What?

In children's clinic, I saw a 21 year old mother attending with her 2-month-old daughter, for reflux and a left side head preference. She was accompanied by her own mother for additional support, who is a secondary carer for the infant. During the appointment, she shared that she had experienced domestic violence and opened up about her history with anxiety, depression and self-harm.

So what?

This experience in particular reinforced my understanding that it is crucial to create a safe, non-judgemental, and respectful environment, particularly when dealing with vulnerable populations such as mothers with complex backgrounds. I realised the impact of building rapport; active listening, maintaining a calm and open posture, and allowing the patient to guide the pace of the conversation with difficult topics to build trust and enable good communication (Naseema Shafqat et al., 2022).

Now what?

This experience has had a lasting impact on how I approach patient interactions. Moving forward, I believe this has meant I am more attuned to the importance of creating a safe, respectful space in order to ensure patients feel heard, while also empowering them to share sensitive information at their own pace.

Naseema Shafqat, Verma, R., Kumar, A., Ravi, R., Verma, M., Roshan Sutar, Singh, V., Das, S. and Agrawal, A. (2022). Revisiting the apparently lost art of compassion in the healthcare system: Challenges, barriers, or impediments. Bengal journal of cancer, 2(2), pp.97–97. doi:https://doi.org/10.4103/bjoc.bjoc_14_23.

Active Listening Online Library of Quality, Service Improvement and Redesign Tools NHS England and NHS Improvement. (n.d.). Available at: https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-active-listening.pdf.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing.

What?

I treated a 47 year old male patient for lower back pain, he spoke very little English and was accompanied by his adult son who he was visiting to translate during the appointment. The patient was Lithuanian, so relying on his son to interpret the history and help me gain consent moving forward had its challenges. It was difficult to gauge how accurately the information was being translated, particularly regarding the understanding of examination and potential treatment options. This meant I couldn't be confident the patient had fully understood what I wanted to do/was trying to achieve.

So what?

This situation highlighted the limitations of using family members as interpreters, specifically with regards to gaining informed consent. I realised that even just with good intentions a family member could filter or simplify information to a point which means true understanding isn't met or inaccurate. This also made me reflect on the ethical responsibility I have as a practitioner to ensure patients have full understanding, regardless of language barriers, to promote shared decision making.

Now what?

For the patient's second appointment I was able to hand their care over to a colleague who happened to be fluent in Lithuanian. This meant that as a practitioner I could have confidence that consent was easier to obtain due to clearer communication between the patient and practitioner directly. This experience taught me the importance of identifying language barriers early and seeking the appropriate solution, whether this is seeking the help from a colleague if accessible or a professional interpreter. Going forward, I will avoid relying on family members to translate sensitive and/or clinic information and will actively take steps to ensure the patient can participate fully regarding decisions of their care.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

This reflection has been carried out using Rolfe et al. (2001) reflective model.

What?

During a new patient appointment clinic, I saw a young female presenting shoulder pain. She seemed engaged during the case history and examination, however, I had noticed a drop in eye contact and body language change appearing more diffident, particularly when I explained my working diagnosis and proposed a potential treatment plan. the treatment plan involved glenohumeral articulation, scapulothoracic articulation and soft tissue work to the upper triangle (trapezius, rhomboids, thoracic spine erector spinae and rotator cuff group). The patient nodded but didn't ask any questions, which felt unusual compared to their earlier engagement.

So what?

This reaction prompted me pause and check in with the patient, asking gently if they felt comfortable with the treatment proposal, if they had any concerns and reassuring them that we can amend anything they are unhappy or even just unsure about. They admitted they were quite nervous abut any hands-on treatment and that they didn't fully understand what joint articulation involved. This made me realise I had use technical language without checking the patients understanding, while also potentially overlooking some signs of discomfort. I went on to further explain everything more clearly, using more commonly understood language and demonstrating some of the techniques also, this meant she became more relaxed and was much more content to proceed.

Now what?

This experience has taught me to never assume understanding based on verbal agreement alone. Now I always make sure to make a conscious effort to check in with patients during explanations, while also paying close attention to non-verbal cues. I aim to use simpler terms, while still providing a detailed explanation but in relatable language and encourage patients to ask questions throughout and voice any concerns they may have. In future, I will also try to incorporate more physical demonstrations where possible and appropriate but relatable analogies, this should hopefully prevent and uncertainties or anxieties around the working diagnosis or treatment plan going forward, ensuring patients are informed decisions about their care.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

What?

In children's clinic I saw a 4-year-old for recurrent ear infections and mild torticollis, while trying to include the child as much as possible during the case history I was primarily spoke to the mother as he was very timid. With that i noticed she was becoming more concerned and reserved. I explained my findings and proposed an examination plan, she nodded throughout but didn't ask any questions. As I moved toward gaining consent, I was aware she looked tense and glanced to he child frequently.

So what?

Although she hadn't voiced any concerns or objections, I felt she was still unsure. I took a moment to pause and clarify if she had any questions or concerns to provide some reassurance. She then admitted she was nervous about her child being in pain or being scared by the examination process and she din't mention it initially because she didn't want to appear overbearing. It was then I realised that I may have delivered too much technical language, without checking in to clarify any misunderstanding or worries about how this experience would be for her young child. I understand the importance of ensuring the patient's/guardians are fully informed and in this case the parent's concern of being overbearing prevented her from voicing confidently an my concerns. As a primary healthcare practitioner it is my responsibility to pick up on this and make certain that they are fully informed before making decisions about their/their child's care.

Now what?

This experience made me aware of identifying unspoken concerns throughout the appointment and made me more self aware of potentially overloading patients with too much information too soon. This awareness is applicable across general clinic but this experience reaffirmed the cruciality of having empathy and providing clarity for parents particularly. Going forward, I will slow down explanations, be aware of the types of language used (avoiding jargon), use visual aids and/or provide demonstrations where appropriate, alongside regularly checking in for their understanding. I aim to normalise questions and emotional responses from parents, with intention of providing a safe environment which they can express concerns and participate fully in the decisions about their child's care.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

A5 1.4 respecting patients’ decisions about their care, even if you disagree with those decisions.

This reflection has been carried out using Kolb's experimental learning cycle (Kolb, 1984).

1. Concrete experience

In year 3, I treated a 63-year-old male patient presenting with chronic low back pain. He was overweight, living a sedentary lifestyle and had been diagnosed with type 2 diabetes. During case history, he shared concerns about exercising due fear that it would make his back pain worse. I discussed how gentle movement and improved activity levels across the week would likely benefit his pain and also overall health. I also advised he speak to his GP regarding any local support programmes, such as walking groups or exercise referral programmes. These can help with motivation as there are other people in a similar situation, the support from others helps keep people accountable.

2. Reflective observation

Although the patient was polite and seemed engaged, I noticed a hesitancy to change his current routine. He admitted he had tried exercise in the past which triggered low back pain flare ups. Despite the advice given I was unsure if this helped his confidence to act on the matters we discussed. This helped me to reflect upon behaviour patterns and the hold they can have on someones mindset, how fears and past experiences create real barriers for people to make better lifestyle choices. While I believe I provided the right information, it made me question whether or not I had done enough to support this patient.

3. Abstract conceptualisation

This experience helped me better understand the wider role we have as osteopaths promoting patient's health outside of the treatment room. A5 1.1 reminds us to provide patients with lifestyle information, as well as A5 1.4 which highlights the importance of respecting lifestyle choices. I realised lifestyle change isn't just about giving appropriate advice - it's about building trust, assessing patient's readiness to make changes and adapting out communication through these stages in a way that empowers that individual rather than creating a sense of shame. Not every patient will be ready to take action which is okay, our role is to facilitate a safe environment with the potential for change at their pace. Judgemental or what may come across as pushy advice would risk damaging rapport and creates further barriers for the individual with regards to their health management.

4. Active experimentation

In future, I will work on tailoring my communication to the patients current mindset, using motivational language and adjusting advice/management plan with small, achievable goals as this likely snowball and encourage gradual lifestyle improvements. I'll also remind myself to be patient, continuing with support and providing educational advice without becoming frustrated if change is slow. If a patient chooses not to follow advice, I will respect their choice while still keeping an open door for further discussion at their pace. Building good rapport with patients across appointments often creates more opportunities for change.

Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs: Prentice-Hall.

Experience:

In clinic, I saw a 16-year-old female dance with medial knee pain. She wore jeans to the appoint, which restricted my ability to conduct the appropriate examination of the affected area. I explained to her and her parent what was required for examination and the importance of observation and physical examination in order to formulate a working diagnosis. At clinic we have disposable gowns to provide modesty when they done have appropriate clothing or potentially don't feel comfortable being as exposed, I offered her one and privacy to get change. She was comfortable with this as she understood the necessity and and consented to proceed.

Reflection:

This experience highlighted the importance of clear communication and professionalism, particularly when addressing sensitive matters such as modesty. By explaining the clinical reasoning for doing so and offering privacy and appropriate modesty options, the patient felt respected and comfortable moving forward with the appointment. I believe this interaction being positive helped with building rapport with this young patient.

Action:

I will continue to consider age, gender and patient individuality when approaching sensitive clinical situations, ensuring my communication is clear and respectful. After graduation, I believe it would be important to ensure I have the modesty options available to provide to my patients as this experience at the ESO clinic has highlighted its value.

Zheng, K. (2024). 5 Ways to Support Patient Modesty. [online] IntelyCare. Available at: https://www.intelycare.com/facilities/resources/5-ways-to-support-patient-modesty/.

Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.

Experience:

During year 1, the importance of patient-centred care without prejudice was highlighted throughout clinical observations and reflective tasks (evidence attached). One observation specifically addressed this and stuck with me throughout my 4 years of study. I observed a 4th year student adapt their approach to accommodate a patient's cultural needs regarding modesty during examination. The student (female) initiated a conversation before starting the case history expressing various modest options and mentioned that the only tutors in on that day were male, the patient was very appreciative that she was made aware of all of this without having to ask as this was something the student did for everything patient. This open conversation allowed the student to personalise the approach to suit the patient, delivering effective care without imposing their own beliefs or values.

Reflection:

Reflecting on this helped me to recognise the unconscious impact our personal values could have on clinical interactions, being aware of this ensures professional integrity and promotes a positive impact. These moments are what bring me back to lectures we have had regarding the osteopathic practice standards OPS and the application is easier to understand as these experiences build.

Action:

I will ensure that moving forward I maintain ongoing self-reflection because actively checking in helps me to identity and manage any potential biases, without them impacting onto patients and the care I provide. This will support me in providing safe and respectful care, throughout my training and into professional practice.

Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.

This reflection has been written using the reflective model previously described by Rolfe et al. (2001).

What?

During my first year, I failed my first anatomy exam, with a mark of 35%, below the minimum required pass mark of 40%.

So what?

This highlighted to me a gap in my foundational understanding of the core osteopathic principle "structure governs function". I was able to recognise its significance moving forward in the course, not just as a bad mark in an exam but how this would impact the care I would be able to provide in years 3 & 4, as well as post-graduation. Despite the pass mark being 40% and the resit being capped at this grade, I aimed higher not as a means of passing but I felt it necessary that my knowledge be as extensive possible. I successfully passed the exam on the second attempt.

Now what?

Failing this exam was a wake up call, personally theoretical study is an area with room for development, despite this I understand the importance of this baseline knowledge for clinical reasoning and patient safety. I continuously approach all anatomy-related topics with a much greater focus applying study methods that work for me such as those supported by research, including - active recall and spaced repetition (Xu et al., 2024) to ensure this doesn't happen again.

Xu, J., Wu, A., Filip, C., Patel, Z., Bernstein, S.R., Tanveer, R., Syed, H. and Kotroczo, T. (2024). Active Recall Strategies Associated with Academic Achievement in Young adults: a Systematic Review. Journal of Affective Disorders, [online] 354, pp.191–198. doi:https://doi.org/10.1016/j.jad.2024.03.010.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle. [online] The University Of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle.

Description: In clinic I saw a 16 year old dancer, who presented at the initial appointment with posteromedial knee pain and an associated snapping sensation. My working diagnosis moving forward was Medial Snapping Hamstring Syndrome (MSHS), which is rare and under researched condition. With the complexity of the case in mind, I developed a Conservative osteopathic management plan. We're also advising the patient to seek further imaging via her GP.

Feelings:

Initially I felt unsure due to the rarity of this condition, it's not something I had come across previously and my tutor at the time had little knowledge about this as well. With the examination findings and joint research between myself and the tutor we come to the conclusion that the most appropriate working diagnosis was MSHS. However, due to our osteopathic focused training, I felt confident in addressing the broader bio-mechanical dysfunctions, and knew when it was appropriate to seek additional support from other healthcare practitioners. I was also mindful not to overstep my competence or delay. Further medical input.

Evaluation:

The working diagnosis was based upon clinical findings and movement based assessment. Well treatment progressed well and the patient responded positively. I was careful to acknowledge my diagnostic limitations without imaging confirmation. I made the patient and her parent aware aware of this and clearly explained the relevance of referring back to the GP, providing our findings and seeking their professional opinion regarding further imaging.

Analysis:

This particular experience reinforce my understanding that Osteopaths must know when to work independently and when to refer and seek support. While I can address compensatory movement dysfunctions, the unfamiliar pathology required me to disclose with full transparency to the patient that their care I need to be managed by multidisciplinary team.

Conclusion:

I refer in for imaging and seeing the professional opinion of other healthcare practitioners more widely qualified in this area, I was able to gain clarity for the patient and my learning, while also upholding to our professional standards working within my scope of practice. This case highlighted the importance of safe and evidence informed practice whilst also reminding me of the pivotal value into professional collaboration has, especially when managing atypical presentations.

Action plan:

Doing this case report allowed me to understand and take the time to explore patient management in more detail, something which I would like to integrate more often moving forward. I plan to do this by reviewing more literature on rare musculoskeletal conditions and undertake further training in kinetic chain biomechanics. I will also continue to familiarise myself with relevant guidelines (Health and Care Professions Council, 2024), to ensure that I have a detailed understanding of other healthcare practitioners and how I can work together with them in future.

Health and Care Professions Council (2024). Scope of Practice. [online] www.hcpc-uk.org. Available at: https://www.hcpc-uk.org/standards/meeting-our-standards/scope-of-practice/.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle. [online] The University Of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle.

Experience:

During Easter break of my fourth year, I attended a CPD course titled introduction to Bruno. This will mobilisation and women's health on the 9th of March 2025. I attended this particular talk, as I felt that I was lacking appropriate knowledge with the removal of the women's health module on our curriculum.

Reflection:

I believe this course deepened my understanding of which visceral techniques I should use and when I should apply them, as well as their relevance regarding women's health, which is an area I'm particularly passionate about. Attending this course, highlighted the importance of filling curriculum gaps as well as continued professional development, in order to provide the best possible care for my patients, as there's only so much that can be covered across a four-year course.

Action:

Postgrad, I plan to continue developing my knowledge in my areas of interest through CPD such as 'The mummy MOT' training course (The Mummy MOT®). Ongoing education will support me as a practitioner to provide evidence informed care, sober enabling me to better support female patients throughout different life stages.

The Mummy MOT®. (n.d.). Mummy MOT Training Course. [online] Available at: https://www.themummymot.com/mummy-mot-training-course/.

Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.

Evidenced experiences across the 4 years - Padlet Portfolio.

Throughout the four years in clinic both observation and practice. I have made a consistent effort to reflect on my strengths and areas for development. I have found that Rolfe model Rolfe et al.'s (2001), has been easily applicable to reflect on patient interactions, helping me process what went well and where I can improve. One example, includes identifying the need for more focused examination rather than following routines. In order to improve accuracy. This is feedback I got in a third year CEX, when I decided to adopt this reflective method to implement into all cases moving forward. I critically analysing feedback and adapting my approach. I've seen tangible improvements in my confidence as well as patient outcomes. I believe ongoing reflection remains a vital part of how I will continue to develop as a safe and effective practitioner.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Despite understanding the theoretical osteopathic principles, well, I struggle to apply them effectively in the practical exam setting. Following this, I made a conscious effort to develop this area, as it highlighted my weaknesses by improving my knowledge even more, my confidence also increased, which would intern benefit my patients.

I felt this was paramount to going into fourth-year clinical practice and FOPE. The highlighted areas of weakness being clinical, justification, full understanding of anatomy (as previously addressed in OPS B1 reflection) and ability to apply this to the osteopathic principles (tensegrity and the unities in particular). The skills are vital as a practitioner to be able to provide safe and suitable care as outlined by the IPS. Are use this exam feedback as well as tutor comments to guide my progress. By the time of the FOPE, I had achieved 59%, reflecting improvement made with room for further development. I feel more competent with regards to applying osteopathic principles and concepts more accurately to my patients individual needs. In future, I will continue to build on these foundations, revisiting baseline knowledge and ensuring my understanding is up-to-date supporting my in providing evidence-based care.

What?

During a session with the continuing patient in year three when I went back to review their last treatment notes to check the progress I realise that I hadn't documented the exact location or quality of tissues that I'd palpated previously I had used make terminology which wasn't region specific and also didn't specify which side or structures.

So what?

This lack of clarity meant that it was harder to assess whether their symptoms had changed or improved and to what extent. It also made me aware that vague note-taking could be make it difficult for another practitioner to understand the reasoning behind my treatment plan. While also posing a potential risk of inadequacy regarding any legal matters as this does not meet the expectation set out by GOsC, (2024), and the osteopathic practice standards OPS, which we should uphold to, they require notes to be clear, comprehensive and suitable for continuity of care.

Now what?

Since then, I've taken more care to write specific detailed records, including exact anatomical, landmarks and descriptive findings, which could be understood by someone who isn't myself if required. I also double check my notes before handing the file back to ensure their legible accurate and useful for anyone reviewing them in the future.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Once finalised, the letter was printed on ESO headed paper and signed by both myself and the tutor before being sent to the GP in line with the ESO protocol, I was careful to keep the letter within my scope of practice, clearly communicating the patient's symptoms and examination findings, without making any assumptions beyond my clinical training.

This was my first experience with a real patient writing a referral letter and I feel this process helped me understand the importance of accuracy and clarity in written communication, especially when collaborating with other healthcare practitioners. This helped me feel more confident in producing appropriate referral documentation and I will continue to refine these skills to support effective most of the multidisciplinary care.

Clark, M., Edlira Vakaj, Beirnat, K.N., McKnight, L. and Cowdell, F. (2023). Knowledge Mobilisation in Safeguarding Adults and Children for Healthcare in England. Health & Social Care in The Community, 2023, pp.1–25. doi:https://doi.org/10.1155/2023/6080695.

Skills for Health (2023). Why is safeguarding so important in health care? [online] Skills for Health. Available at: https://www.skillsforhealth.org.uk/article/why-is-safeguarding-so-important-in-health-care/.

Description:

At the start of each clinic session, I'll make sure to check the system for what patients I have that day and make sure I'm prepared with enough time to set up my treatment room. Ensuring the couch wiped down thoroughly, there is fresh paper towel on the couch and the room is neat and tidy.

Feelings:

Initially, I just saw this as part of the routine, but over time I've come to appreciate how it sets the tone for the professional and safe environment for my patients.

Evaluation:

I've noticed the patients are more comfortable and seem reassured when the space looks clean and organised. I believe this helps build trust before the consultation even begins.

Analysis:

Clean hygienic state not only reduces infection risk, but also shows that I respect my patience and value their experience. It is a reflection of me as a practitioner. Showing little care towards the cleanliness of the place would likely make patients assume that little care will be taken towards them, if little to no care has gone into making it a suitable environment.

Conclusion:

Maintaining hygiene and cleanliness is more than just ticking a box it directly affects the patient's perception of the environment and whether it is safe to proceed with the appointment.

Action Plan:

I will continue to view hygiene and cleanliness as a vital part of the care I will provide and make sure this habit is ingrained before and after every appointment.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle. [online] The University Of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle.

NHS England (2025). NHS England» National Standards of Healthcare Cleanliness 2025. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/long-read/national-standards-of-healthcare-cleanliness-2025/.

Bloomfield, J. (2021). NHS National Standards of Healthcare Cleanliness 2021. [online] Available at: https://nhssomerset.nhs.uk/wp-content/uploads/sites/2/Cleaning-Standards-for-Practice-Managers.pdf.

Concrete Experience:

In year one, I completed a research essay, investigating the interrelationship between microbiota and the immune system in the development of leukaemia. This task required critical analysis of scientific literature in order to gain an understanding of how lifestyle factors impact health.

Reflective Observation:

This is a challenge me to think beyond surface level symptoms and recognise the significance of how external influences such as - diet, breastfeeding and antibiotic use on long-term health. It made me aware that promoting health isn't just about treating pain but also about having the knowledge and understanding of disease, prevention and public health trends.

Abstract Conceptualisation:

I realise that as a future Osteopaths I'm not just a manual therapist. I also have a responsibility to educate and empower my patients about their lifestyle choices which may affect the systemic health. This requires me to stay informed about current research and using that knowledge to guide conversations in clinic.

Active Experimentation:

Now that I'm in clinic, I feel more confident, raising conversations about preventative health, gut health and general well-being when appropriate because I understand the importance. I have seen all this foundational knowledge will help me as a practitioner to engage more holistically. I plan to keep expanding this knowledge base in order to support the broader health goals of my patients.

Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs: Prentice-Hall.

What?

After a full day in summer clinic - morning, afternoon and evening sessions, I got home and realised I had omitted a important detail from a patient's notes.

So what?

At the next available opportunity the following morning I went to clinic discussed the matter with my head of clinic and made dated amendments to the document. As I'm aware there is a legal documentation that shouldn't be tampered with. This reminded me of how critical it is to be honest and transparent, particularly when maintaining accurate patient records.

Now what?

In future, I will double check all clinic notes before getting them signed by the tutor and be proactive in correcting errors.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Description:

In clinic I treated a male patient in his 60s presenting with low back pain. Over the course of three appointments we establish a good rapport and trust. On the third session during a discussion around medical history and his treatment for prostate cancer. The patient disclosed he had been sexually assaulted by a medical professional during his radiation therapy. He explained he hadn't shared this information with many people before, but felt comfortable enough to tell me. I made sure to listen without judgement and remained calm in order to facilitate a safe and supportive environment. I thanked him for sharing it must've been.

Feelings:

This experience made me feel a strong emotional reaction. However, I made sure not to express this in front of the patient despite the unexpected and sudden shift in the tone of the session with this disclosure. I was deeply saddened by what he had experienced. The disclosure resonated deeply with me for personal reasons which made maintaining objectivity a conscious and necessary effort. I was also mindful of my role as a healthcare practitioner to remain professional and uphold boundaries needed.

Evaluation:

I believe I responded appropriately to the situation, being compassionate and allowing space for the patient to speak without probing. I made sure to offer validation of their feelings and emotions well gently redirecting the conversation to ensure we remained within my professional remit. I considered without safeguarding or reporting action was necessary and discuss this with my tutor at the time. However, as this was a historic event, the patient was cognitively sound and there was no current threat present. We chose to document accurately in his case notes and respect his autonomy in choosing not to report it. I offered support to him in any following steps he may wish to take, including signposting him to relevant mental health services.

Analysis:

This experience highlighted the significance of professional boundaries, particularly when a patient place is a high level of trust in you as their practitioner. It also underscored the need for emotional regulation, and the ability to remain grounded during unexpected disclosures, I believe I managed this well by taking a few moments outside of the treatment room to gather my emotions. Recognising the risk of becoming overly emotional and importance of seeking support in processing difficult experiences without blowing professional lines.

Conclusion:

While the situation was emotionally complex, I maintained a professional manner and handled the disclosure in a respectful and supportive way. I learned the importance of being prepared for difficult conversations, even in musculoskeletal focus practice and the weight of trust patients can place on us.

Action Plan:

I will continue to uphold clear professional boundaries. I will seek necessary support and anonymised peer discussion to process difficult cases and seek guidance when uncertain. I will also remain mindful of my own emotional responses, particularly with those situations that could hit close to home.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle [online]. The University of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle

This reflection has been carried out using the Gibbs' reflective model.

Description:

I noticed during an appointment there may have been a miscommunication, regarding the treatment I had delivered in a previous appointment and what I explained to the patient.

Feelings:

I felt concerned that I may have caused confusion or reduce the patients trust in my communication.

Evaluation:

Being honest and explaining the situation openly helped preserve the patient practitioner relationship.

Analysis:

This experience reinforce my understanding of how upholding the duty of candour and honesty facilitates trust and patient safety.

Conclusion:

I learned to acknowledge even small miscommunications in order to maintain professionalism and patient confidence.

Action plan:

In future, I will ensure clear and consistent explanations of techniques and check the patient understanding throughout each appointment.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle [online]. The University of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle

This reflection has been carried out using Rolfe et al. (2001) reflective model.

D4.2: "In the event of a concern being raised, if you act constructively, allow patients the opportunity to express their dissatisfaction, and provide sensitive explanations of what has happened and why, you may resolve this at an early stage."

D4.3: "You should provide information to patients about how they can make comments, complaints and compliments about the service they have received."

D4.6: "You should ensure that anyone making a complaint knows that they can refer it to the GOsC, and provide them with appropriate details explaining the procedure."

What?

Attached is my complaint letter coursework which I completed in year two, where I was required to respond professionally and sensitively to a simulated patient complain. I provided a clear explanation of the situation included details of how the patient could raise the complaint further with GOsC. I am also familiar with the ESO's complaint policy which is available on the website and can be used to direct patients appropriately.

https://www.eso.ac.uk/wp-content/uploads/2015/01/Patient-complaint-procedure.pdf

https://bcnogroup.ac.uk/wp-content/uploads/2023/11/Patient-Complaints-Procedure_Kent.pdf

So what?

I feel this exercise strength and my ability to manage future complaints calmly and professionally, preventing escalation. I now understand the importance of offering patients clear avenues for the feedback.

Now what?

In future clinical practice, I will continue to respond to complaints, constructively provide transparent exclamations and ensure patients are aware of their right to refer issues to GOsC if they wish to.

Patient Complaints Policy and Procedure (Kent) 2023. (n.d.). Available at: https://bcnogroup.ac.uk/wp-content/uploads/2023/11/Patient-Complaints-Procedure_Kent.pdf.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

What?

When using patient case notes for coursework, I ensure that they are fully redacted and returning the original copies, which are stored securely at the ESO reception.

So what?

The bulletin highlights the importance of confidentiality and professionalism while handling patient information in order to follow GDPR.

Now what?

I will continue to follow strict confidentiality protocols with my physical and digital notes in order to fully comply with OPSD5 and all GDPR regulations.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

In the summer before starting clinical placement, I reviewed the equality act 2010 to ensure my communication and care respected all patients diverse backgrounds and needs through a increased understanding.

Concrete Experience:

I engage with the equality act 2010 to better understand the legal and ethical responsibilities in treating patients fairly.

Reflective Observation:

This helped me realise how crucial it is to consciously recognise individual, patient, values, beliefs, and needs during our consultations.

Abstract Conceptualisation:

This reinforced that fair and non-discriminatory practice isn't just morrow, but also a legal obligation as it is essential to safe and inclusive care. So my responsibility is making sure my understanding supports me to implement this well.

Active Experimentation:

I will continue to apply this knowledge, adapting my communication to each individual patient, while ensuring their treatment and management plans align with each patient identity and values. This in turn ensures compliance with the equality law.

Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs: Prentice-Hall.

OPS D7 2.1 "acting within the law at all times (criminal convictions could be evidence that an osteopath is unfit to practise)"

This reflection has been carried out using Rolfe et al. (2001) reflective model.

What?

Before entering clinic as a student practitioner, I was required to provide a enhanced DBS check which would ensure I was safe to work with vulnerable individuals in a clinical healthcare setting.

So what?

This was a reminder of how my conduct both within and outside of clinic, directly impacts public trust in me as a healthcare practitioner and the osteopathic profession as a whole. The DBS check reinforces the standard of integrity and safety which patients rightly expect.

Now what?

I will continue to maintain a high standard of professionalism in all areas of my life, as I'm aware that my actions reflect on my role as a healthcare provider and the wider osteopathic community.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

This reflection has been carried out using Rolfe et al. (2001) reflective model.

What?

I am currently completing handover sheets for long term patients, to support the transfer over to a third-year practitioner, while I'm still around to answer any questions if needed, as I come to the end of my fourth year.

So what?

The sheet provides clear and essential information which shouldn't be overlooked during a clinic session where limited time is available. The practitioner can then find the time to thoroughly read through all clinical notes. I found these sheets helpful myself when taking over patience, so I know from personal experience how valuable it can be.

Now what?

I will continue to use the structured format of the handover sheets were possible if I ever need to involve a new practitioner, as I believe this helps to build trust with the patient and maintains practitioner confidence.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Description:

King clinic I've been treating a male patient, 48-years-old presenting with medial knee pain after football related knee injury where he responded well to treatment over six sessions. He also presented with a secondary complaint of ultrasound diagnosed calcific tendinitis of the extensor tendon in the left arm, which has been an ongoing issue for just over a year, previously treated unsuccessfully with corticosteroid injections, it is something he "just deals with". Although he experienced short-term relief from osteopathic manual therapy of his symptoms for a couple of days, we decided to seek further intervention. After discussion, we decided that a referral to the GP for additional imaging as the previous imaging was over a year and a half ago now while also opening up the opportunity for discussion of alternative care, such as possible barbotage surgery if found appropriate, this was a joint decision made in the consultation with the patient and clinic tutor.

Feelings:

I initially felt disappointed that osteopathic interventions were not as effective for the long-term, although out of our scope of practice, as he had such a positive reaction with his knee. Although it was still empowering, knowing I could still support the patient by coordinating further care and providing informed guidance, it was rewarding to be able to contribute in a shared decision-making approach that the patient could benefit from.

Evaluation:

The positive part of this experience was the multidisciplinary collaboration, seeing how addressing issues out of us at the scope of practice is possible through appropriate referral. The limitation however, was recognising that my role had boundaries and required outside expertise.

Analysis:

This was the first case which I had experience that highlighted the value of multidisciplinary care for patients with chronic musculoskeletal conditions. Research supports barbotage for persistent calcific tendinitis when conservative treatments have failed. Understanding this helped me manage the patients expectations, maintaining therapeutic rapport, while also avoiding over treating the patient and providing them with confidence that there are other options.

Conclusion:

This experience helped me to appreciate, went to the persist with osteopathic management and when collaborative care is best. I felt confident explaining barbotage in a way that the patient could understand, including - the underlying mechanism of the surgery, the benefits and how the referral process would work. I believe this gave the patient autonomy.

Action Plan:

In future I will stay up-to-date with NICE/clinical guidelines on MSK conditions. I will continue to communicate effectively with patients about realistic treatment expectations and encourage team based care when prognosis is uncertain.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle. [online] The University Of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle.

Gatt, D.L. and Charalambous, C.P. (2014). Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including 908 Patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery, [online] 30(9), pp.1166–1172. doi:https://doi.org/10.1016/j.arthro.2014.03.013.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle [online]. The University of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle

What?

During children's clinic, a fellow student attended clinic despite clearly having symptoms of a stomach virus, including visible fatigue, sweating and frequent trips to the bathroom. They explained they were worried about falling behind on clinic hours and didn't want to miss out. However, the tutor did quickly recognise the risk posed to both patients, especially those in paediatric clinic and potentially immunocompromised patients, as well as the rest of the clinic team and staff. He was sent home before seeing any patient. It raised immediate concern among the rest of us both for patient safety and also professional accountability.

So what?

This incident highlighted why self assessing fitness to practice is important. Even with the best intentions such as not wanting to miss clinical hours or not wanting to let patients down coming into healthcare setting while unwell can put them away patients and colleagues at risk. OPS D11 the practitioners must not rely on their judgement alone, following relevant guidance (such as fitness to practice and other guidelines set out - see attached) and advice to actively try prevent any professional misconduct. This situation further reinforced, even as students we're held to the same ethical standards as fully qualified healthcare practitioners, so we should act accordingly. Observing this reminded me that we all carry a shared responsibility to uphold a safe hygienic and professional environment for our patients to come into. It also raise awareness of how institutional support should be better, to encourage student students not to feel penalised for prioritising safety.

Now what?

I will make sure I do not attend clinical sessions if I'm unwell regardless of any perceived pressure or concerns about missing hours. I believe this experience has supported my understanding in the value of communicating with the reception and head of department to relieve any concerns and not try to amend issues in a way that puts others at risk. Moving forward, I feel confident in addressing concerns regarding peers who appear to be unwell as I should take responsibility for myself but supporting others if necessary (i.e. covering patients).

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

What?

During a clinic session, I observed one of my colleagues treating a patient who appeared to be visibly unwell. The student practitioner had mentioned earlier that they hadn't been sleeping very well and felt "burnt out" but they didn't want to reschedule the patient as they knew they were in a lot of pain. Well, nothing harmful occurred during the appointment. It made me pause and reflect on whether the student was in the right state of mind to provide safe care. Although it wasn't my Rota into being clinically. It did prompt me to discuss the scenario with the clinic tutor at a later date, not as a complaint but to seek guidance on how to act in similar future situations. The tutor acknowledged it was a valid concern and also emphasised the importance of self awareness, seeking help we're not fit to practice and referring back to the guidance regularly.

So what?

This situation brought to life, the importance of fitness to practice and our shared responsibility even as student practitioners to follow accordingly. I feel OPS D12 isn't just about individual wrongdoing it's about knowing when a situation might affect patient, safety or professional standards and recognising that in yourself. I also realised that part of being a healthcare professional includes looking out for colleagues, understanding when a concern should be voiced, engaging with this process which is designed to protect patients. It reinforced the concept that competence includes knowing your own limits, acting when accordingly when you're near them.

Now what?

I believe this experience made me more aware of my role in contributing to a safe, learning and clinical environment and made me feel more confident in raising concerns not just about myself, but whenever I feel patient safety could be at risk. If I ever found myself too unwell or unfit to treat, I would notify my clinical team and take the necessary precautions, stepping back without hesitation. This has provided me with a strong understanding, and I believe I am more equipped if a serious situation were to occur. I would not hesitate to engage with the appropriate processes, including informing GOsC if necessary.

www.osteopathy.org.uk. (2025). Home - General Osteopathic Council. [online] Available at: https://www.osteopathy.org.uk/home/.

Rolfe, G., Freshwater, D., Jasper, M. 2001. Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Care Quality Commission (2024). Adult Inpatient Survey 2023 - Care Quality Commission. [online] Care Quality Commission. Available at: https://www.cqc.org.uk/publications/surveys/adult-inpatient-survey.

Bloomfield, J. (2021). NHS National Standards of Healthcare Cleanliness 2021 [online]. Available at: https://nhssomerset.nhs.uk/wp-content/uploads/sites/2/Cleaning-Standards-for-Practice-Managers.pdf.

Care Quality Commission (2024). Adult Inpatient Survey 2023 - Care Quality Commission [online]. Care Quality Commission. Available at: https://www.cqc.org.uk/publications/surveys/adult-inpatient-survey.

Clark, M., Vakaj, E., Beirnat, K.N., McKnight, L. and Cowdell, F. (2023). Knowledge Mobilisation in Safeguarding Adults and Children for Healthcare in England. Health & Social Care in The Community, 2023, pp.1–25. doi: https://doi.org/10.1155/2023/6080695.

Gatt, D.L. and Charalambous, C.P. (2014). Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including 908 Patients. Arthroscopy: The Journal of Arthroscopic & Related Surgery, [online] 30(9), pp.1166–1172. doi: https://doi.org/10.1016/j.arthro.2014.03.013.

Health and Care Professions Council (2024). Scope of Practice [online]. www.hcpc-uk.org. Available at: https://www.hcpc-uk.org/standards/meeting-our-standards/scope-of-practice/.

Jasper, M. (2013). Beginning Reflective Practice. Andover: Cengage Learning.

Kolb, D.A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs: Prentice-Hall.

Naseema Shafqat, Verma, R., Kumar, A., Ravi, R., Verma, M., Roshan Sutar, Singh, V., Das, S. and Agrawal, A. (2022). Revisiting the apparently lost art of compassion in the healthcare system: Challenges, barriers, or impediments. Bengal Journal of Cancer, 2(2), pp.97–97. doi: https://doi.org/10.4103/bjoc.bjoc_14_23.

NHS England (2025). NHS England» National Standards of Healthcare Cleanliness 2025 [online]. England.nhs.uk. Available at: https://www.england.nhs.uk/long-read/national-standards-of-healthcare-cleanliness-2025/.

Patient Complaints Policy and Procedure (Kent) 2023. (n.d.). Available at: https://bcnogroup.ac.uk/wp-content/uploads/2023/11/Patient-Complaints-Procedure_Kent.pdf [Accessed 18 May 2025].

Rolfe, G., Freshwater, D. and Jasper, M. (2001). Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.

Skills for Health (2023). Why is safeguarding so important in health care? [online]. Skills for Health. Available at: https://www.skillsforhealth.org.uk/article/why-is-safeguarding-so-important-in-health-care/.

The Mummy MOT®. (n.d.). Mummy MOT Training Course [online]. Available at: https://www.themummymot.com/mummy-mot-training-course/.

The University of Edinburgh (2024). Gibbs’ Reflective Cycle [online]. The University of Edinburgh. Available at: https://reflection.ed.ac.uk/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle [Accessed 19 May 2025].

www.osteopathy.org.uk. (2025). Home - General Osteopathic Council [online]. Available at: https://www.osteopathy.org.uk/home/.

Xu, J., Wu, A., Filip, C., Patel, Z., Bernstein, S.R., Tanveer, R., Syed, H. and Kotroczo, T. (2024). Active Recall Strategies Associated with Academic Achievement in Young Adults: a Systematic Review. Journal of Affective Disorders, [online] 354, pp.191–198. doi: https://doi.org/10.1016/j.jad.2024.03.010.

Zheng, K. (2024). 5 Ways to Support Patient Modesty [online]. IntelyCare. Available at: https://www.intelycare.com/facilities/resources/5-ways-to-support-patient-modesty/.