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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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This example is a mark scheme which is used throughout the course. This mark scheme / feedback is from a third year in class assessment for visceral. Studying at the ESO has providing myself with lots of different treatment styles and techniques. This enables us to adapt and modify our treatment/management of each patient to suit them. This addresses the patient expectations, ideas, and concerns.

This has reminded me of the idea that osteopathy is unique in the way it identifies and treats certain conditions and musculoskeletal problems.

This has helped me to develop my practical skills, which will put myself at an advantage compared to other students, at different universities.

However, it is required by GOsC to carry out 30 hours of CPD courses, which keeps every practitioner up to a certain standard. Further increasing their knowledge base, improving their techniques, and learning from other professionals.

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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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Attached below is a case report, which was from the OS743 module. The title is as follows – Raising awareness of the psychological implications of breastfeeding.

This experience was during my first consultation during children’s clinic. The presenting complaint (Tongue tie and subsequent feeding difficulties) was a common presentation within the teaching clinic; however, it was brought to my attention, the psychological distress and anguish the mother had to confront during a global pandemic.

The symptoms which were displayed prompted the mother to arrange an appointment. Within the initial consultation, it was clear that the mother was concerned about her situation, this was possible amplified by a range of intrinsic and extrinsic factors. As the patient’s symptoms improved, the mother’s confidence was increasing. She was able to express the feelings she had been experienced during a national lockdown, giving birth, and how it came somewhat of a lonely experience due to the restrictions in place.

As osteopaths, we are in a unique position that allows us to establish a rapport with patients and identify possible issues which had not been noticed previously. By establishing this rapport, we can better understand the patient and provide with the support they need (D10).

Realising the importance of these implications, I can now understand how a multidisciplinary team of professionals, can enhance, and be well adapted to increase the patient’s overall experience and well-being.

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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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This poster was created as a part of the OS745 module. The description was to make and present a PowerPoint presentation about lumbar disc herniations. The information gathered to make this PowerPoint was found from a multitude of different resources. Such as the following – StatPearls, PubMed, the Clinical edge podcast, Orthobullets, Research articles (RCTs, meta-analysis) and the NICE guidelines.

This has reminded me of the idea that updating our knowledge base frequently, enables us as practitioners to optimise our treatment and management plans, we deliver to patients.

Furthermore, from the dissertations we write in the beginning of fourth year, we are now able to identify biases in research articles and simultaneously identify articles which would score highly in Sackett’s hierarchy of evidence.

This knowledge and skill will help to develop my skills and interpret data in the right way within being misled.

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

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

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Within an osteopathic appointment, each patient will have their own concerns and emotions. These worries or concerns can be amplified when struggling with an injury or a particular condition. It can also attribute as a self-limiting factor impacting recovery.

Throughout my two years at the teaching clinic, I have experienced many different personalities and unique characteristics within my patients. This process requires practitioners to respect and uphold their individual concerns and identify the patients’ preferences.

Practitioners use active listening to be empathic and gain a better understand of the patient in front of them. This helps the practitioner to develop an effective and concise treatment and management plan, unique to each patient. Therefore, if there are two patients sharing a common differential diagnosis (i.e., Non-specific lower back pain), the respective treatment and management will differ to suit the individual.

This is beneficial to me as my future career requires me to be adapt to the patients’ requirements and expectations. Attached below is a poster about the benefits for adults and older adults. This highlights how being active (walking, jogging, swimming, dancing, and Tai Chi) which is very beneficial for those diagnosed with diabetes, cardiovascular disease along with joint and back pain. Furthermore, provides improvement in sleep quality, helps to manage stress and improving the quality of life.

This is something to consider when prescribing exercise and rehabilitation programmes.

Selecting exercises and activities which the patient enjoys, means the patient is more likely to adhere and perform even after treatment has come to a natural conclusion.

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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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I now understand, similarly to the reflection in A1, each patient has their own worries and concerns. Even when a patient may appear confident and comfortable within an osteopathic appointment, the patient is putting themselves in a vulnerable position by expressing their needs and concerns which are personal to them.

Experiences like this in clinic has brought to my attention as this can take a lot for a patient to talk to someone and ultimately receive treatment from a practitioner. Not everyone is comfortable within their own skin and having a potentially serious issue can really affect a patient’s mental state.

Having realised the importance of the certain phrases and language we use in day-to-day practice; I can now appreciate what it means to be adaptable and communicate effectively. This can be done by listening to the patient, clarify what they would like from the appointment and what can be done about it.

From this, I have investigated what is needed to have good and effective communication. This entails – Tailoring to the patient’s understanding, in terms of contact and pace of delivery, checking the patient’s understanding, picking up on verbal and non-verbal cues and active listen to the patient. This has been proven to develop a solid practitioner-patient relationship, develop shared decision making and empowering the patient which aids recovery.

To develop this skill further, I will take time to make sure my body language is open and invest time into the patient. Identifying and respect their individual ideologies and communicating 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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A3 - You must give patients the information they want or need to know in a way they can understand. 

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Attached below is an example of an information document which was given to a patient with frozen shoulder contracture syndrome (FSCS) alongside this was a prescription of exercises. The PDF is from the American Academy of Orthopaedic Surgeons (AAOS) which can be found at orthoinfo.aaos.org.

This helped to solidify the patient’s understanding after diagnosing FSCS the session before. It provides a useful summary of FSCS along with its aetiology, epidemiology, treatment and possible interventions and rehabilitation. However, a possible implication could be that it possible may scare the patient. It may be too much information all at once, especially with all the interventions available. Fortunately, the patient was very accommodating, and we built a strong rapport from the first session.

This experience was extremely valuable for me because it demonstrated how my language and demeanour was interpreted by a patient and developed a good rapport, which built up this sense of trust and belief in what I had said.

This will be helpful outside the teaching clinic as this will help the clinic to attract potential patients and contemporaneously enhancing my skills as a practitioner.

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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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Below is a picture of the teaching clinic’s marking criteria for a CEX. This was taken after an initial consultation with an infant patient during children’s clinic. Informed consent is a very hot topic and is needed in order to conduct an osteopathic evaluation but also delivering a safe, competent and appropriate care (C1). This is especially true during children’s clinic.

Studying at the ESO has given me the opportunity to treat a range of different patients and conditions, via a multitude of techniques (IVM, BLT, BMT, MET and visceral). We are very fortunate to have a designated children’s clinic and module, which is often a CPD course or learnt post-grad.

Mothers’ willing bring in their newly born infants to the teaching clinic, knowing a student will be treating their new addition to the family. Meaning they must place a lot of trust in a stranger, which for them can be very scary.

Therefore, when dealing with an infant patient, demonstrating a high level of understanding and empathy will enable to build a therapeutic relationship. The consent and shared decision making took place between myself and the mother. This was vital as this enabled me to 1) perform a full neurologically/osteopathic/orthopaedic screen 2) handle a newly born infant and 3) establish myself as a practitioner and someone the mother could trust.

From this experience, this has highlighted the importance of informed consent, as this enables practitioner to maintain clear professional boundaries. Whilst simultaneously demonstrating your knowledge and understanding of the situation and how it can be addressed.

Children's clinic is not an area I would specialise in; however, it has offered experience which is not found anywhere else. However, has given me an insight into pregnancy, delivery and being responsible for an infant.

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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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This is an example of a rehabilitation outline sent via email to the patient regarding exercises to help correct and stabilise his signs of upper cross syndrome and subsequent limited thoracic mobility due to work related posture. This exercise prescription was a combination of strength and conditioning exercise which could be implemented before his daily runs.

This was sent after a treatment session in year 3. I did not have enough time to demonstrate the exercises and explain the appropriate cues. A possible implication of this could lead to incorrect form when performing the exercises, leading to imbalances and possible issues further down the line.

However, I had anticipated this may happen, so to combat this I had found YouTube video which helped the patient to understand and execute the movement.

This will be beneficial in the future as the patient will gain a better understanding of the movement pattern. Furthermore, if this injury is to occur again, they have the tools necessary to correct it themselves, creating patient responsibility.

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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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At the teaching clinic, before covid we had access to blankets which we could use to cover up the patient to make them feel more comfortable. However, this is not possible currently. Nonetheless, at the teaching clinic we do have access to disposal gowns, which can be described as gowns seen in hospital. This is an option given to patient if they appear to be uncomfortable or uneasy when dressing down.

Often patients can feel exposed or vulnerable during an osteopathic session.

This reminded me of my first practical session at university. It was during the very first lecture, going over the human body, the lecture said “Okay, now in pairs identify the anatomical structures”. I remember thoughts of insecurity and feeling uneasy; thus, I can empathise with patients who haven’t been to an osteopath before.

Having remember these feelings of insecurity, I can understand what thoughts and feelings the patients must go through.

This is mentioned in the first piece of dialogue within the initial consultation. I often say, “This may require yourself dressing down appropriately, so I can examine the area in question – is this something you are comfortable doing?”. This is usually not an issue, yet in some cases the gowns are implemented, or a suggestion may include bring sporting or active attire for the next appointment.

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A7 - You must make sure your beliefs and value do not prejudice your patients’ care. 

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A7 - You must make sure your beliefs and value do not prejudice your patients’ care. 

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Cognitive bias is a type of error in decision making and thinking which occurs when our perception of a situation is skewed by factor such as preferences, beliefs, and personal experiences. Our brains use memories and familiar patterns to make mental shortcuts (Heuristics) to reach what seems to be a reasonable conclusion, despite their being conflicting information or perspectives.

There are many factors which can influence an individual to experience cognitive biases. Usually, it is a combination of learned behaviours and value sets, originating from the individual’s social, cultural, and personal settings.

Therefore, this can impact us as practitioners in clinic. The practitioner can interpret events and facts which are based on their own set of beliefs, and experiences which lead to deviation from a normal rationale. Ultimately, leading to flaws in reasoning which in turn leads to misinterpretation of information.

Practitioners’ cognitive bias can be impacted by the information we receive and learn. Such as Anchoring – a tendency to over rely on base decisions; Confirmation bias – a tendency to look for evidence to confirm a diagnostic hypothesis and therefore give weight to evidence that is supportive of the diagnosis and ignoring evidence which may dispute it; Search satisfaction – a tendency to stop decision on recent encounters; Diagnosis momentum – a tendency to expect and continue initial diagnosis without sufficient scepticism.

Being able to see and appreciate these different types of bias in this way is extremely valuable to me as it will allow me to be a more developed and well-rounded practitioner.

This will be beneficial to me as practitioner as this will help future my career and different between similar clinical presentations.

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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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This is an example of a CEX form, which is used when assessing students at clinic. CEXs are used to give an indication of the progression and development of the practitioner. This also attributes to the OS744 module.

This CEX was conducted on a patient with frozen shoulder contracture syndrome (FSCS or adhesive capsulitis). FSCS has an idiopathic aetiology and can be a frustrating diagnosis especially for the patient. This patient had previously seen numerous practitioners and tutors – which had led to different ideologies and treatment styles.

A possible implication of this includes the patient becoming disheartened by the diagnosis and the realistic timeline of recovery.

This was an extremely valuable experience as this allowed me to follow the course of a patient with frozen shoulder. This also helped me develop a succinct and slick assessment routine and a useful treatment plan.

Therefore, by the time I see a new patient with FSCS, I will have a calculated and well thought, realistic short term and long-term goals.

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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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This was yet another CEX mark scheme. This was performed more recently than the FSCS patient. This was performed on a cover patient who was expressing symptoms of a facet joint related injury.

From the case history and subsequent questioning, this led to a succinct and well-informed assessment, composed of the following: Observation, Palpation, Active and Passive movement of the lumbar spine and hips, Neurological screen, relevant orthopaedic tests (SLR, Slump, FABER, FADDIR, Quadrant test and Laslett cluster).

An assessment routine is used to provoke and recreate the patient’s presenting compliant. Testing can help a practitioner to identify the pain causing structures, whilst ruling out any serious pathology.

Therefore, from this assessment, I was able to decipher an appropriate diagnosis (Facet joint syndrome), and treatment plan. Simultaneously, being able to decide on short- and long-term goals and outcome, relevant to the patient.

The feedback I received (see below) was very positive and demonstrated I was able to swiftly decide on an accurate evaluation and perform adequately.

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

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

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All patient records are completed and upheld to a certain standard. These patient records are then filed and kept in secured filing cabinets at the teaching clinic. No files are allowed off site.

No one has permission to retain any patient records, as this goes against the GDPR (General Data Protection Regulation). The GDPR’s purpose is to provide a set of standardised data protection laws across all the members countries. This should make it easier for EU citizen to understand their data is being used, and raise any complaints, even if they are not in the country where its located. However, I am unsure how this will be altered due to the departure of the UK from the European union.

Furthermore, by making sure patient records are comprehensive, accurate and legible, this not only maintains the standard of note taking clinic, but also providing sufficient evidence in a court of law. This is particularly important when checked and recording the patients understand and consent. There are multiple sections on the case history forms, about informed consent and obtaining consent.

Often in clinic, tutors have made remarks about the neatness of my notes, and how they are easy to read. This is important in the teaching clinic as patient’s get passed on from student to the next. Thus, comprehensive, and legible notes make the person reading the patient’s record easier and gain a better understand of the patient.

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

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

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Every patient has the right to request the production of written material (Case history notes, Personal information, Consent forms, Patient records, etc.).

This is an example of a referral letter, which was made up for a patient with unremitting symptoms. In the document attached, the name of the patient has been deleted and is referred to as “patient X”.

The case presentation was rather usual. This patient was the first case after the teaching clinic had reopened since the national lockdown. The patient presented with bilaterally anaesthesia into the palmar and dorsal aspects on both hands. The anaesthesia, spread down the arm into all the digits on both hands, however it was not dermatomal pattern. The anaesthesia was only exacerbated by extension of the neck, yet the patient was in no pain. The patient had been experiencing these symptoms for almost a year.

Therefore, after several treatments at the teaching clinic, trying different treatment modalities, there was no improvement in symptomology. Subsequently, there was a joint decision made to type up a referral letter to the GP. This was to request an x-ray of the patient’s cervical spine, as I had suspected possible signs of early radiological changes (such as osteophytes or reduction in disc height).

Before we can start to write a referral letter, we need to gain consent for the letter itself. This is done via a separate consent from – consent for a referral letter.

This was beneficial to me as this may be required of me in future practice when something out of my scope is detected.

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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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The COVID-19 pandemic is something we have all had to deal with, individually and as a nation. Initially everyone was put into a national lockdown, resulting in rapid and enormous changes overnight.

For several months, the ESO teaching clinic was unable to open until the summer. A risk assessment was performed before we were allowed to return to practice.

The following changes at clinic were as followed:

-       Smaller clinic groups

-       One-way systems within the teaching clinic and campus

-       Mask and PPE were used to minimise the spread of COVID-19

-       Two receptions were open, to reduce the amount of footfall through one building

-       Spacing of treatments to allow for adequate cleaning and preparation between appointments

-       A swap from tunic to polos were implemented

All students were required to take two lateral flow tests before returning to clinic and practise at the university campus.

This is a unique experience for us as osteopaths and has highlighted the importance of keeping the practice at a clean and disinfected.

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

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

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Quite like C4, COVID-19 prompted numerous changes, not only in the teaching clinic but all osteopathic clinics in the UK. Attached to this section is a poster made by the university, to ensure that COVID-19 rules and regulations were being strictly followed.

When booking an initial appointment at the clinic, the receptionist ask a list of triage questions, to clarify 1) the patient understands the rules in place at the teaching clinic, 2) the patient is indeed safe, and 3) the patient is not putting other patients at risk.

Then upon arrival at the clinic, the patient’s temperature is checked and asked the following questions a) Have you suffered from any change in taste or smell? b) Have you suffered from any sort of cough in the last several weeks? c) Has anyone in the household experienced or had COVID-19 symptoms, and additionally I have added d) Have you had the vaccination? If so, how many doses?

This can help us identify potential asymptotic cases which could risk infecting the clinic.

Each practitioner must don and doff between each patient, sanitising their hands frequently. Then after every patient, the room is cleaned thoroughly, and the used PPE is placed into bags and put into designated waste bins.

This is in accordance with COVID-19 rules and regulations which allows us to remain open and practice. This has been a rather surreal experience, filled with lots of anxiety when returning to clinic, yet exciting to get back into practice life and returning to some sort of normality.

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

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Osteopaths are classified as allied health professionals. This a title which the profession has work for, and not has been recognised as an important frontline service. Allied health care professionals are involved with the delivery or related services pertaining to the identification, evaluation and prevention of diseases and disorders; dietary and nutrition services; rehabilitation and health system management among others.

Osteopathy works on the principle that with structure governs function, implying that the body works as a unit, as they are reciprocally interrelated. We specialise in providing different manual therapy modalities, identifying osteopathic lesions by understanding the body’s biomechanics. However, what sets us apart is the amount of time spent with the patient, and due to this time, practitioners can establish a good rapport.

During treatment sessions, we can offer advice about certain musculoskeletal conditions and diseases. Amongst other lifestyle changes which can enhance the patient’s quality of life.

From talking to the patient, practitioner can pick up on the verbal and non-verbal language given off by a patient. Potentially, the patient may suffer from a mental health disorder, and this is something out of our scope of practice. However, by helping to identify these potential qualities, we can start to get the help they need.

Similarly, patients are sent to an osteopath from GPs, physiotherapists, and other professionals as we can help due to our specialist training. Although the reverse can occur, for example physiotherapists have a superior rehabilitation repertoire. Therefore, we will send them to a physiotherapist if it enhances patient care.

This is something I realised at multiple parts throughout the course. When you begin to research into a certain topic, the more realise how little you know in that chosen field. Which is why we have specialists and refer to other professions. Ultimately the patient’s health both mental and physical is of the upmost importance.

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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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I now understand the as osteopaths, we have a unique opportunity and position within the health and care professionals. We learn a huge amount about the human body (Anatomy, Physiology, Pharmacology, Pathology), this is in the event of a patient presenting with a serious pathology masked as musculoskeletal pain. Similarly, to B1, our knowledge base needs to have sufficient breath and depth when trying to accurately identify a differential diagnosis.

These experiences from the teaching clinic, as previously mentioned, we act as a frontline worker, screening patients for serious pathology then using our osteopathic knowledge to treat accordingly. A possible implication of a lack of knowledge could lead to the practitioner being unsafe and putting the patient’s health at risk.

Therefore, we need this information to make an informed decision. By understanding a certain condition, or pathology, we can then address it appropriately. Providing accurate advice when discussing short term and long-term outcomes. I believe this is very important as this influences our honesty and integrity within clinic.

Thus, demonstrating the correct and sufficient knowledge, this will ultimately help the patient but contemporaneously building a strong therapeutic relationship.

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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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The therapeutic relationship has been extensively researched into, especially in talking therapies and more recently used in other areas of healthcare. The therapeutic relationship involves the close, consistent association between two individuals (health care professional and patient), in this case between the practitioner and the patient. This has been seen to influence clinical outcomes and can be attributed to patient-centred care. Whilst also contributing to the shared decision-making process.

However, the therapeutic relationship should have clear, professional boundaries from the initial consultation and maintained both in and out of clinic. This can be done by using certain language and refraining from being over friendly, chose of vocabulary and sharing personal information.

I believe that a therapeutic relationship relies on the practitioner being open and honest. Therefore, it only seems natural that the patient develops some form of attachment. There will be general conversation after the compliant has been dealt with and must be professional.

This highlights why is it important to be careful with the verbal and non-verbal language used when having a discussion.

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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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Research in physiotherapy, conducted by Miciak et al. (2018), found the following features needed from both practitioner and patient. These are heavily important to developing a healthy therapeutic relationship.

This can be broken down into four categories.

Present – Being present: Reflects therapists and patient’s intention and abilities to be in the moment or embodied in the time and space.

Genuine – To be real or convert sincerity in the present. Being genuine in a therapeutic relationship has three aspects 1) being yourself, 2) being honest and 3) investing in personal, both the person and situation.

Receptive – parties involved must enter interaction with 1) an open attitude to negotiate appropriate treatment plan, 2) focuses receptivity to identify salient issues and needs.

Committed – To be engaged, therapists and patient must be committed to their roles within the therapeutic relationship. The points considered, there are two aspects that characterise being committed 1) committed to understand and 2) committed to action.

By creating a therapeutic relationship, it can enable us to create an open and honest environment. I believe, those who decide to embark on any sort of health care profession have certain characteristics which allow them to be caring and communicate effectively.

This research paper has identified the subtle signals that can be interpreted when creating a therapeutic relationship. Especially how you are as a practitioner is almost as important as your practical skills.

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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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This is a screenshot taken from the ESO website. This can be found under the clinic tab on the website and then in the “patient feedback and complaints procedure.”

This webpage is the location where patients will make any suggestions (positive or negative), whilst also making a formal complain to GOsC if needed.

On the webpage it states, “On occasion, we may not meet an individual’s level of satisfaction and if you are concerned about the care or service you have received from us, we would like to know.”

To date, I believe my current cohort of students have not received any negative feedback or formal complaints to GOsC.

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

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

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All patient records and notes are kept within secured filing cabinet at the teaching clinic. Along with any sort of documentation with personal information.

For example, for the OS743 module, we had to write up a small case report on a case form a specialist clinic. I had decided on a relatively simple case, however it was significant to me as it highlighted the possible psychological implications of breastfeeding. However, in order for me to access and use in my case report, all names and identifiable information was removed. This was to make sure no one knew the patient's name or other details which could identify the individual.

This in turn protects the patient and also prevents any sensitive information being leaked.

The university has numerous rules and regulations in place to follow the guideline set in place by the GDPR.

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

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

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All patient should be and are treated the same. I will always offer my full undivided attention, to achieve a deeper therapeutic relationship. This can be achieved by appreciating and complying with equality and anti-discrimination laws.

Within the government website under discrimination: your rights - it states you are legally protected from discrimination by the Equality act 2010. There is also a section on the website regrading action against discrimination.

This is something called positive action. Taking positive action is legal if people with a protected characteristic - Are at a disadvantage/ Have particular needs/ Are under-represented in an activity or type of work.

The act provides a legal framework to protect the rights of the individual and advance equality of opportunity for all. It provides Britain with a discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society. Furthermore, it makes the law easier to understand and strengthening protection in some situations.

I have been fortunate not to experience or had any experiences of discrimination. I can not imagine what is it like to deal with those situations, thoughts and feelings. Moreover, from spending time on the government website, I have been made aware of what can be done to stop discrimination if I come across it.

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

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

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An osteopath is a full time job. There is no time off, my brain is constantly ticking over, constantly trying to improve my knowledge. I have a special interest in sport specific injuries and rehabilitation.

With the amount of time spent on social media platforms, there is vast and almost endless pot of information out there. A lot of this information can be false and misleading. Often posts about back pain, neck pain or leg pain, are very generalised, and may not work for everyone. In contrast posts about posture can be misleading. On my sports massage page, I have created a post using a array of different studies. The studies were investigating is lower back pain / is text neck and posture related. a
Association between text neck and neck pain in adults by Correria et al. 2018 concluded text neck was not associated with the prevalence of NP (neck pain), NP frequency, or maximum NP intensity in adults. However, it could be argued that this observational cross-sectional study only scores a 4 for the level of evidence. Which is relatively low.

Furthermore, a longitudinal study was undertaken by Widhe in 2001 which explored posture, mobility and pain. This was conducted on 90 subjects at the age of 5-6 and then re-examined at 15-16. Widhe states: occasional low back pain was reported in 38% of the cases in the 15-16 age group, but back pain was not related to posture, spinal mobility or physical activity.

In my opinion, posture does not directly relate to pain. Posture is something that adapts due to our occupation, lifestyle and habits. The laws suggested by Wolff and Davis, states soft and osseous tissue models along the imposed demand. Therefore, posture does not necessary correlate to pain, yet muscles, and altered biomechanics can cause pain. Not posture itself. Thus, advice such as resistance training; recognise external and internal factors play a part in pain perception; exercises and the phrase - "your next posture is your best posture."

Moreover, I try to provide my patients and colleagues with accurate and reliable information.

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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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As a ESO student working at the teaching clinic, we do not deal with any financial aspect. We have a business module within the third year which is assessed via a written piece of work encapsulating a business plan. This needed to be realistic and cover basic work necessities and  how a practice could be started and maintained.

Apart from the theory aspect and learning what it takes to build and develop a business, I have had no implications or involvement with any financial dealings.

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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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As aforementioned in C2, as we are students working in a teaching clinic, patients are often shared or passed over to a new student.

To reduce the possible contact and mixing between the different clinic groups, it was decided that we were split into smaller groups and worked according to a rota. It consisted of two week blocks (One week would be in clinic, One week would be working/studying from home). Therefore, this lead to certain patient who required weekly appointments to be shared between practitioners.

This could be an example of support and cooperation between colleagues to enhance patient care.

Mostly true for adult patients, being treated with mostly structural techniques, it can be difficult to understand and interpret cranial and IVM treatments for infants. Less effecting the patient's care but can be difficult for the practitioner each week. Particularly as it most led by the tutor, and within IVM movements and fluctuations can be very subtle. So from a practitioner and learning aspect it can be frustrating.

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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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From previous research, certain musculoskeletal conditions are best treated by a combination of treatment modalities. By using a multidisciplinary team of professionals enables optimisation of the patient's care. A combination of interventions and professions will yield better results than a singe treatment or surgery alone.

Multidisciplinary care can be seen in numerous environments and in numerous conditions. For this case, I will be focusing on pain and more specifically pain management. Severe pain issues can seriously affect the quality of the patient's social and working lives, especially in chronic cases. It can be described through marked changes in sleep, coping mechanisms and the ability to cope with daily lifestyle and normal daily tasks, that leads to a reduction in the physical, psychological and social well-being of the patient. The impact of chronic pain can be exacerbated further by an increase in the prevalence of co-morbidities  such as anxiety, depression and decreased physical and mental functioning

Patients with this time of chronic pain will require long term re-assessment and adjustment of therapy. The biopsychosocial model recognises these conditions as a combination of physical dysfunctions, beliefs and coping strategies, distress, behaviour and social interactions. Since the introduction of this model to regular practice, the treatment of pain has become multimodal and multidisciplinary, with an emphasis on a range of strategies.

In order to achieve these goal, successful long term management requires a range of specialist treatment that is tailored to the individual patient needs.

Comprehensive multidisciplinary management of pain is a clinically effective and cost-efficient approach when compared with non-disciplinary treatment or usual care. (Turk 2002; Scascighini et al. 2008; Cunningham et al. 2009; Dysvik et al. 2010). The IASP recommends that members of a multidisciplinary teams communicate frequently, both about specific patients and overall development.

However it is not possible for every chronic pain patient to be managed in a multidisciplinary way as there would be too much demand and little supply of professionals. Therefore, it is imperative to identify which patients will benefit from this multidisciplinary approach to care.

Contrastingly, it could be a letter of recommendation from an osteopath to a Physiotherapist for a number of things such as rehabilitation exercises or corticosteroid injections. As this will ensure care is delivered and perform in a programme with a coordinated manner. I believe this is essential in order to optimise the patient's care.

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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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Mental health is an aspect of health, I have been more interested in since starting university. I have personally dealt with mental health issues in the past and have experienced how it can influence your decisions. It does not only influence your own mood and opinions, but can ultimately impact on those around you.

Therefore, it is important to take care of yourself, and seek help when needed. A problem shared is a problem halved. Very much like physical impairments, it can heavily influence the quality of service we can provide.

Attached below is a website sent through recently. This is an example of a mindfulness and meditate exercise. There are a number of useful apps such as calm and headspace. These are very useful and can be a first step in getting help.

Similarly, when returning to the teaching clinic, we underwent weekly lateral flow tests. This was in order to adhere to COVID rules and regulations.

Moreover, mental and physical health should not compromise the treatment to the patient. If there is an issue with a practitioners' wellbeing, it should be assessed independently by another professional.

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Puppy mind exercise - Mindfulness for Students

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A mindfulness exercise in breath control to introduce the concepts of, and show the effectiveness of, mindfulness for students in the UK.

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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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I have not had any significance issues within the teaching clinic. Therefore, I am unable to comment on this particular OPS. However, I can appreciate how the production of written materials should comply with all regulatory requirements.

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Describe - Begin by describing the situation. What did you see, hear, do, read or see? Be as brief and objective as possible.

Interpret - Interpret what happened. What new insights have you gained? How does this experience connect with other things you've learned or experienced before? How did the experience make you feel?

Evaluate - Make a judgement. How useful was this experience for you? What is your opinion? Why do you think this might be?

Plan - Comment on how this experience might inform your future thoughts or actions. How could you apply what you've learned from the experience in the future? How might the experience relate to your degree or future professional life?

This model has helped me to reflect throughout this portfolio. I like the style of reflection, as it offers a structured and detailed plan to construct a well devised self reflection.