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Creating and maintaining effective boundaries between healthcare practitioner and patient is essential to good clinical practice and is an inherent part of professionalism in healthcare. This is also a key requirement of the Osteopathic Practice Standards.

We are interested to explore how we might support and enhance good practice in this area.

Thematic analysis of boundaries education and training within the UK’s osteopathic educational providers

Female osteopath with elderly lady

In 2016, all osteopathic educational providers agreed to participate in a thematic review of boundaries to support teaching and learning in this area and Julie Stone, an independent consultant, was commissioned to write the report. The report was published in 2017.

In 2021, we commissioned an update of the review by Julie Stone to take into account the changing social, political and cultural climate and context within which osteopathic education sits. This report was published in 2022.

Key findings of the 2022 report include:

  • Education providers are the primary source of professionalism training for osteopathic students and classroom and clinic teaching combine to provide students with the skills to provide effective, patient-centred care.
  • Boundaries education, as an element of professionalism training, is dispersed throughout the curriculum, and delivered by a range of lecturers, integrated and reinforced by education providers through clinical teaching in lectures and in the clinic.
  • Education and the Osteopathic Practice Standards only partially influence professional behaviour, and in the case of serious boundary violations, do not deter misconduct. 
  • Students identified inter-generational, cultural, and diversity gaps between themselves and staff/tutors. The ‘Me Too’ movement and COVID-19 have opened up helpful conversation spaces about power, sexual harassment, and patient and practitioner vulnerability.
Literature review on communication of touch in manual therapy

In response to the 2017 report, we worked alongside the General Chiropractic Council (GCC) to commission a literature review that looks at how touch is communicated in the context of manual therapy. The review was done by Dr Michael Concannon and Samuel Lidgley from the University of Huddersfield and supports the work we are doing to reduce concerns about issues related to maintaining effective boundaries and communication and consent. You can read the executive summary of the literature review or the full literature review on this topic.

Thematic reviews

The purpose of a thematic review is to support the enhancement of standards by seeking information about a particular area and providing detailed feedback across the sector. The aim is not to focus on minimum standards, but more to provide an analysis by an independent expert and to describe what ‘good’ looks like.

The aim of both of these thematic analyses is to support learning and the enhancement of quality across the osteopathy sector through a collective report, rather than through individual feedback to each osteopathic educational provider.