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.     

Handheld computers in veterinary medical education: a view from human medical education

Handheld computers are widely used in clinical practice, and their use in both human medical education and veterinary medical education is increasing, especially, for the former, in activities involving point-of-care access. This article references the insights that can be obtained from the usage and activities that are gaining a strong foothold in human medical education. Handheld computer technology gives students access to a large and changing knowledge base for clinical practice, especially when they are geographically dispersed. Differences in use between education and practice largely relate to the importance clinicians place on patient information. Student use focuses on progress mapping and ready access to clinical reference material. Suggestions are made for future use in medical education.     

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.     

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.     

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.     

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.     

Levels of continuing veterinary medical education program evaluation: assessing a course on dairy reproductive management

There are four different levels of continuing education program evaluation: participant perceptions of the program or course; participant competence with new skills, knowledge, and abilities; participant performance or change in behavior; and health care or client outcomes, such as resultant changes in patient care or herd/flock production performance. The purpose of this article is to describe different levels of evaluation and demonstrate some methods used in evaluating a continuing veterinary medical education (CVME) course in dairy reproductive management. Participants' learning needs were assessed using learning stage theory and a pre-test of knowledge. Post-program assessments included a test of knowledge, a satisfaction survey, a commitment to change, and self-reported behavior change. The results of the evaluation indicate that self-reports of learning needs do not necessarily reflect actual needs and that satisfaction with a course does not necessarily indicate behavior change. Providers of CVME must recognize the value of program evaluation, as well as the advantages and disadvantages of different evaluation methods.     

Developing an open-access antimicrobial resistance learning site for veterinary medical students

Recognizing the crucial role of veterinarians in mitigating antimicrobial resistance (AMR), the Centers for Disease Control and Prevention (CDC) has funded the development of a suite of educational materials to promote the responsible veterinary medical use of antimicrobials. An open-access, Web-based multimedia curriculum regarding antimicrobial resistance in veterinary practice was thus created. The antimicrobial-resistance learning site (AMRLS) for veterinary medical students was completed and made available for use in January 2011 (http://amrls.cvm.msu.edu/). Designed for integration into existing veterinary medical courses, the AMRLS is also a resource for continuing education for practicing veterinarians, animal scientists, and food-animal industry specialists. This Web site emphasizes the mechanisms by which AMR emerges and spreads, the significant role of veterinarians in mitigating AMR, and the need to preserve the efficacy of antibiotics for future generations.     

Veterinary medical education and a changing culture

Veterinary medical education is undergoing rapid change in terms of pedagogy, the demographics of the student body, and, in turn, the membership of the profession. Central to the value of the traditional curriculum and the total student experience is the small-group environment, both in client service and in clinical rounds. It is one of the few Socratic learning experiences in higher education today. Similarly, experience in private practice is of inestimable value in terms of developing people skills and a lasting sense of service and accountabilty. In a generation, the student body has transformed from vanishingly small numbers of women to a predominance of female students. However, the profession still is very white, in a world becoming more and more diverse. With a predominantly white faculty and student body today, this circumstance shows little promise of rapid enough change to maintain relevance to a workforce that, a generation from now, likely will be dominated numerically by people of color. The incorporation of various world views and the impact of stereotyping on performance are central to issues of success and failure of minorities and, in somewhat different ways, women in the veterinary medical profession. These issues must become better understood and addressed. And to accomplish this, and to address a host of other culturally important issues, a greater diversity of world views must be engaged in the work and planning of veterinary medical education and the profession at large. Addressing these issues in an environment in which the values of faculty and administrators are intensely focused on the science of veterinary medicine, and in which the participants hold dear a system that places value only on teaching, research, and clinical service, is a formidable undertaking and will require substantial reconsideration of faculty role and reward systems.     

Effective use of simulations for the teaching and acquisition of veterinary professional and clinical skills

Simulation technology will feature prominently in this exciting, yet challenging, time for veterinary medicine. The profession is evolving to keep pace with rapid changes in clinical practice, scientific discovery, and educational strategy, while ensuring that it follows the public mandate to produce competent veterinarians. Among the challenges to meeting this educational goal are limitations-due to important issues such as animal welfare-on the availability of real patients for training. Drawing chiefly on the experience in human medicine, this article explores the use of simulations in veterinary medical education to provide safe and ethical alternative opportunities for learners to practice essential clinical and professional skills.     

The use of information technology in large animal veterinary education

To facilitate large animal veterinary education, information technology has to connect the classroom to the farm. Technology needs to be portable, durable, and cost-effective. Dairy production medicine was one of the first areas in veterinary medicine to use computers to manage large sets of milk production-related data. Now equine practice has embraced technology in almost every diagnostic imaging methodology. The personal desktop assistant (PDA) has allowed students to take large volumes of information with them during clinical rotations. The technology is advancing so quickly that it is difficult to keep up with new software and hardware developments, let alone purchase the most current versions. This article reviews information technology as it is used in large animal practice and, consequently, in large animal veterinary education.     

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.     

Managing stress in veterinary students

The process of obtaining a veterinary medical education creates a number of potential cognitive, emotional, physical, interpersonal, and developmental stressors for veterinary students. Although most universities offer stress management interventions for their students, these programs are often directed toward undergraduate students or non-veterinary graduate students, whose educational programs differ significantly from those of veterinary students. There is a need for specific stress management programs tailored to the needs of veterinary students. This article summarizes research drawn from the psychology, medical, and veterinary medical literature about the causes of stress that veterinary students experience. Interventions are discussed, and several Oregon State University (OSU) programs and liaisons are described. Stress management resources are suggested.     

A new model for companion-animal primary health care education

The majority of graduates from veterinary schools in the United States and Canada join companion-animal practices. In most schools, their clinical learning and client interaction experiences occurred primarily in referral teaching hospitals. These specialty hospitals play an essential role in the veterinary care continuum by providing advanced training, clinically-based research, and sophisticated diagnostics and procedures. However, they are not ideal as the principal setting for preparing veterinarians to bring value to the primary health care practices that they join. A new model for companion-animal primary health care education and service delivery has been developed at the Ontario Veterinary College, University of Guelph. The nine integrated programs, which have defined learning objectives and outcome assessments, include communication, nutrition, rehabilitation, behavior, welfare, One Health (ecosystem approach to health), preventive and general medicine, good citizenship, and research. The learning experience begins with first-year student veterinarians and takes place in a practice setting with paying clients from the community. Significantly, the students are learning in an environment that emphasizes the importance of the client experience, teamwork, and practice management while ensuring quality health care for patients. The future of companion-animal primary health care and the optimal preparation of veterinarians are critical issues for the veterinary colleges and profession. Enhanced research into new models for primary health care education and service delivery is urgently needed.     

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.     

Development and evaluation of a high-fidelity canine patient simulator for veterinary clinical training

High-fidelity human patient simulators have been used for decades in medical education to provide opportunities for students to practice technical skills, diagnostic and therapeutic planning, and communication skills in a safe environment. A high-fidelity canine patient simulator (CPS) was developed using components from a human patient simulator and a low-fidelity foam core canine mannequin. Ninety-six veterinary students participated in cardiopulmonary arrest scenarios in groups of three to five students. Afterwards, participants were asked to complete an anonymous online survey describing their experiences. A total of 70 students (73%) completed the survey. All of the students (100%) felt that the simulator session expanded their cardiopulmonary resuscitation (CPR) knowledge base, and 97% responded that their skills and abilities had improved. Students also expressed positive opinions about the CPS, with 89% agreeing or strongly agreeing that the CPS was realistic and 73% agreeing or strongly agreeing that the scenarios generated emotions similar to real clinical situations. Most participants (98.5%) agreed or strongly agreed that the simulator was an engaging learning experience. Students commonly commented that the simulations allowed them to practice communication and teamwork skills and were more effective than paper-based, problem-oriented learning opportunities and lecture. Students also commented that they wanted more opportunities to participate in simulation exercises. These results suggest that high-fidelity veterinary simulation is an engaging educational methodology that addresses some limitations of other forms of problem-based learning. More studies are needed to quantitatively determine the effectiveness of this novel veterinary educational technology in comparison with more traditional approaches.     

Current economic trends affecting the veterinary medical profession.

This article explores the economic trends affecting the future of the veterinary medical profession. Key aspects of demand and supply are considered, as are several broad-based institutional factors. Demand for veterinarians and veterinary medical services is demonstrating a definitive upward trend across the profession, led by a remarkable in-crease in consumers' willingness to spend on animal health care.Supply is also expanding through increased enrollments at colleges and schools of veterinary medicine and increased productivity and efficiency in private practice. Veterinarians' incomes are increasing, and some sectors of the profession offer outstanding financial opportunities.Provided that critical needs are met for 1) increased diversity and 2) continued improvement in the nontechnical capabilites of veterinarians, the outlook for the economic future of the veterinary medical profession is strong.     

Strategies for educational action to meet veterinary medicine's role in biodefense and public health

It is clear that the profession is not well prepared to respond to society's needs in bio-defense and public health. The imperatives that face the veterinary profession, as emphasized by the agenda for action conference deliberations that are reported in this issue of the journal, require action on many fronts, but possibly none more essential than to address how veterinary education needs to change to meet these challenges. Addressing these needs, participants at the agenda for action conference met in groups of 30 to 50 to shape approaches that would address these key questions. The 161 participants were broadly representative of government, private practice, corporate practice, organized veterinary medicine, and academia (Appendix A). Reported here are the results of those deliberations, with each of the seven sections written up by the discussion leader. Included in the participants were 20 students, representative of eight different veterinary colleges, who both participated in the group discussions and have presented their own report.     

Effects of a pilot training program on veterinary students' pain knowledge, attitude, and assessment skills

The prevention and management of pain is fundamental to the practice of both human and veterinary medicine. The recognition and treatment of pain represents an important indicator of the quality of care delivered in human hospitals and veterinary hospitals. Yet, both human and veterinary health care professionals have cited inadequate knowledge as a significant barrier to effective pain management. The aims of this pilot study were twofold: (1) to gauge veterinary medical students' current attitudes regarding their training in pain management and (2) to assess the impact of training and practice on the use of a canine acute pain assessment teaching tool. Participants, third-year professional veterinary medical students, completed a 16-item survey questionnaire before a 30-minute training session on pain assessment using the teaching tool and completed it again after training and a one-week practice period. Questions related to canine pain, assessment of canine pain, pain management education in the professional veterinary curriculum, and an example case presentation (video) were included in the survey. The analysis of survey results indicated that professional veterinary medicine students find value in didactic and clinical training in canine pain assessment. Additionally, use of the canine acute pain teaching tool in conjunction with a training program improved students' knowledge and skill in assessment while pointing out the importance of further training. Differences with regard to gender and tracking were found and warrant further exploration.     

Connecting knowledge resources to the veterinary electronic health record: opportunities for learning at point of care

Electronic health records (EHRs) provide clinical learning opportunities through quick and contextual linkage of patient signalment, symptom, and diagnosis data with knowledge resources covering tests, drugs, conditions, procedures, and client instructions. This paper introduces the EHR standards for linkage and the partners-practitioners, content publishers, and software developers-necessary to leverage this possibility in veterinary medicine. The efforts of the American Animal Hospital Association (AAHA) Electronic Health Records Task Force to partner with veterinary practice management systems to improve the use of controlled vocabulary is a first step in the development of standards for sharing knowledge at the point of care. The Veterinary Medical Libraries Section (VMLS) of the Medical Library Association's Task Force on Connecting the Veterinary Health Record to Information Resources compiled a list of resources of potential use at point of care. Resource details were drawn from product Web sites and organized by a metric used to evaluate medical point-of-care resources. Additional information was gathered from questions sent by e-mail and follow-up interviews with two practitioners, a hospital network, two software developers, and three publishers. Veterinarians with electronic records use a variety of information resources that are not linked to their software. Systems lack the infrastructure to use the Infobutton standard that has been gaining popularity in human EHRs. While some veterinary knowledge resources are digital, publisher sites and responses do not indicate a Web-based linkage of veterinary resources with EHRs. In order to facilitate lifelong learning and evidence-based practice, veterinarians and educators of future practitioners must demonstrate to veterinary practice software developers and publishers a clinically-based need to connect knowledge resources to veterinary EHRs.