A Novel Model for Teaching Primary Care in a Community Practice Setting: Tufts at Tech Community Veterinary Clinic

A Survey of Veterinary Student and Veterinarian Perceptions of Shelter Medicine Employment

Shelter medicine appears to be popular among prospective veterinarians, but there is a shortage of veterinarians entering the field to fill available positions. The reasons for this discordance are not well understand. This study describes veterinary students' interest in shelter medicine, their perceptions of common duties, and their perceptions of employment attributes in shelter medicine, compared with those of current veterinarians. The sample included 146 first-year students, 155 final-year students, and 221 veterinarians who self-completed an online survey between September 2020 and March 2021. We found high levels of interest in shelter medicine, with 40% of first- and 43% of final-year students indicating they were likely to consider working in shelter medicine. Outreach clinics (84% of first-year students, 86% of final-year students), access-to-care clinics (82%, 83%), and loan forgiveness programs (75%, 64%) encouraged many veterinary students to consider working in shelter medicine. The risk of compassion fatigue, burnout, and stress (70%, 68%); weekend work (51%, 59%); euthanasia decision making (49%, 47%); euthanasia (43%, 41%); and expected salaries of shelter veterinarians (39%, 37%) acted as deterrents. Kruskal-Wallis H tests revealed students reported more positive ratings than veterinarians for most shelter medicine duties and employment characteristics, with moderate to strong consensus within groups. Little difference appeared between first- and final-year students. This study highlights target areas for animal shelters to boost recruitment of newly graduated veterinarians. Increasing veterinary students' exposure to shelter medicine throughout their veterinary training may also help address their concerns regarding euthanasia, salary, and quality of care.

Student Veterinarian Perceptions of Community-Based Primary Care Veterinary Clinics in Indigenous Communities in Southern Ontario, Canada

Community-based primary care veterinary clinics represent an opportunity to benefit multiple populations. Student veterinarians are afforded the opportunity to build technical and non-technical professional skills, while underserved communities are provided with access to companion animal care. The Ontario Veterinary College (OVC), as with many other veterinary colleges across Canada and the United States, has hosted community-based primary care veterinary clinics, including in local Indigenous communities. As these clinics continue and grow, it is critical to evaluate their operation to ensure that they align with community goals and values, adequately support student learning, and do not perpetuate racism and implicit bias. The objective of this study was to explore the perceptions of student veterinarians who had volunteered at community-based primary care veterinary clinics in First Nations communities in southern Ontario, Canada. We used an online survey that consisted of multiple choice and short answer questions focused on motivating factors for involvement, supports available before and during the clinics, exposure to Indigenous cultures, and the challenges and rewards associated with volunteering. Forty-one student veterinarians from OVC completed the survey in January 2020. Most students were motivated to volunteer to make a positive difference in the lives of people and animals and improve their clinical skills. In general, respondents felt adequately prepared for and supported during their experiences but did recommend additional pre-departure instructions on roles and responsibilities. Participants were ambivalent as to whether they had learned about Indigenous culture, with several strongly recommending more cultural sensitivity training. Most students found their experiences rewarding because of the gratitude expressed by clients and the feeling that they had made a difference. We reflect on the potential benefits and challenges of community-based primary care veterinary clinics in light of student responses.

Outreach Medicine as an Experiential Teaching Tool to Improve Veterinary Student and Client Education

Outreach medicine is used to improve students' medical, technical, behavioral, and communication training among health professional schools; it is also used in veterinary schools, but little has been described on its educational impacts among pre-clinical veterinary students. Aiming to train practice-ready graduates, we established a monthly nonprofit vaccine clinic serving low-income clients to provide pre-clinical veterinary students with a realistic experiential learning environment. We developed surveys to assess the educational impacts of outreach medicine on pre-clinical veterinary student and client education. We received 101 student surveys, 26 educator (i.e., veterinarians and registered veterinary technicians) surveys, and 96 client surveys. Veterinarians, students, and technicians reported that students improved in important veterinary skills such as client communication, subcutaneous injection, patient handling, and physical examination. They also reported improved confidence in students' clinical decision making. Veterinarians valued the vaccine clinic as a favorable educational tool to teach behavior assessment and low-stress handling, and they highlighted that experiential learning via the vaccine clinic provided students with a clinical experience representative of most veterinarian practices (i.e., small animal general practitioner). Clients reported that the clinic's students and veterinarians greatly improved their knowledge of their pets' care and vaccines-notably, their knowledge of rabies and leptospirosis improved. Outreach medicine in the form of a vaccine clinic creates valuable experiential learning opportunities that increase veterinary student preparedness and complement didactic, laboratory, and case-based teaching.

Veterinary medical student perceptions of companion animal primary care as a career choice over an academic year

Despite companion animal primary care being the most common career choice for veterinarians, relatively little is known about students' perception of this career choice. In this study, the authors examined students' (233 at Time 1 and 119 at Time 2) perceptions of careers in companion animal primary care and whether perceptions changed over the course of an academic year or differed by year in veterinary school. The study was conducted by an online questionnaire sent to the student email listserv and the results analyzed by Mixed ANOVAs for each perception outcome. The study concluded that a majority of veterinary students have companion animal primary care as their preferred career choice and have a positive perception of it as a career choice. This positive perception increased over the course of an academic year, but did not differ significantly by year in school. First year students had a decrease in perception of level of training over time. This study sets a baseline for students' perceptions of companion animal primary care as a career choice at one college of veterinary medicine.

Barriers to Accessing Video-Based Telehealth Appointments at a Community Veterinary Clinic During the COVID-19 Pandemic

Objective

To assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic, to explore the impact of the pandemic on marginalized communities, and to understand perceptions regarding barriers and incentives of telehealth appointments as a method to increase care access.

Sample

205 active Community Veterinary Medicine Clinic clients at Tufts at Tech Community Veterinary Clinic in Worcester, MA.

Procedures

This cross-sectional study used a survey-based method to assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic. The survey measured client perceptions regarding potential barriers and incentives of telehealth appointments. Participants were randomly sampled from a list of active clients and completed the survey either by email or over the phone. The survey was available in both English and Spanish. Clients who completed the questionnaire received credit for a free examination.

Results

A total of 205 clients submitted survey responses. Factors affecting access to veterinary care were impacted by the COVID-19 pandemic. Access to reliable internet in the home was reported by 87% (n = 177) of participants. Digital access was correlated with education when controlling for race, income, age, and gender. Education was predictive of comfort with using video-chat (χ2 = 65, df = 24, p ≤ 0.01) and of whether or not clients reported need for assistance for using video-chat (χ2 = 52, df = 18, p ≤ 0.01). Patient education level was significantly predictive of wanting to use telehealth for at least one type of appointment (p ≤ 0.05).

Conclusions and Clinical Relevance

The findings indicate that implementing telehealth services at this Community Medicine Clinic is feasible for much of the active clientele and offers a new avenue to provide veterinary care during times of social distancing restrictions and beyond.

Veterinary Clinical Education Delivery Models: A Conceptual Framework

The sustainability of the traditional university-owned and -operated veterinary teaching hospital has been discussed for many years. Concerns around the shortage and lack of diversity of clinical faculty, financial sustainability, and suitability of secondary and tertiary case load for the development of Doctor of Veterinary Medicine students' Day One Competences are perennial issues. Consequently, many schools have been looking at alternative ways of delivering veterinary clinical education. This article provides a conceptual framework for evaluating the delivery of veterinary clinical education, providing putative advantages and disadvantages of each model for further empirical investigation. Four different models are proposed-owner, third party, embedded distributive, and fully distributive-that can broadly be defined along two dimensions: the degree of integration of the clinical enterprise with the academic enterprise and the degree of authority of the dean/head of school with respect to clinical enterprise governance and their role in budgetary, investment, and hiring decisions. The author offers a typology that may assist deans/heads of schools make strategic decisions about the mode of delivery of veterinary clinical education for their school.

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.

Effective Veterinary Clinical Teaching in a Variety of Teaching Settings

This review explores different modalities for clinical teaching of veterinary learners globally. Effective clinical teaching aims to prepare graduates for a successful career in clinical practice. Unfortunately, there is scant literature concerning clinical teaching in veterinary medicine. Our intent for this review is to stimulate and/or facilitate discussion and/or research in this important area. We discuss the different forms that veterinary clinical teaching can take, depending on their setting, which can be university-based clinical activities, work-based in commercial clinical practices, or in a traditional academic setting with little to no real-time exposure to clients and patients. We suggest that each of these modalities has a place in clinical teaching of veterinary learners at any point in the curriculum but that a mix of these approaches will likely provide an improved experience for the learner. Further, we discuss strategies to improve clinical teaching in these different settings. Potential strategies related to the teaching skills of clinical instructors could include training in delivery of clinical teaching in a variety of learning settings, and instructors’ official recognition, including opportunities for career progression. Potential strategies to improve clinical teaching in different teaching settings would vary with the learning settings. For example, in traditional academic settings, case-based learning with incorporation of simulation models is one proposed strategy. The involvement of learners in ‘teach-others’ is a strategy for both traditional academic and clinical settings. Finally, clearly addressing Day One competencies is required in any clinical teaching setting.

Assessing Service-Learning in Community-Based Veterinary Medicine as a Pedagogical Approach to Promoting Student Confidence in Addressing Access to Veterinary Care

Community-based veterinary medicine is a growing field, and veterinary students need to be able to work with clients facing complex barriers to receiving veterinary care for their pet. Many veterinary clients experience challenges accessing veterinary care due to financial limitations, transportation access, language comprehension, the ability to comply to the care plan (e.g., disabilities, physical, or mental health challenges, substance use), the ability to come to the clinic during the hours that it is open, and the ability to communicate outside of the appointment. The goal of this study was to assess student confidence levels working in accessible care before and after participating in a service-learning-based community veterinary rotation. Results show significantly higher student confidence levels for every barrier after completing the Tufts at Tech (TAT) Clinical Rotation at Cummings Veterinary School of Medicine. Additionally, 86% (n = 85) of students strongly agreed or agreed that TAT affected their thoughts about community medicine, and 77% (n = 76) strongly agreed or agreed that the rotation affected their feelings about underserved clients. Service-learning rotations in community-based veterinary medicine could be one pedagogical approach in training veterinary students to work with a diverse clientele.

Using the Five-Microskills Method in Veterinary Medicine Clinical Teaching

Effective clinical teaching is essential for the development of veterinary learners. Teaching clinical reasoning is a challenge for veterinary instructors as many lack adequate training in clinical teaching. In this paper, we propose the use of the five-microskills (FMS; also known as the one-minute preceptor) model of clinical teaching as a tool that can be used not only in teaching during clinical encounters but also during traditional teaching sessions (e.g., practicals). The FMS model assists the instructor in estimating the level of knowledge and development of the learner and allows for providing feedback. The FMS model is applicable in the busy clinical or teaching schedule of the instructor and requires training only of the instructor, not the learner. We provide two examples of the use of the FMS model, one of a clinical encounter and the other a biochemistry practical. From the examples, readers should be able to extract the basis of the model and start using it in their day-to-day practice. For proper use of the model, 1-4 h of training is usually recommended.

'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.

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

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

Assessment of canine health and preventative care outcomes of a community medicine program

The objective of this study was to assess if use of a community based veterinary medical program (the Tufts at Tech Community Veterinary Clinic) was related to indicators of canine health and well-being in a low-income community through the provision of low-cost preventative care. Participants were 177 low-income dog owners; 63 were repeat wellness/preventative care clients of the Tufts at Tech clinic, 46 were new or urgent care clients of the Tufts at Tech clinic, and 68 were a comparison sample of owners who had not used the clinic but did attend an outreach clinic in a community setting. Participants were asked to complete a survey that assessed owner demographic information, indicators of canine health and quality of life, pet attachment, and barriers that limit access to veterinary care. Results indicated that clients of the Tufts at Tech clinic were more likely to be White/Caucasian and female. In addition, there were significant positive differences on several indicators of canine health and preventative care for the Tufts at Tech wellness clients including monthly heartworm use (p < .001), use of veterinary services for both wellness (p < .001) and illness/injury (p = .001), and vaccination status (p = .003). There were no significant differences in spay/neuter status (p = .48), use of flea/tick preventative (p = .17), use of obedience training (p = .75), problem behaviors (p = .05), canine quality of health (p = .74) or attachment (p = .63). The Tufts at Tech clients reported lower rates of several barriers to accessing care, including cost. These findings provide important information regarding who is using low-cost clinics such as the Tufts at Tech model, the potential benefits of repeated preventative care on dog health, and suggestions for reducing barriers to accessing veterinary services.