offers a range of high quality training opportunities in neurological & musculoskeletal & trauma rehabilitation. Training is competency based and mapped to the 2010 RM curriculum via your clinical supervisor, educational supervisor and the ARCP process.

For reasons of geographic convenience and accessibility, the rotation is broadly divided into North and South rotations

Training posts in North London are held at Northwick Park Hospital, Hillingdon Hospital & The Royal National Orthopaedic Hospital.

Training posts in South London are held at St. Georges NHS Trust, Kings College Hospital NHS Trust, Medway Foundation Trust, Sevenoaks Hospital, KMPT NHS Trust, Queen Mary’s Hospital Roehampton.

Training posts are also now available at The National Hospital for Neurology & Neurosurgery and the Defence Medical Rehabilitation Centre at Headley Court. Flexible opportunities exist for trainees interested in further training in the London major trauma system, paediatric rehabilitation or sub-specialisation in Stroke Medicine.

Further information about individual posts is available through the following links:

Research and Audit

Substantial audit and research opportunities exist via the UK Rehabilitation Outcomes Collaborative and the Department of Palliative Care, Policy & Rehabilitation at Kings College London. These provide excellent opportunities for enthusiastic trainees wishing to expand their training beyond the realms of simple clinical experience and develop their career to encompass health services research or quality improvement.

Further information on training in research & audit

Core Training Programmes

Entry into Rehabilitation Medicine training is possible following successful completion of both a foundation programme and a core training programme.

There are 4 core training programmes for Rehabilitation Medicine training:

  • Core Medical Training (CMT)
  • Core Surgical Training
  • Core Psychiatry Training
  • GP Training

The diagram below describes the training pathway:

Rehabilitation diagram

Please view the 2010 curriculum for Rehabilitation Medicine for full details on the training routes and selection criteria.

2010 Curriculum in Rehabilitation Medicine

The 2010 Rehabilitation Medicine curriculum which has been reviewed to: 

  • meet the GMC's 6 new standards as detailed in their Standards for Curricula and Assessment systems
  • keep up to date with medical advances and changes in the service and training
  • incorporate the framework documents produced by the Academy of Medical Royal Colleges detailing Common, Medical Leadership and Health Inequality competencies
  • include 5 new assessment methods (Case Conference Assessment Tool, Case Based Discussion, Patient Survey, Teaching Observation and Audit Assessment).

Further Links for Rehabilitation Medicine

Contact details for further information

Dr Lal Landham, Consultant in Rehabilitation Medicine
Chair of Specialist Training Committee
Training Programme Director South Thames
Tel: 016 3483 3923
E-mail: lal.landham@kmpt.nhs.uk 

Dr Jan Gawronski, Consultant  in Rehabilitation Medicine
Training Programme Director for North Thames
Tel: 020 8909 5596
E-mail: jan.gawronski@rnoh.nhs.uk

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