Return-to Work, Vocational Rehabilitaion
What is our role in vocational rehabilitation (VR)? How well is this dimension in rehabilitation represented in our training? Is VR getting the attention it should? “White book on physical and rehabilitation medicine in Europe” defines the most basic goals of PRM as: “The two fundamental outcomes of rehabilitation that have to be demonstrated are the person's well-being and their social and vocational participation”. The same White book also states that: “PRM specialists use specific diagnostic assessment tools and carry out many types of treatments, including pharmacological, physical, technical, educational and vocational interventions.” In other words, VR is clearly recognized as a fundamental dimension of PRM that should play a substantial role in our training and practice.
Based on the survey conducted among European national PRM managers, the VR topics are underrepresented in both the pre-graduate medical educational program and the PRM residential training program. Additionally, the concept of VR is quite often misunderstood meaning something more limited. As far as I know, the situation in the United States is not much different. Also the European PRM Board examination does not cover VR issues broadly.
VR can be swiftly integrated into PRM practice and training. For example, in the University of Turku, VR is included into PRM training. There are a few lectures at different training years, a seminar for graduating students, and a compulsory small-group-workshop with real patient cases. During a residential rotation, PRM trainees serve at least 8 months as a rehabilitation team-leader at an outpatient VR evaluation clinic. PRM trainees are taught to take into account VR issues with every patient they meet. Entering the clinic, data from every patient concerning their occupational status are systematically collected, including information about educational level, working history, amount of sick leaves, previous vocational rehabilitation measures, sources of income etc. The use of ICF-based WHODAS scale also helps.
VR should be a natural constant part of our training and practice. This way we may correct a bias existing in our speciality. A bias of partially understanding the concept of functioning.