Rehabilitation Medicine Training
Health Education Thames Valley (Oxford and Reading)
Oxford and Reading offer a comprehensive high quality personalised training programme for
anyone wishing to train in Rehabilitation Medicine. The four-year programme ensures each
trainee has a strong foundation in the general knowledge and skills required in the speciality. It
covers all obligatory areas: neurological rehabilitation, musculo-skeletal rehabilitation, spinal
cord injury rehabilitation and rehabilitation for people with limb loss (prosthetics). It also gives
experience and training in most aspects of assistive technology such as specialised wheelchairs,
posture management, orthotics, communication aids and environmental controls. Trauma
rehabilitation training should be available once the consultant post is filled. Trainees may spend
up to eight months gaining additional experience in their preferred area of interest and will
have the opportunity to gain some experience in several of many associated areas of clinical
practice such as palliative care.
What is rehabilitation?
Many medical students and junior doctors have little or no exposure to or knowledge of
rehabilitation, so a brief introduction is given here.
Rehabilitation is an area of healthcare that is concerned with managing the consequences of
disease. This requires good knowledge about the disease, and the medical knowledge required
is high; not all presented diagnoses are correct and patients develop new problems.
The emphasis is on working within a multi-disciplinary team and with the patient and family to
help the patient achieve the level of functional activities that they want and that are possible
given the circumstances. In addition rehabilitation has a vital role in minimising pain and
distress. The goal is to achieve the best quality of life possible for the patient.
The key skills needed by all members of the team including doctors are being able to:
 analyse a complex situation to identify as far as possible the causes and the factors that
can be changed
 identify with the patient appropriate short-, medium- and long-term goals
 negotiate, particularly in case conferences (goal-setting meetings)
 communicate with and relate to all parties (team members, patients, families, other
organisations, commissioning organisations, managers etc)
It is a very challenging speciality intellectually, emotionally and personally but carries great
rewards particularly because it is a speciality where one still has a long-term relationship with
most patients.
Anyone interested in reading more can read material at the following websites:
 The holistic biopsychosocial model of illness used in rehabilitation:
http://www.ouh.nhs.uk/oce/research-education/documents/holistichealthcare09-11-15.pdf
 Clinical Rehabilitation; the leading UK specialist journal free to members of British
Society of Rehabilitation Medicine
http://cre.sagepub.com
http://www.bsrm.co.uk
 Joint Royal Colleges of Physicians' Training Board website: Rehabilitation curriculum etc
http://www.jrcptb.org.uk/trainingandcert/st3-spr/pages/rehabilitation-medicine.aspx
The hospitals
The programme is centred on the Oxford Centre for Enablement (OCE), Nuffield Orthopaedic
Centre, Oxford and the Department of Rehabilitation, Royal Berkshire Hospital, Reading.
However it also involves the National Spinal Injury Centre, Stoke Mandeville Hospital,
Aylesbury and services delivered in surrounding services such as the Major Trauma Centre at
the John Radcliffe Hospital and community rehabilitation service at Newbury Hospital.
It is quite possible to commute to the posts on the rotation from an appropriately located home
within the triangle of Aylesbury, Oxford and Reading.
The posts and rotation.
There are currently six trainees within the rotation (2014) and all trainees appointed have the
same exposure; there are no trainee appointments attributed particularly to any one subspeciality.
Given the small number of trainees, the irregularity of starting and ending dates, the occurrence
of maternity leave and out-of-programme training it is difficult to set out a fixed rota. However
the usual and preferred scheme is approximately:
 Royal Berkshire Hospital (mainly neurological with community and other areas), 16
months
 National Spinal Injury Centre, spinal injury rehabilitation, 4 months
 Oxford Centre for Enablement neurological rehabilitation with assistive technology and
day hospital, 8 months
 John Radcliffe Hospital, trauma rehabilitation, 4 months
 Nuffield Orthopaedic Centre, musculo-skeletal rehabilitation including spinal pain, and
prosthetics, 8 months
 Options, 8 months: additional experience in preferred area, and experience in paediatric
rehabilitation, pain management, stroke, liaison psychiatry etc
It must be stressed that individual programmes may not be in this order, and that trainees will
sometimes be training in two (or more) types of practice at the same time. For example
prosthetics is usually integrated into time in neurological rehabilitation. They are also expected
to take opportunities to gain particular experience of unusual or particular areas when
opportunities arise; for example to attend court when a patient in the Permanent Vegetative
State is having their Best Interests decided.
The programme – what is available
The HETV programme covers all of the areas required within the curriculum, and much more.
Our goal is that any doctor trained on this programme will be able to respond safely and
constructively to any rehabilitation problem they may face, whether or not it is within their own
area of special interest.
In terms of medically categorised areas of experience, the trainee will have the opportunity
within the programme to cover most specialities.
On the programme, as in clinical practice, the largest single speciality concerns rehabilitation of
people with neurological and neuro-muscular disorders, including spinal cord injury and
peripheral nerve injuries. This includes all types of disorder and all stages of the illness.
Patients with functional disorders are also seen.
The other large special area is people with musculo-skeletal disorders. This now includes the
emerging field of complex skeletal trauma rehabilitation, as well as chronic spinal (back and
neck) pain.
The third specific area is rehabilitation of people with limb loss needing (potentially) prosthetic
limbs.
Other obligatory areas of practice covered include all aspects of assistive technology such as
environmental controls and specialised seating.
In addition it is possible to gain experience in many other areas such as paediatric rehabilitation,
cardiac and pulmonary rehabilitation, learning disability and liaison psychiatry. In general
trainees are encouraged to take advantage of the huge range of clinical expertise available in the
Deanery to ensure that they have a broad clinical experience of people with disability.
In terms of settings, trainees will naturally work on in-patient units for much of their time but
they will also be involved in out-patient and day-patient rehabilitation, doing assessments on
wards, in homes, and in nursing homes, and advising on patients in ITU. Furthermore they
should see rehabilitation services being delivered in other settings such as nursing homes,
community centres etc.
Trainees can also gain experience in and are encouraged to participate in research into
rehabilitation and disability, audit (mandatory) and service development, highly specialised
clinics (e.g. neuro-genetics), teaching and training etc.
Further information
Anyone interested in more information about rehabilitation as a speciality and/or this training
programme can contact:
Professor Derick Wade, Training Programme Director, Oxford Centre for Enablement,
Windmill Road, Oxford OX3 7HE
Other contacts are:
Dr Hamid Sultan, Consultant in Neurological Rehabilitation, Royal Berkshire Hospital, London
Road, Reading
Dr Alison Graham, consultant in Spinal Cord Injury Rehabilitation, National Spinal Injury
Centre, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks HP21 8AL
Dr David Henderson Slater, Consultant in Neurological and Prosthetic Rehabilitation, Oxford
Centre for Enablement, Windmill Road, Oxford OX3 7HE