This domain is broken into 2 sections: 1) Profession-specific practice skills and 2)Generic practical & technical skills. When addressing the first aspect of this domain - manual therapy, exercise and movement, electrophysical modalities and kindred physical approaches must be considered (1). These approaches are descendants of the four pillars of physiotherapy granted by the Royal Charter in 1920. As of 2020 the wording of these pillars has been updated to: 

• exercise, movement, and rehabilitation 
• manual therapy and therapeutic handling 
• therapeutic and diagnostic technologies 
• allied approaches (2)

I am aware as a qualified physiotherapist, I must maintain my fitness to practice. Throughout the course of my 5 clinical placements, I have demonstrated, and recorded skills completed, using a skills journal. This is presented here as 'skills journal examples' .The use of the skills journal is to consolidate and refine the performance of complex skills gained from qualifying physiotherapy programme. This does not mean I have 'mastered' the skill, but I have understood and am able to implement it, in a basic sense. By consolidating these skills, my commitment to quality of care can be witnessed. I found that skills related to manual therapy and exercise were initially the most straightforward, as I had come from a Sports Therapy background and have a keen interest in strength training in the gym. Through the emergence of the Covid 19 pandemic, my opportunities to progress skills in manual therapy and electrophysical modalities were limited, as my Musculoskeletal (MSK) Placement was virtual. Due to this, these skills are not as strong as they might be, as they do require more hands-on practice as opposed to theory. I aim to sharpen skills when I start rotations by requesting to spend time in MSK outpatients when possible, to enhance these skills. I also hope to work in a private MSK clinic for a couple of hours every week, while keeping on top of the latest evidence and NICE guidelines on manual therapy, electrophysical modalities and other kindred physical approaches. One area which I feel is strong in my practice, is exercise prescription. This comes from a combination of my undergraduate background and the many opportunities I have had to tailor exercise programmes for patients throughout my placements. I feel from the theory learned in modules since starting this degree, has allowed my knowledge on the subject to grow and therefore my confidence implementing plans with patients has also grown, which has resulted in an improvement in my overall scope of practice and allowed me to assure the quality of my practice.

Due to the fact, I have not got a large volume of recent experience with manual techniques, kindred physical approaches and electrophysical modalities, I feel that my confidence in implementing these techniques is somewhat lowered, on evaluation of my own performance. I would not feel confident performing mobilisations on a patient's joints for example. I would put the lack of experience down to two things: Covid 19, and the direction physiotherapy appears to be moving towards (3). Due to having limited recent experience in areas like this, I would go as far as to say, it is currently outside my scope of practice. Many within the profession seem to be moving away from these type of approaches, with some arguing it should be abandoned due to low levels of evidence and promoting patient reliance (4). From my experiences in University and within the NHS, there would appear to be a move towards exercise therapies, therefore these skills may no longer be a necessity. Moving forward I will look to sharpen these skills by participating in in-service trainings and taking part in external courses to upskill when moving onto relevant rotations, if required. Personally, as I have an interest in moving to private practice, these manual therapies and modalities still may have an important place. By having these skills in my 'toolbox', I ensure my abilities to practice as an autonomous professional stays intact. 

My inclusion of a video of myself, hosting an exercise class with adjoining feedback is to demonstrate my ability to modify a technique in response to feedback, in the area of exercise prescription. These are presented here as 'peer feedback from exercise class' and 'picture of exercise class after feedback'. I believe this to be a strong area of my practice, with regular feedback given from educators that I respond appropriately to feedback. I believe that my ability to adapt to feedback has allowed my scope of practice to grow. This has been evident from many educators who have reported an improvement in my practice following feedback. I have also included a modified 'exercise programme' based on a clients preference, completed during my stroke placement. Once qualified I hope to continue in this regard, but would hope that the more experienced I become, the less feedback I require. To possess these skills is important to maintain fitness to practice and to support the development of physiotherapy.

Generic practical and technical skills are those shared with other healthcare workers and aren't specific to physiotherapy. To demonstrate these skills, I have included training certificates for manual handling and first aid. These are presented here as 'CPR training' and 'manual handling training'. A screenshot from the manual handling section of my skills journal has also been included - this shows my ability to evaluate my own performance on these skills while showing my intentions to operate within legal and ethical boundaries. While I am able to identify that I have the basic skills, evaluating how effective my performance is - is still a relatively new concept. I aim to get around this by requesting feedback on my performance until I am experienced enough to judge my own.

These skills are by no means where they could be - due to lack of experience in certain aspects. As I have an undergraduate background as a sports-therapist, these skills have been developed over a number of years. I have experience using techniques of massage, foam rolling ,TENS and trigger point therapy to name a few approaches. I have presented some samples of my work in these areas as 'foam rolling presentation' and 'BSc Thesis Foam rolling conclusion'. I have also got some exposure to machines such as Functional Electrical Stimulation on a stroke placement. I would like to get more experience using therapeutic and diagnostic technologies and aim to do this by spending some time within private practices. I also potentially plan on studying diagnostic ultrasound in the future to increase my scope of practice and to seek to continuously improve. I believe once working in rotations my scope of practice within this domain will increase at a much faster pace than during University. This is down to working on a full-time basis without there being gaps between placements. This will ensure, I am getting feedback on a regular basis, attending regular In-Service training and having study time to conduct my own personal CPD.

As I have previously spoke about how Covid 19 has impacted the volume of experience I have personally gained, I now wish to speak of its impact profession wide. I have mentioned that my MSK placement was completed virtually. This was due to the suspension of face-to-face services. At the time, all consultations were occurring over the phone. Therefore, we seen the emergence of tele-rehabilitation. Tele-rehabilitation was seen as a feasible option with good levels of patient satisfaction and adherence (5). However, there are a number of limitations, namely the lack of tactile examination and lack of therapeutic experience.  Due to this, physiotherapists have had to improve their verbal communication skills and subjective assessments - as this was essentially all they had to go on. In this way, the pandemic has forced the profession to increase their scope of practice to encompass virtual or remote consultations. With this change in practice, physiotherapists have demonstrated innovation and leadership, while understanding the need to develop a safe practice environment. This format may be kept after the pandemic as it is seen as a way to reduce non attendance rates and help patients self manage (6).