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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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Evidence: Over the course of the four years, at boxley & clinic I have been able to develop my skills as a practitioner through the use of practice with other students and feedback from tutors. Feedback from patients whilst doing a technique is also beneficial to improve. It is important to constantly build on your skills as an osteopath to ensure you are giving patients the best possible outcome from treatment and advice.

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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.

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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.

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Evidence 1: I had one particular patient that was very concerned that as a student osteopath I would just manipulate them, they did not want this style of treatment and therefore I explained that we would incorporate techniques into their treatment that they felt happy with me doing.

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Evidence 2: I think a massive part of osteopathy is having the ability to understand each individual is unique. I believe this OPS was demonstrated with a situation in clinic with a new patient that did not want other student observers in the room. I had to respect their decisions as this was their preference, it meant that I had to work alone and have no observers.

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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

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Evidence: Throughout my time at the ESO, us students are always focusing on our evaluation procedure to ensure the patient is given the most accurate diagnosis. At the start of my time in clinic my examination skills were lacking due to purely concentrating on physical features that were noticeable on patients. As my skills have developed I am able to complete specific tests in the examination based on the patient's case history.
This process has been a struggle for most of my time at the ESO as I found there were unlimited amount of tests that could be performed and I struggled to remember each test. My skills are still developing and it is important to not lose hope as the examination procedure is used to give a patient an accurate diagnosis.

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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

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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

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Evidence: I think patients always feel listened to and supported if they are able to discuss their particular needs and expectations. I always ask patients at the end of a case history what they expect to achieve from a consultation, to give myself an idea on how to fulfil what they want to the best of my ability. Some patients will say a reduction in pain whereas others will want to know why they are in pain, so it does vary.

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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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Evidence: There have been times during clinic where patients have not been progressing with treatment as well as I would have hoped. An example of this is one patient who had 12 consecutive weeks of treatment on their shoulder pain, after 6 weeks I discussed with the patient that due to not being able to reduce the shoulder pain a significant amount, it would be beneficial to seek advice from another healthcare professional for example Lance who ultrasounds at ESO. The patient was interested in booking in but used to always put it off but want to continue coming for treatment. I found this situation in particular difficult to manage as I felt that I wasn't doing much for the patient's condition, and sometimes they would say they had improved just so they could rebook another treatment. In the end I had to explain to the patient that she needed to go to the GP and get their advice as well.

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A3- You must give patients the information they want or need to know in a way they can understand.

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A3- You must give patients the information they want or need to know in a way they can understand.

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Giving the patient the opportunity to be educated on not only their diagnosis, but what is involved within their own body is important for the healing process I believe. Models, diagrams and posters in clinic are useful to use to show patients specific muscles and bones and explain to them in a way they understand.

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Evidence: I was able to demonstrate this OPS by getting involved with a patient who wanted to educate themselves on their injury. I used the muscles and skeletal posters in the clinic rooms to explain to the patient their diagnosis and what it involved.

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A4- You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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A4- You must receive valid consent for all aspects of examination and treatment and record this as appropriate.

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Evidence 1: Throughout the whole of clinic, consent has been an important part of the process to ensure patients are happy. I have learnt that before I start any case history, it is important to debrief the patient on the clinical process and the fact they are able to stop to ask questions at any time. This is to ensure that patient knows exactly what they are consenting to. I have found that many patients disregard the importance of consent and will usually say yes before they even know what is going to happen.

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Evidence 2: I had a patient who came to the clinic very acute after a fall onto her back at work, I was able to take the case history and do an examination however before treatment I discussed with the patient the side effects to treatment, they opted out of treatment in that session as they had a 12 hour shift to complete the next day and were worried they may feel sore from treatment. The patient rebooked.

At first, I think the consent process was too limited due to only practising it in first and second year with exams, but soon developed when I got into clinic.

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A5- You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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A5- You must support patients in caring for themselves to improve and maintain their own health and wellbeing.

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Evidence: It is known that each patient has a different way of living outside of clinic, some patient will prefer to just stick to osteopathic treatment, whereas others are keen to take part in exercise programmes outside of clinic to aid their recovery.

It is important for patients to be aware of ways to improve their own health and wellbeing, rather than just relying on osteopathic treatment alone for their osteoarthritis. Evidence suggests that exercise accompanied with manual therapy has the best outcome for osteoarthritis, and many other disorders (Jansen et al. 2011).

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Jansen, J., Mariette et al. 2011. Strength training alone, exercise therapy alone and exercise therapy with passive manual mobilisations each reduce pain and disability in people with knee osteoarthritis: a systemic review. Journal of Physiotherapy. 57(1) pp. 11-20.

Internet 1. DON and DOFF PPE. Available at: https://www.google.com/search?q=ppe+order&rlz=1C1PRFI_enGB813GB817&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjejo-ei47xAhVDilwKHTHdCoYQ_AUoAXoECAEQAw&biw=1366&bih=625#imgrc=YDvt07kfPpQLYM [Accessed 03.06.2021].

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A6- You must respect your patients’ dignity and modesty

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A6- You must respect your patients’ dignity and modesty

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Evidence 1: I have previously had patients who have their own preferences in regards to their modesty and dignity. One patient in particular said they felt uncomfortable with removing items of clothing, so in order for her to feel comfortable, an examination and treatment was done to the best of my ability whilst her clothes remained on.

It is always important to ensure patients feel safe and have their modesty and dignity taken into consideration as it means they will be more relaxed leading to better results after treatment. I think I would have struggled with this if I was new into clinic as my palpation skills were not as good.

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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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Evidence: Over the course of my time in clinic, I have found that patients will always express their own views on a situation, for example one patient has very strong views of COVID-19. Towards the start of my clinic time, I was always unsure how to react to their comments and therefore I went to my tutor for some advice. Ensuring there is a professional boundary between the patient and myself is key.

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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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Evidence: As a student osteopath, there are things that need further work, however we must stay within our remit. An example of this a patient who had self prescribed co-codamol for their back pain. They asked me if there would be any harm in taking this drug & if there was anything else they could take. I am aware of the potential risks of consuming co-codamol for a set amount of time, e.g constipation and therefore was able to make the patient aware of symptoms they may develop, however I advised them to speak to the GP or pharmacist as I am unable as an osteopath to give them medication they should take.

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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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Evidence: I have undertaken lots of extra courses to better my knowledge as a practitioner:
Sports Massage course completed 2018.
Sports Taping course 2018.
Acupuncture course 2021.
First Aid course completed before going into summer clinic ready for year 3 and 4.
I think it is important when working as a primary health care practitioner that skills are always kept up to date and that we are always learning to achieve better knowledge.

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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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Evidence: Throughout my time in clinic,  feedback from tutors has always been given. This is so that we can better our knowledge and hands on skills for patients. I always found it difficult at the start of clinic to be given constructive criticism as I felt as though I wasn't good enough, however we are all unique practitioners. Throughout my time at the ESO, I have been able to take feedback on board and learn from it, which is helping me become a better osteopath.

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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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Evidence: I have always had neat and precise notes with good level of detail. I am often complimented on clear notes and it is important I take this skill into private practice. I have never struggled with legible and accurate note taking from a patient, I am lucky to have this skill as it means I am able to focus my time on other areas to develop.

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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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Evidence: I have not currently been in a situation where I need to provide patient's notes for any reason. A patient has the legal right to request their notes and therefore if this was needed I would ensure that it was dealt with quickly.

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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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Evidence: This is a key aspect to the OPS and must be met at all times. I have specifically dealt with this OPS a lot over the last year in clinic by always wearing PPE, this is to ensure that both myself and the patient have maximal protection. I have also recently completed a safe-guarding course as well as a female genital mutilation course through the university. I feel as though I have the capability now to detect anything suspicious and report it following the correct procedures in place. It is important to learn the boundary and support patients to keep them away from harm.

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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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Evidence: This OPS is being considered constantly especially through the global pandemic. PPE is used constantly, it is changed after every patient, the clinic rooms are being sanitised after every patient and we are constantly washing our hands. On entry to the clinic, a patient's temperature is taken and they are screened using questions. This has taught me that my own health is just as important as the patient. I will take this consideration with me into private practice. I also noticed that I prefer the use of PPE, especially gloves when treating patients and will most likely use this way of work in the future regardless of the situation.

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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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Evidence: I have found that being a student osteopath I must be able to adapt to each patient based on their needs. Taking the osteopathic models into consideration allows me to adapt with patients to enhance their health and wellbeing. It is also beneficial for patients to feel supported by their osteopath not only with their physical needs but psychologically as well. Each individual is unique and therefore they must be treated and considered in a way that suits them.

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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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Evidence: Throughout the course friends and family have always asked to be treated however I respected this OPS and have decided against this due to wanting to maintain a professional boundary. Similarly, I have had patients who offer for me to attend their business for free. One patient asked me to come to their coffee shop to get a free coffee, however I kindly declined and explained that I have to remain professional and not cross the boundary as stated in this OPS.

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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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Evidence: Over the course of the 2 years in clinic I have found that being honest is the best way to be with a patient. Refusing to treat a patient due to the need of a referral is often something I struggle with and often get help from a tutor, for example one patient I had needed referring for potential PMR.

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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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Evidence: I have not been in the position of having to handle a complaint yet, however in year 2 we were set an assignment to write a reply to a false letter of complaint & I passed this piece of work. Understanding the complaints procedure in a clinic is important as it and I think being able to handle a complaint in a calm yet reasonable way is key to get to the bottom of it.  I went through the complaints procedure at the ESO with Tamara.

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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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Evidence: At the ESO, the patient notes are kept in filing cabinets in a locked room which adheres to the GDPR's policy. I would like to ensure that I have the correct standards in place when I work outside of the ESO clinic. This means that the information is being handled effectively.

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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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Evidence: I will admit that I have misjudged a patient before even learning to work with them. One patient in particular I found myself annoyed with was a lady who was unable to speak English, she had her husband with her to translate the whole time. I found it difficult to get a detailed case history and consent from the patient as they would not understand what I was saying. This was a patient of mine in the third year, since then I have been able to treat all patients equally, adhering to the OPS.

I have since then had another patient who was quite rude and abrupt towards me and I managed to handle it in a professional manner and did not discriminate against them.

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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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Evaluation: I know this OPS is important in maintaining a professional conduct with the public. In a first year party I remember having to send one of my friends home as they got very drunk and I knew it was inappropriate for them to be in that state whilst studying for this degree in front of a lot of people. I thought this was unprofessional. This is something that I will take into consideration not only in the workplace but outside also.

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D8- You must be honest and trust worthy in your professional and personal financial dealings

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D8- You must be honest and trust worthy in your professional and personal financial dealings

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Evidence: This OPS has not yet been met. I will ensure this is maintained in my practice to a high standard.

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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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Evidence: Part of the role of a student is to support other students also. There have been times when I have observed colleagues in clinic and they have asked me to double check their findings, e.g. reflexes. I think it is important to support other colleagues as it allows us all to learn and develop together, making us better practitioners. There have been times where other students have given me feedback using a marking criteria.

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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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Evidence: This has always been managed well in clinic, tutors are able to give us sufficient knowledge regarding uncommon conditions and relevant referrals for patients, especially when working with the tutors that assess in CCA. Using the tutors knowledge has allowed me to learn how to manage certain patients and give patients relevant treatment plans.

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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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Evidence: There have been times through the last four years where I have felt rather overwhelmed and stressed. I have noticed that sometimes it has impacted my learning, for example when my grandad died I did not want to go to lectures for a while and made clinic aware what had happened so that if I felt as though I needed to leave I was able to without having to explain myself a lot. It is important to keep work life and home life separate to ensure there is no overlap and it isn't impact your knowledge as a practitioner.

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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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Evidence: I have not yet encountered this OPS. I will always aim to comply with all the regulations and standards.