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.     

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.     

Evaluation of a dental model for training veterinary students

Periodontal disease has deleterious effects on an animal's health and potentially serious implications for its welfare. Consequently, veterinarians frequently perform routine periodontal treatment in small-animal practice. One would therefore assume that small-animal dentistry would constitute a core component of a veterinary curriculum. However, most practitioners received little or no formal training in dentistry during their veterinary degrees, and the amount of instruction students currently receive is variable, often with limited opportunities to practice. At the Royal Veterinary College, a prototype dental model was developed to address the lack of practical training; it was made using ceramic tiles, silicone sealant, and grout to emulate teeth, gingiva, and calculus, respectively. A study was conducted with third-year veterinary students to compare the outcomes of learning to perform a professional dental cleaning using a model (group A) or a video (group B). Performance was assessed using an objective structured clinical examination. Students in group A scored significantly better than those in group B (p<.001). All students also completed a questionnaire evaluating attitudes toward the use of a dental model in learning dentistry-related skills. All students identified a model as a potentially valuable learning tool to supplement existing teaching methods and facilitate the acquisition of small-animal dentistry skills. The dental model has the potential to equip students with useful, practical skills in a safe and risk-free environment.     

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.     

Analysis of a practice management computer software program for owner compliance with recall reminders

The purpose of this study was to describe clients' level of compliance with reminders that are computer generated and to identify factors associated with owner response to a recall. Client response to a recall notice revealed that clients responded to reminders for vaccination about 3 times less often than for the other recall codes combined (dental procedures, laboratory tests, medical progress examinations, and neutering). These results suggest that veterinarians need to move away from annual vaccination reminders and toward the promotion of preventive veterinary services, such as annual wellness examinations, screening laboratory testing, and routine dental procedures. Once a practice has committed to and set up the required computer systems to promote preventive veterinary care, the stage is set for the implementation and monitoring of recommendations and reminders. This type of practice philosophy and marketing coincides perfectly with an approach to maximizing compliance in all aspects of veterinary medicine.     

Over-the-counter stimulant, depressant, and nootropic use by veterinary students

US veterinary students are subject to significant stress throughout their veterinary education. In this article, the authors characterize the use of over-the-counter (OTC) medications and relate their use to stress in a veterinary student population. Of the students sampled, 35% were OTC medication users; 33% of these were regular OTC medication users. Forty-three percent of students were energy drink (ED) users; 45% of these were regular ED users. OTC medication users had significantly higher stress scores than non-OTC medication users, and ED users had significantly higher anxiety scores than non-ED users. The most common reasons for use given by OTC medication users were to help with studying and to fall asleep at night. Depression scores were significantly higher for juniors and sophomores than for freshmen. Depression, stress, and anxiety scores were all lower in the Colorado State University students when compared with the University of Georgia students. OTC medication and ED veterinary student users had distinct characteristics that differed from those of nonusers. Users suffered from more stress and anxiety and had more difficulties with sleep, which may have affected their overall health and academic performance. Educating veterinary students about the consequences of using OTC medication and ED and providing counseling support may be of benefit to veterinary students' psychological well-being.     

Survey of veterinary technical and professional skills in students and recent graduates of a veterinary college

OBJECTIVES: To determine perceptions of veterinary technical and professional skills among veterinary students and recent graduates. DESIGN: Cross-sectional study. SAMPLE POPULATION: 281 students and 142 recent graduates from the Ontario Veterinary College. PROCEDURE: A survey was designed and administered to first- through fourth-year students and veterinarians who had graduated either 1 or 6 years before survey administration. RESULTS: Overall response rate was 70%. Learning about technical and professional skills was highly valued. Most participants felt they had not received instruction about professional skills, but those who had felt more competent about them. Perceptions of competence increased slightly with increased comfort discussing emotional veterinary issues with instructors. Neither gender nor increased age was related to increased feelings of competence. Almost all fourth-year students felt competent and comfortable about examining an animal with the client present, assessing suffering, diagnosing parvovirus infection, performing surgery, and working as group members. However, many did not feel competent or comfortable about delivering bad news, setting time limits yet providing quality service, helping clients with limited funds make treatment decisions, dealing with demanding people, and euthanasia. Feelings of competence and comfort were closely related but were not identical. CONCLUSIONS AND CLINICAL RELEVANCE: In the interests of best preparing entry-level veterinarians, technical and professional skills need to be emphasized in a learning environment where students feel comfortable discussing emotional veterinary issues. A professional skills curriculum addressing underlying self-awareness, communication, and interpersonal issues, as well as procedural matters, would likely increase the proportion of fourth-year students who feel competent and comfortable about professional skills by the end of their undergraduate training.     

Teaching surgery to the veterinary novice: the Ohio State University experience

Surgical training in veterinary medicine has evolved rapidly over the past several decades. Catalysts for change include pressure from concerned students and the public to reduce the use of live animals in teaching; less-than-effective preparation of students for live surgery experience; an overall reduction in faculty time and effort devoted to skills training; college budgetary reallocations mandating reductions in expensive group laboratory experiences; and more specialized case-load patterns in clinical rotations, which have reduced students' exposure to common surgical conditions. In response to these trends, methods for surgery educators to reduce, refine, and replace live animals in surgery training courses at veterinary schools have received broad attention. When these methods are used effectively in a curriculum, it is no longer necessary to sacrifice animals for adequate student training. This article describes a successful and ethical surgical training program used at the Ohio State University College of Veterinary Medicine (OSU-CVM). This program provides early exposure to skills training using surgical simulators and auto-tutorials, ensures that basic skills are mastered before students are exposed to cadaver practice, and requires application of model-based skills to cadavers, with final matriculation to intensive exposure to multiple live-animal procedures via a collaborative surgery program with a local shelter.     

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.     

Communicating with special populations: children and older adults.

Veterinary professionals must meet the growing expectations of a diverse range of clients to sustain success in veterinary medicine. Few veterinarians, however, receive comprehensive skills training for communicating effectively with clients, particularly among special populations, such as children and older adults. An increasing number of veterinary professionals have recognized a need to master requisite skills for effectively interacting with pet-owning families. This article highlights the importance of the human-animal bond for children and older adults, addresses issues of pet loss, and provides suggestions for meeting the communication needs of both populations.     

Animal handling as an integrated component of animal and veterinary science programs at the University of Queensland.

Students in animal science and veterinary science at the University of Queensland (UQ) have similar introductory courses in animal handling in year 1 of their degree programs. Veterinary students take animal-handling instruction in farm and companion animals, whereas animal science students are instructed in handling farm animals, horses, and rodents. Veterinary students are introduced to rodents, and animal science students to dogs and cats, in subsequent years of the curriculum. Both cohorts receive additional training, with clinical emphasis for veterinary students in years 3, 4, and 5 of their five-year curriculum. The introductory course is well received by students; both student cohorts appreciate the opportunity provided and the effort that goes into the animal-handling classes. Undergraduates realize that acquiring animal-handling skills will increase their proficiency in their subsequent careers; veterinary graduates recognize that their handling prowess will give their clients confidence in their abilities. Most clients cannot judge the competence of a veterinarian's diagnosis or treatment but will judge their ability based on their handling skills. Ongoing practice allows students to become competent in animal handling.     

Evaluation of a hemostasis model for teaching ovariohysterectomy in veterinary surgery

OBJECTIVE: To evaluate the efficacy of a reusable plastic model mimicking the anatomy and hemodynamics of the canine female genital tract for teaching basic surgical skills and ovariohysterectomy. SAMPLE POPULATION: 40 veterinary students of the class of 1998. STUDY DESIGN: Prospective study. METHODS: Students'confidence level and experience in private practice was evaluated via questionnaire before training. Students in 2 groups performed an ovariohysterectomy on cadavers (group C, n = 20) or on the model (Group M, n = 20) for 2 hours. Students' psychomotor and basic surgical skills were objectively assessed by the following tests: ligation of a foam cylinder, passing a needle through the eyelets of an electronic suture board, and ligating latex tubing. Results were compared before and after training and within and between groups. The ability of students to perform an ovariohysterectomy in a live dog after training was compared between groups with a scoring system. RESULTS: Students in both groups had similar surgical experience and basic skills before training. The results of the psychomotor and basic surgical skills tests were better in group M after training than group C. The improvement of each student in performing these tasks also increased when students were trained with the model. Scores assigned to students performing an ovariohysterectomy in a live dog were higher in group M (31.45 +/- 1.15) than in group C (20.7 +/- 1.42). CONCLUSION: The model was more effective than cadavers in teaching basic surgical skills and ovariohysterectomy in dogs.     

What is it like to be an international student at veterinary school? Perception and performance in first year-a case study at a UK veterinary school

Transition into higher education requires students to adjust to a new environment while showing greater independence in managing their own academic and personal life. This is often more difficult for international students who have to adjust to a different country, culture, and potentially another language. A cohort of first-year veterinary medicine students (17% international students) was investigated at a UK university using qualitative and quantitative questionnaires rating first-year experience and support services and statistical analysis of students' assessment performance. While the overall undergraduate perception was that they had learned a lot and progressed well, students in both groups struggled to cope with the workload. The non-UK educated students and students with English as a foreign language also struggled more with teaching delivery in lectures and participation in self-directed group learning and were more likely to feel that the veterinary degree program was too difficult. There was no statistical difference in how British and international students perceived the support system, although it was noticeable that the level of tutorial support was perceived as tutor-dependent. The international students particularly struggled with the assessments in early modules and also with the spot assessment method. However, in the practical assessments, using observed, structured practical exam stations, international and British students performed equally well. Increased support in the initial transition time, especially with regard to communication skills and confidence required for interactive teaching and learning environments such as small-group teaching, as well as increased time for specific assessment types, might benefit the needs of many international students.     

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.     

Evaluation of a Hemostasis Model for Teaching Basic Surgical Skills

The need for alternative methods of teaching veterinary medicine and surgery has increased in recent years because of increasing costs and changing public opinion. For these reasons a hemostasis model was developed that mimics the arteries and veins of the peripheral vascular system, and can be used to teach the basic skills involved in blood vessel ligation and division. This study evaluated the effectiveness of the fluid hemostasis model compared with using live animals for teaching these skills. Forty sophomore veterinary students participated in the study. Two groups of 20 students each received identical instruction in the basic techniques required for vessel ligation and division. The students then completed various exercises using inanimate models to objectively evaluate their psychomotor skills. Both groups then practiced the techniques for equal time periods; one group used the hemostasis model and the other performed a splenectomy on live dogs. After the practice session, the students were videotaped (for later evaluation), as they performed vessel ligations and divisions. The students then repeated the exercises using the inanimate models for evaluation of skills improvement. Questionnaire responses before and after the project were obtained to determine the students' views on the need for inanimate models for teaching purposes. Results of this study indicate that the hemostasis model was as effective as live animals for teaching the basic skills involved in blood vessel ligation. The students' opinions regarding the use of properly designed inanimate models for teaching these skills were dramatically changed.     

Development and evaluation of a leadership program for veterinary students

Leadership skills are important for many facets of professional life, but no known leadership training programs exist in North American veterinary schools. It was the purpose of this project to develop, deliver, and evaluate a leadership program for first-year veterinary students. Leadership attributes emphasized in the course included effective communication, openness to learning from others, self-awareness, commitment beyond self-interest, motivation, decision making, understanding issue complexity, and team building. The five-day course was delivered to 21 new veterinary students randomly selected just prior to their first-year orientation in the fall of 2000. Participants ranked themselves higher than non-participants in a post-course evaluation on their ability to be effective leaders. Participants reported an increase in self-confidence and a clearer understanding of their leadership roles. Participants also noted new support systems among co-participants and expressed a new ability to consider complex issues more broadly. Most reported that they frequently used enhanced skills in giving and receiving feedback and team building. Other leadership tools identified as valuable included negotiation, group dynamics, a structured approach to problem solving, time management, and an awareness of personal learning style preferences as a means to improve communication.     

Features that contribute to the usefulness of low-fidelity models for surgical skills training

For practical, ethical and economic reasons, veterinary surgical education is becoming increasingly dependent on models for training. The limited availability and high cost of commercially produced surgical models has increased the need for useful, low-cost alternatives. For this reason, a number of models were developed to be used in a basic surgical skills course for veterinary students. The models were low fidelity, having limited resemblance to real animals. The aim of the present study was to describe the students' learning experience with the models and to report their perception of the usefulness of the models in applying the trained skills to live animal surgery. One hundred and forty-six veterinary fourth-year students evaluated the models on a four-point Likert scale. Of these, 26 additionally participated in individual semistructured interviews. The survey results showed that 75 per cent of the students rated the models 'useful'/'very useful'. Interviews revealed that tactile, dimensional, visual, situational and emotional features are important to students' perception of a successful translation of skills from models to live animal. In conclusion, low-fidelity models are useful educational tools in preparation for live animal surgery. However, there are specific features to take into account when developing models in order for students to perceive them as useful.     

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.     

A philosophy and approach to teaching the epidemiology of food-borne, waterborne, and zoonotic diseases

Faculty members from veterinary colleges that teach courses on food-borne, waterborne, and zoonotic diseases to non-veterinary students face unique challenges. The diversity of students' backgrounds, skills, and goals and the public nature of the science require some ingenuity in combining good science with the ability to communicate clearly in a variety of public forums. Drawing on pedagogical theory, the nature of the material, and the diverse abilities of the students, we have put together an effective teaching package for non-veterinary courses on these subjects, which includes a range of methods from outbreak investigations to town hall meetings and food diaries.