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General Rehabilitation Medicine

Interim changes to program requirements

Interim requirements for all trainees are now listed under Program requirements. This follows a review by the Faculty Training Committee in Rehabilitation Medicine.

Trainees are expected to satisfactorily complete the 2021 training program requirements where possible.

The interim changes made are to provide flexibility and support to trainees who have been affected by the COVID-19 pandemic.

Program
overview
Apply
or re-register
Training
requirements
Forms and
resources

Program overview

In Advanced Training in General Rehabilitation Medicine, you’ll explore a new depth of specialty training in diagnosis, assessment, prevention and management of an individual with a disability due to illness or injury. You will train under supervision and prepare for independent practice as a consultant. The program builds your skills through work-based learning and assessment tools.

Program updates

See announced interim changes to program requirements due to the COVID-19 pandemic.

The General Rehabilitation Medicine Advanced Training Program is evaluated biennially by the Australasian Faculty of Rehabilitation Medicine (AFRM) Training Committee to ensure that it’s in line with educational best practice. Changes in program requirements may occur and could impact your training plan. The College will provide sufficient notice prior to implementing any change. You must always ensure you’re following the correct requirements during your training.

Entry requirements

Prospective trainees must:

hold a current medical registration
have completed 2 full years of postgraduate supervised training in general medical and surgical areas
have been appointed to an appropriate Advanced Training position.

All trainees need to apply for Advanced Training each year.

Duration

Advanced Training in General Rehabilitation Medicine requires 4 years (48 months) of full-time equivalent (FTE) training.

Fellowship

Once you've completed all requirements of your training and the AFRM Education Committee has recommended you for admission, the College will invite you to apply for Fellowship of the Australasian Faculty of Rehabilitation Medicine.

New Fellows receive formal notification from the College of their successful admission to Fellowship and a letter confirming the completion of their training.

As a Fellow in active practice in Australia, Aotearoa New Zealand or overseas, you’ll need to meet the annual requirements of the Continuing Professional Development program.

Apply or re-register

New trainees

New trainees must first submit an Application for Entry form (PDF) to rehab@racp.edu.au

General Rehabilitation Medicine Advanced Training Program entry requirements apply.

Entry applications are assessed by the Faculty Training Committee (FTC) in Rehabilitation Medicine. You’ll receive notification of your entry decision within 8 weeks.

Once your entry into the program is approved, you're required to apply for prospective approval of training (DOC). Submit your application form to rehab@racp.edu.au

Current trainees

Current trainees need to apply for prospective approval every year.

Submit your application for prospective approval of training (DOC) to rehab@racp.edu.au

Application deadlines

Application for entry

Due at least 3 months before commencing training (as entry decisions can take up to 8 weeks).

Applications for prospective approval

28 February | first half or whole of the current year
31 August | second half of the current year

You’re responsible for organising all necessary documentation for submission by the deadline. We recommend that you keep a copy of your application for future reference.

See program key dates for trainees and supervisors.

Late applications

Late applications will be considered up to 1 month after the deadline.

Applications received 1 month after the deadline won’t be considered unless exceptional circumstances can be demonstrated in line with the Special Considerations for Assessment Policy.

Late applications incur a fee.

Fees

The standard annual membership fees apply.

Visit MyRACP to pay or view previous training program payments.

About your training position

Core training must be undertaken at accredited settings.

Once you have secured a training position, you must prospectively apply for approval as per the Progression through Training Policy.

The College is not involved in the recruitment and selection of trainees. Our role is to set and monitor standards for selection and provide advice to settings and their selection committees.

Training approval and certification

Approval of training periods are determined by the Australasian Faculty of Rehabilitation Medicine (AFRM) Training Committee. To be approved, your individual training program must be consistent with the training requirements and appropriate for the stage of training you have reached.

Upon completion of each rotation or calendar year of training, the AFRM Training Committee reviews your progress according to the training requirements. If you have satisfactorily completed all training requirements, the AFRM Training Committee will certify that training period.

Training variations

See variations in training for processes covering dual, joint, conjoint and post-Fellowship training.

See flexible training options for information on part-time training, interruptions to training, withdrawing from training and time limits.

Rotation or supervision changes

Changes to your rotation require you to re-submit an application form to your training committee as soon as possible. This includes any changes to sites, dates of rotations and flexible training arrangements.

Changes to your supervision must be notified as soon as possible by submitting a Supervisor Details Amendment Form (DOC).

Some changes may require a review of the approval decision and can affect the certification of your training.

More information

Overseas specialists
Trainee responsibilities

Training requirements

At the end of your Advanced Training in General Rehabilitation Medicine, you’ll have completed 48 months of certified training time consisting of work-based learning and assessment tools.

The PREP teaching and learning activities are designed to support you in your reflective practice and self-directed learning. A variety of teaching and learning activities and assessments are used, catering to a range of learning needs, styles and situations that may arise in your workplace training.

See forms and resources for the training program curricula.

Requirements overview

Core training
(36 months minimum)

Supervision

1 x supervisor per rotation, who is a Fellow of the AFRM and practising in rehabilitation medicine

Teaching and learning

1 x Learning Needs Analysis per rotation

1 x Professional Qualities Reflection per rotation

Assessments

2 x In-training Long Case Assessments^* per 6-month rotation

1 x Supervisor’s Report per 6-month rotation (2 per 12-month rotation)

1 x Trainee Term Evaluation Report per rotation

Non-core training
(12 months maximum)

Supervision

1 x supervisor per rotation, who is a Fellow of the AFRM, RACP or other appropriate college

Teaching and learning

1 x Learning Needs Analysis per rotation

1 x Professional Qualities Reflection per rotation

Assessments

2 x In-training Long Case Assessments^* per 6-month rotation

1 x Supervisor’s Report per 6-month rotation (2 per 12-month rotation)

1 x Trainee Term Evaluation Report per rotation

^* In-training Long Case Assessments aren’t required for the first and last 6-month training rotations. A minimum of 12 assessments, including at least 3 observed, must be completed prior to your final 6-month training rotation.

Advanced Training summary

After 48 months of certified training time, you will have completed:

36 months minimum of core training
12 months maximum of non-core training
12 x In-Training Long Case Assessments, at least 3 must be directly observed
Functional Independence Measure^TM (FIM^TM) training course
Module 1 Assessment (completed in first or second year of Advanced Training)
Module 2 Clinical Assessment (completed in first or second year of Advanced Training)
External Training Module 3 — Research
External Training Module 4 — Clinical Neuropsychology
External Training Module 5 — Health Services Administration and Evaluation
External Training Module 6 — Behavioural Sciences
2 x Formal Long Case Assessments
Fellowship Written Examination (completed in third or fourth year of Advanced Training)
Fellowship Clinical Examination (completed in third or fourth year of Advanced Training)
Prosthetics and Orthotics courses (strongly recommended)

2022 program updates

In your 2022 training year, these requirement changes will apply.

Entry requirements

Application for entry
2021	2022
Prospective trainees must: hold a current medical registration have completed 2 full years of postgraduate supervised training in general medical and surgical areas have been appointed to an appropriate Advanced Training position	Prospective trainees must: hold a current medical registration have completed 2 years (or full-time equivalent) of postgraduate supervised training in general medical and surgical areas within the last 5 years have been appointed to an appropriate Advanced Training position

Time-based requirements

Training settings
2021	2022
You’re expected to complete your Advanced Training at more than 1 training settings (recommended).	Trainees commencing in 2022 onwards You’re required to complete your Advanced Training at a minimum of 2 settings.

Supervision requirements

Supervision
2021	2022
Core training
1 x supervisor per rotation, who is a Fellow of the AFRM and practising in rehabilitation medicine	1 x supervisor per rotation, who is a Fellow of the AFRM and actively practising in rehabilitation medicine 1 x Training Program Director (recommended)

Work-based learning and assessment requirements

Advanced Life Support course
2021	2022
N/A	Trainees commencing in 2022 onwards 1 x Advanced Life Support course completed during your Advanced Training

External Training Modules (all)
2021	2022
N/A	All external training module content will be examinable in your AFRM Fellowship Examinations. You’re responsible for submitting all module requirements 6 months prior to completion of the program to avoid delaying your admission to Fellowship.

In-training Long Case Assessment (ITLCA)
2021	2022
12 x ITLCAs over the course of Advanced Training. In your first year, complete a minimum of 2 ITLCAs. At least 3 ITLCAs (1 per year during Years 2 to 4) are to be directly observed by the end of Advanced Training.	Trainees commencing in 2022 onwards 14 x ITLCAs over the course of Advanced Training. In your first year, complete a minimum of 4 ITLCAs. At least 3 ITLCAs (1 per year during Years 1 to 3) are to be directly observed by the end of your third year of Advanced Training.

Time-based requirements

The Advanced Training Program in General Rehabilitation Medicine allows adequate time for you to gain the necessary learning experiences across a range of relevant rotations during your 4-year total training period (48 months FTE).

You’re encouraged to complete your Advanced Training at more than 1 training setting.

Training rotations

Your 48 months of certified training time consists of:

36 months minimum of core training, spent in RACP-accredited settings
12 months maximum of non-core training in other clinical training disciplines or in research

The AFRM Training Committee prospectively approves non-core training rotations on a case-by-case basis.

Non-core training time will only be considered if there is a substantial (minimum 0.5 FTE) clinical component equivalent to Advanced Training.

Training time

Trainees must spend a minimum of 36 months (FTE) core training in Australia and/or Aotearoa New Zealand, with the exception of trainees based in Hong Kong and Singapore.

This requirement ensures that you receive adequate exposure to local practices and health services.

Trainees considering training in overseas positions should seek guidance from the AFRM Training Committee prior to applying for prospective approval.

Program key dates

January – June

28 February | Previous rotation’s Supervisor’s Report and all PREP learning and assessment tools due
28 February | Applications for Prospective Approval for the first half or whole of the year due
March | Module 1 Assessment applications open and close
March | Fellowship Written Examination applications open and close
April | Module 2 Clinical Assessment applications open and close
April | Fellowship Clinical Examination applications open and close

Requirements for completion:

Learning Needs Analysis
Learning Needs Analysis self-evaluation
2 x In-training Long Case Assessments
Professional Qualities Reflection
3 x Supervisor meetings (minimum)
Training Term Evaluation Form

July – December

31 August | Applications for Prospective Approval for second half of the year due
31 August | Previous rotation’s Supervisor’s Report and all PREP learning and assessment tools due

Requirements for completion:

Learning Needs Analysis
Learning Needs Analysis self-evaluation
2 x In-training Long Case Assessments
Professional Qualities Reflection
3 x Supervisor meetings (minimum)
Training Term Evaluation Form

COVID-19 interim changes

Interim requirement changes apply from the start of the 2021 clinical year. Training Committees will review requirements again in late 2021.

Interim requirements

Time-based requirements

Training time
Current requirement	Interim change requirement
48 months of certified training	No change
36 months minimum of core training	33 months minimum of core training
12 months maximum of non-core training	15 months of non-core training allowed
Eligibility
All trainees in 2021.
How to apply
Submit a General Rehabilitation Medicine Rotation Amendment Form (DOC). Indicate in your Supervisor’s Report how you have been impacted. The Faculty Training Committee (FTC) will take into account these documents when considering your certification of training.

Training time in Australasia
Current requirement	Interim change requirement
36 months minimum	33 months minimum
Eligibility
All trainees in 2021.
How to apply
Submit a General Rehabilitation Medicine Rotation Amendment Form (DOC). Indicate in your Supervisor’s Report how you have been impacted. The FTC will take into account these documents when considering your certification of training.

Work-based learning and assessment requirements

Formal Long Case Assessment
Current requirement	Interim change requirement
2 x Formal Long Case Assessments over the course of training (usually during the final 6-month rotation). You’re to be assessed by two AFRM Fellows, one being an accredited AFRM Long Case Assessor.	No change. Trainees are expected to complete the requirement via video conference if social distancing restrictions don’t allow face-to-face interaction.
Eligibility
Final year trainees in 2021.

In-training Long Case Assessment
Current requirement	Interim change requirement
2 x In-training Long Case Assessments (ITLCA) per 6-month rotation (excluding your first and final rotations).	4 x ITLCA per 12 months – this may be completed in the final term of training.
12 x ITLCAs minimum over the course of training, including at least 3 directly observed (1 per year in your second, third and fourth years).	12 x ITLCAs minimum over the course of training, including at least 3 directly observed
Eligibility
All trainees in 2021.

External Training Module 4 — Clinical Neuropsychology
Current requirement	Interim change requirement
5 x essay-type answers completed once over course of training	No change
Submission required 6 months prior to your completion of training	Requirement can be submitted after the Fellowship exams
Eligibility
Final year trainees in 2021. It’s expected all other trainees will be able to meet the requirement in their remaining years of training.

External Training Module 5 — Health Services Administration and Evaluation
Current requirement	Interim change requirement
Complete one of these options over course of training: 2 x Written assignments 1 x Workshop and reflective essay	No change
Submission required 6 months prior to your completion of training	Requirement can be submitted after the Fellowship exams
Eligibility
Final year trainees in 2021. It’s expected all other trainees will be able to meet the requirement in their remaining years of training.

External Training Module 6 — Behavioural Sciences
Current requirement	Interim change requirement
4 x Written assignments over the course of your Advanced Training	No change
Submission required 6 months prior to your completion of training	Requirement can be submitted after the Fellowship exams
Eligibility
Final year trainees in 2021. It’s expected all other trainees will be able to meet the requirement in their remaining years of training.

Leave allowances

In 2021, up to 14 days of leave related to COVID-19 for quarantine or sickness can be taken.

If you exceed your 14-day COVID-19 leave allowance, and it impacts your progression, you can apply to the FTC for special consideration.

Requests for special consideration are considered by the Committee COVID-19 Lead on a case-by-case basis.

How to apply

Submit an application for special consideration (DOC) with supporting evidence from your employer, GP and/or other relevant medical practitioners.

Your FTC will take into account this documentation when considering your certification of training.

Work-based learning and assessment requirements

A work-based learning and assessment tool requirement stipulates what you must achieve as part of your training program.

Type of assessment

Formative: Focuses on learning through feedback and guidance, assisting trainees and supervisors through the formal feedback process, which should prompt discussion of or highlight areas of a trainee’s performance. Assessments are based on existing workplace-based assessment methods and are best practice in medical education.

Summative: Focuses on judgements about trainee progression, resulting in pass or fail decisions on a trainee’s performance.

External Training Module 3 | Research

Trainees who commenced before 2017 can complete an alternative research option.

Advanced Training Research Project

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Overview

The Advanced Training Research Project (ATRP) is a report on a project that you have had significant involvement in designing, conducting of research and analysis of data. It enables you to gain experience in:

research methods
interpretation of research literature
participation in research at some stage of your career
developing quality improvement skills

The ATRP, introduced to most trainees who commenced after 2017, addresses wide variations in purpose, type, quantity and assessment criteria across the RACP Training Programs. An ATRP submission provides evidence of the skills of:

considering and defining research problems
the systematic acquisition, analysis, synthesis and interpretation of data
effective written communication

Review your training program requirements to confirm whether there are any additional research requirements beyond completing your ATRP.

The ATRP requirement must be undertaken and completed during your Advanced Training.

Recognition of Prior Learning

You can apply for a Recognition of Prior Learning (RPL) exemption from the ATRP requirement if you can demonstrate that you’ve successfully completed an approved exemption. This can include:

research doctoral degree, like MD or PhD
Masters by research
major project completed through a Masters by coursework

An ATRP completed through Masters by coursework must meet project type requirements and be submitted for marking according to the marking process.

Recognition of all project exemptions completed prior to entry into training are considered in accordance with our Recognition of Prior Learning Policy.

Exemptions completed during your Advanced Training Program will be assessed for suitability against the ATRP guidelines and marking criteria.

Applying

You must apply for RPL within 3 months of commencing your first rotation in your Advanced Training Program.

Your Advanced Training Committee or Subcommittee, which reviews all RPL applications, will contact you about the outcome.

In the case where your PhD is in progress or incomplete, you can:

submit your PhD upon completion for RPL consideration, or
partially submit your PhD for RPL consideration if it meets one of the acceptable research project types, such as systematic review

Again, in this instance you need to apply within 3 months of commencing your rotation.

All RPL applications are reviewed on a case-by-case basis. Exemption is granted only when the evidence presented fulfils the relevant ATRP requirements, separate to whether your research or coursework is relevant to your current specialty.

All supporting documentation relevant to your RPL application must be reviewed by project markers to allow project exemptions.

Requirements

Requirement

1 x Advanced Training Research Project

Deadline

Due 15 September in any year of your Advanced Training.

Content of all external training modules is examinable in the AFRM Fellowship examinations. You’re responsible for submitting your modules as early as possible to avoid delaying your admission to Fellowship.

Resources

Advanced Training Research Project cover sheet (DOC)

Accepted project formats

Three research project types are accepted:

research in:
- human subjects, populations and communities and laboratory research
- epidemiology
- field research
- medical education
audit
systematic review

Additional project formats may be considered provided they meet the Advanced Training Research Project (ATRP) guidelines and marking criteria. Trainees and supervisors seeking additional format approval need to provide justification as to how the project submission meets the criteria.

Research in human subjects, populations and communities or laboratory research

This project type also includes epidemiology, field research and medical education research.

Step-by-step: Research in human subjects, populations and communities or laboratory research

1. General preparation

Identify a supervisor and review the ATRP guidelines.
Develop skills in scientific writing to apply for grant support, publish scientific and medical papers.

2. Identify the problem and formulate research questions

Consider and define a health-related problem.
Review, analyse and synthesise evidence related to the existing literature, or your current practice, to identify research gaps and formulate research questions or hypotheses.

3. Develop the research design

Convert information needs into answerable questions and clearly identify the specific aims of a study designed to address the question.
Identify an appropriate research method and techniques.
Identify the ethical issues arising from conduct of the study.
Obtain ethics approval from the appropriate body, if required.

4. Collect or identify data to achieve the study objectives

Apply quantitative or qualitative methods.

5. Write up research

Appraise and synthesise the research findings in consideration of the research objectives and hypotheses.
Set findings within the context of the wider literature on the topic.
Apply the results of the study to practice.
Demonstrate effective and succinct written communication.
Outline how research should and could contribute to the practice of evidence-based medicine.
Assess strengths, weaknesses and limitations of the research project.
Reference using a consistent style.

6. Self-reflection

Evaluate your performance.
Discuss your performance with your supervisor — consider any issues that arose during the research project and how the findings might change your practice.

Audit

An audit project aims to assess, evaluate and improve the quality of healthcare through the systematic review of practice. A specific component of practice to be reviewed is identified and local performance is assessed against specific criteria in relation to the gold standard.

An audit will identify substandard areas and develop recommendations for implementation, based on a succinct review of the literature. The audit should then be repeated to assess the success of the interventions. AT Research Project audit diagram

If a repeated audit isn’t possible due to time constraints, then a plan for implementing, measuring and sustaining improvements must be presented.

Your audit should be of an area of interest to you. Look at opportunities to audit a novel project or program within your training setting.

The size of your audit is dependent on the topic and nature of the audit undertaken. The presentation of the audit must adhere to the standards for presentation of research, including the suggested word count.

You must demonstrate a clear understanding of the audit cycle, with evidence of how your work will lead to an improvement in clinical practice.

Step-by-step: Audit

Follow the paradigm of ‘joined-up research’, which begins by assessing a problem, moving on to implementing change and completing the circle by evaluating change over an appropriate period.

1. Identify a topic that is important to audit.

2. Review the literature and other relevant information to determine standards against which to audit.

3. Develop audit criteria that will measure performance against the agreed standard.

4. Collect and analyse data and report results.

5. Reflect on results and develop improvement plan.

6. Implement improvement plan.

7. Repeat data collection to measure improvement.

Systematic review

A systematic review is a method of critically appraising bodies of research studies with a high level of rigour. Systematic reviews are different to narrative reviews and expert commentaries because they use a well-defined protocol to ensure high coverage of all relevant information and can be replicated easily. A standard, published protocol, such as the PRISMA guidelines could be used.

For ATRPs, the systematic review should be conducted in an area of relevance of your practice.

Step-by-step: Systematic review

1. Define the review question and rationale behind question.

2. Develop inclusion and exclusion criteria for including studies, search for studies and explain search syntax, define search strategy — for example a brief description of PICO, identify and defend databases searched.

3. Assess study quality.

4. Select studies and collect data.

5. Assess risk of bias of included studies.

6. Analyse data.

7. Interpret results and draw conclusions.

Resources

RACP Online Learning Resource: Research Project

Submission guidelines

When electronically submitting your Advanced Training Research Project (ATRP), you’re to provide:

an Advanced Training Research Project cover sheet (DOC)
Turnitin similarity report

The Turnitin submission and reporting process is outlined in the project cover sheet.

Email your research project submission to Research.Project@racp.edu.au

About Turnitin

Turnitin is an originality and plagiarism detection tool, which compares projects against electronic texts from the Internet, published works and assignments previously submitted to Turnitin by other users.

The similiarity report you’re to obtain from Turnitin provides you the opportunity to make any changes prior to submitting your project to the College for marking.

An updated similarity report must be submitted with the project if changes are made. If an updated report isn’t submitted, the College will obtain a report on your behalf and you won’t have the opportunity to make changes.

Find out more about Turnitin detection tool.

For most Advanced Training Programs, submission of your research project is due by your second last year of training to ensure enough time for marking the project and the opportunity to resubmit if required. Refer to the requirements for submission dates.

To request an extension, contact your specialty’s Education Officer.

If you don’t meet the prescribed deadline, it could delay your progression of training, or if you are near the end of training, it can delay your admission to Fellowship. It’s important to plan early and submit your project as soon as possible.

Resources

Advanced Training Research Project cover sheet (DOC)
Advanced Training Research Project marking criteria (DOC)
Research Project checklist and planner (XLS)

Marking outcomes

Research projects are independently marked by 2 assessors using the Advanced Training Research Project marking criteria (DOC) common to all Advanced Training Programs.

In the case that the assessors cannot reach agreement, the research project is sent to a third assessor who will determine an outcome.

There are 3 grading outcomes that a project reviewer can make:

Pass — meets expected standard, below expected standard in no more than 1 criterion
Resubmit — 2 or more areas below the expected standard
Fail — doesn’t meet any of the criteria for a research project

You’ll receive the outcome of your project within approximately 8 to 12 weeks of submission to the College. Delays in receiving project outcomes can happen between September and January, when the majority of project submissions are expected to occur.

If your project is marked as ‘resubmit’, you’ll have 2 more opportunities to resubmit the same project to assessors with revisions. If you’re dissatisfied with the outcome following 2 resubmissions, you can request for 2 new assessors to mark the project.

You can also request 2 new assessors to mark your project if it’s marked as a ‘fail’ in the first instance. Note: you will incur a fee for any additional marking.

In this stage of marking, there are only 2 marking outcomes new assessors can provide — ‘pass’ or ‘fail’. If your project is marked as a ‘fail’ by the 2 new assessors, you cannot resubmit again and will need to complete a substantially new project to meet your ATRP requirement.

Resources

Advanced Training Research Project marking criteria (DOC)

Project supervisor's role

Your research project supervisor guides you with your project choice, method, data analysis and interpretation, and quality of written and oral presentation.

A project supervisor requires specific skills and experience and likely won't be your training rotation supervisor. To find an appropriate supervisor:

explore the work of notable researchers in your hospital or network who may be able to help you find suitable potential project supervisors
ask your training rotation supervisor for advice, relevant contacts or to direct you to another colleague who can
attend research groups or events held at your hospital to get ideas, meet research supervisors and network with trainees

These steps are important if you’re at a small training site with limited research opportunities.

If you end up with a project supervisor and a training rotation supervisor, clear communication between both supervisors is important so that they’re both aware of your progress in your research project work.

A project supervisor should:

familiarise themselves with the guidelines and marking standards
recommend colleagues to assist with supervision, if necessary
meet with you early in the period of supervision to clarify the research project goals and requirements
consider and provide feedback regarding the merits of the proposed research project early in the process
ensure that your planned research project is feasible and of a suitable standard
review the feasibility of your developed project timeline
clarify access to statistical support or other resources required
monitor progress at regular intervals
review the research project prior to submission, ensuring it’s of an acceptable standard
support you to find a forum to present the research project
approve the research project prior to submission to indicate that the proportion of work attributed you is correct

When selecting a research project supervisor, choose someone who:

aligns with your goals
is an expert in the area of your research
is available for regular meetings or other correspondence
is interested in providing mentorship and guidance on the project
is interested in the topic of the proposal
provides constructive criticism on completed work, such as abstracts and academic writing
enjoys sharing knowledge, such as laboratory or technical skills, academic research and writing skills
is experienced supervising research students

You should establish manageable expectations and practice open and clear communication with your research project supervisor from the beginning.

Resources

RACP Online Learning Resource: Research Project

External Training Module 4 | Clinical Neuropsychology

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Overview

The Clinical Neuropsychology module provides you a neuropsychological perspective of brain impairment and introduces you to some of the major neuropsychological syndromes encountered in patients referred to a rehabilitation medicine unit.

There are 5 essay-type answers to be submitted over the course of training. Topics to be addressed are:

severe traumatic brain injury
mild traumatic brain injury
dementia
frontal lobe disorders
apraxia, agnosia and visuoperceptual problems

Marking outcomes

Each essay will receive a mark between 1 and 7:

Fail — 1, 2 or 3
Pass — 4
Credit — 5
Distinction — 6 or 7

The College will inform you of the outcome of your essay marking and your overall final mark for the module.

Readings

Key reading references have been supplied under each course unit, but you’re expected to read widely. Relevant journals include:

Journal of Head Trauma Rehabilitation
Brain Injury
Journal of Clinical and Experimental Neuropsychology
Neuropsychology
Neurology
JAMA Neurology (formerly Archives of Neurology)
The Clinical Neuropsychologist
Psychological Assessment
Archives of Clinical Neuropsychology

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

Requirements

Requirement

5 x essay responses over the course of training

Deadline

Complete the module 6 months prior to completing Advanced Training.

Given the length of each assignment, we recommend submitting your assignments 8 months prior to the end of your training to allow sufficient time for marking and resubmission (if required).

Submit all essays via email to rehab@racp.edu.au

Resources

Rehabilitation Medicine Module Assessment cover sheet (PDF)

Unit 1 | Severe traumatic brain injury

Part A

Describe the neuropsychological outcome of severe traumatic brain injury.

Describe how the deficits may be evident on commonly employed neuropsychological tests.

Word limit: 600 words.

Part B

Discuss some of the central neuropsychological issues in relation to the assessment of post-traumatic amnesia.

Word limit: 600 words.

Submission

Submit your essay, along with a Module Assessment cover sheet (PDF) to rehab@racp.edu.au

Ensure your essay adheres to a formal academic written style, including a list of all references (approximately 10 per unit).

Suggested references

Crowe SF. Assessing the Neurocognitive Disorders of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Australian Psychologist, 2015; 50:1-5.

Draper K, Ponsford J. Cognitive functioning ten years following traumatic brain injury and rehabilitation. Neuropsychology, 2008; 22(5):618-625.

Gennarelli TA, Thibault LE, Graham DI. Diffuse Axonal Injury: An Important Form of Traumatic Brain Damage. The Neuroscientist, 1998; 4(3):202-215.

Hanks RA, Ricker JH, Millis SR. Empirical Evidence Regarding the Neuropsychological Assessment of Moderate and Severe Traumatic Brain Injury. In Ricker JH (Ed) Differential Diagnosis in Adult Neuropsychological Assessment. Springer, 2004; 218-242.

Kosch Y, Browne S, King C, Fitzgerald J, Cameron I. Post-traumatic amnesia and its relationship to the functional outcome of people with severe traumatic brain injury. Brain Inj., 2010; 24(3):479-485.

Marosszeky NEV, Ryan L, Shores EA, Batchelor J, Marosszeky J E. The PTA Protocol: Guidelines for using the Westmead Post-Traumatic Amnesia (PTA) Scale. Sydney: Wild & Woolley, 1997.

Shores EA. Annotated bibliography. 2006.

Tate RL, Pfaff A, Baguley IJ, Marosszeky JE, Gurka JA, Hodgkinson AE, King C, Lane-Brown AT, Hanna J. A multicentre, randomised trial examining the effect of test procedures measuring emergence from post-traumatic amnesia. J. Neurol Neurosurg. Psychiatry, 2006; 77(7):841-9.

Zasler ND, Katz DI, Zafonte RD. Brain Injury Medicine: Principles and Practice. Second Edition: demosMEDICAL; 2007.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

Unit 2 | Mild traumatic brain injury

Discuss some of the central neuropsychological issues in relation to the understanding of mild traumatic brain injury.

Word limit: 1200 words.

Submission

Submit your essay, along with a Module Assessment cover sheet (PDF) to rehab@racp.edu.au

Ensure your essay adheres to a formal academic written style, including a list of all references (approximately 10 per unit).

Suggested references

Bigler ED. Neuropsychological results and neuropathological findings at autopsy in a case of mild traumatic brain injury. J. Int. Neuropsychol. Soc., 2004; 10(5):794-806.

Bigler ED. Neurobiology and neuropathology underlie the neuropsychological deficits associated with traumatic brain injury. Archives of Clinical Neuropsychology, 2003; 18(6):595-621.Crowe SF. Assessing the Neurocognitive Disorders of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Australian Psychologist, 2015; 50:1-5.

Dikmen S, Machamer J, Temkin N. Mild head injury: Facts and artifacts. Journal of Clinical and Experimental Neuropsychology, 2001; 23(6):729-738.

Meares S, Shores EA, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ, Chapman J, Gurka J, Marosszeky JE. The Prospective Course of Post-concussion Syndrome: The Role of Mild Traumatic Brain Injury. Neuropsychology, 2011; 25(4):454-465.

Meares S, Shores EA, Smyth T, Batchelor J, Murphy M, Vukasovic M. Identifying post-traumatic amnesia in individuals with a Glasgow Coma Scale of 15 following mild traumatic brain injury. Arch. Phys. Med. Rehabil., 2015; 96(5):956-9.

Ponsford J, Willmot C, Rothwell A, Cameron P, Kelly AM, Nelms R, Curran C, Ng K. Factors influencing outcome following mild traumatic brain injury in adults. J. Int. Neuropsychol. Soc., 2000; 6(5):568-579.

Shores E A. Appendices to guidelines for conducting neuropsychological assessments. 2006.

Shores EA, Lammél A, Hullick C, Sheedy J, Flynn M, Levick W, Batchelor J. The diagnostic accuracy of the Revised Westmead PTA Scale as an adjunct to the Glasgow Coma Scale in the early identification of cognitive impairment in patients with mild traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 2008; 79(10):1100-1106.

Shores EA, Fitzgerald Z. Glasgow Coma Scale (GCS) and Abbreviated Westmead PTA Scale: Administration and Scoring. Sydney: Macquarie University, 2008.

Vanderploeg RD, Belanger HG, Kaufman PM. Nocebo effects and mild traumatic brain injury: Legal implications. Psychol. Inj. and Law, 2014; 7:245-254.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

Unit 3 | Dementia

Describe the neuropsychological features of the most common forms of dementia.

Word limit: 1200 words.

Submission

Submit your essay, along with a Module Assessment cover sheet (PDF) to rehab@racp.edu.au

Ensure your essay adheres to a formal academic written style, including a list of all references (approximately 10 per unit).

Suggested references

Braaten AJ, Parsons TD, McCue R, Sellers A, Burns WJ. Neurocognitive differential diagnosis of dementing diseases: Alzheimer’s dementia, vascular dementia, frontotemporal dementia, and major depressive disorder. Inter. J. Neuroscience, 2006; 116(7):1271-93.

DeCarli C. Vascular factors in dementia: an overview. J. Neurol. Sci., 2004; 226(1-2):19-23.

Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology, 2011; 76(11):1006-1014.

Laakso MP, Hallikainen M, Hanninen T, Partanen K, Soininen H. Diagnosis of Alzheimer’s disease: MRI of the hippocampus vs delayed recall. Neuropsychologia, 2000; 38(5):579-584.

Levy JA, Chelune GJ. Cognitive-behavioral profiles of neurodegenerative dementias: beyond Alzheimer’s disease. J. Geriatr. Psychiatry Neurol., 2007; 20(4)227-238.

Rabin LA, Wishart HA, Fields RB, Saykin AJ. The Dementias. In . Snyder PJ, Nussbaum PD, Robins DL (Eds). Clinical Neuropsychology: A Pocket Handbook for Assessment, 2006; pp. 210-239. Washington: American Psychological Association. Salmon DP, Bondi MW. Neuropsychological Assessment of Dementia. Annu. Rev. Psychol., 2009; 60:257-82.

Stativsky K, Brickman AM, Scarmeas N, Torgan RL, Tang M, Albert M, Brandt J, Blacker D, Stern Y. The progression of cognition, psychiatric symptoms, and functional abilities in dementia with lewy bodies and Alzheimer disease. Arch. Neurol., 2006; 63(10):1450-1456.

Wittenberg D, Possin KL, Rascovsky K, Rankin KP, Miller BL, Kramer JH. The early neuropsychological and behavioural characteristics of frontotemporal dementia. Neuropsychology Rev., 2008; 18(1):91-102.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

Unit 4 | Frontal lobe disorders

Outline the various neuropsychological presentations of frontotemporal dementia (FTD) and the types of cognitive measures that may be useful in differentiating between FTD variants.

Word limit: 1200 words.

Submission

Submit your essay, along with a Module Assessment cover sheet (PDF) to rehab@racp.edu.au

Ensure your essay adheres to a formal academic written style, including a list of all references (approximately 10 per unit).

Suggested references

Bonner MF, Ash S, Grossman M. The new classification of primary progressive aphasia into semantic, logopenic, or nonfluent/agrammatic variants. Curr. Neurol. Neurosci. Rep., 2010; 10(6):484–490.

Piguet O, Hornberger M, Mioshi E, Hodges JR. Behavioural-variant frontotemporal dementia: diagnosis, clinical staging, and management. Lancet Neurol., 2011; 10(2):162-72.

Savage S, Hsieh S, Leslie F, Foxe D, Piguet O, Hodges JR. Distinguishing Subtypes in Primary Progressive Aphasia: Application of the Sydney Language Battery. Dement. Geriatr. Cogn. Disord., 2013; 35(3-4):208-18.

Vandenberghe R. Classification of the primary progressive aphasias: principles and review of progress since 2011. Alzheimer's Res. Ther., 2016; 8:16.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

Unit 5 | Apraxia, agnosia and visuoperceptual problems

Describe the various apraxic, agnostic and visuoperceptual disorders that may emerge following brain damage.

Provide a description of an actual case you have seen of a patient with this type of problem.

Word limit: 1200 words.

Submission

Submit your essay, along with a Module Assessment cover sheet (PDF) to rehab@racp.edu.au

Ensure your essay adheres to a formal academic written style, including a list of all references (approximately 10 per unit).

Suggested references

De Renzi E. Visuospatial and constructional disorders. In Feinberg TE, Farah MJ (Eds). Behavioural Neurology and Neuropsychology. New York: McGraw Hill, 1997; pp 297-308.

Farah MJ, Feinberg TE. Visual object agnosia. In Feinberg TE, Farah MJ (Eds). Behavioural Neurology and Neuropsychology. New York: McGraw Hill, 1997; pp 239-244.

Manly T, Mattingley JB. Visuospatial and attentional disorders. In Goldstein TE, McNeil JE (Eds.). Clinical neuropsychology: A practical guide to assessment and management for clinicians. Chichester, UK: Wiley, 2004; pp. 229–252.

Manning L. Assessment and treatment of disorders of visuospatial, imaginal, and constructional processes. In Halligan PW, Kischa U, Marshall JC (Eds.). Handbook of clinical neuropsychology. New York: Oxford University Press, 2003; pp.181–194.

Tomaszewski Farias S, Harrell E, Neumann C, Houtz A. The relationship between neuropsychological performance and daily functioning in individuals with Alzheimer’s disease: ecological validity of neuropsychological tests. Archives of Clinical Neuropsychology, 2003; 18(6):655-672.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin
UpToDate^®

External Training Module 5 | Health Services Administration and Evaluation

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Overview

The Health Services Administration and Evaluation module will provide you with the necessary knowledge and skills to attain competency in administration, leadership and quality management. Refer to Theme 1.3 in the Advanced Training Curriculum and Domain 7 of the Professional Qualities Curriculum.

No prior knowledge is required for this module. A reading list is provided to you for your assignments, which may be useful pre-reading for the clinician readership workshops.

Your progress through this requirement will be monitored through specific activities conducted during training.

Note: These topics can appear in the Fellowship Written and Fellowship Clinical Examinations.

Module outcomes

At the end of the module, you should be able to demonstrate knowledge and skills in:

planning — you know the basic principles of service design and planning, and have sufficient understanding to describe a simple service or program plan implementation
quality management — you understand current quality management theory and practice, and are able to assess the quality of rehabilitation programs and outcomes
health administration — basic knowledge of resource management of a rehabilitation service will be achieved
leadership — your professional development as a rehabilitation physician includes skill development in leadership and in management of an interdisciplinary team

Marking outcome

Marking is completed by an assessor from an appointed panel and the module isn’t complete until a satisfactory standard has been met for both assignments (or the reflection essay if you choose to attend a workshop).

A standardised marking system is used to assess and mark assignments. Each assignment receives a mark between 1 and 7:

Fail — 1, 2 or 3
Pass — 4
Credit — 5
Distinction — 6 or 7

Each assignment is of equal value.

It's important to meet the submission deadlines to allow adequate time for marking and the possibility of needing to resubmit an assessment. Failing to complete this module can see the certification of your Advanced Training Program delayed.

Resources

Academic Integrity in Training Policy
Rehabilitation medicine curricula

Requirements

Requirement

1 x Health Services Administration and Evaluation module, comprised of:

2 x Written assignments
1 x Reflective essay on an accredited workshop^* you have attended

Deadlines

2 x Written assignments: Due 6 months prior to the end of your Advanced Training.

1 x Reflective essay/workshop attendance^*:

Complete 6 months prior to the end of your Advanced Training.
Your essay, along with a certificate of attendance, must be submitted within a week of attending the workshop^*.

^* Your selected workshop must have a minimum length of 2 days.

Resources

Rehabilitation Medicine Assessment cover sheet (PDF)

Written assignments

Submission guidelines

The written assignments are designed to cover the course outline and reference these components. The option guides should be considered in preparation and finalisation of the assignments.

Each assignment has an introduction and instruction on how to approach developing your answer.

It's important for your learning experience to discuss your assignment with your current supervisor, and potentially other health service staff, to maximise your success in completing the module.

Format

Word limit: 2000 words each assignment.

Use a university accepted referencing system, for example Vancouver, Harvard or APA.

Each option has specific formatting needs, refer to the options that are relevant to you for more information.

Submission

Submit your assignments, along with an assessment cover sheet (PDF) to rehab@racp.edu.au

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

Option 1 | AROC Report

Part 1

Scenario: You’re the Director of Rehabilitation Medicine Services in your hospital and you have just received your 6-monthly report from AROC for the period January to June.

You have chosen the following 4 graphs to present to your hospital’s Quality Management meeting.

Rehabilitation Medicine Module 5 – Episodes by impairment group

Rehabilitation Medicine Module 5 – Comorbidities by impairment

Rehabilitation Medicine Module 5 – Time since onset

Rehabilitation Medicine Module 5 – Episode LOS by impairment

Assignment

Prepare a report explaining these 4 graphs. Your report should follow this format:

Executive summary | 200 to 250 words
Summary of your interpretation (write your summary at the end)
Australasian Rehabilitation Outcomes Centre | 200 to 250 words
- What is it?
- How do you contribute data?
- What are you benchmarked against?
- What data is provided?
Explanation of graphs | 500 words
Explain what each graph means and the possible reasons for variations.
Recommendations | 200 words
Indicate what changes you may be making to the management of the flow of your patients through your rehabilitation ward.

Part 2

Scenario: Your Director of Medical Services requests a meeting with you a couple of days after the Quality Management meeting in early August. They tell you that the Hospital Executive has been told to urgently reduce spending.

Your usual 5-week closure over the New Year period has been extended. Your ward will close for 5 months from 1 September this year until 31 January next year.

Assignment

Outline what you will do to ensure that your rehabilitation ward is re-opened in 5 months and that the patients receive a high-quality rehabilitation service in the meantime.

Word limit: 1000 to 1500 words.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

Option 2 | Management and budget administration

This assignment option is intended to help you develop an understanding of the application of financial reporting in the context of the organisation (or structure) of the workplace.

It is not a simple accounting exercise. It is an exercise in management accounting, which attempts to bring financial information into the decision making of managers. A list of suggested references to assist you in this assignment are provided.

Part of the assignment is in the form of a case study, which you’re encouraged to discuss with your supervisor on information given and your interpretation of it. Also, go and discover the organisational structure of your own workplace as well as the financial reporting lines, and to reflect on how well your local systems promote effective, cost sensitive patient care.

Assignment

Part 1

To begin, you’re required to give a definition and briefly describe a number of terms. The concepts of ‘cost’ and ‘expense’ is used interchangeably in some texts. In your assignment, it’s acceptable to regard the two terms as having the same accounting definition.

When answering the question, try to focus on the relevance of the terms to managing budgets within a healthcare setting.

Define and briefly describe these following accounting terms:

Accounting period
Fixed cost
Variable cost
Direct cost
Overhead cost (indirect cost)
Cost centre

Length: 300 to 400 words per definition.

Part 2

In Part 2, you’re to read and understand a budget report and its appendices (XLS).

Appendix 1 is a report from a typical hospital-based rehabilitation service. The question assumes information that is further discussed in the next part of the assignment. The provided organisational charts (appendices 2 and 3) relate to the service for which this budget report was prepared.

The routine budget report (appendix 1) has been provided to the budget holder (Nursing Unit Manager) of the rehabilitation service and cost centre. The report was printed in May and details expenditure for the first 10 months of the financial year (ends 30 June).

Based on expenditure for the first 10 months, what is your estimate of the total expenditure for the rehabilitation service for the full accounting period? Explain how you calculated this.

Based on the pattern of expenditure in the year-to-date reported, what do estimate the total budget variance will be in both actual dollars and percentage of budgeted expenditure for the full accounting period? Explain how you calculated this.

The expenditure line for Agency and Casual Nurses has both positive and negative entries. The variance line for this expense is both negative (unfavourable) and positive (favourable). Aside from an entry error, what possible explanation could there be for this?

What proportion (as a percentage) of total expenditure is the cost of salaries and associated expenses? Is this typical for Australian hospitals?

Length: 200 words per question.

Part 3

In this part, you’re to examine the relationship between organisational structure and financial control of the organisation.

Management accounting is a branch of accounting that attempts to provide managers with the financial information needed to make well-informed decisions on the organisation’s performance and to allow the monitoring of decision makers within the organisation.

It uses the concept of ‘responsibility centres’ to design and structure information collection, budget development and financial reporting.

A responsibility centre can be defined as:

“An organisational unit headed by a manager charged with achieving certain agreed upon results. Usually the unit comprises a group of individuals who work together to accomplish one or more of the organisation’s objectives. The unit’s manager has overall responsibility for its performance. … [The] goal is to design responsibility centres in such a way that individuals are responsible for those activities over which they exercise a reasonable amount of control”.

David Young — ‘Management Accounting in Health Care Organizations’

Scenario: Assume appendix 2 is the organisational chart of the hospital in which you work.

You’re a rehabilitation physician working in a general rehabilitation ward supporting a general outer urban hospital. The ward has 26 beds with an average occupancy of 88%.

There’s also an outpatient rehabilitation service offered. You are supported by 1 rehabilitation registrar and 1 junior medical officer. Nursing and allied health staff are also allocated to the rehabilitation service.

Appendix 3 gives the managerial reporting arrangements for the staff working in the rehabilitation service. The rehabilitation ward and associated staff are classified as a cost centre within the hospital accounting system. The Nursing Unit Manager is the person nominated as accountable for the budget of the rehabilitation cost centre.

Discuss whether the rehabilitation service in this hospital should be treated as a responsibility centre for accounting purposes. To appropriately answer this question, you’ll need to consider the:
- service goals that hospital management is likely to expect the rehabilitation service to achieve
- organisation structure of the rehabilitation service
- impact of structure on cost control and service delivery
Identify the components of the budget report that the Nursing Unit Manager has limited control over and explain why it is the case.

Also, identify which manager should be made responsible for any budget components that you believe don’t belong with the Nursing Unit Manager and explain why.

Briefly discuss the impact the current reporting lines are likely to have on the treating team cohesion. Does this have any relevance to or impact on the quality of care given?

In answering this, consider the role of leadership in the team and the links between leadership and organisational structure.

Length: 1000 words total.

Part 4

In Part 4, you’ll need to demonstrate an understanding of the level to which costs are effectively ‘fixed’ or ‘variable’ in the short-term (see Part 1).

You’ll also need to show some understanding of the links between control over costs and control over the staff that incur those costs (see Part 3).

Scenario: The Nursing Unit Manager has been advised by the Business Unit Manger that the rehabilitation cost centre is expected to exceed budget in the current financial year, with current spending patterns suggesting an overrun of possibly more than $200,000.

Because of the anticipated overrun, the Nursing Unit Manager has been told she is required to reduce costs and to attempt to finish the financial year within allocated budget. At the same time, the Nursing Unit Manager was advised that extra revenue generation would not be accepted as a response to the problem of budget overrun.

You have been asked by the Nursing Unit Manager for advice. What suggestions would you make to the Nursing Unit Manager?

In your answer, remember to calculate the actual dollar reductions needed to achieve budget and identify where savings could be made. In order to form an opinion on the feasibility of each of the identified options, you will need to identify the:

problem areas within the budget
options for altering costs within the current budget cycle
likely impact on staff and service delivery

Suggested references

Atkinson, A. (2007). Management Accounting. Pearson / Prentice Hall.

Berry, L. (2006). Management Accounting Demystified: A Self Teaching Guide. McGraw Hill. Brooks, A., Oliver, J. & Vesty, G. (2008). Contemporary Management Accounting. Wiley.

Finkler, S. & Ward, D. (2006). Accounting Fundamentals for Health Care Management. Jones and Bartlett.

Hankins, R. & Baker, J. (2004). Management Accounting for Health Care Organisations: Tools and Techniques for Decision Support. Jones and Bartlett. Jones, M. (2007). Management Accounting. Wiley.

Smith, J. (Ed.) (2007). Handbook of Management Accounting. Oxford.

Young, D. (2008). Management Accounting in Health Care Organisations (second ed.). Jossey-Bass.

Resources

Academic Integrity in Training Policy
Budget report and appendices (XLS)
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

Option 3 | Quality and safety

Safety and quality in healthcare has increased in importance in the Australian healthcare system, particularly following major reviews at King Edward Memorial Hospital (WA), Royal Melbourne (VIC) and Camden/Campbelltown (NSW). However, there is a limited understanding of how the concepts of quality can be applied in the clinical setting.

For this assignment, you’re expected to demonstrate your understanding of the practical application of the underlying concepts of quality management.

The assignment begins with 3 statements from the quality management literature that you’ll need to consider when answering the second question.

“The IoM Roundtable on Quality of Care categorized threats to quality in 3 broad families — overuse (receiving treatments of no value), underuse (failing to receive needed treatment) and misuse (errors and defects in treatment. A focus on safety addresses only the third ‘family’, that is, a subset of the whole domain of quality of care”¹.

Managers need to beware of excessive focus on 'the System', such that the function of the System diverts attention from real improvement while creating a 'Shield of Honour' which might be used to deflect criticism of performance².

Measures can be structural (staff numbers, credentialing), process-based (infection rates, falls, standards compliance) or outcome-based (morbidity/mortality, patient satisfaction, change in condition post-treatment). However:

adequate inputs don’t ensure good outcomes but merely indicate that capacity is present
assessment of process alone doesn’t take variations into account and agreement on guidelines is difficult to achieve
compliance and outcomes may be poor despite satisfactory processes
outcomes aren’t determined solely by professional performance – they involve patient factors such as compliance, age, co-morbidities and acuity³

¹ Leape LL, Berwick DM. Five years after To Err is Human; what have we learned? JAMA, 2005; 293:(19)2384-2390.
² Berger Y. Why hasn’t it changed on the shop floor? In Mayhew C, Peterson CL (Eds). Occupational Health and Safety in Australia: Industry, Public Sector and Small Business. St Leonards, NSW; Allen and Unwin, 1999.
³ McLaughlin C, Kaluzny AD (Eds). Continuous Quality Improvement in Healthcare. Third Edition. Aspen Publications, 2006.

Part 1

Assignment

Demonstrate your understanding of each of the following:

quality as it pertains to healthcare
clinical governance
risk management
clinical practice improvement methodology

Length: 100 to 200 words.

Part 2

You’re establishing a new rehabilitation unit at your hospital. Based on the essential readings, describe the features of the quality program you’ll set up.

Assignment

Address the issues outlined in the 3 statements presented and include a discussion of:

the dimensions of quality
the selection of appropriate measures, including ACHS Clinical Indicators for Rehabilitation Medicine
the strategies for monitoring performance, including AROC benchmarking and ACHS accreditation
how you would implement the program

Length: 2000 words.

Essential reading

Simmons F, Stevermuer T. The AROC Annual Report: the state of Rehabilitation in Australia 2006. Aust. Health. Rev., 2008; 32(1):85-110.

Wolff A, Taylor S. Enhancing Patient Care – A practical guide to improving quality and safety in hospitals. MJA Books, 2009.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

Option 4 | Service planning

The service planning assignment is designed to introduce you to the challenges of planning health services, to teach you a little about the wider system in which you plan to work and to test your report writing skills.

Planning in health takes place at many levels:

strategic and policy planning at the population level
service planning at the program level
capital planning at the facility level

Your reading materials further explain the differences between each aspect.

Specifically, this option focuses on program planning since this is the level at which you will most likely be involved in as a rehabilitation physician. You’re guided through the steps involved in planning and report writing. You have the freedom to customise your report for the title you have chosen and change section headings in your report, but all sections are to appear in your final report.

As a new Fellow, you may be involved in hospital or regional program-specific issues and unlikely to be asked to develop a state plan for rehabilitation services. However, we encourage you to take the time to read some state and regional plans for rehabilitation services, to appreciate the place that rehabilitation medicine holds in the wider health system.

The suggested reading material and existing program plans your supervisor may be able to provide will help you to familiarise yourself with the elements of programs and program evaluation techniques. Make time to talk with your supervisor about the logistics of data availability in your current working situation and discuss your progress regularly with your supervisor.

You cannot write this report in a weekend. Writing a plan for a new program usually takes at least a few months. You may find that you will need this amount of time to put your submission together.

Assignment

Scenario: The Board of your hospital or regional health service has agreed to consider a plan for a new/enhanced program within your rehabilitation service. You have been invited by the CEO to Chair the Working Party to develop the plan and justify its costs.

Your assignment is to prepare the Clinical Service Plan component suitable for inclusion in the submission to the Board. Your plan needs to be practical enough for a manager to cost, or an architect to design if it involves a facility.

Choose a rehabilitation area — amputee, chronic pain, spasticity management or cardiopulmonary rehabilitation — and relate the plan to the situation in which you’re working. For example, paediatrics, occupational health or country setting.

Report format

Heading	This is a report, not an essay.
Executive summary 250 to 500 words	An executive summary outlines succinctly to the Board, what exists now, what you want to do, how long you think it will take to achieve your process goals and how you will evaluate the clinical program you wish to implement. Completed at the end of writing your report, it may contain a short list of recommendations or a descriptive timeline, depending on the title of your submission.
Background 200 to 250 words	Describe the structure into which you’re planning to introduce or enhance your chosen program, and the circumstances leading to its initiation. Outline the purpose of the plan. Has the need been identified as part of a larger strategic plan? Are there political issues to be considered? Did you set up an advisory committee? Who were your stakeholders? Is this clinical service plan to be used to outline what is needed in a new building/renovation?
Needs analysis 300 to 400 words	Describe the current level of injury, incidence of disorder, frequency of relevant operations, and presentation of disease in the population under consideration. Can you justify the numbers as to who may benefit from the rehabilitation service being planned? Are you using casemix data? Population survey data? Or estimates by comparison with another hospital? What’s the likely ‘penetrance’ expected? This report is probably about an outpatient program, not a strategic plan about bed numbers. Describe the amount of service you feel you should be providing, for example a dedicated clinic per week or 4 episodes of a group program per year. Are you extrapolating from the data you have found? Are you using established standards/ratios to estimate the need?
Gap analysis 100 to 150 words	What is the level of rehabilitation involvement in the program currently being provided? Who is providing it? Are there gaps in the amount of the service? Are there gaps in the quality of the service? Is there a critical mass? Are the numbers too small? Should you be putting this proposal forward as a component of a larger service? Do staff need special training or qualifications?
Model of care 400 words	What is the model of the service you wish to provide – inpatient, outpatient or both? Is it a multidisciplinary clinic with follow-up by single practitioners? A 6 to 12-week group outpatient program? Practitioners in the model? Outline the goals of the model. Describe the components of the model — assessment, intervention, follow-up — and their relationship to the goals. Outline the admission criteria and exclusion criteria. What are your staffing needs? What skills are needed? Refer to the AFRM Standards for Rehabilitation Services for recommended staffing levels.

Take into consideration what you have written at this stage and discuss with your supervisor if necessary.

Proposal 300 to 500 words	Propose your strategy/mission/vision and describe your model. Outline your key activities/goals/targets for the overall program, including how you’ll address the gaps. These may be activity targets, staffing targets or education targets for example. Outline any major costs in general terms like new staff, new equipment, training costs or database development. Do you have a timeline for implementation? Will you be staging the process?
Performance and outcome measures 300 words	Outline your framework for evaluating the quality of your new rehabilitation service. What activity data will you collate to demonstrate efficiency? What clinical outcome measures will you collate to demonstrate effectiveness and efficacy? Are there safety issues to be considered in this new proposal and how will you be monitoring this? How will your clients’ needs be met?
Recommendations 250 to 500 words	Synthesise your Clinical Service Plan and make recommendations for your overall submission to your Board. Use these recommendations for your Executive Summary at the start of your report.

Have someone proof your report, reviewing its formatting, spelling and grammar before you submit it.

Reference

Eagar K, Garrett P, Lin V (Eds). Health planning: Australian perspectives. Allen & Unwin, Crows Nest, 2001.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

Reflective essay

Submission guidelines

There are 2 components to the reflective essay assessment option.

Attend an accredited workshop on the management or leadership for clinicians.
Note: You need to obtain a certificate of attendance for submission to meet the module requirement.

A 500-word reflective essay

Structure

Pick an essay topic – this can be a workshop theme, an incident that occurred during the workshop, a particular point that was raised during the workshop – or reflect on your own takeaways
What was the issue that struck you particularly? Explain why it was a learning issue.
What challenged you and why was it special?
What will you read more about? Do differently? Prepare more carefully? Do you have a new plan?

Submission

Submit your reflective essay, certificate of attendance and an assessment cover sheet (PDF) to rehab@racp.edu.au

Your assessment must be submitted within a week of you attending the workshop.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Assessment cover sheet (PDF)

External Training Module 6 | Behavioural Sciences

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Overview

In Module 6 — Behavioural Sciences, you will gain understanding of psychological and sociological theories and research relevant to the understanding of how people experience disability.

You’ll be able to demonstrate knowledge of the psychological and social factors influencing peoples' reactions to disability, and an understanding of the implications of the behavioural sciences for rehabilitation care.

The module gives you an opportunity to relate concepts and processes in rehabilitation medicine to psychological, behavioural and social sciences literature, theories and research, and to develop an understanding of theories and research in behavioural sciences relevant to:

people with disability in society
a person’s experience of becoming and being disabled
psychological, social and cultural factors influencing rehabilitation
rural and remote communities
rehabilitation

Module objectives

Upon the completion of this module, you’ll be able to:

employ relevant behavioural science concepts to describe and/or explain issues in rehabilitation
use selected examples of the behavioural science literature to explore psychobehavioural and psychosocial aspects of rehabilitation
write about contemporary issues in rehabilitation medicine in a manner that displays knowledge of, and readings in, the behavioural sciences
identify and understand that rehabilitation is influenced by geographical, social and cultural factors

Note: All External Training Module content is assessable in the Fellowship examinations. You’re responsible for submitting your modules as soon as possible to avoid delaying certification of your Advanced Training.

Marking outcomes

Marking is completed by an assessor from an appointed panel with expertise in behavioural sciences in relation to rehabilitation.

A standardised marking system is used to assess and mark assignments. Each assignment receives a mark between 1 and 7:

Fail — 1, 2 or 3
Pass — 4
Credit — 5
Distinction — 6 or 7

Each assignment is worth 25% of your final mark.

A mark of less than 4 means that your assignment is required to be revised and resubmitted. The module isn’t complete until a satisfactory standard has been met for all assignments.

Resources

Academic Integrity in Training Policy
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Requirements

Requirement

4 x Written assignments over the course of your Advanced Training

Deadline

Due 6 months prior to the end of your Advanced Training.

Resources

Rehabilitation Medicine Module Assessment cover sheet (PDF)

Submission guidelines

All assignments are to be written in formal academic style, including a comprehensive list of references. Use a university accepted referencing system, for example Vancouver, Harvard or APA.

Word limit: 2000 words per assignment.

Submit your assignments, along with an assessment cover sheet (PDF) to rehab@racp.edu.au

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Key content and readings

Key content

1. Definitions and classifications of disability and functioning

The problems of defining and classifying disability, and the major current systems, including:

WHO International Classification of Diseases
WHO International Classification of Functioning, Disability and Health (ICF)

2. Epidemiology of disability in Australia

The Australian Bureau of Statistics Survey of Disability, Ageing and Carers (2003), and the implications of this study for the provision of medical and rehabilitation services.

3. The experience of becoming disabled

The differing behavioural reactions to disability arising from congenital, traumatic and progressive impairments.
Behavioural theories and research relevant to the different reactions expected in each situation.

4. The experience of living with disability

The effects of disability on all aspects of daily living including education, work, relationships and avocational pursuits.
Attitudes to disability, including:
- the attitudes of ‘able-bodied people’ to disability
- the attitudes of people with disability towards disability
- the attitudes of health professional to disability, the reasons for such attitudes, and the potential for such attitudes to foster dependency
Negative attitudes to disability, including:
- theories relevant to the causes and perpetuation of such attitudes
- strategies for changing such attitudes at personal, community and government levels
- characteristics of effective and ineffective programs of attitudinal change
Living in a rural and remote community^*.
Problems of specific disability groups, including:
- spinal cord injury
- traumatic brain injury
- multiple sclerosis
- developmental disability
- children, adolescents and older people
- other groups, including people from culturally and linguistically diverse backgrounds and their families

5. The health system’s response to people with disability

Having a disability and interacting with the health system.

New disability
Pre-existing disability
Disability in the context of geographically and culturally diverse populations

^* A rural and remote community is as defined by the ARIA criteria.

Textbooks (optional)

Annison J, Jenkinson J, Sparrow W, Bethune E (eds). Disability: A guide to health professionals. Melbourne, Nelson 1996.

Oliver M. Understanding Disability: from theory to practice. London, MacMillan, 1996.

Reading list

This a brief reading list relevant to the requirement. When sourcing information for an assignment topic, electronic databases like Medline, CINHAL, Embase and others should be used.

Australian Institute of Health and Welfare. ICF Australian User Guide Version 1.0, Canberra, 2003. Available at: ICF Australian User Guide (aihw.gov.au) (PDF)

Australian Bureau of Statistics. Disability, Ageing and Carers, Australia: Summary of findings, Canberra, 2004. Available at: 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings, 2003 (abs.gov.au).

Athanasou JA. Encountering personal injury: Medical, Educational, Vocational and Psychosocial Perspectives on Disability. Rotterdam, Sense Publishers, 2016.

Dudgeon P, Milroy H, Walker R (eds). Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Canberra, 2016.

Engel GL. The need for a new medical model: a challenge for biomedicine. Science, 1977; 196(4286):129-36.

Engel GL. The clinical application of the biopsychosocial model. Am. J. Psychiatry, 1980; 137(5):535-44.

Engel GL. From biomedical to biopsychosocial. Being scientific in the human domain. Psychosomatics, 1997; 38(6):521-8.

Fougeyrollas P, Noreau L, Bergeron H, Cloutier R, Dion SA, St-Michel G. Social consequences of long-term impairments and disabilities: Conceptual approach and assessment of handicap. Int. J. Rehabil. Res., 1998; 21(2):127-41.

Fougeyrollas P, Beauregard L. Disability: An interactive person/environment social creation. In: Albrecht DGL, Seelman KD, Bury M (eds). Handbook of Disability Studies. Thousand Oaks: Sage Publications, Inc., 2001.

Freeman T, Edwards T, Baum F, Lawless A, Jolley G, Javanparast S, Francis T. Cultural respect strategies in Australian Aboriginal primary health care services: beyond education and training of practitioners. Aust. N.Z.J. Public Health, 2014; 38(4):355-361.

Hung TN. Patient centred care. Cultural safety in indigenous health. Aust. Fam. Physician, 2008; 37(12):990-4.

ICF Browser: International Classification of Functioning, Disability and Health. World Health Organisation, 2001. Available at: International Classification of Functioning, Disability and Health (ICF) (who.int).

Kennedy P (Ed). The Oxford Handbook of Rehabilitation Psychology. New York, Oxford University Press, 2012.

Mpofu E (Ed). Community oriented health services: Practices across disciplines. NY: Springer, 2015.

Mpofu E, Oakland T (Eds). Rehabilitation and health assessment: Applying ICF guidelines. NY: Springer, 2009.

Oliver M. Theories of disability in health practice and research. BMJ., 1998; 317(7170):1446-1449.

Pound P, Bury M, Gompertz P, Ebrahim S. Stroke patients' views on their admission to hospital. BMJ., 1995; 311(6996):18-22.

Shearer A. Disability: Whose handicap? Oxford: Basil Blackwell, 1981.

Wilson AM, Kelly J, Magarey A, Jones M, Mackean T. Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity. International Journal for Equity in Health, 2016; 15(1):187.

World Health Organisation, International Labour Office & United Nations Educational, Scientific and Cultural Organisation. CBR: A Strategy for Rehabilitation, Equalization of Opportunities, Poverty Reduction and Social Inclusion of People with Disabilities, Joint Position Paper. World Health Organisation, 2004.

Related journals

Archives of General Psychiatry

International Electronic Journal of Rural and Remote Health

International Journal of Rehabilitation Research

Journal of Psychosomatic Research

Psychological Medicine

Psychosomatic Medicine

Rehabilitation Psychology

Assignments

Topic A | Biopsychosocial approach

A compulsory topic for all trainees.

Compare and critically contrast the traditional medical model of care with the biopsychosocial approach presented by the International Classification of Functioning, Disability and Health.

Use case examples from your own practice to illustrate the way that either personal or environmental (contextual) factors influence the participation outcomes achieved with particular patients.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Topic B | Process/experience of rehabilitation

Select a topic from these options:

Outline a variety of models of interaction between the rehabilitation physician and the rehabilitation team. Explore the consequences of these models for interdisciplinary team dynamics and team effectiveness.

As the popularity of alternate and complementary medicine rises, discuss your approach of integration of care within the rehabilitation team.

Different service models, including peer support programs and chronic condition self-management, are acknowledged by health service planners to assist adjustment outcomes following disablement. Select one of these models and discuss how it can be used to improve rehabilitation services.

Is breaching patient confidentiality justified in some circumstances? Discuss this in reference to rehabilitation care.

You’re asked to provide a consultation for a new patient and family. The family expresses their anger about the primary medical team and would like you to take on their care. Explore your approach in liaising with the family and medical team.

Rehabilitation professionals’ attitudes to people with disability mirror those of the general community. Do you agree? Review the evidence for and against this statement.

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Topic C | Process/experience of disability

Select a topic from these options:

Describe and contrast the psychological reactions that are associated with rapid onset disablement and chronic progressive disablement. What implications are there for rehabilitation?
Discuss the importance of ‘quality of life’ as an outcome of rehabilitation. Who should evaluate this — when, where and how? Are other measures as important in evaluating adaptation to disablement?
Numerous psychosocial factors have been identified as playing a role in the onset and/or maintenance of various chronic pain syndromes. Discuss this idea, considering its role both in the pain cycle and the efficacy of current treatment approaches.
Discuss the role of personal coping strategies in long-term adjustment to disablement.
Discuss the effect of physical disfigurement, such as burns or amputation, on self-image. Can self-image be preserved in the situation of severe loss?
Describe the nature and effects of depressive illness in long-term disablement.
Spiritual and religious beliefs can be important in a person’s understanding and acceptance of disability. Discuss their possible influence.
What is ‘carer stress’? What factors contribute to carer stress occurring and what can be done to help prevent or alleviate it?

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Topic D | Rural, remote and culturally appropriate rehabilitation

First, choose at least 1 population type:

Aboriginal and Torres Strait Islanders
Maori and Pacific Islanders
Rural and remote communities
Refugees
People from culturally and linguistically diverse backgrounds

Next, select a health condition in the context of the population (or populations) you’ve chosen:

Spinal cord injury
Traumatic brain injury
Stroke
Amputation
Developmental disability and adolescent transition care
Dementia

Task: In relation to the provision of rehabilitation services, discuss each of these issues in the context of your chosen population and health condition:

cultural security
clinical assessment and management of the individual and environment
models of care, including workforce issues

Resources

Academic Integrity in Training Policy
Citing and referencing | Monash University
RACP Online Learning Resource: Research Projects
Rehabilitation Medicine Module Assessment cover sheet (PDF)
Turnitin

Functional Independence Measure^TM training course

Open all

Overview

The Functional Independence Measure™ (FIM™) training course provides an important tool for rehabilitation physicians.

FIM™ is a functional assessment scale for collecting uniform measurement and data on disability and rehabilitation outcomes.

Rehabilitation physicians, as well as most staff members in rehabilitation units, are expected to be FIM™ credentialed.

Resources

Australasian Rehabilitation Outcomes Centre | University of Wollongong

Requirements

Requirement

Complete 1 x Functional Independence Measure^TM (FIM^TM) training course

Deadline

Complete the FIM^TM course by the end of your Advanced Training.

Final certification of your training can be delayed if the AFRM Education Committee is unsatisfied that the requirement has been achieved.

Resources

Australasian Rehabilitation Outcomes Centre | University of Wollongong

Formal Long Case Assessment

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Overview

A Formal Long Case Assessment (FLCA) is an In-training Long Case Assessment completed under examination conditions during your final year of Advanced Training.

This assessment evaluates you in real life settings and assesses your professional expertise and judgement exercised in clinical cases.

The assessment is designed to:

guide your learning through structured feedback
help improve your communication, history taking, clinical decision making, clinical knowledge and patient management
provide you with an opportunity to discuss your approach to the case and identify strategies to improve your practice
be a teaching opportunity allowing assessors to share their professional knowledge and experience

Consultation

Cases for consultations and discussion are chosen by your assessor with each encounter representing a different clinical problem. You should have had no previous contact with the patient.

You’re responsible for ensuring that adequate encounters are completed and that most assessable areas outlined in the Advanced Training Curriculum are covered.

You can complete your 2 FLCAs separately with different assessors or in sequence on the same day if necessary.

FLCA areas of assessment include:

clinical examination
history taking
clinical findings and interpretation
short-term management plan
impact of illness on patient and family
long term management plan

FLCA are assessed by at least 1 AFRM Long Case Assessor and 1 current supervisor or nominated AFRM Fellow.

See Accredited Long Case Assessors (PDF) list.

Step-by-step: Formal Long Case Assessment

Preparation

Initiate your FLCA with your supervisor/assessor, advising which Advanced Training Curriculum areas require assessment.

The supervisor/assessor selects an appropriate consultation for assessment

You need to confirm that you agree to the chosen consultation.

Each assessment should represent a different clinical problem addressed in the Advanced Training Curriculum

Ensure you and your supervisor/assessor have a clear understanding of the purpose, process and outcomes you aim to achieve during the assessment.

Assessment | 90 minutes

You’ll be observed by 1 AFRM Long Case Assessor and 1 current supervisor or nominated AFRM Fellow

You begin with spending 60 minutes with the patient, as they complete their response on the consultation form.

Assessors aren’t required to directly observe you during the 60-minute consultation

Give your completed consultation form to your assessors for them to read before the interview component begins.

For 20 minutes, you discuss the case with your assessors. The discussion begins with 2 to 3 minutes of you summarising your clinical findings, history and brief management plan.

Discussion then switches to your analysis of the:
- problems
- disability
- rehabilitation issues relevant to the patient
- long-term rehabilitation management plan
Assessors can prompt for further information if required.
Assessors make notes and rate your performance on the Long Case Assessment rating form (PDF) throughout the interview session.

Assessors will not provide performance feedback following the conclusion of your FLCA.

The LCA rating form must be completed and submitted by the assessors to rehab@racp.edu.au

Resources

Accredited Long Case Assessors (PDF)
Long Case Assessment rating form (PDF)

Requirements

Requirement

2 x Formal Long Case Assessments (FLCA)

Deadline

You must satisfactorily complete your FLCAs during the final 6 months of your Advanced Training.

Resources

Accredited Long Case Assessors (PDF)
Long Case Assessment rating form (PDF)

In-training Long Case Assessment

Open all

Overview

An In-training Long Case Assessment (ITLCA) is an assessment that evaluates you in real life settings and assesses your level of professional expertise and judgement exercised in clinical cases.

The assessment is designed to:

guide your learning through structured feedback
help improve your communication, history taking, clinical decision making, clinical knowledge and patient management
provide you with an opportunity to discuss your approach to the case and identify strategies to improve your practice
be a teaching opportunity allowing assessors to share their professional knowledge and experience

Consultation

You’re responsible for ensuring that adequate encounters are completed and that most assessable areas outlined in the Advanced Training Curriculum are covered.

Areas of assessment include:

clinical examination
history taking
clinical findings and interpretation
short-term management plan
impact of illness on patient and family
long term management plan

Step-by-step: In-Training Long Case Assessment

Preparation

Initiate your ITLCA with your supervisor/assessor, advising which Advanced Training Curriculum areas require assessment.

The supervisor/assessor selects an appropriate consultation for assessment.

You need to confirm that you agree to the chosen consultation.

Each assessment should represent a different clinical problem addressed in the Advanced Training Curriculum

Ensure you and your supervisor/assessor have a clear understanding of the purpose, process and outcomes you aim to achieve during the assessment.

Assessment | 90 minutes

At least 1 encounter per year, from your second year onwards, must be directly observed by an assessor.

You begin with spending 60 minutes with the patient, as they complete their response on the consultation form.

Give your completed consultation form to your assessor for them to read before the interview component begins.

For 20 minutes, you discuss the case with your assessor. The discussion begins with 2 to 3 minutes of you summarising your clinical findings, history and brief management plan.

Discussion then switches to your analysis of the:
- problems
- disability
- rehabilitation issues relevant to the patient
- long-term rehabilitation management plan
Your assessor can prompt for further information if required.
Your assessor will make notes and rate your performance on the Long Case Assessment rating form (PDF) throughout the interview session.

Following the discussion of the case, your assessor will provide you with feedback, which will cover how well you did and what areas need improvement.

If any significant areas of weakness are identified during the consultation, you and your supervisor/assessor should devise a remediation plan.

You and your assessor must sign the rating form.

Submit record

Enter your rating form data into the AFRM Training Portal.

Once you’ve submitted your rating form data, your assessor will receive a copy via email.

Your training supervisor (if not your assessor) can also view your completed assessment forms via the portal.

You must take a copy of LCA rating form to all your meetings with your training supervisor

Resources

Long Case Assessment rating form (PDF)

Requirements

Requirement

12 x In-Training Long Case Assessments (ITLCA):

Year 1 | 2 x ITLCAs (minimum), in the second half of the year, late in the rotation
Year 2 | 4 x ITLCAs (minimum), 2 per 6-month period, late in the rotation
Year 3 | 4 x ITLCAs (minimum), 2 per 6-month period, late in the rotation
Year 4 | 2 x ITLCAs (minimum), in the first half of the year, late in the rotation

ITLCAs aren’t required for the first and last 6-month training rotations. A minimum of 12 assessments, including at least 3 observed (1 per year across Years 2 to 4), must be completed prior to your final 6-month training rotation.

Trainees undertaking part-time training are required to complete the same number of ITLCAs pro-rated to the amount of training that they have been approved for.

Deadlines

Year 1 | Complete at least 2 x ITLCAs by the end of your first year.

Year 2 | Complete at least 2 x ITLCAs by the end of each 6-month period.

Year 3 | Complete at least 2 x ITLCAs by the end of each 6-month period.

Year 4 | Complete at least 2 x ITLCAs by the end of the first half of your fourth year.

Resources

Long Case Assessment rating form (PDF)

Learning Needs Analysis

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Overview

A Learning Needs Analysis (LNA) embeds the process of planning and evaluating learning in the trainee’s practice.

The LNA is designed to help you:

tailor your learning experiences and build on clinical knowledge and skills
enhance face-to-face communication with your supervisor
provide information on your learning needs and progress
reflect on your strengths, limitations and future learning strategies

Your ward/service consultant or supervisor are responsible for:

advising you of available learning opportunities and resources
ensuring you have set appropriate goals and identified achievable learning objectives
reviewing your completed LNA and providing you feedback

Step-by-step: Learning Need Analysis

You need to complete a specified number of LNAs each year, per rotation. Refer to the training program requirements for the required number.

Prepare for your LNA

To plan the learning objectives for each training period, discuss the learning opportunities and resources available with your ward/service consultant or supervisor.

Meet with your consultant/supervisor to discuss:
- career goals
- personal strengths and weaknesses
- strengths and constraints of the training site/rotation, including the expertise of the medical staff and the resources available
- requirements established in the curriculum, the Professional Practice Framework and Professional Standards (PDF)

Create your LNA: Part 1

Log into your online training portal and create a new LNA
Basic Training Portal^* | Advanced Training Portal | AFOEM Portal | AFRM Portal

You'll be prompted to enter:
- learning goals for the training period
- self-evaluation on current competency for the goals identified
- learning objectives from the curricula that map to your goals (optional)
- strategies and resources that will assist your learning
- contact details of additional supervisors (optional)

Submit Part 1 of your LNA

You and your consultant/supervisor can meet to review and improve your LNA

Begin implementing your LNA over your training period

Complete your LNA: Part 2

At the end of your training period, you'll complete a self-evaluation of your LNA.

Provide your input on:
- competency in the areas specified in the learning plan
- evidence of learning
- reflection on training period

Complete your LNA by submitting LNA Part 2

Your consultant/supervisor can access your completed LNA

^* New trainees who don't currently have access to the Basic Training Portal can complete a Learning Needs Analysis form (DOC). You don't need to submit this to your supervisor. When you have access to the portal, fill in your LNA online.

Resources

Video tutorial

Requirements

Requirement

1 x Learning Needs Analysis (LNA) per 6-month period (core and non-core), early in the period.

Deadlines

First half of the year: 31 August.

Second half of the year: 28 February.

Submit your LNA via the AFRM Portal.

Professional Qualities Reflection

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Overview

A Professional Qualities Reflection (PQR) allows a trainee to reflect on an event, or series of events, that is medically or professionally significant to them.

Through analysis of the event, you’ll be able to identify and integrate new skills and knowledge to improve your performance.

Reflecting on your professional qualities can cause you to question your beliefs, attitudes and behaviours, and develop new ideas and insights to inform your future practice.

When planning your PQR, you should consider:

What happened?
Why did it happen?
What did you learn?
How can you improve patient care?
What action did you or will you take?

Refer to your specific PQR program requirements.

Choosing an event

Analyse an event or events that impacts your professional practice.

The event can be positive or negative but doesn't have to be dramatic or life threatening. The event should relate to a variety of different encounters you might experience in a healthcare setting.

Step-by-step: Professional Qualities Reflection

Go to your online training portal:
Basic Training portal
Advanced Training portal
AFOEM portal
AFPHM portal
AFRM portal

Select the PQR tool and create a new entry.

Describe an event, or series of events, of professional significance.

Reflect on the event. How did you respond to it?

Detail the insights you gained from the event(s) and how it will impact your medical professionalism.

Submit your completed PQR to your Professional Development Advisor^* (Basic Training) or Supervisor (Advanced Training) through your online training portal.

Confirm the date of your two-monthly interview with your supervisor.

At your interview, discuss your PQR with your supervisor and seek feedback on your future practice.

Qualified privilege

Australia

The PQR is a quality assurance activity that has been declared on behalf of the Minister of Health and Aged Care by the Chief Medical Officer of the Department of Health under Part VC section 124X of the Health Insurance Act 1973 under the Commonwealth Qualified Privilege Scheme.

Aotearoa New Zealand

Information entered in the PQR tool and which has become known solely as a result of the PQR is protected under the Health Practitioners Competence Assurance Act 2003.

The Act outlines conditions which apply to use of the PQR, which include:

information already existing, for example in patient notes, is not protected
information entered in the PQR cannot be disclosed to, or recorded by, others who are outside the PQR activity

The Minister of Health can authorise disclosure for investigation purposes if they are satisfied that the material relates to a serious offence.

Anonymity and confidentiality

The RACP strongly advises de-identifying any information entered in a PQR. Please de-identify any names of patients, peers, persons or organisation(s) to protect the privacy of individuals/organisation(s) in accordance with the Privacy Act 1988 (Cth) and the Australian Medical Association Privacy Handbook.

The College won’t release any information that you give in this self-reflective tool to any third party without consent unless it’s required to do so by law.

^* A Professional Development Advisor doesn’t need to be a RACP Fellow. For example, your Advisor can be your Ward/Service Consultant (term supervisor) or an Advanced Trainee.

Requirements

Requirement

2 x Professional Qualities Reflections (PQR) each training year, 1 per 6-month training period

Deadlines

First half of the year: 30 June.

Second half of the year: 31 December.

Submit your PQR via the AFRM Portal.

Supervisor's Report

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Overview

A Supervisor's Report provides a comprehensive overview of your progress and achievement during the training year. It provides you with structured feedback on your performance from your supervisor and will inform the decision on the certification of your training.

Step-by-step: Supervisor’s Report

All your nominated supervisors must complete the Supervisor’s Report. You can view your nominated supervisors by logging in to your training portal.
Advanced Training | AFPHM | AFRM

Completing a report

Arrange a meeting to discuss and complete the Supervisor's Report with your supervisor(s).

You and your supervisor’s declarations must be completed and dated for your Supervisor’s Report to be considered complete.

Australian trainees: Signatures are not required.
Aotearoa New Zealand trainees: Signatures required.

Incomplete reports will be returned to you for completion.

If you have more than 2 nominated supervisors, additional supervisors must complete either a Supplementary Supervisor Comments Report (DOC) or a separate Supervisor’s Report.

Dual trainees: Complete a Supervisor’s Report for the specialty most relevant to that training period. Separate reports for the same training period aren’t required for dual training.

Submitting a report

Submit your report(s) via email to the specialty Education Officer. If you’re dual training, send your report(s) to both specialty Education Officers.

All supervisors must be copied into your report submission email to your specialty.

Reports are accepted in PDF format (preferred) or Word format only.

Save a copy of your report(s) for your own records.

Late submission

Your Advanced Training Committee or Subcommittee may not certify training if your Supervisor’s Report is submitted after the specified deadline.

Late reports will not be accepted unless you’ve been granted an extension through an Application for Special Consideration^* (DOC).

Special Consideration must be applied for prior to the Supervisor’s Report deadline. You can also submit a letter of explanation to support your application.

Applications will be assessed against the criteria outlined in the Special Consideration for Assessment Policy (PDF).

^* As outlined in the Progression Through Training Policy (PDF), section 7.8.1:
'Training will not be certified where the trainee has not satisfactorily completed all training requirements for the prospectively approved training period by the relevant deadline(s), or during an extension period if granted by the committee.’

Resources

Education policies

Requirements

Requirement

12-month position

1 x Supervisor’s Report for the first 6 months of the training year due by 31 August
1 x Supervisor’s Report for the last 6 months of the training year due by 28 February in the following year

6-month position or less (separate supervisors or separate sites)

1 x Supervisor’s Report completed for each rotation:
- Due 31 August for rotations in the first half of the year
- Due 28 February in the following year for rotations in the second half of the year

In your final training year, you must submit a report covering the entire second half of that year by 15 October.

If your supervisor hasn’t directly supervised you throughout the whole rotation, your supervisor should obtain individual reports from those who have and submit a composite report.

You are to ensure all supervisors receive a copy of the Supervisor’s Report. Previous copies of Supervisor’s Reports must be provided to your next supervisor.

Resources

General Rehabilitation Medicine Supervisor's Report (DOC)
Supplementary Supervisor Comments Report (DOC)
Supervisor Details Amendment Form (DOC)

Trainee Term Evaluation Form

Open all

Overview

A Trainee Term Evaluation Form (TTEF) provides feedback to your AFRM Training Committee about your training experience for each 6-month period. The requirement encourages you to reflect on your training rotations, embedding reflection and review into your practice.

All information you provide is confidential. An RACP Education Officer and a New Fellow Representative will have access to your TTEF only.

Your feedback is de-identified and added to a training settings database that is used in the accreditation review cycle for training settings.

You’re required to rate your lived experience in these areas:

orientation
workload
teaching and learning on the job
leadership opportunities
additional training opportunities
skills supervision

If your feedback indicates that you’ve had significant concerns or difficulties during your term, we will contact you to discuss possible follow-up action.

Resources

Trainee Term Evaluation Form (PDF)

Requirements

Requirement

2 x Trainee Term Evaluation Forms (TTEF) per training year, 1 per 6-month training term (core and non-core)

Deadlines

First half of the year: 31 August.

Second half of the year: 28 February in the following year.

You cannot progress to your next year of training without submitting 2 TTEFs for the current year.

In your final year, you must have submitted all required TTEFs for your Advanced Training to be certified and be eligible for admission to Fellowship.

Submit your evaluation form (PDF) via the AFRM Portal.

Resources

Trainee Term Evaluation Form (PDF)

Examinations

AFRM Module 1 Assessment

This assessment tests your basic medical knowledge in rehabilitation medicine.

Eligibility

To be eligible to sit the assessment, you must:

apply by the due date
have at least 2 full years of postgraduate supervised training in general medical and surgical areas
be in an accredited training position or on an approved training interruption
have current medical registration
be in your first or second year of Advanced Training
comply with requirements in Progression Through Training Policy

If you have outstanding training fees, you're ineligible to sit the exam. See College Fees Terms and Conditions.

Exam attempt limit

You cannot continue Advanced Training if you exceed the examination attempt limit, which is based on when you commenced training.

Commenced training	Before 2018	2018 onwards
Attempt limits	5	3

See Progression Through Training Policy for more information about examination attempts.

AFRM Module 2 Clinical Assessment

You’ll be assessed on your clinical knowledge and skills in rehabilitation medicine in a hospital setting. You must perform a competent clinical examination, and analyse and interpret findings to manage patient outcomes.

Eligibility

To be eligible to sit the assessment, you must:

apply by the due date
have at least 2 full years of postgraduate supervised training in general medical and surgical areas
be in an accredited training position or on an approved training interruption
have current medical registration
be in your first or second year of Advanced Training
comply with requirements in Progression Through Training Policy

If you have outstanding training fees, you're ineligible to sit the exam. See College Fees Terms and Conditions.

Exam attempt limit

You cannot continue Advanced Training if you exceed the examination attempt limit, which is based on when you commenced training.

Commenced training	Before 2018	2018 onwards
Attempt limits	3	3

See Progression Through Training Policy for more information about examination attempts.

AFRM Fellowship Written Examination (General)

The Fellowship Written Examination is designed to test your skills in:

evaluating and assessing complex problems of a clinical or administrative nature
communicating relevant information in a clear written form, within the time available
demonstrating an awareness of the judgement of priorities and the importance of sensitive interdisciplinary planning and liaison
adopting an orderly, logical and mature approach to current areas of debate and controversy in disability management

Eligibility

To be eligible to sit the examination, you must have:

completed 24 months FTE of certified training in general rehabilitation medicine
paid the exam fee by the due date, in order to guarantee your place
your College training fees paid up in full

If you have outstanding training fees, you’re ineligible to sit the exam. See College Fees Terms and Conditions.

Exam attempt limit

You cannot continue Advanced Training if you exceed the examination attempt limit, which is based on when you commenced training.

Commenced training	Before 2018	2018 onwards
Attempt limits	N/A^*	3

^* Trainees who commenced before 2018 must successfully pass the Fellowship Written and Clinical Examinations within a period of 47 months from their first attempt at the assessment.

See Progression Through Training Policy for more information about examination attempts.

AFRM Fellowship Clinical Examination (General)

The examination will test your clinical knowledge and skills in rehabilitation medicine in a hospital setting. You must perform a competent clinical examination and analyse and interpret findings to manage patient outcomes.

Eligibility

To be eligible to sit the examination, you must have:

completed 24 months FTE of certified training in general rehabilitation medicine
paid the exam fee by the due date, in order to guarantee your place
your College training fees paid up in full

If you have outstanding training fees, you’re ineligible to sit the exam. See College Fees Terms and Conditions.

Exam attempt limit

You cannot continue Advanced Training if you exceed the examination attempt limit, which is based on when you commenced training.

Commenced training	Before 2018	2018 onwards
Attempt limits	N/A^*	3

^* Trainees who commenced before 2018 must successfully pass the Fellowship Written and Clinical Examinations within a period of 47 months from their first attempt at the assessment.

See Progression Through Training Policy for more information about examination attempts.

Optional tool

Logbook

The logbook (DOC) is an optional tool to assist you in gaining broader experience in the field of general rehabilitation medicine. Broad exposure during training to case-mix and complexity is important for your overall quality of training but experiences can vary from trainee to trainee.

More information

Education policies
RACP Online Learning Resources
Trainee support

Forms and resources

Curricula

General Rehabilitation Medicine Advanced Training Curriculum (PDF)
Professional Qualities Curriculum (PDF)

AFRM training portal

Forms and reports

Specialty societies

Rehabilitation Medicine Society of Australia and New Zealand

The Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) is the peak professional body representing rehabilitation Medicine physicians in Australia and Aotearoa New Zealand.

RACP resources

Trainee support is available through the Training Support Pathway, assisting you in navigating the progression through training process and reporting on your progress to your training committee.

AFRM training resources feature the latest lecture series webinars and presentations on rehabilitation medicine made for the training program and assessments.

RACP Online learning resources is home to all online learning opportunities for trainees, with its range of online learning courses, resources and interactive learning content. It also hosts:

College Learning Series is an interactive online resource specifically targeted to the needs of Basic Trainees.
Curated collections are learning resource guides based on the contributions and peer review of RACP Fellows and other experts.

Pomegranate Health podcast is a monthly medical podcast created by physicians, for physicians.

Evolve is a physician-led initiative to ensure the highest quality patient care through the identification and reduction of low-value practices and interventions.