# data[].attributes.body
20% - A critically reflective demonstration of clinical and Osteopathic Practice Standards/guidelines and their application to patient care through autonomous engagement
40% - The ability to critically evaluate and reflect honestly on their own practice and professional development, showing clear self-awareness and recognition of any limitations.
10% - The ability to identify their own learning needs and how to address these going forward.
20 % - A critical awareness of, and the ability to deal with, gaps and contradictions in the current knowledge base from a personal perspective.
10% -  A clear, logical and concise communication style worded appropriately and suitably referenced.

# data[].attributes.body
[A.2 = Listen to patients and respect their concerns and preferences.]

Today the thing I didn’t like was the patient. I didn’t realise how rude they can be. The patient I observed acted as if the practitioner doesn't know anything he was doing, due to the fact that he is still a studying osteopath. The gentleman was very rude to the practitioner in how he approached and talk to him by asking questions that were, to the patient, unconnectable. He had to get full information about the body he was going to be treating and the patient kept on telling the practitioner, ‘well it's not that’ and ‘it's not related, can we just get on with the treatment’. When he finished his checks the pain was actually due to something a lot further away than the issue the patient came in for.

I think what I gained from this is that communication is extremely important as well as an explanation for the patient. To have a patient that doesn't understand can possibly make them hostile and uncomfortable.

I took from this that I shouldn't take patients' responses personally but actually draw from my own experiences and how uncomfortable it can be to have people watching you in a small room, in your underwear.

Revisited;

From this, I've started to fully use the time before the case history and examination to explain in laymens, as much information about the patients' issue as possible. The majority of the time the patient responds better to treatment because (when asked about it) they feel they are being heard and cared for. As much as it is important for us to fully explain, it's important for patients to fully understand what they are dealing with.

Revisited:

I had a similar experience with a patient recently who came in for their back pain and I was asking about leg symptoms. He said 'no there's nothing wrong with my legs it's my back'. So I explained again the purpose of asking about peripheral limbs and he understood and responded with 'I have actually been having leg pain when I stand up straight' which changed my testing, diagnosis, and management of that patient. He was happy with his treatment response and I haven't seen him since. I'm taking that as a good thing.

# data[].attributes.body
[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.]

With each new patient, I feel as if I am progressing with my 'opening speech' about what might happen, what we'll talk about, how we'll proceed, and making it known to stop if they want to at any point. Simple things like we'll go at your speed' seems to put the patient at ease from the possible stage fright a few of them seem might experience.

The more I do this the more confident I feel. I feel like that conversation allows us to work together rather than me leading, or the patients feeling as if they can't express themselves or aren't comfortable.

On reflection, I am quite advanced in this skill due to my previous work in a customer-facing role.

# data[].attributes.body
[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.]

Today was a hard one for me personally. I struggled with a few things.

Firstly I was put with a really personable Tutor who was very calm and easy to get along with. However, I struggled with how the two practitioners I observed handled their patients.

The first practitioner had an elderly woman who had never been to an osteopath before. She came in with neck pain which the patient said needed, 'to be massaged out.' Through further questioning, the patient told us she lives alone now and has no family. She was in her 80's and really this issue was from 2 years ago. In my mind, I wondered if she had been recently widowed. This also made me think that possibly her late husband may have helped her with her neck pain when he was alive. It was only halfway through the treatment that it was established she was a widow from just over 2 years ago. I found it really hard to let it go and I think this is because it is our job to think of our patients as a whole, including what is happening in their lives that could have an impact on their pain.

As a studying osteopath I'm finding out how much emotions and a patients mental state affects their treatment. It's such as important thing to take into consideration if we are going to look at the body as a whole this also includes the mind of the patient.

The second thing that affected me to a really upsetting stage was the second patient coming in was experiencing back pain and she asked the practitioner if she could try for another baby. The practitioner replied, 'we'll have to check with you're GP'. There is nothing wrong with this response. Actually, it was a very safe thing to say as it could not be confirmed or denied at that moment. It was correct and formal, in a way to protect both the patient and the practitioner but I was so disheartened for the patient. I was so sad for her. I saw her face become deflated and her response was discouraged. It was almost as if there was no hope for her dream. It was promptly finished without any real direction to go. After that, I think that patient didn't have the compacity to express her concerns because of the stark answer towards her because every response afterward was 'yes that's fine'.

Revisited:

I've used this in my 2 years of practitionership to manage how I handle patients. Giving the correct advice in the right manner and working together to manage expectations while making appointments an open place to air out concerns and expressions of what's important to them allows for the patients' response, both towards myself and the management outlook to be greatly aided. I've tried really hard to put what the patient wants first rather than placing my wants for that patient on top. I'm there to support them in the way they need.

# data[].attributes.body
[D1. You must act with honesty and integrity in your professional practice.]

Today I had a 13yro boy who came in with a foot issue. I asked all the questions about the foot and there wasn't anything 'stand out' about its function, so asked about the knee, nothing there, and then the hip. I got an array of answers and his previous history of hip and pelvic problems from his birth had possibly been causing a compensatory pattern which was then presenting as foot pain.

Before treatment, the mother, the patient and I discussed that this may not work as it was a hypothesis for his pain. I gave them their options to think about it but they said they were happy to try anything.

I did a broad treatment through his lower back, pelvis, hips knees, ankles, and toes and it made a vast difference. He was discharged after 4 treatments and he and his mother were surprised that treating the pelvis sorted out his foot issue.

Revisited:

I've started to say this with all my patients now. Even though some I know certain things like muscles will get better on their own I still feel as though I need the patients to know it may not work and I think this is because I don't want patients to get disappointed. However, the consistency of saying 'it might not work' is wearing down on me and placing a negative mindset over what I feel I should be able to achieve.

Revisited:

I've begun to look into time frames for certain healing processes as well as looking into what we specifically can help with in order to not feel as if I'm false advertising as well as to support my thinking that we can help certain things which have helped. I have a printout that is in my folder so that I know I can be truthful with what hypothesis comes my way.

# data[].attributes.attachment_link.readable_text
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

# data[].attributes.attachment_link.authors[].name
Advertising Standards Authority | Committee of Advertising Practice

# data[].attributes.attachment_link.description
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.

# data[].attributes.body
Rolf's Framework

1. What?
- This is a simple description of the events that transpired.
2. So what?
- At this stage, the events are broken down and analyzed in an attempt to interpret what happened and why.
3. Now what?
- Taking in this interpretation of the events how will we move forward and what is the course of action.

# data[].attributes.body
[C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients.]

Today was so great! To see instant improvements in a patient is something that gives me such excitement. To know that one day I'm going to be able to improve someone's life using the person themselves, I can't being to explain how worthwhile that will make these 4 years.

A patient came in today with a stiff and sore neck. After the practitioner had done a (really great, clear, and concise) case history, she proceeded to rid the person of any aliments they had, resulting in a really happy patient that thanked her repeated. I know the practitioner was really chuffed and it gave her a really good outlook for the rest of the session.

I don't fully understand how she knew how to approach the patient. She did all the things we're being taught like flexion, extension, side bending, and so on but she seems to see things that I don't. For instance, she looked at her back and when she placed her fingers on her mid-thoracic it caused pain in the patient as if she just knew where it was.

Revisited:

I feel as though I have progressed in my osteopathic assessment and treatment. Discussing with multiple tutors how they assess has resulted in me beginning my assessment with osteopathic testing and ending with orthopedic testing. This has greatly aided my osteopathic understanding, diagnosis, and management of the patient.

I have also moved away from the pain being what we're looking for. A few tutors have discussed that pain is a symptom of something going on if you understand something you can counteract it if it's mechanical.

On reflection, I feel as this OPS will be one I continually learn and relearn as there is no specific set out for what an osteopathic assessment is. I think this is a developable skill in your personal profession. As for now, I feel I have a good process but will continue to aim for its progression.

# data[].attributes.body
[A3. You must give patients the information they want or need to know in a way they can understand.]

I was impressed at how the practitioner is approaching the treatment and how he's talking to me about the tissues, what he feels, and how he approaches bettering this. He offered the patient chaperones and to stop if anything was concerning if they felt uncomfortable. He also involved the patient and went back and forth from laymen to medical to involve the practitioner.

I think I need to practice this skill as I can improve on how to make sure other students and tutors are informed and also that the patient doesn't feel uncomfortable.

Revisited;

I realised today that this is harder than it looks. I express these options to a mother of a 2-month-old patient in the appropriate manner as I have done multiple times but actually stopped to reiterate that they can have someone in the room. I wouldn't usually double-check but I felt as if I hadn't given the option because it was an actual option, but because I knew I had to protect myself. I came out of my sales-like pitch and changed my perception of what I was saying and actually offered these options again. This time meaning what I was saying, the patient asked for my tutor to come in and chaperone.

When my tutor came in it actually gave the patient more trust for me to be handling her child. The tutor came and just stood in the room and answered any questions while I was assessing the baby and we discussed certain things and asked me for my input and thoughts. In all honesty, I thought if a patient would ask for a chaperone, I would feel as if it was something against me. However, it's actually because they need more support. It's nothing against me as a practitioner it's to make the patient feel as comfortable as possible and that's the main pull away from today.

Revisited:

I've noticed that when offering a chaperone to patients that are in by themselves, the majority choose not to have one. In contrast parents within the Children's Clinic prefer it. Their responsibility for someone else might influence the need for another, more experienced person in order to double-check that nothing is missed. I don't know always know how comfortable that makes the underage patient, babies don't care too much but preteens and 15-year-olds can feel slightly uncomfortable with multiple adults in the room.

I've found that it goes down to the full understanding of the patient, handling two coherent people is another world in itself. Double-checking with parent and child to check certain things is tiring but has to be done. Really now if I need to find, for instance, an ASIS on a teen I ask them to find them and assess from where their hands are. Hands-off is better in those instances and I think makes the child and the parent more comfortable.

# data[].attributes.body
[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.]

I went to an appointment today and as a first-year was excited to see how the appointment would go and what was involved. Firstly it was very long. Originally I was told it would be an hour and 20 minutes but in total it ended up being 2 hours and 20 minutes.

I think when the student knew I was a student he relaxed slightly too much and thought that he could do whatever he wanted as a result.

There wasn't much consent or understanding of what he was doing, I was just put into positions at certain points.

It was uncomfortable and even though I don't think he meant it, it was not an enjoyable experience for me.

Revisited:

I'd forgotten about this until recently when I observed a student with a patient who was also a student. The practitioner was very formal and proper and really handled the situation well. She was clear, consent was there and it was fully observed by the tutor. However, after the appointment, the student expressed how she felt on the top form because the tutor was there.

On reflection, I think this is a simple mindset to put into place. I will perceive the appointment as if I am being observed by a tutor and watched in order to never make anyone feel as I did in the first reflection. I think this will allow me first to let down my professionalism as well as maintain boundaries put into place to protect the patient and practitioner.

# data[].attributes.body
[D3. You must be open and honest with patients, fulfilling your duty of candor.]

I had a tutor today who quotes off by heart the OPS and NICE guidelines. When he watched me ask for consent for a HVT, he stopped me and showed me how he does it. It was very clear, giving 3 or 4 negative outcomes that could happen, and gave counter-arguments for why he doesn't think they would happen but expressed why he needed to discuss them. He later directed me to some resources to look at and come up with an idea of what to say for the next time.

Revisited:

Today I realised the most important thing to discuss is the possible soreness over the next few days an adjustment. I talked all through the possible risks of HVT in terms of what could happen to a disc and forgot to discuss the possible soreness and stiffness over the next few days. The patient called back to say he was extremely sore the following day. Despite the fact I had discussed the soreness in the consent for treatment conversation, I had forgotten to reinstate the possibility again.

I'm unsure if I need to repeat myself every time I do an adjustment but in this case, I think it is important.

Revisited:

A different patient called again today for some advice about the soreness. She wasn't upset like the first patient, as I had discussed the possibility of increased risk of soreness but I had forgotten to give advice. This will be something I add to my discussion of after-care with my patients.

# data[].attributes.body
[D4. You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.]

I had a tutor today who quotes off by heart the OPS and NICE guidelines. When he watched me ask for consent for a HVT, he stopped me and showed me how he does it. It was very clear, giving 3 or 4 negative outcomes that could happen, and gave counter-arguments for why he doesn't think they would happen but expressed why he needed to discuss them. He later directed me to some resources to look at and come up with an idea of what to say for the next time.

Revisited:

Today I realised the most important thing to discuss is the possible soreness over the next few days an adjustment. I talked all through the possible risks of HVT in terms of what could happen to a disc and forgot to discuss the possible soreness and stiffness over the next few days. The patient called back to say he was extremely sore the following day. Despite the fact I had discussed the soreness in the consent for treatment conversation, I had forgotten to reinstate the possibility again.

I'm unsure if I need to repeat myself every time I do an adjustment but in this case, I think it is important.

Revisited:

A different patient called again today for some advice about the soreness. She wasn't upset like the other patient, as I had discussed the possibility of increased risk of soreness but I had forgotten to give advice. This will be something I add to my discussion of after-care with my patients.

Revisited:

The process for complaints needs to be monitored better. I think when I am in practice I will have a complaint form that I can fill out in order to avoid the lack of evidence, which will involve the possibilities of patient response to treatment.

Even though I have made that document, I feel as though it is too stark and should not be relied upon to avoid the possibility of patient complaints. On reflection, I feel that open conversation about treatment effects and being supportive that the patient call and that I am open to helping if any issue should shelter any advancements of complaint, like in my previous reflections.

# data[].attributes.body
[D5. You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.]

I was walking in town today when I saw one of my patients walking the other way. We made eye contact as she was talking with another person. I gave a discrete smile and carried on walking by without saying hello. I didn't know if she'd recognised me because I wasn't wearing a mask but I also didn't want to assume that the person she was talking to knows about her seeing an osteopath so I carried on with my day and left her alone.

On reflection, this was probably the best thing to do. I don't know her personally, I know her within clinic walls and I know information about her that others possibly wouldn't. I remember seeing my dentist in Tescos once and I said hello despite the fact I looked up and saw him looking at me, he didn't approach me first and I guess that's because I looked at our relationship as one from a patient view whereas when I saw the lady, I was her practitioner.

Revisited:

The patient I saw came in today and she mentioned seeing me in town. She said she couldn't figure out if it was me or not so she left it so that 'she didn't look like a crazy person'. I took the opportunity to discuss with her why I didn't come and say hello. She was appreciative and expressed she hadn't thought about it that way before.

I think I'll keep this in mind if I see people out of practice. I discussed it with a few tutors and they agreed that is the best practice. One told a story that while he was shopping a patient of his recognised him and ended up introducing him to her friend to see if he could help her. He gave her his contact information and said we can discuss it in practice which she ended up booking. He said that during the appointment she was talking about the friend that introduced them and how he had to navigate the policy of patient confidentiality by continually saying 'you'll have to ask her'.

What I've learned from this is that both inside and outside practice it's important to remain at the forefront of patient care. From the previous story, I feel as though I also may not want to be recognised outside of practice based on this. I feel as this is a clever approach as to not be seen and also living up to this standard.

# data[].attributes.body
[D6. You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.]

We've been getting an increase of patients refusing to wear masks recently. It's been difficult to navigate around the situation as the clinic still holds a mask policy in place.

Today I observed a student having to deal with someone who refused to wear one. The student came out to greet the patient and bought a mask, she said in a polite manner, 'hello, how are you doing, I'm going to give you a mask to wear' and the patient aggressively stated 'I believe I don't have to wear a mask, I don't have to show you my exempt card and you can't discriminate against me, I'll sue you if you don't see me'. The student, stood pretty stunned at the statement thrown at her.

To be honest I think we were all pretty stunned. The student after a few moments said 'okay, let me get my tutor' who is a stickler for the rules. He came out and expressed the policy that the clinic has, that it would have been discussed over the phone to which you said you were happy to wear a mask and comply with the clinic policies ( new patient forms hold all of the questions and are ticked and crossed out according to the patients' response, one being the expectation of wearing a mask) and if it's an urgent appointment we could do it on the green behind the clinic for confidentiality purposes or he could refer her to another clinic that does not hold that policy.

On reflection, I think the tutor presented the 'case' well in terms of what the patient had agreed to already. I do think the patient has the option to change their mind, however, if what they do not consent to now doesn't line up with the safety policy of the clinic there can't be an expectation to change our rules to accommodate. Also, there were options given to the patient of other places she could go to get the help she needed.

Revisited;

I asked the reception manager for a blank copy of their new patient appointment sheets which have all of their questions on them to see what was involved in the first booking call. I think this is a good idea which I will be inputting into my practice when I leave in order to have something that can support me and the patient in getting the most out of our appointments. As well as this, knowing what other osteopaths are in the area and what safety policies they hold so that I might refer to another practitioner who might be more fitting for them.

# data[].attributes.body
[B1. You must understand osteopathic concepts and principles, and apply them critically to patient care.

The teacher I had today was good. He was very helpful and got very excited when being able to talk about the body, how it produces chemicals, what's in the gut, and how things move and function. He really helped the students learn. I felt he had a good knowledge base and I really enjoy working with him. I've asked to work with him a few times now because I just feel he furthers my understanding when I come into the clinic. I find him easy to be around and extremely knowledgeable and very kind.

Revisited:

One tutor I had these 6 weeks made me recite the 4 osteopathic principles:
- Structure governs function
- The body is a unit
- The rule of artery reigns supreme
- The body is its own medicine chest

Surprisingly I remember them and realised I vary rarely use all of them at once. That really challenged me to find these principles within my patients. I've found since having this influence that it structures my treatments in a more time-effective way. One piece of feedback I regularly get is that I'm too local and don't think globally. For instance, I had a patient, who has thoracic pain. Ruling out the red flags I only had upper cross syndrome for a possible diagnosis. My tutor challenged me in thinking broader and I had no hypothesis about her as a whole. I was left not having much to go off of.

Revisited:

In contrast today I had a 13yro boy who came in with a foot issue. I asked all the questions about the foot and there wasn't anything to 'stand out' about its function, so asked about the knee, nothing there, and then the hip. I got an array of answers and his previous history of hip and pelvic problems from his birth had possibly been causing a compensatory pattern which was then presenting as foot pain.

I did a broad treatment through his lower back, pelvis, hips knees, ankles, and toes and it made a vast difference. He was discharged after 4 treatments and he and his mother were surprised that treating the pelvis sorted out his foot issue.

# data[].attributes.body
[A4. You must receive valid consent for all aspects of examination and treatment and record this as appropriate.]

An elderly male came in today and the tutor and I felt it necessary to assess and possibly treat his pelvic floor. This is quite an intimate technique but it does great effects on the patients' symptoms.

A very clear discussion is necessary for this as he would be sitting on my hands and they would be placed medial to his sitting bones. I asked the tutor to observe, in order to make sure I hadn't missed any glaring obvious details as well as having a chaperone to confirm nothing informal was happening. Overall the conversation took 10 minutes and was a back and forth conversation between me and the patient. It was finished with 'you can go away and research it to understand more if you choose to engage with this technique'.

The patient mentioned how the discussion and supporting reasons for the technique made sense and were happy to continue. I continued to express how he could stop at any time if he changed his mind. After the technique was finished the patient had significantly decreased pain.

# data[].attributes.body
[D7. You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.]

As I near the final stages of this course I've been met with questions about how I present myself to the world. How do other people perceive me and how can I make myself more professional.

At the being of the course we were told to privatise all our social media and they gave a really daunting story of how one student began to be stalked by a patient and harassed over her socials because she didn't monitor who could see her accounts or not.

Revisited:
I made my social media private a long time ago but I'm glad I did as a few patients have expressed that they would like to see how I progress in the profession. So I now can direct them to my professional account which has osteopathic updates and things of the profession's nature as well as courses and CPD courses I have obtained.

# data[].attributes.body
[D8. You must be honest and trustworthy in your professional and personal financial dealings.]

I do not directly deal with the finances of the clinic however, I am well-practiced in financing from my previous work.

For instance, I think I would hold things such as thera/resistant bands, massage balls, pilates mats and foam rollers but would sell them at cost.

Revisited:

I saw a patient today that needed to be referred for an MRI. I gave him the option of going through the NHS which could take some time but was free and also offered a referral clinic in London that charges a high cost however they would be able to see him within 2 days. The clinic in London was one of the tutors' usual referral clinics with which he had built a relationship. We discussed the options but the patient said he felt like if he went to the London clinic it would be in the best interests of the tutor because of their relationship. We discussed that this was only an option and he could definitely find another clinic close to him or one that he felt more comfortable with if he so chose.

I never thought about this scenario with respect to benefiting someone else through someone's issue but I can see how this could be perceived as such. I think I will draw up a referral list with 3 options so that the patient has multiple routes to go down rather than seeing their suffering as a benefit to me.

# data[].attributes.body
[D9. You must support colleagues and cooperate with them to enhance patient care]

I struggled with today was how unorganised the clinic can be for the pupils. I don’t like that I'm paired with the same people in my year each time I come into the clinic for observation. I'd like to be placed with different people to get different views and conversations. I didn't like how I felt like an inconvenience because the fourth years are doing prep for their exams. Understandably they have priority and I didn’t have any issue with the students working but if the school has them as the highest priority at that point and they don't want people in their clinic rooms with them, why has the school bothered to have us come in? They could have booked us in for another day to make it better for all the students. I have given feedback to the clinic in order to help with this.

Revisited:

We're beginning to hand over patients to the upcoming third and fourth years now. It's a difficult process for me being some of these patients I've seen since I began my third year. I'm beginning to write up all my patients' notes as detailed as I can with the progression and the long term and short term management and even the patients' likes, dislikes and lifestyle/traits. I'm even trying to get the students which I'm handing them over to, to come in and meet before I leave so that the patients don't have an unexpected practitioner change. I can then discuss with the new practitioner what I have done and what I have found best for that patient.

I think this shows real patient care and has made the patients trust me more as they can see the effort and time I am putting in, in order to make them the most comfortable.

I

# data[].attributes.body
Today I really enjoyed seeing a woman practitioner work with a woman patient. I felt like it was much easier for the patient to talk to the practitioner about more personal things such as menstruation and bowel movements. I feel this way because when our male tutor walked in the patient went quiet and stopped talking as much, her posture changed and she was very different and it reminded me of the vulnerability of patients that come in. During their appointment they are have people walking in and out of the room and almost feel like they're being paraded or put on show and they don’t know who’s coming in next. That’s not nice.

# data[].attributes.body
One thing I’ve learned;
I need to come in to have a treatment. I think it will further my understanding of what its like to be a patient in a clinic with learning osteopaths.

# data[].attributes.body
Reflective;
I found it really hard today. I wanted to help the people coming in and I actually wanted to make a difference and help the practitioners. I know why I couldn’t and that’s due to the lack of knowledge I have. I get frustrated by that and I don't seem to be able to retain any of the information that we're learning.

I don't like the awkward stage of trying to get to know people and taking so much time to get to know them I want to be good. I want to be really good but I hate waiting for it. My mindset gets me down too because I start to think that I'm bad at it and that I won’t be able to do this in the long run.

I hate the unorganisation, I really hate it. Not having someone I can just talk to about it either is what makes it worse for me. I'd like a tutor, I'd like a really good tutor. I haven't got one yet and I think it's worth saying something to someone but who do I tell?

I feel like I have no connection to anything or anyone in this room today.
It was a bad day.

# data[].attributes.body
My time as a patient;
For some unknown reason I was nervous. I’ve seen practitioners before but today I was nervous about what they’d find, if I’d understand or even if they thought I was a waste of time because I’m a student and can get free treatments.

I walked upstairs and was told there will be students observing and I didn’t mind (obviously). When I said hello no one replied which I thought was strange. It made me feel strangely inferior.

During the treatment it was good I felt secure and the practitioner felt like he knew what he was doing. The process was quite long due to all the checks with the tutors.
Right at the end the students tutor walked in and explained that he needs to start finishing up the treatment. 10 minutes later the teacher came in again and proceeded to tell him he's late, and the tutor explained that they had a prior engagement. It made me feel extremely awkward and also made the student fluster a little. It was so uncomfortable for me. I was in shorts and a bra and having someone walk in and out of the room was worrying and not thought through. Maybe because I was a student the tutor thought I would understand but it wasn't nice either way.

# data[].attributes.body
Especially because we are students I think we need a clear and well thought out (to the point) time table. I didn’t appreciate how we weren't assigned student practitioners today. I felt as if there was no coordination and also that I was intrusive and in the way for the practitioner. It didn't feel comfortable for me to be in that atmosphere and I felt like I was running after people when really it should have felt much smoother. I think this could have affected the patient and also the practitioner because they didn't know who they had in the room and that was an inconvenience to them.

# data[].attributes.body
One thing I didn’t expect was having one of the patients be so knowledgeable about his own body and how he should be treated. This patient had been coming to the clinic for the longest period of time, I think the year it was open he actually started coming and that was really fascinating. He'd seen hundreds of students going through this system and pass. I hope I get to be one of them.

# data[].attributes.body
I'm so excited to start this journey to become an osteopath. Due to how great my practitioner I have such a great goal to reach.
My first appointment with my osteopath was due to a high stress work environment. I was put through such awful mental and physical strain with a lot of people relying on me. After 2 years I couldn't take the pressure anymore and I quit. With quite a personal relationship with the owner I was a horrible half hour of handing in my notice. The day after I was so tense I could barely walk. Someone close to me told me to book to see an osteopath and I did and the way she helped me physically and mentally I cant even begin to explain the gratitude for her. Thats why I want to become an osteopath. What an incredible thing I can do for so many people. To improve someones life like that. I can even begin to explain how excited I am.

# data[].attributes.body
[A5. Support patients in caring for themselves to improve and maintain their own health]

One thing I didn't understand today was when the practitioner didn’t give the patient exercises she could have done at home to help with her progression and response to treatments. The patient was a cover but he knew what the patient had been going through and what his management was so I was surprised he didn't take as much care. I think it would have been good to of given her a treatment plan.

Revisited:

I had a patient today that has been going to the ESO for longer than I've been alive. She also hasn't been offered the necessary help which I later discovered is because of her beliefs. I feel as if we've been conning her all these years. On assessing the previous practitioners' management I feel it was inadequate and I'm shocked someone hadn't changed the cycle prior to our appointments.

I had a discussion with her about her options which were surgery, injections, or exercises to which she refused to do any of them. We agreed that I would give her updated options every 6 - 8 treatments to see if she would be in a better position to undertake the options that she has.

From this, I've gained the understanding that we must give options that promote the best for our patients whether or not they take it. Along with this that just because someone is not in the position now doesn't mean they'll be like this for the whole of the professional relationship.

# data[].attributes.body
[A6. You must respect your patients’ dignity and modesty.]

Today I was able to observe one of my fellow practitioners and she had a patient who has commented on the inappropriate underwear she was wearing. She seem to make a joke about it but we assured her it was okay and if she felt uncomfortable she could put her clothing back on but she assured us that she felt comfortable and didn't mind.

She was face up on the couch and our male tutor came in about half way through the treatment. The atmosphere changed ever so slight even though the tutor introduced himself. He asked the practitioner questions while standing at the side of room and after a few moments he said his thank yous and goodbyes and left.

A few moments went by and the practitioner asked the patient to go side laying if she was comfortable. The patient turned over and then said 'I don't want to if that guy is going to come back in'. During these times we don't have any supplies like blankets due to the pandemic rules against cross-contamination, so the practitioner discussed putting the patients' shirt over herself or even back on if she felt more comfortable.

I learnt from this to explain if I'm seeing a female that I have a male tutor. It might make them less surprised when they come in or even slightly more comfortable. I know that when a patient calls in the reception team explain that they will be in underwear so wear something comfortable like a sports bra or something with more coverage. However I don't necessarily think that was the problem in this scenario, it was being in such a vulnerable position with the possibility that a male might walk in.

Revisited:

I've started the majority of appointments explaining that my male, or female, tutor might come during treatment and the response has been very good from patients, but my patients have been wearing anything out of coverage either.

Revisited:

Today is the first time a female patient asked the male tutor to not come in. I discussed this with my tutor and he said he has to come in for any adjustments that need to be made. I relayed the tutors and my conversation with the patient about him coming back in for an adjustment and that she could be fully dressed if that made her more comfortable. She was happy and consented for him to come in for that technique. I feel as if I have progressed and learned from that first statement at a steady pace and feel as though I have a good understanding of how to make patients feel respected throughout the appointment.

# data[].attributes.body
[B2. You must recognise and work within the limits of your training and competence.]

The students today helped me learn some anatomy. I didn't realise there was a muscle in the neck that connected to the temples which produced headaches in the patient I was observing. I thought it was good that was explained that but by a student rather than a teacher. It encouraged me to do my own research and further my understanding.

Revisited:

Anatomy is a massive part of osteopathy. There has been a steep learning curve for me to understand. Alongside this, understanding what we can and can't help with takes high priority over thinking we can help everything.

Revisited:

I was covering for another student today and saw a male patient who had adductor pain. However, he was now getting an unremitting pain in his right testicle that he didn't submit by position as well as it not allowing him to sleep. He said he discussed this at the last appointment but the symptoms were much milder and could be reduced by position. This appointment ended in an immediate referral as this would signify a non-musculoskeletal pain.

Simple things like understanding musculoskeletal pain vs. early signs of pathological pain are an important part of the appointments as anything out of the realm of mechanical pain, we cannot help with.

I have begun to revise and keep lists of early signs and symptoms of pathological pain that can present as mechanical pain in order to help with my understanding if what I can help with and what patients need to be sent elsewhere.

# data[].attributes.body
[A7. You must make sure your beliefs and values do not prejudice your patients’ care.]

In the clinic, we've started to look at the new patients' age, gender, and expected area of complaint and make preconceived notions for diagnosis. We've decided it's a good way to better our knowledge of diagnosis or expectancy around certain age groups.

Revisited:

We did this recently and I realised it hasn't helped at all. I had an 83-year-old male come in today. We guessed the range of diagnosis and I looked over his previous notes as he had come to the ESO 2 years prior for back pain. I looked over them and did some revisions on what I thought it would be and what to ask. He came in and I expected back pain but he actually said 'I've got thumb pain'. This completely threw me off, everything I had practiced had disintegrated into the background and I was left flustered and unsure of what to ask, all anatomy had left my brain and I had no idea how to proceed.

I've learned that a person is more than their previous case notes and that while, yes there is more prevalence of some diseases in certain age groups or genders which help with narrowing diagnosis, this should not be my first expectation when seeing a patient. While I did this as a means to learn common patterns of certain pains, I narrowed down my patient to age, gender, and sadly a diagnosis. Overall it helped neither of us.

I've decided that while it's good to understand what common diagnoses happen to certain groups of people, it's not helpful to go into an appointment with a held ideology of what may have gone wrong.

Revisited:

Since this happened I've not even bothered looking at my patients' area of complaint, I have held loose possibilities in my mind of what it might be but really looking back it made me close-minded as I was trying to fit a person into what I thought would be the most appropriate diagnosis. Since stopping doing this my patients have greatly improved because I could be more specific and open to what was actually happening rather than what I expected to happen.

# data[].attributes.body
[B3. You must keep your professional knowledge and skills up to date.]

A recent exam of a certain diagnosis has helped me to understand how to research diagnosis efficiently. I have begun to do this with each new patient diagnosis I get which has greatly helped me in how I now approach and manage a patient along with how I word my diagnosis.

# data[].attributes.attachment_caption
Example A (Vizniak, N.A. (2008). Quick reference evidence informed muscle manual. Canada: Professional Health Systems Inc.)

# data[].attributes.body
[B4. You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.]

In the process of starting childrens' clinic, I've begun to research how babies would react to a new environment. The babies are usually on their backs with bright lights above, which is something I've thought about a couple of times. 'An infant is very sensitive to bright light' (Baby's Vision Development, 2017). The clinic has changed some rooms to have dimming lights which is something I think I would utilise in my own clinic, alternatively using sconces to allow for a more comfortable atmosphere.

Baby's Vision Development: What to Expect the First Year (2017). Baby’s Vision Development: What to Expect the First Year. [online] American Academy of Ophthalmology. Available at: https://www.aao.org/eye-health/tips-prevention/baby-vision-development-first-year.

Another example is patients with discogenic pain who cannot lay supine. After treatment on their side, I've noticed sitting back up is difficult because of the increased load onto that disc (Example A). I've in turn begun by explaining while they're laying on their side the mechanisms involved in their pain, holding their upper arm, ask that they move their legs off the table allowing me to maintain the pressure of their upper body which decreased the load on the disc, decreasing the pain they might experience.

As well as this I have opened up the conversation for the patient to place themselves in the most comfortable position. With this, I have broadened my skills in treating a patient optimally in a position that works best for them.

Revisited:

I've been reflecting on how I might implement this in my own practice and how to get better with self-reflection. I have been discussing with some tutors the possibility of mentorships after I graduate and surprisingly there has been a great response and openness to it. As well as this I have joined several Facebook groups which involve all levels of osteopaths. It's designed for people to present cases and start discussions over certain osteopathic literature and so on. I think this will allow me to advance and analyse how I am as a practitioner allowing for better patient care.

# data[].attributes.body
[C2. You must ensure that your patient records are comprehensive, accurate, legible and completed promptly.]

Reflecting on how I used to take a case history to now, there has been a large change. SOCRATES used to help a lot in the early stages to give structure to the case history, however, I found there were holes that lead to missing information. I have remedied this through trial and error over these 2 years and have come up with my own note-taking style that promotes the optimum way for me to take a case history.

Revisited:

As I have progressed from SOCRATES my notes can get jumbled. It was a good way to give concise and clear notes. I have yet to figure out as good a way to present my notes as compared to how I present a case to a tutor, it is different. I follow a line of questioning until I feel it is fully completed which can lead to a jumble if the case is comprehensive. Despite this, I am quickly developing an efficient way that created comprehensive, accurate and legible notes.

# data[].attributes.body
[C3. You must respond effectively and appropriately to requests for the production of written material and data.]

I had to write my first referral letter today which was quite daunting and actually quite stressful. I wasn't sure what information needed to be in it and what to really say and it all had to be done pretty much straight after the appointment. The first draft went something like this;

'To Whom it may concern

MR X came to the clinic complaining of issue A. Your advice would be helpful.

Thank you.'

To which I was scorned for not putting in any information. I was pushed to go and get the referral letter templated from the reception and they gave me a King James bible thick folder with multiple letters to GPs and other services. It wasn't that helpful an I became more flustered than on the first try because there were so many ways to write one. I think I need to come up with my own formula of what to put in and how to write one properly for myself, rather than for how others do it.

Revisited:

I came up with my own template now. I've even prepared one for when I leave. It's split into simple paragraphs with areas that I need to input about that specific patient and reads as follows:

'To whom it may concern

Mr. X : D.O.B
Address

Came to see me (date) complaining of (issue)

Upon further questioning ...

Within examination (insert physical findings and orthopedic testing results) ... was found

I expect (insert intervention needed) would be necessary but would be appreciative of your input on how to progress.

Kind Regards'

Not every tutor likes the format, which is fine by me because it works for me, it is polite and professional and holds all the necessary information. With more experience, I expect this format will change but for now it works.

This also allows for time efficiency. It means I can fill it out during the appointment and print off 3 copies, one for my files, one for my patient and the other to be sent to whichever health provider needs it.

# data[].attributes.body
[C4. You must take action to keep patients from harm.]

I observed a patient today who has low functioning down syndrome resulting in him being nonverbal. He was accompanied by another patient from the ESO who the practitioner handling the case also treats. The carer, because of his previous experiences with treatment believed that this gentleman would benefit from a cranial approach treatment.

As the case progressed the practitioner discussed him laying on the couch for assessment. The complacent patient started to become concerned and resisted the carer's encouragement to lay down.

The practitioner decided to step outside for a moment and allow the patient to calm down. We talked in the tutor room while the tutor was with another student and she shared concerns over how to handle this patient. The main thing was that he wasn't forced into it. Despite being nonverbal it was clear the patient was not consenting to assessment or treatment. The practitioner raised concern about the pressure from the carer but he was clearly trying to keep the patient's best interests at heart.

We went back in and the patient was in the corner of the room being consoled by the carer. The practitioner sat down and said she wouldn't be doing an assessment or treatment.

I'm so thankful that I have other students to discuss concerns with and learn from as well.

On reflection, I think the practitioner did the right thing by stepping out, even for her own sake to ground herself again and to allow the patient some time to settle. Navigating between two people and keeping them on a good level of understanding is difficult but can be done. Moreover, if this was to happen to me out of the tutoring clinic I think I would find the principal or colleague to chaperone in order to have an objective bystander to give feedback as well someone who could comment if the situation was to turn negative.

Revisited:

I have been thinking about this event for a few weeks now and have been trying to approach it if I was in my own clinic with this patient and how I would respond to this situation. I think clear and concise notes taken would be the priority but also making sure there is enough room for these situations to happen. My physical presence should not be blocking any exits to allow the patient to feel as if they can't leave and possibly allow to soften the atmosphere. I also believe that conversation over the phone to the carer so that they fully understand what to expect and to try and explain that to the patient is important.

As well as possibly also discussing the idea of allowing the first appointment to be almost a buffer, letting the patient meet me, and building rapport before treating. Along with this giving the patient the option of doing exercises at home because the management of a patient is important and has a great impact on a persons pain.

Revisited:

I've started to look into how other clinics and other healthcare providers process child abuse, domestic abuse, and vulnerable adult procedures to take away points to take with me for when I go into practice. It was an interesting process and also a difficult one to go through, however, it is important. The main things I've taken away are hotlines and numbers to call if I find myself ever in that situation. I have looked into documents on the clearest process for the patient.

# data[].attributes.attachment_link.title
Vulnerable Adult Protection procedure Final Version October 2013 (1)

# data[].attributes.body
[C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.]

Having started my second year in the COVID-19 lockdown and beginning my clinic process with DONNING and DOFFING, hygiene process have been on high priority in order to not spread the virus. We have had lengthy lectures and meeting about it including when to change clothes, when to shower, wearing aprons, gloves and masks as all times, and making patients comply with mask or visor rules as well.

Revisited:

As we near to the end of the COVID-19 protocols, I have sound myself still using a lot of the PPE provided, especially the hand sanitizer and aprons. I like the fact that I have that added layer of protection for my clothes. Even though it wasn't strange to me that I have picked up bare legs, arms, and in some cases torsos, reflection on that is that its not hygienic. I would do classes wearing the clothes and then go and eat and that isn't safe for anyone.

I have continued to use some of the PPE proceeds to better my hygiene as well as respecting the patients. I will continue to do this when I leave the tutored clinic.

# data[].attributes.body
[C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients.]

There have been a lot of discussions with patients over the COVID-19 vaccinations and its been interesting to me as to what people believe vs what is truthful. I've heard a lot of opinions and uncertainties and, in general, am unsure of what to tell patients. No one has asked my advice on getting the vaccination but some have asked about what it actually is which is hard to say. I need to do some research so that I'm better prepared or at least give some advice on where to look to.

Revisited;
1. https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/covid-19-vaccinations/#patients

2. https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/

3. https://www.gov.uk/government/collections/mhra-guidance-on-coronavirus-covid-19

Before writing the last reflection I did not realise that within the 'read more' drop down there is a COVID-19 patient discussion section (1). It gives 2 sites to send patients when they ask (2 and 3) and they give (especially 3) some good context and other sites to explore for more information.

I printed off the link and cut them into little sheets to give to patients who wanted to know more about the vaccine. I do however believe in wider research so added some other search engines like google scholar to look at differing views on the vaccine.

# data[].attributes.attachment_link.readable_text
COVID-19 vaccinations for osteopaths

The Department for Health and Social Care (DHSC) has published a consultation on revoking its requirements for those working in health and social care to be fully vaccinated against COVID-19 as condition of their deployment in England.

The original mandate planned for April 2022 would have applied to osteopaths employed or commissioned in Care Quality Commission (CQC) registered premises or undertaking CQC regulated activities. Typically, this would apply to osteopaths working in NHS settings or with doctors, nurses or dentists, but not those working in independent practice.

The DHSC has stated that 'those working in health and social care still have a professional duty to get vaccinated and Get Boosted Now'. It also stated that they 'will work closely with Royal Colleges and professional regulators to strengthen guidance, and consult on updates to the Department of Health and Social Care's Code of Practice for regulated providers to strengthen the requirements in relation to COVID-19, which applies to all Care Quality Commission (CQC) registered providers of all health and social care in England'.

GOsC guidance (C5.5 of the Osteopathic Practice Standards) states that osteopaths should 'take all necessary steps to control the spread of communicable diseases'. Further information about infection control is available in our infection control guidance.

GOsC guidance (D11 of the Osteopathic Practice Standards) states that osteopaths must ensure that any problems with their health 'do not affect their patients'.

The NHS website, for example, states: 'Research has shown that the vaccines help:

reduce your risk of getting seriously ill or dying from COVID-19

reduce your risk of catching or spreading COVID-19

protect against COVID-19 variants.'

Further information about vaccines is available on the NHS website.

We will continue to work with other health regulators and professional bodies to ensure consistent and ethical standards for patients and health professionals in the UK.

Message from the Chief Professions Officers for England

The Chief Professions Officers for England, as well as the Medical Director and Medical Director for Primary Care in England, have also published a letter to all health and social care professionals about their professional responsibility to reduce the risk of COVID-19 infection to patients.

Communicating with patients about the COVID-19 vaccination

Osteopaths should ensure that discussions with patients about vaccines are based upon credible and legitimate sources of public health information such as the NHS website or the MHRA website.

Osteopaths are required to work within the framework of the Osteopathic Practice Standards (OPS).

In terms of the COVID-19 vaccines, relevant standards include:

C6: You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients:

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.

B2: You must recognise and work within the limits of your training and competence.
A7: You must make sure your beliefs and values do not prejudice your patients' care.
D7: You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

Our i nfection control guidance contains more information about the actions that can mitigate against the risk of transmission of COVID-19 in health settings. This may include vaccination.

IJOM

This article: Opposing Vaccine Hesitancy During the Covid-19 Pandemic, which was published in the International Journal of Osteopathic Medicine on 18 February 2021, sets out the views of the international osteopathic community on COVID-19 vaccinations.

# data[].attributes.attachment_link.title
COVID-19: Vaccinations - General Osteopathic Council

# data[].attributes.body
[D10. You must consider the contributions of other health and care professionals, to optimise patient care.]

I came up with my own template of how to refer a patient to another health care profession. I've even prepared one for when I leave. It's split into simple paragraphs with areas that I need to input about that specific patient and reads as follows:

'To whom it may concern

Mr. X
D.O.B
Address

Came to see me (date) complaining of (issue)

Upon further questioning ...

Within examination (insert physical findings and orthopaedic testing results) ... were found.

I expect (insert intervention needed) would be necessary but would be appreciative of your input on how to progress.

Kind Regards'

Not every tutor likes the format, which is fine by me because it works for me, it is polite, respectful and professional and holds all the necessary information. With more experience, I expect this format will change but for now it works.

# data[].attributes.body
[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.]

My sister was diagnosed with breast cancer this year. It has been a difficult situation to process as well as cope with at certain times. When she first told me I was sat in my car about to go in for afternoon and evening clinic. I didn't want to tell anyone but also knew that I needed to tell someone just so that in wasn't there the whole time. I ended up telling a clinic supervisor and she gave me the options to go home, stay in clinic but have no patients, or continue as if nothing has happened. I decided to carry on like nothing has happened as I'm better working in those scenarios otherwise I just sit and let things fester. I agree with what I did in order to make sure I was present in clinic.

A few weeks later I began to see her weekly and swapped out my childrens clinic days to drive her too and from her chemotherapy appointments. I was able to aid her in those times. I was there which she has told me made her feel supported and has allowed me to focus more when I'm in clinic as I wasn't worried about her feeling as if I'm unavailable all the time.

On reflection this time has been very difficult for me.  I have found that I'm slightly more compassionate towards my patients, especially those who are going through the same thing as it is something close to my heart. If anything its pushed me to be more prompted and engaging with pathological illnesses and increased the urgency for referral if necessary.

# data[].attributes.body
[D12. You must inform the GOsC as soon as is practicable of any significant information regarding your conduct and competence, cooperate with any requests for information or investigation and comply with all regulatory requirements.]

Due to the fact I have not had to go through a process regarding the General Osteopathic Council in terms of my practice, I have not got any evidence to suffice this standard.

However, looking into the types of concerns and complaints has helped me in reviewing myself and how I practice in order to remove any possibility that I may fall into a complaint one day.

For example 'Osteopaths with between 3-5 years of experience are proportionately more likely to receive a complaint against them' and 'When the concerns and complaints are mapped against the Osteopathic Practice Standards (OPS) we can see that ‘Professionalism’ remains the area of most concerns' (Carnes, 2020).

I have taken more time in these areas to make sure that I am up to date on how to communicate and upload professionalism to the best of my ability.

Through this portfolio practice, I have a much deeper appreciation for the ESO's fitness to practice guidelines. These are guidelines that, as an osteopath, I will maintain through reflective practices, such as this.  In addition to having good judgment, acknowledging and evaluating potential barriers within my practice will hold steadfast.