Four Core Communication Skills of Highly Effective Practitioners

Flemish equine veterinarians' perceptions on the use of and client communication about complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) is increasingly popular in horses. As CAVM usage could have risks, client-veterinarian communication about CAVM is crucial.

OBJECTIVES

Evaluating equine veterinarians' attitude towards CAVM, their CAVM usage and veterinarian-client communication about CAVM.

STUDY DESIGN

Cross-sectional study.

METHOD

A telephone survey was conducted among equine veterinarians providing ambulatory care on a daily or weekly basis. The first section of the survey included questions about the veterinarians' attitude towards CAVM and their CAVM usage. The second section focused on veterinary-client communication about CAVM.

RESULTS

When herbs are included as CAVM modality, 83% of the participants applied CAVM. Nighty-eight percent had already communicated with horse owners about CAVM and 81% agreed to be open to talk about CAVM. However, 95% agreed that sometimes CAVM usage takes place without disclosure to the veterinarian. The majority of participants communicated about CAVM on a weekly (40%) or daily (22%) basis, most often in person during consultations (99%) or via phone (32%). The median percentage of conversations about CAVM initiated by the owner was 50% (range 50%-80%). When the veterinarian initiated the conversation, this was usually by mentioning it as a treatment option, mostly in addition to conventional treatments. Some participants directly asked about CAVM use in the information-gathering phase.

MAIN LIMITATIONS

A convenience sample was used due to lack of data on the number of equine veterinarians in Flanders. Potential favourability bias with higher participation of veterinarians interested in CAVM.

CONCLUSION

Equine veterinarians generally had a positive attitude towards CAVM use, although this depended on the specific modality. Veterinarian-client communication about CAVM occurs frequently in ambulatory care. An open dialogue with horse owners about CAVM is important to provide information about CAVM and thus enable them to make informed decisions concerning CAVM usage, together with their veterinarian.

Recasting the gold standard - part II of II: communicating healthcare options along a continuum of care

SERIES OUTLINE

This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care.

RELEVANCE

Contextual case management prioritizes interventions that are appropriate for both the patient and the client. To identify and explore which healthcare options represent the best fit for those impacted most by medical decisions, veterinarians need to make space for clients to feel comfortable sharing their perspectives. Clients are more likely to be engaged in decision-making when their insight is actively solicited. They have much to share with us as experts about their cat's overall health and wellness needs. Inviting clients to contribute to the consultation and being receptive to hearing what motivates their choices helps us to structure conversations around healthcare options. The ability to communicate healthcare options is as vital as the provision of healthcare, if not more so.

Surveying dog owners' use and understanding of, and communication with veterinarians about, complementary and alternative veterinary medicine

BACKGROUND

Complementary and alternative veterinary medicine (CAVM) seems to be gaining acceptance by pet owners. Client-veterinarian communication about CAVM is important to explore client perceptions and facilitate open exchange of ideas between owners and veterinarians.

METHODS

This study includes an online, cross-sectional survey of dog owners to evaluate CAVM use and client-veterinarian communication about CAVM. Based on the extended theory of planned behaviour, factors influencing the intention to use CAVM were evaluated.

RESULTS

Past CAVM use was reported by 45.3% clients based on 1000 valid surveys. The attitude towards CAVM was generally positive. Perceived knowledge about CAVM positively predicted perceived behavioural control and attitude towards CAVM. Both were the strongest predictors of future CAVM use. Around 45.7% of clients had already talked to their veterinarian about CAVM. This conversation was mainly initiated by the owner (66.3%). Owners expected the veterinarian to have knowledge about CAVM (91.5%) and offer referral (71.5%).

LIMITATIONS

The limitation is difficulty in classifying and defining CAVM modalities.

CONCLUSIONS

Owners' perceived behavioural control and attitude towards CAVM predict CAVM use. Failure to engage in a conversation about CAVM hampers clients to partner with veterinarians to discuss the treatment approach and maximise patient outcome. The veterinarian plays an essential role in providing objective accurate information about CAVM.

Communicating without words: Measuring nonverbal communication between veterinarians and farmers during routine herd health consultations

Uptake of advice and the ability to facilitate change on-farm are key elements for successful veterinary practice. However, having the necessary clinical skills and knowledge is not enough to achieve this: effective communication skills are essential for veterinarians to realize their advisory role by exploring and understanding the farmer's worldview. Research of verbal aspects of veterinarian communication supports the use of a relationship-centered communication style; we next need to study how veterinarian-farmer nonverbal communication (NVC) can influence interactions and their outcomes, which has been examined in medical and companion animal practice. In this study, we considered which aspects of NVC should be measured, and how, to provide an essential first step toward understanding the significance of NVC for veterinarians working in dairy practice, which should be of interest to researchers, veterinary educators, and practitioners. Eleven video recordings of routine consultations in the UK were analyzed for farmer and veterinarian NVC. The NVC attributes with established links to positive patient and client outcomes from medical and social science studies were chosen, and a methodology developed for their measurement, by adapting measures typically used in NVC research. Each consultation was segmented into intervals defined by the main activity and location on farm: introduction, fertility examination, discussion, and closing. This approach allowed us to analyze the content more consistently, establish which aspects of NVC featured within each interval, and whether the activity and location influenced the observed NVC. We measured 12 NVC attributes, including body orientation, interpersonal distance, head position, and body lean, which have been shown to influence empathy, rapport, and trust: key components of relationship-centered communication. Future research should seek to establish the significance of NVC in effective communication between veterinarian and farmer, building on our findings that show it is possible to measure nonverbal attributes. Veterinarians may benefit from becoming skilled nonverbal communicators and have more effective conversations during routine consultations, motivating farmers to make changes and improve herd health.

Enhancing Veterinary Student Engagement in Public Health and Epidemiology Coursework through a Client-Focused Risk Communication Assignment

The ongoing COVID-19 pandemic has highlighted the important role veterinarians play as public health communicators and emphasized the importance of engaging veterinary students in epidemiology and public health curriculum, the majority of whom have a clinical focus and struggle to see their relevance in relation to future career plans. To enhance student engagement, second-year DVM students were asked to create a one-page risk communication handout centered on a zoonotic disease and organized with public health message mapping. Informed by the distribution of students' self-declared career plans at admission to the DVM program, students were asked to choose from a list of zoonotic pathogens previously covered in the DVM curriculum and to select a relevant focus species and expected lay audience member. This assignment was scaffolded with previous infectious disease and communication coursework and provided an opportunity for all students to engage with public health material regardless of prior interest or knowledge. Students chose 13 of 15 zoonotic diseases provided, and their species and audience focuses were distributed across previously stated career focuses, including companion animals, food producing animals, exotic animals, and wildlife. Providing options relevant to diverse student experiences and connecting the assignment to clinical competencies supported student autonomy and engagement in public health content outside clinically focused core classes. Students' successful delivery of constructive peer feedback indicated their engagement with the public health course material, integration of learning from other parts of the curriculum, and perceived relevance of the assignment to their future career focus.

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

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

Veterinarians' use of shared decision making during on-farm interactions with dairy and beef producers

BACKGROUND

The objectives of this study were to explore the level of shared decision making (SDM) between veterinarians and dairy and beef producers during on-farm interactions and to identify factors associated with veterinarians' use of SDM behaviours.

METHODS

A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Their on-farm interactions were audio-video recorded. The recordings were analysed using the 'Observing Patient Involvement in Decision Making' (observer OPTION5 ) instrument to determine the level of SDM utilised during preference-sensitive decisions. A logistic regression model was developed to assess factors associated with a preference-sensitive decision occurring. Meanwhile, a linear regression model was developed to identify factors associated with the level of SDM used.

RESULTS

Forty-one veterinarians participated, and 186 unique veterinarian-producer interactions were audio-video recorded and OPTION5 score was calculated. SDM scores were low and comparable to other studies using the OPTION5 instrument. The only factor associated with whether a preference-sensitive decision occurred was the length of the veterinarian and producer's relationship (in years). As the length of their relationship increased, a preference-sensitive decision was less likely to occur. The use of SDM behaviours was found to decrease as veterinarian burnout score increased. These findings demonstrate that SDM behaviours are being used by food-animal veterinarians, yet an opportunity exists to further implement more producer-centred SDM skills into on-farm interactions.

LIMITATIONS

Small portions of veterinarian-producer conversation occurred outside of audio-video-recorded interactions and were not included in the analysis.

CONCLUSION

The results of this study aid in further understanding on-farm interactions between veterinarians and producers and can help to further improve veterinary communication curricula.

Equine-Assisted Learning - An Experiential, Facilitated Learning Model for Development of Professional Skills and Resiliency in Veterinary Students

Stress has been identified as a major obstacle for students in DVM training programs and can be associated with a high incidence of anxiety and depression among students. Interventions for stress reduction and improved self-confidence have been introduced at many veterinary schools with the intention of increasing resiliency among students and improving skills for wellness to be used throughout a veterinary career. Equine-assisted learning (EAL) is a facilitated, reflective discussion method based on interpretation of equine behavior in a group experiential setting that has been used to improve confidence, self-assurance, verbal and non-verbal communication, focus, mindfulness, and coping strategies in populations of students, medical students, corporate groups, and career professionals. We worked with the Cummings School equine teaching herd to develop an EAL course offered as a weekly class to veterinary students in Spring and Fall semesters since 2018. Our course was modeled after one offered to medical students at the University of Arizona and Stanford University, using progressively more complex equine handling exercises over the course of the semester (Kane, 2007). Our goal was improved communication, focus, and self-awareness among students to help reduce stress and improve resiliency. Outcome surveys showed that the students found a safe space to share anxieties, concerns, or challenges and learn professionalism skills. Incidentally, they also reported improvement in their equine handling skills. We advocate the use of EAL principles and the use of veterinary teaching horses to reduce stress and improve resiliency and equine handling skills among veterinary students.

Increasing Team Effectiveness through Experiential Team Training: An Explanatory Mixed-Methods Study of First-Year Veterinary Students' Team Experiences

This article explores the impact of experiential team communication training on student team effectiveness. First-year veterinary students were concurrently enrolled in the Group Communication in Veterinary Medicine course and applied their knowledge to their authentic team experiences in the Veterinary Anatomy and Introduction to Clinical Problem Solving courses. All students completed a modified team effectiveness instrument and a team self-reflection at the end of the semester. Results show that students experienced a high level of team effectiveness. Although students experienced challenges with respect to staying on task and distributing roles and responsibilities, team coordination and communication improved over time, due in part to the team activities associated with the team training intervention. This research provides support for the impact of experiential team training to the development of team process skills and team effectiveness.

Exploring companion animal caretakers' attitudes, perceptions and behavioural drivers of antimicrobial use within the social context of veterinary care

OBJECTIVE

To explore companion animal caretakers' attitudes, perceptions and behavioural drivers of antimicrobial use within the social context of veterinary care.

MATERIALS AND METHODS

Five semi-structured focus groups were conducted with 26 cat and dog owners. Transcripts were subjected to thematic analysis to systematically code and classify themes related to the study objectives.

RESULTS

Thematic analysis revealed five themes - trust-building/relationships, shared decision-making/empowerment, clear communication, judicious use and concerns surrounding antimicrobial use. Strong veterinarian-client relationships were the underlying factor influencing acceptance of antimicrobial use stewardship principles. Participants viewed themselves as advocates for their animals and preferred a relationship-centred approach to care facilitated through competent communication. They cited the importance of clear communication related to diagnosis and antimicrobial recommendations including using client-friendly terminology, providing explicit instructions for antimicrobial use, and having a shared plan for next steps and follow-up communication. Participants reported challenges with administering antimicrobial drugs, expressed concerns with potential side effects and development of antimicrobial resistance. Consequently, they reported an interest in alternatives to antimicrobial drugs and a focus on preventive medicine that was counterbalanced with concerns for animal comfort and welfare.

CLINICAL SIGNIFICANCE

Conversations about antimicrobial use can be reframed to include alternatives to antimicrobials as part of the treatment plan, and clients can be empowered to play a more active role in their animals' care. Veterinarians can apply core communication skills to advance antimicrobial stewardship principles and thereby contribute to preserving the effectiveness and availability of antimicrobials while preserving the trusting relationship and shared decision-making between clients and veterinarians.

A Call for Compassionate Empathy: Analysis of Verbal Empathic Communication between Veterinary Students and Veterinary Clients and their Dogs

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The "Model of Empathic Communication in the Medical Interview" by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including "fear" and "panic." Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients' perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

The use of the roter interaction analysis system in assessing veterinary student clinical communication skills during equine wellness examinations in rural Kentucky, USA: A pilot study

BACKGROUND

Effective clinical communication can aid veterinarians in building good client relationships, increase adherence to recommendations and, ultimately, improve patient health and welfare. However, available information on veterinary communication in the equine context is limited. The objective of this study was to describe the communication of veterinary students in the equine environment who had previous communication training. Additionally, we assessed the suitability of the Roter Interaction Analysis System (RIAS) for the analysis of audio-video recordings of equine wellness consultations.

METHODS

Twenty-seven equine wellness consultations performed by second-year Ross University School of Veterinary Medicine students were recorded in rural Kentucky, United States of America. Recordings were submitted to a professional coder who applied the RIAS to the equine context by expanding or adjusting code definitions.

RESULTS

A substantial amount of utterances (i.e. segments of speech) were allocated to core communication skills including building rapport (30%), facilitation and client activation (24%) and education and counselling (23%). There was a large variation in utterances used among consultations of the same veterinary student and students; they did not appear anxious or nervous.

CONCLUSIONS

Students made use of core communication skills, indicating that experiences from pre-clinical training could be transferred to equine practice. Furthermore, this study demonstrated that the RIAS could be considered for consecutive studies aiming to provide observational data on clinical communication in the equine context.

Evaluation of Veterinary Students' Communication Skills with a Service Dog Handler in a Simulated Client Scenario

Effective communication skills serve as a key component of excellent veterinary care and provide a foundation for building trusting relationships with clients. While many veterinary clients value their pets for companionship, the focus of other relationships may be based on a partnership between the human and animal, as is the case with the handlers of service dogs. As the use of service dogs in the US continues to grow, it is important that veterinary professionals are educated on how best to meet the unique needs of service dogs and their handlers. This article evaluates the interactions of veterinary students with a service dog handler in a simulated client scenario. Ten videotaped interactions were coded to assess third-year students' communication skills (nonverbal communication, open-ended questions, reflective listening, and empathy), and their ability to discuss the diagnostic and therapeutic options for a dog with suspected intervertebral disk disease. Results showed that the majority of students demonstrated competence in the use of nonverbal communication skills and in discussing the biomedical aspects of the disease. Students require development in the use of open-ended questions, reflective listening statements, and expression of empathy, as well as building client rapport and discussing the psychosocial aspect of the disease on the client and patient. These findings suggest that veterinary students may benefit from targeted instruction on "best practices" in caring for service dogs and their handlers, including greater attention to the psychosocial aspects of a disease, and from additional communication practice using standardized clients with service dogs.

Veterinary Clinical Ethics and Patient Care Dilemmas

Veterinary ethical dilemmas are common, complex, and unavoidable. Creating a transparent and deliberate approach to ethical issues empowers the entire veterinary team and reduces stress associated with these dilemmas. This article discusses ethical considerations and principles and propose use of the 4Es model and core communication skills to address ethical dilemmas in veterinary practice. It reviews literature defining ethical issues in practice and provides case examples to show the application of our proposed methods. The goal is to provide veterinary professionals with an approach they can use to frame and address their own ethical decisions.

Comparing veterinary students' and practitioners' perceptions of communication in a bilingual context

BACKGROUND

Using veterinary medicine as the clinical context, this case study elicited perspectives of practitioners and students in Hong Kong about the impact of their communication skills on clinical practice.

METHODS

A cross-sectional mixed-method design was adopted. Fifty students from the Bachelor of Veterinary Medicine programme were surveyed about their perspectives on expected communication needs as future practitioners and their perceptions of communication skills to be acquired in their programme. Semi-structured interviews were conducted with five veterinary medical practitioners to ask how they themselves feel about communicating in bilingual situations.

RESULTS

The students highlighted that English is the predominant instructional language in their training, although there are evident discrepancies between the curriculum and the clinical setting given the three predominant languages used in Hong Kong. The veterinary medical practitioners also highlighted strategies for clear communication, and the significance of interpersonal skills as effective communication is essential for learners in training to ensure client satisfaction and optimal clinical outcomes.

CONCLUSION

This study can offer insights to educators on ways to bridge veterinary training and the clinical setting in bilingual contexts where communication problems result from language differences used for instruction and in clinical settings. Taking cultural context into consideration, multimodal teaching and learning materials can be developed to accommodate students' needs for both academic and professional purposes.

Impact of a Frame Reflection Assignment on Veterinary Student Perspectives toward Animal Welfare and Differing Viewpoints

Veterinarians are considered leaders in animal welfare, but veterinary curricula often lack training in welfare. Our aims were to describe veterinary student values, assess whether a frame reflection assignment can encourage student willingness to engage with others with differing values surrounding animal welfare, and determine if sex and career area of emphasis related to responses. Two cohorts of second-year veterinary students at the Ohio State University (n = 314) articulated their values (including those of biological functioning, affective states or natural living they value most), interviewed someone with differing values, reported their interviewee's views as if they were their own (frame reflection), then reflected on the process (post-interview reflection). Qualitative and quantitative analyses were used. Students identified as 83% female and 17% male,^a with small animal (56%), large animal (11%), mixed animal (15%), or other (19%) career areas of emphasis. Students valued affective states (45%) and biological functioning (42%) more than natural living (11%). Food animal students were more likely to value biological functioning. In their post-interview reflections, students articulated both productive and unproductive views (e.g., likely or unlikely to improve future conversations, respectively), though productive views were more common. Students reported that the assignment would benefit their careers by improving their communication strategies with clients. Female students were more likely to use themes related to unproductive and career-related views. We conclude that a frame reflection assignment is a novel and effective method for improving veterinary student communication skills when discussing controversial animal welfare topics.

Communication as teaching content of veterinary studies - a joint position paper from the DVG specialist group "communication and didactics" and the GMA veterinary medicine committee

Veterinarians have to face many communicative challenges in their professional capacity. Successful professional communication increases satisfaction among pet owners, staff members and colleagues, and ultimately also the veterinarians' own satisfaction. On the other hand, unsuccessful communication can easily lead to rejection, distrust and dissatisfaction. However, communicative skills are not explicitly taught as part of the compulsory courses in veterinary medicine in Germany. The position paper of the GMA Veterinary Medicine Committee and the DVG work group Didactics and Communication Competence describes the importance of successful communication for working veterinarians as well as the training situation in Germany and addresses topics that are often discussed in connection with the implementation. The authors come to the conclusion that there is both a necessity and a possibility for the introduction of communicative training content and provide recommendations that are intended to support the sustainable introduction of courses and exams to develop the communicative skills of veterinary students.

Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model

In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.

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

OBJECTIVE

To describe how North American veterinary medical teaching institutions (VMTIs) provide communication skills training to students.

SAMPLE

Faculty coordinators of communication skills training programs (CSTPs) at 30 North American VMTIs.

PROCEDURES

An online survey instrument was designed and administered to each respondent followed by a telephone (n = 28) or in-person (2) interview. The survey and interview process were designed to evaluate all aspects of CSTPs, such as communication framework used, program format, number of student-contact hours, staffing models, outcome assessment, faculty background, program priorities, and challenges. Descriptive results were generated, and guidelines for future development of CSTPs were recommended.

RESULTS

27 US and 3 Canadian VMTIs were represented, and communication skills training was required at all. Twenty-five CSTPs used the Calgary-Cambridge Guide framework. Respondents provided a mean of 33 student-contact hours of training, primarily in the first 3 years of the veterinary curriculum in lecture (mean, 12 hours), communication laboratory (13 hours), and self-study (8 hours) formats with formative feedback. Communication skills training was integrated with other disciplines at 27 VMTIs. Most CSTPs were coordinated and taught by 1 faculty member with a < 0.50 full-time equivalent commitment and no administrative support. Stated priorities included acquisition of resources for CSTP faculty, administrative support, and video-equipped facilities; increasing integration of CSTPs into curricula; and assessment of educational outcomes.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that support for CSTPs and recognition of their value continue to grow, but a lack of resources, faculty expertise, validated methods for outcomes assessment, and leadership remain challenges.

Use of the Health Belief Model to identify factors associated with owner adherence to elimination diet trial recommendations in dogs

OBJECTIVE

To use the Health Belief Model to identify factors associated with owner adherence to elimination diet trial (EDT) recommendations by veterinarians for dogs with suspected cutaneous adverse food reactions (CAFRs).

SAMPLE

192 owners of dogs prescribed an EDT between April 1, 2012, and April 1, 2017.

PROCEDURES

Owners of dogs prescribed an EDT to diagnose CAFRs were identified through review of medical records from a single veterinary dermatology specialty practice. Identified owners were invited to participate in an anonymous online survey that was developed on the basis of the Health Belief Model. Multivariable logistic regression was used to evaluate associations between potential predictor variables and 100% adherence to EDT recommendations.

RESULTS

665 owners were invited to participate, and 192 (28.9%) completed the survey. Of the 192 respondents, 77 (40.1%) reported 100% adherence to EDT recommendations, and 115 (59.9%) reported < 100% adherence. Results indicated that the odds of owners reporting 100% adherence to EDT recommendations were significantly decreased by owner perception of barriers (adjusted OR [OR_a] = 0.86) and were significantly increased by owner knowledge regarding diets and CAFRs in dogs (OR_a = 1.30) and by self-efficacy or confidence in performing an EDT as directed (ORa = 1.18).

CONCLUSIONS AND CLINICAL RELEVANCE

Findings indicated that most prescribed EDTs were not followed strictly. Interventions to help owners reduce perceived barriers, increase self-efficacy, and improve related knowledge could improve adherence to EDT recommendations and, thereby, increase the diagnostic utility of EDTs.

Exploring veterinarians' use of practices aimed at understanding and providing emotional support to clients during companion animal euthanasia in Ontario, Canada

BACKGROUND

During companion animal euthanasia, support of clients is equally important as the medical care of the companion animal and requires a clear and developed understanding of clients' feelings, needs and expectations. Yet, veterinarians may not be fully exploring such topics.

METHODS

A 65-item online questionnaire was developed and distributed to veterinarians (n=368) in Ontario to explore veterinarians' use of practices aimed at understanding and providing support during companion animal euthanasia. Measures included veterinarians' use of previously identified communication and support practices, empathy, years in practice and amount of time scheduled for euthanasia appointments. Data were analysed using descriptive statistics and multivariable regression.

RESULTS

Veterinarians reported consistently providing emotional support but inconsistently implementing practices that may assist in enhancing their understanding of clients' expectations, previous or emotional experiences. Veterinarians' empathy scores, years in practice and the amount of time scheduled for euthanasia were positively associated with use of these practices.

CONCLUSION

Providing adequate time (ideally >30 min) for euthanasia appointments may assist in efforts to understand clients' experiences, expectations and emotions, and provide support. Combining empathy, hands-on and self-care training in veterinary curriculum may also be valuable in improving the comfort level and skill of veterinarians in providing compassionate care.

A Competency-Guided Veterinary Curriculum Review Process

Competencies can guide outcomes assessment in veterinary medical education by providing a core set of specific abilities expected of new veterinary graduates. A competency-guided evaluation of Colorado State University's (CSU) equine veterinary curriculum was undertaken via an alumni survey. Published competencies for equine veterinary graduates were used to develop the survey, which was distributed to large animal alumni from CSU's Doctor of Veterinary Medicine program. The results of the survey indicated areas for improvement, specifically in equine business, surgery, dentistry, and radiology. The desire for more hands-on experiences in their training was repeatedly mentioned by alumni, with the largest discrepancies between didactic knowledge and hands-on skills in the areas of business and equine surgery. Alumni surveys allow graduates to voice their perceived levels of preparation by the veterinary program and should be used to inform curriculum revisions. It is proposed that the definition and utilization of competencies in each phase of a curricular review process (outcomes assessment, curriculum mapping, and curricular modifications), in addition to faculty experience and internal review, is warranted.

What makes a great clinical team? Stakeholder perspectives on the attributes of effective veterinary health care teams in Australia

Extensive research in the business and organisational literature links teamwork to enhanced productivity and employee job satisfaction. Good teamwork capability is also a highly regarded graduate attribute linked to employability. This study explored desirable teamwork attributes for veterinary technology graduates in Australia, by surveying veterinarians, veterinary technology graduates, veterinary nurses, clients and academics. Respondents highlighted the importance of seven attributes sourced from the cross-disciplinary teamwork literature-'flexibility' (in approach to work), 'agreeableness', being 'cooperative', 'socially sensitive and perceptive', 'conscientiousness', being 'accepting of others' and 'sharing professional values'. The majority in each stakeholder group viewed all attributes important for teamwork concurring with findings in other fields. Few differences were found between and within groups with veterinarians and academics rating 'conscientiousness' higher than others and female clients placing more importance on relational attributes compared to male clients. Thematic analysis of an open-ended item asking the veterinary health care groups, and veterinary academics, to define teamwork generated nine themes centred on: collaboration, goals and outcomes, sharing values, relationships, diversity, communication, task-orientation, personal attributes, and workplace culture. This study illuminates an interprofessional perspective on veterinary teamwork. Results will be useful for veterinary technology, veterinary nursing and veterinary educators when developing a curriculum for interprofessional teamwork to enhance team performance, employability and, ultimately, the quality of veterinary services.

Being Nice Is Not Enough-Exploring Relationship-Centered Veterinary Care With Structural Equation Modeling. A Quantitative Study on German Pet Owners' Perception

During the last years, the philosophy of relationship-centered care gained increasing attention in veterinary medicine. Relationship-centered care is based on a joint venture between pet owner and veterinarians and therefore offers the opportunity to satisfy the pet owners' need for participation in medical decision-making and to provide the best care for the patient. Although research on relationship-centered care in the veterinary consultation is still limited, the available findings suggest that the characteristics of relationship-centered care reflect the pet owners' expectations on satisfactory veterinary care. In this study a quantitative survey was conducted among German pet owners that collected information regarding their perception of the veterinarians' communication during the last appointments. Questionnaires were available online and paper-based. Data were analyzed using exploratory factor analysis and structural equation modeling using SAS. First aim of the study was to explore structural equation modeling (SEM) as an opportunity to evaluate quantitative data in the field of research on relationship-centered care. Further, SEM was used to evaluate associations between the implementation of different characteristics of relationship-centered care in the veterinary practice (empathic communication, partnership-building) and latent outcome variables regarding the pet owners (pet owners' need for further information, consultation of competing health care providers). N = 1,270 valid questionnaires were completed. Participants owned small companion animals (55.6%), horses (7.6%), or both (36.9%) within the last 2 years. Results of SEM suggest that partnership-centered and empathic communication decreased the pet owners' needs for further information (e.g., from online sources) and their need to consult alternative health providers (e.g., homeopaths). Especially addressing the pet owners' worries and fears, discussing pros and cons of diagnostic and therapeutic options as well as providing the required amount of information were shown to be large influence factors within the model. Therefore, veterinarians are recommended to implement the concept of partnership-centered care in their daily practice, for it may increase pet owners' loyalty and satisfaction. Results may motivate future research in this field. Further development of the proposed model assumptions may enable valuable progress in the field of quantitative research on relationship-centered care.

Understanding Non-Technical Competencies: Compassion and Communication among Fourth-Year Veterinarians-in-Training

Over the past several decades, non-technical competencies have been given an increasing amount of emphasis in veterinary medical training. However, additional research is needed to continue understanding the role that non-technical competencies play in veterinary success and wellness. An inter-related pair of non-technical competencies that needs further empirical investigation is communication and the influence of compassion on veterinarians. This research study investigated the relationship between compassion experiences and communication styles of fourth-year veterinarians-in-training using a canonical correlation analysis. The compassion fatigue resilience (CFR) model was the theoretical framework used to conceptualize how communication behaviors may contribute to compassion fatigue and compassion satisfaction. Compassion experiences were measured using a version of the Professional Quality of Life (ProQOL) scale. Communication style was measured using the Communication Styles Inventory (CSI). Results indicated that communication style is statistically significantly related to compassion experiences (n = 281; Function 1, R_c = .552, p < .001; Function 2, R_c = .369, p < .001). Compassion fatigue was found to have a statistically significant association with the communication styles of emotionality (r = .467, p < .001), impression manipulativeness (r = .191, p = .001), and verbal aggressiveness (r = .239, p = .001). Results indicated support for veterinary training programs to continue adapting their curricula to include communication training and intervention programs to address communication and compassion fatigue, as well as to consider how the relationship between these two constructs may influence the wellness and success of veterinarians-in-training and veterinarians. More research is needed to understand the role of impression manipulativeness in veterinary wellness.

Pet Grief: Tools to Assess Owners' Bereavement and Veterinary Communication Skills

Simple Summary

In Italy, there are approximately 60.5 million companion animals, and 92% of Italian owners consider them as family members. Despite the growing interest in pet bereavement and in end-of-life (EOL) issues in veterinary medicine across the world, there are still very few Italian studies on the psychological impact of losing a pet, and there are no instruments in the Italian language to assess grief, following the death of a companion animal and the impact of effective veterinary communication skills on pet bereavement. The aim of this study is the Italian adaptation of instruments (Pet Bereavement Questionnaire (PBQ); Regret of Bereaved Family Members (RBFM); Shared Decision-Making Questionnaire (SDM-Q-9); Consultation and Relational Empathy Measure (CARE)), which can be useful in assessing bereavement in companion animal owners and communication skills in veterinary medicine. All the instruments obtained good internal reliability. The results showed that the use of the Italian versions of all the instruments is useful, and that the CARE, the SDM-Q-9, and the Regret of Bereaved Family Members (RBFM) developed for the human healthcare context, may also be used in veterinary medicine, and in further Italian pet bereavement and EOL veterinary studies.

Abstract

In Italy, there are still very few studies on the psychological impact of losing a pet. The need to fill this gap springs from the fact that pet loss counseling services are increasingly being activated. The aim of this study is the Italian adaptation of instruments for veterinary counseling services. The survey instruments adapted were: Pet Bereavement Questionnaire (PBQ) to describe the individual experience of pet-grief; Regret of Bereaved Family Members (RBFM) to assess the family regret; Shared Decision-Making Questionnaire (SDM-Q-9) for decision making in end of life; Consultation and Relational Empathy Measure (CARE) to assess the veterinarian relational empathy during clinical encounters. All the instruments obtained good internal reliability, and the results of the confirmative factor analysis of all the Italian versions were in accordance with the original ones. The correlational analysis among the variables evidenced the following aspects: the more the owner feels involved by the veterinarian in the decision making process the more the veterinarian is perceived by the owner as empathetic; when the veterinarian is perceived as empathic and the decision making is shared the owners’ pet bereavement distress and regrets are reduced; negative dimensions of bereavement (grief, guilt, anger, intrusive thoughts and decisional regrets) are strictly linked to each other, therefore if one dimension increases or decreases the others do too. The path analysis suggests that developing a veterinary relationship-centered care practice may be beneficial for pet owners facing end-of-life issues and the death of their companion animals since it showed that shared-decision making strategies and empathic communication may reduce negative dimensions of bereavement that may complicate grief. Interestingly, adopting shared decision-making strategies may contribute to be perceived as more empathic. These aspects may be taken into consideration in end-of -life communication training in veterinary medicine.

Analysis of Final Year Veterinary Students' Telephone Communication Skills at a Veterinary Teaching Hospital

Client communication is a core clinical skill that is taught as part of the required curriculum at many veterinary colleges. Although much client communication occurs face-to-face, telephone communication is used to provide patient updates, relay results of diagnostic tests, and check on discharged patients. This research explored fourth year veterinary medical students' telephone communication skills. We recorded and analyzed the transcripts of 25 calls students made to clients of three different services in the Veterinary Teaching Hospital. Additionally, we explored the perspectives of veterinary educators by distributing a survey to university faculty and house officers (n = 57). Results indicate that students excelled at identifying the patient and purpose of the call and incorporating professional language and clear explanations. They require development in providing structure and incorporating core communication skills. Compared with our survey results, the student findings are at odds with clinicians' expectations of students' communication abilities. We conclude that additional training is required to familiarize students with expectations regarding telephone communication, including reviewing the case thoroughly, preparing to answer questions and provide explanations, following organizational protocol, and incorporating open ended questions, reflective listening, and empathy. This data will inform design, and help to measure the impact, of telephone communication education and training that will be incorporated into the existing veterinary communication curriculum.

Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters

The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.

Evaluating Dog- and Cat-Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire

Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.

Veterinarians and Humane Endings: When Is It the Right Time to Euthanize a Companion Animal?

Current advances in technologies and treatments provide pet owners and veterinarians with more options for prolonging the life of beloved pets, but can simultaneously lead to ethical dilemmas relating to what is best for both animal and owner. Key tools for improving end-of-life outcomes include (1) sufficient training to understand the valid ethical approaches to determining when euthanasia is appropriate, (2) regular training in client communication skills, and (3) a standard end-of-life protocol that includes the use of quality of life assessment tools, euthanasia consent forms, and pet owner resources for coping with the loss of a pet. Using these tools will improve outcomes for animals and their owners and reduce the heavy burden of stress and burnout currently being experienced by the veterinary profession.

An Interactive Teddy Bear Clinic Tour: Teaching Veterinary Students How to Interact with Young Children

Although there are existing guidelines for teaching and learning skillful client communication, there remains a need to integrate a developmental focus into veterinary medical curricula to prepare students for interactions with children who accompany their companion animals. The objectives of this teaching tip are (1) to describe the use of a Teddy Bear Clinic Tour as an innovative, applied practice method for teaching veterinary students about clinical communication with children, and (2) to provide accompanying resources to enable use of this method to teach clinical communication at other facilities. This paper includes practical guidelines for organizing a Teddy Bear Clinic Tour at training clinics or colleges of veterinary medicine; an anecdotal description of a pilot study at the Ontario Veterinary College Smith Lane Animal Hospital; and printable resources, including a list of specific clinical communication skills, a sample evaluation sheet for supervisors and students, recommendations for creating a child-friendly environment, examples of child-friendly veterinary vocabulary, and a sample script for a Teddy Bear Clinic Tour. Informed by the resources provided in this teaching tip paper, the Teddy Bear Clinic Tour can be used at your facility as a unique teaching method for clinical communication with children and as a community outreach program to advertise the services at the facility.

Expectations of Graduate Communication Skills in Professional Veterinary Practice

Good communication skills are an important entry-level attribute of graduates of professional degrees. The inclusion of communication training within the curriculum can be problematic, particularly in programs with a high content load, such as veterinary science. This study examined the differences between the perceptions of students and qualified veterinarians with regards to the entry-level communication skills required of new graduates in clinical practice. Surveys were distributed to students in each of the four year levels of the veterinary science degree at the University of Melbourne and to recent graduates and experienced veterinarians registered in Victoria, Australia. Respondents were asked to rank the relative importance of six different skill sets: knowledge base; medical and technical skills; surgical skills; verbal communication and interpersonal skills; written communication skills; and critical thinking and problem solving. They were then asked to rate the importance of specific communication skills for new graduate veterinarians. Veterinarians and students ranked verbal communication and interpersonal skills as the most important skill set for an entry-level veterinarian. Veterinarians considered many new graduates to be deficient in these skills. Students often felt they lacked confidence in this area. This has important implications for veterinary educators in terms of managing the expectations of students and improving the delivery of communication skills courses within the veterinary curriculum.

The Impact of a Group Communication Course on Veterinary Medical Students' Perceptions of Communication Competence and Communication Apprehension

This paper explores the impact of a group communication course on veterinary medical students' perceptions of communication competence and communication anxiety. Students enrolled in the Group Communication in Veterinary Medicine course completed the Personal Report of Communication Apprehension and the Communicative Competence Scale at the beginning (Time 1) and end (Time 2) of the semester. Results show that first-year veterinary students' self-perceptions of communication competence increased and their self-reported levels of communication apprehension decreased across multiple contexts from Time 1 to Time 2. This research provides support for experiential communication training fostering skill development and confidence.

Evaluation of a Communication Skills Training Program for Companion-Animal Veterinarians: A Pilot Study Using RIAS Coding

Effective veterinarian communication skills training and the related key outcomes provided the impetus for this study. We implemented a pre-experimental pre-test/post-test single-group design with a sample of 13 veterinarians and their 71 clients to evaluate the effects of a 6.5-hour communication skills intervention for veterinarians. Consultations were audiotaped and analyzed with the Roter Interaction Analysis System (RIAS). Clients completed the Consultation and Relational Care Measure, a global satisfaction scale, a Parent Medical Interview Satisfaction Scale, and the Adherence Intent measure. Veterinarians completed a communication confidence measure and a workshop satisfaction scale. Contrary to expectation, neither veterinarian communication skills nor their confidence improved post-training. Despite client satisfaction and perceptions of veterinarians' relational communication skills not increasing, clients nevertheless reported an increased intent to adhere to veterinarian recommendations. This result is important because client adherence is critical to managing and enhancing the health and well-being of animals. The results of the study suggest that while the workshop was highly regarded, either the duration of the training or practice opportunities were insufficient or a booster session was required to increase veterinarian confidence and integration of new skills. Future research should utilize a randomized control study design to investigate the appropriate intervention with which to achieve change in veterinarian communication skills. Such change could translate to more effective interactions in veterinarians' daily lives.

Veterinarian-Client Communication Skills: Current State, Relevance, and Opportunities for Improvement

Communication is increasingly recognized as a core skill for veterinary practitioners, and in recent years, attention to communication competency and skills training has increased. To gain an up-to-date assessment of the current state of veterinary communication skills and training, we conducted a survey among veterinary practitioners in the United Kingdom and United States in 2012/2013. The questionnaire was used to assess the current state, relevance, and adequacy of veterinary communication skills among veterinary practitioners, to assess interest in further training, and to understand perceived challenges in communicating with clients. There was an overall response rate of 29.6% (1,774 of 6,000 recipients), with a higher response rate for UK-based practitioners (39.7%) than practitioners in the US (19.5%). Ninety-eight percent of respondents agreed that communication skills were as important as or more important than clinical knowledge. Forty-one percent of respondents had received formal veterinary communication skills training during veterinary school, and 47% had received training post-graduation. Thirty-five percent said their veterinary communication skills training during veterinary school prepared them well or very well for communicating with clients about the health of their pets, compared to 61% of those receiving post-graduate training. Forty percent said they would be interested in further veterinary communication skills training, with the preferred methods being simulated consultations and online training. While there has been increased emphasis on communication skills training during and after veterinary school, there is a need for more relevant and accessible training.

Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's Experiential Learning Theory

Veterinary graduates require effective communication skills training to successfully transition from university into practice. Although the literature has supported the need for veterinary student communication skills training programs, there is minimal research using learning theory to design programs and explore students' perceptions of such programs. This study investigated veterinary students' perceptions of (1) their communication skills and (2) the usefulness of a communication skills training program designed with Kolb's Experiential Learning Theory (ELT) as a framework and implemented in a primary care setting. Twenty-nine final-year veterinary students from the Ontario Veterinary College attended a 3-week communication skills training rotation. Pre- and post-training surveys explored their communication objectives, confidence in their communication skills, and the usefulness of specific communication training strategies. The results indicated that both before and after training, students were most confident in building rapport, displaying empathy, recognizing how bonded a client is with his or her pet, and listening. They were least confident in managing clients who were angry or not happy with the charges and who monopolized the appointment. Emotionally laden topics, such as breaking bad news and managing euthanasia discussions, were also identified as challenging and in need of improvement. Interactive small-group discussions and review of video-recorded authentic client appointments were most valuable for their learning and informed students' self-awareness of their non-verbal communication. These findings support the use of Kolb's ELT as a theoretical framework and of video review and reflection to guide veterinary students' learning of communication skills in a primary care setting.

Using an objective structured video exam to identify differential understanding of aspects of communication skills

BACKGROUND

Effective communication in health care is associated with patient satisfaction and improved clinical outcomes. Professional schools increasingly incorporate communication training into their curricula. The objective structured video exam (OSVE) is a video-based examination that provides an economical way of assessing students' knowledge of communication skills. This study presents a scoring strategy that enables blueprinting of an OSVE to consensus guidelines, to determine which aspects of communication skills create the most difficulty for students to understand and to what degree understanding improves through experiential communication skills training.

METHODS

Five interactions between a healthcare professional and client were scripted and filmed using standardized patients. The dialogues were mapped onto the Kalamazoo consensus statement by having five communication experts view each video and identify effective and ineffective use of communication skills. Undergraduate students enrolled in a communications course completed an OSVE on three occasions.

RESULTS

A total of 79 students completed at least one testing session. The scores assigned supported the validity of the scoring strategy as an indication of knowledge growth. Considerable variability was observed across Kalamazoo sub-domains.

CONCLUSION

With further refining, this scoring approach may prove useful for educators to tailor their education and assessment practices to specific consensus guidelines.

Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine

Background

The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice.

Results

Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap.

Conclusions

Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.

Social communication skills of chiropractors: implications for professional practice

OBJECTIVE

Social communication skills are critical in the health professions. The aim of this study was to measure and identify professional practice predictors of social communication skills of practicing chiropractors.

METHODS

The study population was derived from a group of doctors of chiropractic who participated in a practice-based research program. Participating chiropractors agreed to complete a survey detailing the chiropractor's sex, years in practice, practice type, size of the practice community, typical weekly practice volume, and an instrument to measure skills of social communication. Regression analysis was applied to identify associations between independent variables and responses to the social skills instrument.

RESULTS

Results suggested that selected characteristics of clinical practice may be associated with clinician's social skills of communication. The weekly volume of patients to the practice emerged as a salient explanatory factor of overall social communication skills and as a factor individually for dimensions of social expressivity and social control. The practice arrangement (solo vs group) proved important in terms of respondent emotional control scores. Similarly, the solo vs group practice variable was associated with higher levels of emotional sensitivity; however, this association was mediated by the sex of the doctor of chiropractic; men reported lower levels of emotional sensitivity than women.

CONCLUSIONS

The findings of this study suggest associations between dimensions of social communication skills, practice characteristics, practice arrangements, and sex that may inform the efforts of educators as they endeavor to better prepare health professionals for practice in a wide spectrum of settings.

Didactic and experiential training to teach communication skills: the University of Wisconsin-Madison School of Veterinary Medicine collaborative experience

Teaching communication skills to veterinary students is recognized as important; however, incorporation of this into an already crowded curriculum is difficult. At the University of Wisconsin-Madison School of Veterinary Medicine we provide mandatory communication lectures to freshmen and sophomores, and offer elective experiential courses to juniors and seniors. Providing both didactic and experiential training allows students to learn and practice communication techniques in a "safe" setting. Our approach to experiential training is unique in that graduate students in counseling psychology (masters and doctoral level) act as "clients" for the juniors, and professional simulated pet owners are hired for digitally captured role-plays with the seniors. A unique inter-professional partnership has been formed between the Schools of Veterinary Medicine, Education (Department of Counseling Psychology), and (Human) Medicine and Public Health to provide this experiential training for our students. The purpose of this article is to describe the communication training program at the University of Wisconsin-Madison School of Veterinary Medicine and to encourage other programs to reach across campus and partner with other colleges with the goal of improving training for all of the individuals involved.

Enhancing communication skills for pediatric visits through on-line training using video demonstrations

BACKGROUND

Training in communication skills for health professionals is important, but there are substantial barriers to individual in-person training for practicing clinicians. We evaluated the feasibility and desirability of on-line training and sought suggestions for future courses.

METHODS

Based on successful in-person curricula for communication skills and our previous on-line curricula, we created an on-line course consisting of 28 modules (4.75 hours CME credit) about communication skills during pediatric visits that included a mental health concern; each module included a brief case, a multiple choice question, an explanation, and a 1-2 minute video demonstrating key skills. Specific communication skills included: greeting, setting an agenda, discussing diagnosis and treatment, and managing negative interactions. The course was announced by emails in spring, 2007; the course was available on-line for 60 days; we aimed to enroll 50 clinicians. Outcomes were analyzed for those who evaluated the course within 75 days of its initial availability.

RESULTS

Overall, 61 clinicians registered, of whom most were nurses (N = 24), physicians (N = 22), or psychologists or social workers (N = 12). Of the 36 (59%) clinicians who evaluated the course, over 85% agreed that all course objectives had been met; over 90% reported greater confidence in greetings and agenda-setting; and over 80% reported greater confidence in discussing diagnosis and treatment and managing negative interactions. Nearly all, 97% would recommend the course to other clinicians and trainees. Suggestions for improvement included a library of additional video vignettes and written materials to accompany the on-line training.

CONCLUSION

On-line training in communication skills for pediatric mental health visits is feasible, desirable and associated with increased confidence in key skills. Positive feedback from clinicians suggests that a comparison of on-line versus in-person training is warranted.

End-of-Life Communication in Veterinary Medicine: Delivering Bad News and Euthanasia Decision Making

Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.