PhD Project - Designing and Evaluating Evidence-Based Practice Education for Osteopathy

Overview

Evidence-based practice (EBP) is central to safe, effective, and accountable healthcare. Within UK osteopathy, EBP is embedded in the General Osteopathic Council’s Osteopathic Practice Standards and underpins the profession’s aspirations for credibility, public trust, and integration within mainstream healthcare systems. As such, the principles of EBP are already formally embedded within undergraduate curricula and regulatory expectations.

Despite this, international research consistently demonstrates a gap between formal endorsement and everyday enactment of EBP in osteopathic practice. While attitudes towards EBP are generally positive, confidence, skills, and sustained implementation in routine clinical practice remain limited (Sundberg et al. 2018; Leach et al. 2019; Cerritelli et al. 2021; Alvarez et al. 2021). Commonly reported barriers include time constraints, limited access to research, variable critical appraisal skills, and a perceived tension between EBP frameworks and osteopathy’s holistic, person-centred ethos (Figg-Latham and Rajendran 2017).

Importantly, evidence from allied health professions suggests that these challenges cannot be adequately explained by deficits in initial education alone. A mixed-methods evaluation of a small-group EBP educational intervention demonstrated improvements in confidence and self-reported behaviours, but limited impact on deeper clinical practice change, with qualitative findings highlighting the influence of professional beliefs, identity, and contextual constraints (Mickan et al. 2019). This aligns with a broader qualitative meta-synthesis showing that clinicians’ use of evidence is shaped by interacting individual, organisational, social, and cultural factors, rather than technical competence alone (Mickan et al. 2017).

More recent qualitative work further reinforces that engagement with evidence is relational, contextual, and identity-sensitive. Studies of knowledge-brokering and embedded researcher roles in allied health demonstrate that trust, relevance, professional alignment, and shared meaning-making are central to whether evidence is taken up and enacted in practice (Mickan et al. 2022). Together, this body of work suggests that conventional EBP education focused primarily on skills acquisition may be insufficient to support meaningful and sustained behaviour change.

Within osteopathy, these issues are likely amplified by the profession’s epistemic diversity, strong traditions of clinical autonomy, and variable orientations towards biomedical hierarchies of evidence (Thomson and MacMillan 2023). While there is a substantial international literature on EBP attitudes and skills, there is limited osteopathy-specific research examining how EBP is enacted, negotiated, or selectively applied in post-qualification clinical practice, and no published intervention that explicitly targets this enactment gap in qualified osteopaths. This PhD shifts the focus away from undergraduate curriculum design and instead examines post-qualification uptake and enactment of EBP, using educational intervention as a mechanism for understanding and supporting meaningful practice change rather than as an end in itself.