Case-based discussions are ‘so relevant to what we do’

Tom Munden graduated from the British School (now the University College) of Osteopathy in 1988. At the start of his career, he was an associate, based in Kent, and then had his own multidisciplinary practice for 22 years. For the past five years, he has practised as a sole, private practitioner and is now based in the West Midlands. Tom provides osteopathy and cognitive hypnotherapy, and special interests include IVM and paediatrics.

How did you prepare?

I paired up with another osteopath, Martin Rose, who is based in Yorkshire and has a similar level of experience to me, as we both qualified in 1988. Our brief was to select a case where the outcome was not as we would wish and to take a balanced approach by also looking at what did go well. I selected specific cases with a recurring theme or issue, so that – by reviewing – the learning gained would be of real benefit in day-to-day practice. I sent summary case-history notes (patient’s identity/details protected) to Martin, outlining the case and the issues concerned, a few days before we were due to have the case-based discussion.

What did you do?

We completed two rounds of the process, looking at four anonymised case histories. The issues considered included:

● managing and following-up patients who do not attend their appointments

● patients who cancel because they have unrealistic expectations of treatment

● patients who attribute the worsening of their condition to their treatment

● patients who make inappropriate comments and unfair accusations.

Why did you decide to focus on that?

While we are all fellow learners, my colleague and I have been in practice for many years, so perhaps chose issues more related to communication and management than to technical issues of diagnosis and treatment.

How did you go about it?

We discussed our cases over the phone, which took about an hour – because of busy practice life, we opted to do this at the weekend. Skype, FaceTime, WhatsApp video call would all have been suitable too.

Any initial hopes or concerns?

We all have areas in which we can improve, and to talk about cases where the outcome wasn’t as hoped could, potentially, make a practitioner feel vulnerable. Stacey Clift, the GOsC Professional Standards Officer, who facilitated the online group sessions, successfully and very importantly created that ‘safe space’ for us to work, where the purpose was to learn, not to judge.

What did you learn? How will your learning impact on your future practice?

That, fundamentally, most of what I did around these cases was correct. My training and experience meant that – while the outcome was not as I would wish –ultimately, there were no serious implications. However, on reflection, there are always things that could be done differently or better. Most importantly, this process better prepares you for any similar scenario.

Any tips for giving and receiving constructive feedback?

Get good rapport with your case discussion partner to begin with (if you don’t already know them). We are all members of a caring profession, where we should be looking after one another not just our clients. It can seem quite alien to ask those questions that will help your partner find their own solutions to their issues. Far easier to act the sage and deliver your own advice!

How did you link your learning points to the OPS themes?

We did this reflectively, at the very end of the process, where the themes became obvious. While some themes were more relevant to each case discussed, the group noticed that there was a lot of overlap between them all.

Would you carry out case based discussions again?

Yes, I will definitely make this part of my new CPD cycle. It’s so relevant to what we do and a good way to reflect. In a group, it would be good to focus on repetitive issues that we all find cropping up in practice. Some examples might be: the management of clients who arrive late; clients who don’t follow advice; and clients who have not improved with treatment.

Any other tips or thoughts on case-based discussion?

Who you work with and how you feel about sharing with and confiding in them, is key. So choose wisely! Having found the right person or group to do this with, the process is a powerful one. Be open to being vulnerable. None of us is perfect. And, if it’s new to you, practice asking questions that will encourage someone to find their own solutions. It’s a great life skill to develop beyond just this process.

How do you feel about moving to the new CPD scheme now?

There are only two ways to respond to inevitable change, so I decided to embrace it. I discovered that the support and resources that the GOsC can provide you with will help to smooth the way and make the process less daunting. My feeling now, is that – once you understand how the new CPD process will work and how it is structured – it should be more doable than you might initially think! Interestingly, there were a number of sole practitioners in our group, all concerned about how they were going to meet the new requirements. Bringing us all together really helped. I was really lucky that I was partnered up with someone who I will now work with for the ‘real’ thing!