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C1 - You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

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C1 - You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.

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This standard is important in order to maintain the quality of osteopathic consultations and to ensure a consistent delivery of assessment, treatment and advice. As a student I am regularly examined and as my evidence ensures I am currently meeting these expectations. This evidence shows a recent exam result in which i perform an assessment after formulating a diagnosis across a wide range of osteopathic approaches. to prove my ability to conduct an osteopathic evaluation and provide safe, competent osteopathic care.

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C2 - You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

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C2 - You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.

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Patient records are important to provide good-quality care in the form of a through case history and medical screen. Notes may be required to be reproduced for court. As seen in my evidence, my handwriting was raised as a concern. This is something I feel is now not an issue and I can provide a thorough and legible case history.
At clinic (Year 3) upon asking my clinic tutor to sign off my notes, my tutor expressed concern on the legibility of my handwriting. This is something that i had never received feedback on. I spoke to my tutor about what was specifically wrong with my handwriting and spoke to them about an action plan and improving my handwriting. The action plan involved finding the reasons why my handwriting was difficult to read and addressing them. As a left hander i have also struggled with handwriting as in the UK we write left to right my hand is also hovering over the words and i have had instances of my hand smudging the ink, Another potential cause was rushing the notes. As part of this i addressed the issue by working on my time keeping in order to allow more time to write notes. I have since not received any concerns on my handwriting as i make an effort to make my writing legible to comply with this standard.

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C3 - You must respond effectively and appropriately to requests for the production of written material and data.

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C3 - You must respond effectively and appropriately to requests for the production of written material and data.

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In my role as a student osteopath, I am sometimes required to produce referral letters most commonly to the patients GP. This effective production of written material and data is integral in the integration of osteopaths into wider healthcare profession. I feel as I meet this as I effectively produce referral letters upon request.
This evidence provides guidance to non-medically qualified practitioners on how to request clinical images which is important for the safe evaluation of patients.
This is something that although is an OPS isn't focused on very heavily in the current curriculum. Intially i wasnt very confident with requesting imagining or writing a letter to a GP. There is guidance around at clinic which allows you to use a template but it is something i feel i am only strong at due to the fact i have had to produce letters on numerous occasions. i believe this OPS could be further implemented into the Curriculum to further support students.

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C4 - You must take action to keep patients from harm.

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C4 - You must take action to keep patients from harm.

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Patient care is paramount in a consultation. As osteopaths treat all demographics from children to elderly it is important as a practitioner to take all necessary precautions. As COVID-19 is relevant it is important to minimize risk of transmission of COVID-19. In clinic I follow strict protocol for donning/doffing PPE as well as cleaning rooms. I have received both COVID-19 vaccinations to reduce my transmission to patients.
For the Standards C4 & C5 the most topical example is the recent COVID-19 pandemic that has drastically changed the way we live our lives for the past year. Osteopaths were shut initially but eventually opened with the introduction of spaced out appointment times and PPE. As a student practitioner i was sent guidelines that were designed to keep all involved at the ESO safe. The guidelines can be found in the C4 evidence. i was also briefed on Donning and doffing protocols with PPE and we had to strictly follow social distancing guidelines along with any other guidelines on the general public when outside of the treatment room.

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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.

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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.

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In clinic, I had an initial consultation with a women in her mid 60's. During the case history it became apparent that the patient's English was minimal and it was difficult to build a picture of the current injury and previous medical history as well as for the patient to understand me and to provide informed consent. A member of my clinic group spoke Italian and was able to translate for the remainder of the consultation. As this process would have been stressful for the patient I took the decision to handover the patient to my colleague for follow up treatments. This follows OPS A1 and helps meet the preferences of the patient both culturally and in Language. In order to provide the best patient experience.
This standard is important as the majority of complaints received by GOSC are due to poor communication between practitioner and patient. Managing expectations and reading body language is important when conforming to this standard although this is difficult skill to learn.

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B1 - You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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B1 - You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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As a osteopath it is important to have sufficient knowledge of anatomy and physiology in order to formulate a safe management plan for a patient. This exam result shows that i am able to meet the criteria set for me at the time of the exam in terms of knowledge and the application of knowledge.
Since the beginning of Year 1 it has been important for me to learn and retain knowledge that i can apply to a clinical setting. I identified my learning style as a mixture of Aural/Kinaesthetic which means in order to develop my knowledge it requires a collection of trial and error and explanation. I created any action plan or revision plan on this basis to maximise my learning.

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C5 - You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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C5 - You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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Continuing on from C4. when inside the treatment room I followed a 10 point checklist as provided below. to limit the potential spread of covid-19. This checklist facilitated my actions to conform to Health and safety legislation and regulations for COVID-19.
To maintain a safe and hygienic practice is important when complying with other OPS such as OPS.C4 as well as meeting law and insurance requirements. Action taken to meet this standard is strict donning and doffing of PPE, cleaning of rooms, sharps bins and COVID screening questions at the door.

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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.

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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.

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During todays clinical integration lesson (April 2018). Our groups were split into pairs and we worked on case history taking. At first I thought it would be a simple activity but I found myself going off on a tangent with the patient. I realised the skill in allowing a patient to express their feelings whilst remaining concise, following experiences in clinic as an observer and using the Gibbs cycle of reflection I created a action plan to make my case history skills more refined to meet the OPS A2.
This standard is important as the majority of complaints received by GOSC are due to poor communication between practitioner and patient. Managing expectations and reading body language is important when conforming to this standard although this is difficult skill to learn.
My limitation for this standard was a difficulty to adapt my communication approaches to each patient needs. This is something i feel has improved in my time during clinic and i am now able to effectively adapt my communication styles to suit patients. My learning need was to practice and experience situations to gain confidence.

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A3 - You must give patients the information they want or need to know in a way they can understand.

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A3 - You must give patients the information they want or need to know in a way they can understand.

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During this follow up appointment in children clinic it became apparent that the patient was describing symptoms of Joint Hypermobility Disorder. As i spoke with the patient about the symptoms i explained the differential diagnosis and answered questions from the patient and the patients guardian on the manifestation of symptoms and how to manage them moving forwards. i checked with the patient that they understood and discussed referral to Rheumatology. As reflected in my evidence as i was scored above expectation on all aspects being assessed.

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A4 - You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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A4 - You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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Consent is important part of a consultation. Examination and treatment cannot go ahead without informed consent. Consent is first recorded on a form that is signed before a consultation and is recorded in the notes prior to examination and treatment. Verbal consent is gained throughout and the patient is aware that consent can be withdrawn at any point. As seen in my evidence my consent and shared decision making was scored above expectation showing that i follow this process and am able to provide a safe and agreed service.

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A5 - You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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A5 - You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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It is important as a practitioner to be aware that patients spend a small fraction of their time with the practitioner and that what the patient does between appointments can have a large impact of the effectiveness of treatment. it is therefore in the best interest of all parties to educate and support the patients in caring for themselves outside appointment times. As seen in this example i provide a thorough support plan for patients moving forward with their injury with work and home life adaptations and expectations on recovery.

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A6 - You must respect your patients’ dignity and modesty.

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A6 - You must respect your patients’ dignity and modesty.

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Upon entry to clinic a new patient is provided with an information sheet describing the process of the consultation at the clinic and a consent form is provided. This consent form details the steps taken to protect the patients modesty.
Before Covid-19 Protocols, practitioners were provided with blankets that could be used to cover the patient over and protect their modesty, this is no longer possible to due potential contamination between patients. however alternative options are available to patients such a disposable gowns. As a patient it can be very daunting having to dress down into their underwear in front of people and its something on reflection i think osteopathic students become desensitised to, this makes it important to monitor patients body language and gain continued consent.

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B2 - You must recognise and work within the limits of your training and competence.

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B2 - You must recognise and work within the limits of your training and competence.

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It is important to know your limitations as a practitioner. The role of an osteopath is to provide the most appropriate care. The most appropriate care may not be osteopathy or in the case of my evidence osteopathic intervention maybe supported by alternative intervention. My limitations are both professional and personal limitations. Professional limitations stem from the knowledge base as a profession including the curriculum provided at university. As Primary heath care practitioners it is important to general medical screen patients should it be appropriate but should the medical screen provide any suspicion then an appropriate medical profession should be advised.
Personal limitations include the fact that i am a student osteopath and lack experience in practice. Also each student practitioner will have strengths and weaknesses so it is important to follow OPS.D9 to support each other.

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B3 - You must keep your professional knowledge and skills up to date.

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B3 - You must keep your professional knowledge and skills up to date.

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This standard is more applicable to qualified osteopaths. The GOSC require registered osteopaths to complete CPD across all four themes of the Osteopathic Practice Standards, including at least one objective activity, and one CPD activity relating to communication and consent. Osteopaths need to keep a CPD record and, with a colleague, complete a Peer Discussion Review towards the end of the three-year cycle. As a student I am formally assessed every 6 weeks in clinic.
As Osteopathy became regulated it is important that all osteopaths contribute to the growth and development of the profession. Maintaining and building on knowledge is imperative for this and can take the form of Continued Personal Development (CPD). As a student practitioner i do not have to complete CPD. my contribution is through our research module. As seen below in my evidence which is a defence of my Research dissertation.

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A7 - You must make sure your beliefs and values do not prejudice your patients’ care.

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A7 - You must make sure your beliefs and values do not prejudice your patients’ care.

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Practitioners are subject to bias in a clinical setting. Cognitive bias can appear in many different forms and affect a clinician in different ways. Practitioners can interpret events and facts based on their own set of beliefs and experiences which can lead to flaws in reasoning and rationale.
Common bias includes;
Anchoring - A tendency to over rely on base decision.
Confirmation Bias - A tendency to look for evidence to confirm a diagnostic hypothesis and therefore give weight to evidence that supports it.
Diagnosis - A tendency to expect and continue initial diagnosis without any scepticism.

It is important as a practitioner to be aware of these biases and self reflect on patients cases on whether bias was a contributing factor in the case.
Upon reflection i found i had a tendency towards certain findings and diagnosis that i was well versed in rather than diagnosis that i wasn't as confident with this causes a focus on certain symptoms that conform to the diagnosis. it is important to understand the limitation on myself as this could lead to an incorrect diagnosis or worst case scenario an oversight on pathology. My action plan was to discuss with tutors to gain guidance on this and how to effectively create a range of DDX. The results of my search was to use Primary Diagnosis which is a direct tissue causing symptom, Secondary Diagnosis which would be indirect pain to the area and Cant miss diagnosis which is important problems in the area that need to be excluded including pathology.

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B4 - You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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B4 - You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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Experience -
During Year 2, I failed my second clinical methods exam. i had gone for a weekend away prior to the exam on the Monday and subsequently failed the exam. As this exam was a pass or fail i had to retake the exam to pass the year. as the exam board for resists meet until September I was unable to fully partake in the induction week for clinic.

Reflection -
As i was unable to take part fully in the induction week i was able to reflect a lot on the year as a whole, my results and my mindset towards the exam. As i had passed comfortably with the previous clinical methods exam i became complacent in my approach to this exam.

Action -
I made sure i thoroughly revised for the Resit exam and passed the resit without any issues. It allowed me to self appraise and change my mindset towards exams at a critical time in my journey as a osteopathic student as it provided me with a wake up call i vowed never to take any exam or assessment on half measures and have since passed all exams i have taken.

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C6 - You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

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C6 - You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.

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This standard is important as an allied health professional using other health care professionals when required is imperative in the safety and care of a patient. As referrals is a good example of using wider health care professions at the ESO we also have access to Ultrasound at the clinic which we can make inter referrals to.
As a student osteopath i have an obligation to provide my patients with the best and most appropriate intervention to aid there recovery. It is important to be aware of my own limitations and ability to fully conform with this obligation. At the ESO there are several opportunities to seek the intervention of the wider healthcare system. including links with a local private hospital for reduced fee scans. There is an inhouse Ultrasound clinic as provided in my evidence as well as referral to specialists via letters.

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D1 - You must act with honesty and integrity in your professional practice.

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D1 - You must act with honesty and integrity in your professional practice.

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As student osteopaths it is important to have a wide range of knowledge in anatomy, pathophysiology and osteopathic skills. On top of this vast knowledge base a student practitioner must be able to dictate and formulate an appropriate and effective treatment plan and management plan. This management plan effects the integrity of a practitioner and it is imperative that all aspects are justified to comply with this standard. The way in which i maintain justification is by testing and retesting during each consultation to record any changes. These changes will inform whether the management plan is appropriate and effective and this should coincide with patient communication on the management plan and consent for examination and treatment. This should be presented in an open and honest way in order to allow the patient to have all facts for informed consent throughout.

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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.

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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.

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The Therapeutic relationship between patients is important for communication and results by improving patient centred care and shared decision making. A positive therapeutic relationship can lead to better results from treatment and is described as close, consistent association between the patient and practitioner. A practitioner should be aware of clear professional boundaries which should be maintained throughout the consultation. Any change in the boundaries should result in immediate cessation of the therapeutic relationship. As a practitioner i believe it is important to careful with verbal and non verbal communication and be aware of any changes in the therapeutic relationship.

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D3 - You must be open and honest with patients, fulfilling your duty of candour.

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D3 - You must be open and honest with patients, fulfilling your duty of candour.

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i always strive to be open and honest with patients from the beginning of the consultation. Managing expectations and providing the patient with accurate information on examination, explaining the diagnosis and what the diagnosis means for moving forward, in turn creating a management plan. I do not have a specific example in which this has been met as the D3 1 &2 suggests should something go wrong in the care of a patient or should a review or investigation take place i must be open honest and fulfil my duty of candour. To meet this standard i test and retest during each consultation and make appropriate record of the findings for comparison, these findings are then compared looking for relative linear improvement. this puts me in the best position to identify should the patient get worse and will allow me to address it as soon as possible. Should any reviews take place i would be able to provide this record in order to support the investigation.

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D4 - You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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D4 - You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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During my clinic session i had a 'Walk-in' new patient. After an extended case history, i presented the case to my tutor and explained my reasoning behind not treating the patient. My tutor shared my opinion on not examining or treating the patient. Upon presenting my management plan to the patient, they became irate that they would not be receiving treatment. something that was explained prior to the consultation. As the patient became more disgruntled i continued to explain my reasoning and their alternative options. The patient began to berate me, questioning my knowledge base and level of training. This is something i had not experienced before and tried not to take it personally. instead I attributed it to a frustrated patient who is in pain. Eventually after 10 minutes of criticism towards myself and the clinic, the patient spoke to clinic management and subsequently agreed to my management plan. Upon reflection with help from my tutor and clinic management i received praise for my approach to the problem and how i dealt with the situation and was reinforced that should that happen again i shouldn't do any different. i felt as if that was reassuring and confirmed my previously assumed confidence in dealing with conflict.

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Patient Experience Group please email clinic@eso.ac.uk or speak to

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D5 - You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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D5 - You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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At the ESO clinic all patients notes and files are stored in a secured filing cabinet. All electronic information is password protected.
This protects the privacy of the patient and prevents any breaking of the data protection act.
As a student practitioner there are protocols to follow in order to not break the data protection act. These protocols include signing out of all programs when not using them, not taking patient notes off site and not using any identifiable information when discussing patients.

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D6 -  You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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D6 -  You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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Understanding Equality and Diversity is important when delivering person-centred care. Equality is about creating a level playing field where everyone can participate and have the opportunity to fulfil their potential and no one is unfairly disadvantaged. Diversity is valuing peoples' differences and addressing their different needs and situations.

Delivering on equality and diversity in Osteopathy means that we can tackle barriers which may prevent some groups of people from accessing services. It also means that we can deliver services which meet the diverse needs of our patients and practitioners.

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Information and guidance on the Equality Act 2010, including age discrimination and the Public Sector Equality Duty.

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D7 - You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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D7 - You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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In todays society with the height of social media. It is important as an Osteopath to maintain a professional public persona. My social media is therefore limited to minimal personal content and professional content. Any social media that is personal is a private account which can only be viewed upon request. This serves to protect any personal information on my account.

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D8 -  You must be honest and trustworthy in your professional and personal financial dealings.

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D8 -  You must be honest and trustworthy in your professional and personal financial dealings.

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At the ESO clinic, I do not deal with the financial side of the consultation as that process is dealt with by the reception. I have had experience in which a patient attempted to give me a cash tip. I politely refused to accept this as i was unsure of the policy in accepting cash tips in the ESO Clinic. I immediately informed my tutor of what happened to maintain my open and honest approach. Although i have no evidence of professional and financial dealings as part of registration to GOsC I have to undergo an advanced disclosure and baring service check (DBS) which covers all illegal activity including financial dealings.

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D9 - You must support colleagues and cooperate with them to enhance patient care.

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D9 - You must support colleagues and cooperate with them to enhance patient care.

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During the Lockdown in the UK to limit the contact between practitioners, The clinic groups within the ESO were split in half with each half group spending alternating weeks on site. A patient was returning on a weekly basis, as a result of this a dual practitionership was formed with a colleague in the other half. I was able to liaise with my colleague to create a fluid treatment approach and able to provide continuity throughout. My colleague and i were able to share our opinions and different approaches to improve our own knowledge and skill.

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D10 - You must consider the contributions of other health and care professionals, to optimise patient care.

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D10 - You must consider the contributions of other health and care professionals, to optimise patient care.

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This poster was created in order to present up to date information on lumbar disc herniations. This task allowed me to update and increase my knowledge around the subject whilst informing myself on more detailed research on the multidisciplinary approach to a common back pain presentation.
The multidiscipline approach encompassed all aspects of the triage for disc herniations, including scans to diagnose and surgical/ non surgical interventions for treatment.
This task opened my eyes to how osteopathy although important is a small part in the overall care for a patient and that to not recognise or actively encourage the involvement of multidiscipline would be not fulfilling optimal care for the patient.

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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.

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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.

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During the COVID-19 pandemic it is important to protect myself as well as the people around me from potential transmission. this became even more important when osteopaths returned to work. As i had a duty of care to my patients. Although we screened ourselves on temperature as well as symptoms screening at the height of the pandemic i regularly took fortnightly lateral flow tests at university. This is something i continue to do at home.

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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.

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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.

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This standard is important for the profession as a whole. As Osteopathy is now an allied health profession there is an importance
to maintain a standard of professionalism and competence across all osteopaths to protect the reputation that has been created. As a student practitioner the role is no different. I have provided the student fitness to practice guidelines set by GOSC. I feel as if I am satisfying the criteria within, by maintaining a professional presence in work and social life.
As a student osteopath it is important that i uphold the same professionalism and reputation of the osteopathic reputation in and out of a clinical setting. All students have a DBS check when entering the course and must follow all Student fitness to practice guidelines. Failure to do so should be reported immediately to the university or GOsC.

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Self-reflection in Reflective Practice: A Note of Caution

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Abstract. In reflective practice, social work students are encouraged to undergo self-reflection. It is a process of self-analysis, self-evaluation, self-dialog