Practicing the skills of evidence-based veterinary medicine through case-based pharmacology rounds

Evaluation of an evidence-based veterinary medicine exercise for instruction in clinical year of veterinary medicine program

INTRODUCTION

Evidence-based veterinary medicine (EBVM) is a fundamental core competency for new graduates. Our objectives were to evaluate clinical students' use, understanding of, and confidence in EBVM before undertaking an exercise consisting of an hour seminar in conjunction with a medical librarian, followed by a journal club and to evaluate students' knowledge of and ability to apply EBVM following the exercise.

METHODS

In this cohort study, students undertaking a large animal ambulatory rotation completed questionnaires before the seminar, following the journal club, and at graduation. Students took a Fresno test evaluating EBVM knowledge at the end of the rotation.

RESULTS

Prior to the seminar, 94% of students defined EBVM at least somewhat accurately, and 51% reported EBVM was at least 'quite important'. During previous rotations, 71% of students had performed literature searches to answer a clinician-assigned question; 89% had done this to answer their own questions. Students with previous research or EBVM training were more likely to perform self-directed literature searches. The most frequently used resource was textbooks. Eighty-seven per cent and 90% of students found the seminar and journal club, respectively, at least moderately useful in improving EBVM knowledge.

CONCLUSIONS

Our results support the inclusion of an EBVM exercise during the clinical year and suggest spaced repetition may be helpful in teaching this topic.

Case-Based e-Learning Experiences of Second-Year Veterinary Students in a Clinical Medicine Course at the Ontario Veterinary College

Exposure to real-life clinical cases has been regarded as the optimal method of achieving deep learning in medical education. Case-based e-learning (CBEL) has been considered a promising alterative to address challenges in the availability of teaching cases and standardizing case exposure. While the use of CBEL has been positive in veterinary medical education, insight into students' learning experience with a CBEL tool have not been considered. This article investigates students' views around the utility and usability of a CBEL tool, as well as perceived effectiveness, clinical confidence, and impact of veterinary students' learning preferences on CBEL use. Through focus groups as well as pre- and post-use questionnaires, students expressed that the design and utility of the online cases, including their authenticity, played an instrumental role in perspectives and acceptance of the CBEL tool. Students perceived the CBEL tool as highly effective in both achieving CBEL outcomes and teaching a methodical approach to a clinical case. CBEL elements were also perceived to potentially contribute to increased clinical confidence after CBEL use. Additionally, exploration of students' preferred approach to learning revealed that hands-on learners and those who prefer to learn by practicing and applying knowledge were more likely to show positive perceptions of a CBEL tool. This article's findings can help guide educators in the future design and implementation of online cases in various capacities and provide a platform for further exploration of the effectiveness and use of CBEL in veterinary medical education.

Critically Appraised Topics (CATs) in Veterinary Medicine: Applying Evidence in Clinical Practice

Critically appraised topics (CATs) are evidence syntheses that provide veterinary professionals with information to rapidly address clinical questions and support the practice of evidence-based veterinary medicine (EBVM). They also have an important role to play in both undergraduate and post-registration education of veterinary professionals, in research and knowledge gap identification, literature scoping, preparing research grants and informing policy. CATs are not without limitations, the primary one relating to the rapid approach used which may lead to selection bias or restrict information identified or retrieved. Furthermore, the narrow focus of CATs may limit applicability of the evidence findings beyond a specific clinical scenario, and infrequently updated CATs may become redundant. Despite these limitations, CATs are fundamental to EBVM in the veterinary profession. Using the example of a dog with osteoarthritis, the five steps involved in creating and applying a CAT to clinical practice are outlined, with an emphasis on clinical relevance and practicalities. Finally, potential future developments for CATs and their role in EBVM, and the education of veterinary professionals are discussed. This review is focused on critically appraised topics (CATs) as a form of evidence synthesis in veterinary medicine. It aims to be a primary guide for veterinarians, from students to clinicians, and for veterinary nurses and technicians (hereafter collectively called veterinary professionals). Additionally, this review provides further information for those with some experience of CATs who would like to better understand the historic context and process, including further detail on more advanced concepts. This more detailed information will appear in pop-out boxes with a double-lined surround to distinguish it from the information core to producing and interpreting CATs, and from the boxes with a single line surround which contain additional resources relevant to the different parts of the review.

Encouraging Critical Clinical Thinking (CCT) Skills in First-Year Veterinary Students

First-year didactic course instructors at the University of Illinois College of Veterinary Medicine leverage earlier clinical rotation experiences with weekly "Clinical Correlations" exercises to provide early exposure to critical clinical thinking (CCT). This study evaluated the efficacy of individual and paired group exercises on CCT development. Before and after instruction, the Cornell Critical Thinking Test (Level Z) (CCTTZ) was administered. Based on the hypothesis that students with higher scores would coach lower-scoring colleagues during group exercises, heterogeneous groups with similar mean scores were established for the year. Students completed 14 individual and paired group exercises over 6 months. Exercises were designed to increase in complexity and decline in scaffolding. Seven of the exercises were cases using the Applied Learning Platform (ALP) at http://www.whenknowingmatters.com . Student analyses were scored according to a six-category critical-thinking rubric using a 5-point scale. Consistent with our hypothesis, individual and group rubric scores increased significantly, plateauing near the end of the year. Contrary to our hypothesis, mean overall CCTTZ scores did not change, but there was a small statistically significant increase in the ability to assess the validity of an argument. Student attitudes were mixed. Positive comments focused on reinforcement of prior didactic instruction, while negative comments focused on preparation time needed to conduct research on clinical concepts, and on a lack of explicit evaluation by summative examinations. Nonetheless, end-of-year GPAs correlated linearly with cumulative individual rubric scores. In summary, the value of early curriculum CCT training was confirmed when discipline-specific criteria were applied.

Teaching Evidence-Based Veterinary Medicine in the US and Canada

There is no comprehensive review of the extent to which evidence-based veterinary medicine (EBVM) is taught in AVMA-accredited colleges of veterinary medicine in the US and Canada. We surveyed teaching faculty and librarians at these institutions to determine what EBVM skills are currently included in curricula, how they are taught, and to what extent librarians are involved in this process. Librarians appear to be an underused resource, as 59% of respondents did not use librarians/library resources in teaching EBVM. We discovered that there is no standard teaching methodology nor are there common learning activities for EBVM among our survey respondents, who represent 22 institutions. Respondents reported major barriers to inclusion such as a perceived shortage of time in an already-crowded course of study and a lack of high-quality evidence and point-of-care tools. Suggestions for overcoming these barriers include collaborating with librarians and using new EBVM online teaching resources.

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Training evidence-based veterinary medicine by collaborative development of critically appraised topics

In current veterinary education, skills such as retrieving, critically appraising, interpreting, and applying the results of published scientific studies are rarely taught. In this study, the authors tested the concept of team-based development of critically appraised topics (CATs) in training students in evidence-based veterinary medicine (EBVM). The 116 participants were in their fifth year and attending the clinical rotation at the Clinic for Animal Reproduction. Students developed 18 CATs of varying quality on topics of their choice. Preparing the CATs in teams stimulated discussion on the topic and the quality of the retrieved papers. Evaluation of the project revealed that more than 90% of the students endorsed training in critical appraisal of information in veterinary education. In addition, more than 90% considered the development of CATs an effective exercise for assessing the quality of scientific literature. A provided literature evaluation form was perceived as a useful tool for systematically summarizing a publication's quality. In conclusion, team-based development of CATs during clinical rotations is highly valuable for training in EBVM. Learning and intrinsic motivation seem to be enhanced by creating a situation similar to veterinary practice because the task is embedded into an authentic clinical problem. This approach to clinical training helps to prepare students to integrate evidence from literature into practice.

Training students to appraise the quality of scientific literature

Implementing evidence-based veterinary medicine (EBVM) into clinical practice requires not only the ability to retrieve, interpret, and apply the results of published scientific studies, but also the ability to critically evaluate the quality of the literature. These skills, however, are not widely taught in the veterinary curriculum. The objective of this study was to test a literature evaluation form (LEF) designed to assist veterinary students in appraising the quality of literature on animal reproduction and to compare their ability to do so with that of students who were provided with a control form (CF). The 68 participants were in their fifth year of study and attended a clinical rotation at the Clinic for Animal Reproduction. Students in the LEF group determined the quality of two scientific papers, considering statements about study design, information content, and objectivity, and determined rating points to obtain an overall score. Participants using the CF ranked the quality of the article without the assistance of the quality assessment form. The LEF group was able to more correctly assess the quality of the literature and the variability of the chosen evidence levels was higher in the CF group. The questionnaire was found to be a useful tool for the systematic assessment of the quality of publications within a reasonable period of time. Seventy-eight per cent of the participants agreed that the LEF helps them evaluate the quality and validity of biomedical scientific information. We conclude that courses that introduce EBVM should be taught in the first semesters of the veterinary curriculum so that students can develop competence in defining a clinical problem, retrieving information from the literature, and developing independent critical thinking.

The role of veterinary medical librarians in teaching information literacy

This qualitative study seeks to determine the nature of the instruction librarians provide to veterinary medical students at all 28 United States veterinary colleges. A secondary goal of the study was to determine in what ways and to what extent librarians participated in other instructional activities at their colleges. Over half of the librarians formally taught in one or more courses, predominantly in the first two years of the veterinary curriculum. One presentation per course was most common. Over half of the librarians interviewed stated that evidence-based veterinary medicine was taught at their colleges, and about half of these librarians collaborated with veterinary faculty in this instruction. Many librarians participated in orientation for first-year veterinary students. The librarians also taught instructional sessions for residents, interns, faculty, graduate students, and practicing veterinarians. This study found that librarians teach information literacy skills both formally and informally, but, in general, instruction by librarians was not well integrated into the curriculum. This study advances several recommendations to help veterinary students develop information literacy skills. These include: encourage veterinary faculty and administrators to collaborate more closely with librarians, incorporate a broader array of information literacy skills into assignments, and add a literature evaluation course to the curriculum.

Epidemiological research and evidence based medicine: How do they fit and for whom

Evidence based medicine involves using the best current information to inform patient care. In veterinary medicine, evidence based veterinary medicine (EBVM) has been discussed for about 15 years. Epidemiology and EBVM are closely linked and epidemiologists can provide crucial support for the practice of EBVM. The secondary literature which summarizes important research into more accessible and applied work could benefit from additional involvement by epidemiologists. Epidemiologists have a broad range of stakeholders for their work and should consider who the specific audience is and what the important endpoints are for that audience. More work on reporting guidelines for observational studies and on issues relating to external validity are needed to facilitate EBVM. Epidemiologists should consider teaching veterinary, graduate and post-graduate students how to perform EBVM. Getting credit for efforts which support EBVM can be difficult but creative presentation of work, publications and grants relating to EBVM should help. Quite a few veterinary journals are actively soliciting manuscripts relating to EBVM.