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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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D1.3 You must have a professional indemnity insurance arrangement which provides appropriate cover in accordance with the requirements of the Osteopaths Act 1993 and the current Professional Indemnity Insurance Rules.

Evidence: GOSc registration with intended insurer

Reflection
Within my GOSc registration form I showed that my intended insurer for post gradation will be the iO as they arrange great support for new graduates, and they were very helpful throughout my full education as an osteopath. They provide appropriate cover for osteopaths which fits with the Osteopaths Act 1993 described in this OPS.

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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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Evidence: Reflection on an experience in student clinic

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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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Evidence: Referral letter due to lack of treatment response

Reflection
One of my previous elderly patients presented with a long history of radiating pain down the leg. In the initial consultation we went through the possible options of care he had for his suspected condition and discussed how manual therapy only would possibly give limited improvement. He chose to still give osteopathy a go. Over a course of four consultations no improvement was experienced so I was honest with my patient that referral would be a better option instead of continuing with osteopathy. My patient appreciated my honesty and my support in providing a referral letter to get more appropriate care.
In the future I want to continue being as honest with my patients as I can and constantly revaluate the effects treatment is having even more than I’ve done in the past and the discuss this openly with my patients. I could achieve this even better by reading up more on the management protocols for more conditions then I’ve covered so far.

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referral letter oktober - Lsp osteophytes - Neuro

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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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D4.2 In the event of a concern being raised, if you act constructively, allow patients the opportunity to express their dissatisfaction, and provide sensitive explanations of what has happened and why, you may resolve this at an early stage.
D4.6 You should ensure that anyone making a complaint knows that they can refer it to the GOsC, and provide them with appropriate details explaining the procedure.

Evidence: Response to complaint letter Y2

Reflection
As part of our curriculum, we had to respond to a fictional complaint letter in our second year of the course.
This made me realize how important it is to have good note keeping during your consultations and make note of informed consent throughout the session to fall back on if a complaint would arise. It made me think about if I would consider offering refunds in my future practice or not.
Looking at it from a business point of view, people are paying for your time which can include your analyses of their case and possible treatment therefore a refund would not be appropriate if they were to complain later on. Looking at it from a more human point of view, if there was any unintended miscommunication and lack of understanding with the patient a refund could be pleasable as you might have fallen short as a practitioner providing clear explanations and protocols.
In the future I would want to look at every possible complaint individually and analyse it in depth before making any decisions or assumptions about the case. Every time should be a learning experience on how to improve your practice and I would wish to stay openminded for that feedback.

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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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D5.7.2 allow them to withhold permission if they wish
D5.7.3 if they agree, ask them to provide their consent in writing or to sign a consent form
D5.7.5 disclose only the information you need to

Evidence: Dissertation data collection student clinic

Reflection
For my dissertation project I conducted a data collection from the student clinic where I needed to anonymize patients’ data and check on every paper file if they agreed to sharing their data for research purposes.
To guarantee anonymity I only extracted the raw data I needed, never mentioning names but using numbers instead. Every file included a consent form where to patient had a choice to opt out of their data being used for research. These choices were respected throughout the process.
This project made me realize how much personal information we gather from people’s live, often including difficult experiences such as loss of a child. It has made me more aware of the responsibility we carry to keep our patients’ data safe.
In the future I am aiming to keep all patients’ information in a locked digital format instead of a paper format we hold at the student clinic to have a lower chance at losing or misplacing files and increasing security in that matter.

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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.

Evidence: Equality Act (2010)

Reflection
The Equality Act 2010 legally protects people from discrimination, offering protection to the following characteristics: age, race, sex, gender reassignment, disability, religion, sexual orientation, marriage and civil partnership, pregnancy or maternity.
I’ve been fortunate enough to have had a very open minded and multicultural upbringing in Belgium. Multiple members of my family endured racism and I saw how much impact this has on their daily life and how I was privileged in that matter because of the skin-color I was born with. It saddens me to see how some individuals can carry so much hate just because of their misconstrued view of what society should look like. Within my family background is also a variety of different religions being Catholicism, Islam and Judaism. This has taught me not only the differences but mostly the similarities between the biggest religions with the messages they can teach. I’ve been lucky enough to have travelled to various parts of the world, broadening my perspectives and reduce my prejudices in regard to all aspects of life.
I believe my personal experiences go hand in hand with the Equality Act and I strongly believe discrimination should never be allowed, in any circumstance. Sadly, this is not equally perceived by everyone. However, in my own practice I wish to establish a safe environment for every person that walks through my door.

Reference
Equality Act (2010) The Stationery Office Limited, London. Available at:https://www.legislation.gov.uk/ukpga/2010/15/pdfs/ukpga_20100015_en.pdf [Accessed June 1st, 2021].

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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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2.2.1 Upholding the reputation of the profession may include: acting within the law at all times (criminal convictions could be evidence that an osteopath is unfit to practise)

Evidence: proof of a clear record Belgium

Reflection
I have started my application process to obtain a critical health visa to work in New-Zealand post-graduation. One of the required documents is proof of a clear record for both the visa as for registering with the NZ osteopathic council.
I find in our profession we carry a heavy responsibility towards our patients and in order to keep our patients safe we need to make sure that the people wanting to become osteopaths don’t have any history of malicious intent. Naturally, having a clean criminal record doesn’t exclude future convictions but it will minimize the chance to a certain extend. I feel that with this knowledge of having to obey to the law, to be able to practice, makes more practitioners aware of the risks if they would ever come across a situation where lines could possibly be crossed. I think the thought of the possible consequences of my actions will have a bigger impact on my decision-making thanks to these OPS.

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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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D8.2 It will help you avoid disputes about fees if you have clear and visible information available on patient fees and charging policies.

Reflection
As I am still only a student practitioner and not charging any patients personally this OPS cannot be met in this point of time. However, as a former patient prior to starting my studies I did experience that osteopathic clinic websites displaying their fees felt more trustworthy prior to booking as I felt there was more transparency into the entire process. Having that personal experience, I plan on doing so myself going into future practice to improve patients’ overall satisfaction and level of trust in the clinic.

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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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D9.1 Where the care of patients is shared between professionals, you should consider the effectiveness of your handover procedures. Effective handovers can be done verbally, but it is good practice to make a note of the handover in the patient’s osteopathic records.

Evidence: Handover sheet Y4 to Y3

Reflection
While progressing onto the end of my fourth year at the ESO I have been advised by the head receptionist to start handing over continuing patients to make more room for initial consultations as a minimum of fifty is needed prior to graduating. I followed the handover procedure by filling in a summary document about that patients’ case for the future third year student taking over.
On the sheet I found no section dedicated to yellow flags, which I found in this patients’ case they, were quite substantial to her presentation. Therefore, I noted a list of all yellow flags that could potentially help the future practitioner manage this patient. This alongside the physical pain presentation and medical history was noted in a clear handwriting.
This first experience in handovers taught me I need to prioritize not only the possible red flags but also the yellow flags if this can have a big impact on your patients’ management.
In the future I will become more mindful of both physical and social factors in both my patient consultations as communicating them to other practitioners.

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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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B1.1.1 an understanding of osteopathic philosophy, principles and concepts of health, illness and disease and the ability to apply this knowledge critically, in the care of patients
B1.1.2 a knowledge of human structure and function sufficient to inform appropriate care
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

Evidence: Pathology and Anatomy (results and exemptions due to prior learning)

Reflection
Prior to starting this course, I studied physiotherapy for three years getting previous accreditation for the modules covering anatomy and pathophysiology. In my third year of study at the ESO I participated for the level 6 exams for pathophysiology and showed good marks throughout. The lectures gave me more insight into pain theories and the types of pain referral, endocrine related pathologies and respiratory conditions which were topics I felt I was lacking deeper insight to. Having a better understanding of pathology and anatomy should help me develop my understanding of health and what the effects can be for my patients. In the future I would like to keep up to date with medical developments especially with conditions such as fibromyalgia and its effects throughout the entire body.

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

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

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D10. 1.2 understand the contribution of osteopathy within the context of healthcare as a whole
D10.1.3 follow appropriate referral procedures when referring a patient, or when one has been referred to you

D10.1.4 work collaboratively with other healthcare providers to optimise patient care, where such approaches are appropriate and available.

Evidence: Poster Disc herniation + Psychology presentation + Referral letter

Reflection
At the start of my degree my assumption was that including other healthcare professionals into your management plan was mostly focused on GP referrals for possible pathological conditions that needed more investigating. However, doing more assignments looking into the evidence of the literature and associated guidelines, I became more aware about the limitations in our profession.
While doing my psychology presentation I realized how important it is to pick up the signs of post-natal depression and how important referral is for mental health issues to avoid possible devastating outcomes.
This made me more aware of the psychological flags and I am implementing them in both my general patient population as my postnatal patients. I have included more conversation with my patients in regard to mental health and what options there are for them, steering them into a more multi-disciplinary approach and plan on continuing to stay open minded to other healthcare professionals and the benefits they may have for my patients.

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Referral Lsp osteophy + Poster Disc + Pyscho

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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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B1.1.5 an awareness of the principles and applications of scientific enquiry and the ability to critically evaluate scientific information and data to inform osteopathic care

Evidence: Dissertation

Reflection
As part of the level 7 requirements, we needed to develop a dissertation topic that could inform better osteopathic care. I investigated if there was a higher prevalence of low back pain in breastfeeding mothers in comparison to bottle-feeding mothers within the population presenting at our osteopathic clinic. This process taught me to become more critical towards the published literature and how to compare them within the broader context of the topic. Before this assignment I would not question published articles much as I assumed they would be analysed extensively before publishing. This study has informed me about common misconceptions about pelvic girdle pain and has helped me provide better care for my maternity/post-natal patients. In the future I would like to specialize in this specific population as I feel that mothers are often forgotten after giving birth and I feel I could provide better support for many women.

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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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D11.1.1.1 seek and follow appropriate medical advice on whether you should modify your practice and in what way
D11.1.2 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.

Evidence: Health reference GOSc + COVID tests + COVID Vaccine

Reflection
Coming back into the student clinic during the COVID pandemic had a huge impact on the perception of my personal health. Before the pandemic, I would view myself as a fit and healthy individual and I wasn’t too worried about getting sick. The thought of being a transmitter of a virus had never crossed my mind.
The evolution of going back into practice where regular covid testing, PPE and social distancing at all times where the new norm, came as a real shock to the system. It made me realize how important it was to follow all regulations to a tee in order to keep all my patients safe.
Therefore, I’ve been engaging with regular lateral flow testing and got fully vaccinated recently. I am planning on continuing frequent testing to keep myself and my patients safe.

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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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C1.1 take and record the patient’s case history, adapting your communication style to take account of the patient’s individual needs and sensitivities
C1.2 select and undertake appropriate clinical assessment of your patient, taking into account the nature of their presentation and their case history
C1.3 formulate an appropriate working diagnosis or rationale for care and explain this clearly to the patient
C1.4 develop and apply an appropriate plan of treatment and care; this should be based on: the working diagnosis, the best available evidence, the patient’s values and preferences your own skills, experience and competence
C1.5 adapt an osteopathic technique or treatment approach in response to findings from the examination of your patient
C1.6 evaluate post-treatment response and justify the decision to continue, modify or cease osteopathic treatment as appropriate

Evidence: CEx in Y3 and Y4

Reflection
Throughout year 3 and 4 being in student clinic we’ve been examined on numerous occasions during entire consultations and the process we go through. The mini clinic exams focus on case history taking, information gathering and recording, clinical reasoning, differential diagnosis thinking, formulation of diagnosis hypothesis, clinical examination, recording of findings, interpretation of findings, prognosis, management, treatment, consent and decision making. Through the years I progressed throughout all the sections marking higher on all the sections on a more regular basis.
With the increased clinical experience comes increased proficiency and confidence which has made me more comfortable in the clinical setting. However, I am aware that there is still a lot of progression to be made on all levels. Therefore, in the future I want to start to finetune all levels of my practice throughout my entire consultation, especially being more aware of my patients’ sensitivities when going through the initial case history.

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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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C2.1 Records help you to provide good-quality care to your patients and should include:
C2.2 Your notes should be contemporaneous or completed promptly after a consultation (generally on the same day).

Evidence: Recent case History sheet

Reflection
All subsections under C.2.1 are recorded in the evidence provided and are signed off on the same day of the consultation showing that they were completed promptly after the consultation (C.2.2). Having this lay-out and sequence already for the last two years, I know this will help my future private practice following these steps as a guideline for good practice.

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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

Evidence: Referral letter

Reflection
This referral letter was produced with the help and approval of my supervision clinic tutor to assure it was written in an appropriate format to support patient care and show effective management. I intend to use this as a template for future reference to make sure I obtain to an appropriate format.

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reference letter may 2021 - Vascular Claudication

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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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C4.1 You must comply with the law to protect children and vulnerable adults.
C4.6 You must comply with any mandatory reporting requirements, for example, those related to female genital mutilation (FGM) in England and Wales.

Evidence: safeguard training and FGM training

Reflection
Before we were allowed to enter the student clinic in Y3, us students were obligated to follow a safeguard and FGM training to make us aware of possible warning signs of abuse or genital mutilation. I found these measurements before entering clinic very beneficial as I felt more ready to pick up any red flags. In the future I would like to go back to the training to refresh the details and keep my guard up within private practice.

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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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C5.1 Your practice premises must be clean, safe, hygienic, comfortable and appropriately equipped.
C5.5 You should take all necessary steps to control the spread of communicable diseases.

Evidence: Safety and cleaning protocol COVID ESO clinic

Reflection
Both the student clinic as the Boxley campus underwent extensive risk assessments and measurements to reassure the safety for both students and patients by introducing PPE, cleaning stations, regular fogging, staggering appointments and social distancing within our smaller subgroups in this COVID pandemic. This provided a safe and clean environment to control the spread of the disease. The use of these measurements made me reflect on how I can implement a similar structure for my own future practice. Even if legal restrictions in regards to COVID measures soften within time because of the high vaccination rate, I am more prone to still keep most of these measurements for a longer period of time.

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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.

Evidence: Infection Control Policy

Reflection
The rise of the COVID pandemic came with a rise of misinformation through all forms of (social) media. Many conspiracy theories were constructed, and a vast group of people are strong believers. When the student clinic reopened summer 2020 there were new rules set into place to provide safety for both students and patients. One of the new main rules was wearing a mask throughout the entire consultation. One of my middle-aged male patients was very reluctant to engage with the process when he showed up to his appointment. As he was sure this was all part of the governments’ scheme to control us all and how he would not die from it. I then had a conversation with him explaining how I had many other vulnerable patients that possibly could die if they contracted the virus. I wear a mask to protect those people around me as I know I would be less likely to suffer serious consequences as I am young and healthy. After this short conversation he agreed to wear a mask for the consultation as he agreed that not all patients are that lucky.
I felt a lot of frustration when this patient showed resistance to protocol as I was already happy to be able to get back into practice after the initial lockdown. I did feel that this man was more likely to have been isolated throughout lockdown and how that was possibly a contributor to his frustrations. This insight made me more understanding of his thought process. However, I was aware of the bigger safety aspect and how being lenient could possibly become a health issue in the clinic. Therefore, I will always look at the bigger picture when it comes to public health issues.

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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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A.1.3 Patients will come to you with different experiences and expectations. You should try to accommodate their wishes as much as you can without compromising the care you can provide. If you cannot accommodate their wishes, you should explain why you are unable to do so.

Evidence reflection patient experience

Reflection
A 43-year-old male presented in clinic complaining of unilateral neck pain of non-traumatic origin. He described how he had similar pain before and consulted osteopaths for pain relief.
He described how during those previous visits to an osteopath he found great relief when a cervical HVT was performed and was hoping he could get similar treatment from me.
I then explained how I was going to try to accommodate his wishes if my diagnosis and assessment would deem it appropriate and safe for his presentation. If I didn’t deem it appropriate for his presentation, I discussed other treatment approaches that could possibly work for him instead. The patient was very happy for my wiliness of considering his wishes and respected that I first needed to deem it appropriate for him in my initial assessment.
After further questioning, examination and discussion with my clinic tutor we concluded that HVT would be suitable for this patient, so I included this in my treatment plan. The patient was very happy with this and had a very good response to treatment.

I felt that I managed this patients’ expectations well by acknowledging his preference but still explaining that there was a matter of safety to be considered first. This experience will help me to manage other patients who come in expecting certain techniques to be performed. I found that communicating why something would/wouldn’t be appropriate for someone’s condition is key for obtaining a good patient-practitioner partnership. I believe this will be of even more importance if you cannot meet the patient's expectations because of safety considerations.

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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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A2.1 Trust is an essential part of a clinical relationship and requires effective communication between osteopath and patient.

Evidence: Case report - Feedback from patients' mother

Reflection
Within our case report there was one section dedicated to the patients’ feedback on their experience. This was a baby I treated in children’s clinic that was brought in each time by her mother. In the document she describes her overall perspective of the care she received. She describes overall exemplary care where everything was explained to what and why I performed any techniques. She also describes how I gave her opportunities to ask questions which I answered in a way that was easy for her to understand.
I feel that trust is absolutely essential when it comes to treating babies as they have no voice of their own yet. Parents come in with a destressed baby not knowing what is going on and they need someone to reassure them and explain what could possibly be contributing to their babies’ discomfort.
I felt in this case that I really put the mother to ease and gained her trust. I feel this was a big component in having a positive therapeutic outcome after each session.
I have been using this experience as something to draw out of each time I have a new baby patient to make sure the parent is involved as much as possible, every step of the way.
In the future I want to finetune my communication to better my use of layman terms especially in the paediatrics’ setting where cranial osteopathy is often used. I find cranial osteopathy the most difficult modality to explain to patients, so I am keen on developing this further.

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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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A3.2 You should discuss care options, encourage patients to ask questions, and deal with these clearly, fully and honestly. You should inform your patients of anticipated benefits as well as any material or significant risks associated with the treatment you are proposing, and confirm their understanding of these. If proposing no treatment, you should explain any potential risks and benefits associated with this.

Evidence: Y4 Mini CEx feedback

Reflection
During my last mini clinic exam, I was examined on a patient which I’ve been seeing for a several months. I received feedback from my examiner that I needed to pay attention to not use too many technical terms with my patients such as “viscera” and “HVT”.
Throughout the many (up to 14) sessions I’ve had with this patient I went through the explanations of HVTs and visceral techniques multiple times and checked his understanding multiple times. Therefore, I assumed that he already had a better understanding.

The examiner made me realize that patients don’t necessarily remember the exact mechanism explained X-amount weeks ago and need to be reminded on the purpose of each technique each time with the associated laymen terms to eliminate the chance of confusion.
In the future I will not assume that long-term patients still have a full understanding of techniques performed previously and will explain things every single session.

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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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D12.1.1.2 being charged with a criminal offence anywhere in the world

Evidence: DBS + GOSc registration

Reflection
When starting to obtain the necessary paperwork for GOSc registration I came across the need to do a DBS check where my possible criminal history would be checked. Even though I’ve never had any convictions or run ins with the law it made me feel quite anxious on how the process would go. I did not know if speeding tickets would be included in this process. Being a foreign student as well I was not sure If I had to do different paperwork to obtain the certificate.
After emailing with the GOSC team for final year students, they put me to ease that simple traffic violations were not an issue, and an UK DBS check would be sufficient as I was in the country for the last four years.
This process has made me more aware of the position we hold as healthcare professionals and how important it is to keep a clear record at all times for both our personal and professional futures.

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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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B1.1.7 well -developed palpatory skills
B1.1.8 understanding of the characteristics of the normal and abnormal functioning of different body tissues and systems to inform the interpretation of clinical findings
B1.1.9 ability to determine changes in health and function by the appropriate use of observation, palpation, motion and clinical evaluation

Evidence: OSPE Y1-3 + FOPE Y4

Reflection
Throughout the course we’ve been examined on our practical skills on a regular basis. With this comes a need to verbalize your findings and how this is maybe different from what we expected to find according to the fictional case we are provided with in an exam situation. I found that every year my ability to distinguish between healthy and dysfunctional tissue has improved and I believe clinical work has been the main contributor for this. Exposure to many patients and experiencing tissue reactions to injury and pain has helped me to identify the main contributors to their discomfort more easily. As my global evaluation improved, I found more confidence within my exams to discuss these fictional cases as I had more of a clear vision of how these patients would present. This also helped me to employ a broader range of different osteopathic approaches and my grades show a positive evolution reflecting my developing understanding of the human body.
I aim to keep reflecting on this process as my clinical experience grows and I want to keep working on being more efficient within the entire examination process to improve my osteopathic practice.

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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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B1.1.10 problem-solving and thinking skills in order to inform and guide the interpretation of clinical and other data and to justify clinical reasoning and decision-making

Evidence: Mock CCA Feedback

Reflection
Throughout years three and four we’ve been in the process of developing our clinical reasoning and decision making by improving our clinical data gathering during the consultations. The mock CCA felt like the first time I was tested from start to finish on my data gathering and decision making during an initial consultation. I found that within the stressful situation of CCA I was so focused on finding possible pathologies that I was lacking musculoskeletal considerations within my differential diagnoses. I find that when patients are systemically well it is easier for me to think in a holistic way than if they are not. Even though I showed a strong development in red flag considerations I want to be able to have more osteopathic considerations in the future when patients present with possible concerning signs and symptoms. I think that with more experience and lack of stress that comes with university studies, I will be able to improve in combining both medical and osteopathic thinking in those challenging cases.

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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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B1.1.12.4 the ability to critically appraise your own osteopathic practice. For example, this could be achieved through: case analysis or clinical audit.

Evidence: Case report

Reflection
As part of our year four requirements, we had to write a case report using a patient from one of our specialist clinics. In this report I had to dive into the surrounding literature that correlates to the premature born baby that was my patient. It was interesting for me to look into the evidence, how that compared to the treatment given and how I could improve my management by using this information. Within the case report I reflect on all these factors, and it has improved my understanding of some common paediatric presentations. I was positively surprised when I came across multiple studies showing the efficiency of osteopathy on infantile reflux, and it made me more confident in my clinical thinking to justify my treatment approaches. In the future I want to create a habit of expanding my knowledge of the evidence surrounding specific conditions of patients presenting and slowly build up my own knowledge base. Ideally, I would do research once a week to keep it realistic and easier to convert into a new habit.

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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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B2.2.3 referring the patient to another osteopath or appropriately qualified healthcare professional.

Evidence: referral letter because of structural scoliosis

Reflection
This particular patient presented to the clinic with an undiagnosed structural scoliosis at the age of 18. My knowledge in regard to scoliosis is limited and my course did not offer any training in this region. Therefore, I found it more appropriate to refer her to her GP to discuss her options in regard to this. I did recognize that as it was found quite late, and she did not receive any early bracing in childhood to delay progression. However, being still young there was a surgical option that needed to be discussed as soon as possible as timing is of the absolute importance if she wished to go into that direction. With this experience I felt that I recognized my limitations as a healthcare professional and sent her in the correct direction to get the appropriate help.
Overall, this was a positive experience for my learning process as I had never encountered a true scoliosis in clinic. Therefore, I feel a bit more confident in recognizing scoliosis in future patients and hopefully referring them in due time for more appropriate interventions.

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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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B3.1.1.1 be professionally engaged, undertaking professional development activities and complying with GOsC requirements regarding continuing professional development

Evidence: CPD certificate Women's Health workshop

Reflection
Last year I developed an interest in woman’s health and how we can approach common complaints as an osteopath. I’ve always felt that women are left behind and almost forgotten about when it comes to the medical field. Therefore, I went searching for an opportunity to deepen my osteopathic understanding on how I can help these women. I found that KESO was organizing a CPD covering this subject and I was quite fortunate to have been able to join this weekend course as a student.
Overall, the weekend was very inspiring to me as a future osteopath as it broadened my understanding of common complaints. It gave me the tools to make a difference for these patients which wouldn’t have been covered in my normal curriculum.
Being a woman myself, my newfound passion for this topic has only grown. Therefore, in the future I want to engage in more in-depth courses to continue my professional development in regard to this subject (f.e. Caroline Stone or Molinari).

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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 sufficient knowledge and ability to collect and analyse information and evidence about your practice to support both patient care and your own professional development.

Evidence: Mock CCA feedback

Reflection
Going into my mock CCA I felt a high level of anxiety and stress even though I prepared well. My initial consultation patient presented with dorsal thoracic pain that translated lateral and anteriorly around the left breast. Because of the location of the pain, I went hunting for pathologies. I became so focussed on ruling out possible red flags that I found it hard to come up with musculoskeletal conditions that could contribute to that pain presentation. I could rule out most pathologies but then found myself a bit “stuck” towards other causes. Eventually I needed a small push from my examiner to write “rib dysfunction” as one of my differential diagnoses. Because I didn’t get this one differential myself, I immediately felt inner panic as I thought I would fail my CCA because of this.
When it came down to feedback after I was almost crying because I thought I had failed. My examiner told me I did really well overall, and that one little thing wouldn’t cause me to fail.

This experience really made me aware that under stress I have difficulties going back to basics and keeping it simple. Realizing this will make me be more aware of future presentations that initially sound very alarming but could also be musculoskeletal. For my stress levels I need to continuously keep reminding myself that I know enough to pass these exams and that making one mistake in an exam doesn’t necessarily make it a fail.

Once qualifying and being in private practice I know without the constant stress of performance in a university environment I will be able to stay calm and think of multiple differential diagnoses that are appropriate for that case presentation.

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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.
A4.4 For consent to be voluntary, the patient must not be under any form of pressure or undue influence to consent to osteopathic care. You must ensure that patients are given the information they need to reach their own decision and give consent.
A4.6 The patient needs to understand the nature, purpose, benefits and material or significant risks to them of the examination or treatment proposed. The patient must then be free to either accept or refuse the proposed examination or treatment. Some patients may need time to reflect on what you have proposed before they give their consent to it.
A4.8 Before deciding that consent has been given, you should consider whether patients have been given the information they want or need, and how well they understand the details and implications of what is proposed.
A4.18 You must record key elements of your discussion with the patient. This should include information discussed, any particular concerns, expectations or requests for information raised by the patient, how you addressed these, and any decisions made. It is important that such issues are evidenced in the patient records.

Evidence: OSPE all years - CEx Y3/4 - FOPE

Reflection
Throughout the past four years we have been taught the importance of consent and have been examined on this particular aspect on every exam in both clinical and school setting. In the evidence you see my progress and good feedback in regard to the consent process in my exams with fake scenarios as in clinical practice with real patients.
I developed my consent process starting off with discussing my suspected diagnosis to my patient, using both clinic data gathering as examination data to explain it. I then progress into discussing all possible options that would be suitable for this patient. This ranges from some techniques, seeing other healthcare professionals, no treatment, or giving them the option to go home and have a think before reaching a decision. With every option I go through the possible risks and benefits, so they have a full understanding for each of them. I then always ask if they have any questions or need for clarification. Whatever was discussed I write down, including the decision made by the patient. This is a fairly simple process as it is part of our mandatory boxes in our clinical notes, so this has become a part of my routine.
Throughout the treatment aspect I recheck for consent before every technique and make my patient aware that there are always other options or that they can always opt to stop if they wish.
I believe because I practiced this routine of consent and communication with every patient for the last two years that I developed a good baseline for professional practice. In the future I want to develop my consent process, so it sounds less scripted and create a more natural flowing conversation while still being aware of my obligations towards my patient. I believe more time in practice will naturally help me develop this.

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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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A5.1.1.2  Supporting patients in caring for themselves may include: supporting decision-making about lifestyle changes where appropriate

Evidence: Rehab plan for patient

Reflection
A 65-year-old slightly overweight woman with an inactive lifestyle presented in clinic with a longstanding left sided L4-5 radiculopathy seeing care. During the initial consultation I discussed the different routes of management that would be suitable for her including physical exercise. We came to a mutual agreement where we would start off with some osteopathic sessions and slowly introduce exercise into her daily regime to help with her complaints. I focused on explaining how increased mobility and strength could help her and she expressed great interest in gaining tools to help herself.
I then developed a rehab plan to both mobilize the spinal nerves effected and strengthening her lower extremity for further support. I monitored her progression over a two-month period increasing difficulty and load and she progressed a lot in a small time period.
The patient was very grateful that I could provide the additional support of exercises within our sessions, and she expressed how she now enjoyed going to the gym as she saw the impact it already had made to her quality of life in a short period of time.
For me personally, it was a really satisfying being able to change a person’s perception on exercise to the point where she made it a part of her daily/weekly routine. I felt that the initial support for that lifestyle change also gave her the confidence to become more independent with non-rehab related exercise.
In the future I hope to be able to motivate more patients to include daily exercise in their routine within their own capacity. However, I am still aware of the fact that not all patients will be open for this process and that is where I will have to learn to stay neutral and respect their decision without trying to change their minds.

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

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

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A6.2 You should respect your patients’ dignity and modesty by:
A6.2.2.1 explaining to patients in advance of their first appointment that they may be asked to undress for examination and treatment
A6.2.2.2 allowing a patient to undress, and get dressed again, without being observed
A6.2.4 giving patients the option of covering areas of their body that do not need to be exposed for examination or treatment. This can be achieved by providing a suitable gown or cover, asking that they only remove such items of clothing as are necessary for the proposed examination or treatment, or providing the opportunity to get dressed again in full or part as appropriate. If you feel it is necessary for the examination or treatment that the patient is undressed to their underwear, you should explain this to the patient, and seek their consent.
A6.3 If it becomes necessary during examination or treatment to adjust or remove items of the patient’s clothing or underwear, they should be asked to do this themselves. If it is necessary for you to assist them, then you must have their consent to do so.

Evidence: information sheet and consent form initial clinic appointment

Reflection
Before the start of an initial consultation at the student clinic, patients need to read through and sign an informative sheet containing the details of what to expect during the consultation. One part is dedicated to their modesty options and informing them they might be asked to get undressed for examination.
During my own consultations I always ask if the patient is comfortable with undressing so I can have a better understanding of their issue during my examination. I’ve made it my common practice to only ask to expose the area that is most essential and advise to bring shorts/sportsbra for the following consultations.
When I ask to remove some clothing, I always leave the room to provide privacy. I’ve had several encounters with patients who have said they are “fine with having me in the room”. When this happens, I always need to remind myself and my patient that I need to follow protocol and step outside. I’ve found that this is an essential professional boundary that I need to keep now and in future practice as everyone needs personal space for them to feel more at ease.
In the future I would want to place a small room divider in my practice room where my patient can get changed in whatever they’re comfortable with and dedicating that space as an absolute no go zone for me as a practitioner.

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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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A7.1 The same quality of service and care should be provided to all patients. 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.

Evidence: reflection on personal background

Reflection
I’ve been fortunate enough to have had a very open minded and multicultural upbringing in Belgium. Multiple members of my family endured racism and I saw how much impact this has on their daily life and how I was privileged in that matter because of the skin-color I was born with. It saddens me to see how some individuals can carry so much hate just because of their misconstrued view of what society should look like. Within my family background is also a variety of different religions being Catholicism, Islam and Judaism. This has taught me not only the differences but mostly the similarities between the biggest religions with the messages they can teach. I’ve been lucky enough to have travelled to various parts of the world, broadening my perspectives and reduce my prejudices in regard to all aspects of life.

I believe my personal history and experiences will help me to provide adequate care to all patients, no matter what their beliefs and values are. I want to create a safe environment for my patients to be themselves and feel comfortable to share their thoughts without the fear of being judged because of it.