Guidelines for resident training in veterinary clinical pathology. II. Hematology

BACKGROUND: The Education Committee of the American Society for Veterinary Clinical Pathology (ASVCP) identified a need for improved structure and guidance in training residents in clinical pathology. To begin to meet this need, guidelines for training in clinical chemistry were published in 2003. OBJECTIVE: The goal of this report is to define learning objectives and competencies in hematology, including coagulation and immunohematology. METHODS: These guidelines were developed and written with the input of ASVCP Education Committee members and peer experts. RESULTS: The primary objectives of training in hematology are: 1) to accrue a thorough, extensive, and relevant knowledge base of the types, principles, and properties of hematology tests and concepts of pathophysiology in animals; 2) to develop abilities to reason, think critically, communicate effectively, and exercise judgment in hematologic data interpretation and investigative problem-solving; and 3) to acquire technical and statistical skills important in hematology and laboratory operations. We also provide options and ideas for training activities and identify hematology resources useful for clinical pathology faculty and staff, training program coordinators, and residents. CONCLUSIONS: The guidelines define expected competencies that will help ensure proficiency, leadership, and the advancement of knowledge in veterinary hematology and provide a useful framework for didactic and clinical activities in resident-training programs. The learning objectives can readily be adapted to institutional and individual needs, interests, goals, and resources.     

Guidelines for resident training in veterinary clinical pathology. III: cytopathology and surgical pathology

The Education Committee of the American Society for Veterinary Clinical Pathology has identified a need for improved structure and guidance of training residents in clinical pathology. This article is the third in a series of articles that address this need. The goals of this article are to describe learning objectives and competencies in knowledge, abilities, and skills in cytopathology and surgical pathology (CSP); provide options and ideas for training activities; and identify resources in veterinary CSP for faculty, training program coordinators, and residents. Guidelines were developed in consultation with Education Committee members and peer experts and with evaluation of the literature. The primary objectives of training in CSP are: (1) to develop a thorough, extensive, and relevant knowledge base of biomedical and clinical sciences applicable to the practice of CSP in domestic animals, laboratory animals, and other nondomestic animal species; (2) to be able to reason, think critically, investigate, use scientific evidence, and communicate effectively when making diagnoses and consulting and to improve and advance the practice of pathology; and (3) to acquire selected technical skills used in CSP and pathology laboratory management. These guidelines define expected competencies that will help ensure proficiency, leadership, and the advancement of knowledge in veterinary CSP and will provide a useful framework for didactic and clinical activities in resident‐training programs.     

Veterinary students' perceptions of their day-one abilities before and after final-year clinical practice-based training

The present study evaluated the impact of final-year clinical practice-based training on veterinary students' perceptions of competence in "Day One" abilities by administering a pre- and post-training self-assessment checklist. This study also investigated the influence of student demographics on their perceptions of satisfaction about their own knowledge and skills and preparedness for practice. Perceptions regarding the usefulness of the checklist as a self-audit tool were also sought. Final year students (N=85) were surveyed on commencement and upon completion of the training using a checklist that had been adapted from the list of essential new-graduate abilities that was developed by the Royal College of Veterinary Surgeons and adopted by the Australasian Veterinary Boards Council. Significant improvements in student perceptions of competence were observed for 38 of the 41 abilities. Students' satisfaction with their knowledge and skill base and their perceptions of preparedness for practice were only weakly correlated with overall perceptions of competence for individual ability items and did not vary significantly with student age, gender, background, intended field and location of work, or with their work experience as veterinary nurses-if any-while studying. Two thirds of students believed that access to the self-assessment checklist on commencement of the training helped them identify areas for improvement before graduation. This article concludes that clinical practice-based training results in considerable improvement in senior veterinary students' perceptions of competence in Day One abilities and that a self-assessment checklist may help students guide their learning. Results from the present study may be useful for veterinary schools as they develop or enhance strategies used for outcomes assessment.     

Teaching veterinary clinical pathology to undergraduate students: an integrated European project

BACKGROUND: Veterinary clinical pathology is a relatively new and emerging discipline in Europe that has gained momentum with the recent establishment of a specialty college. In this situation, veterinary faculties may face challenges in understanding and defining what clinical pathology is and how it can best be integrated into existing curricula. In addition, many schools in Europe may not yet have available a critical mass of suitably qualified faculty capable of teaching in all areas of clinical pathology. OBJECTIVE: The main purpose of this report is to describe the goals, procedures adopted, teaching material produced, and proposed future activities of a major European initiative designed to develop a veterinary clinical pathology curriculum. METHODS: Four working subgroups were formed to establish a list of course objectives and topics and prepare a series of lectures. These contents were reviewed and discussed several times at a series of general meetings. RESULTS: An undergraduate course on veterinary clinical pathology was designed with course objectives, a list of topics and a CD-ROM consisting of 24 lectures. CONCLUSIONS: The results of this project could be useful in the establishment or improvement of training programs in veterinary clinical pathology at the undergraduate level in Europe and in other places around the world. The provision of teaching resources for faculty could help to instill in veterinary students a strong understanding of the discipline and promote development of advanced training programs and career opportunities in clinical pathology in Europe.     

Postgraduate training programs in veterinary clinical pathology in the United States and Canada (1998 to 2002)

Background: Residency and graduate programs in veterinary clinical pathology provide specialized training for board certification and are important pathways to careers in clinical pathology diagnostics, teaching, and research. Information about training opportunities is useful for assessing disciplinary needs, outcomes, and changes, garnering program support, and providing objective data for program evaluation by faculty, trainees, and prospective applicants. Objectives: The goals of this study were to 1) compile detailed information on the number and types of postgraduate training programs in veterinary clinical pathology in the United States and Canada, 2) describe the goals, activities, strengths, and weaknesses of the programs, 3) assess the desirability of program accreditation and program standards, 4) identify supplemental training opportunities, and 5) evaluate changes in programs, trainees, and faculty 4 years later. Methods: In July 1998, the American Society for Veterinary Clinical Pathology Education Committee sent a survey to representatives at the 31 schools and colleges of veterinary medicine in the United States and Canada and 31 diagnostic laboratories, private hospitals, and pharmaceutical companies. Survey data were compared with updated information obtained from training program coordinators in November 2002. Results: Survey response rate was 94% for universities, 39% for nonuniversity institutions, and 66% overall. In 1998, there were 20 clinical pathology training programs, including residencies (n=10) and graduate programs combined with residency training (n=10), with 36 total training positions. In 2002, there were 25 training programs (14 residencies, 11 combined), with 52 total positions. The median faculty: trainee ratio was 2.0 in both years. Of 67 faculty members involved in training in 1998, 57 (85.1%) were board‐certified in clinical pathology and 53 (79.1%) had DVM/PhD degrees. Net faculty numbers increased by 17 (25.4%) but the median per institution remained at 3.0. Primary program goals were 1) eligibility for and successful achievement of board certification in clinical pathology by the American College of Veterinary Pathologists, 2) proficiency in laboratory diagnostics, and 3) contemporary basic or applied research training. Many programs cited research opportunities, caseloads, and training in hematology and cytology as strengths. Program weaknesses included insufficient funding, too few faculty, and limited training in clinical chemistry and laboratory operations/quality assurance. Trainees completing programs within the past 5 years (n=70) were employed in academia (28.6%), diagnostic laboratories (32.9%), and industry (18.6%). For trainees completing programs between 1999 and 2002 (n=38), these percentages were 52.6%, 21.1%, and 7.9%, respectively. Most (62.5%) respondents supported program standards and accreditation, and 76% supported board review sessions for trainees. Conclusions: Opportunities for postgraduate training in veterinary clinical pathology increased between 1998 and 2002, with 5 new programs and 16 new training positions. These additions and the increased emphasis on diagnostic proficiency, efforts to strengthen training in clinical chemistry and quality assurance, and continuation of combined PhD‐residency programs will help address the perceived need for increased numbers of qualified clinical pathologists in academia, diagnostic laboratories, and industry.     

Establishment of the European College of Veterinary Clinical Pathology (ECVCP) and the current status of veterinary clinical pathology in Europe

After 5 years of development, the European College of Veterinary Clinical Pathology (ECVCP) was formally recognized and approved on July 4, 2007 by the European Board of Veterinary Specialisation (EBVS), the European regulatory body that oversees specialization in veterinary medicine and which has approved 23 colleges. The objectives, committees, basis for membership, constitution, bylaws, information brochure and certifying examination of the ECVCP have remained unchanged during this time except as directed by EBVS. The ECVCP declared full functionality based on the following criteria: 1) a critical mass of 65 members: 15 original diplomates approved by the EBVS to establish the ECVCP, 37 de facto diplomates, 7 diplomates certified by examination, and 5 elected honorary members; 2) the development and certification of training programs, laboratories, and qualified supervisors for residents; currently there are 18 resident training programs in Europe; 3) administration of 3 annual board-certifying examinations thus far, with an overall pass rate of 70%; 4) European consensus criteria for assessing the continuing education of specialists every 5 years; 5) organization of 8 annual scientific congresses and a joint journal (with the American Society for Veterinary Clinical Pathology) for communication of scientific research and information; the College also maintains a website, a joint listserv, and a newsletter; 6) collaboration in training and continuing education with relevant colleges in medicine and pathology; 7) development and strict adherence to a constitution and bylaws compliant with the EBVS; and 8) demonstration of compelling rationale, supporting data, and the support of members and other colleges for independence as a specialty college. Formal EBVS recognition of ECVCP as the regulatory body for the science and practice of veterinary clinical pathology in Europe will facilitate growth and development of the discipline and compliance of academic, commercial diagnostic, and industry laboratories in veterinary clinical pathology. Future needs are in developing sponsorship for resident positions, increasing employment opportunities, increasing compliance with laboratory, training, and continuing education standards, and advancing relevant science and technology.     

Residency training programs in veterinary clinical pathology: a comparison of experiences at two institutions

Two institutions with different residency training formats in clinical pathology are compared with respect to application procedures, learning and teaching opportunities, learning resources, research training, publication requirements, and assessment methods of the program and trainees. The University of Florida and Purdue University programs are both based on an emphasis in morphologic recognition and interpretation of disease processes as well as training in basic science and applied research principles. The progress of trainees through each program is carefully monitored to meet individual needs as well as to meet the training requirements to allow candidates to sit for the certifying examination in clinical pathology. Periodic mock board exams are a critical tool to assess trainee progress and learning. The differences in format focus on coursework and publication requirements as well as on program assessment tools. While one program provides training in the form of 75% clinical diagnostic service, the other uses a mixture of 50% coursework and 50% clinical diagnostic training. Despite the contrast between a pure residency training program and one combining residency training with an MS degree, both institutions provide a solid program structure, ample learning resources, and adequate faculty mentorship to produce a high pass rate of board-certified specialists, the major focus for both programs. Numbers of post-training employment positions for both institutions are similar for those selecting faculty positions at veterinary schools. During the period studied, however, the combined residency and MS graduate program at Purdue University produced more graduates employed in pharmaceutical and biotechnology companies, while the residency program at the University of Florida produced more graduates employed by diagnostic laboratories.     

The place of the post-mortem room in the training of the small animal veterinarian

The post-mortem room can be an important focal point in the training of the small animal veterinarian. Repetitive necropsy demonstrations are necessary to provide a firm foundation of gross pathology for the clinician. More importantly, collaborative post-mortem demonstration/discussions involving clinicians, pathologist and laboratory diagnosticians are necessary to develop understanding of clinico-pathological correlation and this has an important function in developing clinical diagnostic skills and confidence.     

ATLes: the strategic application of Web-based technology to address learning objectives and enhance classroom discussion in a veterinary pathology course

A case-based program called ATLes (Adaptive Teaching and Learning Environments) was designed for use in a systemic pathology course and implemented over a four-year period. Second-year veterinary students working in small collaborative learning groups used the program prior to their weekly pathology laboratory. The goals of ATLes were to better address specific learning objectives in the course (notably the appreciation of pathophysiology), to solve previously identified problems associated with information overload and information sorting that commonly occur as part of discovery-based processes, and to enhance classroom discussion. The program was also designed to model and allow students to practice the problem-oriented approach to clinical cases, thereby enabling them to study pathology in a relevant clinical context. Features included opportunities for students to obtain additional information on the case by requesting specific laboratory tests and/or diagnostic procedures. However, students were also required to justify their diagnostic plans and to provide mechanistic analyses. The use of ATLes met most of these objectives. Student acceptance was high, and students favorably reviewed the online 'Content Links' that made useful information more readily accessible and level appropriate. Students came to the lab better prepared to engage in an in-depth and high-quality discussion and were better able to connect clinical problems to underlying changes in tissue (lesions). However, many students indicated that the required time on task prior to lab might have been excessive relative to what they thought they learned. The classroom discussion, although improved, was not elevated to the expected level-most likely reflecting other missing elements of the learning environment, including the existing student culture and the students' current discussion skills. This article briefly discusses the lessons learned from ATLes and how similar case-based exercises might be combined with other approaches to enhance and enliven classroom discussions in the veterinary curriculum.     

Mechanism-based diagnostic reasoning: thoughts on teaching introductory clinical pathology

Abstract: Teaching introductory clinical pathology to veterinary students is a challenging endeavor that requires a shift in learning strategies from rote memorization to diagnostic reasoning. Educational research has identified discrete cognitive stages required to achieve the automated, unconscious thinking process used by experts. Building on this knowledge, we developed a case-based approach to clinical pathology instruction that actively engages students in the learning process and links performance with positive reward. Simulated cases provide context and create a structure, or "schema", which enhances the learning process by enabling students to synthesize facts and link them with their causal mechanism to reach a defensible diagnostic conclusion. Web-based tools, including the "Problem List Generator" and tutorials, have been developed to facilitate this process. Through the collaborative Biomedical Informatics Research Group, we are working to further develop and evaluate Web-based instructional tools and new educational methods, to clarify the diagnostic reasoning processes used by experienced clinical pathologists, and, ultimately, to better educate our future students to be effective diagnosticians.     

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.     

Back problems. Chiropractic evaluation and management.

A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to apply its techniques properly. Chiropractic provides additional diagnostic and therapeutic means that may help equine practitioners to identify and treat the primary cause of lameness or poor performance. Specialized training in the evaluation and treatment of vertebral joint dysfunction and neuromusculoskeletal disorders places chiropractic in the forefront of conservative treatment of spinal-related disorders. Nevertheless, limited research is currently available on equine chiropractic and other nontraditional modalities in veterinary medicine. In 1996, the American Veterinary Medicine Association's Committee on Alternative and Complementary Therapies suggested that the research community should be encouraged to prioritize avenues of research and to allocate research funds to projects that are designed to provide further scientific evaluation of these modalities. The future of equine chiropractic in veterinary medicine is dependent on future research into the clinical effects of chiropractic techniques and the basic pathophysiology of spinal-related disorders in horses.     

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.     

Faculty development: principles and practices

Instructors in the health professions today must acquire knowledge and competencies that go beyond disciplinary expertise. It is now generally accepted that educational training as a teacher is essential to a faculty member's effectiveness as an educator. The educational challenges across the health professions share many similarities. In this article, we draw on the medical education literature and focus on faculty development designed to enhance teaching effectiveness. We first address commonly included faculty development topics, including instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content areas. We then review a variety of educational approaches and formats that are described in the literature. Included in this discussion are commonly used workshops, seminars, short courses, and fellowships, as well as longitudinal programs, peer coaching, mentorship, self-directed learning, and computer-aided instruction. We also briefly explore learning at work and in communities of practice, and we discuss several frequently encountered challenges in designing and implementing faculty development activities, including motivating colleagues and assessing program effectiveness. We conclude the discussion by presenting a set of guidelines for the design of effective faculty development programs.     

Enhancing clinical learning in the workplace: a qualitative study

Workplace learning (WPL) is seen as an essential component of clinical veterinary education by the veterinary profession. This study sought to understand this type of learning experience more deeply. This was done utilising observations of students on intramural rotations (IMR) and interviews with students and clinical staff. WPL was seen as an opportunity for students to apply knowledge and develop clinical and professional skills in what is generally regarded as a safe, authentic environment. Clinical staff had clear ideas of what they expected from students in terms of interest, engagement, professionalism, and active participation, where this was appropriate. In contrast, students often did not know what to expect and sometimes felt under-prepared when entering the workplace, particularly in a new species area. With the support of staff acting as mentors, students learned to identify gaps in their knowledge and skills, which could then be addressed during specific IMR work placements. Findings such as these illustrate both the complexities of WPL and the diversity of different workplace settings encountered by the students.     

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.     

Teaching veterinary parasitology: the North American perspective

The American Association of Veterinary Parasitologists (AAVP) initiated a study of parasitology curricula in veterinary schools in the US and Canada in November 1989. An ad hoc committee (Task Force) and then the Education Committee developed a position paper on teaching parasitology in veterinary colleges. In addition to confirming the importance of parasitology as a discipline they recommended a set of general learning objectives and proposed topic-specific titles rather than parasite-/group-specific titles. Another problem observed in teaching parasitology was a significant reduction in time available to teach parasitology. One way to compensate for the lost classroom time is to utilize some of the technological advances in presenting the material to students.     

Information technology in veterinary pharmacology instruction

Veterinary clinical pharmacology encompasses all interactions between drugs and animals and applies basic and clinical knowledge to improve rational drug use and patient outcomes. Veterinary pharmacology instructors set educational goals and objectives that, when mastered by students, lead to improved animal health. The special needs of pharmacology instruction include establishing a functional interface between basic and clinical knowledge, managing a large quantity of information, and mastering quantitative skills essential to successful drug administration and analysis of drug action. In the present study, a survey was conducted to determine the extent to which veterinary pharmacology instructors utilize information technology (IT) in their teaching. Several IT categories were investigated, including Web-based instructional aids, stand-alone pharmacology software, interactive videoconferencing, databases, personal digital assistants (PDAs), and e-book applications. Currently IT plays a largely ancillary role in pharmacology instruction. IT use is being expanded primarily through the efforts of two veterinary professional pharmacology groups, the American College of Veterinary Clinical Pharmacology (ACVCP) and the American Academy of Veterinary Pharmacology and Therapeutics (AAVPT). The long-term outcome of improved IT use in pharmacology instruction should be to support the larger educational mission of active learning and problem solving. Creation of high-quality IT resources that promote this goal has the potential to improve veterinary pharmacology instruction within and across institutions.     

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。