Feelings
I felt really comfortable with the exam due to the amount of hours of training. As students, we are receiving intense training regarding patient management and safety. Learning how to develop rationality is one of the first processes and skills that you learn at ESO. Even though I am still a bit nervous before any exam, I am always happy when I finish and feel quite proud of myself and realize how much I know. And I have to say that over the course of these 4 years, I have developed and learned how to be more comfortable with any exams or stressful situations, such as having observers or tutors in the background of the consultation.

Evaluation/Analysis
Thanks to this experience, I knew what to focus on, thanks to feedback that my tutors and colleagues gave me. The strengths that I had were:

The weaknesses that I had to work on:

According to the mark sheet, my tutor considered that I was able to conduct a safe osteopathic patient evaluation, as well as safe and logical osteopathic care. The following fields were covered:

I really enjoyed this experience and the fact that it helped me build my confidence. Even though it was a stressful time, it definitely helped me develop certain skills as a healthcare professional. My communication improved, as well as the formulation of logical and rational diagnosis, which became even more precise in my practice thanks to the various clinical exams and feedback.

reference
Cex clinical exam

Although the pandemic presented challenges, such as decreased palpation ability and quality of communication due to wearing masks, I believe that it ultimately provides us as osteopaths with an opportunity for growth. Adapting to the situation is a fundamental aspect of osteopathy, in my opinion. I have gained valuable skills and experiences during this time, such as improving my observation skills and communication through eye contact. This has allowed me to better understand my patients and communicate effectively with them.

Evaluation/ Analysis
In my opinion, the progress we have made as practitioners during this time is a result of our hard work and determination. We have had to work harder to compensate for the loss of palpation ability and adapt our communication methods. I have even gone as far as reading papers about developing my senses when we, as manual healthcare practitioners, are restricted. I have also regularly asked for feedback from my patients and monitored the outcomes, which has been a great source of motivation and encouragement.

Conclusion/Action plan
After the pandemic, I felt the difference as my palpation improved and get even more specific as well as communication skills regarding safety and informed consent regarding patients. It has been challenging but a good reminder to keep our practice safe, clean and hygienic according to safety rules legislation.

Reference
Internet, 2023. GOsC Covid-19 rules available at: https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/ [ Accessed 2^nd of March, 2023]

Feelings
During the first consultation, she mentioned to me the appareance of the headache associated with the pain behing the eyes and the visual disturbances. I screen her for potential red fag (temporal arteritis, migraine etc..) and her answer all come back negative so I advice her to contact her optician. Beside, I am also aware of my role as a healthcare professional to educate my patient and guide her to resources and refer her back to the optician.

Evaluation
Before referring to her optician, I did make sure that she didn't experienced any other symptoms that could be a potential red flag for an urgent referral. I applied my knowledge, knowing that headache could be the cause of visual changes and can be alleviated by adapting the visual field via new pair of glasses.

Analysis
Considering my wider role as a healthcare professional, I invited the patient to read on the NHS website about headache (link attached) and offered her to consult her optician for further investigations and management. I also explained the physiology process and anatomy behind the potential issues and the consequences if no treatment.

Conclusion/Action plan
After this experience, I realized our wider role to educate and support the patients, enhancing their health and well-being by doing the right clinical decisions.

Reference
Internet, 2023. NHS Headache available at: https://global.essilor.com/uk/blog/all-about-glasses/glasses-for-headaches#:~:text=You%20need%20to%20wear%20glasses%20that%20will%20reduce%20the%20need,as%20hypermetropia%2C%20myopia%20or%20astigmatism. [Accessed 2^nd of March, 2023]

B1.1.5. an awareness of the principles and applications of scientific enquiry and the ability to critically evaluate scientific information and data to inform osteopathic care
 B1.1.6. an understanding of the principles of biomechanics sufficient to apply osteopathic treatment safely and effectively

Description
Since the beginning of the ESO journey, we as students are trained and assessed on applying knowledge within a case context and with a timer. The exam is called ''OSPE''  (Objective Structured Practical Examination) and in our final year it is called ''FOPE'' which is the same principle but not with the same expectations. Our knowledge base is assessed since we began the course. It is basically an application of theory and practice from a different taught components of the Osteopathic Skills modules. Especially in my final year, I was expected to critically evaluate the case and apply osteopathic management which include treatment (short term and longer term management), Advices, explanation why did I choose this technique over an other one, and how the technique affect the patient's body which lead me to talk about relevant components within the case history. Finally, the idea of those station is to see if the student is able to create links in every station that have a particular osteopathy fields (visceral, cranial and structural) to prove that I have a good understanding of multi-modal of osteopathy in my management plan.

Feelings
Overall, those assessment allowed me to build my confidence. Time management was challenging because of the amount of stress, time of the station which is only 20minutes and amount of informations to provide to the examiner. However, over the years, I learned to deal with my anxiety, managing my time in a better way.

Evaluation
The assignment was a really good practice and it was a good opportunity to show that I am able to apply my knowledge at the front of examiners and show my palpation skills in my treatment.

Analysis
Over the time, my mark get better and I was able to demonstrate more my knowledge and skills regarding treatment. My treatment and clinical approach were judged to be sufficient to first pass but as well to be considered as ''safe practitioner''. In that kind of exam,  this is where I can as practitioner demonstrate my skills regarding biopshychosocial model and apply my knowlegde especially in clinical decision-making and management care in context of the other osteopathic model (biomechanical, neurological, respiratory, metabolism).

Conclusion/Action Plan
However, I noticed that I need to go back always to the anatomy,  an essential key for osteopath. As well as reviewing disease or certain conditions  as I did  for this assignment. Going forward,  I am aiming to read more articles, news paper regarding osteopathy medical field to keep my mind open and always open  to news techniques,  new theories for a perfectionnisme of my knowledge. It will indeed support my work as osteopath.

Material attached
OSPE

Reference
1. https://bodyworlds.com/exhibitions/human/
2. Ticket for ''Death & Dying'' by Mary Bolingbroke

At the end of year 3, we began the dissertation process, which lasted until December 2021. Each dissertation learning outcome aligns with OPS B4, which requires us to exhibit independence in collecting data for Masters Level analysis in accordance with the protocol.

Throughout the process, we were required to independently conduct, analyze, and interpret data gathering using appropriate software-assisted approaches that addressed the research question in a structured manner.

To complete the dissertation, we had to write a report that integrated the staged research study into a cohesive and succinct narrative that adhered to the structure and presentation style of an academic journal. Through conducting a literature review, I demonstrated my ability to collect data for pre-determined Masters Level analysis, analyze and interpret the data, and integrate it into the report.

Feelings/Challenges
This period during the course of my degree was really challenging. First because I never had to do this kind of work for several months and because of the special methodology to follow such as utilizing certain databases, recorde everything (etc..). The harder part for me was to demonstrate critical reflection in the discussion section and comparing with the wider literature.

Evaluation
I feel that I could expand more time and explained more regarding the scope of methodological quality issues to expand the subject. Overall, the dissertation taught me so much on my way of working and how I can do better in terms of research, following a certain methodology.

Analysis
This assignment was great to develop my focus, research and criticality regarding the literature review based on my research question. All the skills that I obtain from it will serve me for the rest of my career.

Conclusion
Nowadays, thanks to the dissertation I know how to search information, critically evaluate the outside data no matters the database. Beside, I can apply this knowledge to my practice and never stop progress for the future. I would do things differently if I had to do it again such as working more with my tutor at the time,  shared and listen more my peers experienced ( would have been useful as a supportive environment).

Material/Reference
Dissertation

As a result of these findings, the decision was made to refer the patient immediately due to concerns about the progression of his cardiovascular symptoms and the noticeable change in his right leg. However, it was discovered that the patient had already been referred several times this year and had been hesitant to do so again due to his reluctance to undergo surgery or heavy medication.

After some discussion, it was determined that the patient was only interested in being treated for his mechanical issues and did not want to further investigate his condition. Therefore, if he agreed to sign a consent form for a referral letter, the clinic would be able to treat him accordingly. The patient gave his consent, and he was treated for his pain.

Feelings
Initially, I felt quite apprehensive when dealing with this patient due to their presenting complaints and past medical history. In order to ensure that I could respond effectively, I consulted with my tutor and took a step back to assess the situation. I had some doubts about whether osteopathy would be an effective treatment option for this patient, given their complex health history.

Communication with the patient was also a challenge, as I needed to convey the seriousness of the situation and the potential risks if they did not seek medical attention. Despite this difficulty, I made sure to provide the patient with all the necessary information about their condition and the possible consequences if they did not seek appropriate medical care.

Throughout the consultation process, I made a conscious effort to respect the patient's autonomy and their individual needs and preferences. I continued to discuss their options with them at each subsequent consultation, and to support them in making informed decisions about their care.

Evaluation
I learned a lot through this experience and it made me even more aware of how partnership between practitioner and patient is crucial for a positive outcome in general practice. As healthcare professional we are promoting the health in the first line, i tried to make him understand the consequences and he finally gave us his consent and understand.

Analysis
Partnership between patient and practitioner via communication is essential for us as osteopath. This is what pretty much the all appointment rely on and make it effective or not. This shared-decision making is always respected and must be in a patient-centered approach via the 5 models of osteopathy.

Conclusion/Action plan
Finally, communication is a skills that healthcare professional have to master. As osteopath our role is massive and play a big part in the education of the patient. This allow their protection from potential injuries or bad habits in their lifestyle while respecting their needs and preferences.

Reference
Article 

It has been a really good experience regarding communication skills because of the stressful background of the baby and mother. I had to explain everything that I was doing during the treatment and talk about anatomy and physiology and what could have happened during this stressful time in the baby's organism. I was pretty confident and relaxed with the baby, so it was really good practice to communicate the knowledge and put it in relation to the background.

Having these kinds of skills is crucial as an osteopath practitioner and in the relationship between patients. Giving reassurance and justification plays a massive role in the treatment outcome. If the patient, especially parents, fully understand what the practitioner is saying and are no longer stressed regarding the baby's health, it will have a positive loop effect and, therefore, a positive outcome in general.

This skill is not only for communicating but also allows a positive chain effect following treatment and gives confidence to parents/patients, educates them, and gives them self-empowerment.

Reference
Case report

Generally, when I explain this to my patients, they are more than happy, and it strengthens our patient-practitioner relationship. I read an article regarding informed consent and shared decision-making in medical practice that explains all the benefits. Additionally, it explains further strategies on how to approach certain patients, give them choices, increase interactions, better communication, and better outcomes regarding treatment.

Strategies such as the BRAN model (Benefits, Risks, Alternatives, and Nothing (for any questions?)) are really useful for us as osteopathic practitioners by giving us guidance during sessions with patients. It gives us some protection as well as professional healthcare for the patient's safety. Offering the opportunity to refuse treatment is also part of the shared decision-making process.

I find it really helpful to have a strategy that we can rely on as healthcare practitioners. We must be able to communicate effectively the benefits and risks of any treatment that we do, and propose alternatives for any kind of technique. Finally, by applying these principles, the patient is aware of their own options/alternatives, and this enhances the practitioner-patient relationship.

-providing information on the effects of their life choices and lifestyle on their health and wellbeing
-supporting decision-making about lifestyle changes where appropriate
-encouraging and supporting patients to seek help from others, including other health professionals or those coordinating their care, if necessary 

-respecting patients’ decisions about their care, even if you disagree with those decisions.

Description

During my third year, I had a 43-year-old female patient who presented with pain in the sacro-iliac joint area, which was later diagnosed as SIJ (sacro-iliac joint inflammation). During the case history, the patient revealed that she had been diagnosed with fibromyalgia at the age of 15. Fibromyalgia is a condition that sensitizes the central nervous system and affects pain perception, leading to various symptoms. Initially, I was not aware of this condition and how it played a significant role in her presenting complaint. I also did not understand the needs of this condition and how challenging it could be for the practitioner. Fibromyalgia has various severity stages, and it generally requires a multidisciplinary approach and special attention. Additionally, fibromyalgia is associated with irritable bowel syndrome (IBS) and depression, making it difficult for both the patient and the practitioner. Patients with this condition are closely connected to their mental state, and this has a significant impact on their pain perception.

Initially, I felt overwhelmed with the amount of information about fibromyalgia, its management, and its needs. I also felt useless during the first few sessions because of my lack of experience. However, this patient taught me a lot, and I am grateful to her.

After conducting extensive research and reading numerous papers about the condition, I developed a passion for understanding fibromyalgia. It is fascinating that people with this condition have a profound connection between their mind and body. This connection enables them to feel their environment, have a deep understanding of themselves, and react accordingly. Although every patient can react and adapt to their environment, not everyone has the same sensitivity.

The sensitivity that patients with fibromyalgia possess is positive because it enhances their connection between their mindset and body. However, not everyone can do this, and it is one of the processes that allows the healing process to occur. With this patient, we continue to see each other every three months for management, which requires a lot of communication within the session.

I plan to continue my research regarding fibromyalgia patients and the best way to help them. I would like to thank this patient in particular for her trust and support. In conclusion, communication and a multidisciplinary approach are key in helping patients suffering from fibromyalgia.

Reference
Article fibromyalgia and chronicity

During my third year, I had a Muslim patient who wore a hijab to the clinic. When she arrived, I informed her that there were two observers in the room and asked if she was comfortable with their presence during the case history, which did not require undressing. She immediately expressed discomfort and I respected her wishes by asking the observers to leave. During the examination, the patient chose to keep her hijab and clothing on, which made it challenging to perform palpations and observations required for diagnosis. However, I prioritized her comfort, dignity, and modesty, and the patient appreciated it.

Examining this patient was challenging, but I learned the importance of respecting a patient's choices and making them feel comfortable. I felt good knowing that my efforts to be caring and respectful had a positive impact on the patient's experience.

This experience taught me that as a practitioner, it's crucial to work with the patient's preferences and make every effort to ensure their comfort. This not only fosters a positive relationship between the patient and practitioner, but it also demonstrates respect for the patient's dignity and modesty.

Moving forward, I will prioritize patient comfort by respecting their choices and preferences. I will provide a consent form at the beginning of each session to inform patients of what to wear and expect during the appointment, including the option of a chaperone. By doing so, I hope to promote cooperation, reassure patients, and establish a foundation of respect and trust between myself and my patients.

Reference
Article NHS

During my third year at the ESO teaching clinic, a new patient, a 40-year-old man, presented with neck and shoulder pain caused by facet referral pain irritation (C6/C7). There were no neurological signs or symptoms, and the patient reported stable pain over the past few weeks with no progression. However, during our first treatment, the patient requested that I perform a high-velocity thrust (HVT) on his cervical spine and entire spine, claiming that this was the only way to alleviate his pain. The patient was also a heavy smoker with hypertension, which posed a risk to his cardiovascular system if this technique were performed.

I felt uncomfortable being pressured to perform a technique that could potentially harm the patient's systemic health. It can be challenging to engage in difficult conversations, especially when the patient is being passive-aggressive. However, as a healthcare professional, it's important to maintain professional boundaries and communicate diplomatically to create a positive atmosphere.

By explaining the evidence-based research regarding the risks of certain manipulations, the patient understood and appreciated the information. This experience taught me a lot about analyzing a patient's behavior, which can provide valuable insights into their biopsychological aspects and how to best help them as an osteopath within ethical limits.

As healthcare professionals, it's crucial to always maintain professional boundaries and avoid engaging in confrontational conversations. However, if a patient's safety is at risk, we must explain the evidence-based risks of certain techniques and communicate our observations from the case history. This not only prioritizes patient safety but also protects our own safety as practitioners.

Reference
Article HVT Cspine vs Cardiovascular risk

Mc Inerney, S. (2002). Introducing the Biopsychosocial Model for good medicine and good doctors. In response to:What is a good doctor and how can we make one? (2002). BMJ, 324(7353), pp.1537a-1537.

Internet, 2023. GOsC Criminal conviction and fitness Practice available at: https://www.osteopathy.org.uk/news-and-resources/document-library/fitness-to-practise/fitness-to-practise-bulletin-february-2012/ [Accessed 18^th of March, 2023]

 

Internet, 2023. ESO Clinic Guidelines available at: https://padlet.com/21901734/21901734-os746-e-portfolio-reflective-guide-9100kci2r2qc5sg6/wish/2517592005 [Accessed 18th of March, 2023]

Advertising Standards Authority, 2016. Which Medical Conditions Can Osteopaths Claim to Treat? Available At: https://www.asa.org.uk/advice-online/health-osteopathy.html [Accessed 21st of March, 2023].

Manookian, A., Cheraghi, M.A. & Nasrabadi, A.N., 2013. Factors Influencing Patients’ Dignity. Http://Dx.Doi.Org/10.1177/0969733013498526, 21(3), pp.323–334.

Internet, 2023. NHS Headache available at: https://global.essilor.com/uk/blog/all-about-glasses/glasses-for-headaches#:~:text=You%20need%20to%20wear%20glasses%20that%20will%20reduce%20the%20need,as%20hypermetropia%2C%20myopia%20or%20astigmatism. [Accessed 2^nd of March, 2023]

Internet, 2023. GOsC Covid-19 rules available at: https://www.osteopathy.org.uk/standards/guidance-for-osteopaths/coronavirus-covid-19/ [ Accessed 2^nd of March, 2023]