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Throughout the Covid19 pandemic and strict lockdown regulations, us osteopathic students were lucky enough to be able to attend practical lectures on campus. To ensure the security of others and ourselves, the following measures were undertaken:
- We always used PPE when practicing with each other.
- Lateral flow testing was available for all sudents and teachers to reduce the risk of spreading it to a larger group of people.
-Sanitising stations were available around the campus.
-Clinic groups: each class was divided into smaller groups 'bubbles', so that incase someone was covid19 positive, the likelyhood of people outside of the bubble gettig infected was reduced. This however made it more difficult to build a library of experiences as we worked with the same people throughout the term.
-Covid spray was used on all surfaces, such as the treatment benches after each person.

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Attending clinic allowed me to see how students interact with their patients. I thought that one 3rd year student was doing a great job in avoiding creating a hierachy between him and the patient. One of the ways he did this was through using the word "we" more than "you", which made it seem like the patient and the practitioner were a team. To me this is a very important aspect, that I would like to develop throughout my career, to make the patient does not feel pressured.

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Experience:
I had the opportunity to visit an ESO graduate, who now has been practicing for over 13 years. What surprised me the most was that when she took my case history it was much shorter and less detailed than what we use in clinic.
Reflection:
After thinking about this, I felt unsure if it is the right thing to do; to shorten the case history, as to me it seems like a crucial part to making a successful diagnosis. On the overhand, when I went into clinic as a patient myself, I was a bit frustrated because I barely received any treatment and most of the session was focussed on taking notes.
Back at university, I decided to ask my clinical integration teacher why we learn to take such detailed case histories, but once in your own practice, these are much more concise. She explained that once that you are a qualified osteopath you decide in how much depth you need to go into your patients case history.
Thus, I am still not too sure on what the right balance is in order for the patient to receive a long enough treatment and for the practitioner to gather enough information to make an accurate diagnosis.
Action:
From this, I have decided that when I have my first patients in clinic, I would explain to them that there only is limited time for the treatment at the first appointment and that in future appointments, the main focus will be the actual treatment, to avoid misunderstandings.

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prevention certificate

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Marie-Pauline Otzen - Female Genital Mutilation_ Recognising and Preventing FGM

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Throughout all our practical classes, we have had the chance to be both practitioner and patient. This has allowed us to practice asking for consent. It became apparent that asking for consent is crucial before starting any examination or treatment. I have realized that this is so important especially in osteopathy, as sometimes we may not be directly treating the joint that is painful itself but are looking at other parts of the body, which may be compensating. Thus, we have to be clear when explaining what we as practitioners aim to do.

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clinical observation - hands on first real patient 05.05.2021 OPS B1.7 (palpatory skills)

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clinical observation - hands on first real patient 05.05.2021 OPS B1.7 (palpatory skills)

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During this clinical observation I had observed two different patients being treated by the same 3rd year student. The first one had come to clinic for the first time and was complaining of low back pain following a wrong movement. The student decided to do a GOT treatment on his patient. Once he had worked up one side of the body, he asked me if I wanted to practice some GOT on the patient on the other side. I was not expecting to be allowed to put my hands on an actual patient in first year, so I said that I would rather if he finished the treatment instead of me. Later on, I regreted that I did not take this chance to experience how it feels to treat a patient that is in pain. Therefore, I decided to speak to the student after the treatment and he said that I could do some passive testing on his next patient. This experience allowed me to feel what an actual patient may present with, rather than practicing on a 'young, fit and healthy' student.

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Patient referral OPS B2 & sufficient/ appropriate knowledge B1

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Patient referral OPS B2 & sufficient/ appropriate knowledge B1

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Description:
I had never been referred by an osteopath to another health care professional until my osteopath saw an abnormal mole on my back. She recommended me seeing a dermatologist.
Feelings:
At first I was a bit worried about the referral, but when I got it removed at the dermatologist, I realized that my osteopath had done the right thing by referring me to the appropriate healthcare specialist. I was very grateful but at the same time I realized how vast an osteopath's knowledge must be, intimidating me slightly.
Evaluation:
Later on that week, in an anatomy tutorial we were studing the cranial nerves and investigated the differences in symptoms between a stroke and a Bell's palsy, where a referral is indespensable for one and inaccurate for the other. This made me feel more stressed, as referrals are very common, but the right decisions have to be made under time pressure.
Analysis:
I also spoke to an ESO graduate who told me that she had similar concerns, however reassured me by saying how well the school prepares you for real life situations, starting with the OSPE's which teach you to quickly regurgitate knowledge all the way to dealing with complex cases, which end up being referred.
Conclusion:
From this I gathered that after graduating from the ESO, I would like to work in a clinic with other healthcare practitioners to have a wider range of knowledge in the clinic.
Action plan:
This has motivated me to attend the clinic as often as I can to get the most experience possible.

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CPD - Keeping knowledge up to date OPS B3

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CPD - Keeping knowledge up to date OPS B3

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I attended a CPD course on Hamstring injuries in athletes. This improved my understanding on hamstring tears and can help me in the future with the management of patients diagnosed with hamstring tears. This knoweldge will also become useful in sports clinic, where I can ask my tutors on how they would treat hamstring or other tendon injuries, to get different opinions.

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Over summer clinic we had many take over and cover patients. This made me realize how important it is to write clear and detailed notes on the patient's complaint and in examination findings. Some of the notes were very difficult to read and were not very elaborate, making it harder to know how the patient has been progressing and what treatment they may have been receiving and possibly responding to. In some cases, I had to take a full case history again, to ensure that I did not miss any key details. However, this sometimes seemed to frustrate patients a bit, as they just wanted to get treated.

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Safe osteopathic care, treat with a diagnosis OPS C1

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Safe osteopathic care, treat with a diagnosis OPS C1

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•Experience – At the ESO teaching clinic one of my colleagues treated a patient’s secondary complaint (low back pain) without having a working diagnosis. A week later the patient cancels the appointment at the clinic as they were at hospital with kidney failure.

•Observations/ reflections – All of the students were quite shocked about the severity of the case and learned from this incidence. Personally, it made me increasingly aware of our importance of clinical judgement and responsibility for the patient.

•Development of ideas - This event taught the entire class the importance of only treating symptomatic regions if we have a working diagnosis, even if it is ‘just’ a secondary complaint, as they may be linked or there may be underlying systemic issues.

•Testing ideas in practice – I then had a new patient presenting with LBP, which also presented with lower quadrant abdominal pain. I did not treat these as separate causes and continued my questioning, hinting towards a UTI. The questioning was positive, so we referred the patient straight away, without missing a crucial systemic issue.

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In children's clinic I have had the opportunity to manage 2 young boys diagnosed with ADHD. However, I was not fully rehearsed in the management & diagnosis of this condition. Therefore, to deepen my knowledge in this subject I decided to attend a CPD seminar to provide my patients with the best advice possible.

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At the ESO clinic I had a new patient assigned, female, in her 80s, osteoporotic, presenting with neck pain after forced neck extension. She was accompanied by her son, as she could no longer communicate due to dementia. The tutor was happy for me to treat the patient conservatively in the first session, however, we advised the patient to go to A&E if the pain gets worse. The next week I had a different tutor, who was not happy for me to treat this patient due to the inability of the patient to communicate and making difficult to rule out a fracture. We then called the son to inform them that we would not be able to treat. He was very dissapointed, however, he understood our reasoning. Through this experience, I have learned to communicate with a patient if a mistake happens. I have also learned to keep my empathetic feelings away from the patient, to ensure that they are referred accordingly to see if they are safe to treat.

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OPS C6 - wider role as a healthcare practitioner

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OPS C6 - wider role as a healthcare practitioner

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After having my mock CCA, I received feedback regarding my returning patient, who is 76, neck pain and on blood pressure medication. My tutor suggested taking his BP every or every other treatment to ensure that it remains consistent. This reminded me of our wider role as a health care provider. Therefore, I will be more proactive in CV and respiratory assessments with higher risk patients.

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With two of my ESO colleagues we attended the 122nd GOsC council meeting in London. It was reassuring to see that there were quite a few osteopaths on the board to ensure that regulations are applicable to the profession. Prior to this event, I was unsure about the role of the council, however, after attending I became aware of the importance of a regulator in our profession. From this experience, I have understood why certain regulations are in place and their importance in maintaing the reputation of the profession.