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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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D1.2. You should not allow misleading advertising or information about you and your practice. You should make sure that:
D1.2.1. Your advertising and promotional material, including website content, is legal, decent, honest and truthful as dened by the advertising standards authority (ASA) and conforms to current guidance, such as the UK Code of Non-broadcast Advertising and Direct and Promotional Marketing (the CAP code).

Description
Over the course of the degree, As student we had to do a business plan and evaluate a marketing strategy, explain what would be our process to succeed and advertise our profession and area of expertise. As soon as I started the coursework, I realize that the use of certain material such as Committee of Advertising Practice (CAP) is essential in the guidance for osteopaths. It explain basically what we can treat as osteopaths. Thanks to this assignment, I had a better understanding of this type of materials that help our profession and provide a supportive framework.

Feelings
At the beginning, I disagree with the references list which was short in my opinion. And the fact that it is because there is no many evidence base in the literature review, osteopathy is restricted in advertising people on which condition could potentially benefit from osteopathy as well.

Evaluation/ Analysis
There seems to be confusion between symptoms and conditions, indicating a lack of consistency or misunderstanding about what can be treated by osteopathy. It would be helpful to place more emphasis on systemic causes that cannot be treated by osteopathy, which would require a referral instead. Furthermore, the inconsistent use of terminology can be confusing for readers. For instance, an osteopath can treat a patient for "uncomplicated mechanical shoulder pain," but sometimes, such shoulder pain arises after a proper injury to the shoulder (frozen shoulder, Subacromial impigement syndrome injury). This opposition between mechanical shoulder pain and shoulder pain following a trauma injury or something else is misleading and goes against the principle of osteopathy, which recognizes the interconnection of everything. All of these issues could lead to misinterpretation of the range of conditions that can be treated by osteopathy.

Conclusion/Action plan
In my point of view, as osteopath we have to consider the guidance provided. This would be useful to remain ethical and not impose any kind of idea or unrealistic goal for our patients. however, this is where our communication skills have to be perfect and demonstrated the shared decision making process and explain to our patient the non evidence base factors. As long as their are aware and approved, the guidance to follow is respected.

Reference
Advertising Standards Authority, 2016. Which Medical Conditions Can Osteopaths Claim to Treat? Available At: https://www.asa.org.uk/advice-online/health-osteopathy.html [Accessed 21st of March, 2023].

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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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Description
When I started clinic, I had this cover patient that I have been treating since 4th year. I was treating a female patient for neck and shoulder pain,  she started to  become too friendly with me such as hugging me at each end of consultation, offered me many present at each appointment and ask me several time about my personal life and relationship. I decided to talk to my tutors about that and several answers was provided to me. Therefore, I was a bit confuse on how should I react, what should I say. I took in consideration what tutors was telling me for some of them and decided to apply straight away for the next consultation. At the end, I decided to keep my boundaries up and avoid any contact. I explain to her that as a student and practitioner we cannot have this sort of relationship.

Feelings
At the beginning I felt really bad and uncomfortable regarding this situation but once the patient and I talk about those boundaries that was necessary, she accepted and apologies. And I really felt grateful and proud to established my boundaries and know how to communicate to her.

Reference
https://www.youtube.com/watch?v=4SCrXqbhmCY

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Your 3-Step Guide to Setting Better Boundaries at Work |  The Way We Work, a TED series

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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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D3.1. If something goes wrong with a patient’s care which causes, or has the potential to cause, harm or distress, you must tell the patient, offer an explanation as to what has happened and the effects of this, together with an apology, if appropriate, and a suitable remedy or support.

Desciption
One day, I had to cover for my colleague in normal clinic. At the first sight, the patient was really annoyed by the fact that I am not the usual practitioner and told me straight away with a bit of aggressivity that she was upset because of the change of the practitioner and she asked to stay with the same tutor for each appointment. And the patient even complain about the fact that I am french.

Feelings
I felt surprised and a bit upset that I had to deal with that kind of behavior. However, I understand her position and to change each time practitioners would be annoying for her and especially to go over the case history as a recap.

Evaluation
I understood that the patient was in pain (really acute), tired and not expecting this change from practitioner. During the appointment she explained to me how it is difficult for her to adapt through change in general and she is the kind of patient who want and ask for continuity which seems a fair request. After all, my tutor and I weren't responsible for that situation.

Analysis
On the other hand, the teaching clinic had to apologies and book her with the tutor of her choice and specially with the same practitioner. This situation happened when there is a lack of communication from the clinic, lack of consideration of the biopsychological aspect for the patient.

Conclusion/Action plan
Having gone through this experience, I realized that certain patients require a consistent practitioner or tutor to feel comfortable. Additionally, I came across an informative article on the ethical obligation of honesty towards patients, which explains how to express regret for any mishap in their treatment without admitting personal fault. Going forward, if I am assigned to take care of a patient, I will ensure to confirm with them that they are happy with a new practitioner or tutor and that they are given adequate advance notice.

Reference
https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2015.24.16.840

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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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D4.1. A complaint is an opportunity to reect on the communication and standard of care that was given, and it may highlight areas of your practice that could be improved. A complaint which is handled well can also result in a stronger bond of trust between you and your patient, leading to improved patient care.

Description
During my second year of study, we were tasked with writing a response to a complaint letter received after an osteopathic treatment. The complaint raised concerns about a procedure that was performed without proper consent, which led to unforeseen treatment outcomes. The response letter required a delicate approach to address the situation, and it had to reflect on the reasons behind the issue, acknowledge areas of improvement, and recommend suitable remedial actions, considering resources that could offer support to the patient throughout the process.

Feelings
Indeed in my opinion it was a useful process and assignment to do. I found it really hard and complexe and especially when you are on real case scenario where you have to deal with patient's anger.

Evaluation
I had to re take this exam over the course of 2nd year because I did not show enough empathy in this letter regarding the situation of patient.
However, they gave me good feedback regarding the structure, concis writing style and ability of critically and communicating with the patients expectations.

Analysis
Overall, this assignment was challenging because it was during covid and lock down period on a personal point of view and as well as the communication to established with the patient through the letter. Also the fact that students in 2nd year do not practice like 3rd or 4th years, so for me the lack of practice in real case scenario or situation where a massive challenge for all of the students.

Conclusion
Thanks to this assignment, I realized that my communication was not like it should but however normal for a 2nd year student. Therefore, as soon as I started clinic, I tried to work on my communication skills and developing more empathy. This challenge brought me as well some resilience, patient skills and how to behave with some situation like the complaint letter.

Reference
Complaint letter

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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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D5.1. Maintaining patient condentiality includes: 1.1 keeping condential your patients’ identities and other personal information, and any opinions you form about them in the course of your work

Description
Although the teaching clinic model involves informing patients that their personal information may be shared with other students and tutors, it is imperative that we uphold their right to privacy and confidentiality by effectively maintaining and safeguarding their information. As a professional, I have always respected these rights, which is why we consistently seek consent before allowing any observers into the room. Additionally, we take extra care to protect patient information by removing any identifying details from the file copies or referral letters, ensuring that their personal information is not displayed outside of the clinic.

Feelings
In my opinion I found this confidentiality rule and approval totally normal and essential. Indeed patients are vulnerable when they come first to a consultation and especially when they deliver this flow of information (intime and personal information) or when they get undressed.

Analysis
When considering the importance of maintaining patient confidentiality in healthcare, the use of cameras and other equipment can pose a challenge. In the past, we would obtain consent and provide an explanation to patients regarding the purpose of live-streaming. However, the regulations have since changed, and we no longer employ cameras in clinic rooms. Nonetheless, we continue to prioritize patient confidentiality by seeking consent prior to inviting observers into the room or displaying any personal information about the patient.

Conclusion/Action plan
The main idea here for me is to make sure we as practitioner always make sure that patients received the good amount and quality of informations. They also need to understand that this is a teaching clinic, therefore that the presence of camera or observer shouldn't be a problem and especially if they already sign the consent form. In my future and daily practice i will make sure that the patient is aware at the beginning of the session and i will wait for a verbal consent.

Reference
https://transform.england.nhs.uk/information-governance/guidance/consent-and-confidential-patient-information/#:~:text=In%20common%20law%2C%20there%20is,disclosed%20without%20that%20person%27s%20consent.

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Creating a new NHS England: NHS Digital and NHS England have now merged. Health Education England will join us in April 2023. Learn more.

NHS England - Transformation Directorate

This guidance has been reviewed by the Health and Care Information Governance Panel, including the Information Commissioner's Office (ICO) and National Data Guardian (NDG).
The panel exists to simplify information governance guidance. Have we done a good job? Let us know at england.igpolicyteam@nhs.net.

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Consent and confidential patient information

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Creating a new NHS England: NHS Digital and NHS England have now merged. Health Education England will join us in April 2023. Learn more. NHS England - Transformation Directorate This guidance has been reviewed by the Health and Care Information Governance Panel, including the Information Commissioner's Office (ICO) and National Data Guardian (NDG).

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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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D6.1. You should be familiar with the requirements that apply to you under equality law D6.2. It is illegal to refuse a service to someone on the grounds of their age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

Description
In our practice, it is essential to treat every patient equally, with fairness and respect as individuals. This principle applies not only to our patients but also to our everyday interactions with others. As healthcare professionals, we prioritize promoting health and well-being, regardless of a patient's background, including age, gender, disability, marital status, pregnancy status, cultural beliefs, race, or sexual orientation.

Feelings/Evaluation
Throughout my practice, I have always made a point of treating every individual with equal care and attention, regardless of their personal characteristics. I have never witnessed any of my colleagues refusing treatment to someone based on such factors, and I myself would never discriminate in such a way. It is my firm belief that as healthcare professionals and as individuals, we have a responsibility to remain impartial and non-judgmental in all circumstances.

Analysis
For me it's unacceptable to act like this in the profession. A healthcare professional must give the same treatment regardless patient's background, age, gender (etc..) and never judge a patient for their choices in life.

Conclusion
I am aiming to always be fair regarding a patient and recognize the diverse and individuals values. Beside make sure that everyone feels respected, appreciated and welcomed regarding their differences in life.

Reference
https://www.scie.org.uk/key-social-care-legislation/equality-act#:~:text=Anti-discriminatory%20practice%20is%20fundamental,are%20protected%20under%20the%20legislation.

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Social Care Institute for Excellence (SCIE)

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Equality Act 2010 - overview for social care

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This introduction to equality has been developed to assist in promoting dignity in social care.

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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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D7.1. The public’s trust and condence in the profession (and the reputation of the profession generally) can be undermined by an osteopath’s professional or personal conduct. You should have regard to your professional standing, even when you are not acting as an osteopath.

Description
The General Osteopathic Council (GOsC) has published a booklet that explains the expected professional conduct for osteopathy students and the role of osteopathic educational institutions in ensuring patient safety and fitness to practice (the booklet is attached). Additionally, during our first year at the ESO, we received a lecture on the importance of maintaining professional conduct both inside and outside the workplace in relation to the OPS.

Feelings
I totally understand and agree on how to behave in public in or outside of the workplace. For me, patient perception is not that different when they see us in our workplace, therefore, we should as osteopath practitioner follow the rules even outside of the workplace.

Evaluation/analysis
Patients hold healthcare professionals to high standards of ethical and professional conduct, as trust is paramount in building a strong therapeutic relationship. Even as a student, patients expect the same level of trust and professionalism from us as they would from fully qualified healthcare providers. With this in mind, I have always adhered to the rules and regulations, and never acted in a manner that could damage the reputation of the profession or the institution I represent.

Conclusion/action plan
Therefore, we should no matter the circumstances follow the rules and have a proper behavior at the front of the public. By doing that all the time we are meeting patients' expectations.

Reference
GOsC guidance

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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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Description
Over the course of my study time, I had so many assignment that help us as student. Especially one where the main goal was to write a 3-year business plan (attached). This work help us as student to develop clarity on what would be our short term and long term for our future, developing strategies regarding the market and how to understanding it. Personally, it help me to be fully transparent with myself professionally and personally, ask myself the right questions for the future including revenue, set-up cost etc...

Feelings/Evaluation
In my opinion, we are lucky as student to learn how to make a business plan, take the time to ask ourself what and how do we want to process. This assignment made me realized as well that it is essential to build your business where you are fully honest and transparent with yourself and patient. The business and management aspect of the profession is essential to build a strong and trust-based relationship with our patients. The business plan support ourself as osteopaths.

Analysis/ Conclusion/Action plan
Going forward, being honest, humble and trustworthy in my professional and personal financial dealings is the main key and value of my business.

Material
Business plan

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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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D9.3. If you are responsible for an associate or assistant, you should provide professional support and adequate resources for them so that they are able to offer appropriate care to their patients. You should not put them under undue pressure, or expect them to work excessive hours. You should not expect them to provide treatment beyond their competence.

Description
The 2 years spent in the ESO teaching clinic allow students to self-examine, give and receive feedback. The constant questioning of one's own practice, which provides the necessary skills and experience, and allows for personal introspection.

Feelings
At first I was not comfortable with the idea of receiving and giving criticism. As time went by, I realised that this constant questioning was necessary and reflects the humble side of the profession.The opportunity to observe my colleagues allowed me to learn more, to gain experience through different cases and sometimes delicate situations. This has helped me to grow and build my confidence as a practitioner. I have learned to step back from criticism and give it to my colleagues, whether positive or negative.

Evaluation
While searching for content to improve my feedback skills, I found an interesting book (link attached) that talks about the art of giving and receiving feedback. Indeed, this book allows us to open up to others in any situation, be it at work or in everyday life. This Ops is not only an asset to be developed for work but also on a personal level.

Analysis
Receiving feedback and criticism, whether positive or negative, is an opportunity to improve and to keep moving. In terms of health, it allows practitioners to identify areas of weakness and strength. By receiving external feedback, the person in question can gain insight into their external image and change accordingly to improve patient care. However, giving feedback is an art and must be diplomatic, as the ultimate goal is to challenge a colleague without confronting them. Reviewing simple rules of communication can improve communication and strengthen team cohesion, as the osteopath must work in harmony with other health practitioners for optimal care.

Conclusion/ Action plan
As I said at the beginning I found it difficult to receive feedback because I was easily offended. Over the years I have realised that receiving feedback is a chance, a chance to become better and that it should be seen as a kindness. I also realised that I prefer to receive criticism directly and not to wait for it. It seems more productive to me. Whether it is from patients or colleagues, an osteopath must be open to criticism and questioning. In the future, I will ask my patients for feedback so that I can see where I need to improve and target areas of strength.

References
https://medium.com/blindfeedhq/what-weve-read-thanks-for-the-feedback-by-douglas-stone-and-sheila-heen-5b6b187d333c

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This book on the best practices of receiving feedback and developing growth mindset was an obvious choice for the first session of our Blindfeed Book Club ( the epic story of setting up and conducting the club, including how to make sure that all people read the agreed book, is a separate topic that deserves a dedicated post). Here're some of the notes we've taken while reading and discussing it.

Douglas Stone and Sheila Heen have spent the past fifteen years working with corporations, nonprofits, governments, and families to determine what helps us learn and what gets in our way. In Thanks for the Feedback, they explain why receiving feedback is so crucial yet so challenging, offering a simple framework and powerful tools to help us take on life's blizzard of offhand comments, annual evaluations, and unsolicited input with curiosity and grace. They blend the latest insights from neuroscience and psychology with practical, hard-headed advice. Thanks for the Feedback is destined to become a classic in the fields of leadership, organizational behavior, and education.( Summary from the publisher)

What is feedback and why we all need to learn to receive it properly

The term 'feedback' was coined in the 1860s, during the industrial revolution to describe the way in which outputs of energy, moments or signals are returned to their points of origin in a mechanical system. Having undergone a gradual transformation, this term started to be used in industrial relations, particularly in performance management, after the World War II.

If you are interested in the phenomenon of feedback, you'll sooner or later realize that most of the books and articles on this subject are focused on giving the feedback effectively and productively. But what about receiving feedback? Authors of 'Thanks for the Feedback' point out that the real focus should be on receiving feedback ( creating a pull instead of the push attitude). " Creating pull is about mastering the skills required to drive our own learning; it's about how to recognize and manage our resistance, how to engage in feedback conversations with confidence and curiosity, and even when the feedback seems wrong, how to find insight that might help us grow".

In other words the ability to receive and actively seek feedback is likely to create higher job satisfaction, greater creativity, faster adaptation to the new position or company and in the end more meaningful work.
Benefits of receiving feedback well:

Your relationships become richer.

You learn and get better at things.

Other people find it more enjoyable to work around you.

It is easier for you to work with others to solve problems.

By your example, you help others see the value in seeking feedback for themselves.

Whenever we are asking, receiving or giving feedback we need to ask ourselves about the purpose we have. Are we trying to improve, assess or say thank you? Do we want our work to be recognised, or we are more interested in some advice? Depending on the answer we can talk about three types of feedback:

Appreciation is giving thanks to you and encouraging you to keep doing what you are doing. For it to be effective, it needs to be specific, authentic, and in a form that you find satisfying.

Coaching is showing you a better way to do something to help you grow. Coaching can be related to improving your skills or at fixing a perceived imbalance in a relationship.

Evaluation is telling you where you stand compared to a standard or compared to others. Evaluation aligns expectations and clarifies consequences.

Once the type of the feedback is defined we need to be extremely clear about what we're trying to do:

What's my purpose in giving/receiving this feedback?

Is it the right purpose from my point of view?

Is it the right purpose from the other person's points of view?

We can't focus on how to improve until we know where we stand.
How to better receive feedback

When you receive feedback, you need to ask yourself

* What make sense about what they are saying

* What seems worth trying

* What's right about {name}s feedback?

One way to keep and open mindset while receiving feedback is to understand when you are triggered:

Truth triggers - we view the feedback as wrong, unfair or unhelpful. Thus we are either defensive, or completely rject the information.

Relationship triggers - we question the person giving the feedback or the relationship itself. Thus we can view the giver as less trustworthy.

Identity triggers - something about the feedback causes us to question ourselves. Thus we can think of ourselves as a 'failure' in case the feedback is true.

It is definitely a challenge to understand what the feedback giver is trying to convey. Part of the problem is that we use labels which represent a collection of our impressions. We think the label describes what's in our head, but it doesn't.

Beware of the blind spots. Blind spot is something we don't see about ourselves that others do see.

Blind Spot-Your Face: People react to subtle nuances in your eyes and facial expressions that convey your mood to them. You are largely unaware of the messages your face sends.

Blind Spot-Your Tone: You are unable to hear your voice the way others do. Your tone, pitch, and cadence convey your emotional state to them.

Blind Spot-Your Patterns: You often don't realize that you have establish behavior patterns which have affected others' opinion of you.

There are also blind spot amplifiers.

Emotional Math: Others count your emotional state at double the rate of anything else in the interaction. If they see you as angry or tense, that is what they will primarily take away from the interaction.

Your Character: While you tend to attribute your actions to the situation, others tend to attribute your actions to your character.

Your Impact: You tend to judge yourself by your intentions. Others tend to judge you by the impact you have on them. Despite your best intentions, you may have a negative impact on others.

Cultivate the growth identity

Give up simple labels. You are a complex blend of things. Your intentions are a mix of purely positive and some less than noble. You have contributed to the problems you are having.

Shift to a growth mindset. View tough situations as learning opportunities. Praise yourself(andothers) for how much effort they put into learning rather than natural ability.

Move toward a growth identity. See yourself as a person who is eager to put effort into learning. Try to find something you can learn from feedback.

Encourage people to discuss your blind spots with you

Shift from blame conversations to joint contribution conversations, and start by asking what you might have contributed to the problem.

Hold people accountable by showing them how you hold yourself accountable alongside them.

Give yourself a second score. Evaluate yourself on how well you handled the evaluation. This score is as important to your growth as the evaluation itself.

Avoid being an Absorber or a Shifter:

If you absorb all the responsibility for the relationship issues, you will become resentful. You cannot solve the problem on your own because you are only part of the problem.

If you shift the blame to the other person, you make yourself a victim. You become helpless and unable to see the part you play in the problem.

Manage Feedback in Conversations

1. You have the right to choose whether to apply feedback.

2. You have the right to stop receiving feedback.

Four Skills to Manage the Body of the Conversation:

1. Listen. Your purpose in listening should be(1)to be sure you understand what the other person means by what they are saying and(2)let the other person know you understand what they are saying.

2. Assert what's left out. Avoid telling the feedback giver that he is wrong. Instead, add your perspective to the conversation.

3. Be your own process referee. Pause the action to diagnose where you are in the conversation and propose a way to get things on track.

4. Problem solve to create possibilities. Invite the other person to think with you about different ways to meet the underlying interests.

Take action upon receiving feedback

1. Name One Thing. You can get overwhelmed by too much feedback. Look for themes that reveal key areas to address. Ask,"Whatis one thing I could change that would make a difference for you?"

2. Try Small Experiments. Run through a scenario in your head of how a change might work. Pick one small change to try for a set period of time.

3. Ride Out the J-Curve. Sometimes you struggle to make a change you know is right because it is an unpleasant change to make. Consider the reality that things will get worse before you begin to see improvement. Increase the positive appeal of the change. Increase the cost of not changing.

4. Coach Your Coach. Tell your coach how you tend to react to feedback. When you request feedback, state how getting the feedback would help you serve the coach more effectively. Avoid excessive requests for feedback.

5. Invite Them In. Come to people with a specific feedback request and explain why you think they have a perspective that would be helpful.

'Thanks for the Feedback' is full of helpful techniques that can be used by anyone seeking to build meaningful realtionships, lead a team or leverage the value of feedback we all receive every day. This post is just a brief summary of the topics and actionable points covered in the book (e.g., I didn't mention the last chapter of the book with suggestions for HR and management) and hopefully it persuaded you to read the book in full.

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What we've read: "Thanks for the Feedback" by Douglas Stone and Sheila Heen

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This book on the best practices of receiving feedback and developing growth mindset was an obvious choice for the first session of our Blindfeed Book Club ( the epic story of setting up and conducting the club, including how to make sure that all people read the agreed book, is a separate topic that deserves a dedicated post).

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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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Description
Mrs. Y., a 67-year-old retiree, consulted for neck pain between C3 and C7, trapezius myalgia and a constant clicking in both temporomandibular joints. She has a history of falling from a horse, a concussion several years ago and a history of psychological trauma, including abuse by a family member as a child. She is very close to the medical community and cares a lot about her body, so she has had all the scans after each concussion to make sure everything is okay. She seems anxious, lonely and sometimes I can tell she changes moods quickly and can seem depressed.

Evaluation
In her case, I had to take into account other factors affecting her (mental) health and well-being. The psychological aspect of the complaint presented by the patient is crucial, as behaviors, thoughts, feelings, and emotions can impact how she perceives her environment and thus the normal healing process. Most of the signs and symptoms presented are due to the level of constant stress she endures and certain wear factors indicating a spondylotic modification causing these muscular guards.

Analysis
Engel's Biopsychosocial Model of health and illness suggests that a person's behaviors, thoughts, feelings, and emotions can impact their physical health (Mc Inerney, 2002). Therefore, when a patient presents with psychological factors, such as stress and anxiety, which may be contributing to their condition and complaints, it's important for the practitioner to consider these factors in the final diagnosis, treatment, and management plan. By providing preventative information and supporting lifestyle adjustments, practitioners can have a positive impact on their patient's overall well-being and health.

Conclusion
Osteopathy has the potential to reduce stress levels and promote balance and homeostasis. In the context of the biopsychosocial model of health and illness, mental health concerns can have a significant impact on a patient's overall health and well-being. As such, it's important for healthcare providers to work collaboratively to optimize patient care, whether through prevention or treatment. The use of complementary healthcare therapies may also be beneficial in promoting a patient-centered approach that is more effective and holistic.

Reference
Mc Inerney, S. (2002). Introducing the Biopsychosocial Model for good medicine and good doctors. In response to:What is a good doctor and how can we make one? (2002). BMJ, 324(7353), pp.1537a-1537.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124203/

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I remember the time Shipman gave to my Dad. He would come around at the drop of a hat. He was a marvellous GP apart from the fact that he killed my father.

Are you a good doctor? This question is increasingly being asked by patients, governments, third party healthcare payers, and newspaper, radio, and TV investigators. It also topped the list of suggestions for BMJ theme issues in a recent ballot of bmj.com users and BMA members. But why?

PHIL SAYER/KING'S COLLEGE, LONDON

Claims and complaints against doctors are growing worldwide. In the United Kingdom, a series of inquiries has ushered in probably the most sustained investigation and collective appraisal of medical and healthcare institutions since the NHS began. The performance of individual clinicians, laboratory and clinical units, the frequency of medical mistakes, the unacceptability of organ retention practices, and the adequacy of death certification procedures are only a few of many medical activities now subject to intense scrutiny. ⁻ A debate has thereby been prompted about the sort of doctors society wants and expects, and the need for answers is heightened by expansion in spending on medical education and health services.

One approach to defining a good doctor equates the answer with the skills of an applied scientist: good doctors combine individual clinical expertise and best available external evidence; they are thoughtful, evidence based practitioners who use "intangible personal resources" in the care of their patients. Another approach lies buried in the Socratic dictum "Know thyself," an exhortation discernible in the importance the General Medical Council attaches to vocationalism in medicine and to the personal qualities required of its practitioners, including truthfulness and a reflective turn of mind open to audit and to learning from mistakes. Readers from 24 countries responding to a BMJ debate about what makes a good doctor allude to desirable personal qualities more prominently than proficiency in knowledge and technical skills (p 715).

The psychiatrist Jeremy Holmes, writing in this issue (p  722), renders Socrates' dictum in a more modern, psychological form by acknowledging that the inner life of most doctors necessitates grappling with contradictoriness and incoherence of thoughts and feelings. If this state of affairs is the norm, reflecting on good and disapproved of aspects of the self will help doctors to become "good enough" practitioners.

But the proliferation of formal medical assessment agencies signifies that conscience and reflectivity-could they be reliably discerned-no longer offer credible guarantees of goodness in doctors. Five years ago, Richard Smith spelled out a population based rationale for setting up monitoring systems premised on the view that all doctors could potentially become problem doctors: "Think how surprised we would be by a community of 130 000 (the number of doctors in Britain) where nobody committed serious crimes, went mad, misused drugs, slacked on the job, became corrupt, lost competence, or exploited their position."

Society and government now look towards a mix of healthcare process and outcome variables for evidence of clinical competence (p  704) and, where possible, to markers of compliance with standards, guidelines, and clinical service frameworks. Are such variables set to become surrogate measures of the goodness of practitioners?

Does the notion of goodness have anything to add to what we want from doctors once their competence and performance have been specified and verified? After all, when "good" (as an adjective) qualifies "doctor," a great deal of its meaning is determined by what is meant by "doctor." This, in turn, is set out in education and training curricula (p  718) and in the knowledge, competences, and values to be demonstrated in the process of gaining a primary medical qualification. When it comes to doctoring, the term "good" increasingly functions as a descriptive label that denotes having met certain tests of competency.

A poor doctor is generally credited with good intentions but inadequate knowledge or skills required for the job, and there seems little doubt that some poorly performing doctors will be picked out by performance monitoring procedures. But what about bad doctors? A bad doctor, however skilled, is one with bad intentions, undesirable values, suspect-occasionally evil-motives. Judging someone a bad doctor implies serious defects of moral agency, even though these may coexist with commendable aspects of medical practice, as the above statement from the son of one of Harold Shipman's victims makes plain. Although the death rate of Shipman's patient list turned out to be high when examined retrospectively, performance outcome measures cannot detect bad doctors in all possible circumstances.

The varieties of good, poor, and bad doctors are diverse and may sometimes coexist in the same individual. This does not make becoming a good doctor an unattainable ideal. Medical education today should be aiming to marry the skills and sensitivities of the applied scientist to the reflective capabilities of the medical humanist.

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What's a good doctor, and how can you make one? : By marrying the applied scientist to the medical humanist

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I remember the time Shipman gave to my Dad. He would come around at the drop of a hat. He was a marvellous GP apart from the fact that he killed my father. Are you a good doctor? This question is increasingly being asked by patients, governments, third party healthcare payers, and newspaper, radio, and TV investigators.

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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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D11. 2. If you are exposed to a serious communicable disease, and you believe that you may be a carrier, you should not practise until you have received appropriate medical advice, and you should follow any advice you are given about suspending or modifying your practice. You should take all necessary precautions to prevent transmission of the condition to patients.

Description
Since the beginning of the pandemic in March 2020, the ESO teaching clinic has faced numerous challenges. In response to Covid-19, several essential changes and adaptations have been made. When the clinic reopened in July 2020, the focus was on ensuring hygiene and safety for both patients and staff. The ESO provided guidelines for students to follow, which are attached here. These guidelines state that if someone has any Covid-19 symptoms, they should not come to the clinic and should self-isolate at home. Practitioners have to screen patients carefully for the detection of Covid-19 symptoms, wear full PPE, including a surgical face mask, disposable apron, and gloves, and disinfect the treatment room regularly. The ESO also recommended that practitioners receive a free Covid-19 test regularly. Although these guidelines may not provide optimal osteopathic care, they are necessary as the virus can be life-threatening and disabling. Additionally, the Institute of Osteopathy (iO) has provided updated guidelines from Public Health England for osteopaths to follow. These guidelines include information on adapting your practice and frequently asked questions, among other things.

Feelings
It happened to me when I was in my second year, which was a particularly hard year. It wasn't easy having to take online anatomy courses, methods where you just practice and feel with your hands for palpation. My mental health was affected during this period and I have come out of it completely transformed, for the better. On the other hand, I am more appreciative of the fact that our university and clinic were able to stay open during the pandemic because of the nature of our work in the health care sector.

Analysis
This challenging time allowed us as practitioner to take our precaution even more, allow a certain self-questioning regarding the profession because we are using our hands. All the staff members, practitioners at the ESO clinic took all precautions to prevent the transmission of Covid-19. Especially for an optimal management and maintain patient safety.

Conclusion/ Action plan
In my opinion, covid-19 taught us as practitioner a lot. Through resilience (personal growth and development), adapting ourselves as osteopath which is pretty much one of the major skills required. Beside that, this period remained my self how it is important to look after ourself especially if we are working in the medical field.

Reference
Covid-19 Clinic Guidelines

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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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In order to maintain transparency and accountability, it is essential to cooperate fully with any requests for information or investigation and comply with all regulatory requirements. The attached article provided me with valuable insights into the procedures involved in reporting such offenses and what actions are considered a violation. It also guided me on the steps I should take in case of a conviction.The top priority in all matters related to the practice of osteopathy is to ensure patient safety and uphold the public's trust in the profession. If an osteopath is found guilty of misconduct or incompetence, it is important to notify the General Osteopathic Council (GOsC) immediately. This could result in various disciplinary actions, such as admonishment, suspension, or removal from the register.

Reference
Article GOsC - Criminal conviction and fitness practice

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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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Description
In December, I took my CEX exam, which involved conducting a comprehensive osteopathic patient evaluation and delivering safe, competent, and appropriate care. I made all decisions independently, without the supervision of my tutor, and received positive feedback from my assessor. I successfully met all criteria and passed the exam.

Feelings
I felt really comfortable with the exam due to the amount of hours of training. As students, we are receiving intense training regarding patient management and safety. Learning how to develop rationality is one of the first processes and skills that you learn at ESO. Even though I am still a bit nervous before any exam, I am always happy when I finish and feel quite proud of myself and realize how much I know. And I have to say that over the course of these 4 years, I have developed and learned how to be more comfortable with any exams or stressful situations, such as having observers or tutors in the background of the consultation.

Evaluation/Analysis
Thanks to this experience, I knew what to focus on, thanks to feedback that my tutors and colleagues gave me. The strengths that I had were:

Good case history with informed consent

Good examination of LBP

Good safety questions regarding Cauda Equina condition

Good management for treatment plan + advice

The weaknesses that I had to work on:

Formulating a logical diagnosis

Learning more about instability knowledge (factors, consequences)

Running out of time for treatment due to talkative patient

According to the mark sheet, my tutor considered that I was able to conduct a safe osteopathic patient evaluation, as well as safe and logical osteopathic care. The following fields were covered:

Note-taking during the case history with good communication style tailored to the patient's individual needs.

Appropriate clinical assessment of the patient, taking into account patient preferences, pain perception, and sensitivity.

Nice management of the patient in general.

Good treatment, palpation skills, and treatment plan (demonstrated logical aims for short and long-term treatment)

Conclusion/ Action plan:

I really enjoyed this experience and the fact that it helped me build my confidence. Even though it was a stressful time, it definitely helped me develop certain skills as a healthcare professional. My communication improved, as well as the formulation of logical and rational diagnosis, which became even more precise in my practice thanks to the various clinical exams and feedback.

reference
Cex clinical exam

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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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Description
The European School of Osteopathy teaching clinic provides forms for the case history that are well-detailed. These different types of forms include maternity forms, children's forms, and adult forms. During clinic years, students have to cover patients for others due to sickness or other reasons, and sometimes, students come across frustration because of the lack of data or illegibility problems. This creates frustration and wastes time.

Feelings
It was difficult sometimes to read notes from others students. Especially when you had to presented the case history to the tutors at the time and it is a waste of time.

Evaluation
It really was unprofessional to present a case where you provide half of the informations due to the handwriting or inaccuracy of the notes from others colleagues. This is why it is important and crucial for healthcare professional to make note comprehensive and complete to ensure that the patient is safe to treat.

Analysis
It can be really uncomfortable to work with that kind of incomplete or unclear forms especially at students. This create anxiety for the students practitioner, incoherence with the tutor at the time, waste of time and can be really challenging to examine and treat.

Conclusion/Action plan
These experiences made me realize how essential notes are and how important clarity is, not only for the practitioner but also for other healthcare professionals who may need to refer to them for the safety and care of the patient. As a result, I decided to adapt my handwriting and computerize my notes, which makes it much easier for me to transfer information regarding the patient's health in a clear and simple manner.

Reference
ESO form

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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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C3.1.1. produce reports and referrals, and present information in an appropriate format to support patient care and effective practice management

Description
During my last year at the ESO teaching clinic, I observed a tricky case involving a patient who presented signs of severe depression. The situation was complicated because she initially came for a different complaint, and the student practitioners had to refer her for depression symptoms to ensure her safety.

Feelings
On the moment when I was observing I felt really uncomfortable for the patient because it was quiet of a shock to finally put some word on how she was feeling at the time. Her presenting complaint was linked with her depression and the students practitioner explained the physiology and anatomy process behind the pain.

Evaluation/Analysis
Dealing with such situations requires excellent communication skills and empathy towards the patient's understanding. In this case, the student practitioners had to ask for the patient's consent and explain the purpose of the referral letter and how appropriate care could potentially change her life. The patient agreed to have the letter written and signed the consent form, which allowed the practitioner to produce a draft referral letter.

Conclusion/Action plan
It was a good learning experience and the student practitioner did well in terms of communication and explanation regarding this referral. The patient appreciate the fact that it will help her finally and cooperate well with the practitioner on the day.

Reference
Referral letter from case observed

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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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C4.2. You should have an awareness of, and keep up to date with, current safeguarding procedures, including those relevant to your local area, and follow these if you suspect a child or vulnerable adult is at risk.

Description
Over the course of those 4 years at the ESO, students have to complete several compulsory safeguarding training sessions on different subjects such as recognizing and preventing female genital mutilation (FGM), children abuse, risk of radicalization.

Feelings/ Evaluation
I was not really aware of our wider role as osteopath to safeguards the welfare of our patients and must report ay signs of harm or form of abuse.

Analysis
My awareness of safeguarding issues increased significantly when I started working in the children's clinic, as we work with a diverse paediatric population ranging from babies to adolescents. We must acknowledge that we may encounter indications of harm and abuse. As osteopaths, we must remain mindful of our own limitations and understand that we may not be able to resolve certain issues alone. In such circumstances, we are responsible for seeking assistance. It is our duty to report any significant concerns for the welfare of the patient to the safeguarding lead, using the CPOMS (child protection online monitoring system).

Conclusion/Action plan
As healthcare professionals, it is crucial that we know how to respond in situations where the welfare of our patients may be at risk, and provide a secure and nurturing environment regardless of the circumstances. It is especially important to safeguard the welfare of minors and vulnerable adults. Continuing Professional Development (CPD) courses focused on these topics could be extremely beneficial in keeping us up-to-date on the latest knowledge and communication approaches related to safeguarding issues.

Reference
ESO slide Safeguarding Policy (002)

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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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C5.5. You should take all necessary steps to control the spread of communicable diseases.

Description
During Covid-19 period, as healthcare professional we had to wear full PPE, gloves, hygienic mask and for children speciality clinic some glasses protection to ensure the safety of our patients and not spreading the virus. The medical system must adapt to situation as such and respect the rules's legislation.

Feelings

Although the pandemic presented challenges, such as decreased palpation ability and quality of communication due to wearing masks, I believe that it ultimately provides us as osteopaths with an opportunity for growth. Adapting to the situation is a fundamental aspect of osteopathy, in my opinion. I have gained valuable skills and experiences during this time, such as improving my observation skills and communication through eye contact. This has allowed me to better understand my patients and communicate effectively with them.

Evaluation/ Analysis
In my opinion, the progress we have made as practitioners during this time is a result of our hard work and determination. We have had to work harder to compensate for the loss of palpation ability and adapt our communication methods. I have even gone as far as reading papers about developing my senses when we, as manual healthcare practitioners, are restricted. I have also regularly asked for feedback from my patients and monitored the outcomes, which has been a great source of motivation and encouragement.

Conclusion/Action plan
After the pandemic, I felt the difference as my palpation improved and get even more specific as well as communication skills regarding safety and informed consent regarding patients. It has been challenging but a good reminder to keep our practice safe, clean and hygienic according to safety rules legislation.

Reference
Internet, 2023. GOsC Covid-19 rules available at: https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/ [ Accessed 2nd of March, 2023]

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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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C6.1. You should be aware of public health issues and concerns, and be able to discuss these in a balanced way with patients, or guide them to resources or to other healthcare professionals to support their decision-making regarding these.

Description
A new patient, a 50-year-old teacher, visited the ESO teaching clinic and was diagnosed with cspine spondylosis and trapezius weakness, likely caused by her age and lifestyle. She had been sitting with her head in a flexed and rotated position. She also complained of a headache that spread to her suboccipital, temporal, and behind-eye areas, along with recent visual changes. During the initial consultation, I discussed these issues with her and advised her to consult her optician to ensure her overall health and well-being. At her following appointment, she reported that she had visited her optician, who prescribed her a new pair of glasses that greatly improved her headache.

Feelings
During the first consultation, she mentioned to me the appareance of the headache associated with the pain behing the eyes and the visual disturbances. I screen her for potential red fag (temporal arteritis, migraine etc..) and her answer all come back negative so I advice her to contact her optician. Beside, I am also aware of my role as a healthcare professional to educate my patient and guide her to resources and refer her back to the optician.

Evaluation
Before referring to her optician, I did make sure that she didn't experienced any other symptoms that could be a potential red flag for an urgent referral. I applied my knowledge, knowing that headache could be the cause of visual changes and can be alleviated by adapting the visual field via new pair of glasses.

Analysis
Considering my wider role as a healthcare professional, I invited the patient to read on the NHS website about headache (link attached) and offered her to consult her optician for further investigations and management. I also explained the physiology process and anatomy behind the potential issues and the consequences if no treatment.

Conclusion/Action plan
After this experience, I realized our wider role to educate and support the patients, enhancing their health and well-being by doing the right clinical decisions.

Reference
Internet, 2023. NHS Headache available at: https://global.essilor.com/uk/blog/all-about-glasses/glasses-for-headaches#:~:text=You%20need%20to%20wear%20glasses%20that%20will%20reduce%20the%20need,as%20hypermetropia%2C%20myopia%20or%20astigmatism. [Accessed 2nd of March, 2023]

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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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B1.1.3. a knowledge of pathophysiological processes sufficient to inform clinical judgement and to identify where patients may require additional or alternative investigation or treatment from another healthcare professional

B1.1.4. an understanding of the psychological and social influences on health, sufficient to inform clinical decision-making and patient care

B1.1.5. an awareness of the principles and applications of scientific enquiry and the ability to critically evaluate scientific information and data to inform osteopathic care
B1.1.6. an understanding of the principles of biomechanics sufficient to apply osteopathic treatment safely and effectively

Description
Since the beginning of the ESO journey, we as students are trained and assessed on applying knowledge within a case context and with a timer. The exam is called ''OSPE''  (Objective Structured Practical Examination) and in our final year it is called ''FOPE'' which is the same principle but not with the same expectations. Our knowledge base is assessed since we began the course. It is basically an application of theory and practice from a different taught components of the Osteopathic Skills modules. Especially in my final year, I was expected to critically evaluate the case and apply osteopathic management which include treatment (short term and longer term management), Advices, explanation why did I choose this technique over an other one, and how the technique affect the patient's body which lead me to talk about relevant components within the case history. Finally, the idea of those station is to see if the student is able to create links in every station that have a particular osteopathy fields (visceral, cranial and structural) to prove that I have a good understanding of multi-modal of osteopathy in my management plan.

Feelings
Overall, those assessment allowed me to build my confidence. Time management was challenging because of the amount of stress, time of the station which is only 20minutes and amount of informations to provide to the examiner. However, over the years, I learned to deal with my anxiety, managing my time in a better way.

Evaluation
The assignment was a really good practice and it was a good opportunity to show that I am able to apply my knowledge at the front of examiners and show my palpation skills in my treatment.

Analysis
Over the time, my mark get better and I was able to demonstrate more my knowledge and skills regarding treatment. My treatment and clinical approach were judged to be sufficient to first pass but as well to be considered as ''safe practitioner''. In that kind of exam,  this is where I can as practitioner demonstrate my skills regarding biopshychosocial model and apply my knowlegde especially in clinical decision-making and management care in context of the other osteopathic model (biomechanical, neurological, respiratory, metabolism).

Conclusion/Action Plan
However, I noticed that I need to go back always to the anatomy,  an essential key for osteopath. As well as reviewing disease or certain conditions  as I did  for this assignment. Going forward,  I am aiming to read more articles, news paper regarding osteopathy medical field to keep my mind open and always open  to news techniques,  new theories for a perfectionnisme of my knowledge. It will indeed support my work as osteopath.

Material attached
OSPE

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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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B2.3. referring the patient to another osteopath or appropriately qualified healthcare professional.

Description
New patient came at the ESO clinic, male 70 years old complaining about Acromio-clavicular (AC) area/ location of pain with no particular onet since 2 weeks. The patient report pain on movement and a new onset of headache since 3 months, with a feeling of dizziness quiet recurrent everyday, high blood pressure. Mr. X came with some recent imaging (X-ray) explaining the cause of his shoulder area pain/problem. The imaging report the nature of the problem of the AC joint pain related which is some wear and tear (arthritis) in the joint capsule. However, the appareance of the new onset of headache, dizziness and high blood pressure is not explained and in progression.

Feelings/Evaluation
It has been one of the hardest case that I had regarding emergency referral letter. I did quiet a few in the past but this one was the most urgent and dangerous. The patient was really sensitive and already emotional before even starting the consultation. Once the conversation where finished my patient where concerned but at the same time really grateful.

Analysis
At the beginning, I was kind of scared because of the type of case where you as practitioner have to react quickly. Behind the referral letter, the communication is essential between the patient and I. And I realized that I was scared of this part, where I had to communicate with the patient and explain my concerns without making him worried. This is where my communication improved and the relationship between my patient and I regarding trusting each other.

Conclusion/Action plan
I will make sure that in my future practice, approach my patients will be always considered with their context, background, systemic health (in details). Regarding my treatment and management approach, the patients would be always integrated by knowing the limits of my osteopath training. Finally, always considering a referral if I have any doubt and if I want a second opinion from an other qualified healthcare practitioner because that would be the best for patient's management and care.

Reference/Material
lettre referral

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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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B3.1.1. be professionally engaged, undertaking professional development activities and complying with GOsC requirements regarding continuing professional development.

Description
Continuous learning, curiosity and professional development are essential to improve our skills as healthcare practitioners. During my last year at the ESO, I completed quiet a few workshop on different subject such as ''Death and dying'' with Mary Bolingbroke, Andrew Taylor Still technique revision, paediatric workshop (cranial), Sue Turner workshop cranio-sacral techniques etc...
There is many tools outside of the school to keep learning and in different ways such as body world exhibition. This exhibition is incredible for people who are interesting in medical field, you can see every systems, nerves, muscles, blood vessels etc...

Feelings
I decided to join those workshop to improve my skills regarding difficult situation (such as dying), to have an idea and how to handle patient's emotional side. I had this feeling it will help me throughout the course of ESO clinic but as well as in my future practice.

Evaluation
I learned under the supervision of an professional and experienced osteopaths. The course/ workshop was only during a day, for some of them it was for 2 days maximum. It offered me both theoretical and practical skills which was really good for my type of learning (visual).

Analysis
Taking new courses and getting involved in professional activities are also a part of my job as an osteopath. Participating in these types of short courses is very helpful for my career development. For example, attending a workshop on "Death & Dying" improved my communication skills and helped me better understand how to use my behavior and body language in difficult situations.

Conclusion/Action plan
Thanks to those workshop, my osteopathic skills improved, my curiosity increased. As an osteopath I can manage certain situation that are hard to handle. I am aiming to keep going to those workshop even after graduation. Also CPD course to get specialize in certain field and gain even more experiences. Osteopathy is all about self-questioning, self-confidence as practitioner, curiosity and progress.

Reference
1. https://bodyworlds.com/exhibitions/human/
2. Ticket for ''Death & Dying'' by Mary Bolingbroke

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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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B4.1. To achieve this you will need to have sufcient knowledge and ability to collect and analyse information and evidence about your practice to support both patient care and your own professional development.

Description

At the end of year 3, we began the dissertation process, which lasted until December 2021. Each dissertation learning outcome aligns with OPS B4, which requires us to exhibit independence in collecting data for Masters Level analysis in accordance with the protocol.

Throughout the process, we were required to independently conduct, analyze, and interpret data gathering using appropriate software-assisted approaches that addressed the research question in a structured manner.

To complete the dissertation, we had to write a report that integrated the staged research study into a cohesive and succinct narrative that adhered to the structure and presentation style of an academic journal. Through conducting a literature review, I demonstrated my ability to collect data for pre-determined Masters Level analysis, analyze and interpret the data, and integrate it into the report.

Feelings/Challenges
This period during the course of my degree was really challenging. First because I never had to do this kind of work for several months and because of the special methodology to follow such as utilizing certain databases, recorde everything (etc..). The harder part for me was to demonstrate critical reflection in the discussion section and comparing with the wider literature.

Evaluation
I feel that I could expand more time and explained more regarding the scope of methodological quality issues to expand the subject. Overall, the dissertation taught me so much on my way of working and how I can do better in terms of research, following a certain methodology.

Analysis
This assignment was great to develop my focus, research and criticality regarding the literature review based on my research question. All the skills that I obtain from it will serve me for the rest of my career.

Conclusion
Nowadays, thanks to the dissertation I know how to search information, critically evaluate the outside data no matters the database. Beside, I can apply this knowledge to my practice and never stop progress for the future. I would do things differently if I had to do it again such as working more with my tutor at the time,  shared and listen more my peers experienced ( would have been useful as a supportive environment).

Material/Reference
Dissertation

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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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Description
Reflection on a Clinical Case: Recently, I had a new patient who came for therapy. After explaining how the session would run, I started taking her case history. However, I quickly realized that the patient was talking excessively and not allowing me to ask any questions. This was a new situation for me, and I felt uncomfortable as I was unable to follow my usual process for the case history. Unfortunately, the patient was unaware of my process and ended up taking a lot of time to speak, and I lost almost 30 minutes. I tried politely explaining to the patient that we were running out of time and that it was important to focus on the questions, but it was challenging to redirect her attention.

Feelings
I felt really uncomfortable and especially at the front of my observers that I could not gain all the information I needed to discuss the case with my tutor.

Analysis
Towards the end of the session, I observed that my patient had become less talkative. This made me feel uneasy because I had attempted several times to redirect her attention in a polite manner. This experience underscored for me the importance of effective communication in the therapeutic process. Effective communication is critical for obtaining relevant information and ultimately determining the success of the session and treatment. When I think about this case now i am more thinking that it gave me a lot of information on the patient and her mindset and perception of life, pain. So having this case, help me on the biopsychological aspect and how to deal with it.

Conclusion/Action plan
After this experience, I had to find my way and strategies for my communication skills. I read some papers regarding effective communication especially one that change my opinion regarding communication/listening. Nowadays I believe that listening but how to speak as well is an integral part of communication (Manookian et al. 2013).

Reference
Manookian, A., Cheraghi, M.A. & Nasrabadi, A.N., 2013. Factors Influencing Patients’ Dignity. Http://Dx.Doi.Org/10.1177/0969733013498526, 21(3), pp.323–334.

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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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A2.2. You must care for your patients and do your best to understand their symptoms and support their health.
A2.3. You should be sensitive to the specic needs of patients and be able to select and utilise effective forms of communication, which take these into account.
A2.5. The most appropriate treatment for patients will sometimes involve:
5.1. referring them to another osteopath or other healthcare professional

Description
A new patient, who is 40 years old, came to the ESO teaching clinic in April 2021 for ongoing treatment for pain in his right calf and knee joint. The pain was caused by a motorcycle accident he had 20 years ago, which also resulted in the amputation of his left arm and left leg. The patient has a history of being a heavy smoker for 20 years, being obese, and experiencing cardiovascular symptoms such as shortness of breath, palpitations, swelling in his hands, ankles, and feet, and night pain. During the examination, the patient's right calf was found to be red, swollen, and tender.

As a result of these findings, the decision was made to refer the patient immediately due to concerns about the progression of his cardiovascular symptoms and the noticeable change in his right leg. However, it was discovered that the patient had already been referred several times this year and had been hesitant to do so again due to his reluctance to undergo surgery or heavy medication.

After some discussion, it was determined that the patient was only interested in being treated for his mechanical issues and did not want to further investigate his condition. Therefore, if he agreed to sign a consent form for a referral letter, the clinic would be able to treat him accordingly. The patient gave his consent, and he was treated for his pain.

Feelings
Initially, I felt quite apprehensive when dealing with this patient due to their presenting complaints and past medical history. In order to ensure that I could respond effectively, I consulted with my tutor and took a step back to assess the situation. I had some doubts about whether osteopathy would be an effective treatment option for this patient, given their complex health history.

Communication with the patient was also a challenge, as I needed to convey the seriousness of the situation and the potential risks if they did not seek medical attention. Despite this difficulty, I made sure to provide the patient with all the necessary information about their condition and the possible consequences if they did not seek appropriate medical care.

Throughout the consultation process, I made a conscious effort to respect the patient's autonomy and their individual needs and preferences. I continued to discuss their options with them at each subsequent consultation, and to support them in making informed decisions about their care.

Evaluation
I learned a lot through this experience and it made me even more aware of how partnership between practitioner and patient is crucial for a positive outcome in general practice. As healthcare professional we are promoting the health in the first line, i tried to make him understand the consequences and he finally gave us his consent and understand.

Analysis
Partnership between patient and practitioner via communication is essential for us as osteopath. This is what pretty much the all appointment rely on and make it effective or not. This shared-decision making is always respected and must be in a patient-centered approach via the 5 models of osteopathy.

Conclusion/Action plan
Finally, communication is a skills that healthcare professional have to master. As osteopath our role is massive and play a big part in the education of the patient. This allow their protection from potential injuries or bad habits in their lifestyle while respecting their needs and preferences.

Reference
Article

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Promoting Patient-Practitioner Partnership in Clinical Training A Critical Evaluation

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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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A3.3. If you propose to examine or treat a patient who has difculty communicating or understanding, you should take all reasonable steps to assist them. For example, make use of an appropriate interpreter if the patient communicates in a different language to you. If you are unable to communicate sufciently with the patient, you should not treat them

Description
This experience happened in a children's clinic. This specialty required a lot of justification regarding treatment at the beginning of the ESO teaching clinic. When I started the children's clinic, I had my first few babies, and most of the treatment that I was doing was cranial and sacral hold. For this kind of treatment, you need solid justification towards the patient, especially when it comes to the parents of the baby. A five-month-old preterm baby came to the ESO clinic for the first time, presenting with constipation since birth. In this case, the background and story of the mother were key messages to fully understand the baby's presenting complaints and how to be effective in my treatment outcome. The mother initially wasn't aware of the pregnancy until she gave birth at home. It was a traumatic delivery and very short without any medical care around. The mother and baby went to the hospital, and the baby stayed for two months due to prematurity and respiratory, temperature, and weight concerns.

Feelings

It has been a really good experience regarding communication skills because of the stressful background of the baby and mother. I had to explain everything that I was doing during the treatment and talk about anatomy and physiology and what could have happened during this stressful time in the baby's organism. I was pretty confident and relaxed with the baby, so it was really good practice to communicate the knowledge and put it in relation to the background.

Analysis

Having these kinds of skills is crucial as an osteopath practitioner and in the relationship between patients. Giving reassurance and justification plays a massive role in the treatment outcome. If the patient, especially parents, fully understand what the practitioner is saying and are no longer stressed regarding the baby's health, it will have a positive loop effect and, therefore, a positive outcome in general.

Conclusion

This skill is not only for communicating but also allows a positive chain effect following treatment and gives confidence to parents/patients, educates them, and gives them self-empowerment.

Reference
Case report

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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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A4.2. Gaining consent is an ongoing process. You must ensure that patients are able to make decisions at all stages of their treatment and care and continue to give consent.

Description
Since I started the course in 2019, the European School of Osteopathy has trained students on informed consent each year. It is a big subject that we discuss probably at each session and review justifications for treatment, sentences, personal questions, etc. I always try to apply informed consent and shared decision-making at each consultation with my patients. Over time, I am getting better at providing clear, concise, and adequate information. Besides, I always ask if they understand what I am saying and if they want me to repeat. At each step of the consultation, I make sure I obtain informed consent, even if it sounds repetitive. It gives them an opportunity to ask questions each time.

Feeling
I feel that sometimes my patients are annoyed when I repeat the consent question. When I notice that my patient is bored, I try to explain to them that it is for their own benefit and again give them the opportunity to lead and empower themselves.

Evaluation

Generally, when I explain this to my patients, they are more than happy, and it strengthens our patient-practitioner relationship. I read an article regarding informed consent and shared decision-making in medical practice that explains all the benefits. Additionally, it explains further strategies on how to approach certain patients, give them choices, increase interactions, better communication, and better outcomes regarding treatment.

Analysis

Strategies such as the BRAN model (Benefits, Risks, Alternatives, and Nothing (for any questions?)) are really useful for us as osteopathic practitioners by giving us guidance during sessions with patients. It gives us some protection as well as professional healthcare for the patient's safety. Offering the opportunity to refuse treatment is also part of the shared decision-making process.

Conclusion

I find it really helpful to have a strategy that we can rely on as healthcare practitioners. We must be able to communicate effectively the benefits and risks of any treatment that we do, and propose alternatives for any kind of technique. Finally, by applying these principles, the patient is aware of their own options/alternatives, and this enhances the practitioner-patient relationship.

Reference
Article informed consent and shared decision-making

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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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A5. 1.Supporting patients in caring for themselves may include:

-providing information on the effects of their life choices and lifestyle on their health and wellbeing
-supporting decision-making about lifestyle changes where appropriate
-encouraging and supporting patients to seek help from others, including other health professionals or those coordinating their care, if necessary

-respecting patients’ decisions about their care, even if you disagree with those decisions.

Description

During my third year, I had a 43-year-old female patient who presented with pain in the sacro-iliac joint area, which was later diagnosed as SIJ (sacro-iliac joint inflammation). During the case history, the patient revealed that she had been diagnosed with fibromyalgia at the age of 15. Fibromyalgia is a condition that sensitizes the central nervous system and affects pain perception, leading to various symptoms. Initially, I was not aware of this condition and how it played a significant role in her presenting complaint. I also did not understand the needs of this condition and how challenging it could be for the practitioner. Fibromyalgia has various severity stages, and it generally requires a multidisciplinary approach and special attention. Additionally, fibromyalgia is associated with irritable bowel syndrome (IBS) and depression, making it difficult for both the patient and the practitioner. Patients with this condition are closely connected to their mental state, and this has a significant impact on their pain perception.

Feelings

Initially, I felt overwhelmed with the amount of information about fibromyalgia, its management, and its needs. I also felt useless during the first few sessions because of my lack of experience. However, this patient taught me a lot, and I am grateful to her.

Evaluation

After conducting extensive research and reading numerous papers about the condition, I developed a passion for understanding fibromyalgia. It is fascinating that people with this condition have a profound connection between their mind and body. This connection enables them to feel their environment, have a deep understanding of themselves, and react accordingly. Although every patient can react and adapt to their environment, not everyone has the same sensitivity.

Analysis

The sensitivity that patients with fibromyalgia possess is positive because it enhances their connection between their mindset and body. However, not everyone can do this, and it is one of the processes that allows the healing process to occur. With this patient, we continue to see each other every three months for management, which requires a lot of communication within the session.

Conclusion/Action plan

I plan to continue my research regarding fibromyalgia patients and the best way to help them. I would like to thank this patient in particular for her trust and support. In conclusion, communication and a multidisciplinary approach are key in helping patients suffering from fibromyalgia.

Reference
Article fibromyalgia and chronicity

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A6. You must respect you patients’ dignity and modesty. 

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A6. You must respect you patients’ dignity and modesty. 

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A6.1. Patients will have different requirements for maintaining their dignity and modesty during a consultation, and you must be sensitive to these. Some of these ideas may have been shaped by a patient’s culture or religion, but it is unwise to make assumptions about any patient’s ideas of modesty.

Description

During my third year, I had a Muslim patient who wore a hijab to the clinic. When she arrived, I informed her that there were two observers in the room and asked if she was comfortable with their presence during the case history, which did not require undressing. She immediately expressed discomfort and I respected her wishes by asking the observers to leave. During the examination, the patient chose to keep her hijab and clothing on, which made it challenging to perform palpations and observations required for diagnosis. However, I prioritized her comfort, dignity, and modesty, and the patient appreciated it.

Feelings/Evaluation

Examining this patient was challenging, but I learned the importance of respecting a patient's choices and making them feel comfortable. I felt good knowing that my efforts to be caring and respectful had a positive impact on the patient's experience.

Analysis

This experience taught me that as a practitioner, it's crucial to work with the patient's preferences and make every effort to ensure their comfort. This not only fosters a positive relationship between the patient and practitioner, but it also demonstrates respect for the patient's dignity and modesty.

Conclusion/Action Plan

Moving forward, I will prioritize patient comfort by respecting their choices and preferences. I will provide a consent form at the beginning of each session to inform patients of what to wear and expect during the appointment, including the option of a chaperone. By doing so, I hope to promote cooperation, reassure patients, and establish a foundation of respect and trust between myself and my patients.

Reference
Article NHS

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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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A7.2. You should maintain a professional manner at all times, even where a personal incompatibility arises with a patient.

Description

During my third year at the ESO teaching clinic, a new patient, a 40-year-old man, presented with neck and shoulder pain caused by facet referral pain irritation (C6/C7). There were no neurological signs or symptoms, and the patient reported stable pain over the past few weeks with no progression. However, during our first treatment, the patient requested that I perform a high-velocity thrust (HVT) on his cervical spine and entire spine, claiming that this was the only way to alleviate his pain. The patient was also a heavy smoker with hypertension, which posed a risk to his cardiovascular system if this technique were performed.

Feelings

I felt uncomfortable being pressured to perform a technique that could potentially harm the patient's systemic health. It can be challenging to engage in difficult conversations, especially when the patient is being passive-aggressive. However, as a healthcare professional, it's important to maintain professional boundaries and communicate diplomatically to create a positive atmosphere.

Evaluation/Analysis

By explaining the evidence-based research regarding the risks of certain manipulations, the patient understood and appreciated the information. This experience taught me a lot about analyzing a patient's behavior, which can provide valuable insights into their biopsychological aspects and how to best help them as an osteopath within ethical limits.

Conclusion/Action Plan

As healthcare professionals, it's crucial to always maintain professional boundaries and avoid engaging in confrontational conversations. However, if a patient's safety is at risk, we must explain the evidence-based risks of certain techniques and communicate our observations from the case history. This not only prioritizes patient safety but also protects our own safety as practitioners.

Reference
Article HVT Cspine vs Cardiovascular risk

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Mc Inerney, S. (2002). Introducing the Biopsychosocial Model for good medicine and good doctors. In response to:What is a good doctor and how can we make one? (2002). BMJ, 324(7353), pp.1537a-1537.

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Internet, 2023. ESO Clinic Guidelines available at: https://padlet.com/21901734/21901734-os746-e-portfolio-reflective-guide-9100kci2r2qc5sg6/wish/2517592005 [Accessed 18th of March, 2023]

Advertising Standards Authority, 2016. Which Medical Conditions Can Osteopaths Claim to Treat? Available At: https://www.asa.org.uk/advice-online/health-osteopathy.html [Accessed 21st of March, 2023].

Manookian, A., Cheraghi, M.A. & Nasrabadi, A.N., 2013. Factors Influencing Patients’ Dignity. Http://Dx.Doi.Org/10.1177/0969733013498526, 21(3), pp.323–334.

Internet, 2023. NHS Headache available at: https://global.essilor.com/uk/blog/all-about-glasses/glasses-for-headaches#:~:text=You%20need%20to%20wear%20glasses%20that%20will%20reduce%20the%20need,as%20hypermetropia%2C%20myopia%20or%20astigmatism. [Accessed 2nd of March, 2023]

Internet, 2023. GOsC Covid-19 rules available at: https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/ [ Accessed 2nd of March, 2023]