Educational Research Report: Changes in Students' Levels of Empathy during the Didactic Portion of a Veterinary Program

Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study

BACKGROUND

The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences.

METHODS

A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests.

RESULTS

'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher).

LIMITATIONS

Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution.

CONCLUSION

There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Predictors of Psychological Well-Being among Veterinary Medical Students

This study evaluated associations between healthy activities of daily living, common stressors, and psychological well-being among 230 veterinary medical students at Kansas State University. Participants completed the Psychological Wellbeing Scale during the fall semester of 2019. Additionally, students provided information about specific stressors, healthy activities of daily living, and relevant demographic information. Similar to previous studies, participants in this study reported being concerns about heavy workloads, being behind in studies, inefficient study, and academic performance. On average, the students in this study ate fewer than three meals per day, slept less than 7 hours per night, exercised only twice per week, and spent an average of 83 minutes per day on social media platforms. A higher number of daily meals, more days of exercise, and more frequent contact with one's support system, particularly significant others and family members, predicted students' increased psychological well-being. In contrast, lower psychological well-being scores were associated with comparing oneself to others and financial distress. This study identifies potential activities that students can engage in to improve psychological well-being. The discussion section provides specific suggestions for intervention.

One Health clinic promotes veterinarian-client trust among underserved pet owners and provides learning opportunities for veterinary students

OBJECTIVE

To determine the impact of a free One Health clinic with human and veterinary services on the veterinary-client relationship for underserved pet owners. A secondary aim was to understand the experience of veterinary students and volunteers who participated in the clinic.

SAMPLE

78 pet owners, 55 students and 32 volunteers who attended the Delaware Humane Association One Health Clinic between December 2018 and November 2019.

PROCEDURES

Pet owners completed an anonymous questionnaire prior to and following their veterinary appointment regarding their trust in the veterinary profession, feelings of enablement and veterinarian-client concordance. Students and volunteers completed a questionnaire within 72 hours of clinic participation about their perceptions of the educational value of the clinic.

RESULTS

Following the One Health clinic, client trust in the veterinary profession increased significantly (t = -5.50, P < 0.001). Clients also reported high levels of enablement and veterinarian-client concordance. Students and volunteers agreed the clinic was a valuable educational experience (97.7%) and reported increased compassion, enhanced leadership, communication and teamwork skills, and an improved ability to identify social issues and think critically.

CLINICAL RELEVANCE

The results support the utilization of One Health clinics to improve access to veterinary care for underserved pet owners. Clients reported high levels of trust, enablement and concordance following the clinic which could have long-lasting effects on their willingness to seek veterinary care and comply with veterinarians' recommendations. The positive experiences of students and volunteers also highlights the potential of low-cost veterinary clinics as unique educational experiences.

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.

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.

Analysis of Turkish Veterinary Students' Self-perception of Communication Competencies Based on Gender Differences

Communication skills are teachable and learnable skills, which have a vital position among other clinical skills because a student's ability to communicate can increase empathy. The focus of this article is to determine how senior students evaluate themselves regarding communication competence and whether gender has an impact on their perception. The study included 128 volunteering students, using the Communication Competence Scale, consisting of 30 questions, as a data collection tool and the independent samples t-test for statistical evaluations. The evaluation of all participants showed that male participants had the highest score, and female participants had the lowest. However, there was no statistically significant difference between female and male participants' total scores (p = 0.605). There was a statistically significant difference between female and male students in terms of the social competency, empathy, and adaptability. Female scores for empathy were statistically higher than those of males. Male students scored themselves higher than females in terms of social competency and adaptability. In the context of the students' perceptions of their communication competence, it was determined that females assessed themselves to be more empathetic and males perceived themselves to be more social and adaptable. This research is significant as it is the first study of Turkish veterinary students' self-perception of communication competence. Communication training may become more robust in veterinary curricula in Turkey, and further research will be affected by this issue.

Türk Veteriner Fakültesi Öğrencilerinin İletişim Yeterlikleri Algısının Cinsiyet Farklılıklarına Göre Analizi

İletişim becerileri, bir öğrencinin iletişim kurma yeteneği ile empati becerisini arttırabilmesi nedeniyle diğer klinik beceriler arasında önemli bir yere sahip olan öğretilebilir ve öğrenilebilir becerilerdir. Bu çalışmanın amacı, veteriner fakültesi son sınıf öğrencilerinin iletişim konusunda kendilerini nasıl değerlendirdiklerini ve cinsiyetin bu algı üzerinde bir etkisi olup olmadığını belirlemektir. Çalışma 128 gönüllü öğrenci ile 30 sorudan oluşan İletişim Yeterlilik Ölçeği kullanılarak gerçekleştirilmiş, bağımsız örneklemlerde t-testi ile istatistiksel değerlendirme yapılmıştır. Yapılan değerlendirmeye göre, tüm katılımcılar arasında erkeklerin en yüksek puanı, kadınlar en düşük puanı aldığı görülmüştür. Ancak kadın ve erkeklerin toplam puanları arasında istatistiksel olarak anlamlı fark bulunamamıştır (p=0.605). Kadın ve erkekler arasında sosyal yeterlilik, empati yeterliği ve uyum yeterliği açısından anlamlı fark bulunmuştur. Kadınlar empati yeterliğinde, erkekler ise sosyal yeterlilik ve uyum yeterliğinde daha yüksek puan almıştır. İletişim yeterlikleri algısı bakımından kadınlar kendilerini daha empatik, erkekler ise daha sosyal ve uyumlu bulmuştur. Bu çalışma Türk veteriner fakültesi öğrencilerinin iletişim yeterlikleri konusunda öz algılarını yansıtan ilk çalışma olması bakımından önemlidir. İletişim becerileri eğitimi Türkiye’de veteriner fakülteleri müfredatında daha güçlü hale gelecek ve bu konu ileri araştırmaların yapılmasını teşvik edecektir.

Evaluation of team effectiveness and personal empathy for associations with professional quality of life and job satisfaction in companion animal practice personnel

OBJECTIVE

To examine variables of veterinary team effectiveness and personal empathy for associations with professional quality of life (ie, compassion satisfaction, burnout, and secondary traumatic stress) and job satisfaction in companion animal practice personnel.

DESIGN

Cross-sectional survey.

SAMPLE

Data from 232 surveys completed by personnel from 10 companion animal veterinary practices in 2 regions of the United States between April 7 and December 20, 2016.

PROCEDURES

Online surveys were used to collect practice-level data (eg, practice type, setting, and staffing) and individual-level data (eg, demographics, job position, and years in the position and profession). Instruments used in developing the surveys included the Team Effectiveness Instrument, Davis Interpersonal Reactivity Index, Professional Quality of Life Scale, and a measure for job satisfaction. Data were evaluated for associations with professional quality of life and job satisfaction.

RESULTS

Individual engagement was positively associated with job satisfaction, negatively associated with secondary traumatic stress, and moderated by levels of personal distress for compassion satisfaction and burnout. Toxic team environment was positively associated with burnout and negatively associated with job satisfaction. Empathetic concern and personal distress were both positively associated with secondary traumatic stress. Empathetic concern was moderated by team engagement for compassion satisfaction.

CONCLUSIONS AND CLINCAL RELEVANCE

Results indicated that variables influencing professional quality of life and job satisfaction were multimodal and included aspects of team effectiveness and empathy; therefore, workplace strategies that enhance individual and team engagement and mitigate toxic team environments could potentially improve professional quality of life and job satisfaction in veterinary personnel.

Development and Validation of a Novel Measure for the Direct Assessment of Empathy in Veterinary Students

Empathy is a requisite clinical skill for health professionals and empathy scores have been positively associated with professionalism, clinical competency, confidence, well-being, and emotional intelligence. In order to improve empathy in the veterinary field, it is critical to measure the construct of empathy accurately. Most research has relied on self-reporting measures to assess empathy, while some studies have recently implemented the use of simulated client encounters in veterinary education. Building on this research, the aim of the current study was to develop and validate a novel quantitative assessment tool-the Empathy Clinical Evaluation Exercise (ECEX)-designed to measure empathy based on directly observable behaviors, using simulated clients. To evaluate empathy, evaluators used the ECEX to assess the performance of student clinicians in a simulated client encounter, which contained a pre-determined number of opportunities designed to elicit empathic responses from student clinicians. Statistical analysis suggests the test has a high degree of inter-rater reliability. In addition, there was moderate correlation between average empathy scores using ECEX and previously validated measures of empathy, compassion satisfaction, and burnout. Using these methods, we found the majority of students we studied had increased empathy scores at the completion of their primary care rotations. These results provide preliminary support for the use of the ECEX as a direct and quantitative tool for the assessment of empathy. Health professionals could use this novel empathy assessment tool to teach students, evaluate teaching strategies, and improve communication competencies in a wide variety of clinical settings. Our broad aim was to examine the utility of a direct and quantitative assessment tool for measuring empathy-the ECEX-in order to answer the following questions: (1) Does the tool have good inter-rater reliability? (2) Does the tool correlate with previously validated empathy measures? and (3) Does the tool correlate with similar constructs of compassion fatigue and burnout? Our secondary aim was to evaluate the change in empathy scores over the course of a 4-month (16-week) primary care rotation (pre- to -post).

Cross-Sectional Assessment of the Emotional Intelligence of Fourth-Year Veterinary Students and Veterinary House Officers in a Teaching Hospital

Emotional intelligence (EI) is the recognition and management of emotions. This skill set is important to work relationships and professional success. In this cross-sectional, observational study, we investigated EI scores of 4th-year veterinary students, interns, and residents in a teaching hospital, using a psychometric tool with professional population norms. Participants' EI scores were compared with professional norms and between the sample groups. Scores were examined on the basis of demographics and residency program type. Twenty-four 4th-year students and 43 interns and residents completed the survey. Total, composite, and subscale scores for all groups were lower than professional means. We noted no statistically significant differences in EI scores between training levels, but evaluation of effect sizes showed a medium negative effect of higher training levels on Self-Perception Composite, Self-Regard, Emotional Expression, Interpersonal Composite, Flexibility, and Optimism and a medium positive effect of higher training levels on Impulse Control. Medium effects for residency type were found for Stress Tolerance, Flexibility, and Stress Management, with higher scores for residencies with heavy inpatient loads. Medium effects for residency type were found on Flexibility scores, with higher scores for residents in disciplines with a perceived high stress level. We found that baseline EI scores of 4th-year veterinary students, interns, and residents at a teaching hospital were similar to, but uniformly lower than, those of other professionals and did not increase with training level. These results may be used to build on strengths and address weaknesses associated with EI of students and house officers at this institution.

Cognitive Dissonance in Laboratory Animal Medicine and Implications for Animal Welfare

People experience cognitive dissonance when they entertain 2 conflicting ideas at the same time. Cognitive dissonance may cause a negative emotional state, which can lead to engagement of compensation mechanisms to resolve the conflict. Here we describe a survey that explores cognitive dissonance in laboratory animal veterinarians and veterinary technicians and various ways in which veterinary staff manage dissonance associated with research animal use. Respondents-164 veterinarians and 145 veterinary technicians-were asked to rate their opinions of various statements on a sliding scale of 'strongly disagree' to 'strongly agree' or 'never' to 'always.' Statements assessed negative emotions (discomfort, powerlessness, frustration) and compensation mechanisms (devaluing, emotional distancing, shifting responsibility) as bases for inferring effects on welfare states of animals. Responses were evaluated overall and were compared according to level of training (veterinarian compared with veterinary technician), years of work experience (0 to 5, 6 to 10, greater than 10), and species tended (large, mixed, small species). Respondents strongly agreed that animal wellbeing and animal use in research were important. Respondents reported feelings of discomfort, powerlessness, and frustration associated with work. In addition, respondents reported feeling empowered to initiate changes affecting animal welfare. The most frequent compensation mechanism noted was shifting responsibility onto the IACUC and institutional rules. Devaluing the animals was another reported compensation mechanism. Responses to emotional distancing statements were divided. Survey responses supported the existence of cognitive dissonance associated with laboratory animal medicine. Potential negative and positive effects on animal welfare are discussed.

Using a Standardized Client Encounter in the Veterinary Curriculum to Practice Veterinarian-Employer Discussions about Animal Cruelty Reporting

Animal cruelty is the antithesis of animal welfare. Because veterinarians take an oath to protect animal welfare, they are professionally obligated to report animal cruelty. Several US states have mandatory reporting laws for veterinarians, and both the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association support reporting. Some state veterinary practice acts, such as Arizona's, also require reporting. Despite this, animal cruelty is not always emphasized in veterinary curricula. As a result, not all veterinary students and graduates feel comfortable recognizing signs of animal cruelty and may not be aware of the resources that are available to them when considering reporting. AVMA suggests that practices develop their own protocols for identifying signs that patients may have been victims of cruelty and consulting on cases with senior colleagues with regard to when to report. To enhance student comfort with these conversations, Midwestern University College of Veterinary Medicine developed a standardized client encounter titled "Grizabella's Final Fight." I hope that other colleges of veterinary medicine will adapt this teaching tool to allow students the opportunity to practice discussions surrounding animal cruelty reporting in the context of state-specific legislation that guides their code of professional conduct.

The Healer's Art (HART): Veterinary Students Connecting with Self, Peers, and the Profession

This case study sought to understand veterinary students' perceptions and experiences of the Healer's Art (HART) elective to support well-being and resilience. Students' "mindful attention" was assessed using the MAAS-State scale. Course evaluations and written materials for course exercises (artifacts) across the 2012-2015 cohorts of Colorado State University's HART veterinary students (n=99) were analyzed for themes using a grounded theory approach, followed by thematic comparison with analyses of HART medical student participants. HART veterinary students described identity/self-expression and spontaneity/freedom as being unwelcome in the veterinary curriculum, whereas HART medical students described spirituality as unwelcome. HART veterinary students identified issues of "competition" and "having no time," which were at odds with their descriptions of not competing and having the time to connect with self and peers within their HART small groups. HART veterinary students shared that the course practices of nonjudgment, generous listening, and presence (i.e., mindfulness practices) helped them build relationships with peers. Although not statistically significant, MAAS pre-/post-scores trended in the positive direction. HART provides opportunities for students to connect with self and foster bonds with peers and the profession, factors that are positively associated with resilience and wellness.

Vocation, Belongingness, and Balance: A Qualitative Study of Veterinary Student Well-Being

An elevated risk for suicide among veterinarians has stimulated research into the mental health of the veterinary profession, and more recently attention has turned to the veterinary student population. This qualitative study sought to explore UK veterinary students' perceptions and experiences of university life, and to consider how these may affect well-being. Semi-structured interviews were conducted with 18 students from a single UK school who were purposively selected to include perspectives from male, female, graduate-entry, standard-entry (straight from high school), and widening participation students across all 5 years of the program. Three main themes were identified: a deep-rooted vocation, navigating belongingness, and finding balance. Participants described a long-standing goal of becoming a veterinarian, with a determination reflected by often circuitous routes to veterinary school and little or no consideration of alternatives. Although some had been motivated by a love of animals, others were intrinsically interested in the scientific and problem-solving challenges of veterinary medicine. Most expressed strong feelings of empathy with animal owners. The issue of belongingness was central to participants' experiences, with accounts reflecting their efforts to negotiate a sense of belongingness both in student and professional communities. Participants also frequently expressed a degree of acceptance of poor balance between work and relaxation, with indications of a belief that this imbalance could be rectified later. This study helps highlight future avenues for research and supports initiatives aiming to nurture a sense of collegiality among veterinary students as they progress through training and into the profession.

Study of the Levels of Human-Human and Human-Animal Empathy in Veterinary Medical Students from Chile

Social relationships are based on our ability to put ourselves in the place of others, and from there to react appropriately and logically. This empathic ability can be extended to other species, based on the human ability to develop techniques to understand and communicate with animals. In education, the benefits of training professionals with ethical and empathic tools are known. Gender, diet, past experiences, and other factors can modify a person's levels of empathy toward humans and animals, and a relationship exists between both types of empathy. The aims of this study were to investigate some determinants of the level of empathy and to gain insight into the possible correlation between human-animal and human-human empathy. For this, the Animal Empathy Scale and the Interpersonal Reactivity Index by Davis were applied through an electronic survey system to freshmen and final-year students (n=452) from five schools of veterinary medicine in Chile. The correlation between the empathy scores of both instruments and their association with individual factors were studied using Spearman's correlation, the Wilcoxon signed-rank test, and the Kruskal-Wallis test. The results suggest that both instruments correlate significantly, and that gender, year of study, diet, and area of interest have a significant association with the score for empathy toward animals. This research shows that individual characteristics and changes that occur during veterinary training can affect students' attitudes toward animals.

A Decade of Counseling Services in One College of Veterinary Medicine: Veterinary Medical Students' Psychological Distress and Help-Seeking Trends

Much has been discussed about the high prevalence of psychological distress among veterinary medical students. Studies investigating general samples of veterinary medical students indicate that, on average, depression and anxiety symptoms are present at higher rates than in comparison samples. However, little is known about veterinary medical students who seek counseling. This study intends to expand the literature on veterinary student well-being, as the first to examine a sample of veterinary medical students seeking counseling services. It offers an overview of student distress and help-seeking trends from a decade of counseling services provided in one College of Veterinary Medicine (CVM) in the US. The sample includes data from 279 participants. Results indicate a steady increase in students seeking counseling over the last decade. First-year students sought services at higher rates but second-year students experienced the greatest distress when compared to other cohorts. Students seeking counseling services experienced levels of overall distress, symptoms of anxiety and depression, and social role concerns that were, on average, above cut-off scores. Physical health was significantly associated with student distress, suggesting opportunities for intervention.

Veterinary Students' Perspectives on Resilience and Resilience-Building Strategies

In recent years, resilience has been lauded as a valuable, even necessary, facet of an effective veterinary practitioner. This study describes a mixed-methods research exploration of the impact of a self-care and mental well-being teaching intervention on the self-reported resilience of 105 first-year veterinary students enrolled at the School of Veterinary Medicine, University of Surrey, UK. Quantitative data were obtained through a questionnaire, the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), which students completed before and after the teaching intervention. The median total score on the scale increased from 27 (IQR=25-30) to 29 (IQR=26-32) (p<.001), a medium effect size (r=-0.28). Student focus groups were held to allow qualitative data analysis of the students' perspectives on the teaching intervention and on the topic of resilience in general. The results of this study suggest that appropriate training in resilience-building strategies can help veterinary students build greater awareness of resilience, and potentially support their development of a more resilient approach in their personal and professional lives. In this study, veterinary students felt that resilience training was a valuable addition to the veterinary curriculum, and that resilience likely plays an important role in achieving a successful veterinary career. The study also suggested that veterinary students utilize a variety of different resilience-building strategies, including drawing on past experiences, seeking help from support networks, and developing an ability to change their perspectives.

Changes in Affective and Cognitive Empathy among Veterinary Practitioners

Clinical empathy is a multi-dimensional concept characterized by four dimensions: (1) affective-the ability to experience patients' or clients' emotions and perspectives, (2) moral-the internal motivation to empathize, (3) cognitive-the intellectual ability to identify and comprehend others' perspective and emotions, and (4) behavioral-the ability to convey understanding of those emotions and perspectives back to the patient or client. The Davis Interpersonal Reactivity Index (IRI) was used to examine the affective and cognitive facets of empathy in veterinary practitioners. The IRI consists of four subscales that measure cognitive (perspective taking and fantasy) and affective (emphatic concern and personal distress) components of empathy. Data from a cross-sectional sample of practicing veterinarians (n=434) were collected. Veterinarians' fantasy scores were lowest for those with the most clinical experience. Personal distress scores were highest among new veterinarians and lowest for those with 26 or more years in practice. High levels of personal distress in the early years of practice are concerning for the professional wellness of veterinarians. To combat this trend, the implementation of resilience-building interventions should be considered to support veterinary practitioners.