Competencies and core skills

Guidelines on the professional competencies and core skills required to deliver supervised phase III exercise programmes are provided in other countries, for example, the Australian and American Guidelines (Southard, et al., 1994; Goble and Worcester, 1999; ACSM, 2000; American Physical Therapy Association, 2003; AACVPR, 2004). However, there has been limited work in the UK on describing either the role or functions of CR health professionals or their competencies, qualifications and continuing professional development and the education they require. Under the auspices of Skills for Health and the Knowledge Skills Framework (2004) there is increasing acknowledgement of the need for competency-based programmes for health professionals. However, it is generally accepted that all members of the CR team should hold a recognised qualification, i.e. diploma/degree. Most nurses coming into the speciality would ideally have done so via coronary care or similar background. In most countries the minimum requirement to work in the speciality would be attendance at a short course in CR, many of which are delivered by specific interest groups and professional associations, i.e. BACR. Numerous UK academic institutions now offer modular courses appropriate for CR professionals up to Masters level.

A small survey of phase III CR physiotherapists in the West of Scotland (Thow, et al., 2003) defined some aspects of the physiotherapist's professional role. It established that, in addition to cardiac assessment and exercise prescription responsibilities with patients, the physiotherapists had a considerable role in managing, modifying, advising and educating patients with associated non-cardiac physical conditions affecting their exercise programme. Thow, et al.'s (2003) study focused only on the phase III exercise aspect by the physiotherapists. There is a need to expand this study and to incorporate the other professionals involved in CR. The Association of Chartered Physiotherapists Interested in Cardiac Rehabilitation (ACPICR, 2005) is currently developing a competency document for physiotherapists, with guidelines for their role and required knowledge, skills and standard of performance.

A UK survey carried out by Bethell, et al. (2001) identified nurses and physiotherapists as the two largest professional groups represented in phase III exercise CR (82% and 76% respectively). There are now significant numbers of exercise physiologists, sports scientists and BACR phase IV accredited exercise instructors (BACR, 2002; Turner, 2005, personal communication) involved in delivering phase IV exercise programmes. Given the broad range of exercise professionals working in the multi-disciplinary team, definition of individual professional competencies and the complementary roles and responsibilities within the CR team in the UK is required.

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