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.     

Environmental and animal hygiene--an indispensable subject for veterinary education?

Based on conference reports, publications, and personal experiences in the field of veterinary environmental hygiene in Germany and abroad, the question is discussed whether the subjects environmental and animal hygiene have to be considered as indispensable subjects for the curricula in veterinary education or only play a secondary role as a fringe area of veterinary medicine. The analysis and evaluation of the relevant literature have shown that this subject has gained an extraordinary significance for science and practice during the last 4-5 decades. Due to its close interconnections with related fields of science like agriculture, human medicine, biology, ecology, engineering sciences and economics the veterinary environmental and animal hygiene has reached such a high standing that it is now an indispensable component of veterinary education in Germany.     

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.     

Outcomes assessment planning: an overview with applications in health sciences

This article provides a brief overview of the process of outcomes assessment and examples of its application in professional health science education. The article is intended to provide a background for other articles in this issue describing ongoing activities in outcomes assessment in veterinary education and for programs considering developing a plan. The focus is on health professions other than veterinary medicine. The paper is not intended to be a comprehensive review of outcomes assessment; rather, it provides examples and models that may help clarify the outcomes assessment movement and identify trends in health care education.     

Training the veterinary public health workforce: a review of educational opportunities in US veterinary schools

This article presents the results of an Internet-based review conducted in January and February 2003 to assess the educational opportunities available in veterinary public health, epidemiology, and preventive medicine at the 27 veterinary schools in the United States. Most professional veterinary curricula are designed to train students for careers as highly qualified private practitioners, although there is an increased need for veterinary perspectives and contributions in the public health sector. The future of veterinary public health relies on the opportunities available in education to teach and encourage students to pursue a career of public service. The results of this review indicate the availability of a wide variety of required courses, electives, and post-graduate training programs to veterinary students in the United States. Veterinary students are exposed to a median of 60 hours of public health, epidemiology, and preventive medicine in required stand-alone courses in these areas. Four veterinary schools also have required rotations for senior students in public health, preventive medicine, or population medicine. Contact time for required public health, epidemiology, and preventive medicine courses ranges from 30 to 150 contact hours. Advanced training was available in these subjects at 79% of the 27 schools. Greater collaboration between veterinary schools, schools of public health, and the professional public health community will increase exposure to and opportunities in public health to all future veterinarians.     

Part II: directions and objectives of curriculum structure at veterinary medical and other health professions schools

This article surveys reports on various models and methods of curriculum structure and directions of health professions schools in North America over the past 20 years, with particular emphasis on veterinary and allopathic medical schools. The importance of administrative and faculty leadership, a clear sense of vision, recognition that curricula must change to meet societal needs, and continual, extensive communication and collaboration are discussed as important keys to successfully navigating curriculum reform. The advantages of central versus departmental management of the curriculum are noted with respect to implementing curricular change. Investment in faculty development is essential to ensure sustained cultural and curricular change. As instructional methodology changes, new and better methods of assessing student performance must be developed, with timely and appropriate feedback. Barriers to curriculum change are inevitable; effective strategies must be designed and implemented to navigate these barriers. The future of education in the health professions is clearly in the hands of the educators who prepare future health professionals.     

Development and validation of a competency framework for veterinarians

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

Professionalism in the health sciences: lessons learned from its definition, evaluation, and teaching in a medical school

For the past 15 years, the medical profession has been concerned about the professionalism, or lack thereof, exhibited by many physicians, and similar concerns are evident for the broad scope of health professions. This article summarizes the efforts of one school of medicine to define the problem, embark on a program to improve the situation, and evaluate its progress. Because the author's experience is within the realm of human medicine and the education of medical students, the article has been written from this perspective, but it is hoped that readers in the other health professions will find this account of benefit. While the vignettes presented here are taken from human medicine, readers in other health professions should be readily able to translate them into their own spheres of interest.     

The Objective Structured Clinical Examination: three decades of development

The Objective Structured Clinical Examination (OSCE) has become a standard for performance-based assessment in many health professions. Originally developed for assessment in medical schools, the OSCE has been widely adopted for teaching, assessment, and certification purposes in most health professions. This article outlines the reasons for the rapid uptake of OSCEs and explores some of the key features of OSCE development that have implications for use in veterinary medicine.     

Future directions in training veterinarians for companion avian species

Companion avian medicine has become a routine part of veterinary practice. More than 16 million companion birds are owned by approximately 6.4 million US households. This report outlines suggested undergraduate veterinary curricula, opportunities for post-graduate education, and options for training avian veterinarians.     

Implementing change in health professions education: stakeholder analysis and coalition building

The challenges facing the health sciences education fields are more evident than ever. Professional health sciences educators have more demands on their time, more knowledge to manage, and ever-dwindling sources of financial support. Change is often necessary to either keep programs viable or meet the changing needs of health education. This article outlines a simple but powerful three-step tool to help educators become successful agents of change. Through the application of principles well known and widely used in business management, readers will understand the concepts behind stakeholder analysis and coalition building. These concepts are part of a powerful tool kit that educators need in order to become effective agents of change in the health sciences environment. Using the example of curriculum change at a school of veterinary medicine, we will outline the three steps involved, from stakeholder identification and analysis to building and managing coalitions for change.     

Exploring the foundations of population health and preventive medicine as essential elements for veterinary education

The evolution of preventive medicine and public health training in professional veterinary medicine curricula is documented. Most veterinary colleges in the US began with a single course in meat hygiene or public health, with a focus on food hygiene issues. These courses laid the foundation for modern veterinary preventive medicine and public health training for veterinary students. Most graduates of veterinary colleges today have extensive training in population health, preventive medicine, and zoonotic diseases.     

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.     

Veterinary medical education and veterinary involvement in aquatic-animal health and aquaculture in Mexico

This article analyzes curriculum offerings related to aquaculture and/or aquatic-animal health taught in veterinary medical schools or colleges in Mexico. The information database of the Mexican Association of Schools and Colleges of Veterinary Medicine and the Web sites of veterinary institutions indicate that 60% of veterinary colleges include courses related to aquaculture in their curriculum, but most of these are optional courses. There are few specialized continuing education programs or graduate level courses. There is also a lack of veterinary participation, in both public and private sectors, in aquatic-animal health. It is evident that there should be a greater involvement by the veterinary profession in Mexico's aquaculture to ensure food production in a safe and sustainable manner; to achieve this, veterinary medical institutions must include more aquaculture and aquatic-animal health courses in their curricula.     

Zoological medicine and public health

Public-health issues regarding zoological collections and free-ranging wildlife have historically been linked to the risk of transmission of zoonotic diseases and accidents relating to bites or injection of venom or toxins by venomous animals. It is only recently that major consideration has been given worldwide to the role of the veterinary profession in contributing to investigating zoonotic diseases in free-ranging wildlife and integrating the concept of public health into the management activities of game preserves and wildlife parks. At the veterinary undergraduate level, courses in basic epidemiology, which should include outbreak investigation and disease surveillance, but also in population medicine, in infectious and parasitic diseases (especially new and emerging or re-emerging zoonoses), and in ecology should be part of the core curriculum. Foreign diseases, especially dealing with zoonotic diseases that are major threats because of possible agro-terrorism or spread of zoonoses, need to be taught in veterinary college curricula. Furthermore, knowledge of the principles of ecology and ecosystems should be acquired either during pre-veterinary studies or, at least, at the beginning of the veterinary curriculum. At the post-graduate level, master's degrees in preventive veterinary medicine, ecology and environmental health, or public health with an emphasis on infectious diseases should be offered to veterinarians seeking job opportunities in public health and wildlife management.     

Zoo and wildlife medical education: a European perspective

Europe has a long and distinguished history in veterinary science and education, and it was here that the first professional investigations of pathological conditions in zoo animals took place. However, despite an increasing number of veterinarians working with wildlife, education in zoological and wildlife medicine has only recently become part of formal veterinary training at the undergraduate level. Consequently, current educational opportunities in zoological and wildlife medicine vary widely throughout Europe, both in availability and in composition. The need to establish agreed standards in education across Europe and to foster the mobility of students and teaching staff are reflected by international agreements such as the Bologna Treaty and the ERASMUS-SOCRATES program. Europe is also home to a number of voluntary professional organizations, such as the European Wildlife Disease Association and the European Association of Zoo and Wildlife Veterinarians, that actively promote the inclusion of zoological and wildlife medicine in veterinary education. Zoo and wildlife medicine is currently a veterinary specialization in Europe, but educational opportunities are likely to increase in availability in the future.     

素质养成教育在动物医学人才培养中的应用

动物医学专业的实践性较强,稳固的基础知识和过硬的实践技能的训练对动物医学人才的培养尤其重要。专业素质养成教育重视专业素质的循序渐进发展,培养学生日渐形成熟练的操作技巧和良好的思维活动能力,为动物医学人才培养所需。此外,加强教师引领作用和探索更多的实践教育途径,能够促进学生不断地积累知识和逐步扎实提升专业技能,充分发挥素质养成教育在动物医学高素质专业人才培养中的作用。     

Mainstreaming alternatives in veterinary medical education: resource development and curricular reform

Veterinary medical educators are charged with preparing students to enter practice in veterinary medicine during a four-year, intensive, professional education program. This requires giving students in laboratory training that involves dead, anesthetized, or conscious animals, so that they become proficient in the expected range of veterinary knowledge, skills, and abilities. Undeniably, experience with animals is essential to prepare students for a profession in which animals comprise the total domain. However, the consumptive use of animals for teaching students, especially in laboratories, is increasingly subject to regulatory requirements, while also being scrutinized by animal protection groups, and has become a common focus of contention among veterinary students. Not surprisingly, the use of animals in teaching has sharply declined over the past few decades, as new teaching resources and methods, involving less consumptive use of animals, have been incorporated. This change in veterinary medical education has occurred on such a wide scale, in almost all veterinary schools and colleges, that the educational approach can serve as a model for further developments within the veterinary educational community and, indeed, for animal-related material in secondary schools and undergraduate higher education. This article highlights examples of the leadership provided by veterinary educators in developing alternative teaching resources and methods, while maintaining the high level of proficiency expected from traditional educational approaches.