Caseloads should be managed in healthcare settings to ensure patients with urgent needs receive services before patients with less needs (2). This will involve skills to plan, prioritise and and organise personal workloads and use of resources to fulfil work commitments. To accomplish this, exercising autonomy and initiative and taking responsibility for the work of others may be needed. In my opinion, working as a physiotherapist in any setting, these skills are of the utmost importance, as I must be able to work appropriately with others and demonstrate appropriate professional autonomy. When qualified it may be an expectation to manage a wards caseload by prioritising patients most in need of physiotherapy and delegating other tasks to be completed by a therapy assistant. In this way the physiotherapist can use their time in the best way, spending it with patients who need it most.

Up until my third clinical placement, I did not full get a grasp of prioritisation of patients. During this time, I covered two wards. One of these, was a Covid-19 ward, therefore careful planning and prioritisation was required. Every morning, I would get the handover from discharge facilitators and begin prioritising patients based on clinical need. At first, I found this difficult. I was at times struggling to find the information to decide which level of priority a patient would be, due to being unfamiliar with the notes and documentation style in this particular trust. From practicing every day, I eventually got the hang of the process. This skill was very important for a job interview I completed. I was asked a question on prioritisation and I have presented the question and answers as 'Interview question on caseload prioritisation'. As I was offered a job based on this interview and received positive feedback on my answers, I believe that I have the ability to exercise autonomy and initiative in accordance with professional codes of practice and act as an autonomous professional. I feel, my experience of planning and prioritising autonomously has been changed slightly due to the Covid-19 pandemic. Before the pandemic, all patients would be considered for a prioritisation list. However, now in many situations this list has to be split into a 'red' list and an 'amber' or 'green' list. This is a measure of infection control, so that the amount of Covid-19 spread by healthcare workers is minimised. This is a minor change to the scope of practice of physiotherapy, but it is an important consideration when working on hospital wards.

It was once again on my third clinical placement, where I began to gain experience taking responsibility for the work of others (e.g., delegation). Admittedly, this was an area of struggle at the time. While I did attempt to delegate with the therapy assistant on the team, they did not take my delegation seriously and tasks I would ask them to complete would be overlooked. At the time, I did not have the confidence to address this. It was not until my final placement that I had great success delegating with therapy assistants. On this placement I felt confident in my role and  aware I would soon be a qualified physiotherapist. I was more aware of what priorities were for myself, aware what the therapy assistant could offer and aware of the need to work together for patients. There is still some room for development in this area. Although I did delegate, sometimes my delegation was somewhat basic and lacked creativity. I have presented as evidence, 'email delegating to therapy assistant' to demonstrate my attempts of taking responsibility of the work of others.  To progress my delegation skills once qualified, I aim to give clear, detailed instructions to the therapy assistant on what I would like them to do.

Feedback supports learning and reflection, and prepares an individual for future practice (3). It is important for an individual to be open to feedback, reflect upon it and incorporate it into practice with their theoretical knowledge (4). I believe I have shown an ability to modify behaviour & actions in response to feedback throughout my placements. One example that is relevant to this domain, is feedback received on the management of caseload and delegation which I have presented here as 'placement feedback on caseload management, feedback and reflection'. I believe this is a strong element of my practice and have received praise from a number of educators on my ability to receive feedback and implement it. This has been a strong area of my practice from the beginning, with one main area reported for further development. This was being proactive in seeking feedback from my educators. A big improvement in this was noted personally in my last placement. Presented here to show the improvement is a snippet of the placement feedback, 'placement feedback - initiating feedback'. I hope to continue in my openness to receiving feedback and begin initiating feedback on a much regular basis once I begin as a band 5.

I have included a plan that I created on how to implement a placements halfway feedback into practice to improve my grade, 'plan to improve on halfway feedback' as well as a planned schedule of my first placement, 'week 1 timetable placement 1'. To further evidence my reflective practice, I have included a reflection I completed on caseload management, presented as 'reflection on caseload management and prioritisation'. This demonstrates an ability to evaluate the effectiveness of my own performance but also links in nicely with the ability to plan, organise and prioritise personal workload. Similar to this, I have evaluated my own performance and planned for the future with a 'PDP'. I think that reflective practice is an important skill in order to progress as a clinician and learn from mistakes. While I could write more written reflections, I do regularly create plans on how I am going to improve an area of practice - which is reflection in itself. An area I could improve on is reflecting on practice that has gone positively instead of just focusing on what I could do better. However, it must be stated my reflective practice has come a long way - from barely reflecting on work I have completed to routine analysing and evaluating scenarios I have been involved in.

The one area I have not got as much exposure to  is taking the lead to implement agreed plans designed to bring about change and development. This is not to say I do not believe this area to be important, and I have been proactive in creating PDP's for future practice.  While on one of my clinical placements, I identified an area for development within the service. I had noticed in my final weeks of placement; a number of patients were being administered incorrect volumes of supplemental oxygen by means of the flow meter being set incorrectly or the wrong venturi valves being used. I spoke about my ideas about improvements to my clinical educator and my university lecturers, who both agreed that the idea could work. Unfortunately, due to only having a week remaining on my placement when I identified the problem and potential solution, I did not get the chance to implement the change. This is not included on this domain, but the full project can be seen in domain '12' and '13'. The idea of the service improvement caused me great worry throughout placement. I do not see myself as an overly 'creative' person and therefore I struggled to see, how I as a mere student could identify a beneficial proposal for change. Even after I identified the problem and potential solution, I felt it would not work and it would probably be dismissed. The more I discussed the idea with seniors and lecturers, the more confidence I gained in the idea. Moving forward, this project will serve me well as I now have some practical experience when it comes to implementing change. Completing the project allowed me to change my scope of practice to me more comfortable operating in these scenarios. Moving forwards, I will look to bring small changes to practice when I see fit. I also aim to learn more about the process of service improvements through reading literature and completing trust trainings.

As previously mentioned, there has been a slight adaption to the process of prioritisation within trusts due to Covid-19 and infection control. This means that many physiotherapists who are required to cover Covid-19 and non Covid-19 patients need to prioritise accordingly (5). This has brought about a change in practice, in that more consideration is needed.  To adhere to legal, ethical and regulatory requirements, one should not be treating patients on a 'green' ward after previously treating patients with Covid on the same day. While this may seem like a small insignificant matter, it is when it is added to considerations about social distancing and personal protective equipment that means a physiotherapist now has much more to think about.