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.     

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 and learning communication in veterinary medicine

Drawing on extensive evidence and experience in human medicine, this article offers a practical conceptual framework for thinking more precisely about how to teach and learn communication systematically and intentionally in veterinary medicine. The overarching goal is to promote the development of communication programs so as to improve communication in veterinary practice to a professional level of competence. A three-part conceptual framework is presented that first explores the rationale behind teaching and learning communication, including the evidence base regarding the impact of communication on clinician-client interactions and outcomes of care and the research on teaching and learning communication skills in medicine. The second part considers four ways to conceptualize what to teach and learn, as explicated by (a) the domains of communication in veterinary medicine; (b) 'first principles' of effective communication; (c) evidence-based goals or outcomes for communication programs; and (d) delineation and definition of the specific individual skills that research evidence supports, as presented in the Calgary-Cambridge Guides. The last part of the conceptual framework examines how to teach communication, including the use of models, a primary focus on skill development as the backbone of communication programs, and the value of other methods supported by the evidence, such as simulated patients, videotape, small groups, and feedback and facilitation skills. Communication impacts the clinician- client interaction and outcomes of care in very significant ways. Communication can and should be taught and learned with as much rigor as other aspects of clinical competence. Veterinary programs at all levels should include the teaching of communication.     

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.     

The building blocks in the professional education process that lead to best practices and quality medicine

It is time for the faculty of veterinary colleges to take responsibility for the veterinary curriculum, to move beyond the debate over teaching styles, and to understanding what a curriculum needs to accomplish. Our challenge is to engage students, faculty, and all veterinary professionals in evidence-based medicine and medical outcomes assessment and to identify best practices and continually improve the quality of veterinary health care. The education program of students must lay the foundation for this essential approach to veterinary practice.     

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.     

A survey of reading, writing, and oral communication skills in North American veterinary medical colleges

In the 1989 report by the Pew National Veterinary Education Program (PNVEP), communication skills topped the list of characteristics the veterinary graduate should possess in order to function effectively in the twenty-first century. To determine the reading, writing, and oral communication requirements and opportunities in veterinary curricula in the US and Canada, and to determine the perceived communication tasks that might be commonly required of practicing veterinarians in the next century, we sent a 15-item communications skills questionnaire to the academic deans of the 31 veterinary curricula in the US and Canada. The results reinforce the importance of communication skills in veterinary medicine, as detailed by the PNVEP over 10 years ago. Based on the responses to our questionnaire and on our own experiences with veterinary medical students, we make several recommendations to enhance communication instruction in veterinary medical curricula.     

Evaluation of veterinary public practice education programs

OBJECTIVE: To describe the number and types of veterinary professional degree and certificate programs providing education in the area of public practice to veterinarians and determine the availability of these programs via distance learning. PROCEDURES: Web-based internet searches were performed for programs for veterinary public practice or public health, population medicine, or Master's degree in Epidemiology. The information reviewed was derived from individual school and program Web sites and from personal e-mail correspondence with school administrators. RESULTS: 17 professional degree and 4 certificate programs were available to provide education and training in the areas of public practice and population medicine to veterinarians. Twelve of these programs have begun since 1998. Of the 17 professional degree programs, 7 are located in the United States and 10 are located in other countries. Nine of the professional degree programs provide education through traditional teaching methods, and 8 provide education and training through distance learning. CONCLUSIONS: During the preceding 5 years, the number of programs available to educate and train veterinarians in the areas of public practice and population medicine has increased. Distance learning is being used to increase capacity and reach a broader audience of veterinarians. With the increase in programs has come an increase in capacity to educate and train veterinarians in the fields of population medicine and public practice. The impact and sustainability of this increased capacity have not been evaluated.     

Four core communication skills of highly effective practitioners.

For 40 years, medical researchers have been studying physician-patient interactions, and the results of these studies have yielded three basic conclusions: physician-patient interactions have an impact on patient health, patient and physician satisfaction, adherence to medical recommendations, and malpractice risk; communication is a core clinical skill and an essential component of clinical competence; and appropriate training programs can significantly change medical practitioners' communication knowledge, skills, and attitudes. Many of these findings are applicable to the practice of veterinary medicine.     

Using clinical audits to identify practitioner learning needs

Clinical audits are used in medicine to monitor practice performance, provide practice feedback, and identify learning needs. Although relatively new to veterinary practice, they hold promise as personal learning needs assessment tools. Continuing veterinary medical education providers are in a unique position to assist practitioners in the design, implementation, and evaluation of clinical audits. This paper discusses the types, the interpretation, and the potential uses of data from clinical audits in the veterinary setting and links audits to continuing veterinary medical education.     

Pharmacists in veterinary education: bridging the gap

Veterinary patients stand to benefit greatly from the collaboration of pharmacy and veterinary medicine, and there are many ways pharmacy and veterinary medicine can work in concert. The best efforts to revise and remodel veterinary and pharmacy education to fit an evolving world of clinical practice are grounded in an understanding of each profession. Veterinary education should impart to its students and residents the skills necessary to critically evaluate drug therapy, select therapies based on facts from drug information sources, and operate a veterinary practice that abides by the legal, regulatory, and operational requirements necessary to maintain and dispense drugs. The academic training environment of each profession must include information on the other, in order to better prepare professionals for a realistic practice environment. When armed with an understanding of what pharmacists can provide their patients, veterinarians can demand these skills where appropriate. With the ultimate goal of producing an optimal learning environment, veterinary curricula should allow both pharmacy and veterinary medicine to work together to build a path to quality patient care and educational superiority.     

Developing and fostering a dynamic program for training in veterinary pathology and clinical pathology: veterinary students to post-graduate education

Recent reports project a deficiency of veterinary pathologists, indicating a need to train highly qualified veterinary pathologists, particularly in academic veterinary medicine. The need to provide high-quality research training for veterinary pathologists has been recognized by the veterinary pathology training program of the Ohio State University (OSU) since its inception. The OSU program incorporates elements of both residency training and graduate education into a unified program. This review illustrates the components and structure of the training program and reflects on future challenges in training veterinary pathologists. Key elements of the OSU program include an experienced faculty, dedicated staff, and high-quality students who have a sense of common mission. The program is supported through cultural and infrastructure support. Financial compensation, limited research funding, and attractive work environments, including work-life balance, will undoubtedly continue to be forces in the marketplace for veterinary pathologists. To remain competitive and to expand the ability to train veterinary pathologists with research skills, programs must support strong faculty members, provide appropriate infrastructure support, and seek active partnerships with private industry to expand program opportunities. Shortages of trained faculty may be partially resolved by regional cooperation to share faculty expertise or through the use of communications technology to bridge distances between programs. To foster continued interest in academic careers, training programs will need to continue to evolve and respond to trainees' needs while maintaining strong allegiances to high-quality pathology training. Work-life balance, collegial environments that foster a culture of respect for veterinary pathology, and continued efforts to reach out to veterinary students to provide opportunities to learn about the diverse careers offered in veterinary pathology will pay long-term dividends for the future of the profession.     

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.     

基于虚拟仿真技术的兽医微生物学实验教学改革

兽医微生物实验是高等院校动物医学等相关专业的重要基础课程,培养目的是让学生熟练掌握病原微生物的基本知识和实验操作技能。探讨传统兽医微生物实验教学中面临的诸多现实问题,提出引入具有高效率、安全性和交互性等优点的虚拟仿真技术。以虚拟仿真实验教学辅助常规实验教学,“虚、实结合”,可以最大限度地拓展时间和空间,丰富实验教学资源,充分调动培养学生的学习兴趣和创新意识,降低高危病原的实验风险,提升实验教学质量和效果,同时也为动物医学教育改革及多层次专业人才的培养开辟新的途径。     

新形势下动物传染病教学的改革探讨

动物传染病学作为动物医学专业的主干课程,是动物医学专业毕业生与社会需求对接的重要环节。根据新形势下动物传染病流行和防控特点的变化,探讨高校动物医学专业该门课程教学改革的方向和措施,以达到激发学生学习兴趣,提高教学效果,增强学生的专业理论和实践技能的目的,培养出符合行业需求的兽医人才。     

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.     

An overview of veterinary medical education in China: current status, deficiencies, and strategy for improvement

Especially in developing countries, the profession of veterinary medicine is closely tied with agriculture and government economic development, the national structure of education, and national public health. Currently, the Chinese veterinary medical educational system and accreditation standards are distinctly different from those of some more developed countries, such as the United States, Japan, or the countries of the European Union. Chinese veterinary education is still closely based on traditional Chinese education approaches and standards, which has led to some deficiencies in the Chinese system. With the development of a stronger economy in China and the growing trend toward globalization, and particularly since China joined the World Trade Organization (WTO), some important questions about China's system of veterinary education are being raised: How can veterinary science develop more rapidly in China? How can it meet the needs of the growing Chinese society? How can China bring its veterinary medical practice more in line with that of other, more advanced countries? This article describes some of the realities of veterinary medical education in China, discusses several existing problems, and puts forward some ideas for possible reforms. It is hoped that by this means those outside China may gain insight into our veterinary education program and that this, in turn, will lead to helpful input from international educators and other professionals to help improve our programs.     

WAAVP/Pfizer award for excellence in teaching veterinary parasitology: teaching of veterinary parasitology--quo vadis?

Some thoughts on training and recruitment of academic teachers and future trends in teaching veterinary parasitology are presented with emphasis on the European situation. It is underlined that research is an indispensable basis for academic teaching. Besides a broad scientific background of the teacher, motivation and teaching methods are also important. Many academic teachers do not receive formal training in teaching methods. In order to improve future education, training of staff members in teaching methods should be promoted. Quality control of teaching and research, already established in many schools, should generally be introduced. Teaching is mostly underestimated in relation to research. Therefore, more weight should be placed on the former both in selecting scientists for the career as academic teachers and in evaluating and ranking departments for their academic activities. In the future veterinary medicine will have to cope with profound changes in the society and the veterinary profession, and the progressing European unification will enhance trends for internationalizing teaching curricula. Therefore, veterinary medicine has to reconsider the teaching subjects and methods and to lay more emphasis on flexibility, skills of problem-solving and self-learning and on training for life-long learning. At present there is an ongoing discussion on the question how to teach veterinary medicine, including veterinary parasitology. There are various options, and some of them are discussed, namely, the disciplinary and the problem-based/organ-focussed approaches. It is concluded that for teaching of veterinary parasitology and related disciplines a combined disciplinary and problem-based approach offers the best chances for fulfilling the requirements of teaching for the future. In the curriculum of undergraduate teaching of veterinary medicine at least 70-90 h should be dedicated to veterinary parasitology using a disciplinary and taxonomic approach. Additional hours are required for instructions on clinical cases in approaches focussed on animal species and/or organ diseases. As there is a need for discussing teaching issues, post-graduate specialization, and continuing education in parasitology and related disciplines on national and international levels, it is recommended to WAAVP to include regular workshops on teaching in the programmes of the biannual conferences, and to establish a permanent committee which should collect information and submit proposals for improvement of teaching veterinary parasitology.