An Account of the Development of the Conceptual Basis of Osteopathy Course at the British School of...

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An account of the development of the conceptual basis of

osteopathy course at the British School of Osteopathy

K. Nash*, S. Tyreman

British School of Osteopathy, 275 Borough High Street, London SE1B 1JE, UK

Received 10 January 2005; received in revised form 11 February 2005; accepted 11 February 2005

Abstract

Background: The historical background to the teaching of ‘The Principles or Concepts of Osteopathy’ from the foundation of the

British School of Osteopathy (BSO) in 1917 to the present is briefly described in order to provide a context for a curriculum review

that occurred between 2003 and 2004.

Objectives: The objective for the review of ‘The Concepts of Osteopathy’ curriculum change was to develop a clinically relevant

course, which reflected both the historical foundations of osteopathy, current philosophy in health care and contemporary scientific

developments.

Methods: Focus groups were held with members of the BSO faculty in order to ascertain their views about what should be taught

within ‘Concepts of Osteopathy’ curriculum. Additional contributions were received from an online discussion group of BSO faculty

members and through discussions with the members of the teaching faculty. This information was analysed and utilised in

developing the revised curriculum.

Results: Commonly occurring themes which participants felt should be reflected in the concepts course were: (1) it is the osteopathic

concepts that distinguish us from other physical therapists, (2) there are different models of osteopathy being practiced and taught

within the BSO, the UK and internationally and (3) it is the practical application of osteopathic concepts that is important.Discussion: Despite the fact that osteopathy as currently practiced is clinically diverse, there was a considerable measure of

agreement amongst the osteopaths who participated in this focus group exercise. Particular challenges exist in developing the

curriculum content because of both the broad theoretical basis on which the course operates and the importance of presenting the

content in such a way that students are able to apply it to clinical situations.

Conclusion: Further development of the curriculum will be informed by feedback from students, internal faculty and examiners; and

revised to reflect contemporary developments in health care and scientific knowledge.

Ó 2005 Elsevier Ltd. All rights reserved.

Keywords: Education; Principles of osteopathy; Osteopathic medicine; Health care concepts

1. Introduction

The teaching of ‘The Principles of Osteopathy’ or

‘Conceptual Basis of Osteopathy’ (CBO), occupies

a unique place in health care education. No other

main-stream healthcare professions have an equivalent

subject, and even within osteopathy there appear to be

considerable differences between the ways various

teaching institutions manage this part of the curriculum.

This paper reviews some of the changes that have taken

place in teaching Principles or Concepts at the British

School of Osteopathy (BSO), the rationale behind the

changes and the challenges that face this subject area.

From 1917, when the BSO was founded, until

through to the 1950s, The Principles of Osteopathy to* Corresponding author.

E-mail address: [email protected] (K. Nash).

1746-0689/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ijosm.2005.02.005

International Journal of Osteopathic Medicine 8 (2005) 29e37

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mailto:[email protected]



a large extent equated to the whole of the osteopathy

course. Principles of Osteopathy was taught without the

subject demarcations that are familiar in the contempo-

rary tertiary education environment. As the course

expanded over the years, both in terms of the number of

students and the scope of the academic syllabus, the

need to divide content into manageable areas of studybecame apparent. An unexpected consequence of this

development was that three separate ‘cultures’ devel-

oped within the school, namely academic faculty,

technique and clinic. This separation may in part arise

because of the different teaching expertise and structures

of working demanded by these curriculum areas. During

2003 and 2004, the BSO undertook a review of the CBO

subject area in order to further develop the course.

Bringing these cultures together is one of the challenges

this curriculum review sought to address. A second

challenge was how to ensure that students were able to

apply the taught component of CBO into patient

management. This challenge was apparent to Colin

Dove, a lecturer at the BSO, who taught the course

between 1960 and 1980, and it provided the impetus for

this current review.

2. Historical development of the course

John Martin Littlejohn, who founded the BSO in

1917, published a series of lectures on the subject of

Psycho-physiology in 1899.1 He had given these lectures

to students at the American School of Osteopathy. In

the preface to this work he writes:

‘‘The aim is to make the Psychology entirely physiolog-

ical and in this way to lay down a basis for the treatment

of Psycho-pathology and therapeutics, so that the field

of Medicine covered by Osteopathy may be all inclusive,

including means and methods of dealing with the entire

organism of the body and mind.’’

We will further discuss Littlejohn’s lectures again

later in this article. There is some mention in later

works2 that Littlejohn considered ‘mental’ or ‘psycho-

logical’ factors as being contained within the ambit of

‘osteopathic’ lesions. He may well have considered

adjustment (a term that is now commonly associated

with chiropractic) as addressing many levels of a pa-

tient’s life, not simply a technique to address musculo-

skeletal problems. However, in later osteopathic

writings, (for example those of Webster-Jones3 from

the early 1950s), there seems to have been more

concentration on anatomy, physiology, pathology and

treatment plans for specific conditions. These areas were

presented in the context of osteopathic principles: for

example, the role of ‘vital force’ in the preservation of

health, and disease as an effect of imbalance or mala-

djustment. Diagnosis and the technique of adjustment

were seen as synonymous terms and taught together. It

is difficult to ascertain to what extent Littlejohn

incorporated psychology or any of the philosophy and

humanities that he had studied prior to osteopathy, into

his teaching at the BSO. If he did, it may have been that

for his students these insights became implicit.

Shilton Webster-Jones who followed Littlejohn asPrincipal of the BSO, taught a Principles of Osteopathy

course in the 1950s. Webster-Jones’ hand written

Principles of Osteopathy notes, undated, but probably

written in the early 1950s, contain a mix of the current

subject boundaries in osteopathy. Some of the content

includes: a discussion of the defining features of

osteopathy, namely; the significance of the ‘vital force’

in health; function; the self healing properties of the

body and maladjustment as the cause of disease; are all

ideas that are still discussed in the concepts course

today. However, Webster-Jones also includes evalua-

tion, diagnosis, technique, and treatment and manage-

ment for specific conditions under the umbrella of

‘principles’.

In the mid 1950s, Jocelyn Proby4 took over the

teaching from Webster-Jones for about a year. Proby

taught a very structurally based course, looking at

‘triangles of forces’. In his book The Mechanics of the

Spine and Pelvis (undated) he describes this work as

based on lectures given at the BSO in 1934, and based

on research carried out by Littlejohn in 1900. Proby also

shared his interest in naturopathic ideas with the

students, for example the role of diet.

Colin Dove commenced teaching the Principles of

Osteopathy in 1960. He had been frustrated by the lackof a scientific basis in the teaching he had received as

a student, and turned to research into the neurophys-

iological effects of the osteopathic lesion, which was

being published by American osteopaths and associated

researchers around this time. In particular, Dove was

impressed by Irvin Korr’s work on spinal cord

facilitation and the concept of the ‘neurological lens’,

which was based on Denslow’s research begun in the

1940s.5 Dove also incorporated the work of Barry

Wyke, a neurophysiologist who had investigated the role

of joint receptors,6 as well as Melzack and Wall’s gate

control theory of pain.7 In 1967, Dove was invited to

give the Littlejohn Memorial Lecture in which he

outlined Korr’s work and signalled a major change in

the way that the Principles of Osteopathy would be

taught at the BSO.8 The course, which was mostly

neurophysiology from an embryological perspective

focused on neurological links between the somatic and

visceral structures. By 1970, he no longer taught ‘theory

of the osteopathic lesion’, because in common with BSO

faculty member Audrey Smith, he felt it was restricting

students’ ability to achieve a complete evaluation of the

patient. Instead, the idea of somatic dysfunction, which

Colin Dove considered to be just another term for the

30 K. Nash, S. Tyreman / International Journal of Osteopathic Medicine 8 (2005) 29e37



osteopathic lesion and equally flawed, began to be used

in referring both to a specific segmental phenomenon

capable of detrimentally influencing normal neurologi-

cal patterns, and in a broader whole person sense of

disruption to integrated physiological processes.

At the same time as Dove was starting to focus on

neurophysiology, Audrey Smith was developing anosteopathic diagnostic model based on the ‘pathological

sieve’, which analysed ‘the lesion’ in terms of patholog-

ical changes in specific identifiable tissues. Although

these ideas cross-referenced with changes in the Princi-

ples course, they were not entirely compatible with the

ideas that were being introduced there. On the one hand

the focus was on identifying pathological tissues in

a very specific and localised way, while on the other

it was looking at disruption to complex body-wide

patterns of physiological function. By the time he retired

from teaching the course in 1980, Dove was introducing

the idea of psychological and social stress as important

causal factors in conditions as diverse as cardiac disease,

stomach ulcers and low back pain. This change, as

highlighted earlier, reintroduced ideas that Littlejohn

had considered when he referred to psycho-physiology.

3. The recent era

The ‘Principles course’ was taken on by Kathy

Curtis-Lake (nee Keuls) when Colin Dove retired from

this teaching role in 1980. Curtis-Lake set about

broadening the course content. In particular, she was

interested in the way the health of the musculoskeletalsystem and structural components of the body influence

the general health of the individual in the long term.

Sadly, her tragic death at an early age prevented her

developing her ideas further, and deprived the pro-

fession of a potentially valuable contribution.

Stephen Tyreman took over the Principles course

from Curtis-Lake, and he attempted to build on the

scientific foundations that Dove had established, while

also looking more broadly at other ideas. Tyreman, not

wanting to rely solely on the work of Korr, began to

investigate other research in the area of neurophysiology

which demonstrated integrated and interdependent

neurological effects which could be disrupted by a range

of dysfunctions. In particular, Hans Selye’s9 concept of

stress as an adaptive response of the individual to

changes in their environment began to form an

important part of the course. This focus on stress was

in some ways a return to Littlejohn’s claim that

osteopathy is the ‘‘science of adaptation’’.1

Critically examining and updating traditional osteo-

pathic principals was considered by Tyreman as a key

part of programme development, and early in the

revised course a number of influential thinkers from

the profession were brought together to discuss and

critically review what the fundamental claims of

osteopathy are.

Tyreman started to introduce the work of a number

of important thinkers into the course: the works of

Larry Dossey,10 Rupert Sheldrake,11 Fritjof Capra,12

D’Amico13 and others began to be interpreted in the

context of health and osteopathic care. However,perhaps the most important change came with the

introduction of General Systems Theory into the

course.14,15 General Systems Theory offered a theoret-

ical basis for understanding and analysing the idea that

the body is holistic and needs to be understood as

a whole.

Clive Standen and then Bevis Nathan joined the

faculty of the BSO during the 1980s. In 1989 they, along

with Stephen Tyreman, registered on a Master of Arts

degree programme at the Centre for the Study of

Philosophy and Health Care, University College Swan-

sea. This opened all of them up to ideas from other parts

of health care and to the academic rigour of philosoph-

ical analysis. Clive Standen studied the concept of needs

in contemporary healthcare, Stephen Tyreman became

interested in the Philosophy of Science and the concept

of function in biology and health care, while Bevis

Nathan became interested in touch as a central aspect of

osteopathic practice. These subjects each share obvious

importance to osteopathy.

In addition to the curriculum developments of this

period, a significant change was made to the title of the

course which was approved as the ‘Concepts of

Osteopathic Health Care’ in an attempt to recognise

that osteopathy has as much, and perhaps more incommon, with other areas of health care and academic

life, and draws on a wide range of disciplines to explain

and understand its practices. The broad theoretical

basis, on which the course operates, has made the

course a particularly difficult one to both teach, and

learn as a student, since it covers a wide range of topic

areas including physiology, psychology, sociology,

philosophy, communication skills, critical thinking as

well as the history of medicine and osteopathy. Because

the course is concerned with ideas and critical analysis

it has always had the effect of polarising student

opinion with respect to the relevance of some of the

material to their chosen career. At least anecdotally,

there is considerable variation in the way students

engage with the material. Some immediately perceive

the relevance to practice. In the focus groups, which

will be described later, several osteopaths commented

that it was only after being in practice that they

realised the relevance of the concepts course. Extensive

written material was generated to support the course.

This was developed out of necessity because it was not

possible to refer the students to a single key text. The

course material was in the main produced by Stephen

Tyreman, with the module on touch authored by Bevis

31K. Nash, S. Tyreman / International Journal of Osteopathic Medicine 8 (2005) 29e37



Nathan. Because of the broad theoretical basis of the

course, developing the course materials proved to be an

extensive and challenging task. It became apparent that

the very comprehensive and eclectic nature of the

material could have a limiting effect on the student’s

independent learning.

With the introduction of the Bachelor of Osteopathydegree at the BSO in 2000, and the reorganisation of the

course, ‘concepts’ became integrated into a larger area

of study that incorporated the history of medicine and

osteopathy, psychology and sociology. The whole sub-

ject area was overseen by Kate Nash. This large and

critical area of study became known as ‘The Conceptual

Basis of Osteopathy’ (CBO). Tyreman reduced his

involvement with teaching the CBO component of the

course in 1997 and this was taken over by a team of

three headed by BSO faculty member Andy Cotton. The

team took on the challenge of improving the clinical

relevance of the material using case histories to highlight

the relevance of the conceptual material. However, by

2003 it became apparent that a major review of the

course needed to be undertaken.

4. Reasons for review

As mentioned in the introduction, the main reason

for the review was the need to structure the CBO course

in such a way that students are enabled to apply the

theoretical content to clinical encounters. Five further

reasons for the CBO course review were identified by the

course team:

1. By 2003, the written material was 10e15 years old

and in urgent need of updating and revision.

2. There had been important changes to the profession

in recent years including the self-regulation of

osteopathy by statute, the introduction of degree

level study in osteopathy, and an increasing in-

volvement by osteopaths in the National Health

Service.

3. During 1998e1999 when the restructuring of the

course from a diploma to a modular degree was

being undertaken, a number of different areas, for

example sociology, psychology, the history of

medicine and the history of osteopathy, in addition

to the formal CBO content, were incorporated into

the CBO area of study. There were insufficient

resources available at that time to integrate these

related disciplines into a coherent whole with clearly

stated inter-relationships.

4. The student feedback from course evaluation data

contained some negative comment. Students were

finding it difficult to perceive the relevance of the

material for their careers as osteopaths. This in part

may have been because in the degree the course CBO

was taught from year 1, as opposed to year 2. It was

intended that by introducing CBO earlier in the

programme, students would be able to apply the

ideas they met in this area of study to other areas of

the curriculum. However, students have little clinical

experience at this stage, so the material needed to be

adapted to be more accessible to Level 1 learners.5. The degree course programme was due for quin-

quennial review in 2005 and the CBO review would

fit into this wider process.

5. Process of the review

Focus groups were held in September and October

2003. All faculty members at the institution were invited

to attend. Material outlining the current aims and

content of the CBO course was distributed with the

invitation. Attendance was voluntary. Five separate

focus groups were organised, with one on each day of

the week in order to allow all staff to attend even if they

only worked one day a week. Four groups were

convened and varied in size from 6 to 10 participants.

There was active involvement and open expression of

views in all the groups regardless of the size. On the fifth

day, only one participant was available. They were

interviewed by the facilitator, so that their views could

be included. Each group had one facilitator and

a designated note taker. Two of the facilitators had

attended a training course in focus groups. A week

before the focus groups were held the facilitators met fora training session. All focus group discussions were

recorded on audio tape so that matters of accuracy from

the written notes could be verified. The members of each

group were informed that their contribution would be

confidential, but given the nature of a small institution

like the BSO, where individuals may be known for

particular views, their anonymity could not be assured.

The opening question posed by the facilitator to the

group was: ‘‘What do you think students need to know

about the conceptual basis of osteopathy in order to be

able to practice.’’

To facilitate discussion a variety of cards were placed

on the table with titles of topics currently taught on the

CBO course, as well as topics that could potentially be

included. Participants were invited to sort these cards

according to their perceived importance.

The follow up question posed by the facilitator for

group discussion was: ‘‘Are there any other topics which

you feel should be included in the CBO course?’’

The notes taken at the group were distributed to all

members for comment as to whether they accurately

represented the discussions before further analysis took

place. Thirty-seven individuals in total were involved in

the focus groups. The researcher then analysed the




notes for themes. This process was shared with the

facilitators.

6. Analysis

There was considerable diversity of opinion ex-pressed by participants. In fact for each opinion

expressed the opposite stance was argued, either within

the group or across the groups. Not all the participants

trained as osteopaths at the BSO, which may in part

account for the rich mix of views. However, there were

some themes that occurred commonly irrespective of

training, and others that were expressed by several

participants.

6.1. Commonly occurring themes

1. It is our osteopathic concepts that distinguish usfrom other physical therapists

No uniformity arose out of the focus groups as to what

these concepts were, a finding that also emerged from

Corson’s survey of osteopaths.16 There was acknowl-

edgement from the majority of participants for the need

to be clear about the nature of evidence we as teachers put

forward to support osteopathic concepts.

2. There are different models of osteopathy being

practiced and taught within the BSO, within the

UK and internationally.

There was a clear expression of the need to be more

open about differences in opinion amongst osteopaths

teaching both the BSO and also more broadly within the

wider profession. Students quickly become aware of

these differences and can lose confidence if the diversity

of views amongst the faculty is not expressed in an open

way within a culture of critical thinking. It was also

recognised as being important to develop at least some

common ground that all faculty members at the BSO

may broadly accept even though they may disagree on

some of the finer points.

3. It is the practical application of osteopathic concepts

that is important.

This theme, which relates to one of the reasons for

carrying out the review, led to passionate expression of

views. A key question posed by one of the participants

was:

‘‘How can we translate to the novice learner the

unconscious expression of a conceptual framework

that the experienced practitioner is able to do un-

consciously?’’

This relates to another key question posed by another

participant:

‘‘How can we ensure that conceptual material is

delivered in a way that has practical application for

students and their patients?’’

A key connecting theme here was that students foundit difficult to recognise physiology as a link between

evaluation and care. Emotional and psycho-social envi-

ronments cause physiological changes that may lead to

palpably different tissue states. The following quote

from Littlejohn1 in which he explores the relationship

between environment, mental state and physical func-

tion is pertinent to this discussion:

‘‘While the body is a machine, it is not a machine that

is wound up and capable of going for a number of

years wholly under external influence. The moulding

and shaping of the body is from within. Mental

function is at the basis of every physical function.Behind the physical acts involved in digestion,

respiration and circulation there is a mental state

which determines the body condition. It is a notorious

fact that civilization has increased disease and body

weakness. This is due to the fact that along with

civilisation comes a mental excitement that is not

conducive to body health. There is involved a higher

mental effort, a greater struggle for existence which

causes the normal development of mind and body to

be lost sight of and involves the body in numberless

disturbed conditions and diseases.’’

7. Issues to do with content

There was general agreement that ‘Philosophy of

Science’ and ‘General Systems Theory’ were given too

much emphasis and should be in the course more as

background or as a context within which to understand

holism. However, there were extremes of opinion

expressed, some participants feeling that Philosophy of

Science was absolutely essential while others felt it

should be dispensed with altogether.

There was a strong feeling that students should

have a foundation in critical thinking and be clear

about the hierarchy of evidence in relation to

osteopathy. While accepting that we need to give

students confidence in their chosen career, they do

need to be introduced to the idea that practice is

uncertain and evidence may not be produced in some

areas.17

There was strong support for the notion that the

History of Medicine, the History of Osteopathy and

some understanding of Complementary and Alternative

Medicine (CAM) therapies should be taught in a more

integrated manner. Interestingly, this integration had




been the case when Colin Dove taught this subject in the

1980s.

There was discussion as to the content of the CBO

course as a whole. There were many topics that some

participants felt were important for students to be

introduced to, but they felt there was potential for the

size of the CBO curriculum to become unmanageable.

There was also concern that there was some overlap

between different areas of study and that students might

be being over-taught.

V E R T I C A L T H E M E S R E P R E S E N T T H E T A U G H T C O N T E N T A T L E V E L 2

C O N T E X T U A L I S I N G O

S T E O P A T H Y - a

b r o a d o v e r v i e w

I N T R O D U C T I O N

T O C

R I T I C A L T H I N K I N G A

N D

E P I S T E M O L O G Y

T H E H I S T O R I C A L D E V E L O P M E N T O F

O S T E O P A T H Y – i n r e l a t i o n t o t h e h i s t o r y o f m e

d i c i n e

H E A L T H

C A R E C O N C E P T S - h o w

i s o s t e o p a t h y s i m i l a r o r d i f f e r e n t f r o m o

t h e r f o r m s o f h

e a l t h c a r e ?

H E A L T H

B E L I E F S A N D

B E H A V I O U R S

P S Y C H O L O G I C A L A N D

E M O T I O N A L D E V E L O P M E N T T H R O U G H

T H E L I F E C O U R S

E

S O C I O L O G I C A L A S P E C T S O F H E A L T

H

I N T E G R A T I O N

APPLICATION OF THEORY TO PRACTICE

AWARENESS OF DIVERSITY

AWARENESS OF UNCERTAINTY-

Openness to debate and differences of opinion within osteopathy

LEVELS OF EVIDENCE

Intuition---------------------------------------------------------------------Randomised Double-Blind Trials

CRITICAL THINKING

HORIZONTAL THEMES REPRESENT THEMES THAT UNDERPIN THE WHOLE COURSE

Fig. 1. Schematic representation of conceptual basis of osteopathy curriculum at Level 1 (1st year level).




An overview of the musculoskeletal system

The body as a unit from 2 perspectives:

1. physiologically 2. philosophically (holism)

Adaptation to the environment:

1, structure, function and agency 2. posture, gait and response to injury 3. emotional and

psychological adaptation

Stress and the social environment

Stress and the Autonomic Nervous System

Stress and Immunity

Fluid Dynamics

Pain

Palpation

TOUCH

Physiological and psychological aspects of touch

Looking at the individual from

different psychological

perspectives

Concepts and theories of osteopathic treatment and their mechanism of effect

Evidence for the ‘whole person’ approach to treatment

The placebo and ‘nocebo’ effect

Patient empowerment

How do we understand osteopathic theory in the light of current evidence?

INTEGRATION

EVALUATION

TREATMENT

MANAGEMENT

Fig. 2. Schematic representation of conceptual basis of osteopathy curriculum at Level 2 (2nd year). The diagram should be read from above downwar

including touch are particularly relevant to patient evaluation. Elements that appear below touch and including touch have particular relevance for tre



8. Further development

After the material was transcribed and analysed for

themes, a further meeting was held of focus group

leaders, lecturers on the CBO course and any other

interested parties to begin development of a curriculum

outline with reference to the themes that had emergedfrom the focus groups. There were further contributions

by members of faculty who had not contributed to the

focus groups made via an on-line discussion group. At

least five very different models emerged from this

process. However, there were three common themes:

(1) that students should begin with a broad introduction

to osteopathy, (2) that they should be taught how to

apply CBO in a clinical context and (3) that they should

be introduced to different models of osteopathy later in

their clinical career. For example, models of osteopathy

in this context might include osteopathy as an alterna-

tive to orthodox medicine, osteopathy as therapy for

specialising in musculoskeletal conditions, visceral

osteopathy, and osteopathy in the cranial field.

Further discussions with the CBO faculty led to

making a distinction between horizontal themes that

underpinned and informed the course throughout all

years and vertical themes that represented content. The

horizontal themes included: (1) Application of Theory

to practice (2) Awareness of Diversity (3) Awareness of

Uncertainty (3). The Hierarchy of Evidence (from

Intuition through to Randomised Controlled Trials

and Meta-Analyses) (4) Critical Thinking. A model of

the Level 1 course is shown in Fig. 1.

Two major challenges in developing and delivering thecourse were to make the curriculum clinically relevant

and make clear the physiological interface between

evaluation and treatment. The Model for the Level 2

(second year curriculum) curriculum is shown as Fig. 2. In

this model, ‘Touch’ is seen as central because it informs

both patient evaluation and treatment. Perhaps this could

be seen as distantly mirroring Littlejohn’s belief that

diagnosis and the technique of adjustment are synony-

mous. The curriculum is arranged as a clinical encounter

working through content that is relevant to osteopathic

evaluation and content that relates to osteopathic

treatment and management. Psychology and sociology

are seen as inter-relating with this approach at all levels.

In addition we have attempted to integrate physiology

and psychology where possible. So for example, adapta-

tion is not taught simply as a structural adaptation to

physical circumstance but alongside positive and negative

psychological adaptive mechanisms.

9. A note on Level 3 of the CBO course

The Level 3 (year 4) of the CBO course did not form

part of the curriculum review, but we briefly discuss it

here for completeness. In the degree course CBO is

taught at Level 3 in students’ final year, the Pre-

professional Phase. By this stage, it is intended that

students are able to integrate the various components of

the degree course, and subject boundaries are less

relevant. For this reason, the taught component of

CBO is combined with two other areas of study:‘Professional Capability’ which is primarily clinical

work, and ‘Applied structure e Function’. As part of

Level 3 assessment, students are required to prepare

a written case study and 10 min oral presentation based

on a patient they have been treating in clinic, which

demonstrates their understanding and application of

CBO.

In order for students to prepare for this assessment,

and to encourage deeper levels of reflection and thinking

about practical application of CBO from an early stage

in their learning, we are planning to gradually introduce

a workbook to accompany the course over all levels.

This workbook will use clinical vignettes and other

sources of information to demonstrate links between

theory and practice.

10. Conclusion

Developing and implementing a curriculum for the

conceptual basis of osteopathy is a complex task,

because students are completing one curriculum while

the new curriculum is being developed. In addition we

need to reflect changes in scholarship as well as changesin the profession as it continually evolves. We do not

know at this stage whether the new model will achieve

its stated aims. Student feedback and assessment

outcomes are essential components of the development

process, as are contributions from the faculty and the

wider profession. The external examiners report for the

Final Clinical Competence Assessment in 2004 did note

that there was evidence on the whole that students were

attempting to apply osteopathic principles and review-

ing their patients status in a wider psychosocial context.

We will be reflecting on all these sources of information

as we continue to develop the course.

Acknowledgements

We thank Colin Dove for being interviewed about his

experience of being taught and teaching ‘principles’, and

for lending us Webster Jones’ handwritten notes. Hilary

Abbey, Adrian Barnes, Mark Corson and Steven Vogel

for facilitating the Focus Groups. All the members of

the faculty who gave up time to contribute to the

process. Will Podmore, librarian at the BSO for his help.


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References

1. Littlejohn JM. Psycho-physiology. Kirksville, MO: EG Kinney;

1899.

2. Hall TE. The contribution of John Martin Littlejohn to osteopathy.

The British School Osteopathy. The Osteopathic Publishing Co

Ltd; 1952.

3. Webster-Jones S. Handwritten notes, unpublished.4. Proby J. Course notes: the mechanics of the spine and pelvis. The

Maidstone College of Osteopathy; undated.

5. Beal MC editor. Selected papers of John Stedman Denslow, DO.

Indianapolis: American Academy of Osteopathy; 1993.

6. Wyke B. Articular neurology e a review. Physiotherapy 1972;58:

94–9.

7. Melzack R, Wall PD. Pain mechanisms: a new theory. Science

1965;150:971–9.

8. Dove C. A history of the osteopathic vertebral lesion. Br

Osteopath J 1967;3:2–17.

9. Selye H. The stress of life. New York: McGraw Hill; 1976.

10. Dossey L. Beyond illness: discovering the experience of health 1984;.

Boston.

11. Sheldrake AR. A new science of life: the hypothesis of formative

causation. London: Blond and Briggs; 1985.

12. Capra F. The turning point. London: Flamingo; 1982.

13. D’Amico R. Is disease a natural kind? J Med Philos 1995;20:

551–69.

14. Emery FE editor. Systems thinking: 1. Penguin: Harmondsworth;

1981.

15. Von Bertalanffy L. The theory of open systems in physics and

biology. In: Emery FE editor. Systems thinking. Penguin:

Harmondsworth; 1981.

16. Corson M. Unpublished Masters Thesis ‘What makes and

osteopath an osteopath? An investigation into the characteristics

of osteopathy’ completed as part of The Masters in Osteopathic

Health Care at The British School of Osteopathy, 2000.

17. McMullin E. Underdetermination. J Med Philos 1995;20:

233–52.

Further reading

18. Littlejohn JM. Notes on the principles of osteopathy. Maidstone

College of Osteopathy; 1971.

19. Norminton. The Littlejohn companion. Maidstone College of

Osteopathy, undated.


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