Robustness of five different visual assessment methods for the evaluation of hindlimb lameness based on tubera coxarum movement in horses at the trot on a straight line

BACKGROUND

The evaluation of hindlimb lameness remains a major challenge in everyday clinical practice. In the absence of clear guidelines, veterinarians use different visual assessment methods for this task whose robustness is unknown.

OBJECTIVES

Determination of the robustness of five visual hindlimb lameness assessment methods based on the comparison of left and right tuber coxae movement.

STUDY DESIGN

Validated mathematical hindlimb lameness model based on experimental data from the literature.

METHODS

Vertical movement of left (LTC) and right (RTC) tuber coxae was simulated for the range of common hindlimb lameness movement patterns that horses present within practice. Lameness severity ranged from sound to moderately lame (0% to 60% motion asymmetry). The scenarios of a pelvis held tilted and asymmetrical pelvic roll were included to reflect possible adaptations in pelvic rotation. Across all conditions, the outcomes for five different visual assessment methods based on comparative tubera coxarum movement were quantified, including hip hike, -drop and range of motion. The robustness of each assessment method was established through comparison to sacrum-based overall motion asymmetry as the ground truth.

RESULTS

Tubera coxarum-based lameness assessment was highly sensitive to all the unique lameness patterns and changes in pelvic rotation which a lame horse may adopt. None of the five visual lameness assessment methods was 100% robust across all conditions tested. For everyday clinical practice, comparing the upward movement amplitude of the RTC before right hind foot contact and of the LTC before left hind foot contact (Hip_hike_diff) would be the most robust single tubera coxarum-based visual assessment method.

MAIN LIMITATIONS

In the absence of published data regarding the frequency of different movement patterns and hip rotation adaptations in clinical practice, this study cannot indicate the proportion of assessments that would be incorrect for a given visual assessment method.

CONCLUSIONS

Using a single tubera coxarum-based visual hindlimb lameness assessment method may lead to incorrect clinical judgement. Therefore, using multiple assessment methods would be beneficial to substantiate impressions.

Expert visual assessment strategies for equine lameness examinations in a straight line and circle: A mixed methods study using eye tracking

BACKGROUND

A large number of lameness indicators have been suggested for the visual equine lameness assessment. However, it remains unknown which of these are commonly used by experts.

METHODS

Twenty-four expert lameness assessors from 10 leading UK institutions viewed 28 video clips of sound and mildly lame horses (median score 2/10). Horses were shown at trot in a straight line (rear and front view) and circle (side view, left and right rein). Eye tracking data were collected at 60 Hz while participants evaluated each clip. A questionnaire captured contextual information.

RESULTS

During assessment on the straight line, participants consistently looked mostly at the head and pelvis. On the circle, many participants consistently looked at the head, yet the subsequent choice, weighting and order of examined body regions was unsystematic between and within participants, and there was a bias towards prolonged assessment of the horse's front region. Questionnaires revealed different descriptions of lameness indicators for the same body region and different approaches to decision making under uncertainty.

CONCLUSION

In contrast to reasonably high similarity on the straight line, expert veterinarians have not developed a consistent assessment approach when evaluating horses on the circle. The reliability of various lameness indicators on the circle requires a stronger evidence base for a more systematic, repeatable approach.

Effect of gamified perceptual learning on visual detection and discrimination skills in equine gait assessment

BACKGROUND

Visual assessment of equine lameness is an everyday veterinary task suffering from poor diagnostic accuracy. The aim of this study was to quantify the impact of the perceptual learning game 'LamenessTrainer' on skill development.

METHODS

Thirty-six undergraduate veterinary students engaged in four game modules teaching the assessment of fore- and hindlimb lameness. Computer animations of horses in this game displayed 0% (sound) to 70% (moderately lame) vertical movement asymmetry of head and pelvis. Performance, learning effects, diagnostic accuracy, detection thresholds and survey responses were analysed.

RESULTS

Following staircase learning, more than 80% of students reliably classified horses with ≥20% asymmetry for forelimb lameness, ≥40% asymmetry for simplified hindlimb lameness and ≥50% asymmetry for realistic hindlimb lameness. During random presentation, on average 82% of sound and 65% of lame horses were assessed correctly during forelimb lameness evaluation, dropping to 39% of sound and 56% of lame horses for hindlimb lameness.

CONCLUSION

In less than two hours, systematic perceptual learning through deliberate practice can develop visual assessment skills to an accuracy level comparable to expert assessors scoring the same animations. Skills should be developed further to improve misclassifications of sound and mildly lame horses, especially for hindlimb lameness evaluation.

Collaborative Development of a Shared Framework for Competency-Based Veterinary Education

Competency-based medical education is an educational innovation implemented in health professions worldwide as a means to ensure graduates meet patient and societal needs. The focus on student-centered education and programmatic outcomes offers a series of benefits to learners, institutions and society. However, efforts to establish a shared, comprehensive competency-based framework in veterinary education have lagged. This article reports on the development and outcome of a competency-based veterinary education (CBVE) framework created through multi-institutional collaboration with international input from veterinary educators and veterinary educational leaders. The CBVE Framework is designed to reflect the competencies expected of new graduates from member institutions of the Association of American Veterinary Medical Colleges (AAVMC). The CBVE Framework consists of nine domains of competence and 32 competencies, each supplemented with illustrative sub-competencies to guide veterinary schools in implementing competency-based education in their local context. The nine domains of competence are: clinical reasoning and decision-making; individual animal care and management; animal population care and management; public health; communication; collaboration; professionalism and professional identity; financial and practice management; and scholarship. Developed through diverse input to facilitate broad adoption, the CBVE Framework provides the foundation for competency-based curricula and outcomes assessment in veterinary education internationally. We believe that other groups seeking to design a collective product for broad adoption might find useful the methods used to develop the CBVE Framework, including establishing expertise diversity within a small-to-medium size working group, soliciting progressive input and feedback from stakeholders, and engaging in consensus building and critical reflection throughout the development process.

Collaborative Development of Core Entrustable Professional Activities for Veterinary Education

Entrustable professional activities (EPAs) have been proposed as a practical framework for the implementation of competency-based education. As veterinary education moves toward a competency-based approach, core EPAs provide a context for assessment of workplace activities. This article reports on the development of eight core clinical EPAs for veterinary education created through multi-institutional collaboration, with international input from veterinary educators and veterinary educational leaders. These core EPAs are intended as minimal expectations for clinical activities that should be assessed for every graduate of Association of American Veterinary Medical Colleges member institutions. Adoption of the core EPAs and the associated Competency-Based Veterinary Education (CBVE) framework by veterinary schools is intended to promote Day One graduate competence and thereby enhance patient care and client service.

Development of core entrustable professional activities linked to a competency-based veterinary education framework

Purpose: Despite the adoption of competency-based education in some veterinary schools over the past 15 years, only recently has a concerted effort been directed toward this in veterinary education internationally.Methods: In 2015, educational leaders from the Association of American Veterinary Medical Colleges (AAVMC) member schools came together with a strong call to action to create shared tools for clinical competency assessment.Results: This resulted in the formation of the AAVMC Competency-Based Veterinary Education (CBVE) Working Group, which then embarked on the creation of a shared competency framework and the development of eight core entrustable professional activities (EPAs) linked to this framework.Conclusions: This paper will report on the development of these EPAs and their integration with the concurrently-developed CBVE Framework.

The modern UK veterinary profession: photo-elicitation interviewing reveals that small animal and surgical images dominate

More than 80 per cent of vets are employed in clinical practice but other veterinary roles are vital for society. However, even clinical practice does not seem to fulfil some modern graduates, and an increasing number of veterinarians are leaving the profession to pursue other careers. Research suggests that less than 50 per cent of veterinarians would choose to undertake their career path again, so the profession faces a 'workforce crisis'. Through semi-structured photo-elicitation interviewing, this study has explored the image that students embarking on veterinary education have of the profession. The students' dominant image of the profession, and their perception of the public image, was small animal practice. A large proportion (n=16, 80 per cent) of participants saw themselves working in clinical practice, with many (n=8, 40 per cent) aspiring to focus on surgery. The image of the veterinary profession has changed since the 1970s when the James Herriot mixed practice model was well known to the public. The dominant small animal and surgical image emerging demonstrates a need for members of the profession to work together to educate public and entrant perception, emphasising the diversity of veterinary careers and their value to society, to allow aspiring veterinary entrants to develop a range of career goals.

The Veterinary Identity: A Time and Context Model

The nature of professionalism teaching is a current issue in veterinary education, with an individual's identity as a professional having implications for one's values and behaviors, as well as for his or her career satisfaction and psychological well-being. An appropriately formed professional identity imparts competence in making complex decisions-those that involve multiple perspectives and are complicated by contextual challenges. It enables an individual to act in a way that aligns with his or her professional values and priorities, and imparts resilience to situations in which one's actions are dissonant to these personal beliefs. There are challenges in professionalism teaching that relate to student engagement and faculty confidence in this area. However, these cannot be addressed without first defining the veterinary professional identity-in effect, the aim of professionalism teaching. In this article, existing identity models from the wider literature have been analyzed through a veterinary lens. This analysis was then used to construct a model of veterinary professional identity that incorporates the self (personal morals and values), social development (learning from the workplace environment), and professional behaviors. Individuals who form what we have termed self-environment-behavior connections are proposed to be able to use workplace learning opportunities to inform their identity development, such that environmental complexity does not obstruct the link between values and behaviors. Those who fail to connect with the environment in this way may perceive that environmental influences (e.g., the client, financial limitations) are obstructive to enacting their desired identity, and they may struggle with decision making in complex scenarios.

Developing a Professional Studies Curriculum to Support Veterinary Professional Identity Formation

Professional studies teaching in medical and veterinary education is undergoing a period of change. Traditional approaches, aiming to teach students professional values and behaviors, are being enhanced by curricula designed to support students' professional identity formation. This development offers the potential for improving student engagement and graduates' mental well-being. The veterinary professional identity associated with emotional resilience and success in practice incorporates complexity in professional decision making and the importance of context on behaviors and actions. The veterinarian must make decisions that balance the sometimes conflicting needs of patient, clients, veterinarian, and practice; their subsequent actions are influenced by environmental challenges such as financial limitations, or stress and fatigue caused by a heavy workload. This article aims to describe how curricula can be designed to support the development of such an identity in students. We will review relevant literature from medical education and the veterinary profession to describe current best practices for supporting professional identity formation, and then present the application of these principles using the curriculum at the Royal Veterinary College (RVC) as a case study. Design of a "best practice" curriculum includes sequential development of complex thinking rather than notions of a single best solution to a problem. It requires managing a hidden curriculum that tends to reinforce a professional identity conceived solely on clinical diagnosis and treatment. It includes exposure to veterinary professionals with different sets of professional priorities, and those who work in different environments. It also includes the contextualization of taught content through reflection on workplace-learning opportunities.

Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students.

Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education.

Discipline-Specific Compared to Generic Training of Teachers in Higher Education

A recurrent theme arising in the higher education sector is the suitability and effectiveness of generic versus discipline-specific training of university teachers, who are often recruited based on their disciplinary specialties to become teachers in higher education. We compared two groups of participants who had undergone training using a generic post-graduate certificate in higher education (PGCertGeneric) versus a discipline-specific course in veterinary education (PGCertVetEd). The study was conducted using a survey that allowed comparison of participants who completed PGCertGeneric (n=21) with PGCertVetEd (n=22). Results indicated that participants from both PGCertGeneric and PGCertVetEd considered teaching to be satisfying and important to their careers, valued the teaching observation component of the course, and identified similar training needs. However, the participants of the PGCertVetEd felt that the course made them better teachers, valued the relevance of the components taught, understood course design better, were encouraged to do further courses/reading in teaching and learning, changed their teaching as a result of the course, and were less stressed about teaching as compared to the PGCertGeneric participants (p<.05). It is likely that the PGCertVetEd, which was designed and developed by veterinarians with a wider understanding of the veterinary sector, helped the participants perceive the training course as suited to their needs.

What makes a 'good group'? Exploring the characteristics and performance of undergraduate student groups

Group work forms the foundation for much of student learning within higher education, and has many educational, social and professional benefits. This study aimed to explore the determinants of success or failure for undergraduate student teams and to define a 'good group' through considering three aspects of group success: the task, the individuals, and the team. We employed a mixed methodology, combining demographic data with qualitative observations and task and peer evaluation scores. We determined associations between group dynamic and behaviour, demographic composition, member personalities and attitudes towards one another, and task success. We also employed a cluster analysis to create a model outlining the attributes of a good small group learning team in veterinary education. This model highlights that student groups differ in measures of their effectiveness as teams, independent of their task performance. On the basis of this, we suggest that groups who achieve high marks in tasks cannot be assumed to have acquired team working skills, and therefore if these are important as a learning outcome, they must be assessed directly alongside the task output.

The Hidden Curriculum of Veterinary Education: Mediators and Moderators of Its Effects

The "hidden curriculum" has long been supposed to have an effect on students' learning during their clinical education, and in particular in shaping their ideas of what it means to be a professional. Despite this, there has been little evidence linking specific changes in professional attitudes to the individual components of the hidden curriculum. This study aimed to recognize those components that led to a change in students' professional attitudes at a UK veterinary school, as well as to identify the attitudes most affected. Observations were made of 11 student groups across five clinical rotations, followed by semi-structured interviews with 23 students at the end of their rotation experience. Data were combined and analyzed thematically, taking both an inductive and deductive approach. Views about the importance of technical competence and communication skills were promoted as a result of students' interaction with the hidden curriculum, and tensions were revealed in relation to their attitudes toward compassion and empathy, autonomy and responsibility, and lifestyle ethic. The assessment processes of rotations and the clinical service organization served to communicate the messages of the hidden curriculum, bringing about changes in student professional attitudes, while student-selected role models and the student rotation groups moderated the effects of these influences.

Evidence-Based Healthcare: The Importance of Effective Interprofessional Working for High Quality Veterinary Services, a UK Example

<p class="AbstractSummary"><strong>Objective: </strong></p><p class="AbstractSummary">To highlight the importance of evidence-based research, not only for the consideration of clinical diseases and individual patient treatment, but also for investigating complex healthcare systems, as demonstrated through a focus on veterinary interprofessional working.</p><p class="AbstractSummary"><strong>Background:</strong></p><p class="AbstractSummary">Evidence-Based Veterinary Medicine (EBVM) was developed due to concerns over inconsistent approaches to therapy being delivered by individuals. However, a focus purely on diagnosis and treatment will miss other potential causes of substandard care including the holistic system. Veterinary services are provided by interprofessional teams; research on these teams is growing.</p><p class="AbstractSummary"><strong>Evidentiary value:</strong></p><p class="AbstractSummary">This paper outlines results from four articles, written by the current authors, which are unique in their focus on interprofessional practice teams in the UK. Through mixed methods, the articles demonstrate an evidence base of the effects of interprofessional working on the quality of service delivery.</p><p class="AbstractSummary"><strong>Results:</strong></p><p class="AbstractSummary">The articles explored demonstrate facilitators and challenges of the practice system on interprofessional working and the outcomes, including errors. The results encourage consideration of interprofessional relationships and activities in veterinary organisations. Interprofessional working is an example of one area which can affect the quality of veterinary services.</p><p class="AbstractSummary"><strong>Conclusion: </strong></p><p class="AbstractSummary">The papers presented on veterinary interprofessional working are an example of the opportunities for future research on various topics within evidence-based healthcare.</p><p class="AbstractSummary"><strong>Application:</strong></p><p class="AbstractSummary">The results are pertinent to members of veterinary teams seeking to improve their service delivery, to educators looking to enhance their students’ understanding of interprofessional working, and to researchers, who will hopefully be encouraged to consider evidence-based healthcare more holistically. </p><br /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /> <img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" />

Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice

Numerous professional bodies have questioned whether traditional input-based continuing professional development (CPD) schemes are effective at measuring genuine learning and improving practice performance and patient health. The most commonly used type of long-established CPD activities, such as conferences, lectures and symposia, have been found to have a limited effect on improving practitioner competence and performance, and no significant effect on patient health outcomes. Additionally, it is thought that the impact of many CPD activities is reduced when they are undertaken in isolation outside of a defined structure of directed learning. In contrast, CPD activities which are interactive, encourage reflection on practice, provide opportunities to practice skills, involve multiple exposures, help practitioners to identify between current performance and a standard to be achieved, and are focused on outcomes, are the most effective at improving practice and patient health outcomes.

Usefulness of Crossword Puzzles in Helping First-Year BVSc Students Learn Veterinary Terminology

Appropriate terminology is essential for successful communication among health professionals. However, students have traditionally been encouraged to learn terminology by rote memorization and recall, strategies that students try to avoid. The use of crossword puzzles as a learning tool has been evaluated in other education disciplines, but not for terminology related to veterinary science. Hence, the objective of this study was to test whether crossword puzzles might be an effective aid to learning veterinary terminology. Forty-two first-year students enrolled in a Bachelor of Veterinary Science program were randomly divided into two groups and their previous knowledge of veterinary terms tested. One group received a list of 30 terms with their definitions. The other group received the same list plus six specially designed puzzles incorporating these 30 terms. After 50 minutes, both groups completed a post-intervention test and the results were compared statistically. The results showed that the students using the crossword puzzles performed better in the post-intervention test, correctly retaining more terms than the students using only rote learning. In addition, qualitative data, gathered through an electronic survey and focus group discussions, revealed a positive attitude among students toward the use of crossword puzzles.

Veterinary team interactions, part one: the practice effect

Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.

Scaffolded Active Learning: Nine Pedagogical Principles for Building a Modern Veterinary Curriculum

Veterinary discipline experts unfamiliar with the broader educational literature can find the adoption of an evidence-based approach to curriculum development challenging. However, greater societal and professional demands for achieving and verifying Day One knowledge and skills, together with continued progress in information generation and technology, make it all the more important that the defined period for initial professional training be well used. This article presents and discusses nine pedagogical principles that have been used in modern curricular development in Australia, the United Kingdom, and the United States: (1) outcomes-based curriculum design; (2) valid and reliable assessments; (3) active learning; (4) integrated knowledge for action; (5) tightly controlled core curriculum; (6) "just-in-time" rather than "just-in-case" knowledge; (7) vertical integration, the spiral curriculum, and sequential skills development; (8) learning skills support; and (9) bridges from classroom to workplace. Crucial to effective educational progress is active learning that embraces the skills required by the modern professional, made possible by tight control of curricular content. In this information age, professionals' ability to source information on a "just-in-time" basis to support high quality reasoning and decision making is far more important than the memorization of large bodies of increasingly redundant information on a "just-in-case" basis. It is important that those with responsibility for veterinary curriculum design ensure that their programs fully equip the modern veterinary professional for confident entry into the variety of roles in which society needs their skills.

Understanding hind limb lameness signs in horses using simple rigid body mechanics

Hind limb lameness detection in horses relies on the identification of movement asymmetry which can be based on multiple pelvic landmarks. This study explains the poorly understood relationship between hind limb lameness pointers, related to the tubera coxae and sacrum, based on experimental data in context of a simple rigid body model. Vertical displacement of tubera coxae and sacrum was quantified experimentally in 107 horses with varying lameness degrees. A geometrical rigid-body model of pelvis movement during lameness was created in Matlab. Several asymmetry measures were calculated and contrasted. Results showed that model predictions for tubera coxae asymmetry during lameness matched experimental observations closely. Asymmetry for sacrum and comparative tubera coxae movement showed a strong association both empirically (R(2)≥ 0.92) and theoretically. We did not find empirical or theoretical evidence for a systematic, pronounced adaptation in the pelvic rotation pattern with increasing lameness. The model showed that the overall range of movement between tubera coxae does not allow the appreciation of asymmetry changes beyond mild lameness. When evaluating movement relative to the stride cycle we did find empirical evidence for asymmetry being slightly more visible when comparing tubera coxae amplitudes rather than sacrum amplitudes, although variation exists for mild lameness. In conclusion, the rigidity of the equine pelvis results in tightly linked movement trajectories of different pelvic landmarks. The model allows the explanation of empirical observations in the context of the underlying mechanics, helping the identification of potentially limited assessment choices when evaluating gait.

Teacher development: a patchwork-text approach to enhancing critical reflection in veterinary and para-veterinary educators

Reflection is an essential component of teacher-development programs, and reliable, valid methods to teach, assess, and evaluate reflection are critical. However, it is important that appropriate methods are created for and evaluated across multiple disciplinary backgrounds, as the participants' backgrounds are a major factor in the development of critical reflection. The patchwork-text approach is a narrative process that is predominantly focused on the personal development of the individual. The current study used the patchwork-text approach for the development of reflection in participants with a science background who had not used a reflective approach for personal development before. Twenty summative essays and 103 formative essays from 21 participants who underwent a 1-year higher-education teacher-development program were analyzed to assess whether the quality and quantity of reflective writing was enhanced through a regular, iterative process of reflective writing with feedback. The analysis of the essays involved the use of a predefined set of criteria for identifying the different reflective levels from 1 to 4 and the calculation of a reflective score to evaluate the overall development. The results show a clear improvement of higher-level critical thinking as the participants progressed through their course. Higher levels of reflection were achieved particularly where a unit focused on a familiar area for the participant as opposed to one in which the participant had less experience. The analysis provides evidence that the patchwork text is a useful method for development and evaluation of reflection in participants with a veterinary/animal-science base.

Inter-professional practice: from veterinarian to the veterinary team

Animal health care is being delivered by an increasing number of professions and occupations. This article takes an inward look at the veterinary team, focusing on the day-to-day life of veterinarians and those with whom they work, such as veterinary technicians/nurses, physical therapists, and farriers. The evolution of the work of the veterinarian should be explored alongside the evolution of closely related occupations, as the current working practice of veterinarians is affected by the practice of these other occupations. An example is given of UK veterinary nurses (similar to veterinary technicians in North America) who are currently undergoing professionalization. Seminal implementations have included a register (2007), disciplinary procedures (2011), a declaration of professional responsibilities (2012), and required continuing professional development for registered veterinary nurses (RVNs). These implementations result in veterinary nurses who are now accountable for their actions. There are many potential benefits to good inter-professional practice for the practice itself, individual team members, clients, and patients, including better results produced by the whole team rather than the sum of the parts, financial benefits to using individuals in lower-paid occupations for shared roles, and greater client satisfaction regarding increased options for treatment. There are, however, many challenges to inter-professional working that center on the interlinked themes of hierarchy (power, status, and the understanding/appreciation of professional roles) and communication (lack of/poor). Inter-professional education (IPE) is suggested as a potential means to overcome these challenges; however, research into IPE exclusively related to the veterinary team is lacking.

Benefits and limitations of an employer-led, structured logbook to promote self-directed learning in the clinical workplace

A structured logbook, consisting of a competency log and a learning contract, was designed and implemented as part of a two-week structured work placement for final-year veterinary students to help them become more self-directed in the workplace. The competency log encompassed 48 core skills and, along with the learning contract, was reviewed at the start and end of the placement. To assess their perceptions of the logbook in promoting self-directed learning, students and supervisors were asked to complete a questionnaire pre- and post-placement and to participate in focus groups (students) and interviews (supervisors) after the placement. The study found significant increases pre- to post-placement in students' perceived levels of competence in all 48 skills and their confidence in being self-directed. However, student attitudes toward the logbook significantly decreased in terms of it encouraging supervisors to take a clearly designed role in structuring learning and facilitating alignment of employer and student expectations. Although supervisors were generally positive about the logbook, some had not been able to review it with their students, which affected students' perceptions of the logbook's usefulness. Some supervisors felt they had not received enough training, and most, erroneously, believed the logbook to be an external research initiative rather than having been designed by the head of their own organization. This study demonstrated that a structured logbook may be useful in helping students become more self-directed; however, supervisor support for the logbook is critical. To facilitate this, supervisors require training and support from senior management.

Clinical reasoning and case-based decision making: the fundamental challenge to veterinary educators

Confusion about the nature of human reasoning and its appropriate application to patients has hampered veterinary students' development of these skills. Expertise is associated with greater ability to deploy pattern recognition (type 1 reasoning), which is aided by progressive development of data-driven, forward reasoning (in contrast to scientific, backward reasoning), analytical approaches that lead to schema acquisition. The associative nature of type 1 reasoning makes it prone to bias, particularly in the face of "cognitive miserliness," when clues that indicate the need for triangulation with an analytical approach are ignored. However, combined reasoning approaches, from the earliest stages, are more successful than one approach alone, so it is important that those involved in curricular design and delivery promote student understanding of reasoning generally, and the situations in which reasoning goes awry, and develop students' ability to reason safely and accurately whether presented with a familiar case or with a case that they have never seen before.

Factors influencing clinical students' perceptions of an embedded research project and associated publication output

In this article, we describe student perceptions of the value of a short, compulsory research project embedded in a clinical degree program, the research output in terms of publications, and the factors influencing this. It was hypothesized that student attitudes toward the project, student perceptions of how much the project contributed to their generic skills, and the number of publications submitted or prepared for submission would be associated with perceived quality of supervision, perceived difficulty of the project, career plans, and attitude before commencement of the project. We explored this using a questionnaire comprising 30 questions that included demographics, Likert scales, and categorical responses. Student attitudes toward research were found to be associated with student attitude before the start of the project, perceived difficulty of the project, perceived quality of supervision, and perceived relevance to the profession. Students thought that the research project contributed most to the skills of "information gathering" and "critical evaluation" and the least to "teamwork," "problem solving," and "oral communication." Research output was significantly linked to perceived quality of supervision and the help students received with data analysis and data collection, though not with the project report itself. In conclusion, although the success of the research project was influenced by many factors, the perceived quality of supervision influenced all three outcome measures. Therefore it is clear that optimization of this aspect offers the most scope for enhancing the student learning experience.

Care and Justice orientations to moral decision making in veterinary students

An adapted version of the Moral Justification Scale was used to assess moral decision-making orientation in veterinary students, comparing sex and year of study. The Scale consists of vignettes and related statements, each of which was classified as Justice, Care for People or Care for Animals. The importance of each statement in the decision-making process was rated by 204 students on a 10-point Likert Scale. An average score of importance for Justice, Care for People and Care for Animals related statements were calculated for each individual. General inclination scores were calculated by subtracting an individual's average Care score from their average Justice score. Inclination scores suggested that two-thirds of students have a balanced approach, using Justice and Care almost equally in approaching ethical dilemmas. The majority of students, however, show an overall Justice orientation. The attitude towards the importance of Justice did not vary between students of different years or sexes. Students' attitudes towards the importance of Care for People in their decision making were, however, significantly lower for final-year students. Reasons hypothesised include the start of placements. Care for Animals scores were affected by sex, whereby females give more importance to such statements than males.

Vertical head and trunk movement adaptations of sound horses trotting in a circle on a hard surface

Trotting a horse in circles is a standard and important part of the subjective equine lameness examination, yet objective data on this form of locomotion are sparse. The aim of this study was to investigate the effect of trotting in a circle on head and trunk movement symmetry. Vertical movements of the head, withers, os sacrum and left and right tuber coxae were measured using inertial sensors as 12 sound horses were trotted on a hard surface in a straight line and in a circle on both reins. Seven asymmetry measures and hip hike were calculated for each horse for at least nine strides of comparable stride duration across the three conditions (deviation on horse level ≤3.7% stride duration). Trotting in a circle introduced systematic changes to the movement pattern of all five body landmarks, affecting most asymmetry measures. On average the asymmetry magnitude was comparable for midline locations between reins and for the tuber coxae on opposite reins with few exceptions, although individual horses showed unsystematic differences between the two reins. The results from this study showed that the thresholds for objective discrimination between lame and non-lame horses will need adjustment on the circle due to the observed asymmetry bias.

Web 2.0 and the veterinary profession: current trends and future implications for lifelong learning

The NOVICE project is an EU initiative under the Lifelong Learning Programme, which aims to develop an online, professional network to promote informal, lifelong learning within the veterinary profession, using Web 2.0 tools. To inform the development of the network, a need analysis study was undertaken with relevant stakeholders. Focus group discussions were undertaken with veterinary students and veterinarians and a survey was administered to first-year students and recent graduates. The results indicate that use of computers and the internet is ubiquitous among junior members of the profession and that use of Web 2.0 tools is increasing. Concerns raised in relation to participation in online communities include verifying the quality of information and issues around professionalism. Compared with face-to-face communities, online communities were perceived to offer a number of advantages. These include convenient access to expert advice on an international scale, as well as helping to alleviate certain barriers to participation in formal, continuing education such as time, distance and cost.

Evaluating an automated haptic simulator designed for veterinary students to learn bovine rectal palpation

INTRODUCTION

Simulators provide a potential solution to some of the challenges faced when teaching internal examinations to medical or veterinary students. A virtual reality simulator, the Haptic Cow, has been developed to teach bovine rectal palpation to veterinary students, and significant training benefits have been demonstrated. However, the training needs to be delivered by an instructor, a requirement that limits availability. This article describes the development and evaluation of an automated version that students could use on their own.

METHODS

An automated version was developed based on a recording of an expert's examination. The performance of two groups of eight students was compared. All students had undergone the traditional training in the course, namely lectures and laboratory practicals, and then group S used the simulator whereas group R had no additional training. The students were set the task of finding the uterus when examining cows. The simulator was then made available to students, and feedback about the "usability" was gathered with a questionnaire.

RESULTS

The group whose training had been supplemented with a simulator session were significantly better at finding the uterus. The questionnaire feedback was positive and indicated that students found the simulator easy to use.

CONCLUSIONS

The automated simulator equipped students with useful skills for examining cows. In addition, a simulator that does not need the presence of an instructor will increase the availability of training for students and be a more sustainable option for institutions.

Reliability of conformational measurements in the horse using a three-dimensional motion analysis system

REASONS FOR PERFORMING STUDY

The importance of a reliable method for conformation studies is generally acknowledged, but there are only limited data on the accuracy and precision of current assessment methods.

OBJECTIVES

To assess (1) the accuracy and repeatability of marker placement, (2) influence of stance of the horse on conformational parameters, (3) practicality of a computerised motion analysis system and (4) to compare the computerised motion analysis system to photographic systems of assessment.

METHODS

Twenty-eight reflective markers placed over anatomical landmarks were located in 3D using a computerised motion analysis system and their coordinates used to calculate segment lengths and joint angles. Four experiments, involving a cadaver study, a series of repeated measures on a single Thoroughbred and repeat measurements on 108 racehorses were performed.

RESULTS

Identification of anatomical landmarks was found to introduce the biggest variation in the measurements for proximal conformation parameters with the interoperator being larger than intraoperator variation. Length measurements were least influenced by stance, with distal interphalangeal and metacarpo/metatarsophalangeal joint angles being the most variable. In some measurements, the variation between stances within a horse proved to be almost as large as between horses, rendering these parameters less useful as predictors of performance or orthopaedic health.

CONCLUSIONS

A computerised motion analysis system allows 3D assessment of conformation with high accuracy and precision. It eliminates 3 major sources of error associated with photography-based methods and increases accuracy of conformational assessment by allowing repeat measurements in a relatively short period.

POTENTIAL RELEVANCE

Studies on conformation should be viewed in the light of the limitations of the measurement technique used. The presented method maximises accuracy and precision and is a valuable basis for future studies investigating the effect of conformation on performance or orthopaedic health.

Variation in conformation in a cohort of National Hunt racehorses

REASONS FOR PERFORMING THE STUDY

Assessment of conformation is commonly used in the selection of horses for performance purposes. Little information is available on the normal range of conformational traits within the Thoroughbred population.

OBJECTIVES

To describe variations in conformation in a cohort of racing Thoroughbreds in order to provide a set of baseline standards within which conformational traits can be considered normal.

MATERIALS AND METHODS

Ninety-eight conformational parameters were measured in a cohort of 108 National Hunt racehorses using a digital motion analysis system. The measurements consisted of segment lengths, joint angles in 2D and 3D, inclinations, deviations and circumference measurements. The differences between left and right sides were determined to obtain a measure of asymmetry. Conformational parameters were related to each horse's country of origin, preferred race distance and race type.

RESULTS

The majority of parameters followed a normal distribution with the biggest relative variation in hoof related measurements and in stifle and coxal angle. All circumference measurements and the majority of the length measurements were significantly correlated with the height of the horse at the withers. No underlying pattern of combinations of conformational parameters was identified. Twenty-five per cent of the parameters showed a significant difference between left and right-sided measurements. A significant difference in girth and intermandibular width was observed between Irish and French horses.

CONCLUSIONS

Thoroughbreds differ from other breeds, not only with regard to segment lengths but also with regard to joint angles and deviations. Variation in conformational parameters was relatively small and no distinct pattern of combinations of conformational traits identified.

CLINICAL RELEVANCE

The variation in conformational measurements in Thoroughbred racehorses establishes a set of baseline measurements of conformational range against which individual horses can be assessed.

The effect of conformation on orthopaedic health and performance in a cohort of National Hunt racehorses: preliminary results

REASONS FOR PERFORMING STUDY

There is a lack of scientific data and studies on the effect of conformation on performance or on orthopaedic health.

OBJECTIVES

To investigate the relationship between conformation, injury and performance in racehorses used for racing over fences.

METHODS

Over 2 years, 108 National Hunt racehorses were followed and their medical and performance data recorded. Conformation was measured in 3D with a computerised motion analysis system. Linear multiple regression models were used to evaluate the effect of conformation on measures of race performance and stepwise forward logistic regression models to assess the effect on risk of injury.

RESULTS

An increase in intermandibular width, flexor angle of the shoulder joint and coxal angle (the angle between the ilium and ischium) was demonstrated to have a positive effect on performance. Performance decreased with increasing girth, length of the hind digit and valgus conformation of the metacarpophalangeal joint. The risk of suffering from superficial digital flexor tendon injury increased with increasing metacarpophalangeal joint angle and with carpus valgus conformation. The risk of pelvic fracture increased with valgus conformation of the tarsus and decreased with an increasing coxal angle.

CONCLUSION

Valgus deformation was demonstrated to be detrimental to performance or increased risk of injury, perhaps resulting in higher loads on musculoskeletal structures. The coxal angle was the only parameter to have an effect on both risk of injury and performance. An alignment of the muscles with the axis of the pelvis may be beneficial for force transmission and decrease the bending moment of the muscles on the bones. The statistical power of this study is limited, however it provides preliminary data necessary for the planning of a larger scale study on the effect of conformation on performance and risk of injury.

CLINICAL RELEVANCE

Studies of the effects of conformation on performance and risk of injury may aid in identifying individuals likely to perform well on the racecourse and avoid risks of injury.

Assessment of technical skills: best practices

Assessment is an important aspect of veterinary education from the point of view of setting standards, driving learning, providing feedback, and reassuring society that veterinarians are competent to assume the responsibilities entrusted to them. However, no single format exists that can, by itself, assess the complex mixture of knowledge and skills essential to the veterinarian's role. The areas that are most challenging to assess are those involving behaviors and attitudes. These include the various technical skills required for diagnosis and treatment. One approach, aimed at retaining validity but improving reliability compared with traditional, more subjective methods, first described in medicine 35 years ago, is the Objective Structured Clinical Examination (OSCE), which has been introduced into veterinary education as the Objective Structured Practical Veterinary Examination (OSPVE) and run at the Royal Veterinary College since 2004. This approach is good for the assessment of competence in relation to isolated techniques and whole procedures but has been criticized for the way in which these are tested out of context. However, further development of structured clinical assessments, such as the mini-Clinical Examination and the Direct Observation of Procedural Skills, may help address some of these limitations, and the use of multi-source feedback, particularly client feedback, may allow the further domains of professional behaviors, attitudes, and communication to be judged and developed.

The role of undergraduate research experiences in producing veterinary scientists

This study retrospectively examined the influence of a science-based, research-oriented degree on the career choices of a group of "early emerger" students who had aspired from an early age to become veterinarians but chose instead to pursue an alternative career in veterinary research. This transformation was in large part because of active participation in research, with supervisors acting as role models and mentors. This finding has important implications for teachers and course designers seeking to influence career decision making in both bioveterinary science and professional veterinary programs.

Fostering integrated learning and clinical professionalism using contextualized simulation in a small-group role-play

Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed "contextualized simulation" by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.

The importance of cultivating a preference for complexity in veterinarians for effective lifelong learning

Much attention has been paid to the link between students' approaches to study and the quality of their learning. Less attention has been paid to the lifelong learner. We conceptualized a tripartite relationship between three measures of learning preference: conceptions of knowledge (construction and use vs. intake), need for cognition (high vs. low), and approach to study (deep vs. surface) and hypothesized that an individual's profile on these three measures-reconceptualized as a preference for complexity versus simplicity-would affect their attitude toward continuing professional development (CPD). A questionnaire was mailed to 2,000 randomly selected, home-practicing UK veterinarians to quantify their learning preferences, motivation to engage in CPD, and perception of barriers to participation and to assess the relationships between these constructs. Analysis of 775 responses (a 38.8% response rate) confirmed our tripartite model of learning and showed that a preference for complexity was negatively correlated with barriers and positively correlated with intrinsic, social, and extrinsic motivating factors, suggesting that all play a role in the continuing education of this group of professionals. A preference for simplicity was negatively correlated with social motivation and positively correlated with barriers. This study demonstrates that approach not only affects the quality of learning but crucially affects motivation to engage in CPD and perception of barriers to lifelong learning. This should emphasize to veterinary educators the importance of fostering a preference for complexity from an early age, both in terms of its immediate benefits (better understanding) and longer-term benefits (continued engagement with learning).

Introducing peer-assisted learning into a veterinary curriculum: a trial with a simulator

Peer-assisted learning (PAL) was implemented in the context of delivering training with a simulator, the Haptic Cow. This project was undertaken as a way of increasing student access to the simulator and to investigate the possibility of using PAL more extensively in the curriculum. Peer tutors attended a workshop to learn basic teaching skills and were then trained to use the simulator. The tutors taught their peers the basic skills for bovine rectal palpation with the simulator. The PAL project was evaluated using questionnaires and a focus group to gather feedback from both tutors and learners. Sixteen peer tutors trained 99 fellow students with the simulator. Both tutors and learners thought that there were certain advantages in students, rather than veterinarians, delivering the training. Student tutors were less intimidating and could relate more closely to the difficulties of their peers. However, lack of knowledge was identified as a potential issue. Students reported certain benefits from their role as tutors, including improvements in communication skills, knowledge of the subject area, and confidence in performing bovine rectal palpation. Additionally, the skills developed, including learning to teach, were considered to be useful for their future careers as veterinarians. Tutors and learners supported the continued use of PAL both with the simulator and in other areas of the course. The trial of PAL proved a successful way of delivering simulator-based training and the project has provided a basis for the further use of PAL in our curriculum.

The comparative efficacy of percutaneous and surgical coronary revascularization in 2009: a review

Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many recent breakthroughs in metabolic control, improvements in catheter and stent engineering, and advances in surgical technique. Treatment guidelines are still in their infancy and do not take into account several of these recent innovations. Consequently, determining the most appropriate treatment for many patients remains challenging. In this review, we examine the most recent revascularization guidelines, discuss important new data and trials comparing contemporary stent technology and coronary artery bypass surgery, and conclude with updated revascularization recommendations.

Adult learning in veterinary education: theory to practice

This paper argues the case for the increased application of adult learning principles to veterinary education. It encapsulates evidence from the United Kingdom, Europe, North America, and Australia to explain why it has taken veterinary schools so long to transform their curricula to best facilitate the development of lifelong learning skills, such as independent and self-directed learning, problem solving, and critical thinking. Despite the variation in training programs in these different regions, the paper identifies common issues-conflicting educational paradigms and the need for faculty development-and ultimately concludes that professional and continuing education should be viewed as a continuous process, supporting the adult learner's cognitive development and facilitated through experiential learning.

Accuracy of non-invasive ICP assessment can be increased by an initial individual calibration

OBJECTIVE

In a formerly introduced mathematical model, intracranial pressure (ICP) could be non-invasively assessed using cerebral blood flow velocity (FV) and arterial blood pressure (ABP). The current study attempts to check whether the accuracy of the non-invasive ICP assessment (nICP) improves after an initial individual calibration by implanted ICP probes.

METHODS

Thirteen patients with brain lesions (35-77 years, mean: 58 +/- 13 years) were studied. FV, ABP and ICP signals were recorded at days 1, 2, 4 and 7. nICP was calculated and compared to ICP. In the first recording of each patient the (invasively assessed) ICP signal was used to calibrate the nICP calculation procedure, while the follow-up recordings were used for its validation.

FINDINGS

In 11 patients 22 follow-up recordings were performed. The mean deviation between ICP and the original nICP (+/- SD) was 8.3 +/- 7.9 mmHg. Using the calibrated method this deviation was reduced to 6.7 +/- 6.7 mmHg (P < 0.005).

CONCLUSIONS

Initial individual calibration of nICP assessment method significantly improves the accuracy of nICP estimation on subsequent days. This hybrid method of ICP assessment may be used in intensive care units in patients with initially implanted ICP probes. After removal of the probes, ICP monitoring can be continued using the calibrated nICP assessment procedure.

Attitudes of veterinary faculty to the assessment of clinical reasoning using extended matching questions

For assessment purposes, clinical expertise is often divided into three broad components: scientific and clinical knowledge, clinical reasoning, and practical/technical skills. This structure can be used to define the tools used for assessment of clinical students. Knowledge can be assessed through a variety of written formats and skills through various practical assessments, including the objective structured clinical examination (OSCE), but the assessment of clinical reasoning has proved to be far more challenging. A companion paper (Tomlin JL, Pead MJ, May SA. Veterinary students' attitudes toward the assessment of clinical reasoning using extended matching questions. J Vet Med Educ 35:612-621, 2008) reports on the identification and implementation of a valid and reliable method to assess clinical reasoning using clinical-scenario-based extended matching questions (EMQs) in the final examinations at the Royal Veterinary College and looks at students' response to the new examination format. Although EMQs were generally well accepted, many students were concerned about the implied encouragement of pattern recognition, a non-analytical form of clinical reasoning that results from recognition of familiar clinical situations. This paper addresses the attitudes of the teaching faculty to the EMQ format. The students' concerns about promotion of pattern recognition, was also explored in more depth. Overall, faculty perceived EMQs as an appropriate way to test clinical reasoning and as relevant to the experience that students would have gained during their clinical rotations. However, faculty felt that EMQs were difficult to write and that poorly written questions tended to promote pattern recognition. Almost half reiterated the students' concerns that pattern recognition may be an inappropriate reasoning strategy for undergraduates.

LIVE: the creation of an academy for veterinary education

The purpose of this paper is to introduce a new educational development and research program; to describe the vision which created the LIVE Centre for Excellence in Teaching and Learning (CETL) at the Royal Veterinary College, University of London, UK; and to give details of the educational developments and research that have been pursued in LIVE since 2005. LIVE's purpose, to act as an "incubator" to help support all those interested in veterinary teaching and learning, and associated research, is discussed. The paper describes how the aims of the initial funding bid are being realized through the development of a multi-layered strategy. The discussion concludes by suggesting that new faculty models such as the US Academy Network for Medical Educators or veterinary hubs such as LIVE could act as catalysts for the development of a new breed of clinical teachers and educational researchers, empowered by innovative teaching and learning methods relevant to both medical and veterinary education.

Modern veterinary graduates are outstanding, but can they get better?

Despite periodic debate implying that modern veterinary graduates are less competent than their predecessors, analysis of educational inputs and learning outcomes suggests that they continue to qualify with an excellent knowledge and skill set. However, increased public expectations of veterinarians have led to the need for better-designed, more integrated curricula with increased attention to communication and other professional skills and to elements of individual specialization. The need for revision of curricular content will continue. A more overriding reason for reducing content, however, is the effect this has on students' learning. Content overload in all disciplines leads to a superficial acquisition of facts, which overwhelms any drive toward understanding and extracting meaning. Unfortunately, many modern assessment methods permit replication to masquerade as problem solving, leading to short-term gains in grades at the cost of the development of information sourcing and application and other lifelong learning skills. All involved in education must be clear that our task is to develop the independent professional person. Such a person is much more than the possessor of a collection of facts and a set of individual competences. To facilitate the development of this overall capability, educators must pay as much attention to students' engagement in the learning process, and to how they understand and make meaning of our discipline, as to the specific scientific and species content of their school's individual degree programs.

Veterinary students' attitudes toward the assessment of clinical reasoning using extended matching questions

For the purposes of assessment, clinical expertise has been broken down into three broad components: scientific and clinical knowledge, clinical reasoning, and practical or technical skills. This structure can be used to define the tools used for assessment of clinical students. Knowledge can be assessed through a variety of written formats, and skills through various practical assessments, including the objective structured clinical examination. The assessment of clinical reasoning is more of a challenge, and, partly in order to address this challenge, the Royal Veterinary College recently introduced veterinary clinical-scenario-based extended matching questions. A questionnaire was used to collect students' perceptions of the new format. Surprisingly, this questionnaire also delivered important insights into the students' understanding of the process of clinical reasoning itself that could be crucial in future curriculum design. Despite a theory course that introduced students to the nature of expertise and the importance of pattern recognition to experienced clinicians, some final-year students could not recognize this approach as relevant to them and objected to the way in which some of the questions were driving them to think. This may relate to the variety of methods of case management that students observe during their practical experience and the different attitudes of clinicians to the way students work up cases. Overall, the students perceived this question type as an appropriate way to test clinical reasoning and as relevant to the experience they had gained during their clinical rotations, both within the college and in veterinary practices outside it.