Advancing Academic Capacity in Physical and Rehabilitation Medicine to Strengthen Rehabilitation in Health Systems Worldwide

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Rehabilitation is the health strategy of the 21st century.1,2 In retrospect, the 19th century was the century of prevention, resulting in an almost doubling of life expectancy by improving the availability of clean water, sewage, sanitation, vaccination, and nutrition and making these services available to the entire population in developed countries. The 20th century added additional years of life with emergency services and surgery leading to increased survival of previously lethal injuries, pharmacological treatments including antibiotics, immune suppressants, and cancer treatments that turned previously major infectious conditions such as HIV and a range of cancers into chronic diseases. The challenge of the 21st century is now to optimize functioning in people with acute and chronic conditions and aging—“adding life to years.” According to the World Health Organization’s (WHO) global estimates of the need for rehabilitation based on the global burden of diseases study of 2019,3 2.41 billion individuals live with conditions that can benefit from an improvement in functioning by means of rehabilitation. To address the universal need for rehabilitation for people living with functioning limitations, the WHO in 2017 launched the call for action Rehabilitation 2030. Keys to the successful strengthening of rehabilitation in health systems worldwide are (1) the mainstreaming of rehabilitation as a public health strategy under universal health coverage, (2) the integration of systematically collected functioning information into health information systems, and (3) the demonstration of the social return on investment of rehabilitation.4 The European Academy of Rehabilitation Medicine (EARM) has recently discussed the implications of the emergence of rehabilitation as a public health strategy at center stage for shaping the health systems of the 21st century.5 This included a recognition of the need to “think outside of the box” of our medical specialty and engage in health systems thinking. Toward this goal, the first fellow of the EARM has developed a policy framework “Supporting government policies to embed and expand rehabilitation in health systems in Europe: a framework for action.”6 In light of this framework, it is clear that it is the responsibility of academic organizations—in Europe the EARM, in the United States, the Association of Academic Physiatrists (AAP), and internationally the International Society of Physical and Rehabilitation Medicine (ISPRM)—to help develop the workforce needed to expand and strengthen the quality of rehabilitation services. To achieve these related goals, it is essential to enhance academic capacity in universities and academic departments and to have the support of nonacademic professional organizations. Beyond the classical triad of the medical profession in research, education, and clinical practice, academic capacity also entails academic leadership and academic career development. Figure 1 illustrates the various factors that influence academic capacity in PRM.FIGURE 1: Factors influencing the development of academic PRM.Building academic capacity can also benefit capacity building outside of the medical specialty of physical and rehabilitation medicine (PRM; also known in some countries as physical medicine and rehabilitation [PM&R] or rehabilitation medicine [RM]). The EARM, AAP, and ISPRM, working in concert, aim to contribute to the strengthening of rehabilitation in global health systems in response to the WHO’s Call for Action by means of a joint effort to advance academic capacity in Europe, the United States, and countries worldwide. The objective of this document is to develop a common understanding of academic capacity in PRM from different perspectives and grounded in experience that demonstrates that the best foundation for strengthening academic capacity for rehabilitation is strengthening it for the underlying medical foundation. We discuss some of the most important aspects of advancing academic capacity in an attempt to inform younger professionals thinking about a career in academics, professional societies that could include advancing academic capacity in their mission, and policymakers whose decisions can make a substantial difference in setting priorities and allocating resources. The Importance of Promoting PRM as a Medical Specialty to Strengthen Rehabilitation in Health Systems Worldwide Although all health strategies have functioning as the eventual objective, the primary and defining aim of rehabilitation is to optimize functioning.7–9 The complex nature of PRM as a discrete medical specialty, and the challenge that it creates academically, can be addressed more effectively given our understanding of the scope and aim of rehabilitation. This can inform the task of developing and sustaining academic capacity for PRM research and clinical practice and ultimately for academic leadership and career development. As mentioned previously, more than 2.4 billion individuals can potentially benefit from rehabilitation,3 and these individuals experience a vast range of physical and mental health conditions (permanent or temporary)—as well as the natural reduction of functioning associated with the aging process. From a life-course perspective, in short, everyone is a beneficiary of PRM. This wide range of beneficiaries and underlying health conditions, however, requires an equally wide range of competencies and skillsets for the PRM physician (also known as physiatrists). Moreover, although discrete, and in that sense specialized, PRM is also an inherently collaborative area of medicine. Physical and rehabilitation medicine physicians work with other medical specialists and adopt techniques usually associated with the promotive, preventive, and even curative health strategies to best serve their patients. Physical and rehabilitation medicine physicians can also contribute to public health by implementing rehabilitation strategies, such as the promotion of exercise, at the level of the population. From the point of view of academics, this feature of PRM presents the challenge: as the essential core competencies of PRM are developed to a professional standard, the invaluable collaborative linkage with other areas of medicine must be forged to create a synergetic unity both in teaching, clinical practice, and research. Furthermore, a strong collaborative association with other rehabilitation professionals creates an important synergy that benefits students, trainees, and patients. Given the daunting range of health conditions during the course of which rehabilitation services can be beneficial to the well-being of patients, PRM clinical education and training must draw upon a substantial medical knowledge base derived from scholarly activity and scientific research. For its part, PRM research is inherently, not merely multidisciplinary, but interdisciplinary. To secure the collaborative outcome, it draws in results across scientific disciplines—not only biomedical but also biomechanical, and social—and integrates these to create an evidence base that is relevant to the practice of PRM. The Long-Term Perspective: Academic Careers in PRM The Academic Lifecycle It is important to take a long-term perspective when thinking about a career in academic PRM.5 An academic career is divided into several phases, and each has different requirements. The best opportunity to start thinking about an academic career in PRM is in medical school or residency training, an ideal time to explore the two fundamental activities of an academic career: research and education. Universities and academic medical centers are typical workplaces for those interested in an academic career. These environments are characterized by the search for excellence, where the very best clinicians, physician-scientists, and educators work, learn, and share their ideas. The various stages of an academic career can be briefly described as fol

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