Looking ahead to the final exam - the CCAs

Presenting a patient summary to a tutor is a skill that I definitely need to develop, ideally presenting a 'continuation' patient to a tutor follows a logical format:
This is <name>, <age> years old, who is a <occupation / lifestyle indicator>, who presented with <original symptoms> at <date of initial presentation>. The diagnosis was <diagnosis> and we have been following a treatment plan of <treatment plan summary with goals>. <Progression>. We are aware of <notable medical history; medication, trauma, systemic, emotional factors>. Today I am planning to <examination and treatment>.

The clinic tutorial today was very much focussed on preparing for the Clinical Competency Assessment. We have our first formative (mock) CCA in 8 weeks!
The main point that the tutors got across were:
See as many patients as possible
Work together - form study groups
Communication - practice presenting information in a concise and logical way
The CCA is looking for three things: that the practitioner is safe, has a logical approach, and uses osteopathic techniques and concepts

With regards to working together and building up our Team Bonding Event, it was suggested that students from close knit teams generally do better, so I suggested that we meet up and have lunch together after Thursday's clinic. Hopefully this will become a regular study group.

First day of 4th year

The first session of the 4th year was clinic. Now clinic is not new to me, having retaken the third year I've spent a lot of hours there, and it really has become my favourite part of the course. But the new light on the situation is that I am preparing to do this without the support of tutors, and that's a whole new story. That's how I need to start thinking about working with patients, in how I communicate with them, how I look at them, how I make a diagnosis and develop a treatment plan.

Today I had a patient who had made a significant improvement but then had a relapse. I considered that whatever had been predisposing factors in his original presentation, and the cause of his previous symptoms, had not been properly addressed. Hopefully next time I see him I can work more on the bigger  picture.

We had a tutorial today about the structure and function of the lumbar disc. What I had forgotten about was that there are pain receptors in vertebral end plate. This is really significant and if we ask more questions of LPB patients about 'what makes the pain worse' in terms of timing, being on or off of weight bearing, and specific painful movements / actions / leverages we can be more accurate with diagnosis. Of course this can be applied to every part of the body, and although we are encouraged to move away from trying to diagnose which tissues are causing symptoms, this is not a reason to give up on tight anatomical and physiological knowledge. It's useful to bear in mind with a patient, when they are telling us about the problem:
What function is lost?
What structure subserves that function?

In the afternoon we had an induction lecture, lots of non-essential information, some good stuff, but the main thing was that it felt good to be a fourth year (after repeating the third). I saw a lot of weary faces that did not have the same enthusiasm I have for being at this stage in the course right now! The SU president mentioned problems with the year book last year. I might offer to get involved with organising it - as I have some contacts in the photo-book market I could take advantage of!

Preparing for the final year

The light at the end of the tunnel! This week I am preparing to start the 4th and final year of my course at the British School of Osteopathy. I'm really looking forward to life as a post-graduate! I've just been going through the timetable trying to get an idea of when I might be able to work part-time; I think I'll try and find a weekend bar job and do a few massage therapy appointments during the week. Need money!

Starting my Dissertation

I'm going to be using this previously dormant blog specifically to keep a journal of my research project.

I have the next two years of this integrated Masters Degree in Osteopathy to produce a dissertation, and I have been considering what I might like to research. It has to be something of interest to me or I'll never be motivated to keep up with the workload. As I am something of a geek I've come up with the idea of collecting osteopathy related data from Twitter. It's a bit trendy but fast becoming more mainstream; London is apparently the social media capital of the world according to an article in The Daily Telegraph, and if lots of people are sharing their life experiences with each other on public forums, and that information can be captured and analysed, it strikes me a potentially rich source of data. I'm not the first person to think so of course:


http://shu-lti-ai.blogspot.com/2008/04/using-twitter-as-research-data.html
http://www.thegetsmartblog.com/tag/using-twitter-for-research/
http://beingcheryl.com/2009/02/20/using-twitter-for-market-research/
http://www.twitip.com/twitter-for-research-why-and-how-to-do-it-including-case-studies/


So far my plan is just a very general, vague idea and I need to condense it into a specific research question, but so far I have managed to find several helpful people both in and out of the British School of Osteopathy.

The main challenges I face are going to based around the fact that Twitter is a relatively new phenomenon and so I haven't got much of other people's similar work to evaluate. A critical literature review is an important part of the dissertation, and I'm aiming to appraise 15 published peer-reviewed papers discussing as many combinations of Twitter / social networking / research / qualitative analysis / attitudes and sentiments / Osteopathy as possible.

I need to have a think about why people are using Twitter to discuss osteopathy. What is the point being made in this public statement? Are they using Twitter to show off? To seek attention or sympathy? To simply update friends and family on what they are up to? I will need to define the demographic of people that are twitter users, and discuss their motivation for using twitter because that will really put the data into context: Twitter users do not represent the typical general public. I also need to be specific about what information I am looking for and how I will analyse it. It's clearly going to be a qualitative data analysis (I've taken a book out from the library to refresh my memory on research methods). For now my plan is to search for the keyword 'osteopath' using Twitter's basic search tool, and then collect and save that data (I'm not sure how just yet). From the data I will want to extract the UK users, find those who have recently visited an osteopath, and determine sentiment or value attached to the description of that experience.

I think this type of research has value, in that we are collecting information from people who are not particularly responding to a direct question, or to an osteopathic representative. They have given their opinion unprompted and of their own free will. There may be challenges extracting useful data but I think the benefit outweighs the challenges and I am prepared to work my way through them.


This research is the first I have ever undertaken and is clearly in its early stages and may well take a complex and convoluted path to its destination in July 2011. Maybe I will use Twitter as a way to recruit a focus group or questionnaire participants after all, and maybe I'll end up abandoning the idea all together and studying leg length discrepancies. I do hope not.

Summer Holidays

Today is officially one month since school finished. I've been enjoying taking life easy. I've turned 30 with a week of celebrations. And now I'm ready to start building up to the second year! I'm going to spend next week revising and preparing for my Sports Massage Therapy course. Then after the course reviewing the first year LRPs for a couple of weeks. Then reviewing some second year stuff. This all assuming I don't have any retakes to deal with...

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Easter Eggs

So far Easter holidays are going well, with about 4 hours of study every day, apart from the weekend. Mainly just SF stuff but I'm going into school tomorrow to do some technique hopefully and work through some LRPs. The exam on the last day was absolutely horrendous and there's no way I want to be struggling through the next term, so I've written a loose study plan for the next 3 weeks and hopefully start next term on track.

That said, I'm not going to have my nose quite to the grindstone, as I've got a weekend in Dublin to look forward to and some friends to catch up with.

Reflective Practice

I haven't been setting strict times for reflective practice, which is something I will definately do next term. The aim of reflective practice is to "achieve a better understanding of yourself, your skills, competencies, knowledge and professional practice". I have been spending time thinking about my progress on this course and the experiences I have been having, and there have been some surprises, but I haven't taken the time to really analyse these thought processes and develop them. The most useful thing to do with these thoughts is document them, because as a more formal process you are inclined to be more analytical and follow a process of identification and recognition, evaluation, and to consider the outcomes. The objective is to identify what we have learnt in order to construct new or different approaches to our future practice, or to recognise and validate effective practice to utilise in the future. Some experiences I have had this term are:
Cadaver Study
Formative OSPE
Formative and summative FD essay
Back pain and treatment at the BSO clinic
Moving house and setting up a new study area.

I will come back to this post and fill in a more detailed reflection of these experiences, otherwise I'm missing the potential for self development.