https://standards.osteopathy.org.uk

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In a recent clinic appointment, I was involved in the care of a 78-year-old patient who had a colostomy bag. She explained that she would prefer NOT to undress down to her underwear in front of the clinic tutors, especially as predominantly male, and while she was not ashamed about having it, she always felt self-conscious that others might be disgusted by it, that it may smell, even though she is fastidious regarding personal-care, but that on occasion it has been known to become detached. She quickly became noticeably anxious and irritable. This situation prompted me to reflect deeply on how to manage her dignity throughout the examination and treatment process in situations that could evoke shame or uneasiness through anticipation of future events.

So What?

This experience made me hyper aware of how vital it is to respect and uphold a patient's dignity, particularly when they are in a physically and emotionally vulnerable position. While I initially focused on the task clinically and the learning opportunity that the patient case may bring, the patient's unease and concerns reminded me to prioritise patient comfort, emotional support and psychological ,well-being, not just their physical health. It also focused my mind on a different perspective related to communication and informed consent underscored by the necessity to ask permission before exposing any part of the body and who is present in the treatment room. It was a stark reminder that what is a run of the mill routine event for us, can be a distressing and deeply personal and challenging experience for the patient.

Now What?

Going forward, I will be more assertive and proactive in advocating for patient dignity. I will be mindful to clarify what is important to them in the process and what takes place in the clinic environment to ensure trust and comfort and use tools available to me such as drapes, clothing and consideration of who is present to preserve modesty. I will consider my own body language, volume and tone of voice to make sure my patient feels relaxed and safe. Most importantly of all, I will continuously monitor my patients, their concerns and needs throughout their visit.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7948730/pdf/IWJ-16-243.pdf

(Wray & Clarke, 2017)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

During a routine maintenance treatment session, I worked with a 62-year-old male patient who had experienced a stroke 20 years previously. He had ongoing cognitive difficulties and often required additional time to process and respond to communication. During our interaction, I noticed he used several malapropisms, which made it increasingly difficult to follow what he was saying. As the session progressed, he appeared self-conscious and slightly irritable. He apologised for taking so long to answer my questions and commented that he knows it makes him appear to be "stupid", but that if I had known him before the stroke, I would know that he is not. He once more apologised for finding it hard to find the words needed to express himself. I realised that even subtle signs of impatience from the practitioner would cause distress and negatively affect his confidence and willingness to engage. Add to that, the fact that in an interaction it is likely you will need to dress down, making a tense situation, even more vulnerable.

So What?

This situation highlighted the importance of adapting my communication style to meet the individual needs of patients. While I was not aware of feeling impatient, I became aware my facial expressions or silent pauses to allow for expression, may have inadvertently reinforced experiences of other interactions in his life, when people have shown irritation or impatience during conversations. I noted that the patient was not only worried about being seen as less intelligent than he was but that he was also feeling hurried and rushed by others to verbalise answers or details. This encounter reminded me of the need to adapt my communication to allow space for him to think, respond, and to listen to his needs and concerns of judgement related to dignity and trust in healthcare professionals.

Now What?

In future interactions, I will be more mindful of non-verbal cues, that I maintain open and encouraging body language and provide visual and verbal reassurance when patients have low self esteem or low confidence when patients are struggling to express themselves. In future I will allow my patient time to communicate in their own style, will speak clearly and in a supportive way and will clarify that my patients have understood what has been discussed and have any information that they would like. I will commit to continually improve my skills and approach to patient-centred care and empathy to enhance the standard of care offered.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5640038/pdf/bmjopen-2017-017944.pdf

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

While in Children's clinic, I was the practitioner in a new consultation with a mother and her 2-month-old daughter who presented with symptoms of infantile colic and a noticeable right-sided head preference. The mother spoke very good English and was actively engaged in the appointment with myself and the tutor. However, part-way through the consultation, she asked if there was any information available that she could share with her mother and husband that only speak Polish, and were a large part of the baby's care. In response, she was provided with the website details and App information for Cry-sis, an organisation that specialises in Infantile Colic and support for parents. This included selection of language and printable downloads with links to handy 'hints and tips' and a forum of patient experiences and interactions of those going through the same concerns and insecurities.

So What?

This experience demonstrated the importance of accessible and culturally sensitive communication in family-centred care. Although the mother could access support, the father and grandmother sought reassurance to accurate and relevant information that impacted the infants quality of care and supported improvement to health and wellbeing. The effects of which would benefit the whole family. This avoided fractured care and reduced confidence and confusion between family members. It also, fostered cohesion in patient-centred care, empowering the family.

Now What?

Looking ahead, I will actively continue to explore, navigate and promote multi-lingual services and support including audio-description, braille and even PECS books (pictorial books to allow non-verbal communication such as in the case with Cerebral Palsy patients or following stroke. This allows for confident sign-posting to patients and opens up access to healthcare in a uniqu way missed as an opportunity otherwise. I now recognise and understand the effectiveness and importance of this and it's essential impact on quality and duty of care, within the communication process.

https://www.cry-sis.org.uk/help-with-young-babies/

(Shah et al., 2024)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In a new patient appointment, I explained the proposed examination plan to the young patient who had presented with neck pain. The patient seemed satisfied and gave consent for me to begin. However, as I went to proceed to examine his neck using palpation, I noticed a slight flinch. Detecting hesitation, I asked if he would like me to continue, and did he have any questions before we started. He admitted to being nervous as he wasn't sure what I was planning as he wsn't really sur what I had meant beforehand. I took more time and explained the procedure using lay terms and explained what I was looking for and how it may influence our treatment choices. He was greatly reassured and confidently gave consent, apologising for flinching. I explained there was no need of apology and thanked him for allowing me to recognise my initial explanation was not clear and to improve my practice method in that regard.

So What?

The experience reinforced the need for clear communication, informed consent and that consent is not a 'once-and-done' task but an ongoing collaborative patient/practitioner game of tennis with both asking questions, offering information and collaboratively agreeing on appropriate choices and action. Valid consent must involve open dialogue, and must allow time for pause and reflection, and not be forced or rushed to get to an end result when one, but not both parties, are happy to continue.

Now What?

I now make sure I explain clearly, and actively check for comprehension and check if my patient is ready before starting. I am more observant of non-verbal cues and document, explanation and consent fully in my patient records. I will continue to do this as treatments and outcomes progress to resolution reinforcing patient autonomy throughout their care.

https://www.ncbi.nlm.nih.gov/books/NBK430827/

(Martinez et al., 2021)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

My patient at the appointment was a 48 year-old male presenting with diffuse, bilateral low back pain. Following case history and examination it transpired that poor posture, prolonged sitting at home and work with lack of movement generally were contributing factors. I provided manual therapy treatment for initial relief and long-term management was discussed. The benefits of movement throughout the day, regularly rather than sporadic spontaneous events and moving in different directions, rather than just anterior/posterior was discussed. Walking and swimming were suggested as the case history demonstrated a previous interest in this. The patient felt this was realistic and admitted he had missed it.

So What?

The encounter made me consider the need to empower patients to take an active and leading role in their own health and care. While physical hands-on therapy was useful and reassuring it was evident that the gentleman had become complacement to the idea that recovery could only come externally in the guise of an appointment rather than acknowledging that poor habits had lead to these compensation patterns and could, in reverse, lead him to good health. By involving him in the solution strategy be became more motivated and remembered a friend swims locally several times a week and that it might be nice to join one of those sessions, to get started. I learned that by collaborating with him rather than instructing him, it built his confidence and aspirations were raised up to see opportunities rather than obstacles to a fitter, healthier and hopefully pain free future.

Now What?

I now include patient education and self-care strategies into my appointments exploring where their passions lay and motivating them regarding beliefs of what could be possible and realistic at whichever stage of their journey, they are on. I make a note in the file to ask about activities and exercise regularly and include positive reinforcement or gentle motivation where appropriate. These changes support patients in healthier choices and lifestyle improvements in a gentle encouraging way.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8488814/pdf/main.pdf

(Ekpenyong et al., 2021)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In a follow up appointment, while treating a female patient with mid-back pain, I needed access to the thoracic region necessitating the removal of some clothing. Before proceeding the patient told me of her uneasiness about undressing and we agreed that she would use a towel to protect her modesty and cover herself and I left the room while she dressed down to her bra and shorts, ensuring clear, respectful communication throughout the process.

So What?

I was reminded how important it is to respect and protect a patient's modesty and dignity in an environment where they feel vulnerable or exposed. Taking time to explain the examination and treatment plan, offer alternatives and respect my patients wishes demonstrating a respect for their choices and showing a compassionate consideration. This should build patient trust and confidence.

Now What?

I will proceed to be mindful of patient comfort, especially during exposure. I will, in future in my own clinic, provide gowns and towels as standard, always leave the room during dressing and undressing and overtly be respectful of dignity as a core-part of delivering safe, patient-centred care. The more comfortable the patient, the better treatment outcomes are likely to be.

https://doi.org/10.1177/1744987121997890

(Ter Haar, 2011)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

During a maternity appointment, a pregnant patient explained to me their strong feelings concerning a desire to have a home birth. They had also declined the offer of routine scans, which gave me concerns. I believe in the benefits of maternal medical monitoring and found it difficult to understand. I listened respectfully and did not allow my own personal view to influence the consultation but offered balanced information so that my patient was informed about all available options, but felt supported in her own choices regarding maternity and osteopathic care.

So What?

I thought about how I would feel if I had someone pushing me to do something they thought I should do, that did not sit right with me. It made me feel stressed, angry and resentful. I contemplated that to build trust, earn respect and encourage the patient to share the feelings and details that influence their decision-making, that it is important for them to feel safe, supported and trusting. Combining this with supportive behaviours and education allows them to make informed choices that reflect their belief and values based on their life experience of nature and nurture and that what I think or want, really has no bearing.

Now What?

I'll continue to reflect on my own beliefs and ideas and reflect by asking myself why I believe that to be the case and whether it affects the situation or outcomes one way or the other and if it impacts outcomes adversely or favourably, to empower myself and my patient, so everybody wins.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3262273/pdf/rsfs20110029.pdf

(Mayerl et al., 2023)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

My patient presented with unilateral hip pain on the left side. During the case history, I used my knowledge of anatomy to ask relevant questions about onset, aggravating factors, and any red flag symptoms. I identified that the reproduced pain inferred potential sacroiliac involvement more than the hip joint per se which influenced my approach

So What?

This highlighted the importance of anatomy particularly as well as a physiological understanding of functionality in arriving at the correct working diagnosis. My ability to ask specific questions that inform the diagnostic sieve filtering process allow the examination routine to be streamlined and informative preventing a focus on the wrong causation.

Now What?

I am working toward improving my clinical reasoning skills by frequently reviewing anatomy, exposure to pathophysiological conditions in patient encounters and via research. Regular CPD training enhances my skills in conducting a focused case history effectively, insuring that I continue honing the skills adopted through my training to improve patient interactions.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9579268/pdf/nihms-1801192.pdf

(Carey et al., 2021)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

During an initial consultation, I assessed a large male patient who presented with musculoskeletal discomfort. During the case history, he revealed a history of high blood pressure and reported becoming short of breath, while walking to his car for work every morning which is situated 100 yards from his home, on a slight incline. As he sat in front of me, I observed this resting breathing appeared laboured. He had drunk coffee 50 minutes prior to his appointment. On taking blood pressure, it was found to be beyond a threshold for safe treatment, in absence of a GP report for causation or management such as medication. I recommended visiting the GP within 24-48 hours to establish safety for my patient and ongoing pathway advice such as full cardiovascular assessment.

So What?

This scenario made me reflect on the importance of recognising red flags and knowing when to pause or refrain from treatment. Despite the patient being disappointed not to receive hands-on care, we both recognised that without medical clearance, I could risk exacerbating an underlying cardiovascular pathology, placing my patient in harm's way. Understanding and respecting the limits of my professional training and scope, vital here, to protect the patient from harm and myself from potential investigation or litigation and damage to the reputation of myself and my employers and osteopathy in general, referral was made, supported by a letter to the GP. This protected my patient and upheld professional and ethical standards of practice. I ensured the records were comprehensively documented for transparency.

Now What?

I will continue to refine my clinical judgement through regular CPD training and competencies exposure and refresh my knowledge of red flag indicators, particularly around cardiovascular health. I will ensure I communicate clearly and have been understood by patients when referral is necessary explaining my reasoning to harbour trust and confidence and the experience reaffirmed that safety in practice sometimes means NOT to TREAT. All documentation is completed in a timely manner for full disclosure, protecting myself legally.

https://doi.org/10.1161/CIRCRESAHA.121.318083

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

I saw a young, female patient who presented with persistent bloating, abdominal discomfort and irregular bowel habits. She emplained that she had been previously diagnosed with Small Intestinal Bacterial Overgrowth (SIBO) by her GP and while and was seeking osteopathic support to help manage symptoms holistically. I had some knowledge of general principles of gastrointestinal dysfunction, I learned quickly that my knowledge of SIBO was restricted to the snippets shared by a friend relating to their pet dog, which was not ideal. My understanding was insufficient pertaining to best practices, NICE guidelines etc in supporting this patient in recovery from or improvement of symptoms through manual therapy, referral pathways, dietary management approaches and would need to follow up with a bespoke plan of action to address my patient's needs.

So What?

The situation at hand, highlighted to me the significance of recognising and appreciating the boundaries and limitations of my current knowledge and experience. I realised the need for pro-active action to expand my clinical understanding of the condition. By admitting the situation to the patient I was able to draw from her vast knowledge of the subject and organisations and charities where information and further research could be found. Conducting a literature review from reputable peer-reviewed sources, I was able to educate myself further how SIBO may affect MSK function, common co-morbidities and suggestions for appropriate manual therapy techniques to support relief and to complement her care from other specialties.

Now What?

As a direct response, I created a short-summary of the evidence that i had reviewed and used it to formulate a treatment plan for short and longer term, but adaptable to her response to treatments, and to factor in potential flare-ups and missed or rearranged appointments due to excessive flatulence or diarrhea, which as you might expect, she found distressing and embarrassing. I focused on gentle visceral techniques, stress reduction strategies, advice on postural support and offered continued encouragement in her medical and dietary endeavours through GP and dietician. In future I plan to follow the literature as it updates and attend CPD events in support of GUT health and pharmacological advancements. I have also allocated a weekly time slot expressly to allow research and continuous professional development for clinic case files. This patient experience and reflection has taught me the importance of maintaining up-to-date knowledge, as a requirement but to facilitate effective, confident and ethical care to a high standard.

https://www.ncbi.nlm.nih.gov/books/NBK546634/

(Goetti et al., 2020)

Kolb Experiential Learning Cycle, (Kolb, 1984)

1. Concrete Experience (What happened?)

A male patient presented at clinic this evening with chronic recurrent shoulder pain which followed a rotator cuff injury. Despite having had three sessions over 6 weeks, my patient's progress had plateaued. He had been completing his exercises to the descriptors given but was finding discomfort still with some exercises. I realised that I needed to review my original treatment plan and possibly consider a biomechanical element that could have been overlooked and check the case history for something I may have neglected to account for.

2. Reflective Observation (What did I notice?)

Looking at my notes, I observed that my focus had been on soft tissue release and strengthening but minimal assessment of thoracic mobility in later treatments or sufficient reassessment each session on scapular stability. I also realised that I had failed to use all the tools available to me, and that imaging would be prudent despite the chronic nature. My patient was complicit in following advice but was becoming increasingly frustrated with the lack of progress made.

3. Abstract Conceptualisation (What did I learn?)

   I learned here the need to step back and think about the situation and rethink my approach when outcomes are not what I would have expected. I realised I need to be asking myself "Am I still on track with my patient expectations, the rehabilitation development over the time, and what could I be missing? In future I may ask a colleague for a second opinion, or even include the patient in why they believe they are not improving in the time frame, to qualify if they could be doing something new, or have changed their bed/car/job/training/ new sport for example. Any of these things could affect resolution or timelines.

4. Active Experimentation (What will I do differently?)

   I adapted my assessment protocol to build in regular checks and reviews. I built in functional movements for the thoracic spine and ribs, and my patient observed better freedom of movement and less stiffness and pain. The patient decided to hold off on imaging as things were improving but would consider it in future if needed. This attitude to development in rehab is the new normal for me and has been revealing.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7484714/pdf/eor-5-508.pdf

(Davenport, 2019)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In Maternity clinic, my patient, a woman in her third trimester presented with pelvic girdle pain which was affecting both mobility and sleep.

Following a full case history, I completed examination and initial treatment, with consideration of signs of flags throughout. All under my tutor's supervision. Self-care specific strengthening exercises for stability were provided.

The patient reported improved range of movement and function with reduced pain

So What?

I recognised that the specificity of my training with regard to the anatomical and physiological changes that take place, had allowed me to make the necessary adaptations in treatment options for the trimesters at each stage to continue to treat my patient effectively and safely throughout.

Now What?

My plan is to continue expanding on my skills in maternity care through ongoing education and CPD hours. Guidelines are naturally reviewed regularly as is government and organisational policy influenced by research and scientific advances, which I will incorporate into my maternity patient care.

https://bjsm.bmj.com/content/bjsports/53/2/90.full.pdf

(Brown-Schmidtet al., 2023)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In an early 4th-year clinic session, I became overly-enthusiastic and following taking the case history I continued on into physical examination and treatment, without meeting my supervisor first. In doing so, I failed to complete the patient notes contemporaneously

In doing so, I also failed to acknowledge my duty under the tutor agreements and university regarding insurance or in completion of the patient records contemporaneously. The tutor was understandably cross and disappointed, I was very distressed, and the incident was reported to my superiors. I was issued a verbal warning and required to write a reflection. I apologised directly to the tutor and senior team. My actions, though not remotely intentional or deliberately disobedient, breached OPS (GOsC, 2019) standards.

So What?

The experience highlighted how crucial it is to adhere to professional standards and follow guidelines and protocols. Especially of import, tutor oversight, the following of clinic protocols as an undergraduate moving towards graduation and completion of relevant, accurate, completed note-taking in a timely manner. By failing to do so, I compromised patient safety and trust and violated professional standards. It served as a necessary, yet painful reminder that enthusiasm must be curbed with adherence and clinical governance.

Now What?

I have committed to always pausing the session to attain tutor understanding, input and authorisation to continue prior to examination and treatment. I now complete notes as I work through the exam or treatments and am careful to ensure the right information is recored where it should be found on the document including on pages with images or bodymaps. The experience has taught me to respect and value procedural discipline as a core part of our regulatory standards and professional practice for patient safety in mind.

doi:https://doi.org/10.1111/cogs.13271

(Cascini et al., 2024)

'GIBBS Reflective Cycle' - Learning Model (Gibbs, 1988).

1. Description

   A 15 year-old male, presented at evening clinic with his mother, complaining of low back pain, seemingly from playing football. Following the assessment, a phone call was made to clinic requesting a written summary of the appointment to share with the school sports coach. I had NOT been prepared for such a request and the document was delayed. The tutor provided feedback that the response needed improvement to meet professional standards, both for communication and professionalism.

2. Feelings

To start with I was flustered and anxious not knowing how to respond satisfactorily. I intended to respond in a timely manner but was too embarrassed to ask peers, or my tutor for guidance. I eventually asked for help and was advised how to proceed but was disappointed to have waited and delayed the task worrying the patient's mother and coach may perceive my actions as unprofessional or even negligent. I felt awkward when my tutor raised concerns but grateful to receive feedback and assistance in putting the matter right.

3. Evaluation

My clinical care of the patient was acceptable, but my belated and vague initial response undermined that and required improvement, which was done.

The situation taught me effective communication comes in many guises including timely, clear and professional interactions. Positively, I received advice and expertise and learned a great deal to equip me for future events.

Negatively; I wish I had not waited before asking for advice, especially for situations involving minors and in this case, a third party ie, the football coach.

4. Analysis

The experience educated me how influential building and maintaining trust can be which affects perception of our capabilities and professionalism. I comprehend that all documentation passing hands, either in the present or future needs to be accurately and contemporaneously in the present. In addition the records must be written specifically with the expected audience in mind such as clinical language between professionals and lay terms to those externally ensuring correct interpretation. Where a minor is discussed or present then parental involvement and confidentiality must be addressed and supported.

5. Conclusion

I learned that my role incorporates more than just examination and treatment but also good but prompt communication, and timely action. Naturally involvement of minors engages other healthcare professionals, schools, sports club coaches and guardians, both personal and professional such in the case of scholarships or competition. I learned most importantly, to ask for help when needed and to act promptly and get a trusted colleague or supervisor to verify I have followed protocol relating to all parties.

6. Action Plan

   I have created my own checklist using suggestions from trusted sources and have researched the correct protocol for communications with parents, guardians and third-parties. I have reviewed examples of professional correspondence, particularly in the medical/clinical world. In addition I will clarify patient and tutor expectations to provide the highest standard of care

   
   

https://pmc.ncbi.nlm.nih.gov/articles/PMC10963197/pdf/main.pdf

(Kelly et al., 2021)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In clinic in my first year, while observing a year 4 appointment, the fire alarm went off unexpectedly. The practitioner calmly and politely informed the patient that we would be evacuating the building to the car park at the bottom of the driveway, to the assembly point, and asked if she could assist the patient with their clothes as they were in a state of undress.

So What?

This experience taught me the need to remain calm, professional and focused in an emergency, following a well-practised procedure, keeping patients from harm. Some individuals appeared confused and anxious and the practitioner was informative and courteous to them, yet professional and timely in assisting other Year 3 practitioners out of the building, while reassuring other observers en route, as the register was conducted and patients were given clothes and blankets. This demonstrated to me the necessity to follow safety procedures calmly and effectively through information and supportive but assertive communication in a time-sensitive manner.

Now What?

I reviewed the clinic's fire safety police, location of fire hydrants and drill protocol, along with fire exits for both buildings as a precaution to further events, should the need arise. The scenario reinforced the responsiblity to patient's and staff and my colleagues to prevent harm during unexpected events and emergencies.

https://doi.org/10.1111/anae.15511

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

During morning Children's clinic, in preparation for my patient, I observed that the blue couch roll was empty, there was food on the floor from the previous patient's children and the room smelled of stale air. There was also some food on the corner of the couch and a hand print. I wanted the room to be patient-ready, so cleaned and sanitised the couch, cleaned the floor and replaced the couch roll, discarding the empty one. I also opened the window to replace the stale air with clean fresh air and ensured all rubbish was in the bin.

So What?

This situation is fairly uncommon as students habitually clean down the room after their consultations. Clearly on this occasion it had either not been possible or the student simply forgot to do it. This prompted me to think about how during busy clinic, it is essential to be organised and arrive early to prepare your environment as well as to take care to leave the room clean for the next patient interaction. Hygiene standards can slip even through minor oversights which would potentially affect patient confidence and perceptions of quality in practice. Toys, equipment or food on the floor is also a safety hazard and compromises patient safety, whether that be a physical risk of tripping or falling or an allergic reaction in response to contact with a food or beverage harmful to health, for an adult or child. in that space. Due to the cleaning and sanitising products been present and knowing where to find couch roll, the room was prepared in a timely way and welcoming as my patient arrived for their appointment. I also asked reception to email a friendly reminder to students, to ensure they leave the clinic rooms as they found them to facilitate the student and patient experience for all.

Now What?

I now prepare my room in advance whenever possible, ensure I know the location of all equipment and supplies that may be required, set up my room and promote cleanliness and sanitisation both in my role as practitioner, but also teaching these considerations and passing on knowledge to observing students in the more junior years below. I created a checklist for myself specific to room preparation and readiness to maintain patient confidence and hygiene standards (including noise-makers such as rattles and plastic teething keys and toys used to distract and entertain) and check sanitisers and couch roll and filled ready for the clinic session. A polite notice has been placed on the wall, in the student room, as a gentle reminder to prepare rooms early and leave them clean for the next practitioner and patient. This ensures high standards of hygiene and safety are enforced and maintained.

(Plunkett et al., 2022)

Kolb Experiential Learning Cycle, (Kolb, 1984)

1. Concrete Experience (What happened?)

While working in general clinic as a 3rd year student, a 48-year-old female who worked as a teacher in a secondary school, presented with chronic neck pain with stiffness and radiating headaches that emanated from the sub-occipital region. Having performed a full and comprehensive case history and examination, I determined somatic dysfunction at the level of C5/C6, likely predisposed by long episodes of sitting at her desk at work and the associated poor posture that accompanies it.

During the case history, she informed me that work is very stressful at the moment due to exams and that her sleep has not been great recently, through thinking about work at night. Until three months ago, she had been going swimming weekly, but that she cannot seem to find the energy. In addition, she has put on half a stone and has started feeling out of breath when rushing to get to work. She hasn't had blood pressure done for a few months but knows her BP must be elevated as on occasion she has heard her heart beating in her head. Her BP was slightly elevated but within healthy range.

2. Reflective Observation (What did I notice?)

   I contemplated the timing of her musculoskeletal symptoms in relation to her psychological wellbeing and thoughts, strain about juggling home life and work life balance and tiredness overall. I mulled it over, weighing up the benefits of osteopathy in the short and long-term which was beneficial but did not address the actual root of the problem, which was the need for a call to action regarding lifestyle choices, commitments, letting go or delegation of some everyday chores, better support etc. I had to give it some thought.

3. Abstract Conceptualisation. (What did I learn?)

I decided to mix osteopathy treatment and referring to Andrew Taylor Still's suggestions that "The body is a unit" and "The body is a self-healing mechanism", when given the right circumstances. The whole rationale is based on these principles in fact. I think about her enjoyment of swimming and the health benefits with associated influence on improved sleep. The physicality of it but in a relaxed, calm environment. The benefits to cardiovascular health and weight management. Looking at the bigger picture, I suggest she could go to a favourite coffee shop afterward to extend the time for herself and she suggests she could do some of her marking there, which would be quicker than at home where she then has the children.

It occurred to me that our role as osteopath involves many spheres of patient-care that affect success and rehabilitation prognosis. Osteopaths are promoters of health and educators with a strong bent toward prevention as well as restorative resources.

4. Active Experimentation. (What will I do differently?)

At the next appointment, OMT was applied at C6 and we discussed ergonomics, stretching and breaks in different spaces for change of scenery.

I recommended setting notifications for movement breaks or a walk at lunchtime in the park, next to her school to enjoy the space and eat, rather than working at her desk through the lunch break. My patient agrees to try it. I learn that strategies don't always need to be clinical to be osteopathic and decide to create a small section on my appointment forms related to wellbeing and work/life balance which will allow me to consider these elements in relation to each client.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9258824/pdf/pone.0270806.pdf

(Ariyan, 1994)

ERA Reflective Learning Cycle, (Jasper, 2013)

Experience:

While observing a fourth year practitioner when I was in second year, the practitioner recorded the symptomatic side as the left side, despite the patient showing the problem was on the right side. After the session, the same detail was conveyed to the tutor backing up the notes. I was unsure about what to do as I was concerned how my observation might be received but thought it should be corrected before submission for signing and filing. I quietly slipped the practitioner a note, to refrain from embarassment suggesting that I may have been confused but was the issue not on the right instead of the patient's left. The student thanked me for letting them know and discussed it with the tutor who signed the amendments for clarity

Reflection:

I realised it was a silly error due to mirror imaging and that students often in their first year make similar schoolboy errors, verbalising left, while knowing it to be right, but that it should be corrected on the legally binding document, especially as my name appeared on the document as an observer.

Action:

I've learned the importance of vigilence in practice and will continue to focus on always striving for high standards of honesty and integrity both personally and professionally.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1234476/pdf/annsurg00058-0051.pdf

(Phillips, 2022)

Rolfe Learning Model, (Rolfe et al., 2001)

What?

I was at a pub with friends for a night out, when unexpectedly one of my current continuing patients entered with one of our party. I had not known they had any affiliation with our mutual friend or that they would be attending the gathering, which was a group of circa 12 people. They collected drinks at the bar and joined our table. An hour or so later, my patient pulled up a chair next to me and began talking casually to me about the coincidence and offered to buy me a drink. While no flirtations or inappropriate comments or advances were made, I was uncomfortable about the situation and choose to keep my business and personal life at arm's length, in other words 'separate'. I was concerned at how I would extricate myself from the conversation and wondered indeed if I may have to make my excuses and leave. The conversation was very casual and felt most odd to me in context of the usual interaction within the confines of the professional clinic environment. Fortunately, my friend solved the problem within the moment, saving me from making any drastic decisions, explaining that they were only having a quick drink and going on to another location, which they did.

So What?

Over the coming days, I reflected on our clinical appointments and was clear that I had always maintained a very professional demeanour but considered I needed to have strategies in place for similar situations in future. I consulted several of my tutors for strategies and ideas how to politely rebuff or remove myself from any awkward situations in future. I thought about the clinical setting, professional language, standards incorporating dignity, integrity, modesty and so forth. I contemplated the importance of not falling into habits with jokey or casual language or accepting gifts or offers of assistance. I remembered the position of trust and professional knowledge and the responsibility connected to our profession in healthcare, storage of personal details, confidential information, finances related to our business. The blurring of lines in perception of business and pleasure are not without danger.

Now What?

I acknowledge and fully comprehend, the absolute necessity to keep my personal and professional life and ethical boundaries very clear and independent of each other. I will be proactive in setting very clear distinctions between the two, that leave no room for misinterpretation. Should I encounter patients in a social setting, I will politely and courteously acknowledge them, if necessary by their full name but will not be embroiled into personal or casual conversation or banter and will redirect conversation topics if needed. Failing all else, i will make up a legitimate excuse and leave. I will uphold all conduct and behaviour to GOsC OPS standards to the best of my ability.

https://doi.org/10.1016/j.ijosm.2022.06.005

(Zolkefli, 2017)

Rolfe Learning Model, (Rolfe et al., 2001)

What?

During treatment, early in Year 3, I applied more pressure than intended to my patient's calf muscle, not realising my own strength. The tutor was in the room and observed the patient's response, which I was unaware of. Later, in the tutor room, he took me to one side and explained that he saw the patient react and that I needed to acknowledge this to the patient, explain it was not deliberate but due to my inexperience as a new 3rd year, and apologise. This was documented in the notes.

So What?

I was embarrassed, the patient said it was a surprise but that it was fine and comes hand in hand with coming to a school of learning, but thanked me for apologising anyway.

My tutor acknowledged that I had apologised but need to be mindful of my strength in relation to my patient's tissues and to ask my peers when practising and patient's in clinic to give constructive feedback to the pressure used. I learned how you can admit to your failings honestly and how to improve my technique and adjust treatment for different bodies and morphologies and to document honestly in line with transparancy and OPS standards pertaining to a duty of candour.

Now What?

Now I ask for feedback and observe patients closely, I practice on peers and family and ask tutors for advice if required. I document my appointments fully and candidly for full disclosure and will continue practising my skills and acting on feedback to improve my abilities.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6422557/pdf/14mjms25032018_sc.pdf

(Bourne et al., 2016)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

In Year 3, a 36 year-old TMJ patient, that I inherited as a take-over from a Year 4 was not improving. The extensive file for him contained a number of students over sporadic appointments over 14 months with gaps in visits. I read the examination and treatment elements thoroughly and did my own research into TMJ. I also sought advice from a number of tutors. Following 4 appointments I spoke to my tutor about concerns that treatments had gone on a long time with little to no improvement despite all osteopathic principles and concepts having been adopted. I mentioned that my patient, employed by an emergency service, and ex military, had while maintaining confidentiality, spoken of anxiety, stress and PTSD type signs and symptoms related to previous and historical experiences and exposures. He had also raised a blue flag related to a previous superior who abused his position and created angst within the department. I asked myself, honestly if we were the right specialty to assist in recovery of TMJ and Bruxism issues in this instance as following any small gain would be a relapse. I observed that under 'Patient Expectations', the patient had said he was willing to try anything to get rid of the grinding and constant aching'. The tutor spoke to the patient in this regard so that I could observe as new to third year. The tutor enquired as to whether some sort of talking therapy such as Cognitive Behavioural Therapy (CBT) patient was a better fit to potentially reduce the habitual clenching and grinding as discs and dental had also been ruled out as the culprits. The patient agreed that it may be worth trying and that he would take this up with his employer as they had extensive programs and facilities in place for that. He declined our offer to provide any details of recommended organisations.

A day or two later, a complaint was made directly to the senior team at the ESO, about the conversation and my tutor. The patient reported being annoyed, disrespected and upset at the suggestion to take CBT or any other sort of counselling and wanted to continue osteopathic treatments as usual. An urgent meeting was held within a few days. I was not privy to those meetings but the gentleman later rebooked in with one of my peers and the tutor involved was told to have no contact with the patient. The patient was somehow appeased and continued treatment. I saw him on occasion at reception over a short time. Many months later, I learned he was in counselling in CBT and hypnotherapy for work related stress and PTSD. I hope that the patient found a solution and pain reduction. Had the patient not been content with the prompt and professional actions taken, he would have been signposted to next steps. Patients can contact the General Osteopathic Council complaints dept. Further details would have been perused along with documentation, investigation, if grounds for that, and a court case ( for serious cases) of negligence or wrong doing.

So What?

I sympathise with the patient's predicament and respect he had his own reasons for his choices. He made his complaint directly to the senior team, which was addressed in a timely manner to the satisfaction of both parties and my patient was compensated by way of clinic treatment sessions to appease the appointment on the day not treated but recommended for talking therapy. No conversations were directed towards me, just the tutor. I witnessed the interaction in the clinic room on that day, and my tutor explained and justified why he felt it may benefit the patient and the patient agreed. I learned that the language that we use, the suggestions and recommendations we make need to be carefully thought out, are justifiable, and that many facets affect our patients willingness to accept or agree with our decisions. That it it is crucial to work within your skillsets and understand and be familiar with the complaints policy and GOsC protocols to protect patients and the practitioner from harm.

Now What?

I make sure I know the complaints pathway, NICE Guidelines and GOsC OPS protocols for best practice and highest standards of care. I keep up to date with changes for the benefit of my patients, myself, my colleagues, my employer and my profession within Allied Healthcare. I clarify the patient goals and expectations in detail and previous bio-psychosocial elements that could impact recovery and from appointment to appointment and document fully, the comments that could have a bearing on self-care and rehabilitation.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4947769/pdf/bmjopen-2016-011711.pdf

(Tariq and Hackert, 2025)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

During a clinic consultation, one of my peers came out of the room looking for the tutor. Due to no clinic rooms being available, she waited at reception for him to appear, after a couple of minutes she started talking through the case rehearsing presenting to the tutor. I observed that while no specific personal data was mentioned, it was more by luck than judgement. The tutor arrived and as my colleague attempted to start presenting, the tutor suggested a quiet table outside away from crowds, hinting at the patients and reception staff in the foyer. They went outside to discuss the case. On returning the tutor reminded the student to document the details in the patient notes and that anything photocopied for further research must be fully redacted protecting the patient's confidentiality and privacy. He even emphasised the fact by saying "I know I can trust you to do that competently". The student did so and returned to the patient.

So What?

The situation highlighted to me hoe easy it can be to breach protocol when you are in the moment and trying to multi-task, which for myself is extremely difficult. I decided to add a to do list pad to my clinic folder expressly as a checklist which was colour differentiated for before, during and after the appointment. I also asked reception and a tutor for clarification on redaction of documents and researched this at home later as well as filing/shredding when finished. I thought about the ramifications for all parties concerned and for us as a clinic and university pertaining to vigilance and due diligence in our procedural responsibilities to protect patients.

Now What?

I requested a tutorial on the subject as it had been a while since our big lecture on this, which was granted and took place two weeks later. I found it very helpful and was furnished with resources for further study. I am very mindful and continue to be vigilant with patient files and interactions with third-parties and across emails to redact appropriately to avoid a breach.

https://www.ncbi.nlm.nih.gov/books/NBK519540/

(Togioka and Young, 2024)

Rolfe Reflective Model (Rolfe et al., 2001)

What?

In a Friday afternoon appointment, a female new patient arrived with her husband, who spoke on her behalf. In addition, the patient wore traditional religious clothing. The patient remained quiet throughout the case history, except when prompted to answer by the husband. I was unsure how to proceed as the patient demonstrated english language skills but seemed reticent to speak. Additionally, I contemplated that examination may be better suited to a practitioner of the same gender, and needed clarity that fully informed consent was possible.

So What?

This situation demanded recognition of individual and cultural values in healthcare settings. I asked the husband and the patient if she was able to fully understand everything that was being discussed. The patient confirmed this, and so did the husband. I asked if a female practitioner would be more suitable. This was positively confirmed. Another appointment was made for the following day with a female practitioner. This suited the patient, her husband and the tutors well, as the original tutor was male and the following day's was female. Future appointments were booked with a female and the patient records and reception notes were updated to acknowledge this requirement. The encounter took me by surprise and I reflected on how well the clinic able to accommodate the patient's needs. I realised the significance of pre-planning and how easily I might otherwise have overlooked the patient's autonomy. I noted the complexity of potential cultural and ethnic variability, patient modesty and patient/practitioner dynamics as well as influence of family, language barriers as obstacles to adherence of standards, if not considered, relating to consent and comfort or discrimination and as an extreme, patient disempowerment.

Now What?

I now explain to my patients that communication must be made to the patient, while acknowledging and respecting cultural variations in line with OPS standards to gain fully informed consent. I confirm if the consultation is appropriate to go ahead with myself and determine requirements and preferences at the start of the appointment.

I pursue dignity and fairness in my conduct in line with NHS, GOsC and NICE requirements.

https://www.ncbi.nlm.nih.gov/books/NBK568721/

(Rischitelli, 1995)

Rolfe Reflective Learning Model (Rolfe et al., 2001)

What?

While out in town with friends at a birthday celebration, I overheard a peer discussing a difficult patient case in a public location. No names were mentioned but details of the case could have potentially risked confidentiality and the reputation of osteopaths as practitioners.

So What?

I reminded my peer about confidentiality the following day. She wasn't very happy about it, but realised it is not ok and admitted she should have thought about it and not done so.

I avoid discussing any patient sensitive data outside of clinic and am mindful to redact any physical documents before removing them from clinic, such as for exam prep or research for my patients treatments. I work studiously to protect patient and professional trust.

https://pubmed.ncbi.nlm.nih.gov/7640986/

(Cruess & Cruess, 2004)

Rolfe Learning Model, (Rolfe et al., 2001)

What?

During conversation, I noted that my patient had been charged for an appointment that she should not have. It was a mistake due to the patient having had no time for treatment on an earlier visit. I checked the patient records and tutor notes, and then liaised with reception. The billing was amended, which my patient was grateful for.

So What?

The situation required verification of facts and an honest response to a mistake on our part and trust and professionalism was upheld.

Now what?

I will consider fail safes for my dealings in my own clinic in the future or with my employer if I am involved in that element of the business to ensure patient's get what they pay for and that any errors are ameliorated quickly. Upholding financial honesty and transparency is vital to reputation and patient loyalty and to GOsC adherence.

Upholding financial honesty is essential to ethical practice and patient confidence.

https://journalofethics.ama-assn.org/sites/joedb/files/2018-07/msoc1-0404.pdf

(O'Daniel & Rosenstein, 2008)

Rolfe Reflective Model. (Rolfe et al., 2001)

What?

During a busy clinic day, a colleague had multiple patients, and asked if I could make any suggestions for techniques suitable for her patient after lunch. I agreed and studied the patient file. I suggested 3 techniques for my colleague to consider against her knowledge and experience of the patient and included a scientific article I found in favour for her to look at. A week later, my colleague reciprocated.

So what?

Working in collaboration, we both benefitted from the situation and brought fresh energy and exposure to the patient encounter. I considered this helpful in building a teamwork culture and exploring criticality skills. We agreed to explore some CPD courses in future.

Now What?

I will use the resources and tools available to me and proactively collaborate with colleagues, fostering a team oriented culture improving patient care and clinic dynamics.

https://www.ncbi.nlm.nih.gov/books/NBK2637/

(Momtazmanesh et al, 2021)

Rolfe Reflective Model (Rolfe et al., 2001)

What?

A patient presented to headache clinic this afternoon with recurring headaches. After case history, I suspected they may be cervicogenic in nature, but the patient reported some visual disturbances and neck stiffness. She also reported a rash on her chest and neck several days ago that was not obvious at the appointment. I referred the patient to her GP with a letter detailing my concerns and findings reinforcing clarity and continuity of onward pathway of care across different disciplines.

So What?

Referral to the appropriate speciality supported the patient's timely access to qualified personnel and investigation beyond osteopathic care securing safety and wellbeing.

Now What?

I shall continue to communicate with other healthcare professionals and encourage and nurture alliances to advocate referrals, when appropriate, recognising the parameters of my training and competencies of my M.Ost degree. Patient care will be my foremost consideration.

https://doi.org/10.1007/s42399-021-00896-2

(Page, 2008)

Rolfe Reflective Model. (Rolfe et al, 2001)

What?

While still at home, prior to a full day of lectures and clinic, I developed stomach upset symptoms of both nausea and bloating. I felt like I would not be able to do my job well and may be symptomatic of an infection. I know our policy is correctly protective toward other colleagues, staff and patients, many of whom are vulnerable, even more so, since the Covid-19 pandemic. So I phoned clinic and informed management, excusing myself.

So What?

While working in a poor state of health may have been possible to achieve, my own judgement of how potentially infectious I may have been would have been impossible to know. I would risk poor health to numerous others .

Now What?

I always make sure to inform clinic if I am unwell and not fit to practice without compromising patient safety. If I am able to get a doctor's appointment I always call to the student clinic (or to my employer in the future) with an update so they can make any necessary documentation or take action at their end of things for patient safeguards.

https://www.ncbi.nlm.nih.gov/books/NBK2671/

(Koinig & Diehl, 2021)

Rolfe Learning Model, (Rolfe et al., 2001)

What? My own osteopath in Hampshire was diagnosed with a progressive eye condition requiring surgery and a timeframe of reduced vision and inability to continue in practice at that time due to a compromise of safe practice.

So What?

Consequently GOsC were informed and other employees took on extra workload to cover. Temporary or permanent health issues can impact ability and appropriateness to practice responsibly or ethically. GOsC was fully aware and my osteopath ceased practice for 6 months.

Now What?

He was monitored by specialty with surgery followed my optometry and the eye hospital in Southampton. Later when signed off as fit to practice, he resumed work as an osteopath at the clinic. I understand the process and that patient-safety is paramount.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8431400/

(Molinari, 2005)

OPS: B3. This 'Barefoot Talk', with Renzo Molinari, was an introduction to Women's Health in Practice. The lecture demonstrated the application of osteopathic techniques in a real-world, pragmatic way. The guest lecture and workshop were dynamic and hands-on, and Renzo's passion for the subject was infectious and set the tempo for further study in year 4. In addition to new techniques presented, specific to the demographic involved, Renzo exposed the students to current areas of research and development, latest findings and proposed new treatment pathways in Endometriosis, Premature Ovarian Insufficiency (POI), Ectopic pregnancy, In-Vitro Fertilisation (IVF), Polycystic Ovarian Syndrome (PCOS) and the role of HRT in Menopause.

https://www.osteopathicresearch.com/files/original/577d7d636e589f75ca97eafb3ea438f5bfd79718.pdf

(OPS: B1, B3) A fantastic 'Barefoot Workshop' presented and led by the wonderful Mrs Carol Palmer on Still Technique from the founding father of Osteopathy, Dr. Andrew- Taylor Still.

https://doi.org/10.7556/jaoa.2016.129

Ariyan, S. (1994). Of Mice and Men: Integrity in Practice. [online] Nih.gov. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC1234476/pdf/annsurg00058-0051.pdf [Accessed 18 May 2025]. Annals of Surgery.

Ayaz-Alkaya, S. (2018). Overview of Psychosocial Problems in Individuals with stoma: a Review of Literature. International Wound Journal, [online] 16(1), pp.243–249. https://doi.org/10.1111/iwj.13018.

Bourne, T., Vanderhaegen, J. and Renilt, V. (2016). Preparing to Download ... [online] Nih.gov. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC4947769/pdf/bmjopen-2016-011711.pdf [Accessed 18 May 2025].

Brown‐Schmidt, S., Christopher Brett Jaeger, Evans, M.J. and Benjamin, A.S. (2023). MEMCONS: How Contemporaneous Note‐Taking Shapes Memory for Conversation. Cognitive Science, 47(4). https://doi.org/10.1111/cogs.13271.

Carey, R.M., Wright, J.T., Taler, S.J. and Whelton, P.K. (2021). Guideline-Driven Management of Hypertension: An Evidence-Based Update. Circulation Research, 128(7), pp.827–846. https://doi.org/10.1161/circresaha.121.318083.

Cascini, F., Pantovic, A., Al-Ajlouni, Y.A., Puleo, V., De Maio, L. and Ricciardi, W. (2025). Preparing to download ... [online] Nih.gov. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10963197/pdf/main.pdf [Accessed 18 May 2025].

Cruess, S. and Cruess, R. (2004). Professionalism and Medicine’s Social Contract with Society. AMA Journal of Ethics, 6(4). https://doi.org/10.1001/virtualmentor.2004.6.4.msoc1-0404.

Cry-sis.org.uk. (2017). Help with Young Babies | the Cry-sis Helpline. [online] Available at: https://www.cry-sis.org.uk/help-with-young-babies/.

Ms Antoniou provided a thorough hands-on tutorial and practical session of techniques and considerations that could be taken directly into clinical patient interactions.

file:///Users/test/Downloads/10.1515_jom-2021-0255%20(3).pdf

(Huecker et al., 2025)

(Rolfe et al., 2001) (Rolfe Reflective Model)

What?

When I first arrived at the university in Boxley, it had been a long journey to get there. I was excited to be at the ESO, and at Boxley as a beautiful location, so conducive to study and to be embarking on my Masters degree journey. But I was a mature student, not a teenager with many years work and several careers under my belt. I had worn many hats in my personal and professional life. The balance of academia as taught in a contemporary way (so different to how I was educated historically), and the knowledge level in technology for teens who had literally been born into it, was terrifying and more than a small cause for concern. The vast experience I had in my careers would be helpful after graduation certainly, but that seemed like a very long way into the future. The feelings of being a fraud were loud in my ears, and I expected that at any moment there would be a tap on my shoulder and a voice would say, "I'm sorry but there seems to have been a terrible mistake, I'm afraid I'm going to have to ask you to leave the premises".

So What?

These thoughts and concerns were a mainstay as I worked my way through university and on through clinic, which definitely caused difficulties with self-belief and confidence, particularly during assessments, every year. Fortunately, the ESO provides a brilliant counsellor and confidante in the Health & Wellbeing department and many tutors are motivating, encouraging and supportive offering advice, education, practical strategies and support. There are some for whom reassurance and encouragement is not their strong suit. However, on the whole, it has enabled me to benefit from their experience in both academia and clinical practice as well as preparing for my osteopathic career.

Now What?

Now I am in receipt of a placement for work in Osteopathy as a new associate, in a busy practice near my home and I am in the process of registration with the GOsC, and preparing to start earning a salary as a manual therapist, from the summer. The opportunity is scary but also tremendously exciting. I feel ready to take on the challenge and in the workplace I felt extremely comfortable and ready to start my real education, with patients and other osteopaths every day improving the quality of lives and peace of mind for patients. I am very grateful to the ESO and proud to represent osteopathy.

https://pubmed.ncbi.nlm.nih.gov/36251839/

What?

University is an opportunity to learn your chosen subject, that's for sure, but it is also going to teach you a great deal about yourself. Discovering your 'Learning Style' and any strengths and weaknesses is an opportunity to work on those things. From Dyslexia and Dyspraxia to ADHD and Autism. I have observed many students and witnessed the difficulties and great gains in personal development throughout my time at the ESO. It is also a time when many teenagers become adults over the duration of the course. Personally I discovered I have one of these.

So What?

As we hear from our patients, all the time, getting any kind of diagnosis is a great relief as you can recognise and utilise your skills and be mindful of and improve upon areas of weakness. While holding a mirror up to nature makes for painful watching, it does allow you to make changes to work toward your goals and get support when needed.

Now What?

Now I know my superpowers and pitfalls, I am in a position to take action toward making the best of what that involves. I can take advantage of opportunities and evolve and where I am in need of support I know what that looks like and can move towards it. Either way, I'm not in the dark wondering what's going on. I'm out there in the thick of it contributing to the end goal, which is a good thing.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10919267/pdf/pg-34-37.pdf

(Hedley, 2023)

What?

As a student at the ESO, I have been fortunate enough to attend Guy's and St. Thomas' in my first and third year for pro-section cadaveric observation and dissection, which I had never expected to do. I was nervous the first time, unsure what to expect and aware that the utmost professionalism was expected from the start. The privilege to attend this great institution and permitted entrance into the museum that runs down into the basement spanning a huge area across the site was mind-blowing and intimidating. The opportunity to observe the many pathologies and sources untimely demise, the evolution of therapeutic and surgical tools and prostheses for example. It made feel proud to be a part of it and reinforced the enormity of what I was embarking on. The anatomy students were helpful, accommodating and educational explaining how we should proceed to get the best experience from the laboratory exposure.

So What?

The visits to Guy's and St. Thomas' was an eye opener for me, that I wanted to appreciate and put to good use. The anatomists present, recommended specialist authors to follow and watch through various social media platforms, which helped to further my knowledge, especially relating to the role of fascia, or the 'fuzz' to quote Gil Hedley, (Theologian and Somanaut). This improved my palpation and soft tissue skills in clinic during examination and treatment and had an impact on my ability to visualise the tissues during IVM and cranial.

https://www.youtube.com/watch?v=jIoIyRXID3A

Davenport, M.H., Marchand, A.-A., Mottola, M.F., Poitras, V.J., Gray, C.E., Jaramillo Garcia, A., et al. (2019).  Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. British journal of sports medicine, [online] 53(2), pp.90–98. https://doi.org/10.1136/bjsports-2018-099400.

Ekpenyong, M.S., Nyashanu, M., Ossey-Nweze, C. and Serrant, L. (2021). Exploring the Perceptions of Dignity among Patients and Nurses in Hospital and Community settings: an Integrative Review. Journal of Research in Nursing, [online] 26(6), pp.517–537. https://doi.org/10.1177/1744987121997890.

General Osteopathic Council (2023). Osteopathic Practice Standards. [online] Osteopathy.org.uk. Available at: https://standards.osteopathy.org.uk/.

Goetti, P., Denard, P.J., Collin, P., Ibrahim, M., Hoffmeyer, P. and Lädermann, A. (2020). Shoulder Biomechanics in Normal and Selected Pathological Conditions. EFORT Open Reviews, [online] 5(8), pp.508–518. https://doi.org/10.1302/2058-5241.5.200006.

Hampel, E. (2006). Effects of Osteopathic Work to Mother and Child regarding Foetal Heart rate, Uterine contractions, Lumbosacral mobility, and Objective Parameters of Delivery. [online] Available at:

https://www.osteopathicresearch.com/files/original/577d7d636e589f75ca97eafb3ea438f5bfd79718.pdf [Accessed 17 May 2025].

Hedley, G. (2023). Locating Famous Arm Nerves: Learn Integral Anatomy with Gil Hedley. gilhedley.com.

Huecker, M. R., Shreffler, J., McKeny, P.T. and Davis, D. (2022). Imposter Phenomenon. [online] PubMed. Available at: https://pubmed.ncbi.nlm.nih.gov/36251839/.

Koinig, I. and Diehl, S. (2021). Healthy Leadership and Workplace Health Promotion as a Pre-Requisite for Organisational Health. International Journal of Environmental Research and Public Health, [online] 18(17), p.9260. https://doi.org/10.3390/ijerph18179260.

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Lampe, L., Hitching, R., Hammond, T.E., Park, J. and Rich, D. (2023). Being a ‘good’ doctor: Understanding and managing professional boundaries is challenging and can lead to stress and burnout. Australasian Psychiatry, 31(6). https://doi.org/10.1177/10398562231191662.

Liem, T. (2016). A.T. Still’s Osteopathic Lesion Theory and Evidence-Based Models Supporting the Emerged Concept of Somatic Dysfunction. The Journal of the American Osteopathic Association, 116(10), p.654. https://doi.org/10.7556/jaoa.2016.129.

Martinez, N., Connelly, C., Perez, A. and Calero, P. (2021). Self-care: A Concept Analysis. International Journal of Nursing Sciences, 8(4), pp.418–425. https://doi.org/10.1016/j.ijnss.2021.08.007.

Mayerl, C.J., Gould, F.D.H., Adjerid, K., Edmonds, C., and German, R.Z. (2022). The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia, 38((1)). https://doi.org/10.1007/s00455-022-10449-x.

Momtazmanesh, S., Saghazadeh, A., Becerra, J.C.A., Aramesh, K., Barba, F.J., Bella, F. et al. (2021). International Scientific Collaboration Is Needed to Bridge Science to Society: USERN2020Consensus Statement. SN comprehensive clinical medicine, [online] 3(8), pp.1699–1703. https://doi.org/10.1007/s42399-021-00896-2.

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Phillips, A.R. (2022). Professional Identity in osteopathy: a Scoping Review of peer-reviewed Primary Osteopathic Research. International Journal of Osteopathic Medicine, 45. https://doi.org/10.1016/j.ijosm.2022.06.005.

Plunkett, A., Fawkes, C. and Carnes, D. (2025). Preparing to Download ... [online] Nih.gov. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9258824/pdf/pone.0270806.pdf [Accessed 18 May 2025].

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