An Investigation into the Clinical Reasoning Development of Veterinary Students

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.

The Efficacy of Online Case-Based Assignments in Teaching Veterinary Ophthalmology

Veterinarians are required to use clinical reasoning skills to successfully manage their patients with eye diseases. Case-based assignments can be an effective tool for teaching problem-solving skills. Very few models or online modules exist to deepen the instruction of veterinary ophthalmic clinical reasoning skills. The current study aims to assess the value of online case-based assignments given to students during the Ontario Veterinary College's Phase 4 ophthalmology rotation over a 4-year period. Nine case-based assignments were developed as an online module and provided signalment, history, ophthalmic database, and clinical photography. For each case, students were required to describe the ocular lesions, provide a diagnosis, and develop a short-term and long-term treatment plan. A grading rubric was created, and student feedback was collected using an online survey. A frequency analysis was conducted to evaluate final grades across each case. This analysis was also completed for grades of each question across all cases. A total of 285 students were graded individually. Students' grades were normally distributed across each assignment. Students performed better on lower-order cognitive skills (description of ocular lesions) but poorer on high-order cognitive skills (therapeutic plans). These results suggest that students tend to have difficulty with the analysis and interpretation of these cases. Student feedback reported case-based assignments were useful. Online case-based assignments may be a useful adjunctive teaching tool for students rotating through ophthalmology in their clinical year, and this tool could be considered for other specialized rotations.

Assessing the Impact of a Pilot Nutrition Curriculum on Students' Confidence and Ability to Perform Nutritional Assessments on Overweight Dogs and Cats for Use in a Veterinary Outreach Program

Obesity is a growing concern for dogs and cats. Although veterinary input is critical to prevent and manage obesity, conversations addressing overweight pets are challenging and require training to perform effectively. This study assessed the impact of a nutrition curriculum developed for use in a veterinary outreach program on student confidence and ability to perform nutritional assessments, particularly on overweight pets. The curriculum was developed by students and a Board-Certified Veterinary Nutritionist focusing on (1) performing nutritional assessments and (2) discussing the findings with owners. Initial implementation and evaluation occurred with 32 students. Pre-study and post-study surveys were conducted asking students to rank their confidence in 14 aspects related to nutritional assessments, determine opportunities for change from a case summary, and describe their experience using the materials. Five students in the outreach program performed an additional nutritional assessment and developed a plan for a hypothetical case. Results were analyzed for significance via the likelihood ratios Chi-square and Wilcoxon signed-rank tests. Students showed significant increase in confidence for 11 of the 14 questions and significant improvements at determining opportunities for change (p < .05). Feedback was positive and supported the feasibility of using the materials with the outreach program. Overall, the findings support that the curriculum provides a positive learning experience and prepared veterinary students for performing nutritional assessments and creating management plans for obese pets. This article introduces the curriculum as a successful model for providing access to additional self-paced curricular units to veterinary students.

Qualitative Research in Veterinary Medical Education: Part 1-Principles of Qualitative Design

Qualitative methodologies are relative newcomers to health sciences education research. While they may look very different to their quantitative counterparts in terms of size and scope, when well-applied they offer a fresh perspective and generate valuable research findings. Although qualitative research is being increasingly conducted in veterinary medical education, there are few contextualized resources to assist those who would like to develop their expertise in this area. In this article, we address this by introducing the principles of qualitative research design in a veterinary medical education context. Drawing from a range of contemporary resources, we explore the types of research goals and questions that are amenable to qualitative inquiry and discuss the process of formulating a worthwhile research question. We explain what research paradigms are and introduce readers to some of the methodological options available to them in qualitative research. Examples from veterinary medical education are used to illustrate key points. In a second companion article, we will focus on the decisions that need to be made regarding data sampling, collection, and analysis. We will also consider how qualitative research is evaluated, and discuss how qualitative findings are applied. Taken together, the two articles build an understanding of qualitative research, illuminate its potential to contribute to the scholarship of teaching and learning in veterinary medical education, and equip readers with an improved capacity to appraise its value.

Clinical reasoning in feline vestibular syndrome: which presenting features are the most important?

OBJECTIVES

The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis.

METHODS

In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling.

RESULTS

The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3-250.0; P = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5-344,349,142.0; P = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2-1000; P = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0-45.7; P = 0.047) and wide excursions of the head (95% CI 1.0-45.7; P = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5-50.0; P = 0.015).

CONCLUSIONS AND RELEVANCE

Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.

The Creation of a Collaborative, Case-Based Learning Experience in a Large-Enrollment Classroom

Numerous educational studies have shown that passive learning methods are frequently associated with disappointing learning outcomes, yet many faculty instructors continue to rely on passive didactic lectures. This article describes the creation of an active learning teaching approach-referred to as the collaborative, case-based classroom-that combines three pedagogical strategies: peer-assisted learning, case-based learning, and just-in-time teaching. Data from student surveys of a third-year cardiology elective showed a preference for this teaching approach compared with a case-based lecture. Six major themes emerged from survey analysis: engagement/interactivity, instructional benefit, clinical reasoning, clinical relevance, peer-assisted learning, and timely feedback. Although detailed here in the context of a cardiology elective, the collaborative, case-based classroom is a teaching approach that could be modified to fit a variety of other teaching environments.

Use of Inductive, Problem-Based Clinical Reasoning Enhances Diagnostic Accuracy in Final-Year Veterinary Students

Despite tremendous progression in the medical field, levels of diagnostic error remain unacceptably high. Cognitive failures in clinical reasoning are believed to be the major contributor to diagnostic error. There is evidence in the literature that teaching problem-based, inductive reasoning has the potential to improve clinical reasoning skills. In this study, 47 final-year veterinary medicine students at the Royal Veterinary College (RVC) were presented with a complex small animal medicine case. The participants were divided into two groups, one of which received a prioritized problem list in addition to the history, physical exam, and diagnostic test results provided to both groups. The students' written approaches to the case were then analyzed and assigned a diagnostic accuracy score (DAS) and an inductive reasoning score (IRS). The IRS was based on a series of predetermined characteristics consistent with the inductive reasoning framework taught at the RVC. No significant difference was found between the DAS scores of each group, indicating that the provision of a prioritized problem list did not impact diagnostic accuracy. However, a significant positive correlation between the IRS and DAS was illustrated for both groups of students, suggesting increased use of inductive reasoning is associated with increased diagnostic accuracy. These results contribute to a body of research proposing that inductive, problem-based reasoning teaching delivered in an additive model, can enhance the clinical reasoning skills of students and reduce diagnostic error.

The Use of Contextualized Standardized Client Simulation to Develop Clinical Reasoning in Final-Year Veterinary Students

Clinical reasoning is an important skill for veterinary students to develop before graduation. Simulation has been studied in medical education as a method for developing clinical reasoning in students, but evidence supporting it is limited. This study involved the creation of a contextualized, standardized client simulation session that aimed to improve the clinical reasoning ability and confidence of final-year veterinary students. Sixty-eight participants completed three simulated primary-care consultations, with the client played by an actor and the pet by a healthy animal. Survey data showed that all participants felt that the session improved their clinical decision-making ability. Quantitative clinical reasoning self-assessment, performed using a validated rubric, triangulated this finding, showing an improvement in students' perception of several components of their clinical reasoning skill level from before the simulation to after it. Blinded researcher analysis of the consultation video recordings found that students showed a significant increase in ability on the history-taking and making-sense-of-data (including formation of a differential diagnosis) components of the assessment rubric. Thirty students took part in focus groups investigating their experience with the simulation. Two themes arose from thematic analysis of these data: variety of reasoning methods and "It's a different way of thinking." The latter highlights differences between the decision making students practice during their time in education and the decision making they will use once they are in practice. Our findings suggest that simulation can be used to develop clinical reasoning in veterinary students, and they demonstrate the need for further research in this area.

Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students.

Use of Short Animal-Themed Videos to Enhance Veterinary Students' Mood, Attention, and Understanding of Pharmacology Lectures

Professional DVM training is inherently stressful and challenging for students. This study evaluated a simple intervention-short breaks during a veterinary pharmacology lecture course in the form of funny/cute animal videos (Mood Induction Procedures, or MIP)-to assess for potential impact on students' mood, interest in material, and perceived understanding of material. Ten YouTube video clips showing cats or dogs were selected to influence students' affective states. The videos were shown in a required pharmacology class offered during the fall semester of the second year of the DVM program at a large, land-grant institution in the western US. The student cohort consisted of 133 students (20 males, 113 females). Twenty days of the course were randomly chosen for the study and ranged from weeks 2 to 13 of the semester. Sessions in which the videos were played were alternated with sessions in which no video was played, for a total of 10 video days and 10 control days. There were significant differences in all three post-class assessment measures between the experimental (video) days and the control days. Results suggest that showing short cute animal videos in the middle of class positively affected students' mood, interest in material, and self-reported understanding of material. While the results of this study are limited to one student cohort at one institution, the ease of implementation of the technique and relatively low stakes support incorporation of the MIP technique across a variety of basic and clinical science courses.