It is with great trepidation that I face the next CCA. Although I know I have made a big leap from last year and I can't possibly have got worse over the course of this year, my CCA grades so far suggest the opposite to be true. From D high to D low is a damning verdict! Apart from clearly being on the rubbish side, at least there are some obvious reasons for this - my failure to initiate writing a doctors' letter the first time around and then in response to this, an over zealous instant referral the second time around. (However, I still maintain that the patient in question was an unreliable witness and had red flags that may not have been addressed elsewhere, but never mind). I would love to improve on my OSPE grades to boost my confidence (B low/C mid formative; B Low summative), but at this stage a pass will do! However, I will be concentrating on devising treatment routines for specific conditions, as we have been advised that this will be the format of the next exam. I also need to find out more about our first aid requirements - we did something earlier in the year, but it seemed quite basic - I'm just hoping I don't have to pay to do anything else!
In the longer term, it is all about technique for me. In my experience this (and trust/rapport) is the main factor which makes me return to a practitioner and this is where my focus will lie. Feedback suggests I'm good to go on the rapport front! I expect my palpation to improve in time and I generally hope to speed up the whole patient encounter straight away. I have managed to widen the variety of techniques I use in clinic this year, but it is a constant effort not to use the old favourites. I think it is really damaging to stick to a few trusted/most easily achieved techniques at this stage and I am always consciously trying to avoid doing this!
In terms of LPA criteria not quite satisfied, to be investigated more later (when time constraints and health allow) I would like to explore the evidence base for manual techniques further and have a few high quality papers at my fingertips to which I can refer people to. It is my experience in the last couple of years that often evidence is conflicting, as I have found recently regarding subjects such as stretching and using ice/heat etc. I aim to at least stay informed about the latest research both "for and against" ideas, so I can at least discuss it and direct people to it, in order that they can make informed decisions. I think I am coming to the conclusion that the "informed decision" is what it's all about and I will be satisfied that I am being professional enough if I can confidently say that there is no evidence that the treatment or advice causes any harm and if there is an absence of acceptable evidence of significantly good results, it is performed/advised on the basis of anecdotal or experiential success and it is then the patients' choice whether to proceed or not.
I also hoped to read up about harmonics, but this will have to wait. Sadly, an external course I did not take, but an approach I see taken by many students and enjoyed by patients. I am also loathe to admit the supine C/T thrust still evades me at this point, but I hope that I achieve it before I leave (whenever that is)! I also have not achieved the O/A thrust since we were told not to do the only version I ever found success with! I hope I can get over this. My other nightmare is the sidelying, posterior SI thrust - success comes and goes as it pleases!
I anticipate practising mainly structurally at first. I would feel like a fraud if I offered cranial treatment right now. Finances permitting, I will take the cranial course, maybe in January. I am definitely interested, but don't think I'll manage September sadly.
I want to learn all the osteopathic lymphatic (pumping) techniques / protocols! The closest I came to them was on the Classical one day course. The classical guys love them. Sadly, my dissertation left me none the wiser! The nature of the exercise and the papers included for review meant that although the results of various lymphatic protocols were discussed, the techniques and their implementation were mentioned only in the methods sections and were not instructive in their description (hence no enlightening tutorial from me on such techniques)! I also want to learn the specialist manual lymphatic drainage techniques for oedemas / lymphoedemas.
There were various areas I did not include in my learning contract that came up over and over again and will be part of my future quest to fill the gaps. Core muscle strengthening, rehab (especially re shoulder, knee and ankle) and strapping, to name just a few. I also need to brush up on my neurology, keep red flag information at the forefront of my mind and become really familiar with NICE guidelines. It is the information related to the less frequent presentations that is easiest to forget and I think it will require an ongoing reasonable effort to keep it familiar. I have little knowledge about sports injuries, but more about pregnancy which I definitely hope to take further.
There are other areas I would also like to explore in the future. I have always been interested in nutrition and I have recently developed an interest in Alexander Technique. I am quite interested in a few of the post graduate courses at the AECC such as diagnostic and treatment use of ultrasound and I would also like to be able to work with animals. I still find myself drawn to traditional Chinese Acupuncture, an original study consideration of mine. However, fee increases certainly rule out another degree for me!
Finally, I am hoping a couple of practice visits I am arranging locally and up North may lead to even a few hours a week employment and I have also made enquiries about room hire nearby.
Although I have had my ups and downs on the course, I still hope to find that this is a rewarding career and I already see it as an opportunity for lifelong learning!
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