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

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

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.     

Compliance: crafting quality care.

The concept of compliance involves the consistency and accuracy with which a client follows the regimen recommended by the veterinarian or other veterinary health care team member. Contrary to common belief, most compliance failures are not the direct result of a client's unwillingness to comply. This article will help the reader better appreciate the critical importance of effective communication by the entire veterinary health care team in achieving compliance. Success is predicated on an alliance between the practice team and the client. Certain paradigms surrounding compliance in veterinary practice are discussed, and the positive outcomes of compliance, including optimal patient care, exceptional client service, employee career growth, and economic ramifications, are explored.     

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.     

Ethical dilemmas in veterinary medicine.

Veterinarians frequently encounter situations that are morally charged and potentially difficult to manage. Situation involving euthanasia, end-of-life care, economics, and inadequate provision of care create practical and moral dilemmas. Ethical tension may be attributable to differences in beliefs regarding the moral value of animals, client and veterinary responsibilities, and deciding what is best for an animal. Veterinarians can employ communication skills used in medical situations to explore the reasons underpinning ethical dilemmas and to search for solutions with clients, staff, and colleagues.     

Why measuring outcomes is important in health care

A new strategy has been introduced in human health care, namely, achieving the best outcomes for the lowest cost and thus maximizing value for patients. In value‐based care, the only true measures of quality are the outcomes that matter to patients. When outcomes are measured and reported, it fosters improvement and adoption of best practices, thus further improving outcomes. Understanding outcomes is central in providing value and represents an opportunity for redefining veterinary patient care. Value is created by improving the outcomes of patients with a particular clinical condition over the full cycle of care, which normally involves multiple specialties and care sites. To be successful, a key aspect of value based care is working as teams (integrated practice units) centered around the patient's clinical condition. As veterinary medicine has become more specialized and more complex, multidisciplinary communication and trust among the care team are paramount in providing value to patients (and clients). Use of patient‐reported outcomes is an essential aspect for improving clinical care, because it enhances the connections among doctors and with patients. Designing and implementing owner‐reported outcomes in veterinary clinical practice will lead to an understanding of the effects of treatments on outcomes and quality of life (QOL) of our patients from the owner's perspective, a key way to assess a veterinary patient's QOL.     

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.     

Quality of equine veterinary care. Part 2: Client satisfaction in equine top sports medicine in The Netherlands

The aim of this study was to evaluate systematically the quality of equine veterinary top sports medicine in The Netherlands and the degree to which the expectations in the field are met. Focus was on structure, process and outcome of care. The structure of care is generally satisfactory but there is insufficient transfer of applicable scientific knowledge to the equine community and a lack of regular checks by team vets. The process of care is hampered by the failure in communication between the veterinary and paraveterinary members of a team. For continuation of the excellent international results of Dutch riders and drivers a more collaborative approach, abandoning the often secretive character of equine medicine in relation to sport horses, is necessary.     

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.     

Increasing adherence in practice: making your clients partners in care.

Clients may appear compliant but may not fully adhere to recommendations made by the veterinarian or veterinary technician for many reasons. Client adherence is directly related to one's communication skills, which can be practiced by all members of the health care team in each client encounter. The four habits approach to enhancing communication skills has been tested in a large human health care organization and shown to result in greater satisfaction between patients and doctors as well as in improved adherence to recommendations. This model is easily adapted to small animal practice and provides the foundation for a relationship-centered approach to care.     

What makes a great clinical team? Stakeholder perspectives on the attributes of effective veterinary health care teams in Australia

Extensive research in the business and organisational literature links teamwork to enhanced productivity and employee job satisfaction. Good teamwork capability is also a highly regarded graduate attribute linked to employability. This study explored desirable teamwork attributes for veterinary technology graduates in Australia, by surveying veterinarians, veterinary technology graduates, veterinary nurses, clients and academics. Respondents highlighted the importance of seven attributes sourced from the cross‐disciplinary teamwork literature—‘flexibility’ (in approach to work), ‘agreeableness’, being ‘cooperative’, ‘socially sensitive and perceptive’, ‘conscientiousness’, being ‘accepting of others’ and ‘sharing professional values’. The majority in each stakeholder group viewed all attributes important for teamwork concurring with findings in other fields. Few differences were found between and within groups with veterinarians and academics rating ‘conscientiousness’ higher than others and female clients placing more importance on relational attributes compared to male clients. Thematic analysis of an open‐ended item asking the veterinary health care groups, and veterinary academics, to define teamwork generated nine themes centred on: collaboration, goals and outcomes, sharing values, relationships, diversity, communication, task‐orientation, personal attributes, and workplace culture. This study illuminates an interprofessional perspective on veterinary teamwork. Results will be useful for veterinary technology, veterinary nursing and veterinary educators when developing a curriculum for interprofessional teamwork to enhance team performance, employability and, ultimately, the quality of veterinary services.     

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.     

Reducing the suicide rate among veterinary surgeons: how the profession can help

A short communication on page 415 of this issue of The Veterinary Record draws attention to the high suicide rate among members of the veterinary profession. In this article, Professor Richard Halliwell, who has recently chaired a series of meetings on this matter at the Royal College of Veterinary Surgeons, and Mr Brian Hoskin, chairman of the Veterinary Benevolent Fund, describe some of the support mechanisms available to veterinary surgeons and discuss what more might be done.     

AAFP and ISFM feline-friendly handling guidelines

BACKGROUND: The number of pet cats is increasing in most countries, often outnumbering pet dogs, yet cats receive less veterinary care than their canine counterparts.(1) Clients state the difficulty of getting the cat into a carrier at home, driving to the clinic, and dealing with the fearful cat at the veterinary clinic as reasons for fewer visits.(2) Educating and preparing the client and the veterinary team with regard to respectful feline handling is necessary in order to avoid stress and accomplish the goal of good health care. Without such preparation, feline stress may escalate into fear or fear-associated aggression. The resulting stress may alter results of the physical examination and laboratory tests, leading to incorrect diagnoses (eg, diabetes mellitus) and unnecessary treatments.(3-5) Without compassionate and respectful handling by the veterinary team, clients may feel the team lacks skills and compassion, or does not understand cats. Injury may occur to the cat, client and/or veterinary team.(6) Clients who want to avoid stress for their cat may avoid veterinary visits or choose another practice instead. GOALS: The use of feline-friendly handling techniques should reduce these problems. Handling is most successful when the veterinary team adapts the approach to each individual cat and situation. The goal of these guidelines is to provide useful information for handling cats that can lead to: ? Reduced fear and pain for the cat. ? Reinforced veterinarian-client-cat bond, trust and confidence, and thus better lifelong medical care for the cat. ? Improved efficiency, productivity and job satisfaction for the veterinary team. ? Increased client compliance. ? Timely reporting and early detection of medical and behavioral concerns. ? Fewer injuries to clients and the veterinary team. ? Reduced anxiety for the client.     

Classical swine fever and avian influenza epidemics: lessons learned

Experience with recent large-scale epidemics of Classical Swine Fever and Avian Influenza--among others in the Netherlands--have teached us several lessons that should prepare us better for future outbreaks. Among others, improving early detection of outbreaks--by using syndrome surveillance systems--is a key factor, in which farmers and veterinary practitioners have an imminent role. A major step in this respect is facilitation of the use of exclusion diagnostics without closing down the farm in clinical situations with non-specific clinical signs observed in sick animals. The hesitance of farmers and veterinary practitioners to report a suspect clinical situation on a livestock farm and how to facilitate that process is another major issue. Furthermore, the importance of communication between the field and the laboratory with respect to post mortem examination will be highlighted, and the need for outbreak simulation exercises with neighbouring countries in order to be better prepared, will be discussed.     

Use of drama in teaching the human side of veterinary practice

Objective To describe a teaching experiment in which fifth year veterinary students were given the opportunity, using dramatic scenarios, to consider ways of dealing with emotive issues relevant to veterinary practice, that demand good communication skills.
Design Workshops were devised using dramatised scenarios of several critical incidents in practice, including euthanasia. A clinical psychologist and several veterinary practitioners participated in discussions. Both live performances and video scenarios were presented to fifth year veterinary students and were followed by group discussions. Each workshop was evaluated and modifications were made where necessary.
Results The teaching format involving drama was well received. The combination of drama and discussion was more effective than a formal talk and discussion, provoking animated participation and maintaining audience attention. The majority of students considered that comments and advice from attending veterinarians were the most useful parts of the workshops in preparing them for veterinary practice. The large audience (up to 45 attendees) was considered to be desirable for enhancing discussion. Requests for more similar sessions were made by students.
Conclusion Drama was found to be a satisfactory modality in teaching communication skills in preparing veterinary students for practice.     

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.     

基于非线性混合效应模型分析兽药药代动力学研究进展

利用数学建模分析兽药药代动力学历来已久。兽药药代动力学中应用数学建模和模拟分析可简化和加快兽药研发进程。非线性混合效应模型分析方法是兽药药代动力学建模和模拟的主要方法之一,该方法对临床合理用药、新药研发及评审更高效具有很大意义,同时阐明一些传统药动学无法回答的问题。本文综述了非线性混合效应模型在分析兽药药代动力学主要原理及应用进展,以期望非线性混合效应模型分析方法在我国新兽药研发与评审中应用提供积极有益的参考。     

A SURVEY OF RADIOLOGISTS AND REFERRING VETERINARIANS REGARDING IMAGING REPORTS

An imaging report is a vital communication tool between a radiologist and clinician. In a field where in‐person communication may not be readily available, it is imperative that the report clearly relays pertinent clinical information in a timely manner. The purpose of this observational study was to describe and compare opinions and expectations of small animal general practitioners, veterinary specialists, and veterinary radiologists regarding the imaging report. Online surveys were distributed, and data were collected from 202 veterinary clinicians and 123 veterinary radiologists. The majority (89%) of clinicians were satisfied with their imaging reports and stated that they read the radiology report as soon as it was available (92%). Just less than half (48%) of clinicians indicated it was standard of care that a board‐certified veterinary radiologist read all imaging studies. Radiologists and clinicians agreed that a clinical history (98% and 94%, respectively) and clinical question (82% and 68%, respectively) were needed to generate a good radiology report. Fifty‐five percent to 70% of clinicians prefer red bulleted reports, which included incidental findings (96%); while radiologists slightly favored prose reporting (37–46%). Clinicians found it helpful when additional imaging (86%), medical (71%), and surgical recommendations (73%) were made. About one‐third of specialists who had been in practice for >11 years thought they were better able to interpret imaging for their own specialty than the radiologist. Clinicians voiced discontentment with reports that were not completed in a timely manner or did not give a prioritized differential list. Further studies are warranted to provide a more in‐depth evaluation of veterinary radiology reporting structure and style.