# data[].attributes.headline
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.

# data[].attributes.subject
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.

# data[].attributes.body
1.2 First ESO Clinic Treatment (05/03/18) (A1, A6, D5)
Today I received my first osteopathic treatment at the ESO clinic, and it made me realise how intimidating how having multiple observers can be. While, how it also affects the practitioner patient dynamic, as there were certain aspects of my past medical history, I didn’t want to disclose in front of people who weren’t my practitioner. Therefore, in the future when I am in the clinic, I feel it is important that I make the patient feel comfortable in the clinic environment and make them aware there will be an opportunity to discuss any information they do not wish to share in front of observers during the appointment.

3.3 Meningitis In-patient Reflection (20/10/19) (A1, A2, D3)
Last month, after being discharged from the A&E ward I was moved to an isolation room in the hospital as the doctors were still unsure if my meningitis was viral or bacterial. The following morning, I was visited by the consultant neurologist on his rounds, and he explained due to the progression of my signs and symptoms he believed that my meningitis was viral. Even though he insisted that I was to stay in isolation for the next two weeks and I would not be discharged from hospital before that. This was tough for me to hear as he offered little explanation why this time frame and refused to listen to me when I asked why. I found this upsetting and annoying as it felt like he was just picking a timescale out of thin air as well as I wanted to return home as soon as possible as I find hospital environments uncomfortable. A couple of hours later the consultant neurologists understudy returned to administer some medication. Of which after she then took the time to explain to me why the two-week timeframe then went on to add that this wasn’t a definitive time frame, and I may be discharged sooner depending on my progression. This made me feel a lot more comfortable and content with the situation I found myself in. Although made me question why the consultant couldn’t have addressed my concerns at the time. On reflection the consultant and understudy gave me the same information but the way they presented it to me and involved me in the decision-making process was vastly different. When the consultant presented the information to me it felt like he was telling me what they were going to do, and my opinion or concerns didn’t matter. Whereas when the understudy neurologist represented the information the way she did it was more of a conversation while acknowledging my thoughts and feelings throughout the process. This experience has reaffirmed to me that when dealing with a patients’ treatment plan their thoughts and feelings should be considered and adapted to these thoughts and feelings. Therefore, in the future when presenting the prognosis of the dd and treatment plans to the patent in clinic I will approach the topic as a conversation and adjust the plans to their thoughts and feelings.

SC.5 First Maternity Patient (25/08/20) (A1, A2, A3, D3)
Today I saw my first maternity patient she is 33yrs old currently 18wks pregnant and this will be her second child. In her first pregnancy 13mths prior she suffered from pregnancy related pelvic girdle (PPGP) which for the remaining 6wks of she was wheelchair bound due to the pain. She then went on to explain she was attending the clinic proactivity as she was worried about ending up in a wheelchair like she did before and causing her to struggle with everyday tasks. This was an interesting experience for me as I have never heard of PPGP leading to incapacitated in a wheelchair. In this case I felt like it was important to disclose that it was possible that she could end up in a wheelchair like she did before. Although while explaining fortunately there is evidence that osteopathy can slow the progression of PPGP. Therefore, meaning that even though the PPGP will most likely progress with the pregnancy we could potentially slow the progression and make it a manageable condition for her. Upon reflection I feel like I managed this case well as I was able to identify what was important to the patient what her concerns were and then respond with the possibilities of what I could help her with while managing her expectations of the outcomes of the treatment process. Consequently, in the future I will try to continue to implement these aspects of listening, understanding while maintaining the patients expectations of treatment outcomes.

# data[].attributes.headline
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.

# data[].attributes.subject
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.

# data[].attributes.body
1.4 Clinic Observation (04/05/18) (A2, A3, A4, A6)
Today at clinic I observed a new patient (52yrs) who presented with buttock pain after falling downstairs two weeks ago. The conclusion from the practitioner and the clinic tutor was the patient had coccydynia. However, when the practitioner described the diagnosis and informed the patient of what she would like to do next the patient refused to give consent as she didn’t understand why the practitioner wanted to examine her coccyx. At this point the practitioner asked what was concerning her of which she replied that she just didn’t understand why it was relevant. At this point the practitioner took a poster off the wall and showed the patient anatomy of the area and explained how the trauma she had experienced would give her the symptoms she was experiencing. After this explanation the patient said she now understood why the partitioner want to examine her coccyx area and gave consent for the assessment to proceed. This experience showed me exactly why understanding the anatomy and pathogenesis of a condition is essential part of communication and gaining consent from the patient while also showing me how to deal with a situation like this in the future when I am a practitioner in this scenario.

3.3 Meningitis In-patient Reflection (20/10/19) (A1, A2, D3)
Last month, after being discharged from the A&E ward I was moved to an isolation room in the hospital as the doctors were still unsure if my meningitis was viral or bacterial. The following morning, I was visited by the consultant neurologist on his rounds, and he explained due to the progression of my signs and symptoms he believed that my meningitis was viral. Even though he insisted that I was to stay in isolation for the next two weeks and I would not be discharged from hospital before that. This was tough for me to hear as he offered little explanation why this time frame and refused to listen to me when I asked why. I found this upsetting and annoying as it felt like he was just picking a timescale out of thin air as well as I wanted to return home as soon as possible as I find hospital environments uncomfortable. A couple of hours later the consultant neurologists understudy returned to administer some medication. Of which after she then took the time to explain to me why the two-week timeframe then went on to add that this wasn’t a definitive time frame, and I may be discharged sooner depending on my progression. This made me feel a lot more comfortable and content with the situation I found myself in. Although made me question why the consultant couldn’t have addressed my concerns at the time. On reflection the consultant and understudy gave me the same information but the way they presented it to me and involved me in the decision-making process was vastly different. When the consultant presented the information to me it felt like he was telling me what they were going to do, and my opinion or concerns didn’t matter. Whereas when the understudy neurologist represented the information the way she did it was more of a conversation while acknowledging my thoughts and feelings throughout the process. This experience has reaffirmed to me that when dealing with a patients’ treatment plan their thoughts and feelings should be considered and adapted to these thoughts and feelings. Therefore, in the future when presenting the prognosis of the dd and treatment plans to the patent in clinic I will approach the topic as a conversation and adjust the plans to their thoughts and feelings.

SC.3 First New Patient Post Lockdown (19/08/20) (A2, A3)
Today I had my first new patient since returning to clinic after lockdown, he was a 37yr presenting with low back pain. I feel like my case history, examination and DDs justification went well although I really struggled to describe to the patient what I believed the dd was in layman terminology. This is something I had not experienced before the lockdown and was frustrating. However, on reflection this happening should not come as a surprise to me as it’s not something I have practicing since I was last in clinic and therefore, I am glad that it has now been highlighted that it’s something I need to continually work on sooner rather than later. Over the course of the summer to correct this, I will try to practice speaking and switching between medical and layman terminology within my summer clinic group while seeking feedback from them on how clear the information that I’m giving is.

SC.5 First Maternity Patient (25/08/20) (A1, A2, A3, D3)
Today I saw my first maternity patient she is 33yrs old currently 18wks pregnant and this will be her second child. In her first pregnancy 13mths prior she suffered from pregnancy related pelvic girdle (PPGP) which for the remaining 6wks of she was wheelchair bound due to the pain. She then went on to explain she was attending the clinic proactivity as she was worried about ending up in a wheelchair like she did before and causing her to struggle with everyday tasks. This was an interesting experience for me as I have never heard of PPGP leading to incapacitated in a wheelchair. In this case I felt like it was important to disclose that it was possible that she could end up in a wheelchair like she did before. Although while explaining fortunately there is evidence that osteopathy can slow the progression of PPGP. Therefore, meaning that even though the PPGP will most likely progress with the pregnancy we could potentially slow the progression and make it a manageable condition for her. Upon reflection I feel like I managed this case well as I was able to identify what was important to the patient what her concerns were and then respond with the possibilities of what I could help her with while managing her expectations of the outcomes of the treatment process. Consequently, in the future I will try to continue to implement these aspects of listening, understanding while maintaining the patients expectations of treatment outcomes.

SC.7 Returning Maternity Patient (16/09/20) (A2, A3, A4)
Yesterday my 33yrs maternity patient returned for her third treatment a week early as her symptoms had significantly worsened over the last week and was now giving her pain around the pubis region. This, meant for me to be able to accurately assess what was going on I needed to assess the pubis although the patient seemed quite apprehensive about this being done. Consequently, to allow for proper understanding of why I needed to assess this sensitive area I explained why she might be feeling pain in this region using the anatomical posters in the room while also talking her through the process on how I would assess the area. After talking her through the process I offered her a chaperone in case she felt uncomfortable and then asked if she had any questions. Of which after she said it wasn't necessary and gave me consent to assess the pubic area. Personally, I feel this experience shows how important reinforced consent is when a patient is unsure about an examination being done and the explanation of the examination process can be adapted to the level the patient needs to enable them to understand. Therefore, going forward, I will continue to use the anatomical posters in the clinic rooms to help me explain the reasons on why I would like to do something and where the structures are that I would like to assess.

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

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

# data[].attributes.body
1.4 Clinic Observation (04/05/18) (A2, A3, A4, A6)
Today at clinic I observed a new patient (52yrs) who presented with buttock pain after falling downstairs two weeks ago. The conclusion from the practitioner and the clinic tutor was the patient had coccydynia. However, when the practitioner described the diagnosis and informed the patient of what she would like to do next the patient refused to give consent as she didn’t understand why the practitioner wanted to examine her coccyx. At this point the practitioner asked what was concerning her of which she replied that she just didn’t understand why it was relevant. At this point the practitioner took a poster off the wall and showed the patient anatomy of the area and explained how the trauma she had experienced would give her the symptoms she was experiencing. After this explanation the patient said she now understood why the partitioner want to examine her coccyx area and gave consent for the assessment to proceed. This experience showed me exactly why understanding the anatomy and pathogenesis of a condition is essential part of communication and gaining consent from the patient while also showing me how to deal with a situation like this in the future when I am a practitioner in this scenario.

3.2 Meningitis Hospitalisation (19/10/19) (A3, D3)
A month ago, I was rushed to hospital with a temperature of +39°C, bilateral altered sensation/motor output in my LEX and UEX. The sign and symptoms onset were sudden, unexpected, and extremely worrying. Upon arrival at hospital the triage nurse assessed me and moved me straight through to the A&E ward where I was placed in an isolation room, put on IV fluids and blood was taken. Over the course of 4-5hrs nurses and doctors came and went to conduct tests and administer medication. At the time I felt irritated and concerned that no one was explaining to me what they were testing for or explaining what medication they were giving me or why. Eventually a doctor came in and explained everything they had tested for and why I was given certain medications. He concluded that I was suffering from an extreme version of meningitis and that I was to be admitted to the hospital for further treatment and assessment. He also explained the reason for the previous doctors and nurses not telling me what they were doing was because they didn’t want to worry me about some of the things they were trying ruling out. On reflection I believe this experience although worrying at the time to be a positive one as it allowed me to experience health care from the patient perspective. Personally, I appreciate why the A&E team didn’t keep me informed about what they were testing/treating me for as some of the things they were testing me for were life altering illnesses. However, I feel like not knowing was worse than knowing at this point and I can understand why some of the clinic patients feel anxious about their health when dealing with the health care system if this is a common experience. Therefore, in the future when dealing with patients I will do my best explain every dd I am considering before beginning my osteopathic, medical, and orthopaedic testing to allow them to feel informed about their health and included in the decision-making process.

3.4 Meningitis Discharge (21/10/19) (A3, A5, C4)
Three weeks ago, my doctor informed me that after 10 days being admitted to hospital for meningitis I was being discharged and I could go home to continue my recovery there. He then told me to go back to A&E if my temperature came or my symptoms started to worsen again and gave me some strong painkillers to manage any headaches I was still experiencing. Upon returning home I experienced a mixture of anxiety and relief. The anxiety was due to the sudden realisation at if I was to suddenly experience a worsening in symptoms there was no immediate medical attention but also the relief, that I was now in an environment that I felt comfortable. In hindsight my anxiety could of potentially be relieved by the doctors who discharged me by going into a more in-depth explanation on what to expect in my recovery and what was normal to experience when recovering from meningitis. Although this experience has been emotionally testing up to now as I am still experiencing side effects from the meningitis, I feel like this can be reflected and positively acted upon in my role as a practitioner. As I have now experienced how a patient may feel after returning home from treatment or being discharged after a series of treatments. Therefore, once I return to clinic, I will aim to make sure I give my patients a thorough explanation on what may experience post treatment and what possible symptom progressions may warrant further treatment or medical attention.

3.5 Lumbar Puncture (08/10/19) (A3, A4, D3)
Yesterday I attended my post discharge lumbar puncture to assess the progression of my meningitis. Once I arrived at the hospital, I became nervous which is out of character for me as I normally don’t become nervous or anxious over medical procedures although I believe I was nervous as this procedure involves a needle entering the space around the spinal cord to extract a sample of cerebrospinal fluid. Therefore, if the doctor was to hit the spinal cord there is the possibility of permanent nerve damage. Pre-procedure the doctor sat down and explained the process of the procedure, possible complications, and the reasons why they wanted to perform the procedure given the inherent risks. Before asking if there were any questions I had and asking me to read and sign the consent form for the procedure. Throughout the procedure the doctor and nurse continuously check if I was feeling okay while informing me on what they were doing and what I should feel when. Post procedure the doctor explained that the procedure had went well and reiterated what I may experience post procedure. Personally, I feel like this was a perfect example of how informed continuous consent can a nervous patient at ease. Consequently, I will use this experience to strengthen my continuous informed consent gaining skills which in turn will hopefully put my future nervous patients at ease.

SC.3 First New Patient Post Lockdown (19/08/20) (A2, A3)
Today I had my first new patient since returning to clinic after lockdown, he was a 37yr presenting with low back pain. I feel like my case history, examination and DDs justification went well although I really struggled to describe to the patient what I believed the dd was in layman terminology. This is something I had not experienced before the lockdown and was frustrating. However, on reflection this happening should not come as a surprise to me as it’s not something I have practicing since I was last in clinic and therefore, I am glad that it has now been highlighted that it’s something I need to continually work on sooner rather than later. Over the course of the summer to correct this, I will try to practice speaking and switching between medical and layman terminology within my summer clinic group while seeking feedback from them on how clear the information that I’m giving is.

SC.5 First Maternity Patient (25/08/20) (A1, A2, A3, D3)
Today I saw my first maternity patient she is 33yrs old currently 18wks pregnant and this will be her second child. In her first pregnancy 13mths prior she suffered from pregnancy related pelvic girdle (PPGP) which for the remaining 6wks of she was wheelchair bound due to the pain. She then went on to explain she was attending the clinic proactivity as she was worried about ending up in a wheelchair like she did before and causing her to struggle with everyday tasks. This was an interesting experience for me as I have never heard of PPGP leading to incapacitated in a wheelchair. In this case I felt like it was important to disclose that it was possible that she could end up in a wheelchair like she did before. Although while explaining fortunately there is evidence that osteopathy can slow the progression of PPGP. Therefore, meaning that even though the PPGP will most likely progress with the pregnancy we could potentially slow the progression and make it a manageable condition for her. Upon reflection I feel like I managed this case well as I was able to identify what was important to the patient what her concerns were and then respond with the possibilities of what I could help her with while managing her expectations of the outcomes of the treatment process. Consequently, in the future I will try to continue to implement these aspects of listening, understanding while maintaining the patients expectations of treatment outcomes.

SC.7 Returning Maternity Patient (16/09/20) (A2, A3, A4)
Yesterday my 33yrs maternity patient returned for her third treatment a week early as her symptoms had significantly worsened over the last week and was now giving her pain around the pubis region. This, meant for me to be able to accurately assess what was going on I needed to assess the pubis although the patient seemed quite apprehensive about this being done. Consequently, to allow for proper understanding of why I needed to assess this sensitive area I explained why she might be feeling pain in this region using the anatomical posters in the room while also talking her through the process on how I would assess the area. After talking her through the process I offered her a chaperone in case she felt uncomfortable and then asked if she had any questions. Of which after she said it wasn't necessary and gave me consent to assess the pubic area. Personally, I feel this experience shows how important reinforced consent is when a patient is unsure about an examination being done and the explanation of the examination process can be adapted to the level the patient needs to enable them to understand. Therefore, going forward, I will continue to use the anatomical posters in the clinic rooms to help me explain the reasons on why I would like to do something and where the structures are that I would like to assess.

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

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

# data[].attributes.body
1.4 Clinic Observation (04/05/18) (A2, A3, A4, A6)
Today at clinic I observed a new patient (52yrs) who presented with buttock pain after falling downstairs two weeks ago. The conclusion from the practitioner and the clinic tutor was the patient had coccydynia. However, when the practitioner described the diagnosis and informed the patient of what she would like to do next the patient refused to give consent as she didn’t understand why the practitioner wanted to examine her coccyx. At this point the practitioner asked what was concerning her of which she replied that she just didn’t understand why it was relevant. At this point the practitioner took a poster off the wall and showed the patient anatomy of the area and explained how the trauma she had experienced would give her the symptoms she was experiencing. After this explanation the patient said she now understood why the partitioner want to examine her coccyx area and gave consent for the assessment to proceed. This experience showed me exactly why understanding the anatomy and pathogenesis of a condition is essential part of communication and gaining consent from the patient while also showing me how to deal with a situation like this in the future when I am a practitioner in this scenario.

2.2 Danish Osteopath (08/04/19) (A4, D2)
This week I went to observe an osteopathic treatment in Denmark. The practitioner was a physio who had also trained at the ESO via the international course. The thing that I noticed the most was how different the consent process was. She didn’t ask for continued consent though out the treatment and didn’t ask for consent when rolling down the band of the patient’s underwear. As consent is a point of importance that is consistently made and emphasised at school as it gives the patient autonomy and helps establish the patient practitioner dynamic. It made me as an observer who has been taught how important the consent process is, quite uncomfortable. It has helped emphasis how important I feel that continued consent is. Possibly because in its absence it fails to establish and maintain clear professional boundaries between the patient and practitioner.

3.5 Lumbar Puncture (08/10/19) (A3, A4, D3)
Yesterday I attended my post discharge lumbar puncture to assess the progression of my meningitis. Once I arrived at the hospital, I became nervous which is out of character for me as I normally don’t become nervous or anxious over medical procedures although I believe I was nervous as this procedure involves a needle entering the space around the spinal cord to extract a sample of cerebrospinal fluid. Therefore, if the doctor was to hit the spinal cord there is the possibility of permanent nerve damage. Pre-procedure the doctor sat down and explained the process of the procedure, possible complications, and the reasons why they wanted to perform the procedure given the inherent risks. Before asking if there were any questions I had and asking me to read and sign the consent form for the procedure. Throughout the procedure the doctor and nurse continuously check if I was feeling okay while informing me on what they were doing and what I should feel when. Post procedure the doctor explained that the procedure had went well and reiterated what I may experience post procedure. Personally, I feel like this was a perfect example of how informed continuous consent can a nervous patient at ease. Consequently, I will use this experience to strengthen my continuous informed consent gaining skills which in turn will hopefully put my future nervous patients at ease.

3.9 Acute LBP Reflection (30/12/19) (A4, A6, D2)
Last week I had a patient with acute low back pain so bad she booked an appointment on the day which happened to be Christmas eve. After taking the case history it appeared that she was suffering from acute discogenic pain therefore a full LEX neurological examination was required meaning she would have to remove her skinny jeans and she didn’t have any shorts. After informing her what tests I would like to preform and why she said that she was happy to undress to her underwear and said she was wearing appropriate underwear to allow such an examination to be undertaken. Upon re-entering the room, she was wearing a lacy bra and thong this is a situation that believe could be misunderstood therefore I ask my tutor to watch my examination and to chaperone until I could cover the patient up with a blanket. This was the first experience as an osteopath of this nature that I have encountered. Upon personal reflection and discussion with my tutor I believe that appropriate measures were taken and going forward I would handle similar situations in the same manner. I was happy with this handling as I feel that it best protected both myself as the practitioner and the patient.

SC.7 Returning Maternity Patient (16/09/20) (A2, A3, A4)
Yesterday my 33yrs maternity patient returned for her third treatment a week early as her symptoms had significantly worsened over the last week and was now giving her pain around the pubis region. This, meant for me to be able to accurately assess what was going on I needed to assess the pubis although the patient seemed quite apprehensive about this being done. Consequently, to allow for proper understanding of why I needed to assess this sensitive area I explained why she might be feeling pain in this region using the anatomical posters in the room while also talking her through the process on how I would assess the area. After talking her through the process I offered her a chaperone in case she felt uncomfortable and then asked if she had any questions. Of which after she said it wasn't necessary and gave me consent to assess the pubic area. Personally, I feel this experience shows how important reinforced consent is when a patient is unsure about an examination being done and the explanation of the examination process can be adapted to the level the patient needs to enable them to understand. Therefore, going forward, I will continue to use the anatomical posters in the clinic rooms to help me explain the reasons on why I would like to do something and where the structures are that I would like to assess.

# data[].attributes.headline
A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

# data[].attributes.subject
A5. You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

# data[].attributes.body
3.4 Meningitis Discharge (21/10/19) (A3, A5, C4)
Three weeks ago, my doctor informed me that after 10 days being admitted to hospital for meningitis I was being discharged and I could go home to continue my recovery there. He then told me to go back to A&E if my temperature came or my symptoms started to worsen again and gave me some strong painkillers to manage any headaches I was still experiencing. Upon returning home I experienced a mixture of anxiety and relief. The anxiety was due to the sudden realisation at if I was to suddenly experience a worsening in symptoms there was no immediate medical attention but also the relief, that I was now in an environment that I felt comfortable. In hindsight my anxiety could of potentially be relieved by the doctors who discharged me by going into a more in-depth explanation on what to expect in my recovery and what was normal to experience when recovering from meningitis. Although this experience has been emotionally testing up to now as I am still experiencing side effects from the meningitis, I feel like this can be reflected and positively acted upon in my role as a practitioner. As I have now experienced how a patient may feel after returning home from treatment or being discharged after a series of treatments. Therefore, once I return to clinic, I will aim to make sure I give my patients a thorough explanation on what may experience post treatment and what possible symptom progressions may warrant further treatment or medical attention.

3.6 Pre-return To Clinic Dr. Assessment (26/10/19) (A5, C4, D11)
Yesterday I had hopefully my final post meningitis check-up, after a nearly two months of being hospitalised. I am still suffering from post-viral fatigue although I can now get through the day without needing to stop for breaks. Therefore, I felt like I was ready to return to clinic and university. During the visit to the GP, the doctor asked me a series of questions and preformed cranial nerve screening to check I was back to the level required by GOSC to return to active clinical practice. The doctor eventually agreed that I was able to return under the conditions of limited patients and hours to start with. Personally, I am delighted that now my life can begin to return to a level of normality although I must continue to assess my energy levels to allow for continued recovery, not risk patient’s safety and seek medical advice should I feel like I am not able to perform to the level I should be.

4.1 Re-returning Maternity Patient (03/10/20) (A5, A7)
Earlier this week my 33yrs maternity patient returned reporting that she has only mild symptoms post 48hrs after treatment of which after her pain levels quickly progress back to 8/10 on the pain scale. The fact that she has 48hrs of only mild symptoms after treatment gave me a sense of accomplishment as it’s something that she didn’t experience in the previous pregnancy. However, on reflection instead of just being happy with the progress we have made up to now at the time I should have concentrated on what might be the cause for her symptoms progressing quickly after the 48hrs post treatment and if it’s something that the patient is doing around that timeframe. Meaning we could adapt what she is doing to do differently and possibly extending the mild symptomatic window past 48hrs. Consequently, going forward, I will try not to let myself settle for short timeframes of symptomatic relief and investigate how I can extend that timeframe through supporting the patents to adapt their lifestyle while treatment is ongoing.

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

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

# data[].attributes.body
1.2 First ESO Clinic Treatment (05/03/18) (A1, A6, D5)
Today I received my first osteopathic treatment at the ESO clinic, and it made me realise how intimidating how having multiple observers can be. While, how it also affects the practitioner patient dynamic, as there were certain aspects of my past medical history, I didn’t want to disclose in front of people who weren’t my practitioner. Therefore, in the future when I am in the clinic, I feel it is important that I make the patient feel comfortable in the clinic environment and make them aware there will be an opportunity to discuss any information they do not wish to share in front of observers during the appointment.

1.4 Clinic Observation (04/05/18) (A2, A3, A4, A6)
Today at clinic I observed a new patient (52yrs) who presented with buttock pain after falling downstairs two weeks ago. The conclusion from the practitioner and the clinic tutor was the patient had coccydynia. However, when the practitioner described the diagnosis and informed the patient of what she would like to do next the patient refused to give consent as she didn’t understand why the practitioner wanted to examine her coccyx. At this point the practitioner asked what was concerning her of which she replied that she just didn’t understand why it was relevant. At this point the practitioner took a poster off the wall and showed the patient anatomy of the area and explained how the trauma she had experienced would give her the symptoms she was experiencing. After this explanation the patient said she now understood why the partitioner want to examine her coccyx area and gave consent for the assessment to proceed. This experience showed me exactly why understanding the anatomy and pathogenesis of a condition is essential part of communication and gaining consent from the patient while also showing me how to deal with a situation like this in the future when I am a practitioner in this scenario.

3.9 Acute LBP Reflection (30/12/19) (A4, A6, D2)
Last week I had a patient with acute low back pain so bad she booked an appointment on the day which happened to be Christmas eve. After taking the case history it appeared that she was suffering from acute discogenic pain therefore a full LEX neurological examination was required meaning she would have to remove her skinny jeans and she didn’t have any shorts. After informing her what tests I would like to preform and why she said that she was happy to undress to her underwear and said she was wearing appropriate underwear to allow such an examination to be undertaken. Upon re-entering the room, she was wearing a lacy bra and thong this is a situation that believe could be misunderstood therefore I ask my tutor to watch my examination and to chaperone until I could cover the patient up with a blanket. This was the first experience as an osteopath of this nature that I have encountered. Upon personal reflection and discussion with my tutor I believe that appropriate measures were taken and going forward I would handle similar situations in the same manner. I was happy with this handling as I feel that it best protected both myself as the practitioner and the patient.

SC.8 Summer Clinic Review (19/09/20) (A6)
I have just completed my five weeks summer clinic and overall, it was a very enjoyable experience despite the additional challenges that adapting to covid measures provided. The aspect that I found the hardest to adapt and get used to was not being able to offer/give new patients who had not worn appropriate clothing a blanket during the examination/treatment part of their appointment which I would normally do pre-pandemic to preserve their dignity. Throughout summer clinic I took different approaches to this challenge by either allowing the patient to not get undressed, getting the patient to undress for a short period of time to allow for examination or asking the patient to get undressed then covering them with the item of clothing they had just removed. Looking back, I believe I handled this situation the best I could given the circumstances although none of these solutions are acceptable for long term use as they all present their own limitations. I feel it may have been better for me to ask for guidance from the clinic regarding the best way to handle this or look to look to guidance provided by professional bodies. When I return to clinic, I will ask the head of clinic if the receptionist team can reinforce to new patients that it may be beneficial if they bring shorts or a vest top to allow a for full examination and treatment.

4.2 Patient Dignity (05/10/20) (A6, A7)
Today I treated a 67yr woman takeover case who comes to the clinic for maintenance for her lateral and central stenosis symptoms. After meeting her at reception I walked her to the treatment room then I invited her to take a seat in the room to discuss how she has been since last treatment. However instead of taking a seat she proceeded to undress to her underwear I reiterated that she didn’t need to undress just yet. However, she insisted as she’d rather do it now instead of sitting down then having to stand again do it in five minutes. This took me by surprise and affect my ability to collect the information that I needed as I preoccupied by thought of if I should’ve allowed her to undress when she did. Looking back, I should have allowed her to proceed as if she is comfortable to undress at that point I should be as well. While not letting it affect my performance as a practitioner as I treat most of my patients in their underwear and her undressing earlier in the appointment shouldn’t change the level of my performance as that’s how she felt comfortable. Therefore, in the future I will try not to let patients undressing earlier in the appointment if it’s easier for them or its their preference affect my performance by second guessing if I should allow them to do so, as ultimately, it’s their appointment and choice.

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A7: You must make sure your beliefs and values do not prejudice your patients’ care.

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A7: You must make sure your beliefs and values do not prejudice your patients’ care.

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3.11 Drunk Driver (27/01/20) (A7, C4, D5)
Last week I treated a 50yr male presenting with hip osteoarthritis. During the first treatment he said that he regularly drinks a large amount of alcohol and his GP have discussed him drinking less to help with his health. However last week, he mentioned that he sometimes drinks alcohol and then drives home he then went on to further add that his daughter is always telling him that he shouldn’t. I was unsure what the appropriate response to this would be and didn’t want to reaffirm that it was acceptable behaviour though I didn’t know how to correctly convey that or if there was a procedure within the clinic to manage a situation like this. This made me feel angry and uncomfortable that he didn’t seem to care about what he was doing and putting other people’s life in danger. After disclosing this I information to my tutor he said that he was also not sure about what the correct procedure for a situation like this. Although did recommended that I look in the OPS and contacted GOSC to ask them for their advice. Therefore, I contacted GOSC to ask for advice, and they summarised how it would relate to the OPS and went on to say that I should speak to clinic administration. So, I then contacted the safeguarding leader and gave her a statement so that they could evaluate what to do next. I was unaware that I should have reported it to safeguarding immediately after the incident and it was also not mentioned to me by any of the tutors. Therefore, I am happy that I had this experience so that I have made aware of this system should I need it again. I think why I felt so angry and uncomfortable during and after this experience was due to my past being a first responder and dealing with innocent casualties after being hit by a drunk driver. Although I was aware of patient confidentiality and didn’t know when I could break the confidentiality. Consequently, GOSCs perspective on this was interesting and I learnt a lot from communicating with them. I found this to be an intense interaction at the time, but I feel that I learnt a lot from it. Therefore, if I was to have this experience again, I would have responded more confidently and made him aware it was against the law. Nevertheless, I feel more comfortable now that I have been through the procedures now after experiencing this situation and now know how active the correct procedures quicker in the future.

4.1 Re-returning Maternity Patient (03/10/20) (A5, A7)
Earlier this week my 33yrs maternity patient returned reporting that she has only mild symptoms post 48hrs after treatment of which after her pain levels quickly progress back to 8/10 on the pain scale. The fact that she has 48hrs of only mild symptoms after treatment gave me a sense of accomplishment as it’s something that she didn’t experience in the previous pregnancy. However, on reflection instead of just being happy with the progress we have made up to now at the time I should have concentrated on what might be the cause for her symptoms progressing quickly after the 48hrs post treatment and if it’s something that the patient is doing around that timeframe. Meaning we could adapt what she is doing to do differently and possibly extending the mild symptomatic window past 48hrs. Consequently, going forward, I will try not to let myself settle for short timeframes of symptomatic relief and investigate how I can extend that timeframe through supporting the patents to adapt their lifestyle while treatment is ongoing.

4.2 Patient Dignity (05/10/20) (A6, A7)
Today I treated a 67yr woman takeover case who comes to the clinic for maintenance for her lateral and central stenosis symptoms. After meeting her at reception I walked her to the treatment room then I invited her to take a seat in the room to discuss how she has been since last treatment. However instead of taking a seat she proceeded to undress to her underwear I reiterated that she didn’t need to undress just yet. However, she insisted as she’d rather do it now instead of sitting down then having to stand again do it in five minutes. This took me by surprise and affect my ability to collect the information that I needed as I preoccupied by thought of if I should’ve allowed her to undress when she did. Looking back, I should have allowed her to proceed as if she is comfortable to undress at that point I should be as well. While not letting it affect my performance as a practitioner as I treat most of my patients in their underwear and her undressing earlier in the appointment shouldn’t change the level of my performance as that’s how she felt comfortable. Therefore, in the future I will try not to let patients undressing earlier in the appointment if it’s easier for them or its their preference affect my performance by second guessing if I should allow them to do so, as ultimately, it’s their appointment and choice.

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B1: You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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B1: You must have and be able to apply sufficient and appropriate knowledge and skills to support your work as an osteopath.

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1.1 First Clinic Observation (01/12/17) (B1,D9)
Today was my first day observing in clinic where I observed a new patient for the first time. The patient (39yrs) presented with a painful swollen right knee which he described as a stabbing pain and scored it 9/10 on the pain scale. After the case history was complete the practitioner presented the case to the clinic tutor although she struggled with diagnosing the relevant DDs for the case. The clinic tutor then asked me if I had any relevant DDs of which I responded with the DD compressed fat pad. The clinic tutor then confirmed that was the case in this presentation. Upon exiting the team room, the practitioner then confronted me for intervening in the DDx process and spoiling a learning opportunity for her. This was extremely frustrating and annoying as the clinic tutor had directly asked me the question of which before I did not input into the conversation in the room as I did not feel like it was my place to do so. Therefore, at the time I felt like I had done nothing wrong however on reflection the practitioner was in a stressful situation and having a first-year student possibly making her inadequate just before she had to assess the patient physically would only add to the stress and pressure. Consequently, in the future when observing I will first think about the how my response a question will make the practitioner feel and possibly affect his/her confidence.

2.1 Clinic Observation (07/12/18) (B1, B2)
Recently I have had the opportunity to observe third and fourth year students in clinic and one thing that has caught my attention is the difference in level of confidence and competence. The fourth-year student who I recently observed was required to perform a T-spine HVT and was able to do so efficiently without the supervision of a clinic tutor. Whereas the third-year student who was also required to perform a T-spine HVT acknowledged that this skill set was outside his level of competence and required his clinic tutor to perform the technique on his patient. I found this particularly interesting as it showed the natural progression of confidence and competence over the course. While also showing me, it is a great asset to be able to elevate your own strengths and weaknesses. Next year when I am in clinic, I will aim to be admit to myself these strengths and weaknesses and ask my clinic tutor for help when I am required to perform a skill that perhaps isn’t my strongest.

3.1 First Patient Reflection (10/09/19) (B1, B2)
Today I had my first patient, the patient (male, 42yrs) presented with lateral elbow pain that had come on over the last three weeks. Personally, I felt like the case history went well as I stuck to the structure SCORATES as well as being quite fortunate that lateral elbow pain with his presentation could only be a finite amount of dd’s. Although I felt like I did a good job with the case history I really struggled relaying the information to my tutor. The sequence I presented the information wasn’t clear or logical and failed to sufficiently support my dd’s which was frustrating. After I had finished with my patient my clinic tutor sat down with me and ran through a couple of examples of structures I could use in the future when presenting my case history’s. In the future I plan to use one of these structures and slowly adapt it to my preference over time while also seeking feedback from my clinic tutors about how my presentations could be improved further.

3.7 Return to Clinic (29/10/19) (B1, B2, B3, C1)
Today was my first day back at clinic since my first patient and introduction week in September due to having viral meningitis and subsequently post viral fatigue. I was excited to finally be back and being able to see everyone again. Although I was also nervous as I haven’t been able to practice any elements of a case history or even been hands on in a clinical aspect since my introduction week. After observing two new patients, the gap in the depth and details throughout the case history between myself and my colleagues was a lot more significant than I thought it would be and I found this very unsettling. On reflection the gap between myself and my colleagues in the case history elements of a patient’s appointment isn’t necessarily the worst thing as I am in a fortunate enough position to have worked as a first responder. This means that my medical case history and medical testing is an area that I tend to be more comfortable than others and I can focus on improving the osteopathic part of my case history taking skills. I discussed my concerns with the head of clinic, and we agreed to delay any new patients I was meant to have for the next couple of weeks and solely focus on improving my case history taking skills via observations and seeking advice from clinic tutors on what areas I should focus on.

3.12 First Shoulder Patient (14/02/20) (B1, B2, B3, C1)
Today I had my first patient presenting with shoulder pain and reduced range of movement. I really struggled when it came to asking follow up questions in the case history and even more so when coming up with dd’s after presenting the case to my tutor. My tutor also had to step in quite a bit when I was undertaking the examination process as I didn’t know how to interpret the results from each test. This experience really highlighted my lack of knowledge of the anatomy, possible dd’s and testing of the shoulder complex and it is an area I should look to improve for the future. Therefore, over the next couple of weeks I’m going to make it a priority to study the anatomy, physiology, common dd’s and testing of the shoulder complex while practicing testing of the shoulder in my clinic group.

4.8 Mock CCA (23/03/21) (B1, B2, B3)
Yesterday I had my mock CCA overall I felt like it went well and was happy with my performance. However, my examiner gave me some feedback post exam that I didn’t expect. He said that although my dd’s were good, the way I presented the case and that I didn’t explain the dd’s that I had ruled out throughout the case history means that I would only scrap a pass overall. While this feedback was disappointing to hear as I felt like I had done quite well, upon reflection I’m glad that I had this experience as it means I now know how the CCA process works, and I have time to fix this weakness in my presenting skills. Therefore, going forward, when I have a new patient, I will ask the tutor to allow me to present to them in the way that I will be expected to in my CCA and give me feedback on how I can change my presenting skills and improve them.

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B2: You must recognise and work within the limits of your training and competence.

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B2: You must recognise and work within the limits of your training and competence.

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2.1 Clinic Observation (07/12/18) (B1, B2)
Recently I have had the opportunity to observe third and fourth year students in clinic and one thing that has caught my attention is the difference in level of confidence and competence. The fourth-year student who I recently observed was required to perform a T-spine HVT and was able to do so efficiently without the supervision of a clinic tutor. Whereas the third-year student who was also required to perform a T-spine HVT acknowledged that this skill set was outside his level of competence and required his clinic tutor to perform the technique on his patient. I found this particularly interesting as it showed the natural progression of confidence and competence over the course. While also showing me, it is a great asset to be able to elevate your own strengths and weaknesses. Next year when I am in clinic, I will aim to be admit to myself these strengths and weaknesses and ask my clinic tutor for help when I am required to perform a skill that perhaps isn’t my strongest.

3.1 First Patient Reflection (10/09/19) (B1, B2)
Today I had my first patient, the patient (male, 42yrs) presented with lateral elbow pain that had come on over the last three weeks. Personally, I felt like the case history went well as I stuck to the structure SCORATES as well as being quite fortunate that lateral elbow pain with his presentation could only be a finite amount of dd’s. Although I felt like I did a good job with the case history I really struggled relaying the information to my tutor. The sequence I presented the information wasn’t clear or logical and failed to sufficiently support my dd’s which was frustrating. After I had finished with my patient my clinic tutor sat down with me and ran through a couple of examples of structures I could use in the future when presenting my case history’s. In the future I plan to use one of these structures and slowly adapt it to my preference over time while also seeking feedback from my clinic tutors about how my presentations could be improved further.

3.7 Return to Clinic (29/10/19) (B1, B2, B3, C1)
Today was my first day back at clinic since my first patient and introduction week in September due to having viral meningitis and subsequently post viral fatigue. I was excited to finally be back and being able to see everyone again. Although I was also nervous as I haven’t been able to practice any elements of a case history or even been hands on in a clinical aspect since my introduction week. After observing two new patients, the gap in the depth and details throughout the case history between myself and my colleagues was a lot more significant than I thought it would be and I found this very unsettling. On reflection the gap between myself and my colleagues in the case history elements of a patient’s appointment isn’t necessarily the worst thing as I am in a fortunate enough position to have worked as a first responder. This means that my medical case history and medical testing is an area that I tend to be more comfortable than others and I can focus on improving the osteopathic part of my case history taking skills. I discussed my concerns with the head of clinic, and we agreed to delay any new patients I was meant to have for the next couple of weeks and solely focus on improving my case history taking skills via observations and seeking advice from clinic tutors on what areas I should focus on.

3.12 First Shoulder Patient (14/02/20) (B1, B2, B3, C1)
Today I had my first patient presenting with shoulder pain and reduced range of movement. I really struggled when it came to asking follow up questions in the case history and even more so when coming up with dd’s after presenting the case to my tutor. My tutor also had to step in quite a bit when I was undertaking the examination process as I didn’t know how to interpret the results from each test. This experience really highlighted my lack of knowledge of the anatomy, possible dd’s and testing of the shoulder complex and it is an area I should look to improve for the future. Therefore, over the next couple of weeks I’m going to make it a priority to study the anatomy, physiology, common dd’s and testing of the shoulder complex while practicing testing of the shoulder in my clinic group.

SC.2 Children's Clinic Not Treating Babies (18/08/20) (B2, C4, D1, D11)
Earlier today was my first time in children’s clinic and I have decided it is best for me not to treat babies and children up to the age of 5yrs. My decision was based off the patient’s safety, my mental health and being honest with myself. I took this decision because when I was a first responder, I lost a 2-month-old baby boy and ended up having to leave that job due to the consequently PTSD I suffered from that incident. Since that time, I haven’t had to be medically responsible for a baby or child under the age of five and don’t know if I would suffer from a relapse in my PTSD in the room when treating the patient or after. Either way this would not be fair on the patient, the parents, my tutor, or myself if I decided to treat and see how I react when in that situation. I feel like this is the right decision for the at least the short term until I have more exposer to the baby/young child osteopath relationship and treatment process.

4.8 Mock CCA (23/03/21) (B1, B2, B3)
Yesterday I had my mock CCA overall I felt like it went well and was happy with my performance. However, my examiner gave me some feedback post exam that I didn’t expect. He said that although my dd’s were good, the way I presented the case and that I didn’t explain the dd’s that I had ruled out throughout the case history means that I would only scrap a pass overall. While this feedback was disappointing to hear as I felt like I had done quite well, upon reflection I’m glad that I had this experience as it means I now know how the CCA process works, and I have time to fix this weakness in my presenting skills. Therefore, going forward, when I have a new patient, I will ask the tutor to allow me to present to them in the way that I will be expected to in my CCA and give me feedback on how I can change my presenting skills and improve them.

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B3: You must keep your professional knowledge and skills up to date.

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B3: You must keep your professional knowledge and skills up to date.

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3.7 Return to Clinic (29/10/19) (B1, B2, B3, C1)
Today was my first day back at clinic since my first patient and introduction week in September due to having viral meningitis and subsequently post viral fatigue. I was excited to finally be back and being able to see everyone again. Although I was also nervous as I haven’t been able to practice any elements of a case history or even been hands on in a clinical aspect since my introduction week. After observing two new patients, the gap in the depth and details throughout the case history between myself and my colleagues was a lot more significant than I thought it would be and I found this very unsettling. On reflection the gap between myself and my colleagues in the case history elements of a patient’s appointment isn’t necessarily the worst thing as I am in a fortunate enough position to have worked as a first responder. This means that my medical case history and medical testing is an area that I tend to be more comfortable than others and I can focus on improving the osteopathic part of my case history taking skills. I discussed my concerns with the head of clinic, and we agreed to delay any new patients I was meant to have for the next couple of weeks and solely focus on improving my case history taking skills via observations and seeking advice from clinic tutors on what areas I should focus on.

3.12 First Shoulder Patient (14/02/20) (B1, B2, B3, C1)
Today I had my first patient presenting with shoulder pain and reduced range of movement. I really struggled when it came to asking follow up questions in the case history and even more so when coming up with dd’s after presenting the case to my tutor. My tutor also had to step in quite a bit when I was undertaking the examination process as I didn’t know how to interpret the results from each test. This experience really highlighted my lack of knowledge of the anatomy, possible dd’s and testing of the shoulder complex and it is an area I should look to improve for the future. Therefore, over the next couple of weeks I’m going to make it a priority to study the anatomy, physiology, common dd’s and testing of the shoulder complex while practicing testing of the shoulder in my clinic group.

3.10 End of First Term Review (3rd Year) (30/12/19) (B3, D9)
I have finished my first term in third year and overall, I feel quite apprehensive about the experience. Given that I missed the two thirds of the term due having and recovering from meningitis I feel that I'm not at the level I should be. This has also been teamed with ongoing conflict among certain members in my clinic group meaning it isn’t the most supportive environment or conducive to my or the clinic groups learning. I have tried speaking to the group as individuals since I’ve returned to see how we can manage the situation with the members who have an ongoing conflict, though this has seemed to be ineffective. Upon reflection though I have tried to speak to individuals in the group perhaps this was the incorrect way to approach this situation. Next term I will suggest to the group that we sit down with the head of clinic and discus what’s been going on so she can help us correct the situation to make our clinical experience one of a supportive learning environment where we all feel safe and supported throughout our learning. While going forward I will also speak to the head of clinic about further clinic slots for myself to help bridge the gap in experience in a clinical environment I have had due to my recovery from illness throughout the first term.

3.14 Online Clinic (16/05/20) (B3, C4)
Over the last couple of weeks due to covid-19 we have been having clinic sessions online with our clinic tutors. The sessions tend to consist of taking a case history from the clinic tutor about a patient they had seen in the past. However, I find these sessions difficult to follow as I feel like they don’t replicate a real scenario in clinic when the person sitting in front of you is in pain and has paid for your expertise. On reflection given the current situation with lockdown and the pandemic this is the best way for me to continue my learning without putting any myself or other at risk. Therefore, in the coming weeks I will try to engage more with the online classes while trying to focus on the benefits of practicing taking case histories in a controlled environment.

SC.6 PMP-22 Gene Defect Ultrasound Referral (11/09/20) (B3, D10)
Earlier this week I saw my patient who has suspected bilateral plantar fasciitis which is predisposed by her PMP-22 gene defect. I have now seen her four times and she has had no regression in signs or symptoms even though I am following the current guidelines on manual treatment and have asked her to stop her long-distance walking to allow her feet to recover. I found this to be a frustrating and annoying experience as I feel like I am doing everything I possibly can, and nothing seems to be working. Having now had a couple of days to look back, talk to multiple clinic tutors and continue to study PMP-22 gene defect further I have realised that it can sometimes be normal for tissues to respond differently if other factors are in play in this case the PMP-22 gene defect. Therefore, when I next see this patient in a couple of weeks, I will send her for an ultrasound to confirm my diagnosis to allow an informed decision for following treatments or referral and discuss with the patient why she may require more treatments due to her underlying condition and why an ultrasound scan in my opinion will be beneficial.

4.8 Mock CCA (23/03/21) (B1, B2, B3)
Yesterday I had my mock CCA overall I felt like it went well and was happy with my performance. However, my examiner gave me some feedback post exam that I didn’t expect. He said that although my dd’s were good, the way I presented the case and that I didn’t explain the dd’s that I had ruled out throughout the case history means that I would only scrap a pass overall. While this feedback was disappointing to hear as I felt like I had done quite well, upon reflection I’m glad that I had this experience as it means I now know how the CCA process works, and I have time to fix this weakness in my presenting skills. Therefore, going forward, when I have a new patient, I will ask the tutor to allow me to present to them in the way that I will be expected to in my CCA and give me feedback on how I can change my presenting skills and improve them.

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B4: You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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B4: You must be able to analyse and reflect upon information related to your practice in order to enhance patient care.

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Reflective Model (11/01/21) (B4)
Up to now I have been writing reflections without a reflective model as I was unaware that they existed. However, today I watched an uploaded lecture which covered how to reflect properly and what reflections should include. Originally, I was slightly annoyed that before now we had not any guidance on how to reflect and not told that we were meant to use models of reflection. Although upon reflection, I am glad that we have now been informed of how to structure a reflection as previously I have struggled to do so due to my dyslexia. Therefore, going forward, I will apply the DIEP model to my reflections. While also going back to adapt my previous reflections to follow this DIEP model.

4.14 Refection on Portfolio (21/05/21) (B4, D4, D12)
Over the course of the last three and half years I have been keeping and adding reflections and experiences to my portfolio Padlet. To begin with I struggled to find a logical clear sequence to structure my reflections which lead to the quality being poor. However, implementing the DEIP reflective model enabled me to plan out a clear sequence throughout my reflections giving me a clear take reflective point upon which I could act. These action points over the course of three years have allowed me to see trends of weaknesses and strengths in my performance in relation to the OPS as well as seeing what OPS’s I'm not being exposed to as a student practitioner (D4, D12). Upon reflection, I believe the quality of my reflections and how I action them has greatly improved since first year, which in turn, has lead me to develop and improve as a practitioner. Therefore, going forward I will continue to keep a reflective portfolio to allow me to spot weaknesses/strengths in my performance and access myself against the OPS.

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

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

# data[].attributes.body
3.7 Return to Clinic (29/10/19) (B1, B2, B3, C1)
Today was my first day back at clinic since my first patient and introduction week in September due to having viral meningitis and subsequently post viral fatigue. I was excited to finally be back and being able to see everyone again. Although I was also nervous as I haven’t been able to practice any elements of a case history or even been hands on in a clinical aspect since my introduction week. After observing two new patients, the gap in the depth and details throughout the case history between myself and my colleagues was a lot more significant than I thought it would be and I found this very unsettling. On reflection the gap between myself and my colleagues in the case history elements of a patient’s appointment isn’t necessarily the worst thing as I am in a fortunate enough position to have worked as a first responder. This means that my medical case history and medical testing is an area that I tend to be more comfortable than others and I can focus on improving the osteopathic part of my case history taking skills. I discussed my concerns with the head of clinic, and we agreed to delay any new patients I was meant to have for the next couple of weeks and solely focus on improving my case history taking skills via observations and seeking advice from clinic tutors on what areas I should focus on.

3.8 First Patient Post Meningitis (15/11/19) (C1, D1)
Today I had my first patient at clinic post meningitis, the patient was a 54yr male lawyer presenting with cervical pain that came on that came on insidiously two months ago along with symptom free drop attacks. Throughout the case history I felt uncomfortable and out of my depth mainly due to the nonmechanical in origin. A situation that I didn't feel appropriately equipped to deal with as an osteopathic student. Upon reporting the case to my tutor, he agreed with me, that case seemed to be pathological in origin. I then asked for the tutor to help me with the cranial nerve examination, which he said he would. My tutor then instructed me to start, and they would come in as soon as I had explained what I wanted to do to the patient. Upon starting the cranial examination, the tutor didn’t arrive in the room, and I asked one of my observers to go and find them. Upon returning the observer said she couldn’t find the tutor, so I had to continue myself. After the appointment the tutor didn’t acknowledge that they didn’t come to the room which caused the me to feel awkward and like I had done something wrong. Overall, this experience was a steep learning curve and though I had expressed to my clinic tutor this was my first patient since suffering from meningitis, I felt very little support and left out of my depth when dealing with a patient with this presentation. On reflection I am still feeling uncomfortable with how I was left with patient to deal by myself even though I had expressed to my tutor before the appointment that I would require a bit more support than usual as I hadn’t undertaken a full appointment since September. Therefore, I will speak to the head of student support at clinic as I feel like this experience has knocked my confidence and the tutor in question could have made it an interesting learning opportunity instead of an experience that left me uncomfortable and vulnerable. I feel that it is important that I bring this experience to the clinics attention as I would like to do my part to help prevent this type of experience for another student who is returning to clinic after a longer absence as well as for the patients who may have their experience at the clinic affected by a practitioner who hasn’t experienced adequate support.

3.12 First Shoulder Patient (14/02/20) (B1, B2, B3, C1)
Today I had my first patient presenting with shoulder pain and reduced range of movement. I really struggled when it came to asking follow up questions in the case history and even more so when coming up with dd’s after presenting the case to my tutor. My tutor also had to step in quite a bit when I was undertaking the examination process as I didn’t know how to interpret the results from each test. This experience really highlighted my lack of knowledge of the anatomy, possible dd’s and testing of the shoulder complex and it is an area I should look to improve for the future. Therefore, over the next couple of weeks I’m going to make it a priority to study the anatomy, physiology, common dd’s and testing of the shoulder complex while practicing testing of the shoulder in my clinic group.

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

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

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1.3 Dyslexia Assessment (19/03/18) (C2)
Today I got my dyslexia assessment results back as excepted the results indicated that I still have severe dyslexia. At the age of 7 my parents were told I would never be able to read or write to the severity of my dyslexia and there was nothing they could do about it. However, since then, I attended extra English classes until the age of 14 and haven’t been tested since. Therefore, receiving these results is something that I was worried about as it could affect my ability to record patients details and records effectively and correctly. I discussed how I was feeling with the school, and they have reassured me that previously students with the same level of dyslexia have gone on to qualify from the course with no problems and extra help is there for me should I need it. After speaking to the school, I feel a lot more comfortable with the situation I’m in and it’s just something that I need to adapt to by applying myself to learn the common spellings of medication and medial terms.

4.4 Alternating Clinic Weeks (23/11/20) (C2)
Recently due to covid-19 regulations we have had to split our clinic groups in half and alternate weeks between clinic and online tutoring. This has meant we are now required to cover each other’s patients more often. Which has led to some of my colleagues disclosing to me that they struggle to read my patient notes due to my handwriting. Handwriting is something that I have struggled with since I was in school, and I have been told that it is related to my dyslexia. I found it very demoralising to be commentated on it as it has always felt as if it is something that I don’t really have much control over. However, looking back my attitude towards it could be improved. Feeling that I am unable to have any impact on a skill isn’t a very productive mind set so whilst I can’t change my dyslexia, I do have some control over other factors which I can attempt to impact. Therefore, going forward I am going to attempted to change the layout of my notes and change the type of pen to improve the overall legibility of my notes.

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C3: You must respond effectively and appropriately to requests for the production of written material and data.

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C3: You must respond effectively and appropriately to requests for the production of written material and data.

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SC.4 Systematically Ill Patient Candour & Referral (25/08/20) (C3, C6, D3, D7, D10)
Yesterday I had a takeover 84yr male takeover patient, on the previous notes taken two weeks prior it said that the practitioner had wanted to refer but the tutor at the time had disagreed. Upon meeting the gentleman, he was in a wheelchair accompanied by his daughter and looked extremely unwell (pale, sweaty and short of breath). On completing the case history and testing myself and my tutor agreed that this gentleman’s presentation was not mechanical in origin. Therefore, I told the gentleman that I would not be treating today and the reasons why and offered to write a referral letter to his GP. He then asked me to speak to his daughter which I did. Although upon offering to write a referral letter to her father’s GP she was quite rude about the GP citing that they were “useless and didn’t care”.  Which caught me by surprise, meaning that I didn’t know how to react therefore leaving an uncomfortable silence. Looking back, I feel how I handle the situation in terms of being open and honest about the gentleman’s health to him and his daughter and why I couldn’t treat was good and followed the OPS guidance on the duty of candour with patients. Although how I handled his daughter criticising the GP could have been better. As an osteopath I am aware that I can’t take sides with the patient or the GP as the patient has those feelings and beliefs for a reason on the other hand, I can’t be drawn into criticising another health professional. Upon reflection I should asked the daughter to expand on why she felt like the GP was “useless and didn’t care” therefore giving me a clearer picture on why she felt this way. Leading me to possibly being able to explain that sometimes GPs have bad days and with the referral I would write for her father would hopefully help them get the answers they couldn’t get from her father due the time restrains they’re under when conducting their case history.

4.11 Shoulder Patient Ultrasound Referral & Result (22/04/21) (C3, D10)
Over the last two months I have been seeing a 52yr old women for a suspected subscapularis tear/rupture which has led to her absence from work. Due to the lack of progress in her recovery from treatment and the patient being concerned of work needing evidence of her injury I decided to get confirmation of her diagnosis via an ultrasound referral. Today I received her results which showed my suspected diagnosis was incorrect and she has an anterior/lateral impingement, subacromial bursitis and a grade two subscapularis tear. Therefore, I passed the scan results onto my patient as evidence of her diagnosis to her work. Upon reflection, I believe I handle this case well as I listen to my patients concerns about returning to work and gave her the relevant written evidence she required. Consequently, I will continue to listen to my patients concerns and try to supply them with the information written or verbal they need to ease those concerns.

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C4: You must take action to keep patients from harm.

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C4: You must take action to keep patients from harm.

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3.4 Meningitis Discharge (21/10/19) (A3, A5, C4)
Three weeks ago, my doctor informed me that after 10 days being admitted to hospital for meningitis I was being discharged and I could go home to continue my recovery there. He then told me to go back to A&E if my temperature came or my symptoms started to worsen again and gave me some strong painkillers to manage any headaches I was still experiencing. Upon returning home I experienced a mixture of anxiety and relief. The anxiety was due to the sudden realisation at if I was to suddenly experience a worsening in symptoms there was no immediate medical attention but also the relief, that I was now in an environment that I felt comfortable. In hindsight my anxiety could of potentially be relieved by the doctors who discharged me by going into a more in-depth explanation on what to expect in my recovery and what was normal to experience when recovering from meningitis. Although this experience has been emotionally testing up to now as I am still experiencing side effects from the meningitis, I feel like this can be reflected and positively acted upon in my role as a practitioner. As I have now experienced how a patient may feel after returning home from treatment or being discharged after a series of treatments. Therefore, once I return to clinic, I will aim to make sure I give my patients a thorough explanation on what may experience post treatment and what possible symptom progressions may warrant further treatment or medical attention.

3.6 Pre-return To Clinic Dr. Assessment (26/10/19) (A5, C4, D11)
Yesterday I had hopefully my final post meningitis check-up, after a nearly two months of being hospitalised. I am still suffering from post-viral fatigue although I can now get through the day without needing to stop for breaks. Therefore, I felt like I was ready to return to clinic and university. During the visit to the GP, the doctor asked me a series of questions and preformed cranial nerve screening to check I was back to the level required by GOSC to return to active clinical practice. The doctor eventually agreed that I was able to return under the conditions of limited patients and hours to start with. Personally, I am delighted that now my life can begin to return to a level of normality although I must continue to assess my energy levels to allow for continued recovery, not risk patient’s safety and seek medical advice should I feel like I am not able to perform to the level I should be.

3.11 Drunk Driver (27/01/20) (A7, C4, D5)
Last week I treated a 50yr male presenting with hip osteoarthritis. During the first treatment he said that he regularly drinks a large amount of alcohol and his GP have discussed him drinking less to help with his health. However last week, he mentioned that he sometimes drinks alcohol and then drives home he then went on to further add that his daughter is always telling him that he shouldn’t. I was unsure what the appropriate response to this would be and didn’t want to reaffirm that it was acceptable behaviour though I didn’t know how to correctly convey that or if there was a procedure within the clinic to manage a situation like this. This made me feel angry and uncomfortable that he didn’t seem to care about what he was doing and putting other people’s life in danger. After disclosing this I information to my tutor he said that he was also not sure about what the correct procedure for a situation like this. Although did recommended that I look in the OPS and contacted GOSC to ask them for their advice. Therefore, I contacted GOSC to ask for advice, and they summarised how it would relate to the OPS and went on to say that I should speak to clinic administration. So, I then contacted the safeguarding leader and gave her a statement so that they could evaluate what to do next. I was unaware that I should have reported it to safeguarding immediately after the incident and it was also not mentioned to me by any of the tutors. Therefore, I am happy that I had this experience so that I have made aware of this system should I need it again. I think why I felt so angry and uncomfortable during and after this experience was due to my past being a first responder and dealing with innocent casualties after being hit by a drunk driver. Although I was aware of patient confidentiality and didn’t know when I could break the confidentiality. Consequently, GOSCs perspective on this was interesting and I learnt a lot from communicating with them. I found this to be an intense interaction at the time, but I feel that I learnt a lot from it. Therefore, if I was to have this experience again, I would have responded more confidently and made him aware it was against the law. Nevertheless, I feel more comfortable now that I have been through the procedures now after experiencing this situation and now know how active the correct procedures quicker in the future.

3.13 Covid-19 Outbreak (17/03/20) (C4, C5)
Over the last couple of weeks there has been a rise of uncertainty around the growing severity of covid-19 and therefore have been asked to implement new sanitation measures (sanitise couches after every use, no longer use fabric pillows and no longer use blankets). I’m happy that these guidelines have been implemented swiftly as it will help keep everyone safer in the long term even though it may take a bit of getting use to in the short term. Although I am worried about possibly catching or passing the virus should I treat someone with it or have it myself asymptomatically. The head of clinic sent out an email assuring us that should the risk become too high clinic will be shut. This current ongoing event has made me think a lot about sanitation and how in the past I may didn’t consider it as much as I should. Therefore, for the future I will follow the current guidelines of sanitation and strive to continue the level of sanitation after covid-19 has passed.

3.14 Online Clinic (16/05/20) (B3, C4)
Over the last couple of weeks due to covid-19 we have been having clinic sessions online with our clinic tutors. The sessions tend to consist of taking a case history from the clinic tutor about a patient they had seen in the past. However, I find these sessions difficult to follow as I feel like they don’t replicate a real scenario in clinic when the person sitting in front of you is in pain and has paid for your expertise. On reflection given the current situation with lockdown and the pandemic this is the best way for me to continue my learning without putting any myself or other at risk. Therefore, in the coming weeks I will try to engage more with the online classes while trying to focus on the benefits of practicing taking case histories in a controlled environment.

SC.1 Post Lockdown Clinic Return (17/08/20) (C4, C5)
Today was my first day back at clinic since the covid-19 pandemic shut it down in March. Upon arriving at clinic, I was nervous about how we could all safely be in clinic and treat patients while keeping our covid exposure to a minimum. The head of clinic ran us through how clinic had changed from pre-covid regulations. She instructed use that we are now to wear PPE (gloves, mask, apron) whenever we are in close proximity to a patient and that there are separate rooms to put on and take off the PPE between patients. She also went on to tell us that the rooms must be continued to be wiped down with antibacterial spray after use and that there is now a screening process before patients are allowed to enter the clinic. Upon hearing these new rules on sanitation to protect us and the patients I felt reassured that returning to clinic was the right thing to do especially since osteopathy is a primary health care profession. Therefore, to ensure the continued safety of myself and my patients I will make sure that I follow these new rules and regulations and that I am up to date with any changes to these rules and regulations.

SC.2 Children's Clinic Not Treating Babies (18/08/20) (B2, C4, D1, D11)
Earlier today was my first time in children’s clinic and I have decided it is best for me not to treat babies and children up to the age of 5yrs. My decision was based off the patient’s safety, my mental health and being honest with myself. I took this decision because when I was a first responder, I lost a 2-month-old baby boy and ended up having to leave that job due to the consequently PTSD I suffered from that incident. Since that time, I haven’t had to be medically responsible for a baby or child under the age of five and don’t know if I would suffer from a relapse in my PTSD in the room when treating the patient or after. Either way this would not be fair on the patient, the parents, my tutor, or myself if I decided to treat and see how I react when in that situation. I feel like this is the right decision for the at least the short term until I have more exposer to the baby/young child osteopath relationship and treatment process.

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C5: You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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C5: You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation.

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3.13 Covid-19 Outbreak (17/03/20) (C4, C5)
Over the last couple of weeks there has been a rise of uncertainty around the growing severity of covid-19 and therefore have been asked to implement new sanitation measures (sanitise couches after every use, no longer use fabric pillows and no longer use blankets). I’m happy that these guidelines have been implemented swiftly as it will help keep everyone safer in the long term even though it may take a bit of getting use to in the short term. Although I am worried about possibly catching or passing the virus should I treat someone with it or have it myself asymptomatically. The head of clinic sent out an email assuring us that should the risk become too high clinic will be shut. This current ongoing event has made me think a lot about sanitation and how in the past I may didn’t consider it as much as I should. Therefore, for the future I will follow the current guidelines of sanitation and strive to continue the level of sanitation after covid-19 has passed.

SC.1 Post Lockdown Clinic Return (17/08/20) (C4, C5)
Today was my first day back at clinic since the covid-19 pandemic shut it down in March. Upon arriving at clinic, I was nervous about how we could all safely be in clinic and treat patients while keeping our covid exposure to a minimum. The head of clinic ran us through how clinic had changed from pre-covid regulations. She instructed use that we are now to wear PPE (gloves, mask, apron) whenever we are in close proximity to a patient and that there are separate rooms to put on and take off the PPE between patients. She also went on to tell us that the rooms must be continued to be wiped down with antibacterial spray after use and that there is now a screening process before patients are allowed to enter the clinic. Upon hearing these new rules on sanitation to protect us and the patients I felt reassured that returning to clinic was the right thing to do especially since osteopathy is a primary health care profession. Therefore, to ensure the continued safety of myself and my patients I will make sure that I follow these new rules and regulations and that I am up to date with any changes to these rules and regulations.

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

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

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SC.4 Systematically Ill Patient Candour & Referral (25/08/20) (C3, C6, D3, D7, D10)
Yesterday I had a takeover 84yr male takeover patient, on the previous notes taken two weeks prior it said that the practitioner had wanted to refer but the tutor at the time had disagreed. Upon meeting the gentleman, he was in a wheelchair accompanied by his daughter and looked extremely unwell (pale, sweaty and short of breath). On completing the case history and testing myself and my tutor agreed that this gentleman’s presentation was not mechanical in origin. Therefore, I told the gentleman that I would not be treating today and the reasons why and offered to write a referral letter to his GP. He then asked me to speak to his daughter which I did. Although upon offering to write a referral letter to her father’s GP she was quite rude about the GP citing that they were “useless and didn’t care”.  Which caught me by surprise, meaning that I didn’t know how to react therefore leaving an uncomfortable silence. Looking back, I feel how I handle the situation in terms of being open and honest about the gentleman’s health to him and his daughter and why I couldn’t treat was good and followed the OPS guidance on the duty of candour with patients. Although how I handled his daughter criticising the GP could have been better. As an osteopath I am aware that I can’t take sides with the patient or the GP as the patient has those feelings and beliefs for a reason on the other hand, I can’t be drawn into criticising another health professional. Upon reflection I should asked the daughter to expand on why she felt like the GP was “useless and didn’t care” therefore giving me a clearer picture on why she felt this way. Leading me to possibly being able to explain that sometimes GPs have bad days and with the referral I would write for her father would hopefully help them get the answers they couldn’t get from her father due the time restrains they’re under when conducting their case history.

4.5 End of 1st Term Review (4th Year) (27/12/20) (C6)
Last week I completed my first term of fourth year, overall, it was a stressful yet enjoyable term. Over the course of the term one of the major challenges was the lockdown rules have coming back into effect leading to patients asking for advice and information regarding the coronavirus and how the pandemic could further progress. At the time I didn’t really know how to answer this question or where to send the patients to look. I felt quite uncomfortable that patients were seeking advice and guidance about I topic that I am not trained to give advice on.  I spoke to my clinic tutors, and they advised referring patients to seek advice/information on the NHS website. I feel going forward that this is a situation that I can learn from as it made me realise that as a health care professional I may be asked for advice or for an opinion that I am not qualified to give. To ensure that I am equipped for situations like this I am going to work towards being well informed about resources that are reliable and up to date to refer patients too when they ask for advice that it outside of my scope. (https://www.nhs.uk/conditions/coronavirus-covid-19/,  https://www.who.int/emergencies/diseases/novel-coronavirus-2019)

4.7 Maternity Patient Post Covid-19 (29/01/21) (C6, D10)
Today I saw my 28-year-old, 33wk pregnant maternity patient for the first time since Christmas as she has just recovered from covid-19. She told me that she still feels short of breath although the doctor and midwife aren’t concerned and that she has been told to rest. However, I felt like it was important going forward that I check her blood pressure and oxygen saturation levels every appointment precautionary until her baby’s birth to make sure that she is systemically well and to reassure her that she is well. Nevertheless, I also went through symptoms she should look out for and contact her midwife or doctor should they manifest or progress. Upon reflection, I believe this is still the right decision as it reassures me as a practitioner and the patient that she is well. Although in future appointments I will ask the patient to record the readings as well, as then she can inform her midwife, which also makes her aware of what I am doing and can track the patients’ weekly results.

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D1: You must act with honesty and integrity in your professional practice.

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D1: You must act with honesty and integrity in your professional practice.

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3.8 First Patient Post Meningitis (15/11/19) (C1, D1)
Today I had my first patient at clinic post meningitis, the patient was a 54yr male lawyer presenting with cervical pain that came on that came on insidiously two months ago along with symptom free drop attacks. Throughout the case history I felt uncomfortable and out of my depth mainly due to the nonmechanical in origin. A situation that I didn't feel appropriately equipped to deal with as an osteopathic student. Upon reporting the case to my tutor, he agreed with me, that case seemed to be pathological in origin. I then asked for the tutor to help me with the cranial nerve examination, which he said he would. My tutor then instructed me to start, and they would come in as soon as I had explained what I wanted to do to the patient. Upon starting the cranial examination, the tutor didn’t arrive in the room, and I asked one of my observers to go and find them. Upon returning the observer said she couldn’t find the tutor, so I had to continue myself. After the appointment the tutor didn’t acknowledge that they didn’t come to the room which caused the me to feel awkward and like I had done something wrong. Overall, this experience was a steep learning curve and though I had expressed to my clinic tutor this was my first patient since suffering from meningitis, I felt very little support and left out of my depth when dealing with a patient with this presentation. On reflection I am still feeling uncomfortable with how I was left with patient to deal by myself even though I had expressed to my tutor before the appointment that I would require a bit more support than usual as I hadn’t undertaken a full appointment since September. Therefore, I will speak to the head of student support at clinic as I feel like this experience has knocked my confidence and the tutor in question could have made it an interesting learning opportunity instead of an experience that left me uncomfortable and vulnerable. I feel that it is important that I bring this experience to the clinics attention as I would like to do my part to help prevent this type of experience for another student who is returning to clinic after a longer absence as well as for the patients who may have their experience at the clinic affected by a practitioner who hasn’t experienced adequate support.

SC.2 Children's Clinic Not Treating Babies (18/08/20) (B2, C4, D1, D11)
Earlier today was my first time in children’s clinic and I have decided it is best for me not to treat babies and children up to the age of 5yrs. My decision was based off the patient’s safety, my mental health and being honest with myself. I took this decision because when I was a first responder, I lost a 2-month-old baby boy and ended up having to leave that job due to the consequently PTSD I suffered from that incident. Since that time, I haven’t had to be medically responsible for a baby or child under the age of five and don’t know if I would suffer from a relapse in my PTSD in the room when treating the patient or after. Either way this would not be fair on the patient, the parents, my tutor, or myself if I decided to treat and see how I react when in that situation. I feel like this is the right decision for the at least the short term until I have more exposer to the baby/young child osteopath relationship and treatment process.

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

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

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2.2 Danish Osteopath (08/04/19) (A4, D2)
This week I went to observe an osteopathic treatment in Denmark. The practitioner was a physio who had also trained at the ESO via the international course. The thing that I noticed the most was how different the consent process was. She didn’t ask for continued consent though out the treatment and didn’t ask for consent when rolling down the band of the patient’s underwear. As consent is a point of importance that is consistently made and emphasised at school as it gives the patient autonomy and helps establish the patient practitioner dynamic. It made me as an observer who has been taught how important the consent process is, quite uncomfortable. It has helped emphasis how important I feel that continued consent is. Possibly because in its absence it fails to establish and maintain clear professional boundaries between the patient and practitioner.

3.9 Acute LBP Reflection (30/12/19) (A4, A6, D2)
Last week I had a patient with acute low back pain so bad she booked an appointment on the day which happened to be Christmas eve. After taking the case history it appeared that she was suffering from acute discogenic pain therefore a full LEX neurological examination was required meaning she would have to remove her skinny jeans and she didn’t have any shorts. After informing her what tests I would like to preform and why she said that she was happy to undress to her underwear and said she was wearing appropriate underwear to allow such an examination to be undertaken. Upon re-entering the room, she was wearing a lacy bra and thong this is a situation that believe could be misunderstood therefore I ask my tutor to watch my examination and to chaperone until I could cover the patient up with a blanket. This was the first experience as an osteopath of this nature that I have encountered. Upon personal reflection and discussion with my tutor I believe that appropriate measures were taken and going forward I would handle similar situations in the same manner. I was happy with this handling as I feel that it best protected both myself as the practitioner and the patient.

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D3: You must be open and honest with patients, fulfilling your duty of candour.

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D3: You must be open and honest with patients, fulfilling your duty of candour.

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3.2 Meningitis Hospitalisation (19/10/19) (A3, D3)
A month ago, I was rushed to hospital with a temperature of +39°C, bilateral altered sensation/motor output in my LEX and UEX. The sign and symptoms onset were sudden, unexpected, and extremely worrying. Upon arrival at hospital the triage nurse assessed me and moved me straight through to the A&E ward where I was placed in an isolation room, put on IV fluids and blood was taken. Over the course of 4-5hrs nurses and doctors came and went to conduct tests and administer medication. At the time I felt irritated and concerned that no one was explaining to me what they were testing for or explaining what medication they were giving me or why. Eventually a doctor came in and explained everything they had tested for and why I was given certain medications. He concluded that I was suffering from an extreme version of meningitis and that I was to be admitted to the hospital for further treatment and assessment. He also explained the reason for the previous doctors and nurses not telling me what they were doing was because they didn’t want to worry me about some of the things they were trying ruling out. On reflection I believe this experience although worrying at the time to be a positive one as it allowed me to experience health care from the patient perspective. Personally, I appreciate why the A&E team didn’t keep me informed about what they were testing/treating me for as some of the things they were testing me for were life altering illnesses. However, I feel like not knowing was worse than knowing at this point and I can understand why some of the clinic patients feel anxious about their health when dealing with the health care system if this is a common experience. Therefore, in the future when dealing with patients I will do my best explain every dd I am considering before beginning my osteopathic, medical, and orthopaedic testing to allow them to feel informed about their health and included in the decision-making process.

3.3 Meningitis In-patient Reflection (20/10/19) (A1, A2, D3)
Last month, after being discharged from the A&E ward I was moved to an isolation room in the hospital as the doctors were still unsure if my meningitis was viral or bacterial. The following morning, I was visited by the consultant neurologist on his rounds, and he explained due to the progression of my signs and symptoms he believed that my meningitis was viral. Even though he insisted that I was to stay in isolation for the next two weeks and I would not be discharged from hospital before that. This was tough for me to hear as he offered little explanation why this time frame and refused to listen to me when I asked why. I found this upsetting and annoying as it felt like he was just picking a timescale out of thin air as well as I wanted to return home as soon as possible as I find hospital environments uncomfortable. A couple of hours later the consultant neurologists understudy returned to administer some medication. Of which after she then took the time to explain to me why the two-week timeframe then went on to add that this wasn’t a definitive time frame, and I may be discharged sooner depending on my progression. This made me feel a lot more comfortable and content with the situation I found myself in. Although made me question why the consultant couldn’t have addressed my concerns at the time. On reflection the consultant and understudy gave me the same information but the way they presented it to me and involved me in the decision-making process was vastly different. When the consultant presented the information to me it felt like he was telling me what they were going to do, and my opinion or concerns didn’t matter. Whereas when the understudy neurologist represented the information the way she did it was more of a conversation while acknowledging my thoughts and feelings throughout the process. This experience has reaffirmed to me that when dealing with a patients’ treatment plan their thoughts and feelings should be considered and adapted to these thoughts and feelings. Therefore, in the future when presenting the prognosis of the dd and treatment plans to the patent in clinic I will approach the topic as a conversation and adjust the plans to their thoughts and feelings.

3.5 Lumbar Puncture (08/10/19) (A3, A4, D3)
Yesterday I attended my post discharge lumbar puncture to assess the progression of my meningitis. Once I arrived at the hospital, I became nervous which is out of character for me as I normally don’t become nervous or anxious over medical procedures although I believe I was nervous as this procedure involves a needle entering the space around the spinal cord to extract a sample of cerebrospinal fluid. Therefore, if the doctor was to hit the spinal cord there is the possibility of permanent nerve damage. Pre-procedure the doctor sat down and explained the process of the procedure, possible complications, and the reasons why they wanted to perform the procedure given the inherent risks. Before asking if there were any questions I had and asking me to read and sign the consent form for the procedure. Throughout the procedure the doctor and nurse continuously check if I was feeling okay while informing me on what they were doing and what I should feel when. Post procedure the doctor explained that the procedure had went well and reiterated what I may experience post procedure. Personally, I feel like this was a perfect example of how informed continuous consent can a nervous patient at ease. Consequently, I will use this experience to strengthen my continuous informed consent gaining skills which in turn will hopefully put my future nervous patients at ease.

SC.4 Systematically Ill Patient Candour & Referral (25/08/20) (C3, C6, D3, D7, D10)
Yesterday I had a takeover 84yr male takeover patient, on the previous notes taken two weeks prior it said that the practitioner had wanted to refer but the tutor at the time had disagreed. Upon meeting the gentleman, he was in a wheelchair accompanied by his daughter and looked extremely unwell (pale, sweaty and short of breath). On completing the case history and testing myself and my tutor agreed that this gentleman’s presentation was not mechanical in origin. Therefore, I told the gentleman that I would not be treating today and the reasons why and offered to write a referral letter to his GP. He then asked me to speak to his daughter which I did. Although upon offering to write a referral letter to her father’s GP she was quite rude about the GP citing that they were “useless and didn’t care”.  Which caught me by surprise, meaning that I didn’t know how to react therefore leaving an uncomfortable silence. Looking back, I feel how I handle the situation in terms of being open and honest about the gentleman’s health to him and his daughter and why I couldn’t treat was good and followed the OPS guidance on the duty of candour with patients. Although how I handled his daughter criticising the GP could have been better. As an osteopath I am aware that I can’t take sides with the patient or the GP as the patient has those feelings and beliefs for a reason on the other hand, I can’t be drawn into criticising another health professional. Upon reflection I should asked the daughter to expand on why she felt like the GP was “useless and didn’t care” therefore giving me a clearer picture on why she felt this way. Leading me to possibly being able to explain that sometimes GPs have bad days and with the referral I would write for her father would hopefully help them get the answers they couldn’t get from her father due the time restrains they’re under when conducting their case history.

SC.5 First Maternity Patient (25/08/20) (A1, A2, A3, D3)
Today I saw my first maternity patient she is 33yrs old currently 18wks pregnant and this will be her second child. In her first pregnancy 13mths prior she suffered from pregnancy related pelvic girdle (PPGP) which for the remaining 6wks of she was wheelchair bound due to the pain. She then went on to explain she was attending the clinic proactivity as she was worried about ending up in a wheelchair like she did before and causing her to struggle with everyday tasks. This was an interesting experience for me as I have never heard of PPGP leading to incapacitated in a wheelchair. In this case I felt like it was important to disclose that it was possible that she could end up in a wheelchair like she did before. Although while explaining fortunately there is evidence that osteopathy can slow the progression of PPGP. Therefore, meaning that even though the PPGP will most likely progress with the pregnancy we could potentially slow the progression and make it a manageable condition for her. Upon reflection I feel like I managed this case well as I was able to identify what was important to the patient what her concerns were and then respond with the possibilities of what I could help her with while managing her expectations of the outcomes of the treatment process. Consequently, in the future I will try to continue to implement these aspects of listening, understanding while maintaining the patients expectations of treatment outcomes.

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D4: You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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D4: You must have a policy in place to manage patient complaints, and respond quickly and appropriately to any that arise.

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4.14 Refection on Portfolio (21/05/21) (B4, D4, D12)
Over the course of the last three and half years I have been keeping and adding reflections and experiences to my portfolio Padlet. To begin with I struggled to find a logical clear sequence to structure my reflections which lead to the quality being poor. However, implementing the DEIP reflective model enabled me to plan out a clear sequence throughout my reflections giving me a clear take reflective point upon which I could act. These action points over the course of three years have allowed me to see trends of weaknesses and strengths in my performance in relation to the OPS as well as seeing what OPS’s I'm not being exposed to as a student practitioner (D4, D12). Upon reflection, I believe the quality of my reflections and how I action them has greatly improved since first year, which in turn, has lead me to develop and improve as a practitioner. Therefore, going forward I will continue to keep a reflective portfolio to allow me to spot weaknesses/strengths in my performance and access myself against the OPS.

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D5: You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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D5: You must respect your patients’ rights to privacy and confidentiality, and maintain and protect patient information effectively.

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1.2 First ESO Clinic Treatment (05/03/18) (A1, A6, D5)
Today I received my first osteopathic treatment at the ESO clinic, and it made me realise how intimidating how having multiple observers can be. While, how it also affects the practitioner patient dynamic, as there were certain aspects of my past medical history, I didn’t want to disclose in front of people who weren’t my practitioner. Therefore, in the future when I am in the clinic, I feel it is important that I make the patient feel comfortable in the clinic environment and make them aware there will be an opportunity to discuss any information they do not wish to share in front of observers during the appointment.

3.11 Drunk Driver (27/01/20) (A7, C4, D5)
Last week I treated a 50yr male presenting with hip osteoarthritis. During the first treatment he said that he regularly drinks a large amount of alcohol and his GP have discussed him drinking less to help with his health. However last week, he mentioned that he sometimes drinks alcohol and then drives home he then went on to further add that his daughter is always telling him that he shouldn’t. I was unsure what the appropriate response to this would be and didn’t want to reaffirm that it was acceptable behaviour though I didn’t know how to correctly convey that or if there was a procedure within the clinic to manage a situation like this. This made me feel angry and uncomfortable that he didn’t seem to care about what he was doing and putting other people’s life in danger. After disclosing this I information to my tutor he said that he was also not sure about what the correct procedure for a situation like this. Although did recommended that I look in the OPS and contacted GOSC to ask them for their advice. Therefore, I contacted GOSC to ask for advice, and they summarised how it would relate to the OPS and went on to say that I should speak to clinic administration. So, I then contacted the safeguarding leader and gave her a statement so that they could evaluate what to do next. I was unaware that I should have reported it to safeguarding immediately after the incident and it was also not mentioned to me by any of the tutors. Therefore, I am happy that I had this experience so that I have made aware of this system should I need it again. I think why I felt so angry and uncomfortable during and after this experience was due to my past being a first responder and dealing with innocent casualties after being hit by a drunk driver. Although I was aware of patient confidentiality and didn’t know when I could break the confidentiality. Consequently, GOSCs perspective on this was interesting and I learnt a lot from communicating with them. I found this to be an intense interaction at the time, but I feel that I learnt a lot from it. Therefore, if I was to have this experience again, I would have responded more confidently and made him aware it was against the law. Nevertheless, I feel more comfortable now that I have been through the procedures now after experiencing this situation and now know how active the correct procedures quicker in the future.

4.3 GP Patient (27/10/20) (D5)
Yesterday evening I had a new patient who was also a local GP after the case history one of my group members realised, he was their doctor meaning that there was now a conflict of interest among our group. Upon learning this information, it was decided by myself and my tutor that it would be best that all aspects of the case history, examination findings and treatments were talked about in private between myself and the tutor. Looking back although I feel I handled this situation well it could have been handled better by checking if anyone in my group knew the patient before the appointment had started. As my colleague could have overheard the tutor discussing information about the patient before we found out the conflict of interests. In the future if I suspect a patient being in a position where they have a duty of care or possibly knows a student in the clinic group, I will ask my group if they know them and make sure information is not spoken about spoken around that individual if they do.

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D6: You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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D6: You must treat patients fairly and recognise diversity and individual values. You must comply with equality and anti-discrimination law.

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4.9 End of 2nd Term Review (4th Year) (31/03/21) (D6)
Last week I finished my second term of fourth year, overall, the term was intense but fun. At the beginning of the term my clinic group began a discussion regarding how people of different ethnic backgrounds are treated differently in health care. This made me think how little diversity there is at the ESO and within the patients we see at clinic. Consequently, it led me to research discrimination within healthcare.
One video that stood out to me was one that discussed maternal mortality rate. The Ob-gyn that made the video works in the U.S., she focuses on the maternal mortality rate in the U.S., systemic issues within the healthcare system, media framing, and legislative factors. She examines how white women are less likely to die during pregnancy/labour when compared to that of black women and how differences that health crisis derive from aren’t limited to a single situation. But in fact, reflects that person's access to healthcare throughout their lifetime.
This video in particular made me think about how as a practitioner I hold the responsibility to be aware of socioeconomic factors that can influence my decisions regarding my patients health and care, so I don’t make the wrong decisions for the wrong reasons.
This research further then led me to read more about racism and discrimination in healthcare and made me realise how little awareness I have. While I'm fortunate enough not to be personally affected by racism and/or discrimination I feel I need to do more research about this subject so I'm not being an unknown participant. Therefore, I have bought some books about racism in the UK and found some videos from individuals who have experienced racism and discrimination in healthcare which I hope will give me some further insight to the subject.
(https://www.youtube.com/watch?v=CVoSXUwkMsg)

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D7: You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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D7: You must uphold the reputation of the profession at all times through your conduct, in and out of the workplace.

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3.15 3rd Year Review (10/07/20) (D7, D9)
I have now completed third year and as a whole I have enjoyed the experience. The pandemic has been a particular challenge towards the end of the year as when I attend work my colleagues don’t seem to understand the need for social distancing and PPE. Meaning I have had to make concerted effort to make sure I am always wearing my PPE, following social distancing rules, and asking my colleagues to also follow these rules when around me to keep myself safe and give a positive representation of osteopathy as a profession. On a brighter note, my clinic groups conflict in the first term of third year was swiftly resolved in the second term through a supervised meeting and in fact has led the group to being even more supportive and understanding leading to an effective, efficient learning environment. Upon reflection, I feel the way I handled my colleagues at work with not following the pandemic rules was correct. As it established that as a trainee health professional representing osteopathy as a profession following the government guidelines was important and should be followed. Going forward I will continue to set these boundaries of colleagues not following government guidelines and therefore keeping myself safe and positively representing my future profession.

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

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

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4.10 Calcific Tendonitis Ultrasound Results & Referral (31/03/21) (D8, D9)
Today my mock CCA patient returned after his ultrasound scan that I referred him for. Upon reading through his results, he was found to be suffering from bilateral calcific tendonitis and plantar fasciitis. After a discussion with my tutor and recent research on the subject, we concluded that the only non-invasive treatment that is recommend for calcific tendonitis is shockwave therapy. Consequently, before the appointment I spoke to several tutors who are local if they know of any local clinics that offer this therapy of which they didn’t. This meant the cheapest, nearest, and only clinic to offer this therapy was the clinic my girlfriend works for meaning I would potentially be making money out of referring him there. This made me thought made me quite uncomfortable and I was aware it may be ethically questionable. Therefore, I checked with my tutor, the head of clinic and my girlfriend if this was allowed and if they were comfortable with this decision.

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D9: You must support colleagues and cooperate with them to enhance patient care.

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D9: You must support colleagues and cooperate with them to enhance patient care.

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1.1 First Clinic Observation (01/12/17) (B1,D9)
Today was my first day observing in clinic where I observed a new patient for the first time. The patient (39yrs) presented with a painful swollen right knee which he described as a stabbing pain and scored it 9/10 on the pain scale. After the case history was complete the practitioner presented the case to the clinic tutor although she struggled with diagnosing the relevant DDs for the case. The clinic tutor then asked me if I had any relevant DDs of which I responded with the DD compressed fat pad. The clinic tutor then confirmed that was the case in this presentation. Upon exiting the team room, the practitioner then confronted me for intervening in the DDx process and spoiling a learning opportunity for her. This was extremely frustrating and annoying as the clinic tutor had directly asked me the question of which before I did not input into the conversation in the room as I did not feel like it was my place to do so. Therefore, at the time I felt like I had done nothing wrong however on reflection the practitioner was in a stressful situation and having a first-year student possibly making her inadequate just before she had to assess the patient physically would only add to the stress and pressure. Consequently, in the future when observing I will first think about the how my response a question will make the practitioner feel and possibly affect his/her confidence.

3.10 End of First Term Review (3rd Year) (30/12/19) (B3, D9)
I have finished my first term in third year and overall, I feel quite apprehensive about the experience. Given that I missed the two thirds of the term due having and recovering from meningitis I feel that I'm not at the level I should be. This has also been teamed with ongoing conflict among certain members in my clinic group meaning it isn’t the most supportive environment or conducive to my or the clinic groups learning. I have tried speaking to the group as individuals since I’ve returned to see how we can manage the situation with the members who have an ongoing conflict, though this has seemed to be ineffective. Upon reflection though I have tried to speak to individuals in the group perhaps this was the incorrect way to approach this situation. Next term I will suggest to the group that we sit down with the head of clinic and discus what’s been going on so she can help us correct the situation to make our clinical experience one of a supportive learning environment where we all feel safe and supported throughout our learning. While going forward I will also speak to the head of clinic about further clinic slots for myself to help bridge the gap in experience in a clinical environment I have had due to my recovery from illness throughout the first term.

3.15 3rd Year Review (10/07/20) (D7, D9)
I have now completed third year and as a whole I have enjoyed the experience. The pandemic has been a particular challenge towards the end of the year as when I attend work my colleagues don’t seem to understand the need for social distancing and PPE. Meaning I have had to make concerted effort to make sure I am always wearing my PPE, following social distancing rules, and asking my colleagues to also follow these rules when around me to keep myself safe and give a positive representation of osteopathy as a profession. On a brighter note, my clinic groups conflict in the first term of third year was swiftly resolved in the second term through a supervised meeting and in fact has led the group to being even more supportive and understanding leading to an effective, efficient learning environment. Upon reflection, I feel the way I handled my colleagues at work with not following the pandemic rules was correct. As it established that as a trainee health professional representing osteopathy as a profession following the government guidelines was important and should be followed. Going forward I will continue to set these boundaries of colleagues not following government guidelines and therefore keeping myself safe and positively representing my future profession.

4.10 Calcific Tendonitis Ultrasound Results & Referral (31/03/21) (D8, D9)
Today my mock CCA patient returned after his ultrasound scan that I referred him for. Upon reading through his results, he was found to be suffering from bilateral calcific tendonitis and plantar fasciitis. After a discussion with my tutor and recent research on the subject, we concluded that the only non-invasive treatment that is recommend for calcific tendonitis is shockwave therapy. Consequently, before the appointment I spoke to several tutors who are local if they know of any local clinics that offer this therapy of which they didn’t. This meant the cheapest, nearest, and only clinic to offer this therapy was the clinic my girlfriend works for meaning I would potentially be making money out of referring him there. This made me thought made me quite uncomfortable and I was aware it may be ethically questionable. Therefore, I checked with my tutor, the head of clinic and my girlfriend if this was allowed and if they were comfortable with this decision.

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

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

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SC.4 Systematically Ill Patient Candour & Referral (25/08/20) (C3, C6, D3, D7, D10)
Yesterday I had a takeover 84yr male takeover patient, on the previous notes taken two weeks prior it said that the practitioner had wanted to refer but the tutor at the time had disagreed. Upon meeting the gentleman, he was in a wheelchair accompanied by his daughter and looked extremely unwell (pale, sweaty and short of breath). On completing the case history and testing myself and my tutor agreed that this gentleman’s presentation was not mechanical in origin. Therefore, I told the gentleman that I would not be treating today and the reasons why and offered to write a referral letter to his GP. He then asked me to speak to his daughter which I did. Although upon offering to write a referral letter to her father’s GP she was quite rude about the GP citing that they were “useless and didn’t care”.  Which caught me by surprise, meaning that I didn’t know how to react therefore leaving an uncomfortable silence. Looking back, I feel how I handle the situation in terms of being open and honest about the gentleman’s health to him and his daughter and why I couldn’t treat was good and followed the OPS guidance on the duty of candour with patients. Although how I handled his daughter criticising the GP could have been better. As an osteopath I am aware that I can’t take sides with the patient or the GP as the patient has those feelings and beliefs for a reason on the other hand, I can’t be drawn into criticising another health professional. Upon reflection I should asked the daughter to expand on why she felt like the GP was “useless and didn’t care” therefore giving me a clearer picture on why she felt this way. Leading me to possibly being able to explain that sometimes GPs have bad days and with the referral I would write for her father would hopefully help them get the answers they couldn’t get from her father due the time restrains they’re under when conducting their case history.

SC.6 PMP-22 Gene Defect Ultrasound Referral (11/09/20) (B3, D10)
Earlier this week I saw my patient who has suspected bilateral plantar fasciitis which is predisposed by her PMP-22 gene defect. I have now seen her four times and she has had no regression in signs or symptoms even though I am following the current guidelines on manual treatment and have asked her to stop her long-distance walking to allow her feet to recover. I found this to be a frustrating and annoying experience as I feel like I am doing everything I possibly can, and nothing seems to be working. Having now had a couple of days to look back, talk to multiple clinic tutors and continue to study PMP-22 gene defect further I have realised that it can sometimes be normal for tissues to respond differently if other factors are in play in this case the PMP-22 gene defect. Therefore, when I next see this patient in a couple of weeks, I will send her for an ultrasound to confirm my diagnosis to allow an informed decision for following treatments or referral and discuss with the patient why she may require more treatments due to her underlying condition and why an ultrasound scan in my opinion will be beneficial.

4.7 Maternity Patient Post Covid-19 (29/01/21) (C6, D10)
Today I saw my 28-year-old, 33wk pregnant maternity patient for the first time since Christmas as she has just recovered from covid-19. She told me that she still feels short of breath although the doctor and midwife aren’t concerned and that she has been told to rest. However, I felt like it was important going forward that I check her blood pressure and oxygen saturation levels every appointment precautionary until her baby’s birth to make sure that she is systemically well and to reassure her that she is well. Nevertheless, I also went through symptoms she should look out for and contact her midwife or doctor should they manifest or progress. Upon reflection, I believe this is still the right decision as it reassures me as a practitioner and the patient that she is well. Although in future appointments I will ask the patient to record the readings as well, as then she can inform her midwife, which also makes her aware of what I am doing and can track the patients’ weekly results.

4.11 Shoulder Patient Ultrasound Referral & Result (22/04/21) (C3, D10)
Over the last two months I have been seeing a 52yr old women for a suspected subscapularis tear/rupture which has led to her absence from work. Due to the lack of progress in her recovery from treatment and the patient being concerned of work needing evidence of her injury I decided to get confirmation of her diagnosis via an ultrasound referral. Today I received her results which showed my suspected diagnosis was incorrect and she has an anterior/lateral impingement, subacromial bursitis and a grade two subscapularis tear. Therefore, I passed the scan results onto my patient as evidence of her diagnosis to her work. Upon reflection, I believe I handle this case well as I listen to my patients concerns about returning to work and gave her the relevant written evidence she required. Consequently, I will continue to listen to my patients concerns and try to supply them with the information written or verbal they need to ease those concerns.

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D11: You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

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D11: You must ensure that any problems with your own health do not affect your patients. You must not rely on your own assessment of the risk to patients.

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2.3 Reflection on Mental Health (04/05/19) (D11)
Lately I have been quite homesick partially missing my family’s pets/animals and it’s started to affect my performance at school and my studying at home negatively. Therefore, after months of talking with my girlfriend and planning a new study routine, work hours and reviewing future school commitments we decided to buy a puppy. I have now her for two weeks and all my homesick feelings and anxiety have significantly reduced. However there have been challenges that we didn’t foresee meaning that we had to continuously adapt our routines in order to find one that allows for all of our previous commitments. Overall, my output and quality schoolwork has increased significantly. I have been reminded that I must also look after myself mentally and physically to perform at my best level. Therefore, in the future this is going to be something that I am going to make an effort to be aware of and continuously assess.

3.6 Pre-return To Clinic Dr. Assessment (26/10/19) (A5, C4, D11)
Yesterday I had hopefully my final post meningitis check-up, after a nearly two months of being hospitalised. I am still suffering from post-viral fatigue although I can now get through the day without needing to stop for breaks. Therefore, I felt like I was ready to return to clinic and university. During the visit to the GP, the doctor asked me a series of questions and preformed cranial nerve screening to check I was back to the level required by GOSC to return to active clinical practice. The doctor eventually agreed that I was able to return under the conditions of limited patients and hours to start with. Personally, I am delighted that now my life can begin to return to a level of normality although I must continue to assess my energy levels to allow for continued recovery, not risk patient’s safety and seek medical advice should I feel like I am not able to perform to the level I should be.

SC.2 Children's Clinic Not Treating Babies (18/08/20) (B2, C4, D1, D11)
Earlier today was my first time in children’s clinic and I have decided it is best for me not to treat babies and children up to the age of 5yrs. My decision was based off the patient’s safety, my mental health and being honest with myself. I took this decision because when I was a first responder, I lost a 2-month-old baby boy and ended up having to leave that job due to the consequently PTSD I suffered from that incident. Since that time, I haven’t had to be medically responsible for a baby or child under the age of five and don’t know if I would suffer from a relapse in my PTSD in the room when treating the patient or after. Either way this would not be fair on the patient, the parents, my tutor, or myself if I decided to treat and see how I react when in that situation. I feel like this is the right decision for the at least the short term until I have more exposer to the baby/young child osteopath relationship and treatment process.

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

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

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4.14 Refection on Portfolio (21/05/21) (B4, D4, D12)
Over the course of the last three and half years I have been keeping and adding reflections and experiences to my portfolio Padlet. To begin with I struggled to find a logical clear sequence to structure my reflections which lead to the quality being poor. However, implementing the DEIP reflective model enabled me to plan out a clear sequence throughout my reflections giving me a clear take reflective point upon which I could act. These action points over the course of three years have allowed me to see trends of weaknesses and strengths in my performance in relation to the OPS as well as seeing what OPS’s I'm not being exposed to as a student practitioner (D4, D12). Upon reflection, I believe the quality of my reflections and how I action them has greatly improved since first year, which in turn, has lead me to develop and improve as a practitioner. Therefore, going forward I will continue to keep a reflective portfolio to allow me to spot weaknesses/strengths in my performance and access myself against the OPS.