Clinical veterinary students' perceptions of a 'Day one' skills guide

Veterinary schools in the UK are required by the Royal College of Veterinary Surgeons to ensure that their students have attained essential 'Day one' skills (DOS) by graduation. To aid students' understanding of how they could satisfy this requirement, the Royal Veterinary College produced a DOS guide, which was distributed in the 2007 to 2008 academic year to students in the third and fourth years of the professional veterinary course. The same students were surveyed towards the end of the 2008 to 2009 session about the guide, when they were in the fourth and final years, to rate its usefulness and to indicate their perceived levels of competence, both currently and expected at graduation. Focus group discussions were subsequently conducted to explore the findings of the survey. Responses from 88 fourth-year (39 per cent) and 174 (87 per cent) final-year students revealed that while almost all respondents were aware of the DOS guide, their use of it was low. Final-year students rated themselves as being more competent than fourth-year students, but were less optimistic about their expected level of competence regarding several invasive procedures, which some students considered to be 'unattainable' by graduation, despite the apparent value of extramural studies and intramural rotations in providing opportunities for learning.     

Senior veterinary students' perceptions of using role play to learn communication skills

Recent studies of veterinary practice have suggested a correlation between well-developed communication skills and job satisfaction, career retention, customer satisfaction, decreased lawsuits, and financial remuneration for veterinarians. Veterinary educators are under growing pressure to teach functional communication skills to veterinary students; however, the methods employed have not been well evaluated. In this study we have evaluated veterinary student's attitudes to learning communication skills by participating in role play. The study indicates that experiential learning modalities such as role play are perceived as effective by students, despite reluctance to participate and some discomfort surrounding participation.     

Assessment of first-year veterinary students' clinical skills using objective structured clinical examinations

The DVM program at the University of Calgary offers a Clinical Skills course each year for the first three years. The course is designed to teach students the procedural skills required for entry-level general veterinary practice. Objective Structured Clinical Examinations (OSCEs) were used to assess students' performance on these procedural skills. A series of three OSCEs were developed for the first year. Content was determined by an exam blueprint, exam scoring sheets were created, rater training was provided, a mock OSCE was performed with faculty and staff, and the criterion-referencing Ebel method was used to set cut scores for each station using two content experts. Each station and the overall exam were graded as pass or fail. Thirty first-year DVM students were assessed. Content validity was ensured by the exam blueprint and expert review. Reliability (coefficient α) of the stations from the three OSCE exams ranged from 0.0 to 0.71. The three exam reliabilities (Generalizability Theory) were, for OSCE 1, G=0.56; OSCE 2, G=0.37; and OSCE 3, G=0.32. Preliminary analysis has suggested that the OSCEs demonstrate face and content validity, and certain stations demonstrated adequate reliability. Overall exam reliability was low, which reflects issues with first-time exam delivery. Because this year was the first that this course was taught and this exam format was used, work continues in the program on the teaching of the procedural skills and the development and revision of OSCE stations and scoring checklists.     

Evaluating of veterinarians' and veterinary students' knowledge and clinical use of pulse oximetry

RATIONALE FOR THE STUDY: We hypothesized that veterinarians and veterinary students may lack key knowledge about pulse oximetry, which may result in this type of patient monitor not being used on appropriate patient populations or to its full capabilities. METHODOLOGY: A questionnaire was developed to assess an individual's knowledge and understanding of pulse oximetry. Residents and specialists in anesthesiology and critical care at several academic institutions were surveyed first to assess the questionnaire for clarity and to serve as a control group. General veterinary practitioners (GPs) attending continuing education courses at the University of Georgia were surveyed over a 24-month period. Students entering their senior-year anesthesiology rotation at the University of Georgia were also surveyed. RESULTS: Residents and specialists (69% correct responses) scored significantly higher than senior students (46%), who scored significantly higher than GPs (34%). Only 15% of GPs and 21% of senior students reported that they had received training in pulse oximetry in school. Those who had received training scored significantly higher than those who had not. Many GPs did not report using a pulse oximeter on their critical patients under anesthesia, a group that would be expected to benefit from its use. CONCLUSIONS: Veterinarians have a poor understanding of how pulse oximetry works, the information it provides, and how best to apply it to their patients. Furthermore, the respondents did not use pulse oximeters in a manner that would yield the most information and result in the greatest benefit to the patient relative to the cost of the instrument. Didactic training in veterinary curricula and during continuing education opportunities continues to be necessary in order to produce veterinarians who have an understanding of the technologies available to improve patient care.     

Effects of formal training in communication skills on the ability of veterinary students to communicate with clients

All UK veterinary schools have recently introduced small group teaching of communication skills for undergraduates. This study evaluates the effectiveness of this approach in improving the ability of students to communicate with clients in clinical situations. Three groups of clinical veterinary students with either no training or different levels of formal training in communication skills were assessed on their ability to communicate with clients at a local charity clinic. The students' communication skills were assessed quantitatively by direct observation during the consultation and by subsequent questioning of the clients. The accuracy of the clients' recall of relevant information about the animal's condition, medication and management was also analysed. The student groups were then compared on the basis of the scores they obtained. There was a significant improvement in the students' communication skills with increasing levels of training (P<0.0001). The group with the highest level of training consistently achieved higher rankings and median scores than the other two. When appraised by clients, this group significantly outranked both the other groups, but there was no difference between the group with no training and the group with an intermediate level of training. The clients' recall of information given in the consultation was more variable; but the group with the highest level of training achieved higher rankings in all the areas of client recall except for the animal's medication.     

Use of simulated clients in training veterinary undergraduates in communication skills

A course in communication skills has been developed specifically for veterinary students, based on those delivered at many medical schools, and making extensive use of professional actors as simulated clients. Its aim is to raise awareness of the importance of communication among veterinary undergraduates at all stages of the curriculum, and it allows them to role-play in acted-out scenarios. Facilitated small groups provide an environment in which students can receive feedback on their own performance and also give feedback to their colleagues. An independent evaluation suggests that the opportunity to role-play increased the students' confidence in communicating with others. They were able to identify their personal strengths as communicators and gain insights into the aspects of communication they could improve. Feedback and subsequent discussions were highly valued, with the actors playing a crucial role in providing feedback from the client's perspective. Students were able to use the knowledge they acquired when consulting with real clients. Most of the students suggested that the course should continue in its current format, but with more time provided for it in the curriculum.     

Effects of a veterinary student leadership program on measures of stress and academic performance

Assuming leadership roles in veterinary student governance or club activities could be considered an added stressor for students because of the impact on time available for personal and academic activities. The study reported here evaluated the effects of participation in a leadership program and leadership activity across two classes of veterinary students on measures of stress, using the Derogatis Stress Profile (DSP), and on veterinary school academic performance, measured as annual grade-point average (GPA) over a three-year period. Program participants and their classmates completed the DSP three times across the first three years of veterinary school. On average, participating students reported self-declared stress levels that were higher and measured DSP stress levels that were lower than those of the general population. Students were more likely to assume elected or appointed leadership roles while in their first three years of the veterinary degree program if they participated in the optional leadership program and demonstrated lower stress in several dimensions. Some increased stress, as measured in some of the DSP stress dimensions, had a small but statistically significant influence on professional school GPA. The study determined that the most important predictors of students' cumulative GPA across the three-year period were the GPA from the last 45 credits of pre-veterinary coursework and their quantitative GRE scores. The results of the study indicate that neither participation in the leadership program nor taking on leadership roles within veterinary school appeared to influence veterinary school academic performance or to increase stress.     

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.     

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.     

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.     

Assessment of clinical reasoning skills in veterinary students prior to and after the clinical year of training

OBJECTIVE: To examine the effect of various clinical tracks within the veterinary medical clinical curriculum at Texas A&M University on clinical diagnostic proficiency as determined by pre- and post-training assessment. We expected that the clinical track chosen by the student would impact their measured outcome with bias toward higher scores in their chosen field. DESIGN: Prospective cohort study. STUDY POPULATION: 32 students from the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University. PROCEDURES: By use of standardized, written case scenarios, clinical reasoning was assessed twice: once prior to the clinical (fourth) year of the curriculum and again at completion of the clinical year. Students demonstrated their abilities to collect and organize appropriate clinical data (history, physical examination, and laboratory findings), determine clinical diagnoses, and formulate and implement acceptable treatment modalities. Data from clinical assessments were compared for a given cohort and correlated with other measures (eg, grades, standardized test scores, and species-specific curricular track). RESULTS: Differences were detected in clinical diagnostic proficiency among students in different clinical tracks and for different species groups in the case scenarios. Tracking by species group in the clinical veterinary curriculum appeared to affect development of clinical reasoning and resulted in differential proficiency among cases for differing species groups. CONCLUSIONS AND CLINICAL RELEVANCE: Differences in clinical experiences between small animal tracks and all other track opportunities (large animal, mixed animal, and alternative) influenced the development of clinical proficiency in fourth-year veterinary students during their clinical training period.