YEAR 1

Question 1

What are the 4 tenets of Osteopathy?

Answer 1

1. The body is a unit
2. The body is capable of self-regulation and self-healing.
3. Structure and function are reciprocally interrelated.
4. Rational treatment precedes. (Based upon and in depth knowledge of the above 3 principles.)

Question 2

What are the core values of Professionalism?

Answer 2

• Accountability
• Altruism (selfless concern for the well being of others)
• Compassion/Caring
• Excellence
• Integrity
• Professional duty
• Social responsibility

Question 3

According to OSTCAN standards, which principles guide Communication and Patient Partnership?

Answer 3

• Communication
• Informed Consent
• Professional Partnership with patient
• Patient records and documentation

Question 4

What is a Type I Osteopathic program?

Answer 4

-Aimed at those with little or no prior healthcare knowledge
- Typically at least 4 years and a full time program
- Supervised clinical training at an osteopathic clinical facility is and essential component
- Over 4200 hours of instruction including over 1000 hours of surpervised clinical instruction
- Students may be required to submit a thesis or project

Question 5

What is a Type II Osteopathic program?

Answer 5

• Aimed at those with prior training as healthcare professionals
• “Add-on” type course
• On average only 1000 hours in this type of program
• Healthcare professionals typically take this type of training as an add-on to their existing profession Ie to have OMM skills not to become and Osteopath per se

Question 6

When was Osteopathy discovered?

Answer 6

1874 by Andrew Taylor Still

Question 7

What is the purpose of the WHO’s “Benchmarks for Training in Osteopathy”?

Answer 7

-WHO establishes global standards and provides a framework for the development and implementation of high-quality training programs in Osteopathy
- Benchmarks may include recommended educational curriculae, competencies, and standards that ensure a consistent level of knowledge, skills, safety and professional/ethical conduct amoung osteopaths worldwide
- These guidelines assist countries and educational institutions develope their own trainng prgrams or evaluate existing ones to meet internationally recognized standards

Question 8

According to the Regulated Health Professionals Act, “what are controlled acts” and who may preform them?

Answer 8

• OMP’s are not regulated professionals and cannot under any circumstance perform acts that are reserved to regulated health professionals under provincial law.
• Depending the the jurisdication, these are referred to as controlled acts, authorized acts, restricted acts or restricted activities.
• OMP’s who preform these acts will be breaking the law and may be prosecuted, fined or have injunctions brought against them by regulators.

Question 9

What are some key trends in Osteopathy as a global profession?

Answer 9

• Global profession is rapidly growing
• Since 2003 the number of Osteopahtic Physician’s has increased 34% and OMP’s by 84%
• Patient demographic has changed (Osteopaths see more children 0-2 years old and older adults 65+ and working age adults has decreased roughly 20%)
• Reasons for seeking care have not changed (low back and neck pain are the most common complaints)

Question 10

How does Osteopathic education differ around the world?

Answer 10

• DO’s have a minimum medical degree plus training in osteopathic principles and osteopathic manipulative treatment
  Osteopathic physician education institutions are found in at least 6 countries
• Osteopathic training and institutions are found in at least 20 countries
• Osteopathic qualification range from Diploma’s to Master’s Degrees
• Continual professional development is stipulated by hours spent learning (range 11-40 hours)
• The minimum education requirement to practice for new osteopaths is a Bachelor’s degree in most countries

Question 11

What are the functions of the CAO student council?

Answer 11

• Fosters student engagement, leadership and citizenship
• Represents student body to administration
• Organizes student functions and events and creates community

Question 12

How is the Canadian Health Care Delivery System funded?

Answer 12

Publicly funded health care is financed with general revenue raised through federal, provincial and territorial taxation, such as personal and corporate taxes, sales taxes, payroll levies and other revenue

Question 13

What is the role of the provincial/territorial government vs the federal government in provision to healthcare?

Answer 13

Provincial and territorial governments:
- Delivery of most healthcare services
- Management & organization of healthcare services

Federal government:
- Setting and administering national standards for the health care system
- Financial support to provinces and territories
- Funding /delivery primary & supplementary services to certain groups (indigenous communities, army etc)

Question 14

What are the 5 principles of the Canada Health Act?

Answer 14

The 5 principles of the Canadian Health Act are:
1- Public Administration
2- Comprehensiveness
3- Universality
4- Accessibility
5- Portability

Question 15

What is meant by the concept of “Continuity of Care”?

Answer 15

• Continuity of care is concerned with quality of care of time
• It is the process by which the patient and their physician-led care team are cooperatively involved in ongoing health care management toward the shared goal of high quality, cost effective medical care
• As osteopaths we need to be careful with this definition and we must be aware of our scope of practice in regards to “continuity of care”

Question 16

How does the practice of Osteopathy differ from conventional healthcare?

Answer 16

• The fundamental principles of osteopathy are different from those of any other system and the cause of disease is considered from one standpoint
• Disease is the result of anatomical abnormalities followed by physical discord
• To cure disease the abnormal parts must be adjusted to the normal
• Therefore other methods that are entirely different in principle have no place in the osteopathic system
• We want to keep the “purity” of the classical osteopathy lineage and if you add in other modalities the “true” osteopathy becomes diluted

Question 17

What is Utilitarianism?

Answer 17

• John Stuart Mill 19th Century
• “the greatest amount of happiness altogether” was the standard of right action for utilitarians
• Believe the rightness or wrongness of an action depends on the outcomes/consequences the action produces
• According to Mill, what we should consider in determining whether an action is right or wrong, correct or incorrect, good or bad are the results the action produces
• Believe when looking at the consequences, you should look at the best consequences for the greatest number of people
  EXAMPLE: making a decision to about whether or not to report a colleague who you know is having a sexual relationship with a patient. You would have to look at the consequences best not just for you and your colleague, but the patient, society and in general the profession as a whole

Question 18

What is Deontology?

Answer 18

• Emmanuel Kent 18th century
• Also known as Kantianism
• Basically opposite of Utilitarianism
• Duty and intention should dertermine right and wrong
• An action is right, good, appropriate or correct if and only if that action comes from a duty
• Right or wrong should never depend on consequences of an action, and if these are good, or bad for a single individual or largest number of people possible, but on our obligation to fullfill our duty
• Believe intentions play a very important role in decision making about right and wrong
  EXAMPLE: Collegaue is having a sexual relationship with a patient. A Kantian would choose to report their colleague because it was their duty to report this situation as they know this to be unethical behaviour. A Kantian would need to do the right thing and report, even if the consequences were unpleasant for either of them because their duty overrides every other concern, benefit or loss.

Question 19

What tenets are Principlism based upon?

Answer 19

• Based upon values
• Rather than strict adherence to an ethical theory or philosophy, it uses ethical principles to analyze ethical issues and resolve ethical dilemmas
• Uses key ethical principles of beneficence, non-maleficence, autonomy and justice to resolve ethical dilemmas

Question 20

What is autonomy (Ethical principle)?

Answer 20

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Question 21

What is the doctrine of ‘double effect‘?

Answer 21

• The principle of double effect applies when the intention of treatment or care is to benefit the patient, but the result of treatment is unexpected harm.

Example: When a doctor gives a patient medicine to treat an infection, but the patient has a reaction resulting in near death.

Question 22

What is the definition of explicit consent?

Answer 22

• Refers to consent that is more than just implied.
• It must be stated explicitly, either verbally or in writing.
  Example: although explicit consent is not required for direct collections of personal information, you may decide it is a good practice to ask all new clients to sign a consent form before you collect their information.
• When you directly collect personal information from any person, you must give them notice that you may use or disclose their information.
• Sometimes you may need to collect information directly from an individual who is not capable of giving consent (CYFSA, s. 289).
  Example: a children’s aid society
  conducting a protection investigation may need to interview a toddler separately from his parents.
• Service providers may directly collect personal information from an incapable person without consent in three situations:
  ● provide a service, where it is not possible to obtain consent (for example, from a substitute decision-maker) in a timely manner
  ● assess, reduce or eliminate a risk of serious harm to any person or group
  ● assess, reduce or eliminate a risk of harm to a child (if you are a children’s aid society)

Question 23

What is implied consent?

Answer 23

• Consent that is not given specifically, but which can be inferred based on the individual’s actions and the facts of a particular situation.
  Example: if a youth expresses interest in a program and volunteers their personal information to enroll, their consent for the collection of their information may be implied.
• Much of a practitioner’s work is done on the basis of consent which is implied either by the words or the behaviour of the patient or by the circumstances under which treatment is given.
  ANOTHER EXAMPLE: It is common for a patient to arrange an appointment with a practitioner, to keep the appointment, to volunteer a history, to answer questions relating to the history and to submit without objection to physical examination. In these circumstances consent for the examination is clearly implied.
• It is good to note that the extent to which consent was implied initially may later become a matter of disagreement. - Practitioners should be reasonably confident the actions of the patient imply permission for the examinations, investigations and treatments proposed
• When there is doubt, it is preferable the consent be expressed, either orally or in writing (CMPA, 2021).

Question 24

What limits are placed on how much personal information health care providers may collect?

Answer 24

1. You must ensure, to the best of your knowledge, that the collection, use or disclosure is necessary for a lawful purpose.
   EXAMPLE: even if a client gave consent for you to use their personal information “in any way you please,” you may only use it where necessary for a lawful purpose
2. You must only collect, use or disclose as much personal information as is reasonably necessary to provide a service.
   EXAMPLE: even with consent it would not be appropriate to collect information about clients’ political affiliations, unless you somehow need this information to provide service
3. You must not collect, use or disclose personal information where non-personal information will serve the same purpose. EXAMPLE: if you are applying for a grant and are asked to give evidence of successful client outcomes, you could provide de-identified or statistical information. In this case, there would be no need to disclose clients’ personal information in the application.
   *Note that these limitations do not apply to personal information that you are required by law to collect, use or disclose

Question 25

When may personal information be used without consent?

Answer 25

• Sometimes you may need to collect information directly from an individual who is not capable of giving consent
  EXAMPLE: a children’s aid society conducting a protection investigation may need to interview a toddler separately from his parents.
• Service providers may directly collect personal information from an incapable person without consent in three situations. - The collection must be reasonably necessary either to:
  a. provide a service, where it is not possible to obtain consent (for example, from a substitute decision-maker) in a timely manner
  b. assess, reduce or eliminate a risk of serious harm to any person or group
  c. assess. reduce or eliminate a risk of harm to a child (if you are a children’s aid society)

Question 26

What are the 6 key principles of Ethics?

Answer 26

• Autonomy
• Justice
• Honesty
• Fidelity
• Non-Maleficence
• Beneficence

Question 27

Dr. Benjamin and The Ethics of Touch

Answer 27

“The study of moral principles and appropriate conduct. This can be applied to individuals, groups or professions. In general, ethics in somatic therapies involve behaving honorably; adhering to prevailing laws; upholding the dignity of the profession; respecting each client; staying committed to high quality care; working within the appropriate scope of practice; being client-centered; and remaining service-oriented.”

Question 28

Ethical values are intertwined in osteopathic practice. A practitioner demonstrates ethical behaviour by…

Answer 28

• Respecting a client’s informed choice
• Being respectful to clients, clinic staff and the health care community (including peers and other health care professionals)
• Maintaining confidentiality
• Respecting and promoting client well-being
• Acting with integrity, honesty and professionalism
• Exploring their personal beliefs and values

Question 29

Examples of ethical values? (Note these are different from Ethical Principles as values are personal)

Answer 29

• Patient well-being
• Respect for life
• Maintaining commitments
• Truthfulness
• Fairness

Question 30

What is the ethical decision making process?

Answer 30

1. Assessing
2. Planning
3. Implementing
4. Evaluating

Question 31

What is consent?

Answer 31

• In order for consent to for treatment, it must be “informed” consent
• The patient must be given an adequate explanation about the nature of the proposed assessment or treatment and its anticipated outcome as well as any significant risks involved and alternatives available
• The information must be such that will allow a patient to reach an informed decision
• The obligation to obtain conformed consent must always be delivered by the practioner who is carrying out the assessment or treatment

Question 32

What is informed consent?

Answer 32

• The practitioner should disclose to the patient the nature of the proposed treatment, its gravity, any material risks and any special risks relating to the specific treatment in question.
• Even if a risk is a mere possibility which ordinarily might not be disclosed, if its occurrence carries undesired consequences, as for example increased pain or immobility, it must be regarded as a material risk requiring disclosure.
• A practitioner must answer any specific questions posed by the patient as to the risks involved in the proposed treatment.
• Always the patient must be given the opportunity to ask questions.
• The patient should be told about the consequences of leaving the ailment untreated.
• Although there should be no appearance of coercion to frighten patients who refuse treatment, our courts now recognize there is a positive obligation to inform patients about the potential consequences of their refusal.
• The patient should be told about available alternative forms of treatment and their risks.

Question 33

What is expressed consent?

Answer 33

• Expressed consent may be in oral or written form.
• It should be obtained when the treatment is likely to be more than mildly painful, when it carries appreciable risk, or when it will result in ablation of a bodily function.
• Although orally expressed consent may be acceptable in many circumstances, frequently there is need for written confirmation.
• As practitioners have often observed, patients can change their minds or may not recall what they authorized; after the procedure or treatment has been carried out, they may attempt to take the position it had not been agreed to or was not acceptable or justified.
• Consent may be confirmed and validated adequately by means of a suitable contemporaneous notation by the treating practitioner in the patient’s record.
• Expressed consent in written form should be obtained for surgical operations and invasive investigative procedures.

Question 34

What are the requirements for valid consent?

Answer 34

• For consent to serve as a defence to allegations of either negligence or assault and battery, it must meet certain requirements.
• The consent must have been voluntary, the patient must have had the capacity to consent and the patient must have been properly informed.

Question 35

Define capicity for consent

Answer 35

• An individual who is able to understand the nature and anticipated effect of proposed medical treatment and alternatives, and to appreciate the consequences of refusing treatment, is considered to have the necessary capacity to give valid consent.
• However, there are special circumstances to which particular attention must be given.

Question 36

Age of consent for medical treatment?

Answer 36

• The legal age of majority has become progressively irrelevant in determining when a young person may consent to his or her medical treatment.
• As a result of consideration and recommendations by law reform groups as well as the evolution of the law on consent, the concept of maturity has replaced chronological age.
• Legislation in a number of provinces and the territories has codified the law on consent, including the reliance on maturity in assessing a young person’s capacity to consent to or refuse medical treatment.
• Only the Province of Quebec has established a fixed age of 14 years, below which the consent of the parent or guardian or of the court is necessary for the purposes of proposed treatment.
• Generally, where the minor patient lacks the necessary capacity, the parents or guardian are authorized to consent to treatment on the minor’s behalf.
• This consideration becomes all the more important when the parent or guardian seeks to refuse treatment the physician regards as medically necessary.
• In these circumstances, there is an obligation on the part of practitioners to report the matter to child protection authorities.
• The determinant of capacity in a minor has become the extent to which the young person’s physical, mental, and emotional development will allow for a full appreciation of the nature and consequences of the proposed treatment, including the refusal of such treatments.

Question 37

Voluntary

Answer 37

• Patients must always be free to consent to or refuse treatment, and be free of any suggestion of duress or coercion.
• Consent obtained under any suggestion of compulsion either by the actions or words of the practitioner or others may be no consent at all and therefore may be successfully repudiated.
• Consent obtained under any suggestion of compulsion either by the actions or words of the practitioner or others may be no consent at all and therefore may be successfully repudiated.

Question 38

Mental Incapacity & Substitute Decision Making

Answer 38

• In circumstances where it has been determined that a patient is incapable of consenting to a particular medical treatment, the question as to who is authorized to make the decision will arise.
• It is now possible in the majority of provinces for a patient to execute an Advance Directive as to future care in the event that the patient becomes incapacitated or is unable to communicate his or her wishes.
• Advance Directives are sometimes referred to as living wills.
• Advance Directives may contain explicit instructions relating to consent or refusal of treatment in specified circumstances.
• In some provinces, Advance Directives may be contained in Powers of Attorney for personal care.
• An Advance Directive may also be used to appoint or designate an individual who will be authorized to make substitute decisions about consent or refusal of treatment in the event that the patient becomes incapacitated.
• Again, practitioners will want to be generally familiar with any applicable legislation in their particular jurisdiction.
• A number of provinces have also enacted legislation for substitute decision-makers which sets out and ranks a list of individuals, usually family members, who are authorized to give or refuse consent to treatment on behalf of an incapable person.

Question 39

Patient Consent and Intake

Answer 39

• There are rules when a practitioner collects personal information from an individual for the purpose of providing a service, or using or disclosing that information.
• If you are providing services to a child, for example, these rules apply to how you collect, use and disclose the personal information not only of the child, but also of other individuals who may be involved in the services, such as his/her parents.
• As a service provider, you must have an individual’s consent to collect, use or disclose personal information unless the CYFSA authorizes you to do so without consent (CYFSA, s. 286).

Question 40

Even when you have consent what are the 3 limits on when and how much personal information you can collect, use or disclose?

Answer 40

1. You must ensure, to the best of your knowledge, that the collection, use or disclosure is necessary for a lawful purpose. For example, even if a client gave consent for you to use their personal information “in any way you please,” you may only use it where necessary for a lawful purpose.
2. You must only collect, use or disclose as much personal information as is reasonably necessary to provide a service. For example, even with consent it would not be appropriate to collect information about clients’ political affiliations, unless you somehow need this information to provide service.
3. You must not collect, use or disclose personal information where non-personal information will serve the same purpose. For example, if you are applying for a grant and are asked to give evidence of successful client outcomes, you could provide de-identified or statistical information. In this case there would be no need to disclose clients’ personal information in the application.
   * NOTE that these limitations do not apply to personal information that you are required by law to collect, use or disclose

Question 41

Justice (Ethics Principle)

Answer 41

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Question 42

Honesty/Truth Telling (Ethics Principle)

Answer 42

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Question 43

Fidelity/Trust & Respect (Ethical Principles)

Answer 43

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Question 44

Non-Maleficence (Ethical Principles)

Answer 44

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Question 45

Beneficience (Ethical Principles)

Answer 45

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Question 46

Autonomy ( general definition)

Answer 46

The quality or state of being self-governing.

Question 47

Direct collection of personal information is defined as…

Answer 47

A collection is “direct” when the information comes from the person to whom the information relates (or their substitute decision-maker).
EXAMPLE: during an intake interview, the practitioner is directly collecting the client’s personal information.

Question 48

Indirect collection of personal information is defined as…

Answer 48

A collection is indirect when the information comes from a third party, and not from the individual or their substitute decision-maker.
EXAMPLE: if a teacher phones a children’s aid society about a child who may be in need of protection, the society would indirectly collect the child’s personal information from the teacher.
- Service providers may also collect information indirectly
- Sometimes they do so with consent for example, a parent may consent to the service provider obtaining information from a specialist who has assessed their child. In this case, the provider would need the parent’s explicit consent for the indirect collection, and cannot rely on implied consent.

Question 49

As a service provider, there may be times when you need to indirectly collect information, without consent. In which situations are you permitted do so:

Answer 49

• First situation in which you can indirectly collect information without consent if it is permitted or required by law.
  EXAMPLE: when a children’s aid society receives a call from a teacher about a child who may be in need of protection, the society can collect this information from the teacher without consent. Receiving reports about children in need of protection is part of the society’s mandate under the CYFSA and is permitted by law.
• Second situation is the information is reasonably necessary to provide a service or to assess, reduce or eliminate a risk of serious harm to a person or group and it is not possible to collect personal information directly that can reasonably be relied on as accurate and complete, or in a timely manner.
• Finally, children’s aid societies can collect personal information from one another (or from child welfare authorities outside Ontario) if: the information is reasonably necessary to assess, reduce or eliminate a risk of harm to a child. A children’s aid society would not require consent in this situation

Question 50

Service providers may only collect personal information with consent, or in situations where collection without consent is specifically permitted by Part X (CYFSA, s. 288 [2] (c]). Any other collection is unauthorized and contravenes the CFSA. Providers must take reasonable steps to prevent unauthorized collection of personal information (CYFSA, s.307). These steps might include developing clear policies and procedures for collecting information, and regularly training staff.
TRUE or FALSE

Answer 50

TRUE

Question 51

You may also use personal information, without consent, for the following purposes:

Answer 51

• Where permitted or required by law
• For planning, managing and delivering services that you provide or fund (including resource allocation, evaluation, monitoring and preventing fraud)
• For risk and error management, or quality assurance
• To seek consent (in this case you must use only their name and contact information)
• To dispose of or de-identify the information
• For research conducted by a service provider, subject to certain requirements (CYFSA, Section 5)
• For a proceeding (or contemplated proceeding) where the service provider is or is expected to be a party or witness and the information relates to a matter at issue
• If you believe on reasonable grounds that the use is reasonably necessary to assess, reduce or eliminate a risk of serious harm to a person or group
  *In summary, if you collect personal information to provide a service, you can only use it for that purpose or for one of the additional purposes set out in Part X or with the individual’s consent. Any other use of the information is not authorized and contravenes the CYFSA.

Question 52

Once you have collected personal information for the purpose of providing a service, Part X governs the ways you may use this information.

Answer 52

• There is no definition of “use” in Part X.
• Generally, using personal information means viewing or dealing with the information in a manner that does not include disclosing it.
  EXAMPLE: when a social worker prepares for a meeting with a family by reviewing their team’s case notes from a previous meeting with the family, they are “using” the information in the case notes.
• When you use personal information, you must take reasonable steps to ensure it is as accurate, complete and as up-to-date as necessary for the purposes for which it is used.
• You must exercise judgment about how accurate the information needs to be.
  EXAMPLE: personal information used to deliver certain services may in some cases require a higher degree of accuracy than information used solely for administrative purposes.
• Service providers can use information with the consent of the individual (provided that, to the best of the service provider’s knowledge, the use is necessary for a lawful purpose).
• Service providers can also use personal information without consent if certain conditions are met.
• As a service provider, you can use personal information without consent for the purpose it was collected or created.
• You can also use it for all the functions reasonably necessary for carrying out that purpose, including providing the information to an officer, employee, consultant or agent of your organization.

Question 53

Disclosure of personal information means releasing or making the information available to another person or organization.

Answer 53

*Note that sharing information with an officer, employee, consultant or agent of your own service provider is considered a use, and not a disclosure when it is for the purpose for which the information was collected, or for one of the other purposes set out in the “use” section of the legislation (CLYFSA, s. 291[1]).
- When you are disclosing personal information, you need consent, unless Part X permits the disclosure without consent.
- Disclosure of personal information during a referral to another osteopathic practitioner or healthcare provider (i.e., massage therapist) would be considered disclosure.

Question 54

You may disclose personal information without consent in certain situations that are set out in Part X (CYFSA, s. 292). This includes where the disclosure is permitted or required by law. For example:

Answer 54

• All individuals are required to report to a children’s aid society if they reasonably suspect that a child may be in need of protection (CYFSA, s.125). Part X is not a barrier to this disclosure.
• Children’s aid societies are required by the CYFSA to consult with a representative chosen by each of a child’s bands and First Nation, Métis or Inuit communities whenever they are proposing to provide certain services to the child, such as developing a safety plan.
• With one exception, consent is not required in these situations (CYFSA, s. 73)

Question 55

Other examples of where you may disclose personal information without consent:

Answer 55

• If there are reasonable grounds to believe that the disclosure is necessary to assess, reduce or eliminate a risk of serious harm to a person or group
• To a law enforcement agency in Canada to aid an investigation
• To a legal representative or litigation guardian, for certain purposes, such as to represent the individual in a proceeding to comply with a summons, order or procedural rule relating to the production of information in a proceeding, such as a proceeding before a court or tribunal
• To contact a relative, friend or potential substitute decision-maker in certain instances, such as where the individual is injured or incapacitated