Building on existing models from human medical education to develop a communication curriculum in veterinary medicine

Communication is a core clinical skill of veterinary medicine and one that needs to be taught and learned to the same degree as other clinical skills. To provide this education and essential expertise, veterinary schools in many countries, especially including North America, the United Kingdom, and Australia, have begun to develop programs and communication curricula. Human medical education, however, has 30 years' experience in developing communication curricula, and is thus an excellent resource upon which veterinary educators can build and shape their own communication programs. This article describes a skills-based communication course that has been successfully implemented for veterinary medical education at Ontario Veterinary College (OVC) and was based on the University of Calgary Faculty of Medicine's well-established program. The Calgary-Cambridge Guides and supporting textbooks provide the scaffolding for teaching, learning, and evaluation in both programs. Resources such as space and materials to support the OVC program were also patterned after Calgary's program. Communication skills, and the methods for teaching and learning them, are equally applicable for the needs of both human medicine and veterinary medicine. The research evidence from human medicine is also very applicable for veterinary medicine and provides it the leverage it needs to move forward. With this extensive base available, veterinary medicine is in a position to move communication skills training forward rapidly.     

Current perspectives on curriculum needs in zoological medicine

Advances have been made in expanding veterinary curricula to deliver basic key knowledge and skills necessary for provision of health care to captive and companion non-domestic or non-traditional species in the veterinary colleges of the United States and Canada. These advances were in large part facilitated by the deliberations and recommendations of the White Oak Accords. Though a five-year review of curricular opportunities at US and Canadian veterinary colleges shows that progress has been made in implementing the recommendations of the White Oak Accords, there remains room for improvement. The broadly comparative and health-maintenance basis of zoological medicine contributes critically to the potential for veterinary medicine to make important contributions to the concept of the integrated health of the planet. Emergence of key zoonotic and production-animal diseases derived from and within wildlife populations since 2000 has increased awareness worldwide of the importance of zoological medicine in protecting both production livestock and public health. These areas are addressed in elective curricula at colleges emerging as centers of excellence in zoological medicine, but it is critical that core curricula in zoological medicine at all schools be strengthened to include these important areas to prepare our DVM/VMD graduates to protect companion-animal, production-animal, and public health.     

Workplace stress, mental health, and burnout of veterinarians in Australia

Objective To determine the frequency of the states of depression, anxiety, stress and burnout using internationally validated methods and to relate these to the demographic characteristics of veterinarians in Australia. Methods A postal survey of registered veterinarians with at least one year's experience and whose address was available; 1947 returned the questionnaire providing data for analysis. Results Overall, veterinarians describe higher levels of depression, anxiety, stress and burnout than the general population. The severity of these states was determined by gender, background, type of practice and years after graduation. Conclusions Modifying the curricula of veterinary schools to include the teaching of personal cognitive and coping skills to undergraduate veterinary students, the provision of the opportunity to enhance these skills throughout their veterinary career and changes in the veterinary workplace could result in improved mental health, increased job engagement and work satisfaction.     

End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making.

Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.     

Reflection: a critical proficiency essential to the effective development of a high competence in communication

Reflection, or the ability to step back from an experience and consider it critically, in an analytical, non-subjective manner, is an essential aspect of problem solving and decision making, and also of effective communication with clients and colleagues. Reflective practice has been described as the essence of professionalism and is therefore a core professional skill; rarely, however, has it been explicitly taught in veterinary curricula, and it has only a recent history in undergraduate human medical curricula. We describe here two preliminary case studies, one in a veterinary medical education context and the other within a human medical education framework, as examples of approaches to assessing a student's ability for 'reflection.' The case studies also illustrate some of the key principles. Both of the case studies described had as their end goal the enhancement of communication skills through critical reflection. At Monash University, Australia, the majority of students were assessed as being at a level of 'reflection in development.' The students in the Ontario Veterinary College case study showed moderately good use of self-awareness and critical reflection as a basis for modifying and integrating communication skills into practice. While both preliminary case studies point to the fact that students recognize the importance of communication and value the opportunity to practice it, few students in either case study identified the importance of reflection for lifelong learning and professional competence. Opportunities to complete critical reflection exercises in other parts of curricula and outside of communication would likely reinforce its importance as a generic skill. Ongoing scholarly approaches to teaching, learning, and evaluating reflection and self-awareness are needed.     

Part I: twenty-year literature overview of veterinary and allopathic medicine

Over the last 20 years, numerous reports, symposia, and workshops have focused on the challenges and changes facing veterinary and allopathic medicine. Many of these have specifically considered the changing economic and demographic profiles of the health professions, the specific roles of health professionals in society, and the importance of professional curricula in meeting changing professional and societal needs. Changing curricula to address future demands is a common thread that runs through all of these reports. Future demands most consistently noted include the fact that modern veterinary curricula must emphasize the acquisition of skills, values, and attitudes in addition to the acquisition of knowledge. Skills relating to business management, strong interpersonal communication, and problem solving have often been noted as lacking in current curricula. Furthermore, future curricula must allow for greater diversification and "specialization" among veterinary students; should promote greater opportunities for an emphasis on public health and population medicine, including food safety, food security, and bio- and agro-terrorism; and should motivate students to be active learners who possess strong lifelong learning skills and attitudes.     

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.     

Enhanced communication by developing a non-anxious presence: a key attribute for the successful veterinarian

In the recent past much has been written about non-technical skills in veterinary medical education. This dialogue has focused extensively on competence in behaviorally based communication skills for successful veterinary practice. Other relationship-based communication skills are also useful in communication, such as self-awareness, flexibility, non-judgment (compassion), and being present. All of these relationally based skills are present in the concept of non-anxious presence. This article will review the history of the term 'non-anxious presence' (NAP), discuss a proposed model of NAP for the veterinary medical environment, and review some methods useful in teaching NAP in veterinary medical education.     

Is it time to define veterinary professionalism?

The medical profession has spent much time and many resources engaging in a discourse of medical professionalism and debating the appropriate attitudes and behavior of physicians, but little has been published concerning the concept of veterinary professionalism. Physicians are commonly examined by social scientists and educationalists to establish definitions of medical professionalism in order to teach and assess these values within curricula. This challenging process has not been without criticism, however, with some calling the numerous definitions unhelpful, especially when these behaviors are not demonstrated in practice or the wider sociological implications of medical professionalism are ignored. Veterinary curricula often include professional skills, and there has been some discussion about their inclusion as well as the scope of veterinary surgeons and their role in society. Despite this, no true definition of veterinary professionalism exists, and the teaching of the values and behaviors expected of veterinary professionals may not be explicit. Regardless of the difficulties of engaging in such a discourse, perhaps it is time that this occurred and a realistic and usable definition of veterinary professionalism is established. This is a period of change for the veterinary profession, and a teachable and assessable definition can provide some clarity and assist educators within ever evolving veterinary curricula.     

Perceptions of fourth-year veterinary students about the human-animal bond in veterinary practice and in veterinary college curricula

OBJECTIVE: To assess veterinary students' perceptions regarding the importance of addressing the human-animal bond in veterinary practice and their perceptions about the adequacy of curricula on the human-animal bond as presented in US veterinary colleges. DESIGN: Survey. PROCEDURE: Data were collected via a brief questionnaire mailed during the summer of 1996. Questionnaires were returned by 552 senior veterinary students representing 21 of 27 veterinary colleges in the United States. RESULTS: Senior veterinary students believed that the human-animal bond should be a concern of practicing veterinarians, but most did not believe they were receiving adequate instruction about the human-animal bond in their veterinary colleges. Gender was significantly related to differences in perceptions; female students appeared to have more interest in addressing the human-animal bond than male students. Students in small animal programs viewed the human-animal bond differently than those in large animal programs. Finally, students attending schools with extensive human-animal bond or human relations curricula were more likely to believe they were receiving adequate instruction in this area than students in other schools. CONCLUSIONS AND CLINICAL IMPLICATIONS: Curricula addressing the human-animal bond need to be developed and implemented in veterinary colleges in the United States.     

Food-supply veterinary medicine and veterinary medical education: an Australian perspective

Food-supply veterinary medicine has been an essential part of veterinary degree programs in Australia since the first veterinary school opened in the late nineteenth century. Australian veterinary schools, like others internationally, are being challenged by the relevance of material in current curricula for modern food-supply veterinary medicine. Additionally, student aspirations are a major issue, as curriculum designers balance companion-animal training with the herd/flock-based issues that focus on productivity and profitability. One of the challenges is to examine the relative balance of education in generic skills (self-knowledge, change management, teamwork, leadership, negotiation) with more technically or scientifically based education. An ongoing process of curriculum review and renewal, which involves input from both external and internal stakeholders and allows regular review and assessment, is needed to ensure continuing curriculum relevance.     

Coaching and feedback: enhancing communication teaching and learning in veterinary practice settings

Communication is a critical clinical skill closely linked to clinical reasoning, medical problem solving, and significant outcomes of care such as accuracy, efficiency, supportiveness, adherence to treatment plans, and client and veterinarian satisfaction. More than 40 years of research on communication and communication education in human medicine and, more recently, in veterinary medicine provide a substantive rationale for formal communication teaching in veterinary education. As a result, veterinary schools are beginning to invest in communication training. However, if communication training is to result in development of veterinary communication skills to a professional level of competence, there must be follow-through with effective communication modeling and coaching in practice settings. The purpose of this article is to move the communication modeling and coaching done in the "real world" of clinical practice to the next level. The development of skills for communication coaching and feedback is demanding. We begin by comparing communication coaching with what is required for teaching other clinical skills in practice settings. Examining both, what it takes to teach others (whether DVM students or veterinarians in practice for several years) and what it takes to enhance one's own communication skills and capacities, we consider the why, what, and how of communication coaching. We describe the use of teaching instruments to structure this work and give particular attention to how to engage in feedback sessions, since these elements are so critical in communication teaching and learning. We consider the preconditions necessary to initiate and sustain communication skills training in practice, including the need for a safe and supportive environment within which to implement communication coaching and feedback. Finally we discuss the challenges and opportunities unique to coaching and to building and delivering communication skills training in practice settings.     

Teaching veterinary parasitology: the North American perspective

The American Association of Veterinary Parasitologists (AAVP) initiated a study of parasitology curricula in veterinary schools in the US and Canada in November 1989. An ad hoc committee (Task Force) and then the Education Committee developed a position paper on teaching parasitology in veterinary colleges. In addition to confirming the importance of parasitology as a discipline they recommended a set of general learning objectives and proposed topic-specific titles rather than parasite-/group-specific titles. Another problem observed in teaching parasitology was a significant reduction in time available to teach parasitology. One way to compensate for the lost classroom time is to utilize some of the technological advances in presenting the material to students.     

An alumni survey to assess self-reported career preparation attained at a US veterinary school

The American Veterinary Medical Association (AVMA) Council on Education (COE) has challenged veterinary schools to improve self-assessment of curricular outcomes. One way to assess the quality of education is to gather feedback from alumni. To successfully gather feedback using a questionnaire, questions must be pertinent to veterinary education and include quantifiable responses. Several principles must be applied in questionnaire development to ensure that the questions address the intended issues, that questions are interpreted correctly and consistently, and that responses are quantifiable. The objectives of the questionnaire for alumni of Mississippi State University's College of Veterinary Medicine (MSU-CVM) were twofold: (1) to determine whether graduates were comparable to their US peers in terms of work opportunities and salary, and (2) to evaluate how well the CVM curriculum prepared students to begin their veterinary careers. Demographic categories used by the AVMA and published knowledge, skills, attitudes, and aptitudes of veterinary graduates were used in developing the questions. College-specific questions, such as those relating to student activities and impressions of college resources, were also incorporated. Questionnaires were mailed to participants, who could respond via the World Wide Web. Questionnaire results allowed leaders within the college to determine which aspects of alumni's experiences were exceptionally positive, which needed immediate response, and which might require further study. This article describes the application of principles in developing, administering, and analyzing responses to a questionnaire regarding veterinary education.     

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.     

Understanding veterinary students' use of and attitudes toward the social networking site, Facebook, to assist in developing curricula to address online professionalism

Social media is an increasingly common form of communication, with Facebook being the preferred social-networking site among post-secondary students. Numerous studies suggest post-secondary students practice high self-disclosure on Facebook. Research evaluating veterinary students' use of social media found a notable proportion of student-posted content deemed inappropriate. Lack of discretion in posting content can have significant repercussions for aspiring veterinary professionals, their college of study, and the veterinary profession they represent. Veterinarians-in-training at three veterinary colleges across Canada were surveyed to explore their use of and attitude toward the social networking site, Facebook. Students were invited to complete an online survey with questions relating to their knowledge of privacy in relation to using Facebook, their views on the acceptability of posting certain types of information, and their level of professional accountability online. Linear regression modeling was used to further examine factors related to veterinary students' disclosure of personal information on Facebook. Need for popularity (p<.01) and awareness of consequences (p<.001) were found to be positively and negatively associated, respectively, with students' personal disclosure of information on Facebook. Understanding veterinary students' use of and attitudes toward social media, such as Facebook, reveals a need, and provides a basis, for developing educational programs to address online professionalism. Educators and administrators at veterinary schools may use this information to assist in developing veterinary curricula that addresses the escalating issue of online professionalism.     

Implementing a simulated client program: bridging the gap between theory and practice

INTRODUCTION: This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. METHOD: One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. RESULTS: Implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. CONCLUSIONS: Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.     

Development and validation of a competency framework for veterinarians

Changing demands from society and the veterinary profession call for veterinary medical curricula that can deliver veterinarians who are able to integrate specific and generic competencies in their professional practice. This requires educational innovation directed by an integrative veterinary competency framework to guide curriculum development. Given the paucity of relevant information from the veterinary literature, a qualitative multi-method study was conducted to develop and validate such a framework. A competency framework was developed based on the analysis of focus group interviews with 54 recently graduated veterinarians and clients and subsequently validated in a Delphi procedure with a panel of 29 experts, representing the full range and diversity of the veterinary profession. The study resulted in an integrated competency framework for veterinary professionals, which consists of 16 competencies organized in seven domains: veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development. Training veterinarians who are able to use and integrate the seven domains in their professional practice is an important challenge for today's veterinary medical schools. The Veterinary Professional (VetPro) framework provides a sound empirical basis for the ongoing debate about the direction of veterinary education and curriculum development.     

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.     

Interfacing professional training in health maintenance and preventive medicine.

Because of emerging economic realities of the latter half of this century, the practice of preventive medicine, as opposed to curative medicine, is becoming essential in developed and developing countries. This holds true in veterinary medicine as well as in human medicine, and as we become increasingly aware of this fact, we also recognize the increasing interdependence of both fields. To determine the extent to which veterinarians are prepared to deal with this change in emphasis, two surveys have been prepared; one directed to various specialty groups within the profession and the other directed to schools of veterinary medicine. The first survey was designed to identify areas in which veterinarians felt their training had been deficient relative to decision making in applied preventive medicine. The second survey queried the schools to determine what changes had been made in their curricula to remedy these inadequacies.