Evaluation of communication skills training programs at North American veterinary medical training institutions

Farmer-veterinarian communication during herd health visits on dairy farms in Flanders, Belgium

Well-developed clinical communication is crucial for dairy practitioners in providing effective herd health and production management (HHPM) advisory services, as they have potential to enhance farmer satisfaction and adherence to veterinary advice. However, there is limited knowledge regarding specific communication skills veterinarians use during HHPM visits. Understanding veterinarians' communication is essential for developing targeted educational interventions to enhance veterinarian-farmer interactions during HHPM visits. The objective of the study was, therefore, to investigate veterinarians' communication during HHPM visits on Flemish dairy farms. Dairy veterinarians audio-recorded HHPM visits on dairy farms in Flanders, Belgium. Composite communication processes were assessed using the Calgary-Cambridge Guide (CCG), and global scores and specific behavior counts were assessed with a modified Motivational Interviewing Treatment Integrity code (MITI). Twenty-seven participating veterinarians recorded 127 visits with 120 unique dairy farmers. The CCG communication processes "History taking," "Presenting information," and "Safety net and follow-up" were most prevalent. Veterinarians with ≤10 years practice experience provided the farmer with a "Safety net and a follow-up" more often than veterinarians with >10 years of experience. Other CCG processes such as "Agenda setting" and "Needs determination" were often lacking. However, veterinarians who had previously participated in communication skills training determined the needs of the farmer more often than participants who had not. Veterinarians who conducted ≥15 HHPM visits per month more fully performed "History taking" and "Creating a plan" than veterinarians with <15 HHPM visits per month. Participants displayed inconsistent efforts to incorporate "Partnership" and "Empathy." In modified MITI coded audio segments of 20 min, on average, veterinarians gave information 12 times, made a persuasive statement 3 times, asked 3 open questions, and 6 closed questions. This study indicated areas for improvement in dairy veterinarians' communication and highlighted the need for ongoing education and research in this area to enhance veterinary practice and animal health.

Assessing pet owners' knowledge and comprehension of veterinary medical terminology

BACKGROUND

Veterinary communication plays a key role in client satisfaction, patient outcomes and clinician wellbeing. Communication assessment tools can help to facilitate improvement strategies.

METHODS

Over a 5-month period, pet owners attending a small animal hospital were asked to complete a survey assessing their understanding of commonly used veterinary terms and phrases, either online or in paper format. Scores were used to identify areas requiring improvement and investigate the effect of demographic characteristics on owner understanding.

RESULTS

A total of 378 completed questionnaires was received. Over 97% of owners rated the quality of veterinary communication as good or moderate to good. However, approximately one-fifth believed that communication could be improved. While veterinary terms and phrases were broadly understood, none was correctly interpreted by all respondents, and common misconceptions were identified. Respondents with prior medical knowledge scored higher.

LIMITATIONS

The survey methodology allows for misinterpretation of questions, response bias and non-compliance with the requirement that respondents do not receive help in completing the survey from external sources.

CONCLUSION

While pet owners generally perceived veterinary communication to be good, some commonly used terms and phrases were frequently misinterpreted. Vets should therefore be encouraged to use lay terms when communicating with clients and to take time to confirm that their intended message has been fully understood.

A Need for Targeted Teaching of Shared Decision-Making as Identified from an Assessment of Client-Centered Communication Skills Training with Companion Animal Veterinarians

Shared decision-making has been increasingly discussed as a communication practice within veterinary medicine, and it is gaining more traction for diagnostic and treatment planning conversations and specifically offering a spectrum of care. This teaching tip describes the data from an investigation of veterinarians' shared decision-making in a pre-test/post-test communication skills training intervention that used a client-centered, skills-based communication approach. Practice teams from a purposive sample of four companion animal veterinary clinics in Texas participated in a 15-month communication skills intervention, including interactive group workshops and one-on-one communication coaching. To assess the outcome of the intervention, for nine participating veterinarians, appointments recorded pre- (n = 85) and post-intervention (n =  85) were analyzed using the Observer OPTION 5 instrument to assess shared decision-making. The intervention effect was evaluated using mixed logistic regression, adjusting for appointment type. The communication intervention did not significantly impact participating veterinarians' demonstration of shared decision-making (pre = 25.42, n = 55; post = 28.03, n = 56; p = 0.36). Appointment type was significantly associated with veterinarians' OPTION 5 scores (p = .0004) and health problem appointments (OPTION 5 = 30.07) demonstrated greater shared decision-making than preventive care appointments (OPTION 5 = 22.81). Findings suggest that client-centered, skills-based training traditionally used in veterinary curricula and continuing education may not foster the use of shared decision-making, which is a higher-order communication approach that may require a dedicated process-oriented training. This teaching tip highlights the need for a targeted stepwise approach to teach shared decision-making.

Use of an online gaming tool, the Veterinary DialogueTrainer, for teaching clinical communication skills to bovine veterinary practitioners

Effective clinical communication is essential for bovine veterinary practitioners to establish and maintain positive client relationships. When applied properly in herd health consultancy, it increases client satisfaction and adherence to veterinary advice, and improves patient health and welfare. Although communication skills are often taught by providing feedback on simulated conversations, this has limitations, including time constraints, subjective assessments, and cost. The Veterinary DialogueTrainer (VDT) is an online serious game platform using 'digital role-play' with avatars, recently developed to enhance and assess learning outcomes, improve use of learned skills, and increase cost-effectiveness of communication training. The objective was to evaluate its suitability and applicability. Finnish (n = 24) and Swedish (n = 21) bovine veterinarians participated in communication training using VDT for training and assessment. Participants completed the provided scenario at least twice. After playing a bovine health communication simulation, participants received their scores and feedback on selected conversation options. VDT scores measured multiple aspects of communication on a 0-100% scale, based on motivational interviewing methodology and Calgary-Cambridge guidelines. Mean (±SD) number of attempts participants played the scenario was 4.1 (±2.6, Finland) and 3.9 (±1.3, Sweden), with highest total score reached after a mean of 3.5 (±2.1, Finland) and 3.1 (±1.1, Sweden) attempts. On the first attempt, 39 participants (87%) scored <50% of the highest possible score, whereas most (n = 34, 76%) achieved a higher score on the second attempt. Mean total score increased from 15 (±14) to 77% (±33) for Finish participants and from 40 (±22.0) to 87% (±19.4) for Swedish participants. The majority (n = 33, 73%) of participants reached a score >80% after 4.0 (±1.6, Finland) or 2.8 (±1.0, Sweden) attempts. Net Promoter Score of the training was +89 (Finland), +88 (Finland) and + 83 (Sweden) on a scale from -100 to +100, indicating that most participants were very likely to recommend the training to other veterinarians. Use of VDT increased communication skills scores but whether it will improve communication skills in practice requires further study. We concluded there is a likely benefit of using the VDT in teaching and monitoring veterinary communication competencies and preparing for offline role-plays and real-life conversations in veterinary practice.

Teaching feedback skills to veterinary students by peer-assisted learning

Feedback is considered an essential element of effective learning. Students who receive feedback from peers can improve their clinical and communication skills. This paper aims to testify for whether peer-assisted learning (PAL) is successful in teaching students with the ability to give feedback. The study was design as tutors (n=20), tutees (n=20) and control group (n=20). Tutors were educated to provide constructive feedback, and this group trained tutees in PAL to increase their skills in providing feedback. After the training, tutors and tutees used role play about veterinarian-client consultation. At the end of the consultations, each tutee provided feedback to the tutor about his/her communication skills. As findings, there was a statistically significant change between the mean scores of both “tutor and control groups” (P&lt;0.004) and “tutors and tutees” (P&lt;0.001). However, there was no statistically significant difference in terms of the academic year and gender between groups. Tutees benefited from being trained by peers, and tutors also improved their feedback skills by training peers. Conspicuously, PAL was found to be effective for not only tutors but also tutees. With this argument, it is predicted that other veterinary fields can also benefit from PAL throughout veterinary training.

Assessment of a joint farmer-veterinarian discussion about biosecurity using novel social interaction analyses

Veterinarians are trusted by farmers and play an important role in assisting them to implement biosecurity. More research is needed that particularly focuses on the impact of joint farmer-veterinarian discussions to further understand the role of communication in altering biosecurity behaviours. The aim of this study was to analyse joint dairy cattle farmer-veterinarian discussions about the adoption of on-farm biosecurity using novel social interaction methodologies. Farmer and veterinarian stakeholders were invited to take part in a face-to-face meeting. Introductory presentations were given, followed by separate facilitated veterinarian and farmer discussions. All stakeholders were brought together for a final facilitated group discussion which was audio recorded. Corresponding transcripts from the recordings were analysed via thematic and conversation analyses. Conversation analysis assessments such as turn taking, repair, sequence organisation, overlap and asymmetry were employed to investigate the nature of the conversation. Thematic analysis identified the negative repercussions of conflicting information or ineffective communication surrounding biosecurity implementation. The type of, and importance of, the relationship farmers had with veterinarians and other stakeholders was highlighted. The need to provide personalised biosecurity protocols on farms was identified. Four key factors were identified via conversation analyses. These included: 1) how the conversation facilitated agreement, 2) how the conversation allowed the farmer and veterinarian participants to learn from one another in real time, 3) how the discussion enabled participants to expand upon points they were making, and 4) how participants were able to obtain a greater understanding of the other participants' opinions, even without total resolution. Debate around the effective implementation of biosecurity measures on farms, explored using novel techniques, demonstrated the potential for utilising a discussive approach between veterinarians and farmers to lead to solutions not previously considered. Because of the nature of the discussion, conversation analysis resulted in an informative approach to encapsulating the nuanced dialogue between stakeholders, highlighting the potential of this analysis framework.

Evaluating third- and fourth-year veterinary students' communication skills knowledge and performance at Colorado State University

OBJECTIVE

To assess the impact of a communication program on a cohort of veterinary students' knowledge and performance of communication skills.

SAMPLE

Class cohort of veterinary students at Colorado State University.

PROCEDURES

Year 3 students' knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated.

RESULTS

In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students' knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing "chunks" of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure.

CLINICAL RELEVANCE

Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.

Using Learning Theories to Develop a Veterinary Student Preparedness Toolkit for Workplace Clinical Training

Learning theories are abstract descriptions which help us make sense of educational practice. Multiple theories can inform our understanding of a single concept, in this case: veterinary workplace clinical training (WCT), which occurs just prior to students' graduation as competent veterinary surgeons. The competency movement has strongly influenced reforms in veterinary education and is considered important. In reflection of this, the term “preparedness” is operationalised here as a measure of the likelihood that the veterinary student is going to be a competent learner and participant during WCT. Preparedness itself is therefore important because it directly impacts performance. Workplace clinical training is explored through the lenses of cognitivist, social constructivist and socio-culturalist learning theories and used to inform student preparedness characteristics (“tools”) in terms of their behaviours, personal attributes, knowledge and skills, and awarenesses to optimise learning and participation. These form a new conceptual framework—the “Preparedness Toolkit.”

Communication skills training and assessment of food animal production medicine veterinarians: A component of a voluntary Johne's disease control program

In food animal production medicine (FAPM), the success of control programs for infectious diseases that have serious animal health and economic consequences frequently rely on the veterinarian's effective communication and producer adherence to veterinary recommendations. However, little research has been conducted on communication skills of practicing FAPM veterinarians. During this study, we developed a communication training workshop intervention to support the Atlantic Johne's Disease Initiative. Seventeen FAPM veterinarians across 10 clinics practicing within Maritime Canada participated in a pre-post intervention study design. Communication skills were evaluated utilizing 3 assessment tools; an objective structured clinical exam (OSCE), standardized client feedback, and an instrument designed for veterinary participants to assess their self-efficacy. Study results showed that before training, communication skills of participating veterinarians had limitations, including skill deficits in communication tasks strongly associated with increased adherence to veterinary recommendations. Based on the 3 assessment tools, communication skills of participating veterinarians improved with the training provided. Significant increases were detected in pre- to postintervention self-efficacy percentage scores, OSCE percentage and global scores from expert raters, and OSCE percentage and global scores from standardized client feedback. These improvements emphasize the importance of communication skills training specific to FAPM.

Analysis of Turkish Veterinary Students' Self-perception of Communication Competencies Based on Gender Differences

Communication skills are teachable and learnable skills, which have a vital position among other clinical skills because a student's ability to communicate can increase empathy. The focus of this article is to determine how senior students evaluate themselves regarding communication competence and whether gender has an impact on their perception. The study included 128 volunteering students, using the Communication Competence Scale, consisting of 30 questions, as a data collection tool and the independent samples t-test for statistical evaluations. The evaluation of all participants showed that male participants had the highest score, and female participants had the lowest. However, there was no statistically significant difference between female and male participants' total scores (p = 0.605). There was a statistically significant difference between female and male students in terms of the social competency, empathy, and adaptability. Female scores for empathy were statistically higher than those of males. Male students scored themselves higher than females in terms of social competency and adaptability. In the context of the students' perceptions of their communication competence, it was determined that females assessed themselves to be more empathetic and males perceived themselves to be more social and adaptable. This research is significant as it is the first study of Turkish veterinary students' self-perception of communication competence. Communication training may become more robust in veterinary curricula in Turkey, and further research will be affected by this issue.

Türk Veteriner Fakültesi Öğrencilerinin İletişim Yeterlikleri Algısının Cinsiyet Farklılıklarına Göre Analizi

İletişim becerileri, bir öğrencinin iletişim kurma yeteneği ile empati becerisini arttırabilmesi nedeniyle diğer klinik beceriler arasında önemli bir yere sahip olan öğretilebilir ve öğrenilebilir becerilerdir. Bu çalışmanın amacı, veteriner fakültesi son sınıf öğrencilerinin iletişim konusunda kendilerini nasıl değerlendirdiklerini ve cinsiyetin bu algı üzerinde bir etkisi olup olmadığını belirlemektir. Çalışma 128 gönüllü öğrenci ile 30 sorudan oluşan İletişim Yeterlilik Ölçeği kullanılarak gerçekleştirilmiş, bağımsız örneklemlerde t-testi ile istatistiksel değerlendirme yapılmıştır. Yapılan değerlendirmeye göre, tüm katılımcılar arasında erkeklerin en yüksek puanı, kadınlar en düşük puanı aldığı görülmüştür. Ancak kadın ve erkeklerin toplam puanları arasında istatistiksel olarak anlamlı fark bulunamamıştır (p=0.605). Kadın ve erkekler arasında sosyal yeterlilik, empati yeterliği ve uyum yeterliği açısından anlamlı fark bulunmuştur. Kadınlar empati yeterliğinde, erkekler ise sosyal yeterlilik ve uyum yeterliğinde daha yüksek puan almıştır. İletişim yeterlikleri algısı bakımından kadınlar kendilerini daha empatik, erkekler ise daha sosyal ve uyumlu bulmuştur. Bu çalışma Türk veteriner fakültesi öğrencilerinin iletişim yeterlikleri konusunda öz algılarını yansıtan ilk çalışma olması bakımından önemlidir. İletişim becerileri eğitimi Türkiye’de veteriner fakülteleri müfredatında daha güçlü hale gelecek ve bu konu ileri araştırmaların yapılmasını teşvik edecektir.

Uncovering the 'messy details' of veterinary communication: An analysis of communication problems in cases of alleged professional negligence

BACKGROUND

Communication failure is reported as a cause of error in veterinary practice and has been associated with complaints and litigation. Evidence describing the types and nature of communication problems is lacking. This limits our ability to mitigate the risk poor communication poses.

METHODS

This study used a mixed methods approach to explore the frequency and types of communication problems present in settled cases of alleged veterinary professional negligence. Thematic analysis was conducted on written documents associated with 100 such cases involving canine patients. Interpretation was informed by human factors thinking and communication theory. Results were triangulated with findings from a focus group with the Veterinary Defence Society claims consultants and with healthcare literature on communication failures.

RESULTS

Communication problems played a contributory role in 80% of the cases examined. The analysis highlighted features of problematic communication in veterinary practice that are underrepresented in the current literature. These include the prominence of communication problems within veterinary teams, the impact of communication on the safety of care and also the interdependence of communication events with the context, system and environment in which they occur.

CONCLUSIONS

These results suggest that communication is a collective competency. Effective communication is something veterinary systems, rather than individuals alone, achieve. There is a need to consider the team and organisational contexts in which communication occurs to ensure individual communication skills can be translated into communication practices that support the delivery of high-quality, safe veterinary care for the benefits of clinicians, owners and patients.

Barriers to Care in Veterinary Services: Lessons Learned From Low-Income Pet Guardians' Experiences at Private Clinics and Hospitals During COVID-19

This qualitative study aimed to explore the experiences of low-income pet guardians in accessing veterinary care during COVID-19. Participants were recruited through a purposive sampling method: 12 individuals who applied to and met the low-income threshold to access support for veterinary fees from the Vancouver Humane Society (VHS) were invited for semi-structured in-depth telephone interviews. Participants indicated that they experienced pandemic-related barriers related to and compounded by their low-income status. Their experiences fit into three categories: the barriers to accessing veterinary care pre-and peri-COVID-19, the emotional impact of compounding barriers related to accessing veterinary care during COVID-19, and the human-animal bond and resilience in the context of COVID-19. Drawing on the One Health, One Welfare approach, we argue that veterinary and animal services should evaluate and improve their support services, particularly programs developed for low-income pet guardians. Based on the participants' recommendations, we propose that veterinary and animal services prepare for future disaster situations by increasing their financial capacity to support people needing assistance, undergoing training to better work with people experiencing financial and emotional stress, and providing easily accessible resources to better distribute knowledge about animal needs and available financial assistance programming. The suggestions are intended to benefit animals, their guardians, and both veterinary and animal service sector workers.

Evaluating shared decision-making between companion animal veterinarians and their clients using the Observer OPTION5 instrument

BACKGROUND

Communication practices used by veterinarians can impact client's involvement in decision-making. The objective of this study was to evaluate the level of client involvement in veterinary care decisions and factors impacting client involvement.

METHODS

A random sample of practising companion animal veterinarians and a convenience sample of pet owners were recruited. Each consultation was audio-video recorded and analyzed using the Observer OPTION⁵ instrument, adapted from human medicine, to assess veterinarians' level of shared decision-making. A mixed linear model was used to assess statistical associations between veterinarian, client and appointment-level factors and OPTION⁵ scores.

RESULTS

Sixty veterinarians and 909 of their clients were audio-video recorded during a consultation, of which 717 interactions included a decision identified for analysis using the OPTION⁵ instrument. Elements consistent with shared decision-making were uncommon, with a mean OPTION⁵ score of 22.6 (median = 20.0; sd = 13.05; range = 0-75) out of 100. OPTION⁵ scores were positively associated with the length of the appointment and negatively associated with the veterinarian's years in practice when controlling for statistical interaction between client income and appointment type.

CONCLUSION

Findings suggest an opportunity exists for veterinarians to incorporate more client involvement through increased use of shared decision-making behaviours during veterinary consultations.

Community Veterinary Medicine Programs: Pet Owners' Perceptions and Experiences

Many American pet owners struggle financially, and the COVID-19 pandemic has only exacerbated this problem. Yet, the positive effects that companion animals have in people's lives create the need for supportive systems to ensure that financial limitations, and other barriers, do not preclude pet ownership. To help address these barriers, and reach underserved communities, various forms of community-based veterinary medicine programs have been developed across the country. This study assesses two community-based veterinary programs in North Carolina, USA. In addition to perceptions surrounding veterinary services, this study paid specific attention to communication and respect; two additional elements needed for successful community-based veterinary programs. Surveys were given to clients accessing Asheville Humane Society (AHS) mobile veterinary care clinic and Asheville Humane Society (AHS) Affordable Pet Care Clinic. Results of the anonymous survey indicate that the majority of clients had positive veterinary care experiences in terms of both veterinary services and client communication. In conclusion, low-cost or free community veterinary programs—with effective communication, empathy, and cultural competence—can help open the door to future positive veterinary experiences for disadvantaged pet owners.

Canine and Feline Obesity Management

Obesity and overweight have an impact on more than half of pet cats and dogs. Effective and team-based communication is essential for creating an effective weight loss plan. The diet should meet all essential nutrient requirements during energy/calorie restriction. There are several ways to initiate a weight loss plan, and regular monitoring is essential for determining if a plan is working or needs to be adjusted.

Pet owners' and veterinarians' perceptions of information exchange and clinical decision-making in companion animal practice

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.