Learning from clinical experiences

Inevitably in your career you are going to have experiences that cause you an upset.  This could be a complaint against you – formal or informal, an adverse event after treatment, principal-associate issues, business disputes or lots of other situations.  A bad experience can really knock your confidence and have negative effects on how you practice.  Equally a bad experience could become a positive experience helping to develop and inform your practice to become a better practitioner.

Negative or Positive?

There are two factors that can make all the difference – your mindset and the support network you have around you.  In the event of a complaint or an issue arising there are a number of places you can turn for help, support and advice – your insurers are the first port of call in dealing with a complaint, the Institute of Osteopathy offers it’s members expert advice and support in times of need.  Colleagues are an invaluable source of support whether within your practice, friends or through your local Community of Practice (Regional Group).  Most practitioners willing give time and support to colleagues as it is an opportunity to learn themselves and who knows when the situation will be reversed and they will need support.

If a situation arises it is important you spend time reflecting on the situation and learning from it.  You may have fallen into a pattern of negative thinking – ‘I’m never doing that technique again’ ‘I’m no good at treating …..’ ‘I always …..’ etc. etc.  These negative thinking patterns are not helpful, it is important to turn them to positives by not making sweeping statements, remind yourself of the positives and then turn the negatives to action points.

For example – Maybe someone has a bad treatment reaction after you manipulate their lumbar spine and is very dissatisfied with your treatment.  This is dealt with in your clinic and the patient is treated with other techniques and after completing a treatment course leaves satisfied.  You may be left with the lasting impression – ‘I’m no good at lumbar manipulations, I’m never doing that technique again’.  At this point you need to remind yourself of all the times you have manipulated lumbar spines with positive outcomes.  You also need to consider this particular case – was it the manipulation that affected the outcome or were there other factors affecting the situation – both from the patient and yourself.  You could then set yourself some action points from this thought process which could include many things, for example – adjustments to your work schedule, improving your explanation of manipulation, improving your explanation of expected treatment outcomes, reminding patients to call you if they have concerns, practicing your manipulation technique with a colleague, attending a CPD session.  There could be many action points for you to take away but perhaps just focus on one or two to make it achievable.

This kind of scenario could make a very useful case discussion with a colleague so you can both learn and develop your skills.  Your colleague may be able to give you a different, less biased, perspective on the situation and you can both record some CPD.

A useful model for taking you through this process is a Significant Event Analysis.  You simply work through the questions as shown in the model.  This could be recorded and included in your CPD portfolio.

Date: Significant Event Analysis
Date of Event  
Analysers Who is involved in the discussion and their roles

This may just be an individual reflection or involve other practitioners or staff

What happened? Brief description of the event, clear and comprehensive
What issues are raised by this event? Why did you choose this event, why is it significant to you

How does it affect you in terms of procedures and emotionally

What went well? Describe the events and your reaction to them, think of the whole patient journey in your practice in terms of:

knowledge, skills, feelings, performance

* safety and quality

communication, partnership, teamwork

maintaining trust


What could have been done better? Describe the events and your reaction to them, think of the whole patient journey in your practice in terms of:

knowledge, skills, feelings, performance

safety and quality

communication, partnership, teamwork

maintaining trust


What could be done differently in the future? Include personal changes as well as system changes.  Provide definite actions that can be taken rather than possibilities.
What further personal learning needs did you identify? These can be described in terms of knowledge, skills, and feelings.  Plans should be SMART – Specific, Measurable, Achievable, Realistic and Timely.
How and when will you address these? Clear plans should be outlined here.

Bowie, P. and Pringle, M. (2008), Significant Event Audit: Guidance for Primary Care Teams; National Reporting and Learning Service, available at: www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61501


Every situation you come across in clinic whether positive or negative is an opportunity for learning and development.  It is important not to become despondent when difficulties arise but turn them to positives to become a better, engaged, developing practitioner.  It is not uncommon for people to leave the osteopathic profession and I sometimes wonder whether if they had received better support at key moments they would have remained in the profession.

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