Supporting a Medical Professional with Brain Injury

Vocational Rehabilitation in action. 

Member spotlight - Case Study 

By: Spencer Rathborne - Vocational Rehabilitation Consultant (IRCM registered) at SR Vocational Rehabilitation Ltd. 

Supporting a Medical Professional with Brain Injury

Background

A medical student sustained a moderate to severe traumatic brain injury (TBI) following a road traffic collision, alongside orthopaedic injuries. Prior to the injury, the client was progressing through medical school with the goal of becoming a practicing doctor and had completed year five of his seven-year medical degree.

Following the injury, the client experienced significant challenges completing medical school and transitioning into a Foundation Year 1 training post within a highly complex and demanding profession. A Vocational Rehabilitation Consultant (VRC) was instructed as part of a multidisciplinary team (MDT) to support progression through education and into work.

Challenges

Despite presenting as articulate and capable, the client experienced significant hidden difficulties including:

• Executive dysfunction impacting planning, initiation, and organisation
• Cognitive fatigue affecting consistency and endurance
• Difficulties with attention, memory, and self-monitoring
• Emotional regulation challenges and reduced confidence
• Anxiety, social communication difficulties, and auditory processing disorder

The demands of medical training and clinical work created additional barriers, including:

• Navigating complex professional and regulatory systems
• Accessing and maintaining reasonable adjustments
• Inconsistent working environments and expectations
• Limited ability to advocate effectively for support

These challenges raised concerns regarding both sustainability and safe clinical practice.

Vocational Rehabilitation Interventions

A structured and collaborative approach was implemented, with a strong focus on advocacy, coordination, and risk management.

Education and Adjustment Planning

• Extensive support throughout medical school, including attending meetings with medical educators, mentors, and Occupational Health
• Liaison with the university disability team to develop a Summary of Reasonable Adjustments (SoRA) outlining required supports
• Ongoing review and adaptation of adjustments in line with training demands

Advocacy, Risk Management and System Navigation

• Liaison with universities, hospital trusts, Occupational Health, and training bodies
• Securing and maintaining reasonable adjustments across settings
• Supporting disclosure of needs and ensuring consistency of support
• Working with the MDT to raise and address safeguarding and patient safety concerns within the NHS where appropriate

Practical and Executive Support

• Breaking complex tasks into manageable steps
• Ongoing scaffolding to support organisation, planning, and follow-through
• Monitoring deadlines and supporting effective communication
• Implementing adjustments to hours, working patterns, and duties, ensuring work was appropriately supervised and carried out safely
• Securing exam access arrangements and reasonable adjustments including additional time for clinical examinations (e.g. OSCEs) and situational judgement tests. 

Safe Transition to Employment

• Support progressing from medical school into foundation training
• Negotiation of adjustments, including reduced hours and modified duties
• Identification of an alternative hospital placement when the original setting was unable to safely support the client

This was a critical intervention to ensure the client could continue training within a safe and appropriately supported environment.

MDT Collaboration

• Ongoing coordination with the wider therapy team 
• Alignment of vocational goals with clinical rehabilitation
• Responsive input at key points of risk

Workplace Integration and Support

As the client progressed into clinical training, ongoing input was required to manage increasing demands, including:

• Liaison with supervisors and Occupational Health teams
• Monitoring performance, fatigue, and wellbeing
• Supporting engagement in reviews and key meetings
• Ensuring adjustments were maintained across rotations

Each placement required renewed coordination to ensure the working environment remained appropriate, consistent, and safe

Outcomes

With sustained vocational rehabilitation input, the client successfully completed medical school and progressed through Foundation Year 1 training.

However, it became evident that progression into Foundation Year 2 was unlikely to be sustainable in the longer term. The VRC therefore worked with the client to explore alternative vocational pathways, identifying roles that would utilise his transferable skills while reducing clinical risk.

This included supporting transition towards a non-practising clinical role, allowing the client to retain his professional identity and registration as a doctor while aligning with his functional capacity.

The intervention enabled the client to:

• Access and sustain appropriate support across education and employment
• Make informed decisions regarding long-term career direction
• Maintain confidence in his skills and professional identity
• Transition towards a more sustainable vocational pathway

The client described the support provided as “invaluable”, highlighting the impact of consistent advocacy, clear communication, and structured guidance.

Conclusion

This case highlights the importance of specialist vocational rehabilitation in supporting individuals with brain injury within complex and high-risk professional environments.

The success of this intervention was underpinned by:

• Extensive support during education, including formal adjustment planning (SoRA)
• Effective identification of safe and appropriate work environments
• Structured support for executive functioning difficulties
• Active management of risk, including safeguarding considerations
• Consistent advocacy across multiple organisations
• Timely support with vocational redirection

It demonstrates that, with appropriate support, individuals with significant dysexecutive presentations can progress within highly skilled careers, while also being supported to adapt their vocational goals to ensure long-term safety and sustainability.

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