Research report
Osteopaths' professional views, identities and conceptions – A qualitative grounded theory study

https://doi.org/10.1016/j.ijosm.2013.12.002Get rights and content

Abstract

Background

The professional status of osteopathy calls for the critical evaluation of the beliefs, knowledge and conceptions which underlie practitioners' clinical practice.

Objectives

To explore experienced osteopaths' professional identities, views and overall conceptions of osteopathy in the UK.

Methods

This qualitative study employed constructivist grounded theory set in the interpretive research paradigm. The constant comparative method of analysis was used to analyse and code interview data. A total of seventeen semi-structured interviews were conducted with twelve UK registered osteopaths. Data collection methods involved semi-structured interviews with participants and observation and video-recording of clinical appointments, which were followed by video-prompted reflective interviews.

Results

There was diversity in how osteopaths viewed different aspects of their professional practice. Views were constructed into the major categories of: professional identity, traditional osteopathic theories and principles, health and disease and practice skills. Together these views formed three qualitatively different overall conceptions of osteopathy, termed: practitioner-centred osteopathy, collaborative osteopathy, and osteopathy as empowerment.

Conclusions

Osteopaths in this study held differing views, identities and conceptions in relation to their practise of osteopathy. This diversity in professional identities and conceptions may help to explain the variation of individual osteopaths' clinical decision-making and clinical approaches, thereby contributing to an epistemology of osteopathy. These findings may be helpful to educators when planning curricula and clinically tutoring osteopathy students. Further research is required to explore how these views and conceptions develop and evolve during undergraduate education and on-going professional development.

Introduction

In many countries, osteopathy has undergone a process of ‘professionalisation’, which Cant and Shamar define as a “type of occupational change and formation that involves unification, standardisation, and the acquisition of external legitimacy”.1,p.197 There is evidence of the professionalisation of osteopathy in several corners of the world and different countries are at varying stages of the process. For example, in the USA the formal process of professionalisation of osteopathy first began in the early 1960s, and has resulted in the establishment of an osteopathic ‘medical’ profession which enjoys the full range of clinical practices and procedures employed by the orthodox medical profession, in addition to osteopathic manipulative therapy.2 In comparison, osteopathy in the UK and the antipodes is considered to be an emerging manual therapy profession3, 4, 5 where professionalisation has taken place since the early 1990s. Examples of strategies taken to facilitate the process of professionalisation of osteopathy in the UK and antipodes include3, 4, 5: 1) the formation of a single statutory register of osteopaths; 2) a regulatory body which sets standards of practice and training; 3) structured and externally inspected educational programmes; 4) legally protected professional title of ‘Osteopath’; and 5) measures in place to discredit those practitioners who do not practice to agreed standards. All of these strategies have provided osteopathy with unity, exclusivity and social closure which are considered to be characteristics of a profession.1

The professional status of osteopathy carries with it the requirement to be critically reflective, and to constantly self-evaluate and self-question in order to develop the knowledge base which underpins clinical practice and also to understand how osteopaths know, what they know (an epistemology of practice).6 Although a challenging process, identifying an epistemology of osteopathy through critical enquiry and research is crucial to the continued development of the osteopathic profession. A number of other healthcare professions have discussed the importance of developing an epistemology of practice, including the physiotherapy7, 8, 9, 10 and nursing professions.11, 12 Although osteopaths' professional knowledge, values and beliefs has been discussed theoretically,13, 14 and investigated in relation to specific aspects of clinical practice (e.g. prescription rights15 and chronic musculoskeletal pain16), there is little research-based knowledge of how practitioners conceive osteopathic practice and how this influences their clinical work. Developing an epistemology of osteopathy through research would allow for the identification of the tacit or non-propositional knowledge used by practitioners, as they work through the complex problems of daily practice. Research of this kind would help to understand what motivates individual practitioners' actions and decision-making when working clinically with patients. Furthermore, research which develops knowledge of what steers osteopaths' clinical actions and behaviour would facilitate clinical educators when working alongside students and also provide an understanding of the range of professional identities which could be embedded within osteopathic curricular.17 Our recent research suggests that how osteopaths conceive the nature of their practice (practice ontology) influences their clinical work and their views on knowledge (epistemology of practice knowledge), decision-making and technical skills and may help to explain the variation in clinical approaches (e.g. during treatment and management) that each osteopath takes with their patients.18, 19 How an individual practitioner's personal conception of practice develops and changes during the course of their professional life is thought to be related to how they identify with their profession, their professional values and is ultimately tied to their interactions with patients which take place during the clinical milieu.19, 20, 21 The physiotherapy literature suggests that practitioners' professional values and identities develop during their interaction and socialisation with peers during their undergraduate education and continues throughout their professional careers when interacting with professional colleagues.22 The nature of osteopaths' professional values, conceptions and identities is yet to be investigated, and how these relate to their views on the treatment and management of patients is currently unknown.

This paper explores experienced osteopaths' professional identities, views and overall conceptions of osteopathy, and the findings from this study form part of a broader theory of osteopaths' clinical decision-making and therapeutic approaches reported elsewhere.18, 19, 23

Section snippets

Study design

This qualitative study followed a constructivist grounded theory approach, with the primary researcher (OT) iterating between data collection and data analysis.24 In accordance with interpretive research,25 throughout this study, OT assumed “multiple realities; indeterminacy; facts and values as linked; truth as provisional; and social life as processual”.24,p.126 In practice this meant that during data collection the researcher explored the social worlds of participants and co-constructed

Findings

Participants expressed a range of views and perceptions in relation to many different aspects of osteopathy. These professional views are divided into five major categories:

  • professional identity

  • traditional osteopathic theories and principles

  • health and disease

  • practice skills

  • conception of osteopathy.

The categories are discussed in turn and supported with participants' quotations from interview data which serve as evidence for the theoretical claims made in this paper. Table 3 and Fig. 1 summarise

Discussion

This study is the first of its kind to explore the professional views, identities and conceptions of osteopathy of practitioners in the UK. The findings from this study suggest that osteopaths hold different views and perceptions of their professional identity, traditional osteopathic theories and principles, health and disease and practice skills, which together help shape their overall conception of osteopathy. The diversity of views and identities amongst the practitioners in this study is

Conclusion

Osteopaths in this study held a range of views in relation to their professional practice, and were characterised by the major categories of: professional identity, traditional osteopathic theories and principles, health and disease and practice skills. Individually, these views contributed to practitioners' overall conception of osteopathy, which was characterised as either practitioner-centred, collaborative or empowerment. This diversity in professional identities and conceptions may help to

Acknowledgements

Thanks to the British College of Osteopathic Medicine, the British Naturopathic and Osteopathic Association and the Osteopathic Educational Foundation for helping to fund this doctoral research.

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