W/N/E Yorks and N Lincs.
What is Rehabilitation Medicine?
Rehabilitation Medicine is the medicine of function. Not limited to one body system or disease process, Rehabilitation Medicine doctors deliver the medical management of people with complex disabilities. Rehabilitation Medicine involves the treatment of disabling conditions, active management of disability and the prevention of secondary complications. Dealing predominately with adults of working age, Rehabilitation Medicine doctors may also work with children and older adults.
Consultants in Rehabilitation Medicine have the knowledge and skills to confirm medical and functional diagnoses and prognoses, prevent and treat secondary and tertiary complications, manage symptoms, facilitate treatment and contribute to life decisions. In addition, the consultant will lead and co-ordinate the activities of the multidisciplinary rehabilitation team.
There are four main clinical areas in Rehabilitation Medicine: neurological, musculoskeletal, amputee and spinal cord injury rehabilitation.
Why choose a career in Rehabilitation Medicine?
Rehabilitation Medicine is a bright, exciting specialty especially suited to doctors able to work with a team to develop creative and innovative solutions to their patients' problems. Doctors working in Rehabilitation Medicine need to have a wide range of competencies to provide holistic and life-long care to their patients.
The core clinical skills of making a diagnosis, formulating a prognosis, and providing expert medical care—common to all specialities—are important in Rehabilitation Medicine. However, the diagnosis of, for example, a spinal cord injury is often made in the context of multiple traumatic injuries or as part of the complicated presentation of an older person following a fall. And the prognosis is given to a frightened patient at a time that their life is changing, sometimes irreversibly.
Doctors in Rehabilitation Medicine also provide information, support and counselling for patients, families and their carers, including other medical teams. This will include functional and prognostic information as well as information regarding vocational rehabilitation or return to work. Specific skills are required when working with young adults making the transition to adult services. Combining these skills with the specialised medical interventions that you can provide, and an ability to lead the multidisciplinary team in challenging situations, add up to make Rehabilitation Medicine a tremendously satisfying career.
Career path
Training in Rehabilitation Medicine takes four years and starts at ST3 after core training in medicine, acute care, surgery, psychiatry or general practice. Applicants are required to have the same experience and qualifications as any other applicant for an ST3 post, however, the advantage for applicants to Rehabilitation Medicine training posts is that MRCP, MRCS, MRCPsych and MRCGP are all acceptable entry qualifications.
Specialty trainees work in each of the four main clinical areas in Rehabilitation Medicine, before making a decision to gain advanced competencies in one, leading to a CCT in the specialty. Academic Clinical Fellow and Clinical Lecturer posts are available in the training programmes in South and West Yorkshire
There is an excellent balance between training posts and consultant posts in Rehabilitation Medicine, so career opportunities for dynamic, proactive doctors are good.
Working in general hospitals alongside the acute medical and surgical teams, consultants in Rehabilitation Medicine provide rehabilitation input to critically ill and injured patients. They also work in post-acute rehabilitation units facilitating patients' recovery and safe discharge. These posts have on-call commitments, particularly those attached to major trauma centres, where there is an expectation that rehabilitation prescriptions are completed rapidly when a patient is stabilised. Often combined with these roles is outpatient and community rehabilitation – managing people with long-term conditions in their own environments.
Within the team of doctors, there are opportunities for consultants to focus on a particular aspect such as interventional spasticity techniques, uroneurology or respiratory management. Many consultants will take on a management role, be involved in teaching or training or develop a portfolio of research.
If you want a career that is challenging and rewarding, arrange a taster day at one of the rehabilitation centres in Yorkshire and the Humber to experience the passion that doctors in this field have for the specialty.
Further Information
British Society of Rehabilitation Medicine www.bsrm.co.uk
British Association of Spinal Cord Injury Specialistswww.bascis.co.uk
Society for Research in Rehabilitation www.srr.org.uk
Contacts
Training Programme Director for Rehabilitation Medicine
Senior lecturer in Rehabilitation Medicine, University of Leeds
Dr Rory J O’Connor
Registrar in Rehabilitation Medicine, Clinical Research Fellow
Dr John Pearn
Amputee rehabilitation is predominately outpatient focused, although an important role is pre-amputation counselling, which includes inpatient assessment. Many doctors working in this branch of the specialty also provide medical input to orthotics clinics, wheelchair centres and other services providing technological solutions. There are centres in Leeds, Hull and Sheffield.
Musculoskeletal rehabilitation is closest to the specialty's origins in physical medicine. This is the medical management and rehabilitation of disabling rheumatological conditions such as the arthritides, chronic soft tissue injuries and back pain. There are close links with pain management and sports medicine services.
Neurological rehabilitation involves working with people recovering from acute brain injury, including stroke, often in regional neurosciences centres. Services are also provided to people with long-term neurological conditions such as multiple sclerosis and cerebral palsy, generally as outpatients within community settings. Most hospitals in Health Education England - Yorkshire & the Humber are linked to a neurological rehabilitation centre or have one on-site.
Much has changed in recent years in the management of spinal cord injury, with developments in spinal cord regeneration, advances in helping patients to walk again, and the key role that spinal cord injury centres play in bringing expertise and specialist management to patients coming through the major trauma centres. There are two spinal cord injury centres in Yorkshire, in Sheffield and Wakefield, and both are involved in the acute management, rehabilitation and life-long care of people affected by spinal cord injury.