Osteopaths make perceptual judgments regarding the presence of somatic dysfunctions based on information conveyed by their senses. Notwithstanding this, in the diagnosis of somatic dysfunction, osteopaths engage in a series of other cognitive processes such as the encoding and retrieval of diagnostic information, mental imagery, reasoning, and decision making. These cognitive processes are all likely to play important and synergistic roles in their diagnostic decision making. Here, I report on the findings from my doctoral thesis, which examined the extent to which the development of expertise in diagnostic palpation in osteopathic medicine is associated with changes in cognitive processing. Moreover, I propose a putative neurocognitive model of expertise in diagnostic palpation, which has implications for osteopathic education. The results from the six conducted studies indicate that the development of expertise in diagnostic palpation is associated with changes in cognitive processing. Whereas the experts’ diagnostic judgments are heavily influenced by top-down, non-analytical processing; students rely, primarily, on bottom-up sensory processing from vision and haptics. Ongoing training and clinical practice are likely to lead to changes in the clinician’s neurocognitive architecture. As educators, we should encourage students and clinicians to appraise the reliability of different sensory cues in the context of clinical examination, combine sensory data from different channels, and consider using both analytical and non-analytical reasoning in their decision making. Importantly, students and clinicians should develop their skills of criticality and their ability to reflect on, and analyse their practice experiences in and on action.
Jorge Esteves qualified from OSO/Oxford Brookes University in 1993, and after a number of years practicing in Portugal, he moved to the UK in 1999 and became intimately involved with the development and implementation of the osteopathic provision at Oxford Brookes University. In 2010, Jorge moved to the British School of Osteopathy where he is the Head of Postgraduate Studies and Student Research. He is also a QAA osteopathy subject reviewer and a General Osteopathic Council assessor of clinical competence. Jorge has recently completed his PhD thesis on 'Diagnostic Palpation in Osteopathic Medicine: A Putative Neurocognitive Model of Expertise'.