# data[].attributes.headline
A1: You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

# data[].attributes.subject
A1: You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

# data[].attributes.body
WHAT?

During a clinic session in my third year of university, I treated a patient presenting with persistent neck pain. The patient strongly believed their symptoms were due to poor posture from their job as a desk worker and insisted that massage would be the only effective treatment. As a student, I had recently been exploring the biopsychosocial model and the role of stress in chronic pain, and initially felt conflicted between following the patient’s request and applying broader clinical reasoning. I decided to listen carefully, validate the patient’s perspective, and ask open-ended questions to better understand their experience. This opened up a productive dialogue where we co-created a management plan combining soft tissue work with stress-reduction strategies and ergonomic advice.

SO WHAT?

This experience highlighted the importance of truly listening to the patient’s understanding of their condition and not rushing to assert my clinical perspective. Respecting the patient’s views helped build trust and foster a collaborative therapeutic relationship, which I noticed enhanced compliance and engagement. It also helped me recognise my own biases — I was eager to demonstrate new knowledge, but risked overlooking what mattered most to the patient. This reinforced the principle that clinical effectiveness is often rooted in patient-centred care, where both practitioner and patient perspectives are integrated.

NOW WHAT?

Going forward, I will continue to use active listening techniques, such as reflective summarising and open-ended questions, to better understand the patient’s narrative. I intend to use shared decision-making consistently and be mindful not to let academic enthusiasm override patient priorities. I plan to revisit and reflect on patient feedback in my e-portfolio to track how effectively I’m applying patient-centred communication, particularly in managing patient expectations. Additionally, I will seek peer and tutor feedback in clinic to refine these interpersonal skills.

# data[].attributes.headline
C1: You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

# data[].attributes.subject
C1: You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

# data[].attributes.body
WHAT?

Throughout the 4 years of studying at the European School of Osteopathy, I was constantly taught how to safely evaluate a patient during the case history. This meant I had to constantly review red flags for presenting complaints and be able to identify them early into the appointment. By completing the case history, it allows me to gain an overview of the patient and how I should treat them. All treatment is tailored to each patient and is always different, however during out technique lessons we are able to identify when to use certain techniques and when not to use them.

SO WHAT?

By taking the time to evaluate patients carefully to make sure they are safe, I am able provide them with the best care possible and get them on their journey back to recovery. If I do flag up a potential risk with the patient, I am sure to explore it further and make a decision whether to treat then or refer them to another healthcare practitioner.

NOW WHAT?

I will carry on to make sure I am doing a detailed case history for my patients so that I can identify any potential red flags. I will continue to improve on how I ask my question or when to ask questions so that I can make the case history process more enjoyable and effective for the patient.

# data[].attributes.headline
A2: You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

# data[].attributes.subject
A2: You must work in partnership with patients, adapting your communication approach to take into account their particular needs and supporting patients in expressing to you what is important to them.

# data[].attributes.body
WHAT?

In a third-year clinic session, I explained a treatment plan to a patient with chronic lower back pain. I used a lot of technical terms and noticed the patient seemed confused and disengaged. Realising this, I simplified my language and used visual aids to explain the diagnosis and proposed treatment more clearly.

SO WHAT?

This experience highlighted how crucial it is to adapt my communication to the patient’s level of understanding. By doing so, the patient became more engaged and asked more questions, which helped build trust and made them more comfortable with the treatment plan.

NOW WHAT?

I now aim to use Layman's terms and confirm understanding using teach-back techniques. I’ll continue developing these skills through feedback in clinic and reflecting on patient interactions in my e-portfolio.

# data[].attributes.headline
A3: You must give patients the information they want or need to know in a way they can understand.

# data[].attributes.subject
A3: You must give patients the information they want or need to know in a way they can understand.

# data[].attributes.body
WHAT?

In my final year of clinic, I treated a patient experiencing chronic shoulder pain. During the consultation, they asked whether they should get an MRI to check if something serious was going on. I recognised their anxiety and used this opportunity to explain, in simple terms, when imaging can be helpful and when it might not provide useful information. I talked about how scans can sometimes show normal age-related changes that don’t relate to the pain, which can actually lead to more worry. We discussed the treatment options available in clinic and what indicators might suggest imaging would be necessary in future. I made sure they had time to process the information and ask questions before deciding to start with conservative care.

SO WHAT?

This situation helped me understand the importance of providing balanced, understandable information so patients can make informed decisions. It reinforced the value of shared decision-making, particularly in helping patients feel heard, respected, and in control of their care. I realised that it’s not just about giving facts — it’s about guiding patients through their choices in a way that builds trust and supports their autonomy. The patient left feeling reassured and comfortable with their decision to begin treatment.

NOW WHAT?

In future practice, I’ll continue to use patient-friendly explanations, especially when discussing investigations or treatment choices. I want to ensure that patients feel empowered rather than overwhelmed. I’ll also aim to improve how I check for understanding and will seek feedback from supervisors to make sure I’m supporting informed decision-making effectively.

# data[].attributes.headline
A4: You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

# data[].attributes.subject
A4: You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

# data[].attributes.body
WHAT?

In a third-year clinic session, I was treating a new patient with mid-back pain. After taking the case history, I prepared to begin some thoracic spine articulation. I explained what I was planning to do and asked if they were happy to proceed. The patient nodded, but I sensed some hesitation in their body language. I paused and asked if they had any concerns. They admitted they weren’t sure what the technique involved and were worried it might hurt. I then explained the technique more clearly, demonstrated it with my hands away from the body, and reassured them that they could stop at any time. After that, they agreed to continue, visibly more relaxed.

SO WHAT?

This experience made me realise that gaining consent isn’t just a box to tick — it’s an ongoing conversation. It showed me how important it is to look beyond verbal agreement and be alert to non-verbal cues. If I hadn’t picked up on the patient’s hesitation, I might have caused discomfort or lost their trust. Taking that extra moment to check in and explain things properly helped build confidence and made the treatment more effective.

NOW WHAT?

I’ve learned to always explain what I’m doing in plain language and check for understanding, especially when using new techniques. I’ll continue to observe body language closely and invite questions before and during treatment. I want to make consent feel like a partnership rather than a formality, and I’ll keep refining this by reflecting on patient responses and seeking guidance from clinic tutors.

# data[].attributes.headline
A5: You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

# data[].attributes.subject
A5: You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

# data[].attributes.body
WHAT?

I treated a patient with recurrent low back pain linked to a sedentary lifestyle and poor posture at work. During the appointment, I focused not only on hands-on treatment but also took time to discuss simple self-care strategies. We spoke about regular movement breaks, desk setup, and basic stretches they could do at home. I demonstrated a few exercises and checked they felt confident doing them. I also encouraged them to track how they felt after trying the advice, so we could review it together at the next appointment.

SO WHAT?

This encounter helped me see how valuable it is to involve patients in their own recovery. While manual therapy can offer short-term relief, empowering patients with tools to manage their own health makes a longer-term difference. I noticed that when patients understand how their habits contribute to their symptoms — and feel capable of making changes — they become more engaged and motivated. Supporting self-care also helped me shift from being the “fixer” to more of a guide in the process.

NOW WHAT?

I’ll continue to focus on patient education and self-management strategies in every treatment plan. I’ll aim to tailor advice to each patient’s lifestyle and ability, and always check they feel confident to follow through. I also plan to expand my knowledge of exercise prescription and motivational communication so I can better support behavioural change in future practice.

# data[].attributes.headline
A6: You must respect your patients’ dignity and modesty.

# data[].attributes.subject
A6: You must respect your patients’ dignity and modesty.

# data[].attributes.body
WHAT?

During an appointment with a female patient with hip pain, the examination required assessing her lower back and pelvic area. I initially asked her to undress down to her underwear behind the curtain, but I realised I hadn’t fully explained why this was necessary or checked if she felt comfortable with that. She hesitated and asked if she could keep her leggings on. I reassured her that we could absolutely adapt the assessment, and I modified my approach to work around her clothing while still gathering the information I needed.

SO WHAT?

This moment really stayed with me because it highlighted how important it is to actively protect a patient’s dignity, not just physically, but emotionally too. I had assumed the standard procedure would be fine, but every patient is different. By giving her options and responding to her concerns, I preserved her comfort and trust. It reminded me that modesty is about how the patient feels in the moment.

NOW WHAT?

I now make a point to explain clearly what each part of the exam involves and always offer options — like adjusting clothing or using a towel for draping. I’ve also learned to check in regularly during treatment to make sure patients feel safe and respected. Going forward, I want to be even more proactive in creating a space where patients feel in control, especially during sensitive assessments.

# data[].attributes.headline
A7: You must make sure your beliefs and values do not prejudice your patients’ care.

# data[].attributes.subject
A7: You must make sure your beliefs and values do not prejudice your patients’ care.

# data[].attributes.body
WHAT?

I treated a patient who had very different health beliefs from my own. They were strongly focused on alternative healing practices and had certain expectations that didn’t align with evidence-based osteopathic care. Initially, I found it challenging not to let my personal views influence the interaction. However, I reminded myself that my role was to listen, remain neutral, and provide the best possible care within my scope. I focused on building rapport, respectfully exploring their expectations, and clearly explaining what I could offer as an osteopath, without dismissing their beliefs.

SO WHAT?

This experience helped me reflect on the importance of separating my own beliefs from my clinical role. If I had allowed my bias to show, it could have damaged trust and affected the therapeutic relationship. By being open-minded and respectful, I was still able to work with the patient to create a plan that they felt comfortable with, and that stayed within professional boundaries.

NOW WHAT?

Moving forward, I’ll stay aware of my own values and how they might affect interactions. I’ll continue to practise being present and respectful with all patients, regardless of personal differences. I plan to reflect more deeply on these experiences and seek supervision when I find myself struggling with potential bias, so I can continue growing as a fair and inclusive practitioner.

# data[].attributes.body
As part of our 4 year degree, for the 3rd and 4th years we enter a student clinic treating real patients. For our first new patient in the clinic we get a lot of support from the clinic tutor throughout the appointment. For my first appointment I felt very anxious and the appointment did not run very smoothly. I was not very thorough with my questioning which didn't help to put my patient at ease. After discussing the case with my tutor we suspected the patient may be suffering from polymyalgia rheumatica (PMR). Which is a condition I didn't know in a lot of detail. I had to refer this patient off to their GP to have blood tests done. For this we have to write a referral letter. Having never done this I didn't know where to start but my tutor talked me through the entire process. Following this appointment I made sure I was confident in writing referral letters for myself and worked on making the questioning part of the appointment run a lot smoother than it did this first time.

# data[].attributes.headline
B1: You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

# data[].attributes.subject
B1: You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

# data[].attributes.body
WHAT?

During 4th year, we had to do a presentation about a diagnosis of our choice. I picked Sub-acrominal Pain Syndrome (SAPS). We had to research how it is diagnosed, what gets affected and what the treatment outcomes are. This was then presented to an examiner for 15 minutes and then answered any questions at the end. I ended up passing this exam, but it was also a very important task as this new information had helped me adapt my treatment to patients who suffered with SAPS.

SO WHAT?

Doing this research has opened my eyes to the amount of treatment pathways I can go down. This ensure that I am providing the best care possible for my patients and keeping up to date with any new information that comes out.

NOW WHAT?

I will carry on doing this for many different diagnoses to make sure that my knowledge is up to date and I am ready to provide my patients with the best care possible. The research will also allow me to identify when to seek help from other healthcare professionals.

# data[].attributes.headline
B2: You must recognise and work within the limits of your training and competence.

# data[].attributes.subject
B2: You must recognise and work within the limits of your training and competence.

# data[].attributes.body
WHAT?

During my first ever clinic session, I had a patient that presented with pain in stiffness in multiple joints that started 2 weeks ago and was getting worse. This made me feel anxious because I knew this wasn't a musculoskeletal issue but I could not identify what was going on. Luckily my tutor stepped in and helped me out with this patient.

SO WHAT?

This allowed me to further expand my knowledge on what to do as an Osteopath and how to deal with referring patients to other healthcare specialists so that the patient can recieve the best care possible for their issues.

NOW WHAT?

Going forward now, I am able to triage a patient to ensure I am dealing with a MSK issue. By doing so I am keeping myself safe as well as the patient.

# data[].attributes.headline
B3: You must keep your professional knowledge and skills up to date.

# data[].attributes.subject
B3: You must keep your professional knowledge and skills up to date.

# data[].attributes.body
WHAT?

I attended a sports massage course in year 2 where we covered a wide range of soft and deep tissue techniques as well as muscle energy techniques. Since doing this course I have been able to integrate more techniques during my treatments in clinic. It has also helped me understand that different patient will require different techniques and I had to adjust and tailor to the patient how the technique was performed. This overall has massively helped me improve as an osteopath and how I see patients and what techniques to use.

SO WHAT?

By attending this course, I was able to perform a variety of different techniques tailored to their needs. This really helped me excel through the course of treating patients at the ESO clinic and have achieved many positive results.

NOW WHAT?

In the future I will attend many more courses like this which would help extend my knowledge and also help my patients out more. This will be done through CPD courses and will be tracked on a separate document to ensure I am meeting my hours required.

# data[].attributes.headline
B4: You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

# data[].attributes.subject
B4: You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

# data[].attributes.body
WHAT?

In my third year, I treated a patient with non-specific lower back pain. I used a combination of soft tissue work and joint articulation, which initially seemed to help. However, after two sessions, the patient reported no lasting improvement. I felt unsure whether my treatment plan was truly appropriate. I reviewed my notes, re-read the case, and discussed it with a clinic tutor. Through that feedback, I realised I hadn’t explored the psychosocial aspects of the case or considered how the patient’s high levels of work stress could be influencing their symptoms. I revised my approach and incorporated advice on movement, posture, and stress management techniques, alongside continued manual therapy.

SO WHAT?

This case taught me that reflecting on the information I receive, both clinical findings and the broader context of the patient’s life, can reveal key insights that improve outcomes. Without that reflection and feedback, I might have continued a narrow treatment path that wasn’t addressing the root causes. It made me more aware that effective care isn’t just about technique, but also about looking at the whole picture and staying curious about what else might be going on.

NOW WHAT?

Going forward, I’ll make it routine to review complex cases more critically, both through self-reflection and discussion with peers or tutors. I’ll also keep refining my ability to pick up on psychosocial cues and how they affect physical health. I plan to keep a regular reflective diary to track how well I’m integrating this approach into my practice and will use it to inform future learning goals.

# data[].attributes.headline
C2: You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

# data[].attributes.subject
C2: You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

# data[].attributes.body
WHAT?
At the ESO teaching clinic, we use different types of forms depending on whether a patient is new or returning. The new patient form is more detailed, allowing us to gather extensive information about their medical history, symptoms, and any red flags. It also includes a section to list and justify differential diagnoses based on the examination findings. We then record the working diagnosis, the type of treatment delivered, and the patient’s response to it. For returning patients, we use a more concise double-sided A4 form. It allows us to follow up by asking how they felt after the previous appointment, and whether their symptoms have changed. This process helps assess whether the treatment was effective and if the working diagnosis still holds. After every appointment, the completed form is stored in the patient’s file.

SO WHAT?
This system has helped me understand the importance of detailed and timely record-keeping. Accurate documentation not only protects the patient but also supports my clinical reasoning. When reviewing previous notes, I’ve been able to identify patterns in patient responses that I might have missed otherwise. On a few occasions, a patient’s feedback about their response to treatment made me reconsider the effectiveness of my approach, prompting me to re-evaluate the working diagnosis and adapt my technique. These reflections showed me that good record-keeping isn’t just an administrative task — it’s a clinical tool that supports safe, consistent and evolving care.

NOW WHAT?
Going forward, I will continue to ensure that all my notes are detailed, legible, and written up promptly after each session. I’ll also make a conscious effort to reflect on what the records are telling me about the patient’s progress — rather than seeing documentation as separate from the treatment process. I aim to improve how I justify my differential diagnoses and clearly record my reasoning, so that my notes reflect the full clinical picture. This will help me provide better care, and also demonstrate professional accountability.

# data[].attributes.headline
C3: You must respond effectively and appropriately to requests for the production of written material and data.

# data[].attributes.subject
C3: You must respond effectively and appropriately to requests for the production of written material and data.

# data[].attributes.body
WHAT?
At the ESO clinic, I’ve been involved in writing referral letters and patient summaries when required, especially when a case needs input from another healthcare professional. One of the first times I was asked to write a letter, I underestimated how challenging it would be to summarise complex clinical information in a concise, clear and professional way. I found myself including too much detail and struggling to strike the right tone. My tutor provided detailed feedback and helped me focus the letter on the essentials: clinical findings, working diagnosis, and the reason for referral. I also learned that any communication must align with my level of training, avoiding speculation or medical terminology outside of my scope. The process included multiple revisions, tutor review, and administrative steps before the letter was finalised and sent out appropriately.

SO WHAT?
This experience highlighted that written communication in healthcare is just as important as verbal communication. Producing clear, accurate written material is vital to patient safety and inter-professional collaboration. A poorly written letter could cause confusion or delay treatment. I realised that these documents represent not only my clinical reasoning but the professionalism of the clinic and the osteopathic profession. Being trusted with this responsibility showed me how critical it is to be thorough, structured, and professional in all written documentation. I also recognised the importance of responding to these requests in a timely and well-organised manner to avoid delaying the patient’s care.

NOW WHAT?
As I progress into professional practice, I will continue to develop my written communication by seeking feedback on referral letters, patient reports, and treatment summaries. I plan to review examples of high-quality letters and refine my ability to be concise while covering all clinically relevant points. I’ll also stay up to date with record-keeping standards and data protection protocols to ensure compliance and confidentiality. Written material plays a central role in patient continuity of care, and I aim to make every written communication I produce a reflection of safe, effective, and collaborative practice.

# data[].attributes.headline
C4: You must take action to keep patients from harm.

# data[].attributes.subject
C4: You must take action to keep patients from harm.

# data[].attributes.body
WHAT?

Before being able to treat at the ESO clinic, it is mandatory that you complete a First Aid course. Basic First Aid is taught and this is important to know. At the ESO clinic we see many types of patients and it is important that we know what to do in case of an emergency. The patients safety is the most important thing and we need to stay up to date with the first aid.

SO WHAT?

Having completed this, I feel confident that I would be able to help a patient in distress and be in control. I must also be sure to stay calm and collected so that the patient does not get anymore stressed.

NOW WHAT?

I feel confident in my own abilities that i would be able to take care of a patient in an emergency. This is important because in practice, you are not always with someone else so knowing first aid is really beneficial.

# data[].attributes.headline
C5: You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

# data[].attributes.subject
C5: You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

# data[].attributes.body
WHAT?

To minimise infection risk during the COVID-19 pandemic, the Institute of Osteopathy (2021) published recommendations in line with public health guidance. These included the use of fluid-resistant surgical masks (IIR), single-use gloves and aprons, and visors where needed. At the ESO clinic, many of these practices were implemented effectively. Although I didn’t personally agree with every single measure, I understood they were there to protect both practitioners and patients. I always followed the rules: I kept windows open during treatments (or aired the room immediately after if patients were cold), disinfected the couch, pillows, and all surfaces after each session, and disposed of waste correctly. Even as the guidelines changed and full PPE became optional, I chose to continue wearing a mask, especially during face-to-face techniques, as I still felt some anxiety about close contact.

SO WHAT?

This experience helped me recognise how infection control is not just a policy but an essential part of professional responsibility. Even when I felt conflicted about certain protocols, I understood the importance of protecting others and maintaining trust in the clinical environment. It also made me more aware of my own boundaries and how to manage them respectfully within professional settings. I learned to balance my own comfort with patient needs, for example, by airing the room between appointments if it was too cold for a patient during treatment. These habits became second nature and reinforced the importance of consistency in maintaining high hygiene standards.

NOW WHAT?

Moving forward, I will continue to prioritise cleanliness and patient safety, even as public health guidance evolves. I plan to stay updated with future infection control protocols and remain flexible in adapting my practice accordingly. I’ve also realised the importance of self-awareness in clinical decision-making, such as acknowledging my own comfort levels with close contact and making appropriate adjustments without compromising care. I will carry these principles into private practice, ensuring that hygiene and safety are integral parts of the therapeutic environment I provide.

# data[].attributes.headline
C6: You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

# data[].attributes.subject
C6: You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

# data[].attributes.body
WHAT?
During a fourth-year clinic session, I was treating a patient for ongoing neck and shoulder pain. Although the manual therapy techniques helped reduce their discomfort short-term, the symptoms kept returning. Through conversation, it became clear the patient’s job involved high stress and long hours at a desk with poor posture. I realised that to genuinely support their health, I needed to go beyond just physical treatment. I spent time discussing their daily routine, offering simple postural changes, encouraging regular movement, and suggesting stress-reducing activities like walking or stretching breaks. We also spoke about sleep quality, hydration, and screen use in the evenings.

SO WHAT?
This interaction highlighted the importance of recognising the wider context of a patient’s life and how lifestyle factors contribute to their overall wellbeing. I began to understand that my role as an osteopath goes beyond treating pain — it includes educating and empowering patients to take control of their health. It also showed me that patients appreciate when you consider their broader health, not just their presenting complaint. This conversation shifted the therapeutic relationship from passive treatment to active self-management, which improved the patient’s engagement and outcomes.

NOW WHAT?
I now see every consultation as an opportunity to support wider aspects of health — even in small ways. I’ll continue to explore lifestyle and occupational factors during case histories and reflect on how these might influence symptoms and recovery. I aim to improve my ability to give practical, tailored advice that patients can realistically apply to their lives. I also plan to attend CPD workshops on lifestyle medicine and behaviour change so I can feel more confident supporting long-term wellbeing. Helping patients develop better habits is as important as the treatment itself — and something I want to embed into my practice going forward.

# data[].attributes.headline
D1: You must act with honesty and integrity in your professional practice.

# data[].attributes.subject
D1: You must act with honesty and integrity in your professional practice.

# data[].attributes.body
Experience:
As part of my osteopathy training at the European School of Osteopathy, I have learned many treatment styles, including cranial techniques. I tend to use cranial treatment with patients who are very stressed or anxious, as it helps them calm down and feel more like themselves again. I always explain to patients what techniques I will use and how these might affect their body, and most patients seem to understand. Although cranial treatment is not strongly supported by research evidence, I have seen many patients benefit significantly. When patients have questions, I do my best to answer them clearly.

When treating babies, it is important to be very gentle and careful, which is why cranial treatment is often my go-to style. However, this can sometimes lead to uncertainty or skepticism from parents who are unfamiliar with this type of treatment or unsure about its effects.

One particular experience involved treating a baby where, after the first session, I could feel a notable release of tension. However, the parents initially stated that their baby seemed no different and believed the treatment had no effect. This put me in a challenging position where I needed to explain to the parents what I had felt during the treatment compared to before. After a few more treatments, the parents returned extremely happy and reported that their baby’s behaviour had changed positively, crying less and appearing calmer.

Reflection:
This experience made me feel very happy and fulfilled because the parents were finally able to see and appreciate the benefits of the treatments I had provided. However, it also highlighted the importance of clear communication. I realised that my explanations to parents (and patients in general) could be improved, especially in terms of simplifying the language I use to describe what I feel during treatment and how the treatment works. I understood that some people may not be familiar with cranial osteopathy or may be skeptical, so it is crucial to convey information in a way that is accessible and reassuring.

Action:
In the future, I will work on how I verbalise my observations and explanations during treatment, aiming to use language that anyone, regardless of their prior knowledge, can understand. I plan to develop my communication skills further so that I can better manage parents' expectations and concerns, especially when working with babies. This will help build trust and improve the overall treatment experience for both patients and their families.

# data[].attributes.headline
D2: You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

# data[].attributes.subject
D2: You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

# data[].attributes.body
WHAT?
In my third year of clinic, I treated a patient who was friendly and talkative. Over several sessions, our rapport developed quickly, and conversations occasionally drifted into more personal territory, including shared interests outside of clinic. Although the atmosphere remained professional, I began to question whether the tone was becoming too informal. I noticed that the patient started arriving a little early and lingering after sessions to chat. While I didn’t feel uncomfortable, I reflected that the dynamic had subtly shifted and that I needed to re-establish clearer professional boundaries.

SO WHAT?
This experience helped me understand how easily boundaries can blur, especially when rapport is strong. While connection is important in therapeutic relationships, maintaining professional distance is essential to protect both the patient and myself. I realised that allowing conversations to become too personal can unintentionally lead to expectations beyond the scope of treatment. It also highlighted my responsibility to set the tone of the interaction and to maintain focus on clinical goals. Most importantly, it reminded me that trust in the practitioner-patient relationship must be built on respect, safety, and clarity, not familiarity.

NOW WHAT?
Since then, I’ve been more mindful of maintaining clear boundaries in every interaction. I make a conscious effort to keep conversations patient-focused while still being warm and empathetic. If I feel the tone shifting, I now use subtle strategies to redirect the discussion toward treatment or progress. I’ve also reviewed guidance on professional boundaries and discussed this situation with tutors to gain further insight. In future practice, I’ll continue to reflect on my interactions and seek support if I ever feel uncertain. Protecting boundaries is part of maintaining professionalism and safeguarding the therapeutic space.

# data[].attributes.headline
D3: You must be open and honest with patients, fulfilling your duty of candour.

# data[].attributes.subject
D3: You must be open and honest with patients, fulfilling your duty of candour.

# data[].attributes.body
WHAT?

As part of the consultation process, I understand that I must clearly explain my working diagnosis to the patient. This includes any changes to the diagnosis during the course of treatment. However, I’ve noticed that on some occasions, particularly when I’m unsure of how to phrase it, or if I’m not confident in what I want to write, I have avoided explaining the diagnosis altogether. I’ve also had the impression that some patients weren’t particularly interested or didn’t realise that I was giving them a formal diagnosis. When I do explain it, I often feel uncomfortable, especially when the terminology sounds more serious than the condition actually is.

SO WHAT?

This reflection has made me realise that avoiding or softening the diagnosis, even unintentionally, undermines the principle of informed consent and transparency. Whether or not a patient appears interested, I have a professional duty to be clear and honest about what I believe is going on. It also highlighted that my discomfort is likely tied to my confidence, both in my diagnostic reasoning and in my communication skills. Patients have the right to understand their condition and be fully involved in decision-making. By not sharing a diagnosis clearly, I could be preventing that from happening. It also poses a risk to trust and professional credibility.

NOW WHAT?

Moving forward, I will prioritise explaining my working diagnosis to every patient, even if I feel uncertain. I will work on improving how I communicate diagnoses by using language that is clear, accurate, and non-alarming. I plan to practise these conversations with peers or tutors, and seek feedback on how I phrase things. I’ll also review how I document and present diagnoses to help build my own confidence and ensure consistency between what I write and what I say. Upholding the duty of candour is essential to ethical practice, and I now recognise this as an area I am actively committed to improving.

# data[].attributes.headline
D4: You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

# data[].attributes.subject
D4: You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

# data[].attributes.body
WHAT?
During my time in clinic, I encountered a situation where a patient expressed dissatisfaction after a treatment session. They felt that I had not explained what I was doing clearly enough and left the appointment feeling confused about the purpose of the techniques used. Although they did not formally raise a complaint, the comment was fed back to me through the clinic tutor. I was initially surprised, as I believed the session had gone well. However, after reviewing my notes and reflecting on the interaction, I realised I had not taken enough time to check that the patient understood each stage of the treatment, especially during a technique close to the neck area, which may have caused uncertainty.

SO WHAT?
This experience reminded me that communication is central to patient satisfaction, and that complaints, even informal ones, are valuable learning opportunities. I realised that it’s not enough to assume the patient understands or feels comfortable simply because they don’t speak up during the session. Patients may not always feel confident to raise concerns directly, and it is my responsibility to create a space where they feel safe to do so. It also reinforced the need for clear, transparent explanations and regular check-ins throughout treatment. Responding to concerns promptly and non-defensively is essential to maintaining trust and professionalism.

NOW WHAT?
Moving forward, I will prioritise patient understanding during all stages of the consultation and treatment. I’ll make sure to explain each technique clearly, check for understanding, and encourage patients to ask questions or express concerns. I’ll also review ESO’s formal complaints policy to ensure I understand the proper process if a complaint is made. Rather than viewing complaints as negative, I now see them as part of professional growth, a way to strengthen communication, accountability, and patient trust.

# data[].attributes.headline
D5: You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

# data[].attributes.subject
D5: You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

# data[].attributes.body
WHAT?

I had. patient that attended the ESO clinic. Throughout the case history it became clear that the patient did not want to speak about certain surgeries they had in the past. Due to the presenting complaint, previous surgeries were a crucial aspect to my case history. I explained to the patient why I asked these questions and how they would help me narrow down the cause of their complaint and everything that was said in the room would stay in the room. I also told the patient that if they would rather not talk about the surgeries that it would be perfectly fine but I would need to end the appointment there as I could not get a clear medical history.

I had also mentioned that all files are kept safely and comply with the Data Protection Act 2018.

SO WHAT?

Having this experience first hand, it has opened my eyes to the fact that some information would be very sensitive for patients to disclose and I need to keep and open mind for when this happens in the future.

NOW WHAT?

I have now started explaining to patients before the case history begins that there might be some information that will be sensitive to the patient might have to be discussed if its deemed necessary for the appointment. This is and will be explained in a professional manner so that the patients can understand the reasons I ask these questions.

# data[].attributes.headline
D6: You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

# data[].attributes.subject
D6: You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

# data[].attributes.body
WHAT?
During a fourth-year clinic session, I treated a patient who required a translator as English was not their first language. Initially, I found the communication process slower and more challenging than usual. I also realised that some of my usual phrasing around diagnosis and self-care didn’t translate easily or made less sense culturally. This made me reflect on whether I was truly delivering patient-centred care. I adapted my approach by simplifying language, checking for understanding more frequently, and being patient with the process. I also reminded myself not to make assumptions based on culture or communication barriers.

SO WHAT?
This experience made me more aware of the importance of cultural sensitivity and equality in clinical practice. Although I hadn’t considered myself biased, I realised how easily assumptions can form — for example, expecting a certain level of health literacy or understanding of osteopathy. It reinforced that fairness isn’t just about treating everyone the same, but about recognising individual needs and adapting accordingly. I also saw how language, culture, and communication style can influence how care is received and how safe a patient feels in the clinical environment.

NOW WHAT?
In future practice, I will continue to adapt my communication style to meet the individual needs of each patient. I’ll remain open-minded and respectful, particularly when working with patients from different cultural or linguistic backgrounds. I plan to attend further CPD on equality, diversity, and inclusion to deepen my understanding of how unconscious bias can affect care. I’ll also aim to create a welcoming and inclusive space for all patients by ensuring my language, tone, and clinical environment are respectful and accessible to everyone. Recognising diversity is not optional — it is fundamental to ethical and professional osteopathic practice.

# data[].attributes.headline
D7: You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

# data[].attributes.subject
D7: You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

# data[].attributes.body
WHAT?
In my third year, a fellow student posted a casual comment on social media about a long day in clinic. Although no patient details were shared, the post included a photo taken within the clinic and a light-hearted remark about being tired of listening to patients. This raised concerns among staff about professionalism and how online behaviour reflects on the school and the wider osteopathic profession. While I wasn’t directly involved, it prompted a discussion in class about the importance of professional conduct outside of the clinic and particularly on social media platforms. It made me reflect on my own online presence and how my behaviour — even when outside the clinic — represents the profession I’m entering.

SO WHAT?
This experience highlighted that professionalism isn’t limited to the treatment room. As future healthcare professionals, we are held to a high standard of conduct both in and out of work. I realised how easily casual or careless behaviour, especially online, can damage public trust in osteopaths and reflect poorly on the profession as a whole. It also made me more aware that our patients and peers may view us through a professional lens even when we’re off duty. Since then, I’ve taken greater responsibility for how I present myself, ensuring that my behaviour — both in person and online — aligns with the values and expectations of the profession.

NOW WHAT?
Going forward, I will continue to reflect on how my actions, language, and presentation affect the public’s perception of osteopathy. I will remain mindful of what I post online and make sure it reflects the integrity and professionalism expected of a registered osteopath. I also aim to promote the profession positively by maintaining respectful, ethical behaviour in all environments — from the clinic to CPD events and even informal settings. The reputation of the profession is built on each practitioner’s conduct, and I take that responsibility seriously as I step into professional practice.

# data[].attributes.headline
D8: You must be honest and trustworthy in your professional and personal financial dealings.

# data[].attributes.subject
D8: You must be honest and trustworthy in your professional and personal financial dealings.

# data[].attributes.body
WHAT?
As a student osteopath at the ESO clinic, I wasn’t directly involved in financial transactions, but I witnessed how seriously the clinic took honesty in relation to payments and appointments. For example, I observed that every missed appointment or late cancellation had to be properly recorded, and if patients asked for discounts or fee waivers, it had to go through the appropriate process. There was a situation where a patient tried to offer me cash directly as a “thank you” for fitting them in at short notice. Although it was kindly meant, I declined and explained that all payments must go through reception as I cannot take any money.

SO WHAT?
This experience reinforced the importance of maintaining clear boundaries and professional conduct around finances. Accepting gifts or informal payments, even with good intentions, can create confusion, raise ethical issues, or even damage the reputation of the profession. I realised that part of being trustworthy is also being consistent, not only in how I treat patients but in how I handle sensitive topics like money. It also made me aware that even small financial decisions can have professional consequences, and that honesty and transparency are key, especially when trust is central to the patient-practitioner relationship.

NOW WHAT?
As I move into professional practice, I will ensure that all financial transactions are handled through formal systems and clearly explained to patients. I’ll be transparent about fees, cancellation policies, and any financial discussions, and I’ll make sure these are documented when necessary. I will also continue to reflect on ethical scenarios involving financial matters and seek advice when unsure. My goal is to maintain the highest standard of integrity in all areas of practice, including financial dealings, so that patients feel respected, protected, and confident in the care I provide.

# data[].attributes.headline
D9: You must support colleagues and cooperate with them to enhance patient care.

# data[].attributes.subject
D9: You must support colleagues and cooperate with them to enhance patient care.

# data[].attributes.body
WHAT?
During a busy fourth-year clinic shift, one of my colleagues was running behind due to a complex case. Their next patient had already arrived, and I could see they were becoming anxious. Although I was up to date with my notes, I could see the patient growing impatient and confused about the delay. I took the initiative to greet the patient, reassure them, and let them know the previous session was overrunning slightly but that they hadn’t been forgotten. I also checked with the front desk to ensure they were offered water and made comfortable while waiting. Afterwards, my colleague thanked me and mentioned how much they appreciated the small gesture during a stressful moment.

SO WHAT?
This experience helped me recognise that patient care is a team effort. By stepping in with a small act of support, I helped maintain the patient’s trust in the clinic and allowed my colleague to manage their time without added pressure. It reminded me that supporting colleagues isn’t always about clinical advice, sometimes it’s about recognising when someone needs help and being proactive. Positive team dynamics directly influence patient experiences, and our collaboration helps ensure that each patient feels cared for and respected, even beyond the treatment room.

NOW WHAT?
I will continue to support colleagues wherever I can, whether that’s through communication, sharing feedback, or helping manage time and flow in clinic. I aim to develop my ability to work effectively as part of a multidisciplinary or collaborative team, recognising that mutual respect and cooperation are essential for delivering high-quality care. I also plan to reflect regularly on team interactions and contribute positively to the professional culture around me, because how we treat each other inevitably reflects in the care we give to patients.

# data[].attributes.headline
D10: You must consider the contributions of other health and care professionals, to optimise patient care.

# data[].attributes.subject
D10: You must consider the contributions of other health and care professionals, to optimise patient care.

# data[].attributes.body
WHAT?
While treating a patient with persistent shoulder pain, I began to suspect that their symptoms might be linked to an underlying neurological issue rather than just a musculoskeletal one. Although I had reached the limits of what I could confidently assess within my scope as a student osteopath, I didn’t want to ignore the possibility. I discussed the case with my tutor and we agreed that it would be appropriate to refer the patient back to their GP for further investigation. In the referral note, I clearly outlined the history, findings, and rationale for recommending further assessment by a medical professional.

SO WHAT?
This case helped me appreciate the importance of recognising when other healthcare professionals are better positioned to continue a patient’s care. It reminded me that osteopathy does not exist in isolation, and that patient safety and outcomes improve when we collaborate with others. Referring this patient showed me that knowing my limitations and valuing the expertise of others is not a weakness, but a key part of safe and ethical practice. It also taught me how to communicate clearly and respectfully when involving another professional in a patient’s care.

NOW WHAT?
Moving forward, I will continue to develop my understanding of referral pathways and inter-professional communication. I aim to become more confident in discussing cases with GPs, physiotherapists, or other allied health professionals where appropriate. I will also seek opportunities to improve how I document and explain my reasoning in referral letters. By doing this, I can help ensure that patients receive the most appropriate care at every stage and contribute to a healthcare system that is truly collaborative and patient-centred.

# data[].attributes.headline
D11: You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

# data[].attributes.subject
D11: You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

# data[].attributes.body
WHAT?
During the COVID-19 pandemic, the importance of self-monitoring for signs of illness became a core part of clinical practice. At the ESO clinic, we were required to complete daily health screenings, wear PPE, and cancel clinic sessions if we had any potential symptoms. There was one occasion when I felt slightly unwell the morning of a scheduled clinic shift. It wasn’t severe, just a mild headache and slight fatigue, and I debated whether I should still go in. I knew that if I cancelled, it would affect the schedule and potentially inconvenience the patient. However, I ultimately reported my symptoms, stayed home, and followed the COVID-19 protocols. Fortunately, it turned out not to be COVID, but the decision to stay home was supported by the clinic team.

SO WHAT?
This situation reminded me how important it is not to rely solely on my own judgement about whether I am “well enough” to treat. The potential risk of transmitting illness, even something mild, can have serious consequences in a clinical setting, especially for vulnerable patients. I realised that feeling guilty about cancelling or “pushing through” is not just unhelpful, but dangerous. The professional responsibility to protect patients goes beyond technical skill, it includes being honest with myself about my health and acting accordingly. The pandemic especially highlighted how individual actions affect the wider clinical environment and public trust in healthcare settings.

NOW WHAT?
Moving forward, I will continue to monitor my physical and mental health carefully before each clinic session. I won’t hesitate to follow infection control protocols, even if symptoms seem minor. I also plan to stay informed on public health guidance and apply it to my practice without hesitation. If I ever feel unsure, I’ll seek guidance from clinical tutors or senior colleagues rather than making the decision alone. Protecting patients starts with protecting their environment, and that means making responsible choices, even when they’re inconvenient.

# data[].attributes.headline
D12: You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

# data[].attributes.subject
D12: You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.

# data[].attributes.body
WHAT?

As a student osteopath, I was introduced early on to the professional expectations set by the General Osteopathic Council (GOsC), including the duty to report any issues relating to conduct, competence or health that could impact my ability to practise safely. These regulatory requirements are also echoed in the ESO’s Student Fitness to Practise policies. While I have not personally encountered a situation requiring formal disclosure to the GOsC, I’ve witnessed discussions about professional boundaries and honesty during case-based ethics sessions and clinical tutorials, which made the importance of this responsibility very clear.

SO WHAT?

Understanding these responsibilities helped shape my view of what it means to be a professional. It’s not just about treating patients, it’s about maintaining integrity and being accountable for my actions. I’ve come to appreciate that upholding public trust in the profession means being willing to engage with regulation, even when it’s uncomfortable. These reflections also helped me understand that reporting is not about punishment, but about protecting patients and the profession. It gave me more confidence to speak up if I were ever concerned about conduct, either my own or a colleague’s.

NOW WHAT?

As I move into professional practice, I will continue to keep up to date with the GOsC’s standards and guidance, and ensure that I act promptly and transparently if any issue arises. I will also seek advice from senior colleagues or professional bodies when in doubt. I plan to embed a culture of openness and accountability in my practice, and ensure that I don’t hesitate to engage with regulatory processes if required. Doing so is essential to maintaining professional integrity and patient safety.

# data[].attributes.body
Data Protection Act (2018). Available at: https://www.legislation.gov.uk/ukpga/2018/12/contents/enacted [Accessed May 10th, 25].

GOsC, 2018. Osteopathic practice standards | General Osteopathic Council. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/osteopathic-practice-standards/updated-osteopathic-practice-standards/ [Accessed May 8th, 2025].

Jasper, M., & Rosser, M. 2013. Reflection and reflective practice. Professional development, reflection and decision-making in nursing and healthcare, 41-82.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

The Institute of Osteopathy, 2021. Infection control and Personal Protective Equipment (PPE) in osteopathic practice. Available at:

https://www.iosteopathy.org/wp-content/uploads/2021/02/Infection-control-and-PPE-in-osteopathic-practice-1-Feb-21-V7.pdf [Accessed May 10th, 2025].

# data[].attributes.body
Rolfe et al.'s Reflective Model was used throughout this portfolio, with the intention of answering the questions: WHAT? SO WHAT? and NOW WHAT?

By using this model is has allowed me to reflect on each individual Osteopathic Standard (OPS) thoroughly and look what what I would have done differently/adapt in the future to address these OPS and to ensure I meet all of them in and outside of practice

# data[].attributes.body
The ERA model stands for:

1. Experience – Describe what happened.
What did you do? What was the context?

2. Reflection – Think about what went well or not so well.
What did you learn? How did it make you feel?

3. Action – Decide what you’ll do next time.
How will this experience influence your future practice?

ERA is a simple, effective model that helps you quickly structure your reflections and focus on learning from real clinical experiences, making it ideal for clinic diaries, short reflections, or focused portfolio entries.