Teaching Cultural Humility and Implicit Bias to Veterinary Medical Students: A Review and Recommendation for Best Practices

Career-Long Skills for Personal and Professional Wellness: A Staged Developmental Model of Veterinarian Resilience Training

Burnout and mental health concerns are widespread in veterinarians. Exposure to the suffering of animal patients and human clients and to the complex dynamics of providing care in a challenging system is inherently demanding. We must teach veterinarians skills for personal and professional wellness without pathologizing their distress. Existing approaches to resilience training are promising but limited in scope, depth, duration, sequencing, and implementation. We forward a staged, developmental, career-long model, introduced early in veterinary medical training, extending into post-graduate veterinary medical education, and integrated throughout professional training and continuing education. This framework proposes intrapersonal, interpersonal, and systems and sustainability skills that provide resources for veterinarians to cope with the common emotional, social, and physical impacts of care provision.

Exploring the Experiences of Visiting Veterinary Service Providers in Indigenous Communities in Canada: Proposing Strategies to Support Pre-Clinical Preparation

Many Indigenous communities in Canada lack access to veterinary services due to geography, affordability, and acceptability. These barriers negatively affect the health of animals, communities, and human-animal relationships. Canadian veterinary colleges offer veterinary services to Indigenous communities through fourth-year veterinary student rotations. Ensuring that the students and other volunteer veterinary service providers (VSP) are adequately prepared to provide contextually and culturally appropriate care when working with Indigenous peoples has not been explicitly addressed in the literature. We explored the experiences of VSP delivering services in unfamiliar cultural and geographic settings and identified: what pre-clinic training was most helpful, common challenges experienced, and personal and professional impacts on participants. Fifty-two VSP (veterinarians, animal health technicians and veterinary students) who participated in clinical rotations offered by five Canadian veterinary colleges between 2014 and 2022 completed online surveys. Respondents shared their pre-clinic expectations, sense of preparedness to practice in a remote Indigenous community, their clinical and community experiences, and any personal and professional impacts from the experience. Data were analyzed using a directed content analysis approach. Respondents highlighted which pre-clinic training was most valuable and what they felt unprepared for. Community infrastructure and resources were concerns and many felt unprepared for the relational and communication barriers that arose. VSP were uncomfortable practicing along a spectrum of care with limited clinical resources. Many VSP identified positive personal and professional impacts. Our findings suggest that pre-clinic orientations focused on contextual care in limited resource settings could better prepare VSP to serve underserved Indigenous communities.

Integrated, Scaffolded, and Mandatory Community and Shelter Medicine Curriculum: Best Practices for Transformational Learning on Access to Veterinary Care

Within veterinary medical education, there is increasing focus on equity and cultural competency/humility, especially within service learning in community and shelter medicine. This article reviews the current literature and draws from the experience of the Ontario Veterinary College Community Healthcare Partnership Program's development of a community and shelter medicine curriculum. We propose that to graduate veterinarians with the knowledge and skills to address inequities in access to veterinary care, a best practice is to integrate mandatory in-class and experiential learning activities, scaffolded across the curriculum. This is a best practice as it creates the best chance for transformational learning for students and is part of our responsibility to the communities we partner with to move toward cultural safety. This Best Practice report addresses the following questions: 1. What foundation of knowledge in community and shelter medicine is needed? (Five curricular pillars: animal welfare, vulnerable animals, spectrum of care, well-being, and cultural humility). 2. How should programs be structured? (Mandatory, integrated, and scaffolded curriculum). 3. What are the pedagogical goals? (Transformational learning). It is our hope that this synthesis is of value to other veterinary colleges seeking to develop programs and/or curricula in community and shelter medicine to address barriers to veterinary care access.

Veterinary Student Skills Learned at an Access to Care Clinic: Beyond Medicine and Surgery

Incorporating curriculum to effectively help veterinary students learn how to provide accessible quality care to all pet owners is needed. The primary aims of this study are to explore how a 2-week rotation at a veterinary medical service-learning clinic (Wisconsin Companion Animal Resources, Education, and Social Services [WisCARES]) improves (a) comfort in working with clients from diverse race and low socioeconomic (SOCI) backgrounds and (2) confidence in leading cases, communication skills, and providing a spectrum of care options. Students were surveyed at five time points pre-rotation: mid-week 1, mid-week 2, end of rotation, and 1-month post. A total of 115 survey series were at least partially completed. Of the 97 responses that include background information, 68 (70%) students reported having "no to a few weeks" of experience working with diverse or low SOCI populations. When comparing themselves to before starting the rotation, student responses indicated increased comfort (mean = 4.54, standard deviation [SD] = 0.54) and compassion (mean = 4.42, SD = 0.78) working with low-income or homeless populations, more comfort interacting with members of different race or ethnicity groups (mean = 4.21, SD = 0.82), and more appreciation for the human-animal bond (mean = 4.42, median = 5). Students also reported that spending time at WisCARES positively impacted their confidence in a clinical setting, managing and communicating about financial decisions, and approaching cases creatively. Giving students an opportunity to lead cases with clients from diverse races and low SOCI backgrounds can enhance levels of comfort with practice and improve confidence.

One Profession, Multiple Identities: On the Implications of Intersectionality in Veterinary Medicine

It is a well-known fact in veterinary medicine that the field has struggled to diversify the profession and is one of the most homogenous careers in the United States. Discrimination is still quite common in the United States, despite decades of policy changes and implementation of DEI practices. This study discusses how veterinary medicine can benefit from an intersectional approach to diversity, equity, and inclusion. It discusses the need of intersectional data to better understand the disparities that exist within veterinary medicine to make a more significant impact.

Development of a Competency-Based Veterinary Education Diversity, Equity, Inclusion, and Justice Domain

A group of veterinary educators with diverse backgrounds and interests from five universities in the northeastern region of the United States convened in December 2020 to address challenges in diversity, equity, inclusion, and justice (DEIJ) in veterinary education. It was elected to develop a DEIJ-specific competency domain to supplement the nine domains previously described in the Competency-Based Veterinary Education framework. The domain that we created provides a detailed but flexible roadmap that can be used to guide curriculum-development initiatives that support learner development in DEIJ and, as a result, enhance their impact in working teams and the communities in which they will live and practice. However, we anticipate that this domain will be regularly updated to stay relevant with respect to social change and veterinary medicine.

Diversity, Equity, Inclusion, and Belonging in Veterinary Education

Interweaving diversity, equity, and inclusion (DEI) into the standards for accreditation requires veterinary schools to review their curriculum and determine what framework works best for them to implement those changes. The Competency-Based Veterinary Education framework is one that is available via the American Association of Veterinary Medical Colleges (AAVMC) to reach those standards. Five standards have DEI components versus having a single standard of DEI as previously Standards of Accreditation by the Council on Education had approved.

Student Veterinarian Perceptions of Community-Based Primary Care Veterinary Clinics in Indigenous Communities in Southern Ontario, Canada

Community-based primary care veterinary clinics represent an opportunity to benefit multiple populations. Student veterinarians are afforded the opportunity to build technical and non-technical professional skills, while underserved communities are provided with access to companion animal care. The Ontario Veterinary College (OVC), as with many other veterinary colleges across Canada and the United States, has hosted community-based primary care veterinary clinics, including in local Indigenous communities. As these clinics continue and grow, it is critical to evaluate their operation to ensure that they align with community goals and values, adequately support student learning, and do not perpetuate racism and implicit bias. The objective of this study was to explore the perceptions of student veterinarians who had volunteered at community-based primary care veterinary clinics in First Nations communities in southern Ontario, Canada. We used an online survey that consisted of multiple choice and short answer questions focused on motivating factors for involvement, supports available before and during the clinics, exposure to Indigenous cultures, and the challenges and rewards associated with volunteering. Forty-one student veterinarians from OVC completed the survey in January 2020. Most students were motivated to volunteer to make a positive difference in the lives of people and animals and improve their clinical skills. In general, respondents felt adequately prepared for and supported during their experiences but did recommend additional pre-departure instructions on roles and responsibilities. Participants were ambivalent as to whether they had learned about Indigenous culture, with several strongly recommending more cultural sensitivity training. Most students found their experiences rewarding because of the gratitude expressed by clients and the feeling that they had made a difference. We reflect on the potential benefits and challenges of community-based primary care veterinary clinics in light of student responses.

Spanish for Veterinarians Part 1: An Approach to Weaving Spanish Language Education into DVM Curricula

The authors describe the need for discipline-specific Spanish language training in veterinary programs and elaborate on student interest in veterinary Spanish offerings. They outline their interdisciplinary approach to field-specific Spanish curriculum development that evolved from a single third-year practicum offering into a 7-credit Spanish language program while summarizing curriculum content, assessments, and student feedback. The challenges and approaches to weaving the language program into a demanding veterinary curriculum are addressed and program limitations are discussed. The paper ends with an outline of exciting future directions currently underway that hold achieving the necessary level of Spanish language proficiency for successful communication about animal health and well-being as a primary goal. The intent of this publication is to shed light on unique aspects associated with designing and delivering a Spanish language program within veterinary education, including the importance of interdisciplinary collaboration with language teaching professionals for curriculum development and delivery.

Development and initial validation of the Animal Welfare Cultural Competence Inventory (AWCCI) to assess cultural competence in animal welfare

Cultural competence is recognized as critical to reducing disparities within human healthcare settings, but it is rarely incorporated into evaluations of companion animal services. We developed and validated an animal welfare-focused cultural competence instrument with client and provider versions. We then used the instrument to assess the relationship between animal welfare providers' cultural competence and services provided to clients in historically underserved communities. 24 providers across 17 sites participated in the provider survey. 422 clients across those sites also participated and had their service utilization data analyzed. We found a significant correlation between the number of client-provider interactions and their level of agreement within the instrument's "competence/confidence" subscale. We also found that these interactions had a significant correlation with veterinarian care and spay/neuter services. This study provides initial evidence that increasing the use of culturally competent engagement strategies has the potential to increase service utilization for pets in historically underserved communities.

Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care

The American Veterinary Medical Association Council on Education mandates in standard 11 that all accredited colleges of veterinary medicine must develop and deliver formal processes by which students are observed and assessed in nine competencies. The eighth competency combines clinical communication and sensitivity toward soliciting and understanding individual narratives across a diverse clientele to facilitate health care delivery. Several frameworks have been designed to structure health care consultations for teaching and coaching purposes. The Calgary-Cambridge guide (CCG) provides an evidence-based approach to outlining the flow of consultations, incorporating foundational communication skills and elements of relationship-centered care into a series of sequential tasks. Although the CCG was intended for use as a flexible tool kit, it lacks visible connections between concrete experiences (e.g., the consultation) and reflective observation (e.g., the feedback). This teaching tip describes the development of a novel anatomical representation of the consultation that integrates process elements of the CCG with other core curricular concepts. By combining knowledge, technical skills, critical thinking, reflection, cultural humility, and self-awareness into a skeletal consultation model, linkages are established between communication and intergroup dialogue skills and diversity and inclusion (D&I). This model has been further adapted as feline, caprine, porcine, equine, avian, and reptilian versions for in-class use as strategic visual aids that highlight key areas of focus for Professional Skills class sessions. Future developments by the authors will explore how to link species-specific consultation models to assessment rubrics to reinforce the connection between content (what) and process (how).

Physical health caregiver, mental wellness supporter, and overall well-being advocate: Women's roles towards animal welfare during the COVID-19 emergency response

Women's health-specific contributions in emergency response stages pertain primarily to family and community-based rescue and support-focused roles. As disasters affect both human beings and their animal co-inhabitants, comprehensive literature exploring women's contributions towards companion animal welfare in emergency response settings remains sparse. COVID-19-triggered public health mitigation strategies caused diverse challenges relating to veterinary medical service access, thus establishing a platform for a nuanced exploration of gendered roles vis-a-vis animal health and well-being during the initial COVID-19 emergency response period. This project employs a semi-structured interview approach to qualitatively investigate the roles, responsibilities, and experiences of twelve people, eleven of whom self-identify as women, who cared for animal co-inhabitants while seeking veterinary medical services during the COVID-19 emergency response in Metro Vancouver, British Columbia, Canada. This research identifies three primary animal welfare-related roles that woman companion animal guardians (WCAGs) assumed during the COVID-19 emergency response period: 1) Companion animal physical health caregiver, spanning from nuclear to extended families and into the community; 2) Companion animal mental wellness supporter, associated with human-animal interactions in family/household, community, and veterinary clinic settings; 3) Companion animal holistic well-being advocate, utilizing various strategies at family, community, and societal levels. Understanding gender-specific animal welfare contributions in an emergency response setting narrows knowledge gaps and provides WCAGs and animal welfare-related public, private, and not-for-profit sectors with evidence-based strategies for emergency response planning improvements, supporting healthy and sustainable human-animal bonds in the current COVID-19 pandemic and future extreme events.

Actualizing Cultural Humility: An Exploratory Study of Veterinary Students' Participation in a Northern Community Health Rotation

Rotations in diverse, marginalized communities may offer health care students opportunities to develop cultural humility through different clinical experiences and activities. Through the actualization of cultural humility, veterinarians may offer accessible, affordable, culturally proficient, high-quality care to all their patients with a better understanding of how cultural differences affect the animal patient's health, well-being, and care. The purpose of this study was to explore whether participation in a community rotation in remote northern Indigenous communities promotes cultural humility among final-year veterinary students. Small groups of University of Calgary veterinary students travel annually to the Sahtu Settlement Area of the Northwest Territories, Canada, to participate in the Northern Community Health Rotation (NCHR). During the 4-week rotation, students spend 2.5 weeks providing veterinary services to domestic animals in five communities in the Sahtu. Eleven veterinary students who attended the NCHR between 2015 and 2020 answered exploratory open-ended questions in an online survey. Responses highlight areas of learning that contributed to their development of cultural humility. The rotation appears successful in increasing students' confidence working with people from diverse cultures, offering students opportunities to implement a client-centered approach, and advancing their capacity to recognize and challenge their preconceived biases about Indigenous cultures and animal ownership. These experiences are important to the acquisition of cultural humility for veterinary care providers.

Evaluating Communication Training at AVMA COE-Accredited Institutions and the Need to Consider Diversity within Simulated Client Pools

The push for competency-based veterinary medical education by accrediting bodies has led to the inclusion of non-technical skills within curricula. Communication, self-awareness, and cultural humility are considered essential for post-graduate success. To facilitate skills development, veterinary educators have incorporated a variety of modalities including lecture, group discussions, virtual and peer-assisted learning, role play, video review of consultations, and simulated clients (SCs). The overarching goal is developing students into self-reflective practitioners through exposure to clinical scenarios that enhance and embody diversity. Decision making about case management is subject to stereotypes, bias, and assumptions. Racial and ethnic disparities reported in health care can adversely impact patient outcomes. This study was conducted to evaluate communication training and diversity among SC pools within veterinary colleges. A questionnaire was electronically disseminated to assistant/associate deans and/or directors of curriculum/education at 54 American Veterinary Medical Association Council on Education-accredited or provisionally accredited colleges of veterinary medicine. Twenty-one institutions are represented within the data set. Participating institutions summarized their communication curricula: 18 (85.71%) used SCs. Over 55% of these did not track SC demographic data or social identities; among institutions that did track, SCs were primarily monolingual English-speaking (77%), non-disabled (94.2%), white (90.4%), non-Hispanic/Latinx (98.6%) women (57%) over age 56 (64%). Sixteen institutions agreed with the statement "I do not feel that our SC pool is adequately diverse." Respondents shared that lack of time and capacity for recruitment were barriers to diversifying SC pools and proposed strategies to improve outreach.

Co-constructive Veterinary Simulation: A Novel Approach to Enhancing Clinical Communication and Reflection Skills

Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction with simulated participants (SPs) can become performative or circumscribed to evaluative assessments. This article describes co-constructive veterinary simulation (CCVS), an adaptation of a novel approach to participatory simulation that centers on learner-driven goals and individually tailored scenarios. CCVS involves a first phase of scriptwriting, in which a learner collaborates with a facilitator and a professional actor in developing a client-patient case scenario. In a second phase, fellow learners have a blinded interaction with the SP-in-role, unaware of the underlying clinical situation. In the final part, all learners come together for a debriefing session centered on reflective practice. The authors provide guidelines for learners to gain maximal benefit from their participation in CCVS sessions and describe thematic possibilities to incorporate into the model, with specific case examples drawn from routine veterinary practice. Finally, the authors outline challenges and future directions toward implementing CCVS in veterinary medical education toward the ultimate goal of professional growth and co-evolution as veterinary practitioners.

Cultural Competence Is Everyone's Business: Embedding Cultural Competence in Curriculum Frameworks to Advance Veterinary Education

Cultural competence in professional and research practice is important to effectively deliver animal and One Health services and programs. Veterinarians work with culturally and linguistically diverse teams, clients, and communities. Cultural perspectives on the significance and perceptions of animals and differences in consultation and engagement protocols and strategies can influence client-practitioner and researcher-community relationships, impacting animal health, welfare, and/or research outcomes. Curricula have been proposed to build cultural capacity in graduates, but these have not been reported in veterinary programs, and early attempts to integrate cultural competency into the University of Sydney veterinary curriculum lacked a formal structure and were ad hoc with respect to implementation. To address this, the authors introduced a broad curriculum framework into the University of Sydney veterinary program, which defines cultural competence, perceptions of animals, effective communication, and community engagement in a range of contexts. Cultural competency learning outcomes were described for units of study. These were contextually relevant and aligned to course learning outcomes and University of Sydney graduate qualities. Constructive alignment was achieved by linking learning outcomes to teaching and learning activities and assessment. The continuum of cultural competency underpinned mapping of cultural competency across the curriculum with staged, vertical integration of key principles. Additionally, action to engage staff, students, and stakeholders in a cultural competence agenda assisted in sustaining curriculum change. The result was integration of cultural competency across the curriculum aligning with recommendations from accrediting bodies and with best practice models in medicine, nursing, and allied health programs.

Veterinary and Pharmacy Students' Expectations Before and Experiences After Participating in an Interdisciplinary Access to Care Veterinary Clinic, WisCARES

This pilot survey study describes student expectations and experiences at WisCARES, a low-cost veterinary medical teaching clinic where students from multiple disciplines collaborate. We hypothesized that prior to the workday, students would describe different expectations of working in an interdisciplinary access to care clinic than what they ultimately experienced. We surveyed 62 students from the School of Veterinary Medicine (46) and pharmacy (16) who spent a clinic day at WisCARES. Before introductory rounds, students completed a short survey consisting of four open-ended questions about their learning expectations; at the end of the day, they reviewed their initial responses and added what they actually learned. Qualitative information was categorized and analyzed using descriptive statistics. Thirteen major themes emerged: diversity, confidence, communication, case lead/case management, financial experience, helping people, teamwork, technical skills, inter-professional experience, mentoring, non-specific positive regard, appreciation for resources, and rounds. Students reported improved confidence in managing and leading cases with specific positive outcomes in communicating with clients, particularly regarding leading financial conversations. Developing greater insight into diversity was a common theme expressed in students' expectations but was less frequently noted as an end-of-day outcome. Veterinary students less frequently described the value of the inter-professional environment and collaboration, but this was a major theme noted among pharmacy students. Student feedback was positive overall. The current study is useful in identifying areas for improving collaborative instruction and access to care professional student learning opportunities.

Student Experience and Ethnic Diversity: The Experiences of Underrepresented Minority Students at a Veterinary University in the United Kingdom

Despite a lack of diversity, studies on the experience of ethnically diverse (ED) students have not focused on veterinary education. This study used focus groups to explore the experience of ED veterinary students, their challenges, and their sources of support in this setting. Focus groups were held using two formats: a traditional, in-person approach, and online, via a social media group. Recruitment was by invitation and focus group allocation according to participant preference. Conversations were transcribed or downloaded, anonymized, and analyzed using a two-part narrative analysis, the aim of which was to understand the experiences of ED veterinary students at an in-depth level. Students experienced identity conflicts at multiple levels (self, others, profession), which appeared to relate to their ethnicity. Conflict between self and others resulted in a feeling of otherness arising from a White student majority, both within the university and on external placements, and professional identity conflicts arose between students' personal cultural values and their values as a veterinarian. Internal conflicts arose when students felt a wish to integrate but also perceived a need to segregate with similar others to obtain support and a sense of belonging to a group. These challenges have potential implications for mental well-being and career opportunities. For veterinary medicine to adapt to changing client demographics in an increasingly globalized world, a deeper understanding of the ED student experience may offer advantages in areas such as recruitment and profession retention, which will eventually support greater diversity within the professional population.

A Qualitative Analysis of Clinical Year Veterinary Student Journal Entries for a Shelter Medicine Rotation

Veterinary medical schools are tasked with not only providing experiences necessary to graduate veterinarians proficient in the skills and knowledge used most frequently in private practice, but also develop expertise in animal behavior, welfare, ethics, veterinary forensics, and cultural competency. Integrating all these knowledge areas into the curriculum can be challenging. Shelter medicine is increasingly identified by educators as an optimal learning environment to offer exposure to these topics. It can not only meet learning objectives in veterinary medical curriculum, but also provide students with authentic learning experiences to engage in and gain a deeper understanding of cultural humility, implicit bias, diversity, and inclusion. This includes documentation of international learning outcomes for shelter medicine in veterinary medical curriculum. There have been no studies evaluating authentic learning experiences specific to shelter medicine programs and their impacts on students. The aim of this study was to determine the individual activities and thematic categories on which veterinary students chose to reflect on and their potential impacts during a clinical rotation in shelter medicine at Penn Vet through qualitative content analysis of their journal entries. In our study, students found experiences on the shelter medicine rotation to be beneficial to their growth as a future veterinarian, provided them with takeaways that they found applicable and practical, helped them self-identify knowledge gaps, and changed their perspectives on several important topics related to collective human and animal welfare. These results speak to the value perceived by students of the rotation and suggest an authentic learning experience through a shelter medicine program can help cultivate more practice-ready and culturally competent veterinary graduates.

Development of a 1-Week Intensive Course on Diversity and Equity in Veterinary Medicine

While colleges of veterinary medicine continually strive to promote diversity and inclusion on their campuses, few offer dedicated diversity courses within their curriculums. This article provides details on the development and implementation of a 1-week intensive course on equity and diversity in veterinary medicine, discusses the strengths and challenges encountered, and provides suggestions for those seeking to develop similar learning experiences into their curriculum. This selective course was developed to introduce students to the principles of social justice and provide them with the opportunity to examine systems of power, privilege, and oppression within the context of veterinary medicine.

How to Approach Cultural Humility Debriefing within Clinical Veterinary Environments

Cultural humility debriefing provides learners with the opportunity to consider how they engage with clients and patients while keeping their own identities and biases in mind. In this article, we invite a deeper understanding of the cultural humility debrief by reviewing its history and uses, describing the state of mind and communication skills required for successful facilitation, and providing a step-by-step process as a framework for veterinary educators to implement effective cultural humility debriefing in practice. This teaching technique is rooted in established communication tools-specifically, permission seeking, open-ended questions, reflective listening, and empathy. Drawing on experience from an inter-professional clinic that serves people who live at or below the national poverty level, this article offers insights to veterinary educators so they can use the cultural humility debrief. By utilizing the outlined debriefing strategies in a clinical setting, it is possible to augment any existing veterinary curriculum and strengthen education around cultural topics.