This document is a critical reflection by a physiotherapist on their development towards an advanced physiotherapy practitioner role focusing on hip pain. Through various continuing professional development activities like literature reviews, shadowing consultants, and multidisciplinary team meetings, the physiotherapist has improved their knowledge of hip pathologies, diagnostic testing, use of imaging, and management of young adult hip pain patients. The reflection identifies initial areas of weakness and an ongoing commitment to further developing clinical skills and scope of practice to provide the highest quality of care for these patients.

1. SCHOOL OF HEALTHCARE SCIENCES
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2. A Critical Reflection on the Development
in Management of Young Adult Hip Pain
from the Perspective of an Aspiring
Advanced Physiotherapy Practitioner
Advanced physiotherapy practitioners (APP) roles were first developed to work alongside
orthopaedic surgeons in orthopaedic clinics to help reduce waiting times and costs (Russel
2015). APPs incorporate enhanced level skills and knowledge within their practice to make
complex decisions regarding the management of patients and their conditions (CSP 2016).
For a physiotherapist to work at an advanced practice (AP) level, they are required to have
completed an advanced programme of study and able to work at AP level of practice across
the four pillars of clinical practice (CSP 2016). The four pillars are; Clinical Practice,
Leadership and Management, Education, and Research (CSP 2020). Frameworks have been
published to help guide physiotherapist to develop into these roles (CSP 2018; Health
Education England 2020).
It is my aim to become an APP with a focus on hip pain and this paper focuses on the
journey that I have undertaken so far, in my ongoing efforts to develop towards this role.
This paper is reflective in nature, exploring and expanding on my continued professional
development (CPD) experiences to date which have enabled me to develop my clinical skills,
knowledge and understanding in the topic of young adult hip pain. The Health and Care
Professionals Council (HCPC) (2019) suggest that there are four categories of CPD, work-
based learning, professional activity, formal education and self-directed learning. A common
denominator of all CPD is reflection (Jayatilleke and Mackie 2013) and this is essential to
consolidate the experiences and develop your practice.
“Reflection is a complex process of analysis, critical awareness and self-
evaluation that results in a change of practice.”
- Hearle and Lawson (2020 p28)

3. Reflection as a source of knowledge, dates back to the times of Ancient Greece and
Socrates, but more recently, the late 1930’s with Dewey (1938) who suggested that “we
learn by doing and realising what came of what we did”. Since then, reflection has
developed from these superficial musings and there are now many models of reflection
from many different educationalists/philosophers. Reflection is needed throughout all
stages of development; prior, during and after the event (Keogh et al. 2013) which
subsequently, can lead the reflector to learn things that they did not expect to, because
reflection is dynamic, open and often unpredictable (Boud et al. 2006). Without using a
reflective model, there are dangers of relying on habit; leading to superficial and uncritical
understanding of complex experiences (Thompson and Pascal 2011). This paper uses
aspects of the reflective models by Rolfe et al. (2001) and Schon (1991) to help handle the
complexities of reflection by prompting questions about my experiences, however, will not
be structured specifically by them. Instead, this paper is structured around my key learning
areas set out in my learning contract. Rolfe et al.'s (2001) model asks relevant questions
which facilitate reflection, however, the structure was incompatible due to my reflection
occurring on events and experiences that are still ongoing. Schon's (1991) model, echoes
aspects of existentialism, encouraging the learner to be present in the experience allowing
for ‘reflective conversation with the situation’ by reflecting-in and on-action; allowing for
evolving understanding rather that categorised and fixed thought processes (Thompson and
Pascal 2011). However, Schon's (1991) model lacks the rigor of other models due to it
simple design which fails to deconstruct the stages of reflection. This potentially increases
the chance of superficial and uncritical reflection in the ‘novice’ and could increase the
chance of the ‘expert’ jumping to conclusions which fit their bias.
Knowing where you are currently in your career long journey of development, allows you to
see where and what helped you to develop to where you are now. Subsequently allowing
you to analyse what helped you develop most effectively, and what you can focus on in the
future, to continue your development (Gürel 2017). I work as a First Contact Physiotherapist
(FCP) in primary care, and as the clinical lead for hips in an outpatient department, which
has the scope to develop into an APP role. I felt that I was not achieving the AP level for the
clinical practice pillar that is expected of FCPs (Health Education England 2020), not to
mention the enhanced level expected of a clinical lead for hips who wants to progress to an

4. APP role. Along with enhanced knowledge and skills, to be an APP, you must be able to
critically reflect on your own practice, have a self-awareness of your scope and know when
to seek help to improve (NHS 2017). Acknowledging that I needed to improve my level of
clinical practice, I raised my concerns that my knowledge was not to a high enough standard
for my clinical lead role to my university tutor. Through supervision, I was facilitated to
acknowledge aspects of my professional practice that I was unaware about previously, in
that I had a lack of confidence underpinning my practice. Halpern (2009) suggests that
supervisions allow the learner to discover aspects of their practice that they may be hidden,
blind or a mystery to them and when these have been acknowledged, true development can
occur.
I realised that I was most anxious about the quality of care I was giving to young adult
patients with hip pain, attributing this to a lack of knowledge around pathologies,
appropriate investigations, and most effective management of these conditions. I worried
that I managed this patient group poorly, that I had done a “bad job” and often referred
onwards earlier than I felt other clinicians would have. Being appointed as the clinical lead
for the hips, was the motivation I needed to try and progress my understanding in this area
and felt that it would help me achieve an AP level in the clinical practice pillar.
To meet my learning objectives (appendix 1), I have taken part (and continue to do so) in
several CPD activities. I conducted a literature search and review on the topic, as well as
shadowing my health boards hip consultant (Cronin 2020) and having semi-formal
discussions with a lecturer/PhD student about their work (Evans 2020). I have attended and
continue to attend the hip multidisciplinary team meetings (MDT), I have regular
conversations with my colleagues regarding literature and their experiences to date and
have loaded my caseload with more hip pain patients.
Diagnosis and Pathology
It is impossible to act without knowledge (Funke 2017), and therefore, it is impossible to
make a diagnosis and treat someone if you do not know all the potential diagnoses in the
first place. You must also understand how these pathologies present and what the key
features are. With most assessments, I will usually start broadly and narrow in on my
hypothesis throughout my assessment. I believed that I knew some pathologies of the hip,

5. however, I often struggled to confidently differentiate between them in the young adult
patient population. I sought to improve my understanding on the pathologies of the hip so
that I could make more accurate diagnoses for these patients.
I conducted a literature review and found that young adult hip pain is an area of research
that has been studied considerably less than that of paediatric or older adult patients
(Clohisy et al. 2008; Dick et al. 2018; Luthra et al. 2019) and is something that is, therefore,
poorly understood. In some respects, it was reassuring to learn that my understanding of
this area was arguably representative of the research (or the lack there of). Most articles
were reviews or clinical commentaries rather than systematic reviews or randomised
controlled trials (RCT), meaning that there was a generally poorer quality of evidence (Hicks
2009). However, Veras et al. (2016) suggests that physiotherapy should be informed by the
“best available research”, so whilst the quality and depth of research may be poor in this
area, it can still inform my practice but must be used with caution (Portney and Watkins
2014).
A review article by Dick et al. (2018) succinctly listed and described the most common
pathologies and their clinical signs; producing an infographic also. To my surprise, I was able
to process the infographic more easily than the article. I have always believed that I was a
read/write learner but after seeing this infographic, I realised that this might not be the
case. Dobson (2009) reports that learning style can adapt and evolve as one develops
professionally and academically and could explain why I preferred the infographic.
Several subjective markers and clinical assessment tests were highlighted to be effective in
differentiating hip pain in the young adult, especially the use of the “impingement test” for
intra-articular pathology (Reiman et al. 2015; Dick et al. 2018; Kraeutler et al. 2019; Caliesch
et al. 2020; El-Bakoury and Williams 2020; Reiman et al. 2021). Reflecting on these markers
and clinical tests, I realised that I was familiar with them all individually and had some
experiences of patients reporting these symptoms. However, prior to my reading, I had not
been able to “connect the dots” of the combined presentation to formulate the diagnosis. I
had a moment of realisation, that I did have the knowledge and skills, but did not have the
understanding to link the two together.

6. This research affirmed my abilities to effectively assess these patients, regardless of their
presentation. I felt that I had improved knowledge and deeper understanding, which
subsequently gave me more confidence in my ability to clinically reason and formulate a
working diagnosis for these patients. However, I was getting frustrated at the lack of
differential signs and symptoms between femoroacetabular impingement (FAI) and adult
acetabular dysplasia (AAD). I found myself unconsciously biasing my searches to FAI and
AAD, realising that this was the area I was most interested in and wanted to learn more
about (adapting my learning contract in the process). However, I was also concerned that I
had biased my searches for confirmation of my prior knowledge and opinions rather than
remaining open to new ideas.
In the aim of challenging my knowledge and the lack of clarity in the research, I sought
expert opinions and further information from a lecturer at Cardiff University who was
completing her PhD on diagnostic features of AAD (Evans 2020) and with the consultant in
my health board whose speciality is young adults with hip pain (Cronin 2020). Similarly, to
the research, they were not able to add any specific information on differentiating these
pathologies using assessment techniques and advised that it was common practice to utilise
diagnostic imaging to categorically differentiate between FAI and AAD. Realising I had the
skills to suspect intra-articular pathology was reassuring, yet I felt unfulfilled about the lack
of confirmation that I would be able to give a patient. Crucially, however, it made me
recognise my current scope of practice and that, to expand this and remedy my lack of
fulfilment, I would need the rights to request imaging, which is a key aspect of an APP role
and something that I will endeavour to seek in the future.
Diagnostic Imaging
APPs have been shown to be as accurate as orthopaedic surgeons when providing a clinical
diagnosis (Moore et al. 2005) and with the ability to refer for imaging, APPs can help
improve the patient journey and are more cost effective than current models of care
(Fennelly et al. 2020). To diagnose intra-articular pathology, imaging is required to confirm
and differentiate (Dick et al. 2018; Kraeutler et al. 2019; Luthra et al. 2019; Cronin 2020;
Evans 2020; Reiman et al. 2021). Previously, I had been resistant to referring patients
onwards for imaging at an early stage as I felt that this would have a negative impact on the

7. therapeutic relationship I had with patients and would decrease their confidence in me as it
would appear that I did not know what was wrong with them. However, the research
suggests delays in diagnosis can lead to prolonged morbidity and psychosocial issues
(Kennedy et al. 2017; Gambling and Long 2019). On observation of the consultants practice
(Cronin 2020) and other professionals in the MDT meetings, I was initially surprised at how
frequently they referred for imaging. This surprised me at the time because of the
associated increased risk of malignancy from the radiation (Wylie et al. 2018) and how
reliant they were on imaging for confirmation of diagnosis. However, from my conversation
with the lecturer (Evans 2020) and my colleagues from the outpatient team, I learnt that my
opinions were matched by many others. Evans (2020) found that the physiotherapists
tended to hold on to patients for longer than they should do before referring onwards,
which really resonated with my own practice.
Afterwards, I realised that my surprise at the rate of referrals for imaging by the consultant
and MDT, was due to my own obstinance in thinking that imaging should be a last case
scenario. This may have been due to patients regularly expressing a reliance and want for
imaging and how I perceived this as the patients belittling my professional opinion. This may
have been why I spent an extended period of time, looking for literature on the diagnostic
features of AAD and FAI and could have spent my time more wisely. This really challenged
my personal beliefs on imaging and had I been more open to imaging in the first place and
not sought literature and evidence to confirm my bias, I may have learnt more about
imaging itself.
Since these experiences I have been more open to the idea of referring patients for imaging
and my threshold is substantially lower. This also has wider implications, to other joints and
other presentations, and has made me reflect on the use of imaging in these areas too. Due
to my initial viewpoint, I did not take much theory away from my shadowing experience
with Mr Cronin (2020) but have been able to develop this by completing parts of the
electronic Ionising Radiation (Medical Exposure) Regulation training. This helped develop my
theoretical knowledge of imaging and has helped me further realise the importance of it,
motivating me further to seek the referral rights for imaging. At present, there are several
barriers to me being able to refer independently, including funding and designated
protocols/pathways. However, with an aim of improving the service both for the

8. stakeholders and the service users, it is something that I am keen to change/improve. For
the meantime, I can use the doctors, when working as an FCP, and the MDT, when working
in outpatients to organise imaging. Through these processes, it makes me clinically reason
the need for imaging for each patient, as I must confidently present a valid case to these
colleagues, before they will agree to imaging, which in turn is helping me to develop these
skills further (appendix 2).
Best Management
The American Orthopaedic Association report that care of young adult patients with hip
pain was inadequate in nearly 60% of cases (Clohisy et al. 2008). Whilst this report is from
over 10 years ago, it appears to still be the case today. On discussion with Evans (2020)
about her study, she relayed to me that she had many responses to her call for volunteers
from an AAD support group. This led me to think, the fact that there is a support group
could imply that there is not enough support for them in the first place and compounds the
evidence to conclude it is still a poorly managed condition. Unfortunately, there is a paucity
of knowledge with respect to physiotherapy management for adult hip pain (Kemp et al.
2020a) and a lack of high quality RCTs. In terms of developing, I felt I was not going to
improve my management skills by reading and sought to increase my exposure to young
adult hip pain patients. Papadopoulou (2011) suggests that personal participation is
involved in all acts of knowing and understanding. Increasing the amount of hip pain
patients in my diary, is allowing me to trial different exercises and management techniques,
however, the rehabilitation is often a slow process, so it is difficult to ascertain the quality of
my management at this stage.
Reflecting on previous patients helped me realise that I had doubted my management skills
and felt they needed improving because of one experience at the start of my career. I
treated a patient and diagnosed a groin strain which was eventually diagnosed as a tumour.
Reflecting on my management of this patient, I realised that I would manage and treat them
almost identically to how I did in the initial scenario, because they denied any red flags and
did not raise any of my concerns at the time. Furthermore, I realised that my management
of his hip led to the discovery of his cancer and without my input, he may not have
discovered it until much later. However, I believe that if a patient presented in a similar way,

9. due to my development over my career to date and from reflecting on this experience, that
I would question further and have a lower threshold for referring onwards sooner. I had let
this experience create anxiety and fear of managing patients ineffectively, and reflecting on
the experience, reassured my processes, and increased my confidence that I knew when
conservative management was not working.
Non-conservative management (especially for FAI and AAD) is an area of research which has
been of greater quality and quantity than that of conservative management. There has been
a number of research papers comparing surgery to conservative management (Di Pietto et
al. 2018; Griffin et al. 2018; Palmer et al. 2019; Kemp et al. 2020b; Ferreira et al. 2021).
Discussing some of these papers with the consultant (Cronin 2020), I learnt that he took part
in the UK FASHIoN trial (Griffin et al. 2018). This trial compared physiotherapy to
arthroscopy for FAI, finding that arthroscopy was more effective, something which is
supported by Palmer et al. (2019). These studies (Griffin et al. 2018; Palmer et al. 2019) are
high-quality, large scale, multicentred, RCTs, which are considered gold standard for
experimental design (Hicks 2009) and, therefore, the results should be applied with
confidence. Whilst the consultant predominantly agreed with the results of the studies; he
regarded physiotherapists very highly and felt that our role was essential to achieve best
results, sometimes pre, post or instead of surgery. He admitted that he would
predominantly seek physiotherapy first, before he would consider an operation.
His opinion was somewhat contradictory to the evidence (Griffin et al. 2018; Palmer et al.
2019) and mirrored my feelings regarding physiotherapy’s important role in the
management of musculoskeletal conditions and gave me confidence that he respected our
decision making and management skills. I believe this to be because his opinions were
founded on his personal experience of physiotherapists and our role in the assessment and
management of all hip pathologies, not just FAI. Rolfe (2002) argues that practice should be
valued higher than theory and therefore, people’s knowledge that arises from practice can
be valued above the abstract theoretical knowledge that people make fit to practice from
specific trials. Whilst controversial to the accepted hierarchy of evidence, the reflective
practices of the consultant and his views on physiotherapy, according to Rolfe (2002), could
and should inform my practice more than the propositional knowledge ascertained from
reading several high quality RCTs. Ironically, since last speaking to the consultant, a paper

10. (Ferreira et al. 2021) was publishing suggesting that at 24 months there was no difference
between patients who had either physiotherapy or arthroscopy for their FAI. This
inadvertently supports the claim, that experiential knowledge should inform practice more
than clinical trials, because it supports the experiential knowledge the consultant had
relayed to me.
Prior to this experience, I was resistant, on occasion, to refer patients on for consideration
of surgery, due to viewing it as a failure for physiotherapy. However, through this process, I
have learnt that conservative management does not always work, that the consultants will
always consider all possible options prior to surgery, and that a close joint working
relationship will produce best outcomes for the patients.
Future Development
The experiences of shadowing the consultant (Cronin 2020) and discussion with the lecturer
(Evans 2020) were by far the most useful to me. It has enlightened me to how I develop
better from experiencing a situation rather than reading about it and that I may not have
one specific learning style. Believing that I have any specific learning style could be
detrimental to my ongoing development and I should embrace any opportunity available to
develop going forwards (Newton and Miah 2017). Furthermore, it has left me agreeing with
the opinions of Rolfe (2002) in that there is a high value in experiential knowledge; more
than we may give credit to. To that end, I will continue to seek shadowing experiences of
more experienced colleagues and with consultants, to continue to develop my
understanding of how we will be able to work and learn together as I progress towards the
role of APP. I feel it will allow me to further my understanding of surgical procedures and
which investigations are appropriate now that I have disabled my prejudices. Furthermore, I
will keep in contact with the lecturer with regards to her research to further my
understanding where possible.
With regards to developing into an APP, I must work at an AP level across all 4 pillars (CSP
2020). FCPs should work at an AP level for the clinical practice pillar (Health Education
England 2020) and it took me this experience of trying to develop it, to realise that I was
already working to a good standard, yet restricted by personal beliefs and health board
protocols. When looking at the pillars, I realised that to achieve the role of APP, my focus

11. should be turned to the other pillars. This process has enabled me to develop across the
Clinical practice, Research, and Education pillars most, leaving the Leadership and
Management pillar to work on. To achieve an AP level for this, I will need to take an active
lead on audits/research projects on the hip, leading the education of my colleagues to
improve their understanding and knowledge about hips, and leading the challenge against
the status quo of current management of hip patients by seeking referral rights to decrease
the burden on senior colleagues, such as the consultant. These activities will enable me to
continue my development towards an AP level across the other pillars and further
consolidation of my knowledge. A key aspect that underpins all these tasks is having the
confidence to take these roles on and that through this process, I have realised I was
lacking. Therefore, moving forwards, I need to work with more confidence and assurance in
my abilities to give the best standard of care to the service users and support to my
colleagues.
Conclusion
Through this process of learning and reflection, I feel I have developed in several ways. I am
confident that my overall management of young adult patients with hip pain (through
assessment, diagnosis, conservative and/or nonconservative treatment) has improved, due
to an improved understanding of the pathophysiology of the common conditions (more
specifically FAI and AAD) and reduced prejudices against imaging and non-conservative care.
Furthermore, I believe I have a better sense of what I need to do in the future to achieve the
role of APP and how to continue developing my practice in general. I have developed in my
views towards the use of reflection, seeing the benefit of reflecting more deeply and the
benefit that this has for my practice. Furthermore, I have learnt that I am able to learn in
several different ways, not just in my preconceived way of read/write.
Most saliently, I have learnt to be more confident in my own abilities. Many of these
experiences were affirming of my current skills and knowledge meeting the AP level
required for my current FCP role and some aspects of the APP role that I am aspiring to.
With continued work and focus, I believe that I can develop to become an APP.

12. References
Boud, D. et al. 2006. Productive reflection at work: learning for changing organizations.
London ; New York, NY, London : New York, NY: Routledge.
Caliesch, R. et al. 2020. Diagnostic accuracy of clinical tests for cam or pincer morphology in
individuals with suspected FAI syndrome: a systematic review. BMJ Open Sport & Exercise
Medicine 6(1), p. 772. doi: 10.1136/bmjsem-2020-000772.
Clohisy, J.C. et al. 2008. AOA Symposium: Hip Disease in the Young Adult: Current Concepts
of Etiology and Surgical Treatment: *. JBJS 90(10), pp. 2267–2281. doi:
10.2106/JBJS.G.01267.
Cronin, M. 2020. Experiences and conversation from New patient and Follow Up Clinics on
the 9th and 10th December.
CSP 2016. Advance practice in physiotherapy. Available at:
https://www.csp.org.uk/system/files/csp_advanced_practice_physiotherapy_2016_2.pdf
[Accessed: 21 November 2020].
CSP 2018. CSP welcomes framework to support first contact MSK physiotherapists. Available
at: https://www.csp.org.uk/news/2018-07-31-csp-welcomes-framework-support-first-
contact-msk-physiotherapists [Accessed: 31 December 2020].
CSP 2020. The four pillars of advanced and consultant practice. Available at:
https://www.csp.org.uk/careers-jobs/advanced-consultant-practice-physiotherapy/four-
pillars-advanced-consultant-practice [Accessed: 31 December 2020].
Dewey, J. 1938. Experience and Education. New York: Macmillan Company.
Di Pietto, F. et al. 2018. Articular and peri-articular hip lesions in soccer players. The
importance of imaging in deciding which lesions will need surgery and which can be treated
conservatively? European Journal of Radiology 105, pp. 227–238. doi:
10.1016/j.ejrad.2018.06.012.

13. Dick, A.G. et al. 2018. An approach to hip pain in a young adult. BMJ 361, p. k1086. doi:
10.1136/bmj.k1086.
Dobson, J.L. 2009. Learning style preferences and course performance in an undergraduate
physiology class. Advances in Physiology Education 33(4), pp. 308–314. doi:
10.1152/advan.00048.2009.
El-Bakoury, A. and Williams, M. 2020. Management of hip pain in young adults. Surgery
(Oxford) 38(2), pp. 74–78. doi: 10.1016/j.mpsur.2019.12.004.
Evans, L. 2020. Conversation regarding Adult Hip Dysplasia and Young Adult Hip Pain on
10th December.
Fennelly, O. et al. 2020. Advanced musculoskeletal physiotherapy practice: The patient
journey and experience. Musculoskeletal Science and Practice 45, p. 102077. doi:
10.1016/j.msksp.2019.102077.
Ferreira, G.E. et al. 2021. The effectiveness of hip arthroscopic surgery for the treatment of
femoroacetabular impingement syndrome: A systematic review and meta-analysis. Journal
of Science and Medicine in Sport 24(1), pp. 21–29. doi: 10.1016/j.jsams.2020.06.013.
Funke, J. 2017. How Much Knowledge Is Necessary for Action? In: Meusburger, P. et al. eds.
Knowledge and Action. Knowledge and Space. Cham: Springer International Publishing, pp.
99–111. Available at: https://doi.org/10.1007/978-3-319-44588-5_6 [Accessed: 27
December 2020].
Gambling, T.S. and Long, A. 2019. Psycho-social impact of developmental dysplasia of the
hip and of differential access to early diagnosis and treatment: A narrative study of young
adults. SAGE Open Medicine 7, p. 2050312119836010. doi: 10.1177/2050312119836010.
Griffin, D.R. et al. 2018. Hip arthroscopy versus best conservative care for the treatment of
femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised
controlled trial. The Lancet 391(10136), pp. 2225–2235. doi: 10.1016/S0140-6736(18)31202-
9.

14. Gürel, E. 2017. SWOT ANALYSIS: A THEORETICAL REVIEW. Journal of International Social
Research 10, pp. 994–1006. doi: 10.17719/jisr.2017.1832.
Halpern, H. 2009. Supervision and the Johari window: a framework for asking questions.
Education for Primary Care 20(1), pp. 10–14.
HCPC 2019. What activities count as CPD? Available at: https://www.hcpc-uk.org/cpd/your-
cpd/cpd-activities/ [Accessed: 10 January 2021].
Health Education England 2020. First Contact Practitioners & Advanced Practitioners -
Musculoskeletal - A Roadmap To Practice. Available at: https://www.hee.nhs.uk/our-
work/primary-care/first-contact-practitioners-advanced-practitioners-musculoskeletal
[Accessed: 31 December 2020].
Hearle, D. and Lawson, S. 2020. A Strategic Guide to Continuing Professional Development
for Health and Care Professionals: The TRAMm Mode. 2nd ed. Keswick: M&K Update Ltd.
Available at:
<http://search.ebscohost.com.abc.cardiff.ac.uk/login.aspx?direct=true&db=nlebk&AN=261
9542&site=ehost-live&scope=site>. [Accessed: 26 December 2020].
Hicks, C. 2009. Research Methods for Clinical Therapists. 5th ed. Edinburgh: Churchill
Livingstone.
Jayatilleke, N. and Mackie, A. 2013. Reflection as part of continuous professional
development for public health professionals: a literature review. Journal of Public Health
35(2), pp. 308–312. doi: 10.1093/pubmed/fds083.
Kemp, J.L. et al. 2020a. Improving function in people with hip-related pain: a systematic
review and meta-analysis of physiotherapist-led interventions for hip-related pain. British
Journal of Sports Medicine 54(23), pp. 1382–1394. doi: 10.1136/bjsports-2019-101690.
Kemp, J.L. et al. 2020b. Physiotherapist-led treatment for young to middle-aged active
adults with hip-related pain: consensus recommendations from the International Hip-
related Pain Research Network, Zurich 2018. British Journal of Sports Medicine 54(9), pp.
504–511. doi: 10.1136/bjsports-2019-101458.

15. Kennedy, J.W. et al. 2017. Delays in diagnosis are associated with poorer outcomes in adult
hip dysplasia. Scottish Medical Journal 62(3), pp. 96–100. doi: 10.1177/0036933017727969.
Keogh, R. et al. 2013. Reflection: Turning Experience into Learning. Taylor and Francis. doi:
10.4324/9781315059051.
Kraeutler, M.J. et al. 2019. The “Outside-In” Lesion of Hip Impingement and the “Inside-Out”
Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury. The American
Journal of Sports Medicine 47(12), pp. 2978–2984. doi: 10.1177/0363546519871065.
Luthra, J.S. et al. 2019. Understanding Painful Hip in Young Adults: A Review Article. Hip &
Pelvis 31(3), pp. 129–135. doi: 10.5371/hp.2019.31.3.129.
Moore, J.H. et al. 2005. Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of
Patients Referred by Physical Therapists, Orthopaedic Surgeons, and Nonorthopaedic
Providers. Journal of Orthopaedic & Sports Physical Therapy 35(2), pp. 67–71. doi:
10.2519/jospt.2005.35.2.67.
Newton, P.M. and Miah, M. 2017. Evidence-Based Higher Education – Is the Learning Styles
‘Myth’ Important? Frontiers in Psychology 8. Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366351/ [Accessed: 16 January 2021].
NHS 2017. Multi-professional framework for advanced clinical practice in England. Available
at: https://www.lasepharmacy.hee.nhs.uk/dyn/_assets/_folder4/advanced-practice/multi-
professionalframeworkforadvancedclinicalpracticeinengland.pdf [Accessed: 23 December
2020].
Palmer, A.J.R. et al. 2019. Arthroscopic hip surgery compared with physiotherapy and
activity modification for the treatment of symptomatic femoroacetabular impingement:
multicentre randomised controlled trial. BMJ 364, p. l185. doi: 10.1136/bmj.l185.
Papadopoulou, M. 2011. The authority of personal knowledge in the development of critical
thinking — a pedagogy of self-reflection. Enhancing Learning in the Social Sciences 3(3), pp.
1–23. doi: 10.11120/elss.2011.03030012.

16. Portney, L.G. and Watkins, M.P. 2014. Foundations of Clinical Research: Applications to
Practice. Third. Harlow: Pearson Education Limited.
Reiman, M.P. et al. 2015. Physical examination tests for hip dysfunction and injury. British
Journal of Sports Medicine 49(6), pp. 357–361. doi: 10.1136/bjsports-2012-091929.
Reiman, M.P. et al. 2021. Infographic. Consensus recommendations on the classification,
definition and diagnostic criteria of hip-related pain in young and middle-aged active adults
from the International Hip-related Pain Research Network, Zurich 2018. British Journal of
Sports Medicine 55(2), pp. 115–117. doi: 10.1136/bjsports-2020-102219.
Rolfe, G. et al. 2001. Critical reflection for nursing and the helping professions: a user’s
guide. Basingstoke: Palgrave.
Rolfe, G. 2002. Reflective practice: where now? Nurse Education in Practice 2(1), pp. 21–29.
doi: 10.1054/nepr.2002.0047.
Russel, V. 2015. About APPN. Available at: https://www.appn.org.uk/about-us/about-esp
[Accessed: 27 November 2020].
Schon, D. 1991. The Reflective Practitioner: How Professionals Think In Action. Scrantan,
Pennsylvania: Basic Books.
Thompson, N. and Pascal, J. 2011. Reflective practice: an existentialist perspective.
Reflective Practice 12(1), pp. 15–26. doi: 10.1080/14623943.2011.541089.
Veras, M. et al. 2016. What Is Evidence-Based Physiotherapy? Physiotherapy Canada 68(2),
pp. 95–96. doi: 10.3138/ptc.68.2.GEE.
Wylie, J.D. et al. 2018. Computed Tomography Scans in Patients With Young Adult Hip Pain
Carry a Lifetime Risk of Malignancy. Arthroscopy: The Journal of Arthroscopic & Related
Surgery 34(1), pp. 155-163.e3. doi: 10.1016/j.arthro.2017.08.235.

17. Appendix 1 – Learning Contract
Learning Need –To work towards an Advanced Practice level when managing Hip Pain in
Young Adults. Develop my ability to assess and manage young adults with musculoskeletal
hip pain.
Learning Needs Learning Resources Evidence & Validation Sign When
Achieved
What do you need/want to
learn?
Consider your own
competency levels and the
opportunities available in this
setting
What will you utilise to
achieve your learning needs?
Where can you find the
information? How do you
learn best?
How can you demonstrate
that you have met your
learning need? What
evidence will you offer? How
should the evidence be
evaluated? By whom? What
criteria will be used?
Timescale for evidence.
1. Improve my
knowledge and
understanding of
the pathologies (and
their presentations
both MSK and non
MSK) that cause hip
pain in young adults
and how to manage
them appropriately.
Focus on FAI and
Adult Hip dysplasia,
diagnostic features
and how to
differentiate.
• Supervision with
clinical supervisor
• Journals/Articles
• Orthopaedic
Consultants
• Shadowing
specialist clinic
• Peer discussion
• Podcasts
• Admin staff to load
diary with more hip
patients.
• I will provide a
written synopsis of
the common
pathologies and
presentations to use
as a reference for
the department
based on a literature
review.
• Reflection of
shadowed practice
of an ortho
consultant in clinic.
• Synopsis of
appropriate
investigations (what,
when and why) –
could use reflection
using Rolfe?
• Make a flow
chart/pathway for
helping classify
managements of
different
presentations
groups.
• Completion of E-
learning modules for
considerations and
risks to surgical
intervention.
• Reflection on
shadowing of
consultant’s practice
• IST back to the
physiotherapy team
with respect to all
learning needs.
JC
2. To develop better
understanding of
appropriate
investigations for
young adults with
hip pain.
(e.g., When to refer,
bloods, imaging,
what imaging they
will require etc)
Focus on rationale
for imaging.
• Journal/Articles
• Shadow
consultants/GP
• E-IRMER training
• Peer review
• Nice Guidelines
JC
3. Improve
understanding of
best (conservative
or non -
conservative)
management
(Surgical/invasive
interventions)
• NICE
• Surgical Guidelines
• Orthopaedic
Consultants current
practice
• ? shadow surgery as
well as clinic
JC

18. Appendix 2 – MDT reflection
Describe briefly a recent significant experience in your professional life:
I have taken part in hip MDT for the last few months
What did you do…
I have listened to and presented cases to the
MDT, where further discussion on the cases is
able to happen
…and why?
Discussing with the MDT allows us to make a
plan of action for the patients. Also allows us to
get the opinion of the consultants and ask
questions if we are unsure
What went well…
Able to present a patient who was not improving
who I suspected had Acetabular dysplasia due to
their HPC and assessment. Presented it and was
able to answer most of the questions from the
MDT, agreed to XRAY- x-ray came back with a
decreased centre edge angle – implying
dysplasia. Consultants agreed to get further
imaging – MRI. Able to subsequently give
feedback to patient that my suspicion was correct
and that we needed to continue rehab whilst we
wait for the consultant review and? surgery as no
improvement. Quicker for the patient than
traditional routes. Also, able to offer opinions on
patients, which the MDT appreciated and valued
…and what could have been better, if anything?
Could have had key points written down, with
the notes easier to hand. Could have spoken
more on other cases, had more confidence with
other patient cases. Could have asked about the
literature I had read about surgery vs rehab and
their opinions
What would you do differently, if anything, if faced
with a similar situation again?
Have more confidence to speak more in the
meetings, will bring up the topic of research prior
to the MDT and therefore we will be able to
discuss. Put more patients on the list to be
discussed
How did you feel during the experience?
Anxious when presenting and somewhat under
confident. Reassured when my suspicion was
right. Happy for the patient and happy when the
patient was pleased that they were finally getting
somewhere in their management.
Describe what you learnt from this experience
Not to be afraid to discuss with colleagues, as they are there to help us learn. Be more assured of
self with diagnosis. Planning for these meetings will allow me to get more from it, make sure I have
all the key points. Clinical judgement/reasoning regarding imaging seems to be improving.
What is your action plan from this incident, if anything?
Make sure I have notes and key points when presenting. Present more cases in upcoming MDT
meets, offer opinion when I have one on cases.
Date: 7/1/21