Developing the Field of Competence of the Specialist in Physical and Rehabilitation Medicine – the European View
The Field of Competence (FOC) of specialists in Physical and Rehabilitation Medicine (PRM) in Europe follows uniform basic principles described in the White Book of Physical and Rehabilitation Medicine in Europe. An agreed basis of the field of competence is the European Board curriculum for the PRM-specialist certification (www.euro-prm.org). However, due to national traditions and different health systems and other factors, PRM practice varies between regions and countries in Europe. Even within a country the professional practice of the individual doctor may vary because of the specific setting he or she is working in.
PRM-specialists have a wide range of skills and aptitudes including diagnostic methods, team working skills and have to know about a wide range of interventions, including medication, physical therapy and social measures. Additionally PRM-specialists have skills to set-up a medical diagnosis, to perform functional assessments, to set-up a rehabilitation plan, and to coordinate team work. Professional practice of Physical and Rehabilitation medicine include different settings from the acute hospital to community based rehabilitation.
Many factors influence the professional practice of a PRM specialist. As in every specialist work education and training is the basis of professional practice. In PRM it is following the European Board Curriculum and covers specific skills and competencies. Of course basic medical training and continuous medical education as well as continuous professional development are part of PRM training. The PRM specialist curriculum is based on basic medical principles (setting up a diagnosis, functional evaluation, treatment-plan, and evaluation), the ICF-model, and scientific results (evidence based medicine). Three main factors are influencing professional practice too. These are
the patients to be treated (micro-level): this includes different pathologies as classified in the ICD as well as the levels of functioning as classified in the ICF.)
the settings he or she is working in (meso-level): this includes the facilities, programs, equipment (as classified in ICHI) and team structure
the public health strategy of the country or region (macro-level) including the health care system, funding rules, epidemiology of diseases and disabilities as well as the general health policy.
Last but not least continuous evaluation and quality management as well as ongoing scientific work are factors improving the quality of professional practice in PRM.
The Professional Practice Committee of the UEMS-PRM-section defined an action plan to develop the given definitions and descriptions and to specify the field of competence of the PRM in different clinical settings and rehabilitation programs for special groups of patients. Examples for this are the role of PRM in acute rehab units (ARU) and peripatetic acute rehab teams (ART), the role of PRM in rehabilitation teamwork, the cooperation with other medical specialties, the role of PRM in community based rehabilitation and others.