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Veterinary Education

Researchers investigate what really goes on in small animal consultations

5 Nov, 14 | by Assistant Editor

 

New open access research published in Veterinary Record indicates that almost half of veterinary consultations last longer than the 10 minutes allocated and that preventive medicine consultations last just as long as consultations for a specific health problem. The results raise issues to do with practice management, as well as the importance of educating veterinary students about comorbidities. 

 

Consultations are a major part of small animal practice, with small animal vets often meeting a large number of clients and patients each day. Generally speaking, 10 minutes is allocated for each consultation, but the amount of time required to address all of the client’s concerns can often exceed 10 minutes. Furthermore, consultations are often complex interactions in which a wide range of potential health problems are discussed.

In human medicine, large amounts of research has been conducted into the nitty gritty of how consultations work and the types of issues that are discussed. This has shown that more lengthy consultations tend to lead to more issues being discussed and better detection and management of certain conditions. However, until now, veterinary consultations have been less well understood.

A group of researchers at the University of Nottingham recently sought to fill these knowledge gaps by conducting some in-depth research into small animal consultations in the UK. They wanted not only to better understand how long consultations last and what happens during a consultation, but also to develop a tool that would make it easy to analyse veterinary consultations in depth. Their results are reported in two articles recently published in Veterinary Record (found here and here), both of which are open access.

Natalie Robinson, one of the authors of the studies, explains the idea behind them.

‘When the Centre for Evidence-based Veterinary Medicine was first set up at the University of Nottingham, one of our first questions was “What should our research priorities be?”’, she said. ‘We needed to make sure our research was relevant to first-opinion practitioners, so examining the veterinary caseload to determine what practitioners see and do every day was the first logical step. By examining consultations in greater depth, we can start to identify the important decision-making points during the consultation. This will allow us to generate new evidence which can support veterinary decision-making and hopefully lead to improved patient care.’

Eight small animal practices in England and Scotland took part in the study. The team observed a large number of consultations in detail, and recorded what they saw using a specially developed tool.

 

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The research showed that small animal consultations often ran over the allocated 10 minutes

 

Timings

One of the studies assessed how long consultations tended to last. The researchers timed 182 consultations involving 203 animals in two of the participating practices in England.

They found that there was a huge range in the length of consultations. The shortest consultation observed lasted for just 51 seconds, while the longest lasted for 36 minutes and 45 seconds. Almost half (48 per cent) of consultations exceeded the 10 minutes allocated. Perhaps unsurprisingly, consultations in which more problems were discussed, or which involved more patients, tended to last longer.

‘One of the things that surprised us is that preventive medicine consultations lasted just as long as consultations for a specific health problem’, said Dr Robinson. ‘Preventive medicine consultations are often seen as “quick and easy” but the results would suggest that this is not necessarily the case. In fact it would appear that preventive medicine consultations may be even more complex than other types of consultations, with even more problems discussed, and so are an important part of the healthcare of our pets.’

 

Looking at consultations in more detail

In another part of the study, a total of 1720 consultations (involving 1901 patients) were recorded and analysed. The results make interesting reading.

The first key finding was that a total of 4486 problems were discussed for the 1901 patients, an average of 2.4 problems per patient. In almost two-thirds of consultations, more than one problem was discussed. The highest number of problems discussed in one session was eight.

‘Interestingly, fewer problems were discussed for rabbits than for cats or dogs,’ said Dr Robinson. ‘While there could be a range of reasons for this finding, it could be that vets and owners are less familiar with identifying health problems in this species. Previous work within our group has suggested that vets feel there is less information available for rabbits than for dogs or cats, so it could be that rabbit medicine is an important area for the generation of new evidence.’ The previous study she refers to was published in Veterinary Record earlier this year.

 

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In almost two-thirds of consultations, more than one problem was discussed. The highest number of problems discussed in one session was eight.

 

More health problems were also discussed in consultations involving older animals, while when younger animals were presented, preventive medicine was more likely to be discussed.

While the results answer some questions, they also raise others. For example, if consultation length varies so widely, should vets begin to offer different types of appointments? The authors suggest that practices could set up geriatric clinics specifically aimed at older animals in which appointments are longer, ensuring enough time for all problems to be discussed.

They also note that the findings could have implications for veterinary education, as they show that comorbidities are common and consultations can be complex.

‘We need to make sure that training in consultation skills adequately prepares veterinary undergraduates for the realities of first-opinion practice,’ said Dr Robinson. ‘The findings suggest that first-opinion consultations often involve dealing with multiple problems and comorbidities within a single consultation, meaning the decision-making process is often complex.’

‘Ultimately, we need more evidence to support decision-making in patients with comorbidities, which will benefit not only undergraduate education, but also the wider veterinary profession and the patients they treat.’

 

On the right track: should UK veterinary schools introduce tracking to degrees?

3 Jul, 14 | by Assistant Editor

 

Currently, veterinary students at schools in the UK are trained to be ‘omnicompetent’ (able to treat any species) upon qualifying as a vet. However, in some vet schools elsewhere in the world, degrees include either full or partial ‘tracking’, meaning that students focus on a particular area or species for either some or all of their degree. Two studies recently published in Veterinary Record assessed attitudes towards tracking in UK veterinary degrees among key stakeholders.

Ever since the UK’s first veterinary college was founded in 1791, the way that vets are trained has been the subject of debate and controversy. This is hardly surprising when considering the wide variety of work that vets undertake; from ensuring the health and welfare of companion animals to maintaining the safety and wellbeing of food-producing livestock, they play a key role in several industries. For the profession to work, therefore, vet schools need to produce graduates with a very wide range of skills and expertise.

Currently, in the UK, veterinary students are expected at the end of their five-year degree to be ‘omnicompetent’ and qualify with the ability to practise in any area or on any species. Most schools do, however, offer opportunities for students to focus on some areas that are of more interest to them, for example, through elective choices. Outside of the UK, some vet schools have taken a different approach, allowing students to specialise or ‘track’ at some point during their studies. In 2001, the University of Utrecht in the Netherlands introduced tracking to its six-year veterinary degree, allowing students to take specialised modules in each year except the fifth, with the final year being spent only studying their specified field. Some schools in the USA also offer tracked courses, with students deciding how they want to specialise at the beginning of the course.

There is currently debate about whether UK vet schools should follow suit. Some proponents of tracked degrees suggest that expecting students to master so many different areas is unrealistic, while supporters of the current system say that UK vet schools produce competent and well-rounded vets capable of treating any species.

To try and find out what current opinions were on this subject among key stakeholders, a team of researchers at Bristol university vet school and the Royal (Dick) School of Veterinary Studies in Edinburgh conducted a mixed-methods study, which was recently published online as two research papers (here and here)  in Veterinary Record .

‘There is ongoing debate in this area, but little evidence regarding what stakeholders think, which is why we chose to conduct a broad-based survey,’ said Emma Crowther, one of the authors of the papers. ‘The mixed methods approach allowed us to quantify stakeholder opinion, and to understand some of the reasons behind those opinions.’

A survey was distributed to three groups – current UK veterinary students, staff at UK veterinary schools and vets currently practising in the UK. Participants were asked about their opinions on both partial tracking (where students are trained in all species, are able to focus on one area but then graduate with the ability to practice in all areas) and full tracking (students take a species-specific final examination and are qualified only to practice in their chosen species).

A total of 203 university staff, 700 students and 158 practitioners returned completed questionnaires and their responses made interesting reading.

The majority of respondents (69 per cent) either strongly disagreed or disagreed with full tracking, with 19 per cent either agreeing or strongly agreeing (the remainder had no strong opinions either way). There was much more widespread support for partial tracking, however, with 79 per cent of respondents saying that they were for the idea. Only 14 per cent disagreed or strongly disagreed with partial tracking.

‘Respondents mentioned a number of advantages and disadvantages to tracking, and often expressed opposing views,’ said Miss Crowther. ‘The comments were grouped into six major themes relating to choice, flexibility, competency and knowledge, stakeholder implications, specialisation, and ‘what is a vet?’.

The study also assessed how the career aspirations of current students matched up to the reality of the profession’s employment as it currently is in the UK. There were significant differences in aspirations for students at different stages of their degree. Significantly more final-year students wanted to go on to work in small animal practice compared with first-year students. First-year students were more likely to aspire to working in mixed practice, but by the fourth year, this proportion had decreased. The results also showed that the career aspirations of final-year students were similar to graduate employment figures.

‘Although final-year students’ career aspirations aligned well with likely employment opportunities, the data indicates that students’ aspirations in the early years were not so well matched, which would have implications if tracking were introduced early in the curriculum’, explained Susan Rhind, who also co-authored the papers.

Taking both the quantitative and qualitative data into account, the authors conclude that there is widespread support for partial tracking among key stakeholder groups in the UK.

With the debate still ongoing, it is unclear whether UK vet schools will act on these results potentially overhauling the way that vets are taught in the country and aligning veterinary education more closely with some of the other educational models around the world.

Pick of the litter: how interviews help vet schools choose the right undergrads

2 Sep, 13 | by Assistant Editor

 

Each year, staff at the seven UK veterinary schools face a huge challenge – how to whittle down hundreds of young, hopeful A-level students to just a few future vets. What’s more, the task is becoming more difficult each year. Data from the Royal Veterinary College show that total applications to undergraduate veterinary science courses rose by a quarter in the space of five years – from 6781 in 2007 to 9029 in 2012. This is compounded by the fact that the percentage of A-level students achieving top grades (A or A*) has increased from 21.6 to 26.3 in the past decade (according to stats from the Joint Council of Qualifications), making it more difficult to differentiate based on academic ability. On average, there are nine applicants for every place on veterinary degree courses in the UK.

To make sure they pick only the candidates most suited to the course and the profession, interviewers look for a wide range of qualities. Desirable traits may include critical thinking, mental ability, motivation, communication and empathy. However, gauging these characteristics using a personal statement and exam grades can be difficult, and in order to more accurately assess applicants, all seven of the UK schools use some form of interview in their admissions process, evaluating both academic and non-academic attributes.

In order to investigate the interview process for veterinary undergraduates, a team at the Royal (Dick) School of Veterinary Studies and the Roslin Health Institute in Scotland, designed a study, recently published in Veterinary Record, which focused on one cycle of interviews of school-leaving applicants to the veterinary medicine course at Edinburgh university. The study had two main goals; first, to evaluate the influence of the interview on selection decisions and, secondly, to investigate the impact of discussion after the interview between interviewers on their decision-making.

All of the applicants in the 2008/2009 admissions cycle were first shortlisted based on their applications. Shortlisting criteria related to their references, academic history, personal statement and work experience. Following this, 181 students were invited for a 20-minute interview.

Untitled

Before each set of interviews (usually comprising eight candidates), the interviewers were first asked to independently rank each candidate in descending order of merit based on their application and supporting material and also to make a provisional decision of ‘accept’, ‘reject’ or ‘hold’ for each candidate. Immediately following the interview, members of the selection panel were asked to repeat this process without discussing with their colleagues. Finally, after the selectors had discussed the candidates and reached a consensus, they were again asked to rank and make a decision on the candidates.

The authors used statistical analysis to investigate the levels of agreement among members of the selection panel during different stages of the interview process.

Before interview, members of the selection panel agreed only slightly about selection decisions (58 per cent agreement), but after interview they agreed significantly more (78 per cent agreement). The results also showed that interviewers’ perceptions of applicants often changed before and after interviews, as the level of agreement between each interviewer’s pre-interview and post-interview decisions was on average 67 per cent. In contrast to this, there were very high levels of agreement between the interviewers’ individual post-interview decisions and the consensus decisions achieved through discussion with their colleagues (84 to 90 per cent). The pattern described here also applied to the rankings the interviewers made before and after the interviews.

For most candidates (around 60 per cent), the selection decision did not change before and after the interview. However, many of the candidates had their provisional decisions changed for the better, for example, from hold to accept, after their interview. Of the candidates who were given a hold decision before interview, around half were moved to an accept decision afterwards. Inversely, some candidates’ provisional decisions were changed from accept or hold to reject after the interview.

The authors then further explored which attributes had the biggest impact upon interviewers’ decision-making and these were found to be: communication skills, overall knowledge gained from work experience and the ability to think on their feet. Candidates who performed well in these fields were more likely to have their selection decision changed to accept after interview, and vice versa for those who performed poorly.

The authors conclude that face-to-face interviews allow selection panels to achieve greater levels of agreement about who are the best candidates for the limited number of places. The results also showed that once the interviewers had formed their opinions during the interview, post-interview discussions with their fellow panel members tended to have little influence on those decisions.

In the medical and, more recently, veterinary professions, there has been a shift towards the use of multiple mini interviews rather than panel interviews. However, the authors state that their results show that there is still a place for the traditional panel interview in veterinary admissions procedures.

Neil Hudson, one of the authors of the paper, states:

‘Getting into Vet School is tough, with much competition for places. We wanted to make sure that the way we were selecting students was a good way of giving the students the best chance of showing that they are suited to our course, on top of what they have told us through their UCAS applications. It is a tough decision for selectors and what we wanted to do in this study was to try and ‘look at some science’ behind our decision making. What we found was that it was easier for selectors to agree on decisions made based on  interview than on paper applications alone. Furthermore, it was good to be able to drill down and see what potential attributes had the most influence on decisions. No selection system is perfect and what we have done here is say that the interview can, and should, play some part in the process, but it is very much for each school to adopt the blend of approaches that suits the candidates for their respective courses.’

Here’s one I made earlier: an equine nerve block simulator for vet students

22 Mar, 13 | by sarahbrown

Equine lameness constitutes a large proportion of an equine clinician’s caseload and performing diagnostic nerve blocks is an essential skill for equine practitioners. However the opportunities for veterinary students to practice this skill are limited. Traditionally, equine diagnostic analgesia is taught with the use of equine cadaver limbs. However, due to economical, logistical implications, in conjunction with the increase in the number of veterinary students, and ethical reasons, the use of cadavers is becoming increasingly more difficult.

In a paper recently published in Veterinary Record, a team of researchers from the Royal Veterinary College in London, UK, designed an equine nerve block simulator using an equine forelimb skeleton and expanding foam, which was carved to mimic the shape of the soft tissues.1 Wire wool targets were placed under the foam in the positions corresponding to the anatomical location of the palmar digital, abaxial and low four point nerve blocks and attached to an electric circuit and a buzzer, which provided auditory feedback when the needle had been placed correctly and the closed the electric circuit.

In order to validate the simulator, third-year undergraduate veterinary students were randomly assigned to one of three groups: the cadaver group, which received training in a 45 minute cadaver session, the simulator group, which received training using the nerve block simulator and the hand-out group, which was given a handout and a textbook to study. Students from all groups were asked to return one week later to demonstrate what they had learned on an equine cadaver forelimb.

Taking all the nerve blocks together, the cadaver group demonstrated the highest accuracy (73 per cent), followed by the simulator group (71 per cent) and the handout group (58 per cent). Feedback from the students showed that those in the simulator group enjoyed their training more and felt more confident in performing the technique than the other two groups.

The authors conclude that the nerve block simulator enabled students to learn how to perform diagnostic analgesia in the equine distal limb with a similar proficiency to traditional cadaver limb training. They add that this safe, cost-effective method also allows students to repeatedly practice skills with ease and could be a useful supplement the teaching of diagnostic nerve blocks to undergraduate veterinary students.

Follow this link to watch the simulator in use!

 

Equine nerve block simulator

 

References:

1. Gunning, P., Smith, A., Fox, V., Bolt, D. M., Lowe, J., Sinclair, C., Witte, T. H. & Weller, R. (2013) Development and validation of an equine nerve block simulator to supplement practical skills training in undergraduate veterinary students. Veterinary Record doi: 10.1136/vr.101335

Influences on veterinary career choices

12 Mar, 13 | by sarahbrown

 

How much influence does someone’s background and environment have on their career choices? Should veterinary schools consider this when designing curricula to encourage graduates to enter the full range of roles for which their skills are needed, such as food animal vets rather than the perhaps more obvious choices of, for example, small animal practice?

In a paper recently published in Veterinary Record, Tierney Kinnison of the Lifelong Independent Veterinary Education (LIVE) centre and Stephen May, the vice principal for teaching at the Royal Veterinary College (RVC), used the results of the RVC’s ‘teaching quality survey’ for recent graduates from 2005/06 to 2010/11 to compare the vets’ background information with current position and career ambition, and to investigate perceptions of curriculum balance.1 This was a formal part of the feedback that the College collected to inform its curriculum planning. Complete responses were gained from 261 respondents (26.8 per cent).

The study demonstrated strong correlations between veterinarian gender and upbringing location on career choice, and current experience on perspectives on the appropriate  balance of content for a veterinary professional curriculum. The majority of respondents in this recent graduate population were females from suburbs, small towns or villages, who attended non-selective schools and entered veterinary school directly from school. It was found that females were more likely to be employed in and desirous of small animal, equine and other positions (mostly truly mixed small, equine and farm).  In contrast, farm animal and mixed farm and equine positions are likely to be filled  and most desired by males. There was also a significant difference between individuals from different childhood areas; individuals from urban areas preferred small practice, in comparison to those from rural areas who were more likely to choose farm animal practices.

The RVC's 'quality teaching survey' gave insights to the perspectives of recent graduates

The authors conclude that key demographics such as gender and upbringing location have an effect on the short- and long-term career choices of vets and need to be taken into account alongside ‘in course’ measures to encourage the pursuit of a food animal career. They recommend that the demographic nature of veterinary students continue to be monitored and that further consideration regarding recruitment of students and retention of veterinarians for certain roles through qualitative methods may be advantageous.

Stephen May comments, ‘We live in an age where our leaders mistake anecdote for evidence, and this can lead to well-intentioned but often inappropriate decisions on how to act.  Many suggestions have been made over the years about different ways to select veterinary students, but it is important that any new criteria are soundly framed based on evidence like that which Tierney has produced here.  None of us would ever want to be responsible for preventing an applicant achieving a lifelong ambition, based on faulty assumptions.

 

References:

1. Kinnson, T & May, S. A. (2013) Veterinary career ambitions correlate with gender and past experience, with current experience influencing curricular perspectives. Veterinary Record doi.10.1136/vr.101261

 

 

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