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Eur J Phys Rehabil Med
Eur J Phys Rehabil Med
EJPRM
European Journal of Physical and Rehabilitation Medicine
1973-9087
1973-9095
Edizioni Minerva Medica

38958693
8577
10.23736/S1973-9087.24.08577-0
Article
Setting the European standards for training in Physical and Rehabilitation Medicine
BAROTSIS Nikolaos 1 *
ORAL Aydan 2
ZAMPOLINI Mauro 3
JANSSEN Wim 4
FRISCHKNECHT Rolf 5
TEDERKO Piotr 6
CERAVOLO Maria G. 7
1President of the European Board of PRM, Physical and Rehabilitation Medicine Outpatient Clinic, Naxos, Greece; 2UEMS PRM Section and Board Secretary General, Incoming President of the European Board of PRM, Istanbul University, Istanbul, Türkiye; 3UEMS PRM Section President, Department of Rehabilitation, Hospital of Foligno, USL Umbria2, Perugia, Italy; 4Treasurer of the European Board of PRM, Care for Hands, Barendrecht, the Netherlands; 5Deputy Treasurer of the European Board of PRM, Lausanne, Switzerland; 6Deputy Secretary of the European Board of PRM, Department of Rehabilitation, Center of Postgraduate Medical Education, Otwock, Poland; 7Past President of the European Board of PRM, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
* Corresponding author: Nikolaos Barotsis, El. Venizelou str., 84300, Naxos, Greece. E-mail: nbarotsis@icloud.com
Authors’ contributions: All authors read and approved the final version of the manuscript.

28 8 2024
8 2024
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2024 THE AUTHORS
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.
The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the “Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula” published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.

Key words:

Physical and rehabilitation medicine
Education
Europe
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pmcThe European Union of Medical Specialists (UEMS) has a fundamental role in improving and harmonizing post-graduate medical training across Europe. Established in 1958, the UEMS has been instrumental in developing the European curriculum for each medical specialty and formulating comprehensive training standards. A landmark initiative was the adoption of the “Charter on Training of Medical Specialists” in 1994, which outlined the principles for high-quality specialist medical training. This Charter comprised five chapters applicable to all specialties, with a distinct sixth chapter tailored to individual disciplines. Each UEMS specialist section was tasked to adapt this crucial chapter, ensuring it aligns with the specific training framework and requirements of the specialty.

Over recent years, the UEMS Specialist Sections, European Boards, Divisions, and Multidisciplinary Joint Committees have diligently worked to evolve these European Standards in Medical Training. This progression reflects the dynamic nature of medical education and scientific advancements. A significant development in this regard has been the transformation of “Chapter 6” into the “European Training Requirements for the Specialty” (ETRs). This document undergoes regular updates by the UEMS Specialist Sections and European Boards.

The European Board of Physical and Rehabilitation Medicine (EBPRM) serves as the educational committee of the PRM Section of the UEMS.1 Its primary objective is to standardise the qualifications of PRM physicians across Europe.2 This is accomplished through a comprehensive approach that defines the essential theoretical knowledge required for proficient practice in PRM and outlines the competencies that trainees must demonstrate upon completing their training. Furthermore, the EBPRM ensures that a consistent level of education is achieved and maintained by PRM physicians, based on a system of fellowship (re)certification. This commitment guarantees that the education and training of PRM physicians are consistently of a high standard, in line with the latest advancements and best practices in the field. By doing so, the EBPRM significantly contributes to the continuous improvement of training programs, providing PRM physicians with the necessary knowledge, skills, and competencies to provide optimal patient care, thus raising the standards of PRM across Europe.3

A noteworthy milestone was the development of the first version of the ETRs for PRM by the EBPRM in 2017. This version incorporated a thorough review of existing training requirements for PRM across European countries. It detailed the scope of PRM as “the medicine of functioning” and presented the training standards for trainees, trainers, and training institutions. The 2017 curriculum was built upon the foundations of the 2011 European Curriculum in PRM, integrating the core competencies the PRM physicians were required to achieve, when completing their postgraduate education. In 2022, the EBPRM started to elaborate the first update of the ETRs in PRM. This endeavour aimed to integrate recent advancements in medical specialist education and assessment, along with reflecting significant scientific progresses in the field of PRM. The updating process adhered to the latest UEMS guidance and recommendations4 for ETRs and was successfully completed in 2023.

The first ETRs update: timeline and procedure

According to the UEMS recommendations the ETRs should be updated every three to four years. The EBPRM elaborated the first draft within the Executive Committee in January 2022, by revising the first version of ETRs in PRM, published in 2017. The revision considered the release, on January 22nd, 2021, of the Rehabilitation Competency Framework issued by the WHO5 and, most importantly, of the “Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula.”6

In March 2022, a consensus was obtained within the EBPRM regarding the ETRs update. The prefinal draft was approved by the General Assembly of the UEMS PRM Section and the EBPRM. It was subsequently sent to the relevant European PRM bodies, (i.e. the European Academy of Rehabilitation Medicine and the European Society of PRM) and a panel of trainees and young PRM specialists for external review. The involvement of trainees in the revision process was considered as an invaluable step in the whole procedure. The comments received by the external reviewers were taken into consideration and the final draft was submitted to the delegates of the UEMS PRM Section and the EBPRM for further discussion and approval. After incorporating all necessary improvements, it was approved by the General Assembly in September 2022.

Upon receiving the final draft, the UEMS requested the feedback from all European National Medical Associations (NMAs), Specialist Sections, European Boards and ETRs Committee. The extensive consultation and interaction with NMAs and other medical specialties have been an invaluable source of inspiration for significant improvements as it concerns the quality of the ETRs and the achievement of integrative interaction across specialties. The final version was approved in April 2023 by the assembly of the UEMS Sections and the Council of UEMS (assembly of NMAs), and is available on the UEMS website.7

Structure of the new ETRs and revision concepts

The comprehensive update of the ETRs in PRM is structured into three distinct sections, each addressing specific aspects of training and professional development in PRM.

The first section delineates the European standards for post-graduate PRM education. It sets the requirements for the content (theoretical knowledge, skills and competencies) and organization (schedule, curriculum, assessment, evaluation and governance) of training, as well as detailed certification criteria for trainers (e.g. qualification, experience and core competencies) and training centres (staff and equipment resources, range and volume of clinical activities, quality management). The EBPRM encourages National Authorities to adopt these guidelines, which were formulated through extensive consultation and consensus with European medical bodies. The guidelines are periodically updated to stay consistent with evolving medical education standards and practices.

Curriculum of training in PRM

The curriculum, presented in the second section, is a comprehensive framework divided into nine chapters and several subchapters. It adopts a three-level scale to rate the minimum recommended level of clinical knowledge and skills that trainees should attain during their training. This innovative approach ensures a standardised yet flexible pathway of training in PRM. The competencies and activities in the revised curriculum are organized into five thematic domains: practice, professionalism, learning and development, management & leadership, and research, aligning with the structure proposed by the WHO Rehabilitation Competency Framework.5 A three-level scale proposed by the EBPRM is intended as a practical tool in the assessment of trainees at the conclusion of their residency programme, ensuring a well-rounded and competent PRM professional development.

Entrustable professional activities (EPAs)

A novel addition in this version of the ETRs is the incorporation of Entrustable Professional Activities (EPAs) as an Annex. In line with the modern concept of a competency-based education, the ETRs call for post-graduate training securing the minimum standards for unsupervised practice in PRM. EPAs can be used to assess the range of competencies a trainee has achieved, as they are “units of professional practice that can be entrusted to a trainee once he/she has demonstrated the necessary competence to execute them without supervision.”8 Considering the vast range of clinical scenarios where the PRM physician is expected to play a role, the EBPRM has developed a complex framework, for assessing the proficiency of PRM trainees in real-world scenarios, where the EPAs are grouped into the five domains of Practice, Professionalism, Learning and Development, Management and Leadership, and Research, and mapped against a choice of rehabilitation settings (e.g. clinical rehabilitation unit, acute care services, outpatient care, specialized brain injury rehab, specialized spine injury rehab, rehab in developmental age, geriatric care and others). The list is adaptable, allowing training authorities and institutions to modify it according to local requirements and circumstances. Examples of EPAs in the domain of Practice are: “Collecting information from medical history, physical examination, functional evaluation, and additional investigations”, “drawing-up the functional prognosis and the individual rehabilitation plan” or “managing patients with pain”. To be entrusted to complete the activity unsupervised, a trainee must demonstrate relevant theoretical knowledge and practical skills, but also show collaborative attitudes toward patients and carers, exhibit adequate communication skills, and rigorous approach to problem-solving and decision-making.

By building this EPAs framework, the ETRs for PRM aim to provide a natural construct for establishing the required training outcomes, foster a mental model amongst learners and trainers, provide standards for certifying bodies and boundaries for scope of practice, thus reflecting the EBPRM mission to enhance the training and assessment of PRM physicians.

Conclusions

The comprehensive update of the ETR in PRM marks a significant milestone in the pursuit of excellence in medical education and patient care in PRM across Europe. This revision holds profound implications, both for the training of PRM physicians and the quality of care provided to patients.

By setting unified criteria for training and certification, a consistent and high level of competence among PRM professionals is ensured. This standardisation is crucial for fostering mobility among professionals and for assuring the quality of care across different European health systems.

The introduction of EPAs in the training process signifies a shift towards a more practical and competency-based approach. Programmatic assessment might effectively track learning progress within and across competencies during training.9 This evolution in training methodology is expected to directly translate into enhanced patient care. By ensuring that PRM physicians are well-trained, with the necessary competencies and skills, the ETRs update contributes significantly to the overall improvement of rehabilitation services and patient outcomes in Europe.

In conclusion, the revised ETRs stand as the essence of the collaboration among various European medical bodies. It not only elevates the standard of PRM training but also paves the way for significant advancements in the delivery of rehabilitation services across Europe, ultimately benefiting patients.

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
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