Reflection 1

Development of confidence in clinical skills

A central concern at the commencement of my Chiropractic degree was perceiving whether I

would develop the confidence to apply the clinical skills such as manual and manipulative
therapy. During the practical classes, students came face to face with inherent complexities of
clinical practice, and the way in which these are navigated can vary significantly among
students. For example, some students may possess high levels of perceived confidence prior to
commencing their practical class, only to find the reality of practice confronting and therefore
experience a sudden reduction in confidence.
To address the change in level of confidence over time, one of the goals of the practical
sessions is to provide an environment that increases confidence alongside competence in
clinical skills and student-teacher communication. Also, developing a better understanding of
how confidence evolves during the practical classes is imperative. Moreover, the factors that
lead to either increased or decreased confidence need to be better understood.
This has been addressed in a study by Hecimovich and Volet (2012). The aim of their research
was to measure prior experience within the profession, for example, a chiropractic assistant, or
a massage therapist upon entry into the bachelor program. This study also evaluated specific
aspects that contributed to increasing or decreasing confidence in clinical skills and student
communication. Hecimovich and Volet (2012) established that students’ levels of confidence in
clinical and communication skills increased significantly over the duration of their course.
Various factors influenced my confidence as I progressed through the course. The tutors played
a major role and the theory content consolidated the meaning behind each adjustment. I
would constantly seek critical feedback to fine tune my manual skill and improve the amplitude
in my thrust. Negative feedback did not deter my confidence, rather, it drove my determination
to do better. Therefore, I did not have the same deflation I had experienced in the earlier years
of my course. Having a positive attitude towards my learning reflected in my manipulation skills.
Initially, I thought my body lacked the co-ordination of performing a drop thrust for the lumbar
manipulation. With continuous practice and observation, I improved significantly, and received
excellent feedback from my peers and tutor. This boosted my confidence and reduced my self-
doubt.
The significance of practicing at home every week continued to be a contributing factor that
supported my confidence in skill performance. Being aware of table height, primary and
secondary contacts, high velocity low amplitude mock thrusts and my body position were all
implemented in my delivery to perform these skills. These factors became embedded mentally
and I had a conscious awareness of my environment. I would observe my stance, my angle, my
elbows being tucked in, shoulders depressed to ensure my patient’s (student) safety and my
own.
The intense practical sessions this term due to the current climate meant that eight hours a
week of constant adjustments, orthopaedic examinations and SMR tests have consolidated our
learning and increased my confidence in both communicating with my peers and tutor and in
delivering improved clinical skills. In reassessing this strategy, building a good rapport with my
class has significantly allowed me to develop my personal skills and mature as a chiropractic
student. Furthermore, accepting constructive feedback is critical in evolving one’s clinical and
patient skills.
This is well documented in the mentoring literature (Holmes et al. 2010) where positive
feedback was verbal and non-verbal with clinicians providing supporting comments but also
demonstrating how to perform a skill. This is consistent with Pitney and Ehlers (2004) who
stressed how mentor accessibility and student initiative need to be enforced as these create an
environment encouraging student participation and assist in the building of confidence. Thus,
by gaining a higher level of confidence, it gave an incentive to become more proactive and
mature as a student-clinician to achieve the desired results.
With a few weeks remaining of my bachelor’s degree in Chiropractic, my practical skills and
theory have evolved with the assistance of my teachers and my dedication to learning. I have
pondered over my previous reflections and realised that my initial fear of not achieving a body
drop or lumbar adjustment has changed dramatically. I am looking forward to 4 th year with
enthusiasm and believe that my teachers have enriched my learning with relatable clinical
study scenarios to build upon with my own experiences in clinic.
References

Ende, J. (1983). Feedback in clinical medical education. JAMA. 25: 777-781.

Hecimovich, M., Volet, S. (2012). Tracing the evolution of chiropractic students’ confidence in clinical
and patient communication skills during a clinical internship: a multi-methods study. BMC Medical
Education. 12(42).

Holmes, D.R., Hodgson, P.K., Simari, R.D., Nishimura, R.A. (2010). Mentoring: Making the Transition from
Mentee to Mentor. Circulation. 121: 336-340.

Pitney, W., Ehlers, G. (2004). A grounded theory study of the mentoring process involved with
undergraduate athletic training students. Journal of Athletic Training. 39(4): 344-351.