I believe that communication is an important skill as a clinician. Elements of having quality communication are evident in the CSP framework, HCPC standards and CSP code of practice.

One of the first articles I read while studying on the MSc was on communication. It detailed the importance of appropriate communication with the patient in order to build a relationship with them (2). This can also be applied to building appropriate relationships with colleagues and external agencies ensuring we work together for patients. Over the course of my 5 clinical placements, I have attempted to communicate effectively through using a wide range of routine and advanced communication skills to share information. These include presentations, exercise classes, clinical notes, discharge letters and the delegation of tasks.  I have included a coffee presentation I complete on placement one as 'Clinical Coffee', a discharge letter I completed as' Discharge summary Letter', and an email sent to a staff member to delegate as 'delegation email'. This demonstrates the basic communication skills necessary to share information, ideas and problems with both specialist and non-specialist audiences. Composing each of these posed their own challenges. With the discharge summary and delegation email, I composed drafts and showed them to my educator in order to get feedback prior to sending.  At the beginning my language was not professional enough and I was not appropriately judging my audience. With the presentation, I needed to discuss a case study to my peers. I found this the most nerve wrecking as I see public speaking as one of my weaknesses. How I plan to address this moving into practice, is to present to small groups of people and gradually build confidence in order to talk in larger groups of people. This will help me with Multi-disciplinary team meetings also.

I must admit that starting out communication was a challenge for me. As I am somewhat a quiet person, speaking up and communicating with the MDT involved me coming out of my comfort zone. However, through getting feedback on my notes and getting more exposure to MDT communication, the more comfortable I got in different settings. My communication and interactions with patients were always something I was commended with, and feedback was usually that I had a good 'bed side manner', presented here as evidence as ' Placement Feedback'. One area which presented greater challenges, was delegating with Therapy Assistants. This was due to not realising the importance of prioritising tasks that require a qualified physiotherapist's scope of practice. I also felt slightly out of my depth, and that it was not my place as a student. However, after reflecting and having conversations with a number of my educators, I began to understand how fundamental delegation was (3). Improvements in this were seen as demonstrated here by ' Placement Objective delegation'. Moving into qualified practice, I aim to talk to difficult therapy assistants privately, and if these discussions do not work I will speak with my seniors about the problem.

During my first placement, part of the job role was to provide live exercise classes virtually via Facebook to a population of knee osteoarthritis patients. This was something hugely out of my comfort zone, and I felt almost stupid conducting an exercise class in my living room, in front of a camera. This was completed on 3 consecutive weeks. On the first week, I felt extremely nervous, stumbled over my words, and forgot to deliver important information to the participants such as precautions. My peers gave me feedback on the strengths and weaknesses of the class. Following this I was able to modify my communication in response to feedback to enhance user involvement.  This is presented as ' Facebook Live class' and 'Facebook live feedback'. By listening to feedback from peers and supervisors and regularly reflecting on communication skills, I have been able to improve my own scope of practice - to allow me to adapt communication skills based on changing scenarios and in circumstances where I do not feel entirely comfortable. A number of these reflections are presented here as 'placement 1 reflection', 'Reflective Assignment' and 'IPL reflective essay'

Through the emergence of Covid-19, many things changed within the world of physiotherapy from a  communication perspective, which have impacted me and the profession as a whole. Speaking from personal experience, one of these changes came as I completed my first placement, from the comfort of my own home via Microsoft teams. Evidence shows that telephone/video consultation can be effective for managing conditions such as low back pain and forms of osteoarthritis, even improving adherence (4,5). While I did miss out on aspects of a traditional placement such as getting hands-on with patients and enhancing my manual handling skills, it did aid in my progression in using a range of ICT's to support and enhance practice. For me personally, my scope of practice has changed, and I would now feel competent working in an environment such as this due to my experience. For me this means I can assure the quality of my practice in a variety of environments. For physiotherapy as a whole, I believe that having phone skills and skills using ICT'S is going to have increased importance. Through the promotion of technology in the NHS long term plan (6) and the uncertainty around COVID-19, it is looking increasingly likely that physiotherapists will be required to have these skillsets within their scope of practice to support the development of physiotherapy.

In conclusion I think being able to communicate effectively is a major part of the job of a physiotherapist. This involves using the correct type of communication at the correct time, knowing what type of language to use based on your audience and knowing what level of detail is required from the person you are communicating with. My communication skills have gone on a journey over the course of  2 years doing this course. When I began, I was very tentative and lacked the confidence and knowledge of when and how to communicate - this has developed to a point where I am now much more confident in selecting different channels to communicate. There is still much room for improvement with this. For example, liaising with doctors and nurses is something I am beginning to do more of but had done relatively small amounts until my final placement. Referring patients to services, is an area that also could be improved by requesting to be inducted into the process by more senior staff members. By reflecting on my practice and receiving feedback from my peers I aim to keep improving.