Applicability of the Calgary-Cambridge Guide to Dog and Cat Owners for Teaching Veterinary Clinical Communications

Challenges of the Calgary-Cambridge Consultation Guide in Veterinary Multicultural and Multilingual Scenarios and the Role of Veterinary Translators

The Calgary-Cambridge Guide is a widely recognised framework for teaching communication skills to healthcare professionals that has become a cornerstone of communication training programs in medicine and other healthcare fields. In the context of veterinary medicine, its integration into communication training programs has become an asset improving communication, education, interaction, and quality of service, enhancing the veterinary-client-patient relationship (VCPR). In veterinary medicine, however, a more challenging consultation dynamic involves the veterinarian, the owner, and the animal. The addition of a veterinary assistant that acts as an interpreter or translator is common in Hong Kong where the native language (Cantonese) coexists with English when consultations are led by non-native language speakers. This addition converts this commonly dyadic model into a triadic communication model. The addition of an assistant interpreter influences the way consultations are conducted, how information is conveyed, and how interpersonal cues and empathy are delivered. In this report we depict challenges applying the Calgary-Cambridge Guide in multicultural and multilingual veterinary medical centres in Hong Kong and highlight the role of veterinary supporting staff in these scenarios, specifically veterinary assistant interpreters.

Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care

AIM

This is the first part of a two-part series on spectrum of care that encourages practitioners to embrace a non-binary approach to healthcare delivery. When care is not framed as all-or-none, either/or or best versus lesser, the provider and client can agree to diagnostic and/or treatment plans that individualize the practice of veterinary medicine. Care is tailored to the patient along a continuum of acceptable options. Care may also be intentionally incremental, with plans to reassess the patient and revise case management as needed.

RELEVANCE

Acknowledgment and ultimately acceptance that patient care journeys can be distinct, yet equitably appropriate, offers providers the flexibility to adapt case management competently and confidently to the patient based upon contextualized circumstances including client needs, wants and expectations for healthcare outcomes. Thinking outside the box to recast the historic gold standard with a continuum of care strategically offers feline practitioners a means by which they can overcome barriers to healthcare delivery.

SERIES OUTLINE

This first article introduces spectrum of care as an appropriate approach to case management and broadens its definition beyond cost of care. Part II explores communication strategies that enhance veterinary professionals' delivery of spectrum of care through open exchange of relationship-centered dialogue.

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.

2023 AAFP/IAAHPC feline hospice and palliative care guidelines

The '2023 AAFP/IAAHPC Feline Hospice and Palliative Care Guidelines' are authored by a Task Force of experts in feline hospice and palliative care convened by the American Association of Feline Practitioners and the International Association for Animal Hospice and Palliative Care. They emphasize the specialized communication skills and ethical considerations that are associated with feline hospice and palliative care, with references to other feline practice guidelines for a more complete discussion of specific diseases, feline pain management best practices and cat friendly interactions. A comprehensive, multi-step hospice consultation allows for tailoring the approach to both the cat and the family involved in the care. The consultation includes establishing 'budgets of care', a concept that greatly influences what can be done for the individual cat. The Guidelines acknowledge that each cat and caregiver will be different in this regard; and establishing what is reasonable, practical and ethical for the individual cat and caregiver is important. A further concept of the 'care unit' is introduced, which is extrapolated from human hospice and palliative care, and encourages and empowers the caregiver to become a part of the cat's care every step of the way. Ethical considerations include a decision-making framework. The importance of comfort care is emphasized, and the latest information available about how to assess the quality of a cat's life is reviewed. Emotional health is as equally important as physical health. Hence, it is fundamental to recognize that compromised physical health, with pain and/or illness, impairs emotional health. A limited discussion on euthanasia is included, referring to the AAFP's End of Life Educational Toolkit for recommendations to help the caregiver and the veterinary professional ensure a peaceful passing and transition - one that reflects the best interests of the individual cat and caregiver.

Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care

The American Veterinary Medical Association Council on Education mandates in standard 11 that all accredited colleges of veterinary medicine must develop and deliver formal processes by which students are observed and assessed in nine competencies. The eighth competency combines clinical communication and sensitivity toward soliciting and understanding individual narratives across a diverse clientele to facilitate health care delivery. Several frameworks have been designed to structure health care consultations for teaching and coaching purposes. The Calgary-Cambridge guide (CCG) provides an evidence-based approach to outlining the flow of consultations, incorporating foundational communication skills and elements of relationship-centered care into a series of sequential tasks. Although the CCG was intended for use as a flexible tool kit, it lacks visible connections between concrete experiences (e.g., the consultation) and reflective observation (e.g., the feedback). This teaching tip describes the development of a novel anatomical representation of the consultation that integrates process elements of the CCG with other core curricular concepts. By combining knowledge, technical skills, critical thinking, reflection, cultural humility, and self-awareness into a skeletal consultation model, linkages are established between communication and intergroup dialogue skills, diversity and inclusion (D&I). This model has been further adapted as feline, caprine, porcine, equine, avian, and reptilian versions for in-class use as strategic visual aids that highlight key areas of focus for Professional Skills class sessions. Future developments by the authors will explore how to link species-specific consultation models to assessment rubrics to reinforce the connection between content (what) and process (how).

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.

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.

Survey of communication challenges that impact relationships between veterinarians and dog or cat breeders and proposed solutions for retaining breeders as clients

OBJECTIVE

To characterize communication challenges between veterinarians and dog or cat breeders and elicit their perspectives on how professional relationships between the two might be improved.

SAMPLE

793 dog breeders, 540 cat breeders, and 514 veterinarians.

PROCEDURES

Veterinarians, cat breeders, and dog breeders were recruited through social media and electronic newsletters from breed registries to complete online surveys about their professional interactions with one another and proposed strategies for improving dialogue. Data used for the study were gathered as categorical or free-text responses.

RESULTS

Dog breeders commented that an apparent lack of training in theriogenology among veterinarians was a primary concern. Both dog breeders and cat breeders felt sidelined from patient care when veterinarians were dismissive, made assumptions about their character or motivation for breeding, or expressed disapproval of mating companion animals for profit. Breeders also wanted veterinarians to learn more about reproductive health and disease. Veterinarians expressed disinterest in working with breeders who seemed arrogant, argumentative, or inflexible. Financial constraints and breeders' apparent tendencies to trust anecdotal reports over evidence-based medicine contributed to veterinarians' biases about breeders and presented additional challenges. Each group proposed that communication challenges could be overcome through mutual engagement in active listening, eliciting perspective, assessing knowledge, offering partnership, and withholding judgment.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that veterinarians and dog and cat breeders are more alike than dissimilar in terms of communication preferences that facilitate a positive veterinarian-breeder relationship. Understanding how to improve interactions is an important step toward dialogue that facilitates patient care.

First Experimental Study in Turkey Teaches Veterinary Students How to Break Bad News

The importance of communication skills in veterinary medicine has been increasing for a long time. The aim of this article is to investigate how theoretical training, role-playing, and standardized/simulated client (SC) methods improve senior (fifth-year) veterinary students' skills in breaking bad news. The study was carried out with 67 volunteer senior students. The research was designed from a pre-test and post-test control group pattern. All students encountered the SC. After pre-tests, theoretical training was given to Experimental Group A (EGA) and Experimental Group B (EGB). Then, only the students in EGA role-played together. Each student completed a checklist consisting of 10 basic items after pre-tests and post-tests. After post-tests, focus group interviews with open-ended questions were conducted. In the pairwise comparisons, EGA's and EGB's adjusted post-test mean scores were significantly higher than the control group's (p < .001). EGA's and EGB's post-test scores were found to be significantly higher than their pre-test scores. Women's empathy and eye contact scores were found to be statistically higher than men's scores. This study is the first of its kind in Turkey to use SCs and peer-to-peer learning with role-play simulations in training students about breaking bad news in veterinary medicine. These findings show that theoretical training and role-playing has an impact on senior veterinary students' skills in breaking bad news.

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.

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).

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.

Assessing Communications Competencies through Reviews of Client Interactions and Comprehensive Rotation Assessment: A Comparison of Methods

The primary purpose of this study was to compare two methods for assessing student communication skills: a labor-intensive review of video-recorded interactions and global communications assessment using a comprehensive rotation-assessment tool. Secondary goals of the study were to evaluate student strengths and weaknesses to inform the pre-clinical communications curriculum and to evaluate for consistency between types of reviewers. Video recordings of 43 student encounters with clients presenting their animals for wellness or diagnostic appointments to the primary care service at a veterinary teaching hospital were reviewed by one of three primary care clinicians, a social worker, and a clinical communications instructor, using a common rubric. Scores using the rubric were compared with overall scores for verbal communications on a comprehensive rotation-assessment tool, both for the primary care rotation and for other small-animal rotations. Duration did not vary significantly between wellness and diagnostic appointments, or between dog and cat appointments. Scores achieved by students on video review varied by evaluator, with the clinical communications instructor scoring students the lowest and the social worker scoring students the highest. Strengths identified included greeting the client appropriately, gathering initial information about the reason for the visit, and using lay terminology appropriately. Weaknesses included summarizing information for the client, talking to clients about money, and making strong recommendations.