Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context

Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.     

The Objective Structured Clinical Examination: three decades of development

The Objective Structured Clinical Examination (OSCE) has become a standard for performance-based assessment in many health professions. Originally developed for assessment in medical schools, the OSCE has been widely adopted for teaching, assessment, and certification purposes in most health professions. This article outlines the reasons for the rapid uptake of OSCEs and explores some of the key features of OSCE development that have implications for use in veterinary medicine.     

Relationships between admissions requirements and pre-clinical and clinical performance in a distributed veterinary curriculum

The purpose of this study was twofold: first, to assess the relationships between knowledge-based admission requirements and pre-clinical and clinical performance in a distributed model of veterinary education that uses problem-based learning as the main instruction method in the first two years of the curriculum; second, to compare pre-clinical and clinical performance with performance on the Program for the Assessment of Veterinary Education Equivalence (PAVE) exam. Admissions data including overall GPA, prerequisite GPA, Graduate Record Examination (GRE) score on the Analytical, Analytical Writing, Quantitative, and Verbal sections), veterinary school performance data (GPA for pre-clinical and clinical years), and performance PAVE (taken at the end of second year) were analyzed for two classes (N = 155, 85.8% women and 14.2% men). Overall GPA, prerequisite GPA, and GRE Quantitative and Analytical scores were the best predictors for pre-clinical (years 1 and 2) performance (R = 0.49, 23.5% of the variance), GRE Analytical score was the best predictor for year 3 (pre-clinical and clinical) performance (R = 0.25, 6.3% of the variance), GRE Quantitative score was the best predictor for PAVE performance (R = 0.27, 7.5% of the variance), and GRE Analytical score was the best predictor for clinical performance (year 4; R = 0.21, 4.4% of the variance). PAVE scores correlated with GRE Quantitative scores (r = 0.27, p <.01) and veterinary school performance, with higher correlations in the pre-clinical years (rs = 0.67-0.36, p < .01), providing evidence of convergent validity for the PAVE exam.     

The Objective Structured Clinical Examination (OSCE) as a determinant of veterinary clinical skills

The Objective Structured Clinical Examination (OSCE) has become an excellent tool to evaluate many elements of a student's clinical skills, especially including communication with the patient (human medicine) or client (veterinary medicine); eliciting clinical information from these conversations; some aspects of the physical examination; and many areas of clinical evaluation and assessment. One key factor is that the examination can be structured to compare different students' abilities.     

Increased student self-confidence in clinical reasoning skills associated with case-based learning (CBL)

Second-year veterinary students were surveyed at the beginning and end of a 15-week semester regarding their confidence in performing three clinical reasoning skills: (1) making Problem Lists; (2) making Rule-Out Lists; and (3) selecting appropriate diagnostic tests. Each week during the semester, these skills were practiced in small-group case discussions. Changes in self-confidence were analyzed and studied in light of faculty assessments of student competence in performance of the three skills. RATIONALE: The purpose of the study was to determine if students' self-confidence in performing three clinical reasoning skills increased with practice. METHODOLOGY: On the first and last days of class, students rated their confidence in each of the three skills on a scale of 0 to 10. Mean confidence scores for the whole class both for time points and for each of the three skills were analyzed. RESULTS: There were significant increases in students' self-confidence in all three clinical reasoning skills over the semester each year. A greater percentage of students expressed improved confidence in selecting appropriate diagnostic tests than in the other two skills in three of the four years studied. CONCLUSIONS: Students' self-confidence in performing three clinical reasoning skills improved over the course of a semester in which they practiced the skills in a CBL format. Subjective faculty assessment of students' competence in these skills generally indicated improvement. However, no meaningful conclusions about the correlation of skill competence and student confidence could be drawn because of inadequacies in the measurement of student performance.     

Web-based documentation of clinical skills to assess the competency of veterinary students

Kansas State University implemented a Web-based program to assess students' competency to perform technical skills during clinical rotations throughout the fourth year of the veterinary curriculum. The classes of 2009 and 2010 recorded a minimum number of procedures (104 and 103, respectively) from a menu of more than 220 recommended procedures. Procedures were categorized by species (small animal, equine, food animal) and disciplines (imaging, anesthesia, diagnostic medicine/necropsy). Ophthalmology was added as a fourth discipline for the class of 2010. Students recorded procedures into the Web-based system, including information about the patient, procedure performed, supervisor, and a self-assessment of performance. Faculty, staff, and house officers evaluated the procedures electronically by confirming that they witnessed the procedure and providing qualitative and written feedback. The class of 2009 recorded 18,492 procedures (M=171/student) and the class of 2010 recorded 16,935 procedures (M=158/student). Two students from each class (2009 and 2010) did not complete the minimum required skills during clinical rotations and returned to perform procedures immediately before (n=3) or immediately after (n=1) graduation to receive their diploma. The Web-based system captured a large number of assessments of technical competency performed in the clinical setting. The system provided students with formative feedback throughout the clinical year, ensured equitable distribution of procedural opportunities across the student body, and required minimal additional resources.     

The dual DVM/MPH degree at the University of Wisconsin--Madison: a uniquely interdisciplinary collaboration

The University of Wisconsin-Madison (UWM) launched a new Master of Public Health (MPH) degree program in 2005. This 42-credit MPH degree consists of 18 core and 14 elective course credits, two seminar credits, and eight field project/culminating experience credits. Unique strengths of the program include its strongly interdisciplinary philosophy, encompassing both health science (human medicine, veterinary medicine, pharmacy, nursing) and social science units on campus, and its emphasis on service learning through instructional and field project ties to the public-health community of the state and beyond. To date, the program has admitted 87 students, including full-time students as well as part-time students who continue to work in the health care and/or public-health sectors. The program is currently proceeding with the process for accreditation through the Council for Education in Public Health. In 2007, a formal dual DVM/MPH program was approved to allow students to integrate DVM and MPH training and complete both degrees in a total of five years. Nine MPH students over the first three years of admissions have been individuals affiliated with veterinary medicine (five DVM students and four post-graduate veterinarians).     

Comparison of the clinical efficacy of two commercial fatty acid supplements (EfaVet and DVM Derm Caps), evening primrose oil, and cold water marine fish oil in the management of allergic pruritus in dogs: a double-blinded study.

Twenty dogs with atopy or idiopathic pruritus were treated in a double-blinded clinical trial with computer-randomized and computer-generated sequences of 4 fatty acid-containing products: evening primrose oil, cold water marine fish oil, DVM Derm Caps, and EfaVet. Each dog received each product for a 2-week period. Five of 20 dogs (25%) had a good-to-excellent reduction in their level of pruritus with at least 1 of the products: evening primrose oil (2 dogs), DVM Derm Caps (1), EfaVet (1), DVM Derm Caps and cold water marine fish oil (1). Only 1 dog experienced a side effect (loose stools). Clinical response to fatty acid supplements appeared to be quite individualized, and independent of age, breed, sex, weight, duration of disease, specific diagnosis, or number of positive intradermal test reactions.     

Assessment of incidental learning of medical terminology in a veterinary curriculum

The objective of this study was to determine whether students in a veterinary curriculum at Mississippi State University would gain an understanding of medical terminology, as they matriculate through their courses, comparable to that obtained during a focused medical terminology unit of study. Evaluation of students' incidental learning related to medical terminology during the 2004/2005 and 2005/2006 academic years indicated that 88.7% and 81.9% of students, respectively, scored above 70% on a medical terminology exam by the end of the first year of the curriculum. For the 2004/2005 academic, 67.6% increased their percentage of correct answers above 70% from the first medical terminology exam to the third. For the 2005/2006 academic year, 61.1% of students increased their score above 70% from the first to the third exam. Our data indicate that students can achieve comprehension of medical terminology in the absence of a formal terminology course.     

Use of key feature questions in summative assessment of veterinary medicine students

Purpose

To prove the hypothesis that procedural knowledge might be tested using Key Feature (KF) questions in written exams, the University of Veterinary Medicine Hannover Foundation (TiHo) pioneered this format in summative assessment of veterinary medicine students. Exams in veterinary medicine are either tested orally, practically, in written form or digitally in written form. The only question formats which were previously used in the written e-exams were Type A Single-choice Questions, Image Analysis and Short Answer Questions. E-exams are held at the TiHo using the electronic exam system Q [kju:] by CODIPLAN GmbH.

Methods

In order to examine less factual knowledge and more procedural knowledge and thus the decision-making skills of the students, a new question format was integrated into the exam regulations by the TiHo and some examiner used this for the first time in the computer based assessment. Following a successful pilot phase in formative e-exams for students, KF questions were also introduced in summative exams. A number of multiple choice questions were replaced by KF questions in four computer based assessment in veterinary medicine. The subjects were internal medicine, surgery, reproductive medicine and dairy science.

Results

The integration and linking of KF questions into the computer based assessment system Q [kju:] went without any complications. The new question format was well received both by the students and the teaching staff who formulated the questions.

Conclusion

The hypothesis could be proven that Key Feature questions represent a practicable addition to the existing e-exam question formats for testing procedural knowledge. The number of KF questions will be therefore further increased in examinations in veterinary medicine at the TiHo.     

石质边坡植被建植两周年群落特征与土壤养分动态

为了解边坡生态防护工程植被建植初期植被特征与基质养分变化规律,依托实际工程,采用定位研究法,对3个不同坡向、坡度的边坡在人工植被建植后2年主要群落特征(物种、盖度和高度等)和土壤养分因子(有机质和速效态养分元素)等每月进行跟踪测试。结果表明,1)边坡人工植被建植初期,群落特征总体上存在明显的季节性变化,建植后第1年物种主要以初播物种为主,物种数相对较少,第2年,随着当地植物的入侵,物种数大量增加。边坡植被一年存在2个枯黄期,分别出现在夏季高温期和冬季低温期,存活部分盖度在冬春季平均盖度最低,到5月随气温回升而突增,8、9月下降,10月又上升,到11月覆盖度最高。群落高度第2年同比第1年均高,表现出较旺盛的长势。2)土壤中碱解氮和有效磷质量分数在植被建植后2年内波动下降,均低于建植初水平;1、2号坡速效钾质量分数在波动变化后有所下降,3号坡在波动变化后略有上升;有机质的质量分数在第1年波动变化后大幅度增加,第2年前3个月明显下降,之后基本持平,第2年末比第1年末有所下降。3)在植被建植初期的2个月内,不同坡向和坡度的边坡之间在群落物种组成和盖度等特征方面存在显著差异(P＜0.01),之后随着边坡植被的大面积覆盖,坡向和坡度对群落特征的影响已不明显。     

An integrative and case-based approach to the teaching of general and systemic pathology

Since 1993, the pre-clinical phase of the professional (DVM) curriculum at Michigan State University College of Veterinary Medicine has included two pathology courses in which both anatomic and clinical pathologists collaborate to teach concepts in general and systemic pathology. Topics such as inflammation, circulatory disturbances, and neoplasia are taught in this collaborative manner in the year 1 General Pathology course, and pathology of the digestive system (including liver and pancreas), urinary system, and lymphoid system are "team-taught" in the year 2 Clinical and Systemic Pathology course. We feel that this approach gives students an appreciation of the whole-body dynamics of a disease process as it occurs in bone marrow, peripheral blood, body fluids, and tissues and that it leads to a deep understanding of pathologic processes. In addition, the use of "active learning" instructional strategies grounded in case discussions further enhances students' understanding of important concepts by demonstration of practical applications and serves to generate strong interest in learning the subject matter. Integration of concepts of pathology with those taught concurrently in other courses, such as those in physiology and microbiology, is also an important component of pathology instruction in the pre-clinical curriculum.     

Communication skills training at the Atlantic Veterinary College, University of Prince Edward Island

Communication skills are considered a core clinical skill in human medicine. Recognizing the importance of communication skills and addressing them in veterinary curricula, however, is just beginning. In the fall of 2003, the Atlantic Veterinary College, University of Prince Edward Island, markedly changed the way in which it approaches communication teaching. An intensive one-week elective rotation on client communication was offered in the senior year. This rotation made extensive use of experiential techniques through the use of role plays and videotaped real client interactions. A group of faculty and hospital staff members were trained as coaches to support students as they practiced their communication in various client scenarios. The skills taught were based on the Calgary-Cambridge Observation Guide, which outlines observable behaviors that contribute to effective medical communication. Student response to and feedback on the rotation have been very positive. As a result, the number of rotations given per year has been increased. Long-term plans include expanding communication skills teaching into other years of the DVM program and incorporating simulated clients into the teaching program. Challenges that lie ahead include the development of a fully integrated communication teaching program that spans the whole curriculum, addressing the ongoing need for the professional development of coaches, improving methods of student assessment, and recruiting/training a sufficient number of coaches.     

Clinical skills and knowledge used by veterinary graduates during their first year in small animal practice

Objective To determine the clinical skills and areas of knowledge used by veterinarians in small animal practice during their first year after graduation and the degree of assistance and supervision they received while developing these skills. Design A postal survey was sent in December 1999 to 59 veterinarians who completed their training at Murdoch University in December 1998. Procedure The first part of the survey asked for information on veterinary work patterns since leaving university. The second part consisted of a list of diagnostic and therapeutic skills of varying complexity and the graduates were asked to indicate whether they had used these skills in practice and whether they had been assisted or supervised while doing them. The respondents were also asked if they had had the opportunity to practise these skills as undergraduates at university or during extramural experience. In the third part the areas of knowledge used in practice were assessed by analysis of a series of consecutive cases. Results Forty replies were received but since three graduates had done no small animal work the analysis of the skills section is based on 37 responses. Thirty graduates supplied information on 994 canine cases and 308 feline cases. The distribution of the mean work time was dogs and cats 69%, horses 13%, farm animals 11%, birds 3% and others 4%. Skills used by over 90% of graduates included general anaesthesia, examination of the tympanic membrane, taking and interpreting an abdominal radiograph, catheterising a male cat, fine needle aspiration of a mass, neutering dogs and cats, tooth scaling and extraction and treating an aural haematoma. The survey also identified the opportunities for undergraduates to practise some of these skills during extramural experience and the extent of assistance given to new graduates during their first year in practice. The areas of knowledge used in over 10% of the cases included vaccination, anaesthesia/sedation, skin/coat problems, general advice on pet health, neutering and musculoskeletal diseases. Conclusion Veterinarians, in their first year after graduation, use a wide range of complex diagnostic and therapeutic skills. Although many of these skills are acquired during the undergraduate training, a significant contribution is made by extramural practical work undertaken during the clinical years of the undergraduate course and in the first year following graduation. Practising veterinarians play an important role in providing opportunities and supervision for clinical training.     

Clinical skills and knowledge used by veterinary graduates during their first year in small animal practice

OBJECTIVE: To determine the clinical skills and areas of knowledge used by veterinarians in small animal practice during their first year after graduation and the degree of assistance and supervision they received while developing these skills. DESIGN: A postal survey was sent in December 1999 to 59 veterinarians who completed their training at Murdoch University in December 1998. PROCEDURE: The first part of the survey asked for information on veterinary work patterns since leaving university. The second part consisted of a list of diagnostic and therapeutic skills of varying complexity and the graduates were asked to indicate whether they had used these skills in practice and whether they had been assisted or supervised while doing them. The respondents were also asked if they had had the opportunity to practise these skills as undergraduates at university or during extramural experience. In the third part the areas of knowledge used in practice were assessed by analysis of a series of consecutive cases. RESULTS: Forty replies were received but since three graduates had done no small animal work the analysis of the skills section is based on 37 responses. Thirty graduates supplied information on 994 canine cases and 308 feline cases. The distribution of the mean work time was dogs and cats 69%, horses 13%, farm animals 11%, birds 3% and others 4%. Skills used by over 90% of graduates included general anaesthesia, examination of the tympanic membrane, taking and interpreting an abdominal radiograph, catheterising a male cat, fine needle aspiration of a mass, neutering dogs and cats, tooth scaling and extraction and treating an aural haematoma. The survey also identified the opportunities for undergraduates to practise some of these skills during extramural experence and the extent of assistance given to new graduates during their first year in practice. The areas of knowledge used in over 10% of the cases included vaccination, anaesthesia/sedation, skin/coat problems, general advice on pet health, neutering and musculoskeletal diseases. CONCLUSION: Veterinarians, in their first year after graduation, use a wide range of complex diagnostic and therapeutic skills. Although many of these skills are acquired during the undergraduate training, a significant contribution is made by extramural practical work undertaken during the clinical years of the undergraduate course and in the first year following graduation. Practising veterinarians play an important role in providing opportunities and supervision for clinical training.     

Teaching the principles of health management to first year veterinary students

A course called Health Management 1 was created as part of a new DVM curriculum at the Ontario Veterinary College. This full year course was designed to introduce students to basic concepts of health management, integrating the disciplines of epidemiology, ethology, and public health in the context of selected animal industries. The course was comprised of 60 lecture hours and four two-hour laboratories. A common definition of health management, incorporating five principles, was used throughout the course, in order to reinforce the concepts and to maintain continuity between lecture blocks. Unlike in the years prior to the introduction of the new curriculum, epidemiology was presented as a tool of health management rather than as a separate discipline. To supplement the lecture and laboratory material, a Web-based resource was created and the students were required to review the appropriate section prior to each lecture block. Small quizzes, consisting of 10 questions each within WebCT, were used to stimulate self-directed learning. Overall, the course was well received by the students. The Web resources combined with the WebCT quizzes proved to be an effective method of stimulating students to prepare for lecture.     

Survey results of an interdisciplinary animal physical rehabilitation course for physical therapy and veterinary students

Elon College and North Carolina State University co-organized an animal rehabilitation elective course given to 12 MPT and 12 DVM students and conducted a post-course survey of the participants. Changes in perceptions of the field of animal rehabilitation, in perceived practice patterns, in the DVM students' perception of the field of PT, and in knowledge of animal rehabilitation were present for 84-100% of students who answered the survey.     

Effect of the recently established admissions procedure on success in the first-year exams at the University of Veterinary Medicine Vienna, Austria

RATIONALE FOR THIS STUDY: The purpose of this study was to compare the success during the first academic year of students who underwent an admissions procedure (class 2005) and students of the three previous classes (2002-2004), who did not undergo an admissions procedure but took their exams under the same curricular framework. METHODOLOGY: Exam results of 802 students of the 2002-2004 classes were compared with those of 181 students from the 2005 class. RESULTS: Students of the 2005 class were more likely to pass all three exams given in the first academic year than students of the 2002-2004 classes (p < 0.001; OR = 3.2), and the quality of two of the three exams (indicated by individual scores) was also significantly better in 2005 than in the preceding classes (p < 0.001). In unselected classes, 25% to 31% of students showed no successful attempts to pass any of the three exams currently administered. CONCLUSION: The implementation of an admissions procedure measuring, among other indicators, academic ability has significantly improved first-year exam performance. Incoming students presenting with higher scores on academic standards are more likely to complete their courses successfully.     

Intermandibular width and and cannon bone length in “winners” versus “others”

Conformation is defined as the form or outline of an animal and is sometimes expanded to include a relationship of form to function. In the course ofa studentproject,25 traits were measured in each of 20 Thoroughbreds as 3-year-olds in training. "Winners" were three year olds who had won a listed race in 1990 as two year olds. "Others" were three year olds who had raced but not won in listed races in 1990 as two year olds. Twelve of these Waits were evaluated using a linear assessment scoring system; 13 traits were measured using a steel tape, vernier calipers or an improvised compass. This short communication confines itself to two measured waits, intermandibular width and cannon bone length.     

Teaching non-technical (professional) competence in a veterinary school curriculum

Data from focused studies and comprehensive surveys suggest that developing or enhancing non-technical (professional) skills will result in a more satisfied and successful veterinary student or veterinary graduate. The College of Veterinary Medicine at Washington State University has devoted considerable time, effort, and resources to augmenting the non-technical aspects of its curriculum while maintaining the traditional strengths of its DVM program. Here we summarize pertinent research and best-practice recommendations from a variety of sources and outline the steps that have been taken, with the underlying rationales, to integrate the teaching and modeling of non-technical (professional) competence throughout a four-year course of veterinary study.