Veterinary anesthesia curricula beliefs and practices

OBJECTIVE

To document the anesthesia curricula in colleges of veterinary medicine and compare it with student clinical supervision and expectations of new graduates by anesthesia staff.

STUDY DESIGN

Cross-sectional open survey study.

POPULATION

American Veterinary Medical Association-accredited colleges of veterinary medicine (41 out of 49) and members of the American College of Veterinary Anesthesia-L (ACVA-L) listserv (88 of 128 responses).

METHODS

We created two separate surveys: one distributed to colleges and one distributed to individuals. Anesthesia faculty members of each college were encouraged to complete the survey together; only one survey was submitted for each accredited veterinary college. The college survey asked about current practices of teaching veterinary anesthesia. The individual survey was distributed to the ACVA-L listserv and asked members about tasks they permit students to perform on clinic rotations, knowledge, and skills they believe are Day One Competencies.

RESULTS

Communicating with clients about anesthesia was a Day One Competency for 95% of respondents, but not taught in almost 50% of colleges. Students are not allowed to perform this duty on their clinical rotation by almost 60% of instructors. Cardiac arrest and resuscitation, euthanasia, patient safety/systems thinking, and professionalism were cited as Day One Competencies by 97% of participants but were not taught in the anesthesia core course in at least 25% of colleges. Use of simulations for education was mentioned as important but was rare as an instructional tool.

CONCLUSIONS AND CLINICAL RELEVANCE

Veterinary anesthesia curricula generally agree with each other and the content generally aligns with what are expected Day One Competencies, as judged by anesthetists. Some topics are taught in the core anesthesia course although they were rarely considered Day One Competencies. Removal of these topics may allow room in the curriculum for the content cited more commonly as Day One Competencies.

Teaching experience, not surgical residency training, is the critical factor in optimizing student learning outcomes in performing ovariohysterectomy on a model

OBJECTIVE

To determine if surgical skills instructors' experience and qualifications influence students' learning of small animal ovariohysterectomy on a model (mOVH).

SAMPLE POPULATION

Second-year veterinary students (n = 105).

METHODS

Students were randomized to three groups, taught by: (1) residency-trained surgeons with over 3 years' experience teaching mOVH, (2) general practitioners with over 3 years' experience teaching mOVH (GP >3), and (3) general practitioners with under 3 years' experience (GP <3). Students completed four 3-h laboratories where they performed mOVH under the supervision of one of the three types of instructors. Students were assessed performing mOVH using a validated 22-item rubric and completed a survey about their experience.

RESULTS

GP <3 group students achieved lower total rubric scores than GP >3 group students (p = .021). Surgeon-taught students' scores did not differ from those taught by GP >3 (p = .685) or GP <3 (p = .052). GP <3 group students were more likely to require remediation than those taught by surgeons (p = .001); there were no differences between the other groups (surgeons vs. GP >3 p = .44; GP <3 vs. GP >3 p = .11). Students reported similar satisfaction with their instruction. Instructors with over 3 years' experience teaching mOVH had better student learning outcomes compared to instructors with under 3 years of experience. While mOVH teaching experience did influence learning, the instructor's completion of a surgical residency did not.

CONCLUSION

The results of the study indicate a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

CLINICAL RELEVANCE

This study indicates a need for more extensive training for new surgical skills instructors and demonstrates that GPs with experience teaching surgical skills are suitable instructors for teaching ovariohysterectomy on a model.

A Prioritized List of Veterinary Clinical Presentations in Dogs, Cats, and Horses to Guide Curricular Content, Design, and Assessment

The Association of American Veterinary Medical Colleges competency-based veterinary education (CBVE) framework can be used to guide curriculum and assessment design and is intended to prepare veterinary graduates for Day One of clinical practice. However, while the framework defines curricular outcomes in terms of demonstrable competencies, it does not define the specific knowledge, skills, and attitudes required to achieve those outcomes. In some human medical curricula, prioritized lists of clinical presentations guide curricular content, design, and assessment. These lists are based, in part, on practice analysis surveys. A prioritized list of this nature does not currently exist in veterinary medicine. We surveyed 1,706 veterinarians across the country regarding the relative frequency and importance of 274 clinical presentations to generate a prioritized list by species. Acceptable statistical power was achieved for dogs, cats, and horses. These lists can be used in conjunction with the CBVE framework to inform curricular content and assessment decisions.

Clinical Year Veterinary Students' Expectations of New Graduate Independence Exceed Their Self-Perceived Competence and Expectations of Community Practitioners

Veterinary medicine is unique in that graduating veterinarians can be licensed to practice independently at the time of graduation. A veterinary curriculum needs to not only prepare graduate veterinarians to meet the expectations of their professional community but also ensure those veterinarians have an accurate perception of expected job requirements. This paper evaluates and compares veterinary students' perceived expectations of graduate-level independence with their self-perceived competence over their clinical (fourth) year. Additionally, we compare these findings to practitioner expectations of graduate-level independence. A survey assessing nine technical and three non-technical categories was distributed to clinical year students at the beginning and end of their clinical year at the University of Wisconsin-Madison School of Veterinary Medicine (UW-SVM). These results were compared to previously obtained survey data from community practitioner members of the Wisconsin Veterinary Medical Association (WVMA). Results indicate an improvement in student self-perceived competence in technical tasks over the clinical year, with the final measures of self-perceived competence aligning with community practitioner expectations of graduate-level independence. However, our results demonstrate a significant difference between student expectations of graduate-level independence, their self-perceived competence, and the community practitioner expectations of graduate independence. These results indicate that veterinary students have unrealistic expectations of their expected independence at graduation and that their self-perceived competence cannot meet these perceived expectations of independence. This misalignment and perceived self-deficit could perpetuate stress and burnout. Further investigation into the cause of this misalignment may help inform educational interventions that encourage students to set realistic expectations.

The Rapid and International Expansion of Veterinary Clinical Skills Laboratories: A Survey to Establish Recent Developments

Veterinary clinical skills laboratories are used for teaching a wide range of practical, clinical, and surgical skills on models and simulators. A survey conducted in 2015 identified the role of such facilities in veterinary education in North America and Europe. The current study aimed to capture recent changes using a similar survey with three sections to collect data about the structure of the facility, its uses in teaching and assessment, and the staffing. The survey consisted of multiple choice and free text questions, was administered online using Qualtrics and was disseminated in 2021 via clinical skills networks and Associate Deans. Responses were received from 91 veterinary colleges in 34 countries; 68 had an existing clinical skills laboratory and 23 were planning to open one within 1-2 years. Collated information from the quantitative data described the facility, teaching, assessment, and staffing. Major themes emerged from the qualitative data relating to aspects of the layout, location, integration in the curriculum, contributions to student learning, and the team managing and supporting the facility. Challenges were associated with budgeting, the ongoing need for expansion and leadership of the program. In summary, veterinary clinical skills laboratories are increasingly common around the world and the contributions to student learning and animal welfare were well recognized. The information about existing and planned laboratories and the tips from those managing the facilities provides valuable guidance for anyone intending to open or expand an existing clinical skills laboratory.

Establishing the Most Important Clinical Skills for New Graduate Veterinarians by Comparing Published Lists with Regional Stakeholder Expectations: A Bangladesh Experience

Veterinary clinical skills training is evolving rapidly around the world and there is increasing interest in Bangladesh in opening clinical skills laboratories and using models in teaching. The first clinical skills laboratory was opened at Chattogram Veterinary and Animal Sciences University in 2019. The current study aimed to identify the most important clinical skills for veterinarians in Bangladesh to inform the further development of clinical skills laboratories and ensure resources are deployed effectively and efficiently. Lists of clinical skills were collated from the literature, national and international accreditation standards, and regional syllabi. The list was refined through local consultation, focused on farm and pet animals, and was disseminated via an online survey to veterinarians and final-year students who were asked to rate the level of importance of each skill for a new graduate. The survey was completed by 215 veterinarians and 115 students. A ranked list was generated with injection techniques, animal handling, clinical examination, and basic surgical skills among the most important. Some techniques requiring specific equipment and some advanced surgical procedures were considered less important. As a result of the study, the most important clinical skills for a new graduate in Bangladesh have been identified for the first time. The results will inform the development of models, the use of clinical skills laboratories, and the design of clinical skills courses for veterinary training. Our approach of drawing upon existing lists followed by local stakeholders consultation is recommended to others to ensure clinical skills teaching is regionally relevant.

Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study

BACKGROUND

The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences.

METHODS

A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests.

RESULTS

'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher).

LIMITATIONS

Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution.

CONCLUSION

There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Comparison of Community Practitioner and Clinical Educator Expectations of Veterinary Graduates

One goal of veterinary curricular development and revision is to ensure graduating veterinarians meet entry-level competencies to perform successfully in their community. Most curricula are developed by clinical educators in a university setting; therefore, we must determine whether clinical educators can predict community practitioner expectations. This article evaluates practitioners' expectations of new graduate independence in veterinary tasks and compares these expectations with those of clinical educators at the University of Wisconsin-Madison School of Veterinary Medicine (UW-SVM). A survey was designed to measure expectations of graduate-level independence within nine technical and three non-technical categories. Members of the Wisconsin Veterinary Medical Association (WVMA) and UW-SVM clinicians were invited to participate. Expected levels of independence were compared between these two populations and between WVMA specialists and generalists. Results indicated significant differences in the expected levels of graduate independence between UW-SVM clinicians and WVMA members, with UW-SVM clinicians generally expecting higher levels of independence for both technical and non-technical tasks. Although most SVM clinicians are specialists, this difference does not appear to reflect a difference in expectations between specialists and generalists, as WVMA specialists had lower expectations of graduate independence for most technical and non-technical tasks than did WVMA generalists. These results suggest that academic clinicians are not able to predict practitioners' graduate expectations or that graduates in practice are not meeting the levels of independence expected by their clinical educators. Further investigation into the differences in expectations will enable fruitful partnerships between academic clinicians, practitioners, and students in curricular design and revision.

Retention of basic surgical skills in veterinary students

OBJECTIVE

To quantify veterinary students' retention of surgical skills after a 5-month period without practice.

STUDY DESIGN

Prospective longitudinal descriptive study.

SAMPLE POPULATION

Convenience sample of second year veterinary students (n = 57).

METHODS

Students practiced ovariohysterectomy (OVH) on a model during 4 clinical skills laboratories during spring 2021. Students were assessed performing OVH on their model using a validated 22-item rubric. Students not meeting expectations repeated their assessment 2 weeks later. All students had a 5-month period, including summer break, without skills practice. Students were again assessed performing OVH on their model in the fall. Students' rubric scores and pass rates were compared before and after summer break.

RESULTS

Students scored lower on their retention test in fall (median = 43) than at the spring assessment (median = 56, P < .001). No difference was detected between lower and higher performing students. Five students (9%) did not meet expectations on their first assessment; more students (17/57, 30%) failed to meet expectations on their retention test (P = .004).

CONCLUSION

Students experienced a decay in the surgical skills required to perform OVH after a 5-month period without practice, regardless of the quality of their initial performance.

CLINICAL SIGNIFICANCE

Veterinary educators should emphasize the importance of continual practice to maintain skills and should consider assisting students in regaining skills during review sessions on models to improve surgical skill retention after a prolonged break.

Stakeholder perspectives on veterinary student preparedness for workplace clinical training – a qualitative study

Background

The success of workplace clinical training (WCT) is important given that veterinary students are licensed to work independently upon graduation. Considering this, it is perhaps surprising that there is limited published work describing what it means to be prepared for this educational experience, particularly given that the transition to WCT can be stressful for students. This paper reports the results of a qualitative study aiming to generate a rich understanding of veterinary student preparedness for WCT using emic, or insider, perspectives of key stakeholders.

Methods

From a constructivist standpoint, homogenous online group interviews were held with final year veterinary students, recent student alumni, clinical supervisors, faculty, and academic educationalists to discuss what it means to be prepared for WCT. The data was analysed using a template analysis approach.

Results

A three-tier taxonomy to describe preparedness for WCT was constructed from the data. At the topmost level, there were seven themes to illuminate different aspects of preparedness: students should be prepared 1) for the transition to learning and working in a clinical and professional environment, 2) for self-directed and experiential learning whilst working, 3) with a growth mindset, 4) with intrinsic motivation and enthusiasm for learning and working, 5) for communication, consultation and clinical reasoning, 6) with the knowledge for work, and 7) with the practical competence and confidence for work.

Conclusions

This study provides a deeper understanding of the tools we can provide, and the attributes we can nurture in, senior veterinary students to facilitate their learning and working during WCT. This improved understanding is a necessary precursor to refining pedagogical support and curriculum design within veterinary schools.

Validation of a Rubric Used for Skills-Based Assessment of Veterinary Students Performing Simulated Ovariohysterectomy on a Model

Surgical skills are an important competency for new graduates. Simulators offer a means to train and assess veterinary students prior to their first surgical performance. A simulated ovariohysterectomy (OVH) rubric's validity was evaluated using a framework of content evidence, internal structure evidence, and evidence of relationship with other variables, specifically subsequent live surgical performance. Clinically experienced veterinarians (n = 13) evaluated the utility of each rubric item to collect evidence; each item's content validity index was calculated to determine its inclusion in the final rubric. After skills training, veterinary students (n = 57) were assessed using the OVH model rubric in March and August. Internal structure evidence was collected by video-recording 14 students' mock surgeries, each assessed by all five raters to calculate inter-rater reliability. Relationship with other variables evidence was collected by assessing 22 students performing their first live canine OVH in November. Experienced veterinarians included 22 items in the final rubric. The rubric generated scores with good to excellent internal consistency; inter-rater reliability was fair. Students' performance on the March model assessment was moderately correlated with their live surgical performance (ρ = 0.43) and moderately negatively correlated with their live surgical time (ρ = -0.42). Students' performance on the August model assessment, after a summer without surgical skills practice, was weakly correlated with their live surgical performance (ρ = 0.17). These data support validation of the simulated OVH rubric. The continued development of validated assessment instruments is critical as veterinary medicine seeks to become competency based.

What's the evidence? A review of current instruction and assessment in veterinary surgical education

Veterinary surgical education is improved by studying the relevant literature. The aim of this literature review was to report the theory and methods used to provide surgical education to veterinary students; to discuss the training most likely to create a competent general practitioner; and to review assessment methods for simulated and live surgeries. The literature reviewed demonstrates that new graduates are expected to perform small animal sterilization, dental extraction, onychectomy, abscess treatment, aural hematoma repair, and mass removal with little or no supervision. Students require repetitive practice to reach competence; some practice can take place in a clinical skills laboratory on models or cadavers. When training novices, distributing practice over a longer time improves retention, but months without practice causes skills to decay. Suturing skills may be taught on models at a ratio of 1 instructor per 10 students. Veterinary students require 6-10 repetitions of each small animal sterilization surgery to reach competence; however, learning curves for other surgeries have not been established. Assessment of surgical skills has been undertaken using objective structured clinical examinations (OSCEs) and observed model and live surgeries. Additional validated rubrics are needed in the field. Surgical educators are urged to continue to search for innovative ways to foster deliberate practice, assess skill, and provide feedback for students.

Veterinary Clinical Ethics and Patient Care Dilemmas

Veterinary ethical dilemmas are common, complex, and unavoidable. Creating a transparent and deliberate approach to ethical issues empowers the entire veterinary team and reduces stress associated with these dilemmas. This article discusses ethical considerations and principles and propose use of the 4Es model and core communication skills to address ethical dilemmas in veterinary practice. It reviews literature defining ethical issues in practice and provides case examples to show the application of our proposed methods. The goal is to provide veterinary professionals with an approach they can use to frame and address their own ethical decisions.

Comparison of a Silicon Skin Pad and a Tea Towel as Models for Learning a Simple Interrupted Suture

There has been rapid growth in the range of models available for teaching veterinary clinical skills. To promote further uptake, particularly in lower-income settings and for students to practice at home, factors to consider include cost, availability of materials and ease of construction of the model. Two models were developed to teach suturing: a silicon skin pad, and a tea towel (with a check pattern) folded and stapled to represent an incision. The models were reviewed by seven veterinarians, all of whom considered both suitable for teaching, with silicon rated as more realistic. The learning outcome of each model was compared after students trained to perform a simple interrupted suture. Thirty-two second-year veterinary students with no prior suturing experience were randomly assigned to three training groups: silicon skin pad or tea towel (both self-directed with an instruction booklet), or watching a video. Following training, all students undertook an Objective Structured Clinical Examination (OSCE), placing a simple interrupted suture in piglet cadaver skin. The OSCE pass rates of the three groups were silicon skin pad, 10/11; tea towel, 9/10; and video, 1/11. There was no significant difference between the model groups, but the model groups were significantly different from the video group (p < .017). In conclusion, the tea towel was as effective as the silicon skin pad, but it was cheaper, simpler to make, and the materials were more readily available. In addition, both models were used effectively with an instruction booklet illustrating the value of self-directed learning to complement taught classes.

Arizona Veterinarians' Perceptions and Consensus Regarding Skills, Knowledge, and Attributes of Day One Veterinary Graduates

The purpose of this study was to assess Arizona veterinarians' perceptions and consensus regarding the importance of items in the domains of clinical skills, knowledge, and attributes of Day One graduates of veterinary school and to determine demographic predictors for items on which consensus was low. In this survey-based prospective study, respondents were asked to rate the importance of 44 items on a 5-point Likert scale ranging from 1 (not at all important) to 5 (extremely important). Responses were visualized as divergent stacked bar charts and evaluated via summary quantitative and qualitative analyses. Several items had a median score of 5. For clinical skills, items were the ability to formulate a preventive health care plan, the ability to interpret test results, and basic safe handling and restraint of animals; for knowledge, knowledge of pain management and anesthesia; and for attributes, teamwork, problem-solving skills, and client communication skills. The majority of items (80%) had a strong or very strong consensus measure, 18% had a moderate consensus measure, and 2% had a weak consensus measure. Six items (14%) varied by at least one demographic category. We found demographic differences between large and small animal practices in the clinical skill of ability to perform a necropsy, knowledge of large animal theriogenology, and knowledge of canine theriogenology. In conclusion, we found differences in the importance of items and agreement among practitioners, suggesting that critical evaluation of the mapped curriculum, particularly with regard to core curriculum compared with electives and clinical tracks, may benefit students and future employers.

Challenges & Issues: Evidence-Based Clinical Skills Teaching and Learning: What Do We Really Know?

The recent programmatic focus on skills development in veterinary medicine means that many programs are devoting increased time to formal clinical skills teaching. This expansion makes it essential that we use the time as effectively as possible. This review examines current practices and veterinary training principles using the broader field of evidence-based motor skills learning as a lens. In many areas, current practices may be hindering learning. Proposed practices include using videos and discussions for pre-laboratory training, focusing on a single complex skill at a time, using more near-peer instructors rather than faculty, including assessments in each teaching or practice session, and encouraging supervised distributed practice by incorporating practice sessions into the formal curriculum. Ensuring mastery of a few core skills rather than exposure to many may be the new goal. Further research is urgently needed on block versus spiral curricula, optimum instructor-to-student ratios, learning and practice schedules, hours required for proficiency, and the benefits of exercise on motor skills learning.

Evaluation of peer teaching and deliberate practice to teach veterinary surgery

OBJECTIVE

To assess the impact of peer teaching and deliberate practice on surgical skills acquisition and retention in first- and second-year veterinary students.

STUDY DESIGN

Randomized, prospective, comparative study.

SAMPLE POPULATION

Eighteen first-year and 25 second-year students from 1 college of veterinary medicine who had previously demonstrated proficiency in basic surgical skills.

METHODS

Forty-three participants were divided into 3 groups: the test group (group A, n = 15), who participated in a structured peer-assisted learning program using deliberate practice; the time-practice control group (group B, n = 15), who participated in an unstructured peer-supported environment; and the assessment-only control group (group C, n = 13), who participated in the assessments. Participants performed a subcutaneous mass removal on a cadaver model and were assessed via a global rating system. Three assessment points were evaluated: pretraining, immediate posttraining, and retention.

RESULTS

The number of participants who achieved acceptable or excellent grand total scores in group A increased after training. Among all participants, 22% in group A, 35% in group B, and 38% in group C did not achieve an acceptable total score at the retention assessment.

CONCLUSION

The study population improved in skill level and retention through the use of standardized video and peer instruction with attention to effective learning strategies, particularly deliberate practice.

CLINICAL SIGNIFICANCE

Use and enhancement of the format introduced in this study could augment veterinary surgical education.