Identity, environment and mental wellbeing in the veterinary profession

Enhancing Primary Care Learning in a Referral Hospital Setting: Introducing Veterinary Clinical Demonstrators

With the majority of veterinary graduates entering primary care practice (PCP), there is increasing recognition of the importance of preparing students to practice across a broad spectrum of care (SoC). The traditional model of veterinary training focused on the referral hospital environment, can make this challenging. In 2018, Bristol Veterinary School recruited five primary care (PC) veterinary surgeons as veterinary clinical demonstrators (VCDs) who collaborated with rotation-specific specialists to help enhance student focus upon day-one skills and to emphasize SoC relevance of the referral caseload. To evaluate the initiative, two separate online surveys were disseminated to clinical staff and final year veterinary students. The survey was completed by 57 students and 42 staff members. Participants agreed that VCDs helped students feel prepared for a first job in primary care practice (students 94.7%; staff 92.7%); helped students to focus on the primary care relevance of referral cases (students 96.5%; staff 70.8%); helped students develop clinical reasoning skills (students 100%; staff 69.3%), practical skills (students 82.4%; staff 72.5%), and professional attributes (students 59.6%; staff 71.4%). Thematic analysis of free-text comments revealed the benefits and challenges associated with implementing the role. The data gathered helped to guide the role's ongoing development and to provide recommendations for others who may be looking to implement similar educational initiatives to help prepare graduates to practice across a spectrum of care.

Veterinary professional identity: Conceptual analysis and location in a practice theory framework

Professional, social, and cultural issues and phenomena of veterinary practice are now established areas of commentary and interest in research, education, professional publications and even in the mainstream media. Despite the availability of theoretically informed literature in diverse relevant domains and disciplines including professional practice, workplace learning, and medical sociology and anthropology, commentary and research on veterinary practice issues and phenomena remains dominated by clinician-educators and clinician-policymakers. Reflecting the clinical disciplinary traditions, there is a resulting over-representation of individualistic, positivist perspectives and under-theorized research studies. In this paper we provide an interdisciplinary theoretical framework for veterinary practice and veterinary professional identity grounded in a practice theory perspective. We begin by arguing for the need for such a framework by scoping veterinary practice in its contemporary social context. We go on to provide a sociocultural framing of veterinary practice, underlining the mutual constitution of individuals and the social world through participation in practices and taking into consideration important concepts including knowledge, institutions, ethics, and embodiment. We assert the importance of professional identity as a core phenomenon of veterinary practice, constituted by making meaning of professional practice experiences, especially through narrative and dialogue. This practice theory framework for veterinary practice and veterinary professional identity development provides rich opportunities for understanding, researching, and enacting diverse activities and phenomena, especially learning, development and change within and beyond formal educational settings.

"Obligated to Keep Things Under Control": Sociocultural Barriers to Seeking Mental Health Services Among Veterinary Medical Students

Research reveals veterinary medical students and professionals are at increased risk for mental health problems such as depression, anxiety, and suicidality, yet many individuals in distress do not seek professional mental health services. Although some barriers to accessing services have been identified, other factors, including how professional culture influences service underutilization, are poorly understood. In this study, we used a mixed-methods approach to investigate 573 veterinary students' perceptions of barriers to seeking mental health services and potential mechanisms to lessen them. We identified four barrier themes: stigma, veterinary medical culture and identities, services, and personal factors. Participants' suggestions for reducing barriers to seeking help related to three themes: culture, services, and programmatic factors. We compared perceptions of barriers based on the severity of participants' self-reported symptoms of depression and anxiety and found that participants with severe depression, compared with participants with mild depression, were more likely to perceive barriers related to veterinary medical culture. The results of this study provide a deeper understanding of veterinary students' barriers to seeking mental health services and, in particular, how these barriers, as both individual and sociocultural phenomena, are often interrelated and mutually reinforcing.

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

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

Professional Identity of 0.24 Million Medical Students in China Before and During the COVID-19 Pandemic: Three Waves of National Cross-Sectional Studies

Background

Professional identity (PI) influences the doctor's thoughts and behaviors. Thus, PI formation (PIF) plays an important role in medical students' education. Major changes to the learning environment could impact PIF, but the influence of the novel coronavirus disease 2019 (COVID-19) pandemic on medical students' PI had confusing conclusions in previous studies. We aimed to compare PI of medical students by using the data from three waves of national cross-sectional surveys conducted in China in 2019, 2020, and 2021, and to examine factors that influence PIF.

Method

We used data from the China Medical Student Survey (CMSS) which has conducted three national cross-sectional surveys. From 2019 to 2021, CMCC retrieved data on PI from a nationally representative sample of medical students from 33, 121, and 123 colleges, respectively. We analyzed the data using Chi-square test, analysis of variance, and multivariable logistic regression according to sociodemographic characteristics, pre-university experience, college characteristics, and college experience.

Results

A total of 244,040 medical students in China participated in the surveys. The overall score of PI increased from 3.80 in 2019 to 3.85 in 2021. Medical students with family medical background, high intrinsic and extrinsic motivation of major selection, teachers' positive role model, and high personal comprehensive quality ranking were more likely to have higher PI (all p < 0.05). The more attention students paid to the COVID-19 pandemic, the higher PI they would have (aOR 1.93, 95% CI 1.67-2.24 for more attention; aOR 2.31, 95% CI 2.00-2.68 for the most attention). However, parents' participation on the front lines of COVID-19 pandemic negatively influenced the PI of medical students (aOR 0.72, 95% CI 0.57-0.93).

Conclusions

PI of medical students increased during the COVID-19 pandemic. The impact of the pandemic on PI was complex. To improve the PI of medical students, the education sector, health sector and the society need to make concerted efforts.

Connection and conflict: influence of the hidden curriculum on veterinary residents' professional identities within the specialty of laboratory animal medicine

OBJECTIVE

To explore the role of the hidden curriculum in residents' development of professional identity during postgraduate training in laboratory animal medicine.

SAMPLE

24 residents enrolled in 1 of 7 laboratory animal medicine training programs in the eastern US.

PROCEDURE

24 qualitative, semistructured interviews were conducted and recorded. Deidentified transcriptions were analyzed by each author using open and axial coding. Constant comparative methodology was used to develop themes and subthemes. Member checks were performed to verify trustability of the conclusions drawn.

RESULTS

3 themes and their related subthemes emerged from the qualitative analysis: 1) building relationships through competent communication (building rapport, practicing clinical empathy, overcoming language barriers, communicating in the "authorized" way, and navigating email limitations), 2) tension within the process of identity formation (acting as the middleman among stakeholders, overcoming the stigma of the policing role, experiencing a lack of power to impact change, and managing a culture of conditional value of veterinary knowledge), and 3) outlets for tension in identity formation (reliance on residency mates, limitations of venting).

EDUCATIONAL RELEVANCE

Our findings suggest that residents are navigating professional identity formation under challenging circumstances that include conflicting stakeholder needs, conditional value of veterinary knowledge, and lack of power to influence change. Residents have limited outlets for relieving the discord between their ideal professional role and their lived experiences. These results provide an important background for refining curricula and creating effective support systems for residents.

Are They Ready? Trials, Tribulations, and Professional Skills Vital for New Veterinary Graduate Success

Stress and burnout levels are high among young veterinarians with the transition to practice being particularly challenging. This qualitative study aimed to capture and document the new graduate veterinary experience within the United States and which professional skills are most important for success during the transition to practice. The researchers sought to better understand this challenging transition period and provide insight for veterinary educators who are tasked with preparing new veterinary graduates for day 1 practice readiness. To gain a deeper understanding of the new graduate experience, a focus group was conducted with six veterinarians who recently graduated from four different U.S. veterinary colleges. Several themes arose regarding their experiences in the transition to practice including setbacks and adaptations, self-sufficiency and self-doubt, changing clientele and ethical dilemmas, leadership and conflict, and good vs. bad mentorship. Self-care, conflict management, and client communication were perceived as the most important professional skills for success in the transition to practice. New graduate veterinarians reported that they were least prepared for working with clients with financial constraints and managing conflict. Drawing from this qualitative data, the researchers propose several topics that could be incorporated into professional skills curriculum to further enhance day 1 preparedness of new veterinary graduates to promote well-being in the transition to practice.

National Study of Nursing Faculty and Administrators' Perceptions of Professional Identity in Nursing

BACKGROUND

Establishing a professional identity in nursing is integral to professional development, yet this area of inquiry remains understudied.

PURPOSE

This segment of a multiphased national study measured nursing faculty's perceived level of importance regarding key components of professional identity in nursing using the newly developed Professional Identity in Nursing Survey (PINS).

METHODS

Fifty subject matter experts from nursing education, practice, and regulation utilized the DeVellis scale development process to develop the PINS over the course of 2 years. Nearly 1200 nurse educators evaluated the importance of a 34-item scale relating to professional identity in nursing.

RESULTS

At endorsement of 95% or greater, 28 items were found to be important components of nursing identity. Effective communication, integrity, and being trustworthy and respectful were reported as most important to nursing identity.

CONCLUSIONS

Nurse educators identified the important items to assess professional identity in nursing. Item refinement and psychometric evaluation of the survey are the next phase of the multiphased study.

The individual in the system: The role of affect in recent veterinary graduates' reflective activity

BACKGROUND

The transition to professional practice can be a challenging time. The Royal College of Veterinary Surgeons' (RCVS) Professional Development Phase (PDP) aims to support recent graduates through this transition, with graduates required to reflect on their experiences. This study drew on the concept of "lived experience" to explore the influence of affect (feelings, emotions and mood) on recent graduates' experience of reflective activity.

METHODS

Data comprised semi-structured interviews with 15 recent graduates from one veterinary school. Thematic analysis was used to explore the influence of three aspects of affect on reflective activity: affective valence (whether a chosen action is anticipated to result in positive or negative feelings), tacit aspects (such as tiredness) and perceptions of workplace mood.

RESULTS

Participants preferred to engage in activities associated with positive feelings. Tacit feelings, such as panic or tiredness, and perceptions of workplace mood, influenced how and with whom participants engaged in reflective activity. Participants often made different choices when reflecting primarily on affective compared to clinical aspects of situations.

CONCLUSION

These findings suggest that acknowledging and understanding aspects of affect during the professional development phase has the potential to help the profession improve support for recent graduates.

International multi-stakeholder consensus for the capabilities most important to employability in the veterinary profession

BACKGROUND

Employability has been defined within the veterinary context as a set of personal and professional capabilities that enable a veterinarian to gain employment, contribute meaningfully to the profession, and develop a career pathway that achieves satisfaction and success. This study explicitly addressed the construct of veterinary employability by exploring the perceptions of multiple stakeholders (recent graduates, employee veterinarians, veterinarian and non-veterinarian employers, para-veterinary staff, academics and policy makers).

METHODS

A four-part online survey was distributed internationally via various agencies. Free-text responses, ratings of capabilities and rankings of categories were analysed.

RESULTS

The congruence of stakeholder responses was notable, regardless of age and geographical location, with minor differences noted in academics' and para-veterinary staff responses, and gender. The most important capabilities were honesty, ethical behaviour, communicating effectively and collaboratively with clients, knowing when to ask for help, and the willingness to learn. The categories of communication and teamwork ranked highest.

CONCLUSION

This study adds granularity to the existing evidence for the importance of communication and teamwork. The relationship between the veterinarian (self) and their work, enabled by engagement, meaning and purpose, and respect for their profession was a key finding, and illustrative of how to achieve personal satisfaction and well-being within the profession.

Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting

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Owners describe a range of early behavioural indicators of canine osteoarthritis.

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Their beliefs and prior knowledge may impact when and how they seek advice.

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Vets in general practice describe a common “typical osteoarthritis” presentation.

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History, examination and trial treatment are used to diagnose osteoarthritis.

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Vets and owners may find osteoarthritis consultations frustrating and unrewarding.

Canine osteoarthritis is a common, painful condition that is typically managed in a general practice setting. Osteoarthritis may have significant negative impacts on the welfare of both dogs and their owners. Anticipated early clinical signs of canine osteoarthritis and the preferred route to its diagnosis are well described by veterinary subject experts in published literature. However, little is known about changes owners first recognise in a dog ultimately diagnosed with osteoarthritis, how they make decisions about when to present that dog to a general practitioner, or whether the described diagnostic pathways are followed by general practitioners. The aim of this research was to investigate how dog owners and veterinary surgeons describe identifying and diagnosing canine osteoarthritis.

Owners of osteoarthritic dogs were recruited for semi-structured interview, and veterinary surgeons working in general practice were invited to take part in practice-based focus groups. Transcripts from both datasets were thematically analysed using a contextualist epistemology with an ontology based on critical realism to construct convergent themes from latent and semantic codes. Thirty-two interviews were completed with 40 owners from 32 households who discussed 35 dogs with osteoarthritis, and 26 veterinary surgeons engaged in four practice-based focus groups.

Owners described identifying a wide range of acute and chronic, typically subtle and intermittent, behavioural and demeanour changes prior to their dogs’ osteoarthritis diagnosis. Few attributed these changes to canine osteoarthritis, and some waited many months before presenting their dog to a veterinary practice. Veterinary surgeons described a consistent ‘typical osteoarthritis’ presentation that they recognised through history taking and clinical examination. Their diagnostic work-up rarely followed that advocated by subject experts for reasons including lack of time and perceptions that it would not change the outcome. Many veterinary surgeons described frustration that some owners did not accept their recommendations to provide analgesia for affected dogs. Short consultation lengths, poor awareness of owner knowledge levels, and lack of recognition of the importance of owners’ prior knowledge, beliefs and assumptions may contribute to these consultations being perceived as challenging by some veterinary surgeons and owners.

This research demonstrates that veterinary surgeons and owners want dogs with clinical signs of osteoarthritis to be happy and comfortable, but that ineffective communication and lack of trust in the consulting room may be a barrier. Our data identifies many new avenues for future research and improved communication strategies that could facilitate earlier identification and treatment of canine osteoarthritis in general practice.

How do veterinary students engage when reflecting on their development towards being veterinary surgeons?

BACKGROUND

Reflection has been widely acknowledged to contribute to professional development, the ability to manage tension and enhanced resilience. However, many practitioners struggle to reflect productively due to a lack of clarity of what constitutes effective reflection.

METHODS

To help develop reflective competence among future professionals, 30 veterinary students' reflective assignments were analysed by thematic text analysis. Theoretical frameworks were based on published criteria for critical and core reflection.

RESULTS

Reflection was described through resources (the tools used), practices (the ways of using these tools) and outcomes (what was achieved). This helped to distinguish simple skills based reflection from higher-level core reflection. Simple skills-based reflection was associated with an identity of expert learner: students perceive that their task is to identify a knowledge deficit that can be easily rectified through new learning. Core reflection was associated with students articulating an identity of adaptable professionals: rather than veterinary challenges being resolved simply through application of a body of knowledge, wider complexities of professional practice are recognised, including a need to resolve tension between their own and other stakeholders' priorities, values and beliefs.

CONCLUSION

Scaffolding an iterative, cyclical reflection process may support outcomes oriented towards resilience and the management of tension.

Best Practice in Supporting Professional Identity Formation: Use of a Professional Reasoning Framework

Professional identity and professionalism education are increasingly important to veterinary education, but many of the concepts remain intangible to veterinary students, and engagement is a persistent challenge. While whole-curriculum integration is recommended for a successful professional studies program, this is complicated by clinical faculty's discomfort with the content. Where professional studies education is centered around professional identity formation, a key element of this is the multi-perspective nature of veterinary work, with the veterinarian negotiating the needs of multiple stakeholders in animal care. Constructing teaching around a framework of professional reasoning, which incorporates the negotiation of different stakeholder needs, ethical decision making, communication, teamwork, and outcome monitoring, offers the potential to make professional identity a concept more visible to students in veterinary work, and guides students in the contextualization of taught material. A framework is presented for veterinary professional reasoning that signposts wider curriculum content and helps illustrate where material such as veterinary business studies, animal welfare, the human-animal bond, and professional responsibility, as well as attributes such as empathy and compassion, all integrate in the decisions and actions of the veterinary professional. The aims of this framework are to support students' engagement in professional studies teaching and help them use workplace learning experiences to construct an appropriate professional identity for competence and resilience in the clinic. For faculty involved in curriculum design and clinical teaching, the framework provides a tool to support the integration of professional identity concepts across the extended curriculum.

'I wish I was someone else': complexities in identity formation and professional wellbeing in veterinary surgeons

BACKGROUND

There is widespread concern surrounding veterinarians' mental health. Upon entering the profession, early career veterinary surgeons encounter colleagues with diverse and conflicting identities, manifesting in their differential prioritisation of definitive clinical treatment, interpersonal interactions or the commercial success of the practice. In other professions, poor wellbeing arises from confusion between these conflicting identity discourses, as new professionals attempt to identify role models aligned with their own identity beliefs. New veterinarians' wellbeing may thus depend on their negotiation of different identities, as they construct their own sets of professional values and determine the type of veterinarian they wish to become.

METHODS

Identity formation was explored narratively using veterinarians' social media stories.

RESULTS

Poor professional wellbeing appeared to arise from identity confusion: failure to consistently commit to either the dominant diagnosis-focused discourse valued by academic role models, or a relational discourse, emphasising working through contextual challenges such as varying client needs. Workplace stress appeared to magnify the dominance of academic priorities in self-identity understanding, worsening identity confusion. Also concerning was the positioning of the client 'as enemy', obstructive to veterinarians' identity goals. Social dialogue, intended to provide support during veterinarian-client conflict, potentially reinforced rejection of the client from the veterinary professional identity, strengthening a context-inappropriate, non-relational identity. This worsened identity confusion between the prized 'diagnostic identity' and the locally valued relational identity and was detrimental to wellbeing.

CONCLUSIONS

Interventions are required, within veterinary education and postgraduate continuing professional development, that encourage reflection on identity and reinforce the value of relational identity attributes.

The influences of curriculum area and student background on mindset to learning in the veterinary curriculum: a pilot study

A student's mindset influences their achievement and response to challenge, with a ‘fixed mindset’ encouraging disengagement from challenging tasks and avoidance of learning and feedback opportunities. These behaviours resemble those reported for professional and non‐clinical curriculum areas, which are important for employability and resilience in veterinary practice. Students with a ‘growth mindset’ to learning are more persistent when faced with challenges and actively seek more demanding tasks. They also demonstrate higher levels of psychological well‐being. The objectives of this study were to explore whether variation in veterinary students’ mindset to learning exists across different curriculum areas, and to identify whether students’ backgrounds influence their learning mindset. The mindsets of veterinary students at a UK veterinary school were measured using an adapted version of the Implicit Theories of Intelligence Scale. The survey was constructed to compare mindset in clinical reasoning, professional reasoning (incorporating ethics and critical thinking), communication skills and reflection. More students demonstrated a growth mindset to communication skills (59%), reflection (84%) and clinical reasoning (83%) than to professional reasoning (34%). There were more students with a fixed mindset to professional reasoning (10%) than in other areas (0–5%). Students’ background (international or non‐traditional university access) did not appear to influence mindset to learning. Disengagement from professional studies curricula may be a consequence of students lacking a growth mindset in professional reasoning. Curriculum interventions that encourage engagement and the development of a growth mindset to learning non‐clinical competences may be beneficial.