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

Description
In 3rd year, we had to make a business plan and elaborate a marketing strategy including how we will advertise our profession and area of expertise. During my research, I came across the Committee of Advertising Practice (CAP) guidelines in association with the Advertising Standards Authority (ASA) which display advice and guidance for osteopaths on what treatable conditions they can advertise or promote. Before this assignment, I was not aware of the advertising and promotional guidelines for osteopathy but it seemed cautious and necessary for the profession to have a supportive framework.

Feelings
First, I was surprised to discover the short-listed conditions that osteopathy can treat according to their guidance. I can understand the advantages to have an approved evidence-based list for osteopaths to share and advertise on their website for legal purposes. However, I thought that it also restricts the way osteopaths can advertise themselves, as other conditions not displayed on this list could potentially benefit from osteopathy as well.

Evaluation/ analysis
Although the purpose of this list is to provide evidence-based supportive guidance for osteopaths, there are some ambiguous components that have caught my attention. The confusion between symptoms and conditions shows a lack of consistency or a misunderstanding of what can be treated by an osteopath. More emphasis could be made on the systemic causes which are untreatable by osteopathy and would induce a referral. It is also very confusing for the reader to be misguided by the lack of consistency in the terminology, indeed an osteopath can treat a patient for "uncomplicated mechanical neck pain", and sometimes those neck pain will arise after a whiplash injury, so opposing mechanical neck pain with neck pain following a whiplash injury is confusing for the reader and a misunderstanding of the principle of osteopathy where everything is interconnected. All of which may lead to misinterpretation of the spectrum of conditions treatable by osteopathy.

Conclusion/ Action plan
My understanding is to use the guidance to remain ethical and not impose unrealistic expectations on my patients. However, with consent and shared-decision making we can always offer osteopathic treatment to our patients even when presenting with a condition not listed, as long as the patient acknowledges the non-evidence-based approach.

Reference
Advertising Standards Authority, 2016. Which Medical Conditions Can Osteopaths Claim to Treat? Available At: https://www.asa.org.uk/advice-online/health-osteopathy.html [Accessed May, 14, 2022].

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Note: This advice is given by the CAP Executive about non-broadcast advertising. It does not constitute legal advice. It does not bind CAP, CAP advisory panels or the Advertising Standards Authority.

Osteopaths are trained in therapeutic approaches that are suitable for a broad range of individuals, including pregnant women, children and babies. Osteopathic care is delivered through a range of interventions which may include onward referral, health management advice, manual therapy, exercise therapy and others. Osteopaths adapt their therapeutic approach depending on the individual needs of the patient and their presenting complaint. Manual therapy techniques employed may include articulation and manipulation of joints and soft tissues.

Osteopaths have been regulated by statute since 1993 by the General Osteopathic Council (GOsC) and may refer to conditions for which medical supervision should be sought if they hold convincing evidence of the efficacy of their treatments.

Which medical conditions can osteopaths claim to treat?

Based on evidence submitted to CAP prior to November 2016, the ASA and CAP accept that Osteopaths can claim to treat the following:

Arthritic pain
Circulatory problems
Cramp
Digestion problems
Fibromyalgia
Frozen shoulder/ shoulder and elbow pain/ tennis elbow (lateral epicondylitis) arising from associated musculoskeletal conditions of the back and neck, but not isolated occurrences
Headache arising from the neck (cervicogenic)
Joint pains
Joint pains including hip and knee pain from osteoarthritis as an adjunct to core OA treatments and exercise
General, acute & chronic backache, back pain (not arising from injury or accident)
Generalised aches and pains
Lumbago
Migraine prevention
Minor sports injuries
Muscle spasms
Neuralgia
Tension and inability to relax
Rheumatic pain
Sciatica
Uncomplicated mechanical neck pain (as opposed to neck pain following injury i.e. whiplash)

If marketers use different medical terms to describe one of the above conditions, they may be asked to provide evidence to demonstrate that this description is generally agreed to have the same meaning as that approved condition.

Which medical conditions can osteopaths not claim to treat?

Any conditions that are not reflected above are likely to be problematic unless the marketer holds robust clinical evidence to support their claims.

Are claims to treat babies, children and pregnant women acceptable?

As regulated health professionals, osteopaths may refer to treating specific population groups such as pregnant women, children and babies. However, at present there is a limited or negative evidence base for the effectiveness of osteopathy in treating conditions specific to those groups, such as colic or morning sickness.

Consequently, references to treatment for symptoms and conditions that are likely to be understood to be specific to babies, children or pregnant women are unlikely to be acceptable unless the marketer holds a robust body of evidence.

Where an adequate evidence base has been established for the efficacy of osteopathic treatment for particular conditions in the general population, claims that do not materially depart from those already deemed acceptable by CAP and which describe interventions that are consistent with osteopathic practice, are likely to be acceptable.

The ASA has recently carried out a review of advertising claims in relation to the treatment of babies, children and pregnant women using osteopathy which explains in more detail the types of claims (including phraseology) that are likely to be acceptable and those that are not. Osteopathy: ASA review and guidance for marketing claims for pregnant women, children and babies.

Can I call myself a "Doctor"?

Claims such as "Dr" and "Doctor" are likely to be understood to mean that the Osteopath holds a general medical qualification. As such, Osteopaths not holding such a qualification should avoid references to "Dr" or claims that are likely to have the same meaning.

Updated on 2 December 2016.

More on

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Advertising Standards Authority | Committee of Advertising Practice

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Note: This advice is given by the CAP Executive about non-broadcast advertising. It does not constitute legal advice. It does not bind CAP, CAP advisory panels or the Advertising Standards Authority. Osteopaths are trained in therapeutic approaches that are suitable for a broad range of individuals, including pregnant women, children and babies.

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

Description
In January I had my mock CCA exam, where I had to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate care. I was taking my decisions autonomously without the supervision of my tutor and I received a good feedback from my assessor (attached here).

Feelings
I am always a bit nervous before an exam, even if it was a mock exam I decided to act as if it was my CCA. I was concerned about my time management as my patient was very talkative and I was running late. Overall, I was happy with my performance for this exam, I just felt I could have asked more gynecological questions as my patient had underlying issues. Because the patient was very talkative, I tried to direct the conversation to avoid any irrelevant information that would not be useful for the case history.

Evaluation
According to the feedback I received, the strengths demonstrated during the exam were:

A good introduction and case history with a logical sequence

Logical differential diagnosis backed by the case history

Good examination with adaptation to patient pain

Logical diagnosis linked to past medical history

Logical treatment and good management plan with consent recording

The areas to improve on were:

To follow up on underlying gynecological problems

Run out of time for treatment due to talkative patient

Need to include no treatment or alternative in the consent process

Analysis
According to the evaluation of the feedback, I was able to conduct an osteopathic patient evaluation and deliver safe, competent, and appropriate osteopathic care including the following domains:

take and record the patient’s case history, adapting the communication style to the patient’s individual needs and sensitivities

select and undertake an appropriate clinical assessment of the patient, taking into account the nature of pain

formulate an appropriate and logical working diagnosis and rationale for care and explain this clearly to the patient

develop and apply an appropriate and logical treatment and management plan

adapt an osteopathic technique or treatment approach in response to findings from the examination

Conclusion/ Action plan

From this experience, I learned that I have to improve my time management by communicating more effectively with my patient to avoid any interruptions. I also realized that I needed to improve my gynecological knowledge. Overall, it was a good opportunity to practice and get feedback.

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OPS A1. You must listen to patients and respect their individuality, concerns and preferences. You must be polite and considerate with patients and treat them with dignity and courtesy.

Description
I had a new patient coming in and I was made aware that he might feel uncomfortable with observers. Although he gave me his consent for observers in the room, when I started to take the case history I felt that he was not at ease with people watching him. I noticed the way he started to move on his chair and how his answers were very short and almost dismissive. This did not help me with gaining all the information I needed. When I went to discuss the case with my tutor I realized I needed more information to have a good differential diagnosis. At that moment I decided to go back into the room alone and re-discuss with the patient a few points of the case history. I then realized how different my patient was without any observers in the room. My tutor challenged me to improve my listening skills since it shows respect to patients and colleagues as well. At that moment I understood how important it was to effectively communicate with patients and learn to read their nonverbal signs.

Feelings

I felt very frustrated because I could not gain all the information I needed to discuss the case with my tutor. I also felt that by having observers in the room, my patient might have felt uncomfortable.

Analysis

When I joined the ESO, I was determined at realising my own potential to help patients. With that experience, I realized how important it is to effectively communicate with patients and be able to read their nonverbal signs.

Conclusion/ Action plan

After this experience, I had a look and read some of our Psychology lectures in 3rd year on effective communication and listening skills which are attached here. I will challenge myself to improve my listening skills and be a more effective and active communicator. I am now more convinced that listening is an integral part of communication that clarifies a speaker's message (Denniston et al. 2017).

References

Denniston, C., Molloy, E., Nestel, D., Woodward-Kron, R. & Keating, J.L., 2017. Learning Outcomes For Communication Skills Across The Health Professions: A Systematic Literature Review And Qualitative Synthesis. BMJ Open, 7(4).

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Advertising Standards Authority, 2016. Which Medical Conditions Can Osteopaths Claim to Treat? Available At: https://www.asa.org.uk/advice-online/health-osteopathy.html [Accessed May, 14, 2022].

AgeUK, 2021. Equality, discrimination and the Public Sector Equality Duty, Available At:https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs79_equality_discrimination_and_the_public_sector_equality_duty_fcs.pdf  [Accessed April, 26, 2022].

Denniston, C., Molloy, E., Nestel, D., Woodward-Kron, R. & Keating, J.L., 2017. Learning Outcomes For Communication Skills Across The Health Professions: A Systematic Literature Review And Qualitative Synthesis. BMJ Open, 7(4).

Department of Health, 2003. Confidentiality, NHS Code Of Practice, Available At: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf [Accessed April 26, 2022].

Gibbs, G., 1988. Learning By Doing. A Guide To Teaching And Learning Methods. O. Polytechnic, ed., Oxford: FEU.

GoSC, 2017. Guidance about professional behaviours and fitness to practise for osteopathic students. Available at: www.osteopathy.org.uk/news-and-resources/document-library/training/guidance-professional-behaviours-and-ftp-students/ [Accessed April 9, 2022].

GOsC 2012. Criminal convictions and fitness to practise. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/fitness-to-practise/fitness-to-practise-bulletin-february-2012. [Accessed May, 14, 2022].

Internet, 2019. 3 Firm Ways To Set Therapy Boundaries, Available At: https://youtu.be/HHdXCHnZo3c [Accessed May, 14, 2022].

Internet, 2020. The secret to giving great feedback | The Way We Work, a TED series, Available At: https://youtu.be/wtl5UrrgU8c [Accessed May 14, 2022].

NICE, 2014. Obesity: identification, assessment and management, Available At: https://www.nice.org.uk/guidance/cg189/chapter/1-Recommendations [Accessed May, 14, 2022].

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

Moyo, M., Goodyear-Smith, F.A., Weller, J., Robb, G. & Shulruf, B., 2016. Healthcare Practitioners’ Personal And Professional Values. Advances In Health Sciences Education, 21(2), pp.257–286.

The Institute of Osteopathy, 2021. COVID-19, Available At: https://www.iosteopathy.org/covid-19/ [Accessed June 14, 2021].

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May 14th, 2022

OPS D2. You must establish and maintain clear professional boundaries with patients, and must not abuse your professional standing and the position of trust which you have as an osteopath.

Description
In 3rd year I was treating a male patient for scapular and shoulder pain, he started to become too friendly, asking me questions about my personal life, relationship status, and spare time activities. After 1 or 2 sessions, I asked him during the interview which movement was worsening his pain, he made a reference to particular movements he was performing during sexual intercourse. I thought that it was an inappropriate response and felt very uncomfortable. I decided to talk to my tutor about the patient attitude, she asked me to keep a record of the conversation and follow it up in writing in the event of a future complaint and to bring a chaperone for the time being. When I came back to the room, I decided to keep my boundaries up and avoid a friendly attitude, to discourage him from starting any inappropriate conversation with me. At the end of the session, I referred him to another male practitioner.

Feelings
At the time, I felt very uncomfortable and disrespected that the patient was trying to challenge my professional boundaries. I also remember feeling uncomfortable speaking about it in front of my tutor and other team members in the meeting room, as it was an awkward situation.

Analysis
It was a challenging experience because I had to maintain professional behavior at all times while the patient was clearly disrespectful and out of line. I applied the advice given by my tutor to discontinue treatment with him. This experience helped me to establish and maintain clear professional boundaries with my following patients.

Conclusion/ Action plan
After this experience, I decided to explore other strategies for keeping professional boundaries in a clinical setting. The link attached provides a video on how to maintain appropriate patient boundaries and avoid unwanted attention from patients.

References:
Internet 3, 2019. 3 Firm Ways To Set Therapy Boundaries, Available At: https://youtu.be/HHdXCHnZo3c [Accessed May, 14, 2022].

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Reflection on a patient's dissatisfaction due to the constant change of tutor and practitioner 

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Reflection on a patient's dissatisfaction due to the constant change of tutor and practitioner 

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

Description
On one occasion, I had to cover for a colleague in the children's clinic. The mother of the patient was also pregnant and seemed very stressed and tired. First, she didn't show that she was annoyed by the sudden change of practitioner and tutor, however, after treatment, she went to reception and started to complain about the constant change of practitioner and that she asked to stay with the same tutor as well for continuity and better results for her baby. She told me that it was nothing related to me, that she didn't mind the change of practitioner really but she wanted at least the same tutor.

Feelings
First, I was surprised and helpless to witness the sudden change of attitude from the treatment room to the reception room. She didn't display any sign of irritation to my tutor or to myself during the session, so it was baffling to witness this scene. I also understood her position, as continuity is important for good results, and changing practitioner and tutor every time would not help her baby in the long run. I also felt relieved when she mentioned to the receptionist that I did well with her baby but the constant change of tutors and practitioners was worrying and stressful for her.

Evaluation
I understood that the mother of the patient was going through a large amount of stress in her personal life, and had difficulty coping with changes with already too much on her plate. She was tired to go through the baby's story each time and she just wanted continuity which seemed a fair request. My tutor and I weren't responsible for her situation, however, on behalf of the teaching clinic we had to apologize and find a solution with the receptionist to book her with the tutor of her choice as she requested.

Analysis
The patient's mother reacted in such a way because of different expectations and a lack of information from the clinic, associated with a large amount of stress. Anxious or stressed people can have difficulties coping with changes, and we should always consider the biopsychosocial aspect when treating any patient.

Conclusion/ Action plan
This experience made me think about how some patients need continuity with the same practitioner/tutor to feel at ease. I also read the article attached above on the professional duty of candour which shows how to apologize to patients without taking any personal responsibility for something that has gone wrong in their care that was not our fault. In the future, if I am covering a patient I will double-check that the patient is happy to carry on with a new practitioner and tutor and that they received appropriate notice.

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OPS D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.
D4.1. A complaint is an opportunity to reflect on the communication and standard of care that was given, and it may highlight areas of your practice that could be improved. A complaint which is handled well can also result in a stronger bond of trust between you and your patient, leading to improved patient care.

Description
In 2nd year, one of our assignments was to write a response to a complaint letter following an osteopathic treatment. The complaint had allegations that brought into question a procedure performed, without due consent, which has ramifications in terms of an unexpected response to treatment. The response letter had to demonstrate a sensitive handling of the situation and be reflective on why the issue has arisen, what could have been done better, and what remediation is appropriate in the circumstances, taking into account resources that the patient can be directed to in order to feel supported in the process.

Feelings
I felt that it was a very useful coursework, learning how to handle a patient complaint, and an opportunity to reflect on the standard of care before starting the teaching clinic.

Evaluation
I remember that the feedback received was good but unfortunately I didn't find a copy of it. I was very satisfied with my response letter, and successfully demonstrated:

a professional, structured, and concise writing style

an ability to evaluate and respond to a patient's expectations and requirements in a way compliant with the standard of care

evidences independent thought when evaluating what the management should be for the patient's issues

an intelligible reflection on the biopsychosocial issues apparent, using an appropriate communication style

Analysis
The coursework was overall challenging for students who did not have any practical experience in clinic yet while still learning professional and clinical communication styles. However, I find it very interesting and useful as a coursework, preparing future clinicians to address and manage unexpected situations, highlighting the importance of consent and shared-decision making while reflecting on communication and standard of care.

Conclusion
This exercise made me realize the importance to record consent and everything discussed with the patient in the treatment room with clear notes to refer to, as well as the importance of shared-decision making. It also made me realize that a complaint well-handled can result in a stronger patient-practitioner relationship. If needed, I could use this response as a model to adapt for possible future complaints.

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

Description
A take-over patient presented at the teaching clinic of the ESO in April 2022 for continuing treatment for mechanical thoracic pain and trapezius myalgia predisposed by a previous fall and his occupation as an emergency call handler. His past medical history includes a third ventricle tumour and hydrocephaly with ventriculoperitoneal shunt placement in 2016. Ongoing symptoms include nausea, dizziness, vomiting, headaches, visual changes, and left upper limb weakness. Due to progressive severe headaches for the past 2 months and new transient pupillary asymmetry for the past 3 weeks, I decided to refer him to his GP to arrange a review with the neurology department. Concerns were raised about the progression of the previous tumour or the ventricular-peritoneal shunt malfunction. When looking at his field, I realized that he was already referred a couple of times this year, and he seemed reluctant to be referred again. When I asked him the reason, his response was unclear at first, he told me that he didn't want to go through surgery again even if his condition was concerning. Then, he told me that the waiting time for an appointment with a specialist was very long, probably months to be able to see someone, and that he had never heard back from the GP after a referral. Finally, our understanding was that the patient didn't want to investigate his condition further, and just wanted to be treated for mechanical issues. After discussing the situation with my tutor, we agreed that if the patient was willing to sign a consent form for a referral letter we would be able to treat him. The patient gave his consent and was treated accordingly.

Feelings
The situation with this patient was confusing, I wasn't sure he wanted to be helped and it felt like he was aware of the situation but would not do anything about it for different personal reasons. I felt helpless to see that the patient was not willing to investigate his condition and the new severe symptoms. While making sure to adapt my communication approach, to be sure that he was aware of the situation, I did not impose anything on him and respected his choice.

Evaluation
This experience made me aware of how important it is to work in partnership with patients, taking into account their particular needs and supporting them to express what is important to them. I did my best to communicate effectively with the patient and understand his needs. As a healthcare professional, my duty was to refer this patient as it was the most appropriate form of treatment for him. He understood the necessity for us to refer him and finally gave his consent.

Analysis
The relationship and communication between osteopaths and their patients is an important aspect of the osteopathic practice. As osteopaths, we consider our patients and their clinical presentations in a wider living context, and we work in partnership with them as a shared-decision making in a patient-centered approach, rather than a disease-centered approach. We also consider the inherent biopsychosocial aspects to be able to treat and manage effectively our patients.

Conclusion/ Action plan
This experience made me reflect on our wider role as healthcare professionals to educate, protect and support patients suffering from severe or life-threatening conditions while respecting their particular needs and choices. To effectively manage the situation with my patient I decided to do some research on the topic (here attached).

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March 2022

OPS B1. You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.
These should include:
B1.1.3. a knowledge of pathophysiological processes sufcient to inform clinical judgement and to identify where patients may require additional or alternative investigation or treatment from another healthcare professional
B1.1.4. an understanding of the psychological and social influences on health, sufficient to inform clinical decision-making and patient care
B1.1.5. an awareness of the principles and applications of scientific enquiry and the ability to critically evaluate scientific information and data to inform osteopathic care
B1.1.6. an understanding of the principles of biomechanics sufficient to apply osteopathic treatment safely and effectively

Description
I did a poster presentation that required me to autonomously demonstrate the application of theory and practice from different taught components of the Osteopathic Skill modules. I was expected to critically evaluate and apply osteopathic management on thoracic outlet syndrome while demonstrating a critical level of knowledge and understanding of the condition, providing a critical evaluation of the relevant guidelines/research including the clinical context (NICE, WHO, NHS), applying the appropriate models of osteopathic care (5 WHO models) and identifying a range of osteopathic treatment/ management and patient care. According to my feedback, I demonstrated a good understanding of the context of the condition by providing in-depth anatomical and pathophysiological knowledge, logical osteopathic considerations with the appropriate osteopathic models, good treatment and management justifications with an understanding of the multimodal care, and the influence of biopsychosocial aspects on health. I could have improved a few points such as the breakdown of short and long-term management plans, and some pathophysiological clarifications with an evidence-based approach.

Feelings

Overall I felt satisfied with my presentation but there is always room for improvement. Time management was challenging because of the amount of information given in a short time. I had to imagine the poster being presented to a group of professionals which was motivating.

Evaluation

This assignment was a good practice and the opportunity to show that I am able to apply sufficient knowledge and skills to support my work as an osteopath.

Analysis

Overall I managed to score well demonstrating a very good awareness of the clinical context of the condition, sufficient to inform clinical judgment and a good understanding of the biopsychosocial influences on health sufficient to inform clinical decision-making and management care while understanding the principles of biomechanics sufficient to apply osteopathic treatment safely and effectively. However, this could have been explored in more depth.

Conclusion/ Action Plan

Going forward, I think about reviewing other conditions more in-depth as I did for this assignment. I also intend to read more on diverse osteopathic subjects and osteopathic principles and I already planned a post-graduate diploma for the next 2 years to improve and maintain my knowledge and skills up-to-date and therefore support my work as an osteopath.

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April 26th, 2022

OPS D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.
D5.1. Maintaining patient confidentiality includes:
1.1 keeping confidential your patients’ identities and other personal information, and any opinions you form about them in the course of your work

Description
Despite the teaching clinic concept where the patients are informed that their personal information will be shared with other students and tutors, we have the duty to respect their rights to privacy and confidentiality by maintaining and protecting their information effectively. I have always respected their rights to privacy and confidentiality, this is the reason why we always ask for consent before having observers in the room. We also make sure to not display their personal information outside of the clinic, by removing any name on the file copy or referral letter.

Feelings
All patients have different personalities and it is crucial that every patient is acknowledged and respected for who they are and what they expect from us. I always engage with the consent process before displaying any information with my colleagues and peers.

Analysis
If we think about the need to protect patients' confidentiality in a healthcare setting, the use of cameras and other equipment can be problematic. We used to gain consent and explain to the patient the purpose of live-streaming, however, the rules have changed and we no longer use the cameras in the clinic rooms. We still need to ask for consent if we want to invite observers into the room or display any personal information about the patient.

Conclusion/ Action plan
I will always make sure I give the patient all the information they need to understand the purpose of having observers or cameras in the room or sharing personal information with my clinic team. Ensuring that patients are not feeling pressured to give their consent and that they can stop or refuse to be observed at any time while keeping a written record of their consent. I have also familiarized myself with the confidentiality code of practice from other health care institutions, such as the NHS (Department of Health 2003).

References:
Department of Health, 2003. Confidentiality, NHS Code Of Practice, Available At: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/200146/Confidentiality_-_NHS_Code_of_Practice.pdf
[Accessed April 26, 2022].

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April 23rd, 2022

OPS B2. You must recognise and work within the limits of your training and competence.
B2.3. referring the patient to another osteopath or appropriately qualified healthcare professional.

Description
A female patient presented at the teaching clinic of the ESO on April 20th, 2022 complaining of a unilateral severe restless headache from the right periorbital to the frontotemporal region extending posteriorly into the ear and neck associated with trigeminal autonomic signs (ipsilateral nasal congestion, conjunctival injection, and lacrimation), that started 4 months ago with no specific onset. The patient had a clear MRI done in February 2022 and was provisionally diagnosed with cluster headache. She also had a previous history of migraine with aura and was diagnosed with ADHD and depression 2 years ago while describing that she is generally stressed and tired. After case history and examination, we diagnosed her with suspected hemicrania continua associated with possible cervicogenic headaches.

Due to the context of this rare headache type, and as indicated by the BASH and NICE guidelines, we decided that it would be preferable to refer the patient to her GP in order to be prescribed a diagnostic dose of indomethacin in case this might provide rapid relief from her symptoms, and alternatively a referral to a headache specialist.

Feelings/ Evaluation
After discussing the case with my headache tutor, I realized the limits of my osteopathic training and competence in treating this type of rare headache. I felt relieved for my patient to learn that there was an effective alternative option to treat her symptoms and that I needed to work in her best interest by collaborating with another qualified healthcare professional.

Analysis
This case was an excellent reminder that we need to work within the limits of our training and competence, and in collaboration with other qualified healthcare professionals in order to achieve the best management care and results for the patient.

Conclusion/ Action Plan
Going forward, I will ensure that I always integrate a patient-centered approach to my treatment and management plan, by knowing the limits of my profession and referring when needed to other healthcare professionals and therefore secure the most appropriate care for my patient.

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

Description
The ESO Clinic provides a template case history form which includes all the necessary contents mentioned in OPS C2: the date of consultation, the patient's personal details, any problems symptoms concerns and priorities discussed with the patient, relevant medical family, and social history, clinical findings, information and advice provided, a working diagnosis and treatment plan, records of consent, any treatment undertaken, clinical response to treatment outcome and treatment outcomes, where an observer is present and their status.

This template provides a structured framework, however, the practitioner needs to ensure that the notes are comprehensive, accurate, legible, and complete.
During the past 2 years at the teaching clinic, I realized that some colleagues have difficult handwriting, which could be problematic to read their notes and carry on where they left off. Sometimes, some information was also missing and I had to take another case history to clarify some points.

Feelings
It feels frustrating sometimes when the patient notes are not comprehensive, and therefore I can't present the case properly to the tutor. It seems unprofessional to go through the same case history again because of the inadequate notes of my colleagues and it can also be frustrating for the patient.

Evaluation
It is difficult to justify a second case history taking to the patient because of inadequate note-keeping of a colleague. However, it is necessary to have comprehensive, accurate, and complete notes to ensure that the patient is safe to treat. Therefore, I always make sure to maintain adequate clinical notes for my colleagues and myself.

Analysis
It can be challenging to examine and communicate with the patients while keeping proper notes at the same time. As healthcare professionals, we need to be aware of how important it is to keep a record of all key details given during the consultation, to ensure continuity of care for the patient but also vital for legal use when defending a complaint or clinical negligence claim.

Conclusion/ Action plan
It made me aware of how important it is to have a good note-keeping ability and how it can impact patient care and safety. For practical purpose, I think about changing my handwritten notes for computerised notes in the future, I find it more manageable to have every records at the same place, and more sustainable by reducing paper waste. It will also be legible for my colleagues.

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OPS D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.
D6.1. You should be familiar with the requirements that apply to you under equality law
D6.2. It is illegal to refuse a service to someone on the grounds of their age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex or sexual orientation.

Description
Patients should be treated fairly and as professionals, we should recognize diversity and individual values, not only towards patients but also towards colleagues.
The equality act 2010 (attached here) protects people against discrimination and unfair treatment in the public sector on the basis of certain personal characteristics:

age

disability

gender reassignment

marriage and civil partnership

pregnancy and maternity

race

religion or belief

sex

sexual orientation

Feelings/ Evaluation
In practice, I have never observed a colleague nor myself refusing treatment to anyone and would never discriminate against someone because of their personal characteristics. I believe as professionals and individuals we have the duty to remain impartial and non-judgemental in any circumstances.
And I would be very upset and disappointed knowing about a healthcare professional who refused to attend to a patient based on their personal characteristics. I should mention that I have witnessed unacceptable talks between a few students, but not in a public space, which nevertheless reflected badly on them and made me feel very upset.

Analysis
Having been raised in a very diverse education system with multicultural communities, I feel aware and attentive to giving the same treatment regardless of one's background, preferences, nationalities, and beliefs. I believe that discrimination comes from a place of ignorance and fear of the difference. And I suppose that I have only witnessed a lack of awareness among those students. That's why cultural awareness is of prime importance to understand the difference and open new perspectives for everyone.

Conclusion
In my practice, I intend to be fair and recognize the diverse and individual values of my patients and colleagues. I will make sure that everyone feels welcomed, valued, and respected regardless of their age, gender, background, belief, and cultural differences.

Reference
AgeUK, 2021. Equality, discrimination and the Public Sector Equality Duty, Available At:
https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs79_equality_discrimination_and_the_public_sector_equality_duty_fcs.pdf  [Accessed April, 26, 2022].

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Professional behaviours and fitness to practise for osteopathic students 

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Professional behaviours and fitness to practise for osteopathic students 

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OPS D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.
D7.1. The public’s trust and confidence in the profession (and the reputation of the profession generally) can be undermined by an osteopath’s professional or personal conduct. You should have regard to your professional standing, even when you are not acting as an osteopath.

Description
The GOsC has released a booklet to outline the professional behaviours expected of students of osteopathy and to provide an outline of the role of the osteopathic educational institution in relation to fitness to practise and the ensuring of patient safety (attached here). Furthermore, in our 1st year at the ESO, we had a lecture on the OPS and the importance of our professional behaviours in and out of the workplace. I remember an interesting case of a staff member that behaved inappropriately in a public space, out of the workplace, which impacted his professionalism and career.

Feelings
I first thought that it was a bit harsh to dismiss someone for drinking too much at a party and publishing inappropriate photos on social media. But after reading other cases and content, I understood how this kind of attitude can actually affect the profession and the trust of the public.

Evaluation/ analysis
The public has certain expectations of healthcare professionals, that they behave properly and ethically, as trust is critically important in the therapeutic relationship. Also, they expect the same level of trust in a student, as they would in a fully-qualified health professional, for this reason, I have always followed the rules and never behaved in such a way that would be likely to bring the reputation of the profession and the school into disrepute.

Conclusion/ action plan
I feel that as healthcare providers we should always meet our patient's expectations and have a faultless attitude out of the workplace. I aim to keep meeting this OPS at all times.

Reference
GoSC, 2017. Guidance about professional behaviours and fitness to practise for osteopathic students. Available at: www.osteopathy.org.uk/news-and-resources/document-library/training/guidance-professional-behaviours-and-ftp-students/ [Accessed April 9, 2022].

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April 2022

OPS C3. You must respond effectively and appropriately to requests for the production of written material and data.
C3.1.1. produce reports and referrals, and present information in an appropriate format to support patient care and effective practice management

Description
A take-over patient presented at the teaching clinic of the ESO in April 2022 for continuing treatment for mechanical thoracic pain and trapezius myalgia predisposed by a previous fall and his occupation as an emergency call handler. His past medical history includes a third ventricle tumour and hydrocephaly with ventriculoperitoneal shunt placement in 2016. Ongoing symptoms include nausea, dizziness, vomiting, headaches, visual changes, and left upper limb weakness. Due to progressive severe headaches for the past 2 months and new transient pupillary asymmetry for the past 3 weeks, I decided to refer him to his GP to arrange a review with the neurology department. Concerns were raised about the progression of the previous tumour or the ventricular-peritoneal shunt malfunction. When looking at his file, I realized that he was already referred a couple of times, and he seemed reluctant to be referred again.

However, after considering his past medical history and the new severe symptoms, we decided with my tutor and with the patient consent that producing a referral letter was the most appropriate and effective action we could do to support patient care and effective practice management.

Feelings

The situation with this patient was challenging, I wasn't sure he wanted to be helped and it felt like he was aware of the situation but would not do anything about it for different personal reasons before he gave us his consent. Nevertheless, I felt that I was responding effectively and appropriately by producing this referral letter.

Evaluation

I asked the patient to sign the consent form to enable me to produce a referral letter (draft attached) and send it to his GP. The letter writing was short and straightforward and reviewed by my tutor.

Analysis

The tutor wanted me to insist on the fact that the patient was referred several times with no return and no investigations done by his GP since then.

Conclusion/ Action plan

I think I could have added more information about his medical background and a slightly less aggressive style of writing which was suggested by my tutor. I will keep some templates of referral letters for the future and practice writing and recording appropriate information.

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

Description
In 3rd year we had the opportunity to write a 3-year business plan (attached here) to demonstrate:

a clear understanding of the business planning process offering an innovative solution to a profitable business model

a financial plan that supports the business plan and is conservative and realistic

a marketing strategy that supports the business plan

The financial plan helped me to reflect with full transparency on my professional and personal financial planning and considerations including my revenue assumptions, set-up costs, and recurring costs for the next 3 years.

Feelings/ Evaluation
I found it very helpful to examine the financial aspect of the profession, by understanding the tax system in the UK while reflecting on fees and different services/products that I could incorporate into my practice. Furthermore, it highlighted the importance of maintaining financial and accurate records in my practice.

Analysis
The business and management aspect of the profession is fundamental to building a strong and trust-based relationship with the patients. It also supports our identities as practitioners by defining our values and who we are.

Conclusion/Action plan
Being honest and trustworthy in my professional and personal financial dealings would be the core values of my business.

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

Description
During my 2 years at the ESO teaching clinic, I had numerous opportunities to give feedback to other student practitioners on their performance in clinic while observing them treating patients.

Feelings
I am always happy to give constructive feedback to my peers, this also made me feel valued and part of a team. I also find it useful to have the opportunity to observe and reflect on their practice, as it could help me to improve mine as well. While I was giving feedback, I realized that I could improve the way I was delivering the message, avoid being too direct, and learn how to give a constructive feedback.

Evaluation
As I was looking for some content to help me improve my feedback skills, I found an interesting Ted talk (link attached) displaying a four-part formula to give great feedback:

Micro-yes: begin your feedback by asking a short and important question, letting your colleague know that feedback is actually coming and they can still refuse it

Datapoint: naming specifically what you saw or heard, staying objective by giving data, and avoiding blur words (nonspecific words)

Impact statement: name how the data point impacted the situation to give a sense of purpose and meaning between the points

End on a question: creating commitment rather than compliance, it makes the conversation becomes a joint problem-solving situation

Analysis
Receiving feedback from other colleagues helps healthcare professionals become more self-aware of both their strengths and the areas they need to improve, as well as how others perceive them. And this gives them the opportunity to grow as professionals and to enhance better patient care. However, giving a constructive feedback, avoiding confusion and too direct situation is important for the message to be delivered. Also, reviewing some simple feedback rules can help to improve your communication skills and better support your colleagues.

Conclusion/ Action plan

What I realized when reflecting on feedback is that I prefer not to wait for feedback to be given but actively ask for it which establishes practitioners as continuous learners and put the power in our hands. In the future, I aim to ask for more feedback from my patients as well as reflect, share and communicate with colleagues as I think it is an effective way to support osteopaths to improve the standard of care by maintaining high-quality practice.

Reference
Internet, 2020. The secret to giving great feedback | The Way We Work, a TED series, Available At: https://youtu.be/wtl5UrrgU8c [Accessed May 14, 2022].

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The secret to giving great feedback | The Way We Work, a TED series

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February 1, 2019

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

Description
Mrs H, 41 years old personal assistant, came for neck pain around C1 to C3 with a clicking sound occurring constantly. She had a previous accident 11 years ago, potentially a whiplash and went to the hospital. She has had regular migraines since ever and neck pain, she is sensitive to light and see blind spots. She seems very anxious and stressed by her current work taking antidepressants. She is constipated and her energy level is low.

Evaluation
In her case, the practitioner had to take into account other factors affecting her health and well-being, the psychological factor in the patient's presenting complaint is important as behaviors, thoughts, feelings, and emotions may impact our physical state (biopsychosocial model). Most of the presenting signs and symptoms were due to the stress level the patient endure constantly.

Analysis
The “Biopsychosocial Model of health and illness as proposed by Engel (1977) implies that behaviours, thoughts, feelings and emotions may influence a physical state.” (Mc Inerney, 2002) A patient presenting psychological factors related to her condition and complaint such as stress and anxiety leading to antidepressant intake need to be considered by the practitioner in the final diagnosis, treatment and management plan. By providing preventive information in order to adjust their lifestyle, practitioners may have a positive impact on their patient’s life and health.

Conclusion
Osteopathy can have a positive impact on stress levels and help to bring back balance and homeostasis. When we consider the biopsychosocial model of health and illness, mental health issues may have an impact on the patient's overall health and well-being. Therefore, working collaboratively with other healthcare providers to optimize patient care, as a prevention or a treatment, should be considered. Complementary healthcare therapies could contribute to a more efficient patient-centered approach.

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

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June 14th, 2021

OPS D11. You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.
D11. 2. If you are exposed to a serious communicable disease, and you believe that you may be a carrier, you should not practise until you have received appropriate medical advice, and you should follow any advice you are given about suspending or modifying your practice. You should take all necessary precautions to prevent transmission of the condition to patients.

Description
It has been a challenging time at the ESO teaching clinic since the pandemic started in March 2020. There have been a number of essential changes and adaptations in response to Covid-19. When the clinic reopened in July 2020, there was an emphasis being put on hygiene and safety for both patients and staff, and the ESO provided guidelines for students (here attached) to implement and support the different changes when returning to the teaching clinic:

If you have any Covid-19 symptoms you must not come to the clinic and self-isolate at home

Practitioners have to perform a careful patient screening at reception for the detection of Covid-19 symptoms

Practitioners have to wear full PPE including a surgical face mask, disposable apron, and gloves

Practitioners have to disinfect the treatment room and were advised to regularly receive a free Covid-19 test

Although these guidelines may compromise optimal osteopathic care, this was irrelevant as the virus carries life-threatening and disabling effects.

Furthermore, the Institute of Osteopathy (iO) has informed osteopaths with updated guidelines, from Public Health England (The Institute of Osteopathy 2021). It includes sections such as adapting your practice, frequently asked questions, and many more.

Feelings
In the beginning, I felt very overwhelmed by the new Covid-19 guidelines, it was already difficult enough to adapt to this new clinical environment. My mental health was impacted during this period, I felt isolated with repetitive lockdowns, not being able to travel or see my family for months. I understood the whole situation and followed all the rules to protect the most vulnerable people. Also, I became more appreciative as our university and clinic were able to remain open during the pandemic due to the nature of our work in the healthcare sector.

Analysis
The healthcare system can be a stressful environment for everyone involved, and it felt even more demanding during the pandemic with all the new guidelines and changes. All the practitioners and staff members at the clinic took all necessary precautions to prevent the transmission of Covid-19 and maintain patient safety. We also receive support from the university for the management of our mental health during this challenging period.

Conclusion/Action plan
During this challenging time, I have learned that isolation and stressful situations can impact greatly our mental health. Also that we need to look after ourselves before helping our patients, as we must ensure that any problems with our own health do not impact them.

References
The Institute of Osteopathy, 2021. COVID-19, Available At: https://www.iosteopathy.org/covid-19/[Accessed June, 14, 2021].

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Compliance with the safeguarding training 

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Compliance with the safeguarding training 

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

Description
In years 2 and 3, we completed 2 compulsory safeguarding training sessions: one about recognizing and preventing female genital mutilation (FGM) and one about the risks of radicalization. I completed both of the courses at the ESO through videos and online training, and we also had a meeting in person with the welfare team.

Feelings/ Evaluation
Before the safeguarding training, I was not aware of our wider role as healthcare professionals to safeguard the welfare of our patients and report any signs of harm and abuse. I also learned a great deal about female genital mutilation and radicalization, two subjects that I was not familiar with.

Analysis
As student practitioners or osteopaths working in direct contact with under-18 or adults at risk on a day-to-day basis, we may come across signs of harm and/or abuse. It is not our responsibility to try to resolve the issues, but we may be asked to help in some circumstances. It is our responsibility to provide a safe and secure environment for our patients and to safeguard the welfare of under-18 or adults at risk. We must ensure that significant concerns for the well-being of the patient are reported to the safeguarding lead, via the CPOMS (child protection online monitoring system).

Conclusion/ Action plan
If I encounter a similar situation in my practice, I will know how to act and help my patient. I will be able to handle the situation and create more awareness around these topics if necessary. I can see the purpose and benefits of the safeguarding training, regular training is necessary to keep up to date and ensure the safety of our patients.

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January 31, 2019

OPS A3. You must give patients the information they want or need to know in a way that they can understand
A3.3. If you propose to examine or treat a patient who has difficulty communicating or understanding, you should take all reasonable steps to assist them. For example, make use of an appropriate interpreter if the patient communicates in a different language to you. If you are unable to communicate sufficiently with the patient, you should not treat them

Description
During my first year at the ESO, I had the opportunity to observe at the teaching clinic an interesting case of a 56 years old woman presenting with a massive swollen and painful elbow associated with numbness in the lower arm and hand with curling up fingers. The patient coming from Mauritius was visiting her daughter in England and had a very limited understanding of the English language. It was challenging for the practitioner and the tutor to communicate and understand the patient effectively, therefore they had to ask her daughter waiting at reception to come and help with the translation.
The daughter was able to explain that her mother had a previous operation in her home country a year ago (February 2018) for a varicose ulcer on the leg and received a skin graft for the wound. The elbow started to swell shortly after the operation in May 2018 which may be related to a nosocomial infection she might have contracted in the hospital in Mauritius while she was receiving the skin graft. The daughter explained that the pain was sharp and increased at night with no strength in the arm at all. Upon examination of the elbow X-Ray brought by the patient, the differential diagnosis was a traumatic fracture type A potentially due to osteosarcoma (bone cancer) or osteomyelitis (bone infection). That kind of fracture is considered a type-A fracture and then a red flag. The tutor explained to the daughter the severity of her condition and that her mother would probably need to go to A&E on the same day, and that an osteopathic treatment would not be appropriate due to the red flag condition.

Feelings
Given the difficulty to communicate and understand the patient, and the severity of the condition, I thought that the tutor and the practitioner handled well this challenging situation making the appropriate change to assist the patient. I was also impressed by the clinical environment and the amount of knowledge and skills required to deal with this case as it was one of my first time in a clinic.

Analysis
Due to the difficulty to communicate information and understand the patient presenting complaint and past medical history, the practitioner and tutor took the appropriate step to resolve the issue by making use of an interpreter to assist them. They were able to understand the missing components of the case history to draw a potential diagnosis and take the necessary steps to support the patient health.

Conclusion
As osteopaths, making sure that a patient has understood the information provided is essential, explaining the risks is also part of the communication role expected from the practitioner. I concluded that understandable, unambiguous communication is crucial for all aspects of the consultation, especially the case history and informed consent. Moreover, the past medical history needs to be understood and communicated effectively in order to determine whether or not the patient is safe to treat. Finally making sure that the patient understands the severity and urgency of a situation is important to take the necessary steps for their health and recovery.
I received a tutorial from a clinic tutor (here attached) to help highlight the different aspects of patient and practitioner interaction in regard to communication in a clinical context. This gave me further insights into the importance of effective communication skills and how to improve the patient-practitioner relationship.

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OPS A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.
A4.2. Gaining consent is an ongoing process. You must ensure that patients are able to make decisions at all stages of their treatment and care and continue to give consent.

Description
I always spend a lot of time in practice asking for consent and shared decision-making. I like to make sure I communicate effectively by providing clear, concise, and adequate information. I also check their understanding regularly and continue to obtain consent during the whole consultation. I offer them a few opportunities to ask questions and to formulate their individual wishes, concerns, preferences, or special needs.

Feelings
Sometimes it can feel a bit repetitive to ask several times the same question to the patient, to make sure the patient is at ease and happy to carry on. However, it also highlights the shared decision-making process and builds a stronger patient-practitioner relationship underpinned by trust, which is the essence of our work.

Evaluation
To make sense of the consent process and to better understand how to obtain consent from the patient. I have read the full GOSc guidance for osteopaths on obtaining consent (here attached).

Analysis
I always make sure that my patients understand and retain information that is relevant to their condition and to the treatment that I propose. It also includes the various options available (including not having treatment) and to make decisions about their treatment. Offering the opportunity to refuse treatment is also part of the shared decision-making process.

Conclusion
To get informed consent, we should be able to communicate effectively the benefits and the risks of any treatment or technique to our patients and offer alternatives or no treatment at all. To improve my informed consent I have used the BRAN model: Benefits, Risks, Alternatives, Nothing, which gives me a structure to communicate clearly to my patients in practice. Most importantly, I make sure that my patients always know their options and alternatives, as part of a shared decision-making process enhancing the practitioner-patient relationship.

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Supporting patients in caring for themselves

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Supporting patients in caring for themselves

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OPS A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.
A5. 1.Supporting patients in caring for themselves may include:

providing information on the effects of their life choices and lifestyle on their health and wellbeing

supporting decision-making about lifestyle changes where appropriate

encouraging and supporting patients to seek help from others, including other health professionals or those coordinating their care, if necessary

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

Description
In year 4, I was taking care of a challenging patient who was suffering from chronic low back pain due to lumbar disc overload predisposed and maintained by obesity. The patient denied any improvement after receiving continuous care for weeks. In this case, the management plan was central as the patient was not doing any kind of activity, walking was difficult due to the disc overload and her mental health was challenged. After discussing the case with my tutor, we decided to provide her with information to make healthy lifestyle changes and lose weight to improve her health and well-being. We explained to the patient that we could continue with our treatment plan as proposed however we highlighted the management aspect and the necessity to lose weight in order to decrease lumbar loading and improve her overall well-being. The patient understood the point and consented to follow our advice, as a shared decision-making process. Following her consent, I sent her an email with some alternative therapy options such as a free online service of Cognitive Behavioural Therapy (CBT) counseling and weekly hydrotherapy sessions. A few weeks later, she came back for another appointment but the situation was unchanged and she did not try any other alternative option suggested previously.

Feelings
I felt very helpless with this patient, she kept coming for treatment but clearly was lacking of motivation and was passive in her own wellness journey. I was aware of her mental health state and decided to respect her decision and carry on with treatment if it could bring her some relief.

Evaluation
This situation was extremely challenging because I had to support the patient in caring for herself to improve and maintain her health while she was not cooperative and lacked motivation.

Analysis
In this case, the patient was supported by providing information on the effects of her life choices and lifestyle changes to improve her health and wellbeing. But also to seek help from other healthcare professionals with alternative therapy options to encourage her to take action and be an active participant in her wellness journey. Finally, I respected her decision even if I disagreed.

Conclusion
As healthcare professionals, we must learn to recognize the warning signs of a potentially non-compliant patient to provide supporting motivational techniques. We should be able to talk about any subject as long as it supports the health and well-being of our patients. And respecting their decision is also fundamental, they are the key to their health, and we are only the support they need if they are ready to make a change in their life.

Action plan
I would like to develop valuable communication skills to empower my patients and motivate them to be actively working towards their health and well-being.
NICE guidelines provide recommendations for obesity and explore criteria ranging from identification, assessment, and management (NICE 2014). It covers all the important points such as belief systems about obesity, weight loss and lifestyle, eating patterns, physical activity, previous attempts at losing weight, motivation and time.

References:
NICE, 2014. Obesity: identification, assessment and management, Available At: https://www.nice.org.uk/guidance/cg189/chapter/1-Recommendations [Accessed May, 14, 2022].

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October 10th, 2021

OPS B3. You must keep your professional knowledge and skills up to date.
To achieve this, you should:
B3.1.1. be professionally engaged, undertaking professional development activities and complying with GOsC requirements regarding continuing professional development

Description
Continuous learning and professional development (CPD) are essential to improve our skills as healthcare professionals. Accordingly, I completed this year a maternity workshop that covered the physiology of pregnancy and labor from an osteopathic viewpoint, covering assessment protocols in pregnancy and how this varies throughout pregnancy, as well as techniques to include assessment of treatment of the lumbar spine and sacrum, uterus, and round ligament, thoracolumbar fascia, hip and piriformis, c-section scar and perineum through clothing.

Feelings
I decided to join this course as I felt that it will help me to improve my skills in treating pregnant patients at the teaching clinic and later in my practice. Furthermore, my other motive was to be introduced to the maternity clinic before the start of the specialist clinic offered in the 4th year.

Evaluation
I learned, under the supervision of an experienced practitioner in Women's Health, how to assess and treat pregnant patients. The course was short but offered both theoretical and practical skills, which made it very interactive. I also had the opportunity to learn more about another Women's health course that I plan to attend next year as a post-diploma course.

Analysis
Pursuing new courses and professional engagement will ensure continuous learning and development, which is essential to improve osteopathic skills and knowledges. For instance, the maternity course was useful to start treating pregnant patients in clinic, giving me a good understanding and practical skills to feel confident and achieve good results in my practice.

Conclusion/Action plan
Thanks to this course, I had the opportunity to discover another Women's health course that I will be attending part-time from October 2022 for a 2 years-period. It will also ensure continuous learning and practice through revising learning material and taking other courses, combining workshops, conferences and e-learning programs, to ensure the best practice for my patients.

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

Description
In the first month of my 3rd year, I had a Muslim patient who came to the clinic wearing the hijab. Two other students wanted to observe the case history on that day and one of them was a male student. When the patient arrived I explained to her at the reception that there were two observers in the room and asked her if she was comfortable being observed during the case history only which will not involve being undressed. To my surprise, she told me that she was completely fine to be observed during the examination and treatment as well even if she needed to be undressed and that she understood the purpose of the teaching clinic and was fine undressing for medical purposes.

Feelings/ Evaluation
I must admit that I made assumptions about that patient's ideas of modesty. The fact that she was wearing the hijab would not induce that she might feel uncomfortable undressing in front of several students. I just wanted to be caring toward her to make sure that she felt comfortable and I think that she understood and appreciated my consideration.

Analysis
This consultation made me realize that one should always avoid making assumptions about a patient's culture or religion, even with the best intention, however, respecting the patient's dignity and modesty by explaining the process and offering modesty options to cover or to avoid being observed, are necessary.

Conclusion/ Action plan
In any case, I intend to allow the patients to express themselves clearly and try to accommodate their needs by providing them with all the necessary information. I also intend always to inform patients on why they need to undress and provide them with a gown or cover for the areas that do not need to be exposed for examination or treatment. In some cases, I will consider offering the chaperone option. The ESO teaching clinic provides a consent form (here attached) for new patients, including information about the possibilities discussed above. Nevertheless, it is necessary for practitioners to remind their patients about their options for keeping their dignity and modesty.

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February 20th, 2022

OPS B3. You must keep your professional knowledge and skills up to date.
To achieve this, you should:
B3.1.1. be professionally engaged, undertaking professional development activities and complying with GOsC requirements regarding continuing professional development

Description
I decided to enroll for a 2-year part-time postgraduate diploma in Women's health starting in October 2022. This course aims to offer advanced knowledge and expertise to professionals who want to master women's health issues, bringing together a team of experts in their field (Osteopaths, Medicals specialists, and complementary and alternative practitioners). The objective is to create a body of Osteopaths who have the expertise and a specific capability in dealing with women s health issues by offering continuous professional development, clinical expertise, a responsible human and ethical approach to these patients and allowing the graduates to work in an integrative partnership with other health professionals.

Feelings/Evaluation
I feel very enthusiastic to start this postgraduate diploma, as a natural next step in my osteopathic journey, feeling professionally engaged while complying with GOsC requirements regarding continuing professional development. Furthermore, I am looking forward to attending this course as it is considered a reference in this field.

Analysis
Pursuing new courses and professional engagement will ensure continuous learning and development, which is essential to improving osteopathic skills and knowledge.
This course would be useful to gain clinical expertise in women's health issues, offering me practical skills and knowledge to help my patients while working in an integrative partnership with other healthcare professionals.

Conclusion/ Action plan

It will also ensure continuous learning and practice through revising learning material and taking other courses, combining workshops, conferences, and e-learning programs, to ensure the best practice for my patients.

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January 8th, 2022

OPS B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.
B4.1. To achieve this you will need to have sufficient knowledge and ability to collect and analyse information and evidence about your practice to support both patient care and your own professional development.

Description
By the end of year 3, we had to start the dissertation process which lastest until december 2021.
Each learning outcome for the dissertation is in accordance with OPS B4:

Demonstrate independence in gathering data for pre-determined Masters Level analysis as per protocol

Autonomous conduct, analyze, and interpret data gathering using an appropriate software-assisted approach that addresses the research question raised in a structured manner

Write a report that integrates the staged research study into a cohesive and succinct narrative that conforms to journal-style structure and presentation with academic prose

By completing a literature review, I demonstrated that I was able to gather data for pre-determined, Masters Level analysis, to conduct, analyse and interpret data gathering and write a report that integrates the staged research study.

Feelings/ Challenges
I found the dissertation research very challenging due to the amount of data that needed to be gather while finding a gap in the literature and a field of interest for the research. I had to change my dissertation title and refine the subject for a more concise research question due to lack of time and the wide literature to review. While demonstrating critical reflection in the discussion section and comparing with the wider literature, I could have explained the larger scope of methodological quality issues to expand the subject.

Evaluation
The dissertation has taught me how to perform a research and apply an appropriate methodology in answering a focused research question: how to utilize databases in order to retrieve relevant information, to produce original and innovative research in a clinically relevant area, to analyze and objectively be critical on retrieved sources to draw conclusions that answer the research question while identifying limitations and expanding the field of research.

Analysis
The dissertation has undoubtedly helped me to learn how to collect and analyze information, and to critically appraise the literature, which gave me skills and knowledge that would be useful when I will be working as an osteopath.

Conclusion
If I had to do it again, I would have start to work on my dissertation earlier and in closest collaboration with my supervisor who was supporting me through the process by giving advices and answering any relevant questions. Also, working in close collaboration with peers and discussing about the challenges they might have faced and overcomed, would have been useful as a supportive environment.

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Reflection on personal beliefs and values in a clinical setting 

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Reflection on personal beliefs and values in a clinical setting 

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OPS A7. You must make sure your beliefs and values do not prejudice your patients’ care.
A7.2. You should maintain a professional manner at all times, even where a personal incompatibility arises with a patient.

Description
One of my patients was a strong-opinionated person and was often talking about politics, economy, immigration, and other subjects in the news during our consultation. As a professional, I never engage strongly in a conversation and prefer to avoid any kind of confrontation or disagreement by keeping my opinion to myself while allowing him to express his ideas.

Feelings
It can be uncomfortable to be drawn into an unpleasant conversation, that's why I always keep a professional barrier and never let my patient know my opinions. I don't feel the need to expose myself and I usually prefer small talks in a professional context.

Evaluation/ Analysis

This experience was useful to understand what kind of attitude should be avoided in a professional context. Because I am also a very communicative and talkative person, I always make sure to share on an appropriate and respectable level making sure that my beliefs and values are kept to myself and therefore do not prejudice my patient's care.

Conclusion/ Action plan

As a healthcare professional, I always maintain professional boundaries at all times, and never engage strongly in a conversation to avoid unnecessary confrontation and disagreement. I feel confident in the way I exchange with my patients, and I never had any issues as I know how to act in a similar situation. While doing some research on the subject, I found a review on the different strategies to change the topic and redirect the conversation and thus focusing on patient-centered care (Moyo et al. 2016).

References

Moyo, M., Goodyear-Smith, F.A., Weller, J., Robb, G. & Shulruf, B., 2016. Healthcare Practitioners’ Personal And Professional Values. Advances In Health Sciences Education, 21(2), pp.257–286.

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Reflection on a clinical case and 2 OPS combined 

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Reflection on a clinical case and 2 OPS combined 

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OPS C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.
C6.1. You should be aware of public health issues and concerns, and be able to discuss these in a balanced way with patients, or guide them to resources or to other healthcare professionals to support their decision-making regarding these.
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OPS C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.
C5.5. You should take all necessary steps to control the spread of communicable diseases.

Description
One of my patients, a 67y/o retired engineer, was diagnosed with lumbar spondylosis and gluteus myalgia predisposed by age and maintained by his lifestyle, he was gardening 2-3 times per week which included heavy lifting. This patient also presented with a fungal nail infection spreading to all his toes on both feet. Following the OPS C6, I discussed with my patient about his fungal infection during the initial consultation to be sure that he was taking good care of his health and well-being and advised him to consult his GP. When he came back on the following appointment, he told me that he went to see his GP who prescribed him an antifungal liquid and he was very glad about the first results.

Feelings
When I saw the fungal nail infection on his feet, I immediately thought that it was very contagious and that I should be careful not to contact the patient's feet during the treatment. I also was aware of my role as a healthcare professional to educate my patient and guide him to resources and refer him back to the GP.

Evaluation
A fungal infection can be very contagious, I have the obligation to ensure that my practice is safe, clean, and hygienic, and need to take the necessary steps to control the spread of communicable diseases, following the OPS C5. I made sure to wear a full PPE (facemask, gloves, apron), to sanitize and wash my hands before and after treatment, to avoid direct contact with the contagious area, to clean the couch with an antibacterial product, and most importantly to educate my patient on the importance to treat the infection and avoid direct contact with the others.

Analysis
Considering my wider role as a healthcare professional, I invited the patient to read on the NHS website about fungal nail infection (link attached) and offered him to consult his GP for further investigations and management. I also explained the risk of spreading the infection to others and made sure to take the necessary steps to work in a safe, clean, and hygienic environment at all times.

Conclusion
After this experience, I realized our wider role to educate and support the patients, enhancing their health and well-being by doing the right clinical decisions. But also ensuring that the practice complies with health and safety legislation.

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Read about fungal nail infections, including the symptoms, causes and treatments.

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Criminal convictions and fitness to practise  

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Criminal convictions and fitness to practise  

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OPS D12. You must inform the GOsC as soon as is practicable of any signicant information regarding your conduct and competence, cooperate with any requests for information or investigation, and comply with all regulatory requirements.

As in all fitness to practise matters, the aim is to ensure patient safety and maintain trust in the profession. The GOsC has to be notified immediately in case an osteopath is convicted for misconduct or for a competence issue, and this could result in admonishment, suspension, or removal from the register. Also, cooperation with any requests for information or investigation and compliance with all regulatory requirements are necessary. The attached article helped me to understand the procedure and which actions are classified as an offense, and how I should act in case of conviction.

Reference
GOsC 2012. Criminal convictions and fitness to practise. Available at: https://www.osteopathy.org.uk/news-and-resources/document-library/fitness-to-practise/fitness-to-practise-bulletin-february-2012. [Accessed May, 14, 2022].