This research, exploring a theory of professionalism in osteopathy, comes at an opportune moment when regulation and implications for practice are evolving in healthcare. The study sought to uncover the perceptions of osteopaths, students and patients as to their concept of professionalism and to seek a consensus on what this constitutes in osteopathy. It developed the PIECE theory of professional trust containing five key elements which are mediated by dialogue and touch used by the osteopath.

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... The elements are Personal approach; Interaction and communication; Engagement and relationships; Customised approach; Empowerment and education. Twenty-nine interviews were undertaken using two video vignettes to prompt discussion, three facilitated and three unfacilitated focus groups with individual stakeholder groups followed, with a final focus group of mixed stakeholders to develop the final theory using Constructivist Grounded Theory methodology. The findings show how the elements of dialogue and touch are key throughout all phases of the osteopathic consultation and to the formation of professional trust in osteopathy. An important implication of these findings is that the values and attitudes are not stand-alone concepts but learnt and enacted within the clinical context, not only for students, but for clinicians throughout their working lives. The research has explored the perceptions of patients who are also learners within the osteopathic consultation. The PIECE learning cycle to build professional trust in osteopathy has been developed to aid educators and students along with the PIECE self-reflection tool for students to learn about professional trust in osteopathy.