Concrete experience: In an initial patient consultation , the patient presented with pain located in the sacrum/coccyx after a fall off a bicycle the week prior. After the case history we suspected the possibility of a fracture among other things. I performed the relevant testing including vibration and Percussion which came back negative. After conferring with my tutor i was confident it was not a fracture. After 3 treatments, the patient was painless and symptom free from the competent care based on my final diagnosis.

Reflective Observation: I was quite confident in my ability to carry out the testing and interpret the results from tests with good relevance. My preparation and learning allowed me to focus on what was important and not be overwhelmed. I knew that Closed fist percussion had a high sensitivity (87.5%) and a high specificity (90%) for detecting spinal fracture (Langdon et al., 2010).

Abstract Conceptualisation: Care is allowed for only by combining all the elements of practice such as clinical reasoning, accurate testing and clear communication with the patient.

Active experimentation: I will continue to research the best clinical tests , understand how red flags may present and practice case history taking alongside my examination routines to continue being confident in handling complex cases.

Langdon, J., Mohan, H., Gupta, A., and Venkatesan, M., 2010. A new clinical test for identifying vertebral fractures: the closed fist percussion sign. European Spine Journal, 19(3), pp.382–386. doi:10.1007/s00586-009-1209-5.

Concrete experience: After a busy afternoon in clinic i had not had time to fill out all my patient notes with back to back patients taking up the time. When i came to write up the notes for one of the patients i could not remember exactly the treatment we had done, and couldn't write anything with confidence it was accurate.

Reflective observation: I felt quite anxious and a little nervous that i wasn't able to totally confirm what treatment i had done. This showed to me how important immediacy is in clinic.

Abstract conceptualisation: Records are there to protect both patients and practitioners. Prompt and accurate details are important to support cases where documentation needs to be given.

Active experimentation: I now prioritise completing notes after a patient, leaving myself some time towards the end of a consultation as time for recording all notes and reading the next patients notes.

(University of Cambridge, 2023)

Experience: A patient who i had been seeing for a few months wanted to further their insurance claim and explore options with work so they requested for me to write a summary letter for them which they could take to their GP, employer or whoever was managing their claim following an RTA. I was responsible for the writing of the letter, while being overseen by a tutor.

Reflection: The task highlighted the importance of written communication as a way of communicating with professions outside of healthcare as well. Due to the responsibility i had , i knew the letter content needed to be accurate , appropriate and informative while still remaining professional and unbiased. A summary letter is not a referral letter.

Action: In future practice i will reflect back to this time to make sure i execute the same standard of professional writing to ensure my letters, documents and data is accepted by other professions.

Concrete experience: A patient attended clinic with left sided chest discomfort and some pain which they indicated in the scapulothoracic area. The patient couldn't identify any MSK causes or aggravating symptoms other than general exercise which made me concerned. Additionally they had large fissure on their arm so we were unable to take an accurate blood pressure reading. After a brief discussion with my tutor we advised the patient went from the clinic to A and E.

Reflective observation: I felt unsure at the beginning as the presentation wasn't very acute although i still recognised the potential danger in the symptoms. Combined with the fissure and the patient not looking overly healthy i was reassured by my tutor we had made the right decision.

Abstract conceptualisation: For me, the case still stands as a good reminder that not all red flags are immediately obvious or or dramatic. Any suspicion of underlying medical issues should be acted on.

Active experimentation: I keep making efforts to refine my screening process and ask relevant, clear and precise questions to help rule out non- MSK conditions.

Concrete experience: During a patient consultation in paediatric clinic, a patients mother asked me if they could change the baby i was treating on the couch. I told them that they could and had done this before. When we left the room to discuss the case, my tutor informed me that personally they would not allow that as it does risk infection or contamination further.

Reflective observation: This made me realise that i should consider the patients welfare who have to use this treatment room next , and whether i myself would want to be treated on a plinth that had just been used to change a babies nappy.

Abstract conceptualisation: Hygiene, safety and infection control isn't optional, its a must for clinical practices. Complacency in this area can undermine our trust with patients and possibly lead to harm.

Active experimentation: When i leave a treatment room at the end of a consultation , or enter a treatment room to prepare for a consultation, the first thing i do is a hygiene checklist.

(University of Cambridge, 2023)

Experience: A patient of mine in clinic had recently been promoted to a management job at work which they were happy about, although it meant they had become more sedentary and it was worsening their thoracic pain. I took the opportunity to open discussions about daily activity , exercise , posture and sleep schedule. This ultimately led to an in-depth conversation about their lifestyle in general. Collaboratively we highlighted and explored ways to encourage more movement into their day and healthier habits.

Reflection: Having this experience has been good because it reinforced to me how , despite the hands on treatment being a huge part of our management, Osteopathy goes far beyond that , into the every day life of patients. Understanding our patients lifestyle and facilitating positive changes will promote health. This can even be a better way of creating long-term change for patients, all within our scope.

Action: Since this particular consultation i have become increasingly interested in lifestyle education , and aspire to take courses so that i can be more qualified in giving advice , expanding my therapeutic scope.

(University of Edinburgh, 2024)

Description- Just prior to Christmas I was in headache special clinic where we treat and manage different headache disorders. In my headache CEX I applied a structures approach, including the relevant red flag screening, differential diagnosis and testing routine using my knowledge of anatomy and physiology to distinguish and create an appropriate, effective management plan. I achieved 88%.

Feelings- I was proud of myself and happy that the effort I had put in had helped me develop as a clinician. It was nice for a moment of validation.

Evaluation- My strong knowledge of anatomy, physiology, headache types and presentations combined with good case history taking and thorough examination contributed to this outcome.

Analysis- This experience demonstrated that I have the ability to apply my good level of knowledge in a practical way.

Conclusion- Due to my good engagement, revisiting and revision of the relevant content I felt ready and was confident in managing this patient presentation.

Action plan- I will continue to apply these study methods to other areas and maintain a regular revision of the important material.

(University of Edinburgh, 2024)

Description- While assessing a baby in paediatric clinic I noticed nosy and raspy breathing that worsened when laying down or when the baby was feeding. Among other things the presentation suggested Laryngomalacia, which is a medical issue which Osteopathy cannot treat directly. After conferring with my tutor we advised that they informed their GP about our concerns at their next appointment which was in a weeks’ time.

Feelings- I was a bit upset for the mother and baby that we couldn’t help but also proud of myself for recognising a red flag and taking appropriate action.

Evaluation- The experience was overall a positive one for me in clinic, we avoided inappropriate treatment and got the baby on the right path.

Analysis- This showed me that whilst the osteopathic scope is broad, but recognising what we cant treat is just as important as recognising what we can.

Conclusion-I made the right decision, with the support of my tutor.

Action plan- I will study more paediatric red flags and understand different pathways of care available for patients.

Bikdeli, B., & Farzan, S., 2023. Laryngomalacia. [online] StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK544266/ [Accessed 11 May 2025].

(University of Edinburgh, 2024)

Description- During my final year FOPE exam, a proportion of the marks go towards understanding osteopathic principles and concepts. This material is taught to us in the very first year of the course. Despite passing the exam, I didn’t achieve a grade I would have desired and realised I hadn’t been able to practically apply any concepts or principles to the case.

Feelings- I was slightly disappointed but mostly frustrated with myself as if I had revisited these early lectures, it would’ve been easy marks to pick up in the exam. I had prioritised clinical, orthopaedic material too much.

Evaluation- One good thing to take from this is that I was able to retrospectively see where I had gone wrong. Despite this, the impact was clear that I had lost marks due to a lack of revision, and an underdeveloped professional approach to reviewing content.

Analysis- Keeping my skills in Osteopathy up to date isn’t just about learning the new material I’m presented with but reinforcing and regularly integrating previous material too. Long term retention needs effort.

Conclusion- I should have broadened my revision list and searched for core topics from earlier years, clinical exposure and memory was not enough.

Action plan- I will download and revisit core principles and primary materials more regularly to ensure I’m able to apply them practically. I will make use of active recall methods and relate them to real scenarios to keep it relevant.

(University of Edinburgh, 2024)

Description- A patient with recurring upper thoracic pain and associated trapezius myalgia had been coming for a few months with only minor relief post treatment. After analysing and reviewing the initial case history, I realised that their presentation correlated with similar symptoms to stress and poor sleep. The patient was diagnosed with anxiety and chronic fatigue.

Feelings- I felt equally happy and frustrated because I had identified a new approach, but I felt it was something I should have done earlier.

Evaluation- This case further reinforced to me the importance of being holistic and viewing all of the patient, rather than just their presenting complaint.

Analysis- Effective care is more than just the treatment. Effective care involves listening, understanding and reviewing information continuously through the management of a patient. Without review , the care for this patient would have continued to be ineffective.

Conclusion- Reflecting helped me to shift the treatment approach to more support towards to stress and other lifestyle factors. Additionally opening up pathways to other healthcare specialist if extra support was needed. The patient has now recently stopped attending the clinic as they are pain free and much more positive about their body.

Action plan- I now make post treatment reflection a regular thing for patients who are not following the standard prognosis. I actively try to step back and view their case from a different perspective.

Vasseljen, O. and Westgaard, R.H., 1996. Can stress-related shoulder and neck pain develop independently of muscle activity? Pain, 64(2), pp.221–230.

(University of Cumbria, 2016)

What? In year 1, while observing a fourth-year students consultation, I noticed that the patient was slow to answer and appeared nervous when being asked some questions. I remember how the practitioner remained calm, spoke slowly and clearly, giving the patient time to respond. The patiently really relaxed and became more confident throughout the process.

So what? After reflecting on this I realised how much a patients comfort depends on the practitioner’s manner. Treating someone with dignity includes allowing them to speak without pressure.

Now what? For me now, as a current fourth year student, I focus on not only articulating correctly, but how my behaviour, tone and body language can make a patient feel respected.

(University of Cumbria, 2016)

What? While taking an initial case history, the patient did not speak English and had their daughter there to translate for ease of communication. The tutor commented that just because the patient could not understand me, I should still direct most of my attention to them and not disregard them, solely speaking to the translator. I realised that I needed to work in partnership with both parties.

So what? This showed me how important it is to adapt to individual communication needs in cases, while still making the actual patient the priority.

Now what? I will make a more conscious effort to address both the patient and the translator of this happens in the future, and also express my apologies if I talk more towards the translator at the start of the appointment.

(University of Cumbria, 2016)

What? While observing a fellow third year college during summer clinic, they diagnosed the patient with something very complex. When they tried to explain the diagnosis to the patient, they didn’t alter any language or give the patient a chance to ask any questions.

So what? It was clear to me that the patient hadn’t understood the diagnosis and just went along with the treatment because that’s what they were here for.

Now what? It was a reminder for me to check in with my current and future patients understanding of their diagnosis and use language they are comfortable with when explaining things to them. I also tend to circle back at the end of appointments and double check they have a clear grasp on everything.

(University of Cumbria, 2016)

What? When I first started treating in clinic, I wanted to sacral toggle a patient, I explained the technique and the desired effects well, and told them I would first palpate to the bottom of their spine with the bottom of my palm. When I placed my palm on the bottom half of the sacrum the patient jumped and rolled to one side, exclaiming that I was way below their spine.

So what? I realised I had assumed that the patient knew the sacrum was the bottom of the spine, but in fact they thought it ended just at the start of pelvis. I realised I had also then not got full informed consent for the technique. Consent is a process based on a meaningful dialogue between doctor and patient (General Medical Council, 2020).

Now what? I now break consent into stages, first for the technique and its aims and then for exactly where I will need to place my hands along with any exposure of sensitive areas. During treatment I check-in to ensure they are still comfortable with the technique, before recording that I obtained consent clearly in my notes.

General Medical Council (2020) Decision making and consent. London: GMC. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent (Accessed: 11 May 2025).

(University of Cumbria, 2016)

What? I covered a patient while a college was off ill. They had chronic neck pain and had been coming for a while. I asked what exercises they had been doing and they said none because they were just told to go and look some up on YouTube. I spent some time showing the patient targeted deep cervical flexor and peri scapular strengthening exercise, getting them to mirror them. The patient then rebooked with me, and after 3 more treatments had noticed the biggest improvement yet.

So what? It was evident to me that advice and management needs to be specific and empowering for patients to give them confidence in their recovery.

Now what? I routinely check up on patients exercises, making alterations where needed to help them feel empowered and actually be able to maintain their own health.

(University of Cumbria, 2016)

What? During a consultation with a long-term maintenance patient, they expressed concerns about their hip, while we had always previously focussed on the neck. I asked them if they wanted me to take a look, which they agreed to. I then asked if they were comfortable to undress so I could see and move the hip easily. The patient said they would but not this week as they didn’t feel uncomfortable undressing to their underwear. I explained a few modesty options for them, explaining we could use a towel or jumper to cover the good hip and other sensitive areas, to which they agreed. Later on in the appointment the patient expressed that it wouldn’t have been the physicality of me seeing them undressed that was a concern, but that they had not undressed for anyone in a long time.

So what? This experience made me realise that patient dignity and comfort runs deeper than physical exposure and can often have more emotional connections.

Now what? In all initial consultations I explain modesty options, and with my returning patients I ask them to wear clothes they feel comfortable being examined in, reinforcing the fact they should not feel pressured and any reason not to is a valid reason.

(University of Cumbria, 2016)

What? A patient told me that they used recreational drugs regularly. After asking them if they had taken anything recently or were currently under the influence to which they fortunately denied, I found myself slightly withdrawing and becoming less personable through the treatment. I lost focus while performing techniques and stopped picking up on cues.

So what? I realised my personal values should not affect my professionalism and this moment identified how much unconscious bias can affect the way we administer treatment.

Now what? I regularly remind myself that I should challenge my personal bias, with the aim to make sure every treatment, to every patient should be equal and non-judgemental. Furthermore, unconscious bias can lead to false judgements or assumptions about patients, which could harm their management (Healthstream, 2023).

HealthStream (2023) 'The Impact of Unconscious Bias on Healthcare', HealthStream. Available at: https://www.healthstream.com/resource/blog/the-impact-of-unconscious-bias-on-healthcare (Accessed: 13 May 2025).

(University of Cumbria, 2016)

What? I was looking after a patient for a colleague who was off absent with sickness. The patient had an extensive file and had been coming a long time so i sifted through the notes checking for anything major. After roughly 10 minutes of treatment the patient asked me politely if i was going to actually work on the knee that was the issue. I realised i had misread the notes and was working on the wrong leg.

So what? I immediately acknowledged my mistake and apologised to the patient. They were understanding but the incident reminded me how vital it is to reread and double-check notes. It reinforced that even though embarrassing, being honest to the patient and owning up to my mistake is always the correct thing to do.

Now what? I take an extra moment before every appointment to clarify and review key information in cases, even something as seemingly simple as the side of their complaint. I'm also continually open and honest with patients throughout practice.

(University of Cumbria, 2016)

What? A patient i had been seeing for a few months requested to be my friend on a social media platform. I denied the request and told them that it would be inappropriate and explained our professional boundaries at our next consultation.

They told me they had previously followed a couple of their Osteopaths and i explained that there is a difference between following an Osteopathy clinics social media that they use to advertise, compared to my personal use account.

So what? This experience highlighted to me how easily boundaries could be pushed and potentially breached. It is also clear that boundaries are not always broken with malicious intentions.

Now what? I will review guidance eon boundaries in practice and thoroughly explain patient/practitioner boundaries if i suspect or anticipate they might be compromised.

(University of Cumbria, 2016)

What? A patient that i had treated a couple of days prior rang the clinic complaining that their pain had got much worse. I knew i had used appropriate, gentle techniques well within the scope of practice so we arranged for them to come in the following day for a follow-up to see what was wrong as they were concerned.

So what? I felt confident that i had not done anything wrong and explained to the patient the reasons why sometimes after treatment the pain and symptoms can increase for a period of time. I advised them on how to cope and reduce the pain until it went away. I took full responsibility for the flare in symptoms while still ensuring to the patient it was not necessarily a fault. After this interaction i thought about how being transparent with patients is important to maintain trust. The patient mentioned they appreciate the attentiveness and honesty.

Now what? I make sure i clearly explain that post-treatment responses can initially occur an advance in symptom's before they start to reduce. I also ask patients about previous treatment reactions to know who can tolerate harsher techniques.

(University of Cumbria, 2016)

What? I observed a patient become very irate at reception because they were told they would have to change practitioner. The patient said they did not want to and asked for a refund. The receptionist said a refund was not possible but a rescheduling of the appointment was. The receptionist clarified the reasons they would have to change practitioner and after the patient calmed down they rebooked for another time.

So what? I realised that having a clear set of guidelines and options when receiving a complaint makes it easy to act without being defensive or emotional, ultimately leading to a better outcome.

Now what? I certainly know when i open my own clinic that i will make sure all staff know and review the policies and guidelines regularly.

(University of Cumbria, 2016)

What? I observed a fellow student practitioner and a receptionist discussing private details of a patients case in front of a full waiting room of patients. I politely reminded them that many people could hear their conversation and that i wasn't sure they should be having it in the first place.

So what? I realised that patient confidentiality can be compromised unintentionally. I realised that the first thought should be not to discuss patient cases at all.

Now what? Before engaging in conversation about private information i always check my surroundings and mentally check the person I'm talking to is appropriate such as a tutor.

(University of Cumbria, 2016)

What? During a standard clinic session, when i went to collect a patient for an initial consultation from the waiting room, they refused to come with me as i was male and they did not want a male practitioner for religious reasons. I told them that it was not a problem, and worked with the patient and reception to find a female student and female tutor to take and oversee the consultation. The patient remained polite to me and thanked me for helping.

So what? The situation helped me to reflect more on cultural awareness , and while it will be easier to avoid these scenarios in private clinic, efficiency should not be prioritised over patient accommodation when matching students availability. Equality does not mean treating everyone the same , it means treating everyone fairly and making adjustments so that everyone is comfortable (NHS England, 2020).

Now what? I plan to ask patients in clinic whether they are happy for me to be their practitioner and facilitate a change of practitioner if necessary.

NHS England, 2022. Core20PLUS5 – An Approach to Reducing Health Inequalities. London: NHS. Available at: https://www.england.nhs.uk [Accessed 14 May 2025].

(University of Cumbria, 2016)

What? I overhead a couple of other student practitioners making negative comments about a patient who had just been in for a consultation. Although it wasn't meant with any bad intentions, it was still unprofessional and inappropriate. I felt uncomfortable but was not confident enough to intervene or speak up.

So what? This moment really highlighted to me how to reputation and integrity of the profession can be undermined so easily my casual comments. Despite the fact that no names were mentioned and specific case details were not included, speaking negatively about patients is disrespectful.

Now what? Going forward into the future i consciously make myself aware of conduct protocols , both inside and outside of clinical settings. Not only being mindful of how i speak about patients, but anyone involved in the clinic such as tutors and receptionists. I also hope in future, should this situation occur again i will have the confidence to speak up and educate my peers.

(University of Cumbria, 2016)

What? A patient arrived late to our session, due to a work meeting running over schedule. I informed them that i would still need to do the relevant check-in questions and testing, so treatment time would be cut short. The patient told me that they would be willing to give me some cash if i ran over and gave them the usual amount of treatment, claiming they really needed it. I declined the offer as i was not sure it complied with policies , and explained to the patient i could not run over schedule.

So what? it was tempting both financially and from a healthcare point of view to try and accommodate the patients request as they were late through no fault of their own and seemed genuinely in need of treatment. Even though the offer came with good intentions i knew i had to stay professional as leniency around financial matters can lead to further misconducts.

Now what? I will always stick firmly to clinic policies, ensuring to shut down any possibility of infringements early and communicate this to the patient early. Financial trust is important for my professional reputation.

(University of Cumbria, 2016)

What? In the student room , a colleague was expressing their difficulty with refining a diagnosis for one of their patients, i offered to review their notes and share my own testing approach to create a diagnosis.

So what? When colleagues work in harmony and support each other, patient care can only benefit from shared knowledge pr approaches.

No what? When colleagues ask for help, i am always willing to offer my perspective. Fostering a collaborative mindset is important in clinical practice. Furthermore, when i feel like i need advice, i don't hesitate to seek support from my colleagues or tutors.

(University of Cumbria, 2016)

What? My patient was recommended to come to us by a friend following a car accident they had been involved in. At the same time they were seeing a physio provided by the NHS who had prescribed them exercises. Despite being qualified to prescribe exercises myself, i respected the fact they already had a comprehensive plan in place, noted it and reinforced the importance of the patient doing it.

So what? This experienced helped me to understood that respecting the practice of other types of therapy can improve patient outcomes and that its about cooperation instead of competition.

Now what? I regularly encourage my patients to maintain plans they have had from other healthcare providers when i think they are appropriate.

(University of Cumbria, 2016)

What? When i first started being able to observe in clinic, we had to regularly test for COVID-19. One week i had an observation scheduled but was feeling unwell on the morning of that day. I had no lateral flow tests in my house so called and cancelled my observation as it could have potentially put patients at risk.

So what? Protecting patients means airing on the side of caution, and that risk taking is not appropriate. Especially with something as serious as COVID-19.

Now what? I regularly reflect on my fitness to practice and make decisions early if i feel unwell or unable to come into clinic safely.

(University of Cambridge, 2023)

Experience: During a new patient consultation, the patient began divulging that their mother had recently passed away from cancer and they were struggling , so needed to be pain free as their was lots of stress and pressure on her. This uncomfortably mirrored something which was actively happening in my life and i became very quickly overwhelmed. I managed to complete the case history before getting too emotional , and then excused myself from the room. Recognising i was not in a fit state to carry out the rest of the consultation i handed over to another student to complete it.

Reflection: I initially felt embarrassed, but the support from my tutor and colleagues helped me to see that stepping away was the correct decision , and that i needed to deal with some things before i was fully clinically competent again. This experience showed me how quickly emotions can change, and not recognising when something is too much can lead to a compromise of patient care.

Action: Since this experience i have reflected more deeply on how to manage emotions and personal vulnerability while in practice. If a situation like this were to impact my ability over a longer period of time i would inform GOsC. I see emotional maturity as a key part of maintaining safe osteopathic care.

General Medical Council (GMC), 2020. Decision making and consent. London: GMC. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent [Accessed 11 May 2025].

HealthStream, 2023. 'The Impact of Unconscious Bias on Healthcare'. HealthStream. Available at: https://www.healthstream.com/resource/blog/the-impact-of-unconscious-bias-on-healthcare [Accessed 13 May 2025].

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

Langdon, J., Mohan, H., Gupta, A. and Venkatesan, M., 2010. A new clinical test for identifying vertebral fractures: the closed fist percussion sign. European Spine Journal, 19(3), pp.382–386. doi:10.1007/s00586-009-1209-5.

NHS England, 2022. Core20PLUS5 – An Approach to Reducing Health Inequalities. London: NHS. Available at: https://www.england.nhs.uk [Accessed 14 May 2025].

University of Cambridge, 2023. Reflective practice models. [online] Available at: https://www.cctl.cam.ac.uk/reflective-practice/models [Accessed 14 May 2025].

University of Cumbria, 2016. Reflective models. [online] Available at: https://my.cumbria.ac.uk/media/MyCumbria/Documents/ReflectiveModels.pdf [Accessed 11 May 2025].

University of Edinburgh, 2024. Gibbs' Reflective Cycle. [online] Available at: https://www.ed.ac.uk/reflection/reflectors-toolkit/reflecting-on-experience/gibbs-reflective-cycle [Accessed 13 May 2025].

Vasseljen, O. and Westgaard, R.H., 1996. Can stress-related shoulder and neck pain develop independently of muscle activity? Pain, 64(2), pp.221–230.