Promoting safety and effectiveness in osteopathic care through clinical decision making: insights from educational and cognitive science

Osteopaths operate as primary contact practitioners. At the point of graduation, students are required to possess a clinical competence profile which enables them to operate as autonomous health care practitioners. This competence profile is evidenced by a well-developed clinical reasoning. Recent evidence from the field of cognitive science proposes that everyday’s decision making is underpinned by two distinct systems of judgment: a fast, intuitive, tacit and largely unconscious mode of processing (System 1), and a slow, analytical, deliberate and conscious mode of reasoning (System 2). Despite its claimed unique philosophy of care, clinical decisions about patient’s diagnosis and care in osteopathy are, arguably, likely to be either intuitive or analytical. Although intuitive judgments are highly effective and essential in everyday’s clinical practice, they are also more likely to fail. In contrast, analytical processes are more reliable and robust; however, they are cognitively demanding and require appropriate training and individual disposition. Clinical decision making is highly influenced by our tendency as humans towards cognitive biases and by, for example, context, fatigue, affective state, gender and rationality. In this presentation, I will present evidence from the fields of educational and cognitive sciences and critically appraise its relevance to osteopathic clinical decision making. I will argue that as educators, we need to ensure students develop strategies that enable them to self-monitor for bias and be critically aware of sub-standard clinical decisions in complex or challenging situations, and for the risk of over-relying on intuitive judgments without further reflection.


Jorge Esteves qualified as an osteopath in 1993 and has since worked as a clinician and academic. Currently Head of Research at the British School of Osteopathy, Jorge was formerly Senior Lecturer and Programme Leader for Osteopathy at Oxford Brookes University, from where he received his PhD. His research focused on diagnostic palpation in osteopathy to develop a neurocognitive model of expertise. He is currently investigating the role of diagnostic palpation in clinical decision making; and the links between emotional processing, chronic pain, body awareness and the role of touch in osteopathic treatment and patient care. Jorge has extensive experience in curriculum development, planning, implementation, evaluation and quality assurance at undergraduate and postgraduate levels in the fields of osteopathy, research and higher professional education. He is an osteopathy subject reviewer for the UK Quality Assurance Agency for Higher Education and an appointed member of Council at the General Osteopathic Council.