In healthcare learning never stops. Nobody is an expert in every aspect of practice, evidence and guidelines are constantly changing and we all must continuously improve. Therefore it is important to continuously enhance and maintain ones professional competence.  This ensures being able to practice effectively and safely within my scope of practice. As a student, I feel that this domain is somewhat more difficult to get a grasp of than others. I believe that this is in part due to being part of an education programme, where at times learning is very structured with assignments and exams. However, I do understand that in order to maintain an ability to improve lives, I must maintain a fitness to practice. In order to do this I must engage in self-directed learning (2).

One element, I began to introduce more into my student practice was having self-awareness of learning preferences, & with guidance can identify personal learning & development needs. While quite early on in this degree, I identified that I am a practice based learner and I learn by doing (3). For me my learning preference was to get exposure to a variety of techniques while on placement and attempt to better these with practice, feedback and reflection. Echoing this, I am presenting a 'VARK questionnaire', which I completed to identify learning preferences. In terms of identifying personal learning and development needs, this is something I often found challenging during early placements. While I was aware of my limitations, sometimes I required significant guidance in identifying a solution to this. This meant creating 'learning objectives' at the beginning of placement was time consuming. However, as placements passed and I neared the end of my degree, I became much better at identifying my learning needs, and this is evident in my 'placement 5 feedback'. I believe the improvement was based off increasing my patient mileage but also increasing the frequency of self reflection. Moving into qualified practice I will need to improve this skill, as I will solely be responsible for identifying my learning needs, with some guidance given during supervision with a band 6. Therefore, before each rotation, I will complete a SWOT relative to the rotation and my goals for CPD, in order that my SOP continually progresses.

As part of my placement booklet, there is a section which requires reflection on strengths and weakness during each placement. Then with the guidance of my educator, this information is used to inform the development of a future 'action plan'. This entails areas I wish to address on my next placement or when moving to a band 5 role. I also created a personal development plan ('PDP'). Creating this, involved analysing my strengths and weaknesses, thinking about goals I want to achieve in the future and the means of achieving these goals. Both these pieces of evidence  demonstrates my attempts at reflection on personal learning & development, & with guidance & support, using this information to inform the planning & management of future learning & development experiences.

On my second placement I was on an acute, short stay unit. A number of patients there, were in need of chest physiotherapy. On one occasion, I attempted to assess a patient in the presence of my educator. The assessment went poorly. I structured the assessment inadequately and my lack of confidence lead to communication problems. My educator afterward suggested I do some work and come up with a structure that would work for me to help my respiratory assessment. From this I decided to read through some on call literature on respiratory assessment and constructed notes to help me with a structure to guide my practice. I have included my 'respiratory notes' as evidence of independently
advancing personal knowledge, understanding & skills in line with identified learning needs. I found this worked well. Due to having a structure, my confidence improved. Overall, my assessments were much better. Similarly to this, prior to beginning my stroke placement, I independently identified learning needs and advanced my personal knowledge by completing 'stroke notes' to help me revise at the beginning of placement. As I had not previously had a stroke placement, and had not covered stroke in University for over twelve months, I felt I needed to have certain things fresh on my mind in order to be able to draw on appropriate knowledge and skills to inform practice. Advancing my own personal knowledge is not something I find too difficult. When I am unsure around a topic, I will read textbooks and articles and listen to podcasts or videos until I feel I have advanced my personal knowledge.

During my time on an orthopaedic placement, I had the opportunity to participate in a number of in service trainings. One of which was about amputees. As this was an area I had an interest in but where my knowledge was limited I decided to take notes on what I believed to be most important parts, to be able to understand the key concepts of my knowledge base relevant to my profession. From my notes I created a 'PowerPoint presentation' and presented it to my educator to showcase what I had learned. This highlights my ability to record the outcome of personal learning & development in a format that meets personal preferences. Admittedly, this is one of few occasions where I have recorded the outcome of learning that has not been a reflection. Much more variety could have been selected in this regard, and by experimenting with formats I may have been able to discover new preferences for learning. This is an area I must improve on when graduated.

While I have engaged in activities that resulted in CPD, I find this is an area I struggle slightly with. I am capable of identifying areas of weaknesses but still sometimes need prompts at how to address these weaknesses. In that regard, I can sometimes find making development plans challenging. I know where I want to get to but sometimes find it  difficult identifying the steps I need to take. The more experience I get at conducting CPD and assessing my own strengths and weakness, the more comfortable I will get identifying methods to strengthen my weakness- as I will become aware of more resources.

Similar to other domains, lifelong learning has been affected by the emergence of COVID-19. On one placement I was attending, all in-service training had been stopped due to the pandemic - as caseloads were high and staff were not allowed to be congregating in groups due to social distancing guidelines. This would have had a big impact on the CPD of staff - as essential topics that were normally being regularly taught to new band 5's during in-service trainings had stopped. New starters were at times somewhat thrown into the deep end of 'red' wards. The other change has been the prominence of webinars the past 18 months. As face to face conferences have not been possible, or at best had very limited capacity - webinars were a good alternative as individuals can partake in CPD from the safe environment of their own home. As convenient as this is, I personally feel that when staring into a computer screen I lose focus and would much rather in person teaching.

Finally, due to demand during the height of the pandemic, midwives, paramedics and physiotherapists were involved in vaccine administration (4). This is an interesting development for physiotherapy. For some time now physiotherapists have been able to advance their scope of practice to cover areas such as prescribing medications (5) and administering injections (6). With the need for human resources to administer vaccines, it is entirely possible that this could become part of a physiotherapists normal scope of practice in future.