Curriculum - Rehabilitation Medicine Training
JRCPTB Specialty Overview and Recruitment - http://www.st3recruitment.org.uk/specialties/rehabilitation-medicine
Training Programme Director
Dr Colin Pinder
The Walton Centre NHS Foundation Trust:
Clatterbridge Rehabilitation Centre:
Rehabilitation Medicine is an exciting and rapidly expanding speciality involved in the management of patients with complex disability. Rehabilitation doctors work with a multidisciplinary team aiming to help patients with a wide variety of impairments to optimise their independence and quality of life. This requires a good knowledge of the underlying conditions causing impairment and specific skills in symptom management as well as strong communication and problem solving skills.
Training typically consists of a four-year programme. This encompasses core skills in neuro-rehabilitation, spinal, amputee and musculoskeletal medicine. In practice some Consultants work in one of these specific areas, others have roles encompassing multiple branches of rehabilitation, including the growing field of trauma rehabilitation. Further information on the speciality is available on the BSRM website
The Mersey Training Programme
Health Education North West – Mersey benefits from training based with the following providers;
- Cheshire and Merseyside Rehabilitation Network
- The Walton Centre
- St Helen’s Hospital
- Broadgreen Hospital
- Clatterbridge Rehabilitation Centre
- North West Regional Spinal Injuries Centre
- Two centres for prosthetics and amputee rehabilitation
- The Wirral Limb Centre
- Aintree Prosthetic and Wheelchair Centre
A trainee’s programme will include rotation through some/all of the above units with opportunity to meet all of the core requirements of the curriculum and opportunity for self-selected attachments tailored to the trainee’s specific interests.
The Cheshire and Mersey Rehabilitation Network
The Cheshire and Mersey Rehabilitation Network is a unique network established in 2013 to offer high quality specialist rehabilitation to all patients following traumatic injury or illness through a coordinated pathway across hospitals and community. The network is organised into a hub and spoke infrastructure, with hyperacute and level 1 rehabilitation situated in The Walton Centre (the hub) and level 2 rehabilitation in the spoke units of St Helens, Broadgreen and Clatterbridge hospitals, 2 community rehabilitation teams and an extended rehabilitation facility. Patients can move along the pathway as their needs change, starting with a hyperacute setting through to the supportive level 1 unit, active level 2 rehabilitation and then back to the community with support from a community team. This service won the prestigious Health Service Journal (HSJ) award for its work in creating a specialist rehabilitation network.
The following links will take you to the Cheshire and Mersey Rehabilitation Website and staff and patient videos which describe the network in more detail:
The Walton Centre
The Walton Centre is a dedicated neuroscience centre which includes one of only three Hyperacute rehabilitation units in the country. This unit involves the management of patients early after neurological injury or major trauma. These patients still require acute medical and surgical management including tracheostomy care/weaning, however still benefit from early goal orientated rehabilitation. This unit has involvement with the assistive technology service and also facilitates assessment of patients with prolonged disorder of consciousness. The larger Complex Rehabilitation Unit is based in the separate Sid Watkins building and takes patients with complex rehabilitation and medical needs who require regular input from rehabilitation physicians and work with the comprehensive multidisciplinary team.
Placements in neuro-rehabilitation at The Walton Centre will involve attendance at OPD spasticity clinics with opportunities to become proficient in ultrasound guided botulinum toxin injections and nerve blocks. There are attachments to neurology clinics for management of those with long term neurological conditions such as multiple sclerosis and also general rehabilitation clinics. There is also a newly developing neuromuscular service. There is an opportunity to gain experience in other fields such as within Pain medicine, Neurophysiology, Neuropsychiatry and also attend other neurology clinics. There is a weekly Neuroradiology meeting and a weekly Neurotrauma meeting held alongside the Neurosurgical team.
Seddon Specialist Rehabilitation Unit, St Helen’s Hospital
Seddon Specialist Rehabilitation Unit is a 20 bedded level 2 unit based at St Helen’s Hospital. The unit’s comprehensive multidisciplinary team works with patients with physical, cognitive and communication impairments as a result of neurological illness, trauma or critical illness. Patients on Seddon are generally medically stable and able to participate in active rehabilitation looking to optimise levels of independence and improve quality of life, aiming for discharge into the community.
St Helens Hospital is part of the St Helen’s and Knowsley Teaching Hospitals NHS Trust. Acute care is provided at Whiston Hospital. In addition to rehabilitation, St Helens Hospital provides extensive outpatient services and elective surgery.
The unit has lots to offer RM trainees. There is opportunity to gain experience and skill in the assessment of rehabilitation potential, identification of goals, interdisciplinary working, and chairing case conferences. Trainees will be expected to manage patients with a wide variety of conditions and also learn about the management of specific symptoms including spasticity, pain, challenging behaviour, bladder and bowel dysfunction. The unit has close links with acute specialties at Whiston Hospital, Neurosciences at the Walton Centre, the Major Trauma Centres and with the Community Specialist Rehabilitation Teams which could provide a variety of core or special interest placements.
There is a weekly outpatient clinic which includes multidisciplinary botulinum toxin injection under EMG guidance. The unit has an audit and research group with numerous projects underway. Trainees are able to attend regular educational meetings including those at the Walton Centre, Grand Round at Whiston and local teaching on the unit.
The Phoenix Centre, Broadgreen Hospital
The Phoenix unit is a 15 bedded level 2 unit based at the Royal Liverpool and Broadgreen University Trust. This unit also has a comprehensive multidisciplinary team working with patients with level 2 needs. The Royal Liverpool has a Major Trauma Unit and patients from this unit with come to the Phoenix Centre for complex rehabilitation needs. This unit also receives patients from the Community and also from surrounding hospitals around the area. The unit is covered out of hours by the on call F2 and the experienced nurse practitioners on site.
On the unit, the trainees will perform ward rounds independently and with the Consultant. Trainees will see referrals in the Royal Liverpool Hospital and other hospitals prior to admission. There is a weekly general rehabilitation clinic and a spasticity clinic including the use of botulinum toxin. There will also be opportunities to review patients in stroke rehabilitation for management of spasticity. There are weekly MDT meetings led by the medical team and goal setting meetings.
Teaching is arranged on the Unit to discuss case presentations and audit. There is a grand round available via video link from The Royal Liverpool Hospital. There are opportunities to be involved in medical student teaching while they are on rotation.
Clatterbridge Rehabilitation Centre
Whilst placed in the centre the trainee will gain experience in managing the inpatients in the specialist level 2 spoke rehabilitation unit which is part of the Cheshire and Mersey Rehabilitation Network. Although the post will focus on the patients within the specialist rehabilitation beds, there will also be the opportunity for the trainee to be involved with the management and rehabilitation of the stroke patients in the Stroke Rehabilitation Unit which is co-located with the Rehabilitation Unit. The trainee will support the consultant and will be expected to do their own ward rounds and chair MDT and family meetings. The trainee will attend a weekly general rehabilitation outpatient clinic and a monthly botulinum toxin clinic gaining experience in the use of EMG to inject botulinum toxin. They will also attend the unique, monthly multidisciplinary, neuropsychology, neuropsychiatry and rehabilitation medicine clinic gaining excellent experience of the management of brain injured patients who have a dual diagnosis of psychiatric disorders. There are also opportunities to spend time with the community brain injury team and visiting other peripheral hospitals to assess patients for admission to the inpatient beds.
Wirral Limb Centre
In Keeping with the most recent amputee rehab competencies, a trainee at the Wirral Limb centre will be attached to The MDT which consists of:
- Lead consultant in Rehabilitation medicine.
- Nursing team.
- Therapy team (Senior Physio and OT team specialised in Amputee therapy)
- Prosthetic limbs manufacturer team
Trainees will attend 5 Amputee clinics /week dealing with:
- Pre amputation consultations.
- Upper/ lower limbs with primary (new) patient assessment and well established patient.
- Ante natal Consultation and management of children with congenital limb deficiencies.
- Opportunity to attend the MDT Bone reconstruction/ Plastic surgery and Rehabilitation medicine clinic held quarterly at Alder Hey Hospital.
During placement, trainees will be able to understand the psychological / vocational aspect of amputee Rehabilitation. They will learn about gait biomechanics, pain, wound management and stump problems. Trainees will attend a weekly ward round at the local Vascular/ Orthopaedic centre to be acquainted with the pre amp decision making regarding the Amputation levels, post-operative acute phase of rehabilitation and decision on prosthetic training suitability.
The trainees will have the chance to spend time with the Therapy team to understand about goal setting and training on early mobility aids. The trainee will spend time with the Prosthetic team to understand the concept of casting, using different prosthetics designs, and dealing with the most recent prosthetics technologies. Also, the trainee will attend a weekly Wheel Chair clinic dealing with Seating complexities, basic manual and powered wheel chairs assessment.
Also as part of this placement, there will be opportunities to be part or lead on different audit and research topics during training.
North West Regional Spinal Injuries Centre
The North West Regional Spinal Injuries Centre is based on the Southport Hospital site, it was purpose built and opened in 1992. Care of people with spinal cord injury across the North West began in Southport in 1944 and was one of the first generation of spinal injuries centres in the UK. Placements on the unit provide trainee with experience in the acute management and rehabilitation of patients following spinal cord injury.
Placements at this centre provides opportunities to gain experience in urology– managing neurogenic bladder, ventilator weaning and respiratory services, psychological services, baclofen pump insertion and phrenic nerve pacing in addition to tailored physiotherapy, occupational therapy and patient education.
There will be chances to develop skills in the management of patients requiring long term ventilator support. The centre has 9 beds allocated for ventilator dependant patients. The respiratory service is supported by the Weaning Centre at Aintree Hospital.
Education and Teaching Programme
The Mersey Medical Rehabilitation meeting is held on a monthly basis at the Walton Centre, this typically consists of case presentation, audit presentations and an external speaker with topics targeted to meet trainees educational needs.
At The Walton Centre, there is a weekly neurology grand round and lunchtime lecture on Wednesdays.
As part of the Health Education North West, trainees are invited to education half days taking place in the North Western part of the deanery. In addition, Mersey trainees are part of the Regional academic meeting held at Salford Royal.
Rehabilitation medicine is a rapidly developing and exciting specialty managing complex disability. Doctors in rehabilitation medicine (RM) provide holistic, patient centred care, covering a wide range of clinical presentations (brain injury, spinal cord injury, musculoskeletal injury, major trauma and amputation medicine). This care is provided in a range of settings ranging from the community to hyper-acute rehabilitation units.
Will this specialty suit me?
RM is centred on a multidisciplinary team approach; it is especially suited to doctors who want to work with a team to develop creative and innovative solutions to their patients’ problems. Doctors in RM will provide support for the individuals, families and care providers with an aim to promote independence/autonomy, improve quality of life, and where patients remain profoundly impaired ensure that they have optimum opportunities for improvement and high quality care.
Rehabilitation doctors enter the specialty from a wide variety of backgrounds including medicine, general practice, psychiatry and surgical specialties. Essential qualities of a rehabilitation doctor include empathy and sensitivity, excellent communication and, team working skills, and the ability to support patients, families and staff in dealing with complex problems.
Although rehabilitation medicine can be emotionally challenging and demanding at times, amongst the many advantages of this specialty is knowing that you can make a real and practical difference to the quality of life for patients and their families. RM benefits from close working relationships with the multi-disciplinary team and other specialties to achieve this. As the diverse patient group provides unique and often new clinical situations, the average day of a rehabilitation doctor is often stimulating and varied.
Overview of the programme
Health Education North West - North Western has one of the largest Rehabilitation Medicine training schemes in the UK providing trainees with a varied and unique experience. In particular this includes valuable exposure to hyper-acute neurorehabilitation and hyper-acute trauma rehabilitation. There are 9 trainees from ST3 to ST6, with 8 potential training placements in Greater Manchester and Lancashire (this includes a total of 17 consultants in Rehabilitation Medicine), ensuring comprehensive and structured cover of the Rehabilitation Medicine curriculum in a variety of settings.
Training placements include 2 Neuroscience Centres (Salford Royal and the Royal Preston Hospitals), both of which are also Major Trauma Centres; in Greater Manchester acute Major Trauma care is currently provided by a collaborative of 3 NHS Trusts. Hyper-acute Neurorehabilitation and Hyper-acute Major Trauma rehabilitation is provided at Salford Royal Hospital. Post-acute Neurorehabilitation is provided in 6 Neurorehabilitation units in Greater Manchester and Lancashire. In addition there are mandatory placements of 3 months each in the rehabilitation of limb loss (amputees / prosthetics) and spinal cord injury rehabilitation (usually at the Regional Spinal Cord Injuries Centre in Southport). Musculoskeletal rehabilitation training is provided at several sites.
A typical training programme may be as follows (subject to availability of placements), but can vary:-
- ST3 Post - Hyper-acute Neurorehabilitation
- ST4 Post - acute Neurorehabilitation
- ST5 Post - acute Neurorehabilitation for 6 months and including musculo-skeletal rehabilitation, Spinal Cord Injury rehabilitation for 3 months, rehabilitation of limb loss for 3 months
- ST6 Post - Major Trauma rehabilitation, hyper-acute Neurorehabilitation, musculo-skeletal rehabilitation
Training in community based rehabilitation is available at several sites in the training programme, and all sites provide outpatient services. Attachments to other specialties for short periods are encouraged as optional modules eg: palliative care, pain services, neurology, neurophysiology etc.
Greater Manchester trainees will participate in a 1 in 8 non-resident on call rota, providing specialist rehabilitation medicine input to the Greater Manchester Hyper-acute Neurorehabilitation and Major Trauma services, to the level 1 post-acute Neurorehabilitation service, and occasional telephone advice to the 4 Level 2 post-acute Neurorehabilitation units. There may be opportunities for trainees based in Lancashire Teaching Hospitals Trust to participate in the acute medical rota.
Educational and academic medicine
Within Health Education North West - North Western, each trainee is linked to an Educational Supervisor throughout their 4 years of training. Clinical Supervisors are present at each training placement.
There are monthly educational half days for StRs, held at venues throughout Health Education North West - North Western. These are arranged by one of the trainees, and supported by a Consultant in Rehabilitation Medicine. A wide range of topics are included, to ensure coverage of curriculum topics.. Mersey trainees also are invited to attend these educational half days.
In addition to this, a regional Rehabilitation Medicine academic meeting is held monthly at Salford Royal Hospital on a Friday afternoon. This is attended by trainees and consultants from the whole of the North West, including Spinal Cord Injury consultants. The format is of a guest lecture, case presentations, audit/research topics, and journal club. The trainees are on a rota to ensure that they are presenting regularly at these meetings, giving an excellent opportunity to present their academic work, discuss future work and gain feedback.
At Salford Royal Hospital there is a weekly Neurology academic session on Friday afternoons, which includes “hot cases” of interest followed by a guest lecture.
Are there any examinations I need to take?
At present there is not a formal exit exam for the specialty but it is recommended that you complete the UEMS PRM Board Examination. Further information is available at: www.euro-prm.org.
Contacts & Useful Information
ST3 recruitment website: http://www.st3recruitment.org.uk/
British Society of Rehabilitation Medicine: http://www.bsrm.co.uk/