# data[].attributes.body
Year 3
Today I had my first formative exam in the clinic and I was very nervous about it. It was an opportunity to see how much I progressed for the first 2 months in the clinic and an opportunity to get feedback, but I did not feel ready for this.

I had a new patient with unilateral neurological symptoms and neck pain. Although I felt very nervous and struggled to concentrate, I was trying my best to make sure my nerves will not affect my patient. I started by asking my patient how I can help them and what are their concerns as I wanted to make sure they tell me their story and express what is important to them. My patient was very happy to tell their story and explained how it is important for them to get better quickly because of their work.

As it was my exam and I was very nervous,  I felt like I need to address my patient's concerns in the first session. However, after I had a talk with my tutor he told me to stop being so nervous and explain to the patient how long the healing may take, and what we can do to help. When I came back to the room I have explained to my patient very politely that healing may take some time and I mentioned to them that I understand their concerns regarding their work, so I have mentioned that they can always ask for a second opinion. My patient said that they are happy to try the treatment.

After my patient left my tutor gave me positive feedback regarding my rapport with the patient by mentioning that I was polite and considerate as well as gave my patient a chance to tell their story and express their concerns. It made me feel proud of myself that despite my nerves I was still able to communicate well with my patient. However, I think I could have done a lot better if I was not so nervous and would just explain to my patient that I understand their concerns, but healing may take longer than they think. In addition, I think that it would help me to address patient's concerns better if I knew more about alternative options that they may decide to go for. Although, my communication possibly was not perfect I was very polite and considerate during the whole time.

In conclusion, it was a good chance to demonstrate my patient communication under exam pressure, which demonstrated some areas for improvement, but also demonstrated that I am polite and considerate with my patients, and able to build a good rapport with them.

Action Plan: try to control my nerves and do not think of the tutor's presence in the room too much, because patients are the most important people in this room. In addition, learn about alternative options which will help to address patients concerns and preferences.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference
Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
At the end of year 3, we had our final clinical exam online due to pandemic, where we had to demonstrate our clinical reasoning and differential diagnostic thinking. In addition, we had to demonstrate how safe we are by taking comprehensive case history of a simulant patient.

This exam was very difficult for me because it was done in an online format instead of a usual clinical assessment we would have in the clinic. In addition, having a tutor as my simulant patient made me very anxious. However, during this exam, I was able to demonstrate competent osteopathic patient evaluation and demonstrate a safe approach, which is evident from the attached feedback.

However, I could have done better in certain areas this exam demonstrated to me in areas where I can improve such as being more thorough with my osteopathic examination by considering the patient as a whole and being more holistic with my osteopathic evaluation.
In conclusion, It was difficult to adapt to the new exam format which may have impacted my performance as well, but this exam demonstrated areas that I think I need to be better at.

Action plan: be more holistic with my osteopathic evaluation, which will help me improve my osteopathic care for my patients. Do not limit my examination to orthopaedic testing only.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Year 3
Exam feedback

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Year 4
I had my second clinical assessment on my continuing patient who I diagnosed with Achilles Tendinopathy. I have communicated well with my patient by addressing their concerns and preferences in terms of their recovery by reassuring them about Tendinopathy and giving them exercises to do for the rehab. I demonstrated good communication with my patient as I considered that they have anxiety issues and it was important to use positive reinforcement with them to enhance the best recovery.

I felt proud of myself for considering the patient as a whole as before I felt not confident enough to address someone's concerns with diagnosed anxiety disorder.

I believe that I can improve my skills regarding patients with yellow flags by researching and learning more about psychological conditions, which will help me to understand better what other strategies can be used with patients suffering from anxiety.

After the appointment, my clinic tutor has given me feedback where he provided me with a detailed analysis of my actions regarding my communication. As shown below my tutor's feedback was generally positive regarding my communication, and they also mentioned that positive reinforcement was a good strategy to choose with this patient and that I can research more about anxious patients.

In conclusion, it was a valuable experience showing my ability to address individual concerns and listening skills. I can improve my skills by learning more about communication strategies with will help me to develop my communication skills further.

Action plan for the future: after having this experience I know the basics of how to communicate with anxious patients, and positive reinforcement and reassuring strategies that I will be using with all my patients. I would perform in the same manner in the future due to positive response from my patient and good feedback from my tutor.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had my CEX in the children clinic on my continuing patient that I first saw in December 2020. I have diagnosed this child with hypermobility. Due to the fact that we started doing alternating weeks in the clinic as a precaution to control COVID spread, most patients were not able to see one practitioner every time.

This patient and his dad were quite confused because they have seen many people, who had different opinions on what is going on. However, I have explained to my tutor and demonstrated during examination why I think this child diagnosis is hypermobility. My tutor agreed with me and since she was observing me for my CEX, she was able to give me feedback on the way I adapted my communication to make sure both patient and his parent understand everything. The patient’s father asked me if there is anything they can do at home to help it and I have advised a couple of exercises.

In addition, I checked if they possibly want us to email them exercises as the father mentioned that he has a learning disability, and he struggles to understand/memorise things sometimes. This is the reason why I wanted to be very clear on everything and make sure that exercises are written down. I asked my tutor to send my patient an email with the list of exercises.

At the end of the session, my patient and his father were really happy and both gave me good verbal feedback. It made me very happy because I felt proud of my abilities. I think that I have managed this situation well by clarifying diagnosis and giving exercises by adapting my communication. All of the above led to a positive outcome.

In conclusion, it was a positive experience and I believe I was able to adapt my communication well in order to take into account my patient's and his father's needs.

Action Plan: always make sure that I take into account my patient's needs and support them in expressing these needs, as well as that I adapt my communication to ensure the patient’s understanding.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
At the end of Year 3, I had my final clinical exam online due to the pandemic and it was a very different experience because our tutors had to pretend to be patients, and we had to take a case history of them. I always feel very nervous during the exams and doing it in a completely different format did not help my anxiety. It was very difficult with communication because with our patients in the clinic we adapt our communication to make sure they understand everything. However, it was difficult to do that with the tutor, but I was still able to not use medical terminology to show my ability to adapt my communication with patients. I have used a few medical terms during my exam a couple of times, but I was able to correct myself quickly and explain my patient  what I meant in a way that a patient would understand.

When I received my feedback after the exam it demonstrated that I was able to adapt my communication well during the exam, to the level that the patient would understand. However, due to nerves and the fact that the situation was different to normal, I came across as a cold practitioner, which I was advised to improve in my feedback. I believe that during 3rd Year I have managed to learnt well how to adapt my language with patients, which was difficult at the start of Year 3 because I did not practice this with my colleagues during prior years.
However, this was not a completely normal clinical experience I think I did well on adapting my communication, which was harder than usual because our tutors were our patients during this exam.

In conclusion, I found this learning experience very stressful, but helpful in terms of practising to adapt my patient communication in abnormal circumstances.

Action Plan: always adapt communication to the patient, which will help to take into account their needs.  Practise adapting language with colleagues.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Reflection of information giving to patients
Since the start of the clinic at Year 3 one of the things that we have to do when we see our patients is to make sure that we give them enough information. At the beginning of my clinical experience, I used to struggle to understand what kind of information patients require, how detailed it must be and how to deliver this information in a way that my patients will understand it. I often asked my tutors to observe the part where I got to describe different stages of the appointment, and I would ask for feedback later.

One of the tutors said that I often speak too much and overload my patients with information, which made me want to improve my sharing information skills. I asked more tutors to observe some parts of information sharing and give more feedback, and advice on how I can improve. In addition, I have practised with my colleagues later and asked them for verbal feedback as well.

It helped me to develop my skills on how to share information with patients in a much clearer and concise way, and not to forget to check their understanding at the end. I think that I should have practised information sharing in the Year 1 and 2 during techniques classes instead of skipping that part, which would have been helpful.

In conclusion, I have been able to develop that skill to
a better level now and I always try to give my patients the required information, make sure I use words they can understand and check their understanding after. I always check if my patients have any questions, which in the past I would often forget.

Action Plan: continue developing that skill by practising and verbalising information.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Year 1 and 2
In Year 1 and 2, I have completed 100 hours of clinic observations, which gave me a great opportunity to watch different bits of Osteopathic treatment and management and observe 3rd and 4th Year students obtaining consent.

I have noticed that all students were very good at getting informed consent, which was useful to observe in order to learn the consent procedure application in practice.  Consent was a difficult concept to understand at the start of the course because it was difficult to know what I need to say and how long my explanation must be.  This is why having observations in the clinic was so helpful as I was able to observe how Year 3 and 4 students interact with patients and how they obtain consent for each stage of the osteopathic consultation. Observations were also helpful for me to understand how I can obtain consent during my practical exams more efficiently. I have observed many students taking consent and I  feel that I have learnt a lot from them, by later applying that skill during my practical exams.

In conclusion, observations of real interactions in the clinic helped me to adapt and develop my consent obtaining procedure to make sure my consent is valid and informed.

The action plan is to continue working on developing my consent obtaining procedure skill by practising it with other students every time we practice.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had a clinical assessment exam in the children clinic and I have seen a boy with hypermobility. It was a very interesting experience as it was my first ever child in the children clinic. It required more explanation as I had to explain everything to the father and the patient. I had to be really careful with the language I used as I wanted to make sure they both understand everything, and that I can gain valid and informed consent from a parent.

I felt really happy about my ability to explain everything in the easiest way, and I have given an opportunity to my patient and his parent to ask as many questions as they wish.

As I was very clear on what hyper-mobility is and what we as osteopaths can do to help, I was able to gain valid informed consent from the patient’s parent.

In conclusion, it was a positive experience and I gained valid informed consent in the most professional manner, which is evident from my tutor’s attached feedback.

Action plan for the future: always use easy language for patients, check their understanding and let them ask questions.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had my first CEX in Year 4 and my tutor mentioned the importance of developing my skills regarding management plan for patients. Being a student it is difficult to learn everything in a short time period and I believe that I have not paid much attention to how to manage different musculoskeletal conditions. My tutor highly advised me to start learning about alternative options, exercises and life modification advice that I can provide for my patients. Many colleagues of mine received similar advice regarding patient management.

This incident made me question my knowledge regarding my abilities to enhance my patients' health and well-being. I was not happy that I am not confident enough as a health care professional to contribute to my patients' health and well-being by providing good health advice. I decided to improve my knowledge in this area and cooperated with my other colleagues regarding management plans.

I along with my friends decided to produce management plans for each condition each week, and present them to each other as well as have a small discussion on each subject. This made me feel way more confident in the clinic giving advice to my patients to enhance their health and well-being. As I have researched a lot about exercises and rehab programs of different musculoskeletal conditions including tendinopathies, ligament sprains, muscle strains, radiculopathy and neuropathy.

In conclusion, getting feedback from my tutor regarding my abilities in this area was very helpful as it gave me a good perspective on where I can improve as a health care professional to be able to contribute to enhancing my patients' health and well being.

Action plan: continue learning about the management of different conditions. Completing webinars and CPD’s regarding health and life modification advice.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
I had my second Clinical exam in Year 4, which generally went well.  I had this exam on my continuing patient, who I diagnosed with Achilles tendinopathy.  However, I did not produce an efficient rehab programme for my patient. When my tutor asked me about a rehab programme for this patient I suggested an exercise that would not load the Achilles tendon and would not help to strengthen it. My tutor started to question my choice of exercise and suggested a better rehab programme for this patient.

It made me feel stupid that I could not support my patient in caring for themselves to improve their own health, by giving them good rehab exercises. However, this also made me feel motivated to learn more about it and I asked my colleague to share rehab protocol articles with me, which I read and I prepared a good rehab programme for my patient.

I think I could have done better if I prepared an efficient programme for this patient after the first session. However, when I saw this patient the next time my tutor was very happy with my rehab programme, and the fact that I really listened to his feedback.

In conclusion. I believe that this was a good learning experience because this exam showed me my weak area and I reflected on it by doing more reading about the subject, which will help me in the future to support my patients in caring for themselves to improve and maintain their own health.

Action Plan: continue learning about rehab exercises for different body regions, watch rehab exercises videos, engage with research articles and listen to podcasts.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
In October I had a cover patient present with chronic low back pain. She was not really happy at first because I was not her full-time practitioner. She seemed very uncomfortable at the beginning of the appointment. I read in the notes that the patient is normally wearing a gown as she does not like being undressed. I have asked my patient if she has a gown with her, and she said that she forgot it at home, and I told her not to worry as I will bring her a new gown from the reception.

I was happy that I carefully read the notes and noticed that this patient needs to wear a gown, as she never mentioned that herself and she appeared nervous. However, offering her a gown put her at ease and the rest of the appointment she communicated in a less anxious way. Although, probably it could have been much better if I offered her a gown when I met her first at the reception, which would put my patient at ease at the beginning.

In conclusion, it was a positive learning experience of how important it is to maintain patients dignity and modesty, and how some patients may feel very anxious simply because they left their gown at home and they are too shy to ask for another one.

Action plan: never underestimate how anxious people may feel about potentially being undressed even if the patient/practitioner is the same gender.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 1
This evidence demonstrates my Year 1 final results. Overall, the first year was very challenging in terms of exams and study load. I found it especially hard to learn Anatomy and Physiology theory, which is evident in my results. My first anatomy exam was a real challenge, which I was only able to pass at 49,5%, and I failed my second Pathophysiology exam.

It made me feel really down at first and I massively doubted my abilities to continue. However, my friends supported me and I was able to analyse what I did wrong in terms of revision for exams, which helped me to improve both my Anatomy and Pathophysiology results in the next exams. I spend more time revising for both exams and prepared memory cards for each subject as well as watched Anatomy and Physiology videos.

It helped me to feel more confident about my knowledge which also lowered my anxiety about the upcoming exams.

In conclusion, I did well overall as it is evident from my results, but there are areas that require more learning and improvement.

Action plan for the future: be more committed to continues learning and trying to work on the material in a more consistent way by addressing any issues I have along the way. Continue to improve my timekeeping at a good level regarding any exam preparation or essays.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 2
Year 2 exam results attached to demonstrate that this Year I managed to pass all my exams and I successfully proceeded to Year 3.

This year was very challenging as we had a lot of new theory to learn before entering the clinic next year. However, since I learn a lot on how to manage a study load better in Year 1 I was not as anxious in Year 2 about it. I was happier because I was able to study continuously and I knew more resources of where I can learn anatomy, physiology and clinical tests.
I could have maybe been spent more time practising my techniques as I feel like in Year 2 I mainly concentrated on the theory and did not practice my manual skills as much.

In conclusion, I think this was a successful academic year and I gained a lot of theoretical knowledge, I learnt how to control my exam anxiety better as well.

Action plan: continue with consistent studying and practice my techniques more.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
This year started very well, with me making a lot of success in my academic studies and I was able to pass all my exam to the point of spring exams. This Year something that no one expected happened and the whole world was hit by a global pandemic. As a student, I feel I was massively affected which also affected my academic progress. In Spring I failed the Pathophysiology exam as due to all the stress and unexpected events I was not prepared for this exam.
I felt absolutely devastated and crushed when I got my results. I felt like all the anxiety and self-confidence issues I experienced in Year 1 came back.

However, already having failure experience I was very quickly able to pull myself together and started to prepare for my finals. I have studied very hard for my final Pathophysiology exam and even consulted Pathophysiology teacher on what I should do to archive good results. It worked perfectly as I archived over 70% for my final Pathophysiology exam and I did not have to resit an exam I failed. Analysing it now I could have been prepared for the exam I failed, but I did let the whole world situation affect me more than I should have.

In conclusion: it was a useful experience showing the importance of being prepared for exams and studying consistently no matter what happens around me.

Action plan: continue to study consistently, which I often struggle with.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
Year 4 has been a very stressful year due to a lot of anxiety regarding final exams and graduation. I have struggled a lot during this year with studying and learning, but I was able to pass all my exams so far. The big thing this year was a dissertation project, which was a very difficult and time-consuming process. I have never done a research project before and due to lack of experience in this field, it was a big challenge to complete this project. I have decided to do interviews and my biggest issue was to find participants because I was not familiar with the recruitment process. I have tried to recruit participants in the wrong way at the beginning, which led to a lot of anxiety because I did not get any responses. I have decided to contact my supervisor to ask for advice and my supervisor explained to me that the best way is to use publicly available emails on the General Osteopathic Council register. This helped me to get enough participants for my project. I think that I should have asked my supervisor at the start on how to do this instead of trying to figure it out myself, which would have helped me to start my project earlier and would have given me more time for the other parts of the project. However, that experience taught me that I need to ask my supervisor for help in case I am really stuck with something and do not waste my time trying to understand it myself. Despite the delay with getting participants I was still able to complete my project on time and submit my draft for my supervisor to read, which gave me a good idea of where I can improve my dissertation. Overall, this experience helped me to learn a lot about research and I was happy with my dissertation results.

The rest of the exams this year included clinical assessments and poster presentation.

My first clinical exam this year did not go too well. I have done well on information gathering, but my examination was not very efficient and my tutor told me to improve my Spurling test. My tutor gave me 52 per cent, which made me upset at first but at the same time, it was a good chance to find out which areas I need to improve and what skills require more practising. After my exam, I asked my tutor to demonstrate the Spurling test and I practised it later with my colleagues to improve my handling and technique. Later this year when I was observed by the same tutor, he told me that my Spurling test looks much better now and more efficient.

One of the other assessments that I had this year was a poster presentation that I had to prepare about disc herniation. This assessment required me to prepare a poster about what disc herniation is and how we as osteopaths practitioners can manage it, and present it to the examiner. I have not spent enough time on this assignment and I did not practice it before presenting, and it affected my performance during the assessment. I ended up passing this assessment with a low grade, which made me realise how important it is to practice a presentation before actually presenting it. During the presentation, I got nervous and started reading from the poster and my examiner noticed it and marked me down for this. In addition, I could have researched more regarding this subject and present more detailed information. In conclusion, this learning experience taught me that I should never neglect certain assignments and always do my best for every single one.

My second clinical exam went better and I achieved over 60 per cent. Although, I have done well on certain aspects I have been told that I need to improve on my exercises knowledge. I had a patient with tendinopathy, but my exercises plan were not good, which made me feel motivated to learn more about it. I asked one of my colleagues to help me with that. My colleague shared tendinopathy rehab articles, which I read and prepared good management for my patient.  My tutor was happy the next time I had this patient because I really listened to his feedback and prepared a good rehab plan for this patient.

In conclusion, this year is difficult but so far I have been managing well and I was consistently reflecting on areas I can improve.

Action Plan: continue preparing for my next assessments by learning more theory and practicing manual skills.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Year 4
CEX results

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Year 4
Poster presentation results

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Year 4
During my training, I had to write referral letters for my patients when I thought that they are not safe to treat.
Recognising red flags in patients is crucial to make sure the patients are referred to another health care practitioner to get help.

This is a very challenging skill to develop because having patients when you are being observed by the tutor is extremely stressful. In Year 4 when I had a new patient, and  I nearly missed a red flag as I was so concentrated on trying to impress my tutor with my skills. I took a very good case history, but I started presenting too quickly without taking a minute to think first, which nearly led me to make a dangerous decision to treat a patient that was not safe to treat. However, my tutor started questioning me and drawn my attention to the information I collected during case history and told me to think again before making a decision. The fact that I nearly missed a red flag in my patient made me feel stupid because I had all information and I considered it at first but decided to dismiss it as I did not analyse the systemic information I collected properly.

After a conversation with my colleague and tutor, I realised that this patient must be referred due to the potential risk of VBI. I went back to the room with my tutor and explained to my patient why we cannot treat her today and asked for written consent to contact her GP.  I have written a referral letter straight after my patient left and got it signed by my tutor.
Overall, it was a great experience to have while I am still a student and not on my own in practice. It taught me how important is to always remember that patients are the most important people in the room and they always come first. In addition, it taught me that I should never dismiss my thoughts regarding potential risks and put patient's safety first.

Action Plan: always pay attention to systemic concerns and before considering musculoskeletal conditions consider if my patient is safe to treat.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
Today I was observing my colleague having a new patient and he asked me to provide honest feedback at the end of the session as he wanted to know what areas he needs to improve on. I observed my colleague while he was taking a case history and his examination process. I decided to take notes to be able to provide detailed feedback at the end. My colleague took a thorough case history, but he forgot to ask some follow-up questions about the patient’s history of cancer such as what treatment they had and what stage cancer they had, and how often they have check-ups with their consultant. My colleague did a generally good examination, but his handholds seemed awkward during the Passive Range of Motion.

At the end of the session, I have explained to my colleague what I believe went well in my opinion and what he can improve at. It made me feel uncomfortable at the start because I did not want to sound harsh or upset him with my feedback. In addition, it was not easy for me because we are good friends and I did not want him to feel like I am judging him. However, I wanted to be very honest with him about areas where he can improve because this is what I would want for myself. I think it is important to be able to give constructive and honest feedback to my colleagues because it will help them improve in the future and it will help them to do their best for their patients. Although it was not easy and I struggled to give feedback at the start, I explained to him that I am not being judgmental and just trying to be very honest and helpful. My colleague appreciated that and he asked me if we can practice Passive Range of Motion later together to improve his handholds. In addition, I suggested that we can ask a tutor about what kind of questions are the most useful to ask if the patient has a history of cancer, which might be helpful for the whole team.

In conclusion, this experience showed me the importance of honesty with my colleagues in the practice, which might be difficult sometimes because your colleagues are your friends and you do not want to hurt their feelings. However, honest and constructive feedback can help them improve.

Action plan: always provide honest feedback, and be constructive, rather than judgmental which will motivate others to improve.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
Today I had a patient who I diagnosed with Knee osteoarthritis. My patient did not know much about this condition and they wanted to know if osteopathy can cure osteoarthritis. My patient questioned the efficiency of Osteopathy and was not sure if they want to continue if osteopathy cannot cure their knee completely.

It was the first time when my patient questioned the efficiency of the osteopathic approach and at first, I was not really sure what to answer, and what I should do. I explained to my patient that I will leave the room to consult my tutor. When I came to the team room to talk to my tutor, I really felt lost on what I should say to my patient and how I must act in this situation. My tutor questioned what do I think is the best thing to do and I said that the best thing to do is, to be honest, and say that osteoarthritis cannot be treated with osteopathy but what it can offer is to hopefully help to relieve pain and help to manage this condition. My tutor said that this is exactly what I need to explain to my patient and I asked him to come to the room with me to observe how I will discuss this with my patient. When I explained everything to my patient, they were grateful for my honesty and said that they want to try osteopathy first before trying other options.

I think I could have addressed this situation better as I knew exactly what I should have said, but due to lack of experience, I decided to consult my tutor first. However, it was an important lesson on how honesty and integrity in the practice are valued by patients.

Action plan: always be honest with patients and not be afraid to tell what exactly you can do and how. In addition, I must try to be more autonomous with this kind of conversation with my patients.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
During my training, I had to develop my skills to be able to conduct an osteopathic patient evaluation and deliver safe and competent care to my patients.

At the start of my clinical experience at the teaching clinic, it was extremely difficult because we had to learn how to apply all the theory we have learnt in practice. However, with the help and supervision from very experienced tutors, I was able to improve and develop my skills to ensure I can conduct an appropriate patient evaluation, and deliver safe and competent care for my patients.

It included seeing new and continuing patients, asking tutors and my colleagues for feedback, learning and practising. We had clinical exams every 12 weeks of the clinic, which was helpful to see your own progression and identify areas, that I need to develop.

Sometimes it was very challenging to reflect on myself as well as learning from my own mistakes. However, I always listened to my tutors and colleagues feedback to be able to improve.

In conclusion: Clinic experience and clinical exams helped me to develop a range of skills required by the osteopathic profession in order to evaluate, treat, and manage my patients in a competent, safe, and appropriate manner.

Action Plan: All skills must be continuously updated and develop further to ensure the best practice.

The evidence to demonstrate results for clinical exams attached.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 2
At the end of Year 2, I had a clinical integration exam, and I had to take a case history during it. This was a very stressful experience for me as I do not have the best handwriting and It gets even worse when I am under pressure. It made me aware that I may struggle in the clinic with writing my notes because our notes must be legible and accurate. I do often misspell words as well when I need to write fast.

During this exam, I had 40 minutes to write down my case history, but in the clinic, I will have 20-25 minutes for that. In addition, during this exam, I realised that I struggle to fit all the information in the case history form as I had to ask for extra paper.

I think I could have done better on that If I practised more history taking skills and writing information down during Year 2. Although, I was able to record all the information if I controlled my exam nerves and if I have practised writing notes more I could have done much better.

In conclusion, it was a good experience that helped me to identify a problem I may have with writing notes in the clinic.

Action plan: practice writing notes during the summer to make sure the recorded information is accurate and legible when I start a clinic in September.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3 and 4
At the start of clinic, I was extremely worried about writing my notes as I am aware that my handwriting is not the best. I always struggled to write fast because I often misspell word under pressure and the stress. In addition, our notes required to be comprehensive, accurate, legible and completed promptly. At first, it was very hard taking a case history and writing at the same time. I had the same issue with doing my examination and writing my findings down.

However, by practicing this skill it has improved massively. I always try to make sure that my notes are written in enough detail, that I write every important part down and do it during the appointment, or straight after. However, my hand writing is still not the best, but I feel this is an issue that can be solved in practice as most notes in practice are now done in digital format. I always ask for feedback on my notes from my tutors and they seem happy about the detailed content, which puts my mind on ease regarding my record keeping.

I think I could have possibly practiced more in Year 1 and 2 by taking more case histories from my colleagues, to practice fast writing. However, I was able to gain better record keeping skills in the teaching clinic, I believe that in practice It will be better for me to use digital notes to make sure that record keeping standards are at the high level.

In conclusion: I think I am able to keep my patients records comprehensive, accurate and legible. I can complete my notes promptly, but I cannot change my hand writing. However, this issue can be addressed in practice by switching to digital notes.

Action plan: make sure that patients records are completed that the high standards required by profession. Asking my potential employer if it is possible to complete digital patient records instead of hand written records. Buy Grammarly App

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
Today I had a patient who asked me if I can give him printouts with exercises because he forgot the exercises that I have given him on the last appointment. This was the first time when my patient asked me to prepare a printout with exercises for him and I was not sure if I am allowed to do it as a student.

I have advised my tutor and he said that I can prepare a printout and that I need to make sure that I do not give too many exercises at once.

I have researched the exercises and printed them out for my patient. I think I could have done much better in this situation by suggesting it myself if my patient wants his prescribed exercises to be printed out. However, due to a lack of experience, I find certain things difficult in the clinic.

In conclusion, it was a useful experience as I have never been asked to prepare any printouts before. In addition, now I will ask all my patients if they want their exercises to be printed out if they struggle to remember them.

Action Plan: ask patients if they want their exercises to be printed out. Ask patients if they want to get their exercises via email. Ask for the patients' consent to send exercises to them via email.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had my CEX in the children's clinic on my continuing patient that I first saw in December 2020. I have diagnosed this child with hypermobility. Due to the fact that we started doing alternating weeks in the clinic as a precaution to control COVID spread, most patients were not able to see one practitioner every time.

This patient and his dad were quite confused because they have seen many people, who had different opinions on what is going on. However, I have explained to my tutor and demonstrated during examination why I think this child diagnosis is hypermobility. My tutor agreed with me and since she was observing me for my CEX, she was able to give me feedback on the way I adapted my communication to make sure both the patient and his parent understand everything. The patient’s father asked me if there is anything they can do at home to help it and I have advised a couple of exercises.

In addition, I checked if they possibly want us to email them exercises as the father mentioned that he has a learning disability, and he struggles to understand/memorise things sometimes. This is the reason why I wanted to be very clear on everything and make sure that exercises are written down. The father was really happy that we can send printouts with exercises by email because he was not sure if he would be able to remember them all.
I asked my tutor to send the list of exercises to my patient via email. My tutor asked me to prepare the list of exercises and email it to her, and she will contact the patient via email.

At the end of the session, my patient and his father were really happy and both gave me good verbal feedback. It made me very happy because I felt proud of my abilities. I think that I have managed this situation well by telling that we can email exercises via email because the patient’s father knew that we are not allowed to give out printouts due to COVID and he was not sure if we can email them. All of the above led to a positive outcome

In conclusion, it was a positive experience and led to a positive outcome and positive feedback from the patient’s parent.

Action Plan: always give options to patients regarding producing written material.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 2
First Aid Course
At the end of Year 2 as part of my course, I had to complete a first aid course to address potential situations at the teaching clinic, where I would be required to provide first aid to my patients such as in a case of heart attack for example. The course was all day long with both theory and practical elements.

I found this very helpful and interesting as they have shown us how to do CPR and use the defibrillator. However, some elements were very basic in terms of theory and I felt that the theory part was not adapted for the students with medical background knowledge. This is the feedback we all as a group have provided at the end of the training.

I have listened very carefully and practised all the elements with my colleagues, which helped me to successfully answer exam questions at the end of the training. Being attentive and motivated in the class made me confident I will be able to address the potential situation where my patient might be at health risk situation fast and efficient.

In conclusion, I enjoyed this professional training and it showed me how important first aid knowledge is in practice as you may save someone’s life not just in practice but also outside of it.

Action plan: first aid course must be completed every two years, to make sure you are up to date and be able to protect your patients from harm. I will comply with this requirement when I graduate and refresh the first aid course every two years as required.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 2
Female Genital Mutilation
At the end of Year 2, I had to complete an online course about Female Genital Mutilation procedure to be able to prevent possible harm to my patients. Female Genital mutilation is a procedure where female genitals are deliberately cut, injured, or changed without any medical reason for that (NHS  2019) . This procedure is usually done in young girls between the age of infancy and the age of 15 (NHS  2019) . This procedure is illegal in the U.K. and considered child abuse. This procedure is practised in 31 countries including Asia, Middle East, and Africa (NHS  2019). This online course explained in detail what to look for in the child if you believe this procedure might have been done or will be done soon. This course explained how it might be done against girls will and they even may be restrained to do it (NHS  2019). In addition, it has explained possible risks as this procedure is usually not done by health professionals, and anaesthetic or antiseptics are not used (NHS  2019). This course went into detail about possible long-term harm such as problems with childbirth, sex, and mental health. In addition, this course contained a personal story of a woman who went through this procedure as a little girl.
This online course left me shocked at first because the personal story was really sad and I have never even heard about this procedure in the past. I decided to read more about it after completing this course to improve my knowledge because as part of my course I knew I would be seeing children in a children's clinic. I wanted to make sure I know enough and will be able to protect them from harm. During the course, it was clarified that if you suspect the possibility of this procedure, it must be reported.
I think that completing this course was very useful because we live in a multicultural society. Although it is important to respect everyone’s culture, it is also important to protect children from harm to their health.

In conclusion: This learning experience was extremely helpful and I learnt about something I have never even heard about, which is useful knowledge that may help me protect my children patients from potential harm.

Action plan: applying the skills I have learnt during this course in practice. Report if I notice something that will concern me to protect children from potential harm. In addition, continue doing online CPD course involving safety in practice.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

References

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

NHS, 2019. Female Genital Mutilation | National Health Service, Available at: https://www.nhs.uk/conditions/female-genital-mutilation-fgm/ [Accessed 20 February, 2021]

# data[].attributes.body
Evidence attached to demonstrate that risk and prevention of radicalisation course was completed during training:

# data[].attributes.body
Year 3 and Year 4
Summer clinic this year was different for everyone as it was reopened after the pandemic and PPE was implemented to make sure that everyone in the clinic is safe. It was at first very difficult to get used to working in gloves, aprons, and masks. In my experience, the hardest one to get used to was wearing masks as it was very hot and difficult to breathe at the start.

On the first day back the changes seemed shocking and I struggled to remember all the new rules. However, it was nice to come back and in a very short time, I got used to wearing PPE.

In my opinion, it is very important to wear PPE as it helps everyone to stay safe and the clinic can stay open, meaning we can continue to see our patients. Wearing PPE made me feel safe and I was happy to know that patients are also feeling safe knowing we are wearing PPE.

In conclusion, despite my bad experience with pandemic during my course, I think that we managed well as a university and healthcare providers to keep our patients safe by providing a clean and hygienic environment as well as complying with health and safety legislation.

The action plan for the future is to keep wearing PPE and maintaining a hygienic environment for the patients' safety, which worked well after the clinic reopened.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
Professionalism is a very important part of the osteopathic profession because I have to make sure that I always maintain professional boundaries with my patients and do not get involved in their personal matters.
During my training, I had a chance to develop those skills and make sure that I demonstrate professional behaviour in practice. The feedback from my tutor attached below is demonstrating that I can maintain professionalism throughout a whole session with my patient.
Receiving positive feedback from my tutor on my professionalism made me feel very proud of myself as it demonstrated how I developed my professionalism skills during my training.
It was a great experience because positive feedback on your skills always shows how you improved on certain things. However, it is always important to remember that you can improve more on anything. For example, observing others and their professional skills might be a helpful modality to see where you can improve and reflect on your skills.
In conclusion: Professional boundaries are very important in osteopathic practice to ensure the best patient's management.
Action Plan: I am planning to continue to develop my professionalism by visiting webinars and CPD courses, and learn from more experienced professionals about professionalism in practice.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
In the children’s clinic, a baby girl presented to me with suspected Cow’s Milk Protein Allergy (CMPA). Her mother complained of excessive crying since birth and diagnosis uncertainty. After the case history and examination, I and my tutor explained that we also believe this might be the CMPA. In addition, we have explained honestly to the patient’s mother that we cannot treat CMPA with osteopathy. It was the mother’s first experience visiting an osteopath and we wanted to be very honest and clear on what we can and cannot do.

We have explained to the mother that we cannot treat CMPA due to it being an immune response to an allergen, but we can assess her baby and treat any MSK findings, that may benefit the baby (NICE 2020). The mother appreciated our honesty and agreed to try an osteopathic approach. We have addressed the baby’s preferred head position and diaphragm tension along with OA joint restriction (Haydena & Mullinger 2006). On the next session, the mother reported a positive change in night sleep patterns and head-turning has become much easier for the baby (Carnes et al. 2018).

I think that being very honest and clear on what we can do with osteopathy helped us gain the trust of a patient as well as enhancing a positive response to the treatment and management. It helped to set up realistic expectations for the patient’s mother and helped to avoid any disappointment regarding osteopathy.

In conclusion, this situation in a clinical setting showed me how honesty with your patients and setting up realistic expectations will help to gain positive results.

Action plan: I will always be honest with my patients regarding my abilities as an osteopath. Making them understand that I cannot treat everything with osteopathy but explaining why osteopathy deserves a try to be a good supportive approach while they get additional treatment from another health care practitioner.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

References:

Carnes, D., Plunkett, A. & Ellwood, J., 2018. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ, 8(1), pp. e019040.

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

Haydena, C. & Mullinger, B., 2006. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complementary Therapies in Clinical Practice, 12, pp. 83 - 90.

NICE, 2020. cow's milk allergy in children | National Institute for Health and Care Excellence, Available at: https://www.guidelines.co.uk/paediatrics/nice-cks-cows-milk-allergy-in-children/455249.article [Accessed 16 March, 2021]

# data[].attributes.body
According to OPS standards every osteopathic practice must have a complaint policy in place  (GOsC 2019).
As a student practitioner I was not responsible to produce it. However, our teaching clinic and University has its policy in place for complaints. I have never had to respond to any complaints as a student as none were raised against me. However, I am aware that European School of Osteopathy has its own complaint procedure in case patients need to make a complaint.

ESO website explains how the patient can provide feedback and make suggestions. In addition, the website suggest to make an informal complaint first by talking to a student practitioner, tutor or receptions regarding any raised concerns. According to ESO policy the formal complaint must be made within the 6 months of the incident, and must be reported to clinic administration either by phone or email (ESO 2020). ESO website also contains information on how patients can complain directly to the General Osteopathic Council, if they feel that the situation cannot be solved via ESO complaint procedure (ESO 2020).

I decided to read this information regarding complaints procedure in order to be able to advise my patients on this matter. As I believe knowing this information demonstrates professionalism and awareness of different clinical procedure.

In conclusion, knowing this information is important because patients may request it and being able to provide this information demonstrated professionalism in practice.

Action Plan: always be aware of complaint procedure of a practice I work for to be able to advise patients if they request this information.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

References:

ESO, 2020. Patient Feedback & Complaints Procedure | European School of Osteopathy, Available at: https://www.eso.ac.uk/eso-clinic/feedback/patients-complaints-procedure/#1556728377315-1c990718-6b13 [Accessed 3 March , 2021]

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

GOsC, 2019. Standards of Practice | General Osteopathic Council,  Available at: https://www.osteopathy.org.uk/standards/osteopathic-practice/
[Accessed 11 January, 2021]

# data[].attributes.body
Year 4
As part of my module of the specialist clinic, I had to write a case report on one of my patients that I have seen in any specialist clinics. For this assignment, I have chosen an 8-month-old baby girl with a suspected Cow’s Milk Protein Allergy. The patient’s mother was very kind and agreed to consent for me to write a report on her daughter, and shared her personal perspective of the treatment. As part of the patient confidentially act I mentioned to the patient’s mother that all names/emails will be redacted and everything will be anonymised.

When I received her response (she directly communicated to one of the staff in the clinic). I have redacted all the names and any personal information before adding to my assignment, to make sure I comply with the patient confidentiality act and protect my patient’s personal information. At first, it made me nervous to handle this situation as it is possible to miss something in the text. However, I double checked everything and made sure no names appearing on the text.

I think I handled this situation well and gained some experience on how to protect the patient’s confidentiality. In addition, it was the first time I asked for written consent as well.

In conclusion: it was a positive learning experience. I learnt to not just ask for written consent, but also maintain a patient’s confidentiality and protecting my patients' personal information.

Action plan: always comply with patient confidentiality act in practice. Making sure that no files or notes with any names or any identifying information are taking home or left unattended. Patients files must be kept in the locked room.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3
My second new patient in the clinic was an interesting experience for me because I was able to recognise and see that she does not feel comfortable being undressed or having observers in the room. My second ever patient was Muslim, but she did not mention anything when I told her at the reception that I have observers in the room. However, during the case history, it has become obvious that she does not feel comfortable.
It made me feel nervous in regards to how to manage this situation best. When we walked out of the room to have a discussion with my tutor and the team, I decided to ask them to not go back to the room because the patient is not comfortable. My tutor also advised me to offer my patient a gown, which may help my patient to feel better as well.
This helped a lot because when I said to my patient that my observers are not going to come back to the room, I could have seen relief on my patient's face. When I explained to my patient that we have gowns on the reception, that she can wear for examination/treatment. I also later reminded her that she can always bring shorts/vest top to wear as well. This made my patient to feel a lot more comfortable and the rest of the consultation went easier as my patient was way more relaxed.
This experience showed me the importance of the patient's culture and origin. Although, my patient did not say anything regarding observers or getting undressed for examination/treatment this made her feel very uncomfortable during the case history. It is important to understand that in different cultures certain things are less acceptable than in others, which will help me to successfully address any issues and make sure that your patient feels safe and comfortable.
In conclusion: it was an interesting and useful learning experience, which showed me that I need to educate myself more about different cultures to be able to recognise certain things with patients and avoid awkward situations.
Action plan: read more about different cultures to be able to understand my patients better.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
It is crucial for osteopathic professionals and osteopathic students to uphold the reputation of the profession at the highest level, and we have been explained that at the start of our training. It includes our behaviour in and out of work as well as our social media profile.

As part of my course, I had to complete a DBS check to demonstrate that I did not break any law and that I am a trustworthy individual for this profession. High behavioural standards of this profession always made me feel responsible regarding my behaviour and I always made sure that I do not do anything that would put a shade on me as an osteopathic professional, which is evident from my clear DBS check attached below. In addition, I only use social media for educational purpose.

In conclusion: It is vital to always demonstrate the best professional profile, and uphold the reputation of this profession because as an osteopathic practitioner or an osteopathic student I do not just represent myself as an individual, but I also represent the osteopathic profession.

Action Plan: Always demonstrate professional behaviour in and out of the workplace.

Evidence of clear DBC attached below

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
Today I had my continuing patient with Tendinopathy who I decided to discharge because he was progressing really well, and I decided that he does not need any further treatments.

During the talk with my patient he told me that he is doing much better and he is completely pain free. I have explained to him that it means that I can discharge him today and he can continue with the agreed exercises rehab programme. My patients said that he is happy with his Tendinopathy progression and asked me about getting cranial treatments for his migraines. I very honestly explained to my patient that cranial osteopathy cannot help with migraines because migraines are vascular in nature. I explained my patient that it would not help and he does not need cranial therapy for migraines. It made me uncomfortable at first because I felt bad saying that cranial osteopathy is not an efficient approach to a patient. However, I wanted to be honest and did not want my patient book unnecessarily treatments that may financially affect him.
I think that I demonstrated honesty to my patient and considered how getting unnecessary treatments for migraines may affect him financially. It was challenging to choose words to explain this to my patient, but I believe that I managed this situation well.

In conclusion, it was a great experience that let me to apply my communication skills to ensure that my patient will not book unnecessary treatment that may affect him financially.

Action plan: always explain patients why you discharging them and why you think they will not further benefit from more treatments. Always consider how booking a treatment may affect a patient financially. Ask patients if they see benefits from continuing treatments.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 3 and 4
Being a supportive colleague is not easy because people you work with might have different views and beliefs, which sometimes may cause issues. During my training, at the start of the clinic, we were allocated into teams, which at first for me was a very challenging experience.

It was hard for me to work with people who I did not know that well and who had different views to mine, which at some stage created a lot of tension between me and my team. However, during the summer clinic, I had a chance to work with another team, which was a positive experience and it showed me how much you can learn from your colleagues.

It made me decide to move teams and I was very happy about this decision because it has become an enjoyable experience for me to work alongside my colleagues, having discussions with them about patients and how we can improve our management, as well as practising with them.

It showed me the importance of cooperating with colleagues because in the end despite any differences we all have the same goal, which is to ensure the best patients' care.

In conclusion: I think that I made the best decision moving teams because I was able to start learning together with my colleagues, which improved my overall skills and patients' care.

Action plan: making sure that any differences that I have with my colleagues, will not create tension and instead use it as an opportunity to learn something different, which can help to ensure the best patient's care and management.

The evidence below demonstrates one of the presentations that I produced to share with my colleagues and to have a further discussion.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
Today I had a cover patient that presented to me with a significant DDD. The patient was overweight and after examining him, I needed to have a conversation with him regarding his condition. As a professional, I must be able to recognise when I can advise my patient to see someone else who can help to my patient’s recovery. At first, I decided to ask my tutor how to approach an overweight patient and advise them to see a dietician.

It made me nervous to talk about weight to a cover patient at first, but I wanted to set up realistic expectations for these patients. In addition, I wanted to make sure they understand their own responsibility for their health.

Losing weight is not something I know much about and this is the case where I thought about advising my patient to consider consulting a dietician if they struggle to lose weight. I have chosen my words carefully and at first, asked my patient if they monitor their weight. It helped me to start the conversation in a nice way and my patient appreciated that.

I believe that I was able to recognise with this case where a patient may benefit from consulting another specialist, which may contribute to their overall health.

In conclusion: this was a very helpful learning experience demonstrating the importance of considering the patient as a whole and being able to recognise when a patient needs advice from another health care professional.

Action plan: learning more about referral patterns to different health care practitioners.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
3 Year
During summer clinic I had a cover patient with Hip labrum tear. I had to cover this patient for two weeks as my colleague was unwell. On the first session with me, this patient seemed very upset as it was her third treatment and she still was in a lot of pain. She was concerned because she enjoys going to the gym and training with kettlebells. However, since the onset, she could not go to the gym to train because the pain is way too strong. In addition, my patient explained to me that going to the gym is her stress-coping strategy as a lot is going on in her personal life.

After examining this patient, I went out to talk to my tutor and explain to him my concerns and thoughts about this patient. I explained to my tutor that it is the third session and the patient had no improvement at all in her symptoms and that I think we should consider referral. I justified my idea by saying that labrum tears do not heal easily, and many cases would require surgery, and since after three weeks, there is no improvement maybe we should refer this patient earlier than later because she really wants to get back to her training, and she is really upset about the lack of progress. My tutor advised me to explain options to my patient and see what she thinks.

I explained to my patient that Labrum healing is difficult because of the bad blood supply and some cases may require surgery. She got very upset about the idea of having surgery but also said that if she will have to get it, she wants it sooner than later. I asked if she wants to have treatment today or she just wants me to write her a referral letter for her GP. My patient said that she will try the treatment one last time and decide next week what she wants to do next.

When my patient came back next week, she still had no improvement and said that she wants to get the referral letter. I said that I will write it for her and asked for her consent to contact her GP.

I think that I did the right thing by suggesting a referral to my patient on the first session I covered for my colleague because she was already very upset about the lack of progress and stressed because she had to stop training. It is crucial for the osteopathic practitioner to be able to recognise when we need to cooperate with other medical professionals to enhance the patient’s progress.

In conclusion, this was a very useful experience I received during summer clinic because as an osteopath we need to know when our patients require help from other professionals and act accordingly.

Action plan: learn more about referrals and alternative options.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
As a medical practitioner student, I must ensure that my own health is not a potential hazard for my patients. During my final year at University and with the global pandemic, I had to make sure that my own health is in the best state.

Regular testing for COVID is very important to make sure that I am not putting my patients at risk.
At first, it made me feel really uncomfortable to be tested every week because I find lateral flow test quite unpleasant, but as a medical professional, I understand the importance of regular testing.

I started being tested as soon as it has become an available option and I think it was the right thing to do to keep my patients safe.

In conclusion: I made the right decision in the current situation, which helps me monitor my own health and keep my patients safe.

Action plan: continue to be tested regularly.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
Evidence demonstrating regular testing

# data[].attributes.body
Year 3
Research paper
I found this journal article when I was preparing my dissertation protocol. This research was published in 2020 in British Sports Medical Journal (Duboise & Esculier 2020). It proposes a new soft tissue injury protocol:
P-protection
E-elevation
A-Avoiding anti-inflammatory modalities
C-compression
E-education (of a patient)

L - loading
O - Optimisation
V- Vascularisation
E - Exercises (Duboise & Esculier 2020).

I found this protocol quite straightforward with a rational explanation of each step.

It made me happy to find new research and to read a new approach suggesting a detailed approach for soft tissue injuries, considering that we as osteopaths see soft injuries very often. In addition, it made me aware that we always have to research new information to stay up to date with the new evidence. However, at this stage of my training, it scared me how to do it and what is the best way to search for articles. It is very important for us as osteopaths be evidence-based and constantly improve our knowledge by engaging with new peer review articles to be able to keep up to date with our knowledge, which we can apply with our patients.

Before I found this article, I used an old RICE and PRICE approach for soft tissue injuries because they are published on NICE (2020) and NHS (2018) guidelines. However, after I have done my research I realised that NICE and NHS guidelines do not always publish the most up to date advice (Graham et al. 2015).

This made me think that I need to engage more with peer-reviewed articles to be able to have a broader knowledge about different medical topics because it will help me to provide my patients with the most up to date advice, which will improve the outcome of patients' management.

I think that I could have started to engage with evidence earlier during my training but due to study overload, I struggled with that and before I started the dissertation project I also struggled with the language used in the research papers, which I was able to start to understand a lot better during my preparing to start my dissertation.  In addition, research and statistics lectures were incredibly helpful to start understanding the research field.

In conclusion, when I found this article I only started to engage with research, which can be challenging considering how difficult the research field is. However, it was a positive experience and helpful new knowledge was gained through it.

Action plan: I will continue to engage with research and use journals mainly as they are peer-reviewed sources with the reference list.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

References:

Dubois, B. & Esculier, J. F., 2020. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), pp. 72 - 73.

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

Graham, T., Alderson, P. & Stokes, T., 2015. Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study. PLoS One, 10(3), pp. e0122313.

NHS, 2018. Sprains and Strains | National Health Service, Available at: https://www.nhs.uk/conditions/sprains-and-strains/ [Accessed 6 January, 2020]

NICE, 2020. Sprains and Strains | National Institute of Health Care Excellence, Available at: https://cks.nice.org.uk/topics/sprains-strains/ [Accessed 5 May, 2020]

# data[].attributes.body
Year 4
Online Webinar about concussion syndrome

It was my second experience of attending a webinar, which one of my friends sent me a link for. The registration process was very quick and straightforward, with clear instructions on how to join a webinar. The whole webinar lasted for about 45-60 minutes, although since it was a free webinar the lecturer talked a lot about his concussion course, and knowledge-wise I gained only very few bits, which was kind of upsetting as I stayed for the whole thing.

I was able to learn about the Pathophysiology of concussion, statistics, and some management strategies, which were a helpful experience because I did not know much about concussion before visiting this webinar. However, as I stayed for the whole webinar the lecturer talked too much about their course that they offer and the price of the actual course was too expensive for me as a student to consider.

However, it was a useful experience as it kind of showed that paid webinars would be better in the future as they will be mainly based on the subject and not course advertising. Although at this stage, I would not be able to afford a paid course about concussion, I may consider it in the future when I will have more time and money to afford to do this course. Although this webinar did not provide too much information, I made useful notes of things that I did not know about before and I read these notes after, which helped to gain new knowledge. In addition, this webinar prompted me to some additional reading about concussion subject.

In conclusion, I was still able to learn new information about concussion physiology and the diagnosis process, although in the future I would rather pay for a good webinar than visiting a free one. As it will help me to gain more knowledge.

Action plan: engage with webinars and CPD courses as they will help me to learn more new things, stay up to date with my knowledge, and help me to provide the best care for my patients. Possibly consider doing a concussion course in the future.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
As part of my course, I had to write and defend a dissertation project, which helped me to develop skills required by the profession to be able to critically analyse the information.

After completing my dissertation project, I had to present my project as well as apply criticality to it.
In March we received our dissertation feedback, which we had to use to be critical about our project.

I prepared a presentation(attached below as evidence) where I summarised my work in 10 slides as well as applied criticality regarding it. The purpose of this was to demonstrate our critical thinking.

This project helped me to develop my research skills and critical thinking. It was an interesting learning experience to apply criticality to my own work. At first, I found this very hard and confusing on how to reflect on the provided feedback. However, after making a feedback table with the most important comments for each section, I was able to complete this part successfully and explain to my examiner what I could have done better. A huge part of the dissertation project was referencing, which I overall could have done better, which would improve the quality of my project. I used old references in my discussion sections, and I was not critical enough about why I used old references. In addition, I did not references my limitations section, which affected my grade. After reading my feedback I realised how I could have improved.  I have done more research for my presentation and I found more evidence for my limitation section and I reflected on that during my defending presentation.  This learning experience helped to develop critical thinking that I must apply throughout my career not just about the information I read, but also regarding my own work.

In conclusion: the dissertation project and presentation were very difficult, yet very useful experience to learn how to apply critical thinking to the information.

Action plan: continue to develop my skills in research, which can help to improve my critical thinking further.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had my first CEX in Year 4 and my tutor mentioned the importance of developing my skills regarding management plan for patients. Being a student it is difficult to learn everything in a short time period and I believe that I have not paid much attention to how to manage different musculoskeletal conditions. My tutor highly advised me to start learning about alternative options, exercises, and life modifications for patients. Many colleagues of mine received similar advice regarding patient management.

This incident made me question my knowledge regarding my abilities to enhance my patients' health and well-being. I was not happy that I am not confident enough as a health care professional to contribute to my patients' health and well-being by providing good health advice. I decided to improve my knowledge in this area and cooperated with my other colleagues regarding management plans.

I along with my friends decided to produce management plans for each condition each week, and present them to each other as well as have a small discussion on each subject. This made me feel way more confident in the clinic giving advice to my patients to enhance their health and well-being. As I have researched a lot about exercises and rehab programs of different musculoskeletal conditions including tendinopathies, ligament sprains, muscle strains, radiculopathy, and neuropathy. I have attached one of the presentations I produced on the management plan of the Carpal tunnel entrapment containing NICE guidelines management.

In conclusion, getting feedback from the tutor regarding my abilities in this area was very helpful as it gave me a good perspective on where I can improve as a health care professional to be able to contribute to enhancing my patients' health and well being.

Action plan: continue learning about the management of different conditions. Completing webinars and CPD regarding health and life-modification advice.

The evidence attached demonstrates a presentation prepared for discussions with colleagues containing information about the management of median nerve entrapment.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Year 4
Evidence demonstrating regular testing

# data[].attributes.body
Year 4
In 2019 the whole world was hit by a global pandemic, which changed everything around us. In summer 2020 the teaching clinic was able to reopen and PPE was implemented to protect both patients and students. In January 2021 when vaccine started being offered, we as health care students classified to get the vaccine first. I had my first vaccine at the end of January and my second vaccination three months later in April.

At first, the perspective of getting a vaccine that was produced so quickly seemed very scary to me. However, as a health care professional, I felt that I need to take all the precautions to keep my patients and colleagues safe.

I think I made the right choice when I decided to get a vaccine because after I had it, it put my mind at ease. I did not have any side effects.

In conclusion: although the situation was not ideal and it scared everyone, I believe that as an osteopathic student I was able to adapt to the situation in the best way to make sure that my patients are safe around me.

Action plan: It is important to continue with regular testing to maintain my patients' safety because the vaccine does not offer 100% protection.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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Year 3 and 4
I always try to maintain professional boundaries with both my patients and colleagues at ESO. At the start of September, I had an opportunity to take a part in a Sports clinic, with our tutor proving his feedback at the end of week 6. One of the areas, that our tutor had to assess was overall professionalism which includes maintaining professional boundaries within our practice.

My tutor provided positive feedback on my professionalism both with my colleagues and patients. He provided detailed verbal feedback saying that I always come across as professional, use appropriate language and professional attitude with my patients and colleagues.

It made me feel more confident about my professionalism as sometimes maintaining professional boundaries and not coming across as a cold individual can be difficult.

I think I could have asked my tutor about specific areas of my professionalism that in his opinion require improvement, but I did not ask about them since his feedback sounded very positive.

In conclusion, being assessed in a specialist clinic on overall professionalism helped me to gain a perspective on how good my professionalism is in practice with both my patients and colleagues.

Action plan: improving my professionalism skills, always maintaining clear and professional boundaries with patients and colleagues in practice. Ask tutors to give me more feedback and guidance regarding my professionalism.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
During my training at the teaching clinic, I have never had any complaints raised against me. However, it is very important to understand the complaint procedure of the General Osteopathic Council (GOsC, 2019). It is crucial for the osteopathic practitioner to understand the process as well as to know how to respond if the complaint is raised.
The General Osteopathic Council website contains all the information about how the deal with complaints against osteopaths or osteopathic students (GOsC, 2019). Once General Osteopathic Council agrees to consider a complaint, they will contact an osteopath with all the details of a complaint and ask for a response (GOsC, 2019).

I felt that reading about the procedure is important because as an osteopathic practitioner I must know about the possible legal procedures. I think it is great that we have been advised to look at this information before graduation because that made me more prepared for the different situations and it helped me to understand how they can be avoided as well.

In conclusion: It is important to be aware of GOsC complaints procedures, as well as understand what actions they are taking in case of the procedure.

Action Plan: Monitor any changes and be always aware of any General Osteopathic Council complaints policy changes.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

References
GOsC, 2019. Our Complaints Process | General Osteopathic Council, Available at: https://www.osteopathy.org.uk/standards/complaints/our-complaints-process/ [Accessed 5 February, 2021]

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

# data[].attributes.body
Year 4
I had my second Clinical exam in Year 4, which generally went well.  I had this exam on my continuing patient, who I diagnosed with Achilles tendinopathy.  However, I did not produce an efficient rehab programme for my patient. When my tutor asked me about a rehab programme for this patient, I suggested an exercise that would not load the Achilles tendon and would not help to strengthen it. My tutor started to question my choice of exercise and suggested a better rehab programme for this patient.

It made me feel stupid that I could not provide a good rehab programme to my patient, which they would benefit from. However, this also made me motivated to learn more about it and I asked my colleague to share rehab protocol articles with me, which I read and I prepared a good rehab programme for my patient.

I think I could have done better if I prepared an efficient programme for this patient after the first session. However, when I saw this patient the next time my tutor was very happy with my rehab programme, and the fact that I really listened to his feedback.

In conclusion. I believe that this was a good learning experience because this exam showed me my weak area and I reflected on it by doing more reading about the subject, which improved my knowledge and will help me to provide my patients with good rehab advice. All of the above demonstrates that I am aware of my wider role as a healthcare professional to contribute to enhancing the health and well-being of my patients.

Action Plan: continue learning about rehab exercises for different body regions, watch rehab exercises videos, engage with research articles, and listen to podcasts.

Gibbs reflective cycle was used for this reflection (Gibbs 1998).

Reference

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

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References:

Carnes, D., Plunkett, A. & Ellwood, J., 2018. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ, 8(1), pp. e019040.

Dubois, B. & Esculier, J. F., 2020. Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), pp. 72 - 73.

ESO, 2020. Patient Feedback & Complaints Procedure | European School of Osteopathy, Available at: https://www.eso.ac.uk/eso-clinic/feedback/patients-complaints-procedure/#1556728377315-1c990718-6b13 [Accessed 3 March, 2021]

Gibbs, G., 1988. Learning by Doing: A Guide to a Teaching And Learning Methods. Oxford, Polytechnic: Further Educational Unit.

GOsC, 2019. Our Complaints Process | General Osteopathic Council, Available at: https://www.osteopathy.org.uk/standards/complaints/our-complaints-process/ [Accessed 5 February, 2021]

GOsC, 2019. Standards of Practice | General Osteopathic Council,  Available at: https://www.osteopathy.org.uk/standards/osteopathic-practice/
[Accessed 11 January, 2021]

Graham, T., Alderson, P. & Stokes, T., 2015. Managing Conflicts of Interest in the UK National Institute for Health and Care Excellence (NICE) Clinical Guidelines Programme: Qualitative Study. PLoS One, 10(3), pp. e0122313.

Haydena, C. & Mullinger, B., 2006. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complementary Therapies in Clinical Practice, 12, pp. 83 - 90.

NHS, 2018. Sprains and Strains | National Health Service, Available at: https://www.nhs.uk/conditions/sprains-and-strains/ [Accessed 6 January, 2020]

NHS, 2019. Female Genital Mutilation | National Health Service, Available at: https://www.nhs.uk/conditions/female-genital-mutilation-fgm/ [Accessed 20 February, 2021]

NICE, 2020. cow's milk allergy in children | National Institute for Health and Care Excellence, Available at: https://www.guidelines.co.uk/paediatrics/nice-cks-cows-milk-allergy-in-children/455249.article [Accessed 16 March, 2021]

NICE, 2020. Sprains and Strains | National Institute of Health Care Excellence, Available at: https://cks.nice.org.uk/topics/sprains-strains/ [Accessed 5 May, 2020]