A qualitative study to explore communication skills in veterinary medical education

Development and validation of a questionnaire to assess owner and canine quality-of-life and treatment satisfaction in canine allergic dermatitis

BACKGROUND

Animal and owner quality-of-life (QoL) is pivotal in treatment decisions. Accurate measurement of owner-reported QoL and treatment satisfaction (TS) supports disease burden and treatment benefit evaluation.

OBJECTIVES

Develop and evaluate an owner-completed canine dermatitis QoL and TS questionnaire (CDQoL-TSQ) in allergic dogs.

MATERIALS AND METHODS

The CDQoL-TSQ was drafted following review of existing measures and expert input. Content validity was assessed through interviews with owners of allergic dogs. Psychometric properties of the QoL domains (Canine QoL, Owner QoL) were evaluated. Score interpretation was derived.

RESULTS

Twenty dog owners were interviewed. Item wording was amended following the first 10 interviews. Data from 211 owners were used in the psychometric evaluation. The Canine QoL domain demonstrated strong internal consistency (α = 0.89), test-retest reliability (ICC2,1 = 0.844), moderate convergent validity (r = 0.41) and moderate-high known-groups validity (effect size 0.37-0.64). The Owner QoL domain demonstrated strong internal consistency (α = 0.73), high convergent validity (r = 0.63) and moderate-high known-groups validity (0.43-0.63). Test-retest reliability approached moderate strength (ICC2,1 = 0.490). Group-level interpretation analysis showed minimal important difference of 7.0-13.6 points for dogs and 13.0-13.6 for owners. For individual dogs a change of 6.3 or 12.5 points for dogs, and 12.5 or 18.8 for owners indicates a response.

CONCLUSIONS AND CLINICAL RELEVANCE

The CDQOL-TSQ is a two-part assessment to evaluate QoL and TS in canine allergic dermatitis. The QoL questionnaire demonstrated validity and reliability, and interpretation of scores was derived, making it suitable for use in research and practice. The TS module is suitable for clinical setting use to improve owner-veterinarian communication.

Evaluation of an Interprofessional Blended Learning Course Focusing on Communication within Veterinary Teams

Based on the importance of communication and teamwork in veterinary practice, we explored the impact of a blended learning course designed to enhance interprofessional communication skills among veterinary students and apprentice assistants. The blended learning course design included online modules, synchronous (online) seminars, and simulation training sessions. The asynchronous online elements should complement the varied schedules of different professions and meet the individual needs of participants, especially considering the challenges posed by the COVID-19 pandemic. The course structure, evaluations, and outcomes were documented, showing a positive impact on knowledge gain concerning communication and self-assessment in communication skills. In the pretest, the participants scored 43.18% correct answers to a knowledge test, whereas 71.50% correct answers were given in the posttest. Some participants indicated an improvement in the self-assessment of their skills. For example, before the training only 13.64% answered the question "How prepared do you feel regarding your communication skills for entering the profession?" with "Very good" or "Good", versus 50.00% in the posttest. There were also only 22.73% of participants who agreed to having sufficient understanding of the roles of other professional groups, while in the posttest, 81.82% agreed. The evaluations highlighted positive feedback on the organization, learning environment, and overall course structure. However, challenges such as limited resources, especially time and financial constraints, influenced the implementation and ongoing development of the course. Subsequent runs of the course could gather more data to further improve the teaching of veterinary interprofessional communication. This ongoing data collection would allow continuous insights into and adjustments to the teaching methods, ensuring maximum benefit for veterinary students and apprentice assistants.

Are They Thinking Differently? The Perceptions and Differences in Medical Disputes between Veterinarians and Clients

Medical disputes in veterinary practices are widespread; yet, a limited amount of research has been conducted to investigate the factors contributing to medical disputes. This study examined veterinarians' and clients' perceptions regarding risk factors and possible solutions to medical disputes. A total of 245 respondents from Taiwan, including 125 veterinarians and 120 clients, completed an electronic self-administered, semi-structured questionnaire in 2022. The questionnaire covered six dimensions: medical skills, complaint management, the attitudes of stakeholders during interactions, medical expenses, clients' perspectives, and communication modes. The results highlighted significant differences in the perceptions of risk factors for inducing medical disputes and possible solutions between clients and veterinarians in veterinary practice. First, young veterinarians and clients perceived medical skills as the highest risk factor for inducing medical disputes, while experienced veterinarians disagreed (p < 0.001). In addition, veterinarians with medical dispute experience identified stakeholders' attitudes during interactions as the top contributing factor. Second, regarding possible solutions, all veterinarians preferred offering clients cost estimates and cultivating empathy and compassion towards them. On the other hand, clients underscored the importance of obtaining informed consent for treatments and expenses and suggested that veterinarians should supply comprehensive written information to facilitate this process. This study underlies the importance of understanding stakeholders' perceptions to mitigate medical disputes and advocates for improved communication education and training for young veterinarians. These findings provide valuable insights for veterinarians and clients, contributing to preventing and managing medical disputes in veterinary practices.

Treatment options, complications and long-term outcomes for limb fractures in pet rabbits

BACKGROUND

Limb fractures represent the most common orthopaedic disease in pet rabbits. However, only a few studies have evaluated therapeutic details of limb fractures. There are no data available for long-term outcomes of limb fracture treatment.

METHODS

The medical records of six institutions were reviewed retrospectively to identify cases of traumatic limb bone fractures in pet rabbits between 1999 and 2020. The medical records (n = 387) were analysed for details of fracture prevalence, aetiology, therapy protocols, treatment complications, outcome and long-term effects. In addition to the retrospective data evaluation, 13 rabbits were re-evaluated in person in recent clinical analyses, including orthopaedic examination, radiography and computed-tomographic imaging. Details of long-term effects of fracture treatment were requested over the telephone for a further 232 animals using a standardised questionnaire.

RESULTS

Long bone fractures accounted for the majority of all fractures (296/387; 76.5%). Hindlimb fractures (301/387; 77.7%) were more common than forelimb fractures (86/387; 22.2%), and tibial fractures and combined fractures of the tibia and fibula (119/387; 30.8%) were observed most frequently. Most fracture treatments were based on osteosynthesis procedures (243/328; 74.1%). Treatment complications occurred in 130 out of 328 (39.6%) cases. A high bodyweight (p = 0.047) and an older age (p = 0.01) were found to be significant risk factors for the emergence of therapy complications. Overall, 75.4% of animals (175/232) had a satisfactory long-term outcome. Limb posture anomalies were evaluated in 61 cases (26.3%).

LIMITATIONS

The multi-centre approach led to the inclusion of various institutions, veterinarians, treatment protocols and rabbit populations that might have influenced the results. The medical records were reviewed retrospectively, so there were some data that were lacking or could not be collected in a standardised manner. Furthermore, rabbit owners' evaluation of long-term outcomes might be prone to error, despite the use of a standardised interview questionnaire.

CONCLUSION

Limb fractures are a common orthopaedic issue in pet rabbits. The patient's bodyweight and age are significant risk factors for the emergence of complications during the fracture treatment process. Long-term orthopaedic effects, such as abnormal limb posture and permanent lameness of the affected limb, were observed regularly.

The relationship between evaluation of shared decision-making by pet owners and veterinarians and satisfaction with veterinary consultations

Background

Communication skills are a necessary competency in veterinary medicine, and shared decision-making (SDM) between practitioners and patients is becoming increasingly important in veterinary practice as in human medicine. There are few studies that have quantitatively measured SDM in veterinary health care, and the relationship between SDM and consultation satisfaction is unknown. The purpose of this study was to investigate the status of SDM implementation in veterinary hospitals and the relationship between SDM implementation and consultation satisfaction among pet owners. We conducted a cross-sectional study using self-administered questionnaires among pet owners and veterinarians. In total, 77 pet owners who visited a veterinary clinic and 14 veterinarians at the clinics participated in this study. After a veterinary clinic visit, owners were asked to rate their decision-making preferences using the Shared Decision Making Questionnaire for patients (SDM-Q-9) adapted for veterinary medicine, as well as their satisfaction with the consultation. The corresponding veterinarians were asked to complete the veterinary version of the survey (SDM-Q-Doc).

Results

Most pet owners (64.9%) preferred SDM in veterinary consultations. Cronbach's alpha coefficient of 0.84 for the veterinary SDM-Q-9 and 0.89 for the veterinary SDM-Q-Doc both confirmed high reliability. The Spearman's correlation coefficient between the SDM-Q-9 and consultation satisfaction was 0.526 (p < 0.001), which was significant. The SDM-Q-Doc was not significantly correlated with either the SDM-Q-9 or pet owner consultation satisfaction. We conducted a sensitivity analysis of correlations among veterinarians; responses on the SDM-Q-Doc to examine the association between the SDM-Q-Doc and SDM-Q-9 and owner satisfaction; the results remained the same and no association was found.

Conclusions

Our findings suggest that evaluation of SDM among pet owners was associated with their satisfaction with veterinary consultation. Veterinarians may be able to improve the satisfaction level of pet owners by adopting a consultation method that increases SDM. We did not consider the content of veterinary care or the number of visits to the veterinary clinic; future studies should be conducted to confirm the validity of our results.

Early career clinicians euthanize more dogs with nontraumatic hemoabdomen but not gastric dilatation and volvulus than more experienced clinicians

OBJECTIVE

To determine if clinician experience influenced the euthanasia rate in 2 common surgical emergencies.

ANIMALS

142 dogs with nontraumatic hemoabdomen (NTH) due to suspected ruptured splenic mass and 99 dogs with gastric dilatation-volvulus (GDV) where the owner either elected surgery or euthanasia.

PROCEDURES

Medical records were reviewed for dogs that had either NTH or GDV. For each patient, the owner's decision to pursue euthanasia versus surgery was recorded. The primary clinician was categorized as an intern, defined as a clinician with < 12 months experience, or a non-intern, defined as a clinician with more than 12 months experience. The euthanasia rates were compared used a Fisher exact, and the 95% CI was calculated for the risk of euthanasia if the primary clinician was an intern compared with a non-intern. If a difference was identified, subgroups comparing time of day, referral status, age, Hct, total solids, lactate, and heart rate were evaluated using a t test with a Bonferroni correction for the continuous variables and a Fisher exact for categorical variables.

RESULTS

For dogs with NTH, the euthanasia rate for cases primarily managed by non-interns (52%) was significantly lower than that of interns (76%; P = .005). The relative risk of euthanasia associated with NTH when the case was treated by an intern was 1.44 with a 95% CI of 1.1229 to 1.8567. For 99 dogs with GDV, the rate of euthanasia was not different between interns and non-interns.

CLINICAL RELEVANCE

The euthanasia rate for dogs with NTH may be impacted by the level of experience of the clinician. Support of new clinicians during challenging conversations should be provided.

Use of Actors or Peers as Simulated Clients in Veterinary Communication Training

Using simulated clients is an effective teaching method for training and assessing communication skills in veterinary education. The aim of this study is to evaluate the use of actors and peers in communication skills training in veterinary medicine. For this purpose, the subjective perception of the use of actors was assessed in a first study using a paper-based self-evaluation survey. In a second study, different groups of veterinary students who trained their communication skills with actors or peers were compared in an electronic Objective Structured Clinical Examination (eOSCE) assessment with regard to their outcomes of communication proficiency. All participants reported the actors to be helpful and supportive in learning communication skills. Above all, participants highly rated the achieved authenticity when using actors as well as feedback sessions. Regarding the comparison of actors and peers as teaching methods, no significant difference in the performance of veterinary students in an eOSCE was identified. Despite the lack of objective evidence, both methods may be considered valuable and accepted teaching tools. Training with peers gives students an opportunity to learn how to conduct structured history interviews and to understand pet owners' motives at an early stage of undergraduate veterinary training. Change of perspective is considered a positive training element. However, when portraying authentic and standardized emotions and reactions and giving formative feedback based on the pet owners' internal perspectives, actors are beneficial for training advanced veterinary students and graduates in difficult conversation topics.

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.

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.

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.

Interprofessional survey on communication skills in veterinary and veterinary-related education in Germany

BACKGROUND

Communication is an indispensable skill in the everyday working life of a veterinary team. In German higher educational institutions, communication skills training is explicitly mentioned in the curricula of veterinary assistants, including veterinary nurses and veterinary technicians, and of animal keepers, but not for undergraduate veterinary medicine. Little is known about interprofessional education in veterinary medicine and related professions. Therefore, the purpose of this study is to describe and explore the current interprofessional state of knowledge regarding communication skills of the aforementioned groups in Germany.

METHODS

To explore the perception, assess the knowledge and identify the attitude regarding communication skills and interprofessional training, an online survey was distributed. The survey was sent to all five veterinary higher educational institutions, 38 schools for veterinary assistants and 15 schools for animal keepers throughout Germany.

RESULTS

In total, 294 veterinary students, 111 veterinary assistant trainees and 62 animal keeper trainees participated. The majority of participants (98.07%, n = 458) perceived communication skills as highly important for their everyday work. In total, 413 participants (88.44%) felt that their communication skills needed improvement and more than half admitted having difficulties in effective communication (59.31%; n = 277). In addition, 62.74% of respondents (n = 293) were not sufficiently informed about the training content of their future colleagues. Most were convinced that training could positively influence on their communication with clients (95.72%; n = 447) and the team (92.29%; n = 431), and 76.45% of respondents (n = 357) wished to participate in an interprofessional training.

CONCLUSIONS

Results of this study confirm that communication skills are perceived as highly important for professional life. Students and trainees show a great interest in communication skills and interprofessional training. The findings indicate that appropriate adjustments to existing curricula are necessary in Germany.

What Use is Anatomy in First Opinion Small Animal Veterinary Practice? A Qualitative Study

Despite the uncontested importance of anatomy as one of the foundational aspects of undergraduate veterinary programs, there is still limited information available as to what anatomy knowledge is most important for the graduate veterinarian in their daily clinical work. The aim of this study was therefore to gain a deeper understanding of the role that anatomy plays in first opinion small animal veterinary practice. Using ethnographic methodologies, the authors aimed to collect rich qualitative data to answer the question "How do first opinion veterinarians use anatomy knowledge in their day-to-day clinical practice?" Detailed observations and semi-structured interviews were conducted with five veterinarians working within a single small animal first opinion practice in the United Kingdom. Thematic analysis was undertaken, identifying five main themes: Importance; Uncertainty; Continuous learning; Comparative and dynamic anatomy; and Communication and language. Anatomy was found to be interwoven within all aspects of clinical practice; however, veterinarians were uncertain in their anatomy knowledge. This impacted their confidence and how they carried out their work. Veterinarians described continually learning and refreshing their anatomy knowledge in order to effectively undertake their role, highlighting the importance of teaching information literacy skills within anatomy curricula. An interrelationship between anatomy use, psychomotor, and professional skills was also highlighted. Based on these findings, recommendations were made for veterinary anatomy curriculum development. This study provides an in-depth view within a single site small animal general practice setting: further work is required to assess the transferability of these findings to other areas of veterinary practice.

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.

Preliminary assessment of a tool for measuring relationship-centred communication in veterinary consultations (adapted VR-COPE)

This article was migrated. The article was marked as recommended. Relationship-centred communication is considered a desirable goal in veterinary medicine, and a number of different tools have been developed to measure relationship-centred communication. This study was designed as an initial assessment of an adapted version of the Verona Patient-centred Communication Evaluation (VR-COPE) scale, originally developed for medical communication research, to evaluate its potential for measuring relationship-centredness in veterinary consultations. Fifty-five consultations in the United Kingdom and United States of America were videotaped and analysed. The median VR-COPE total score (out of a potential 100 points) was 76.00 for all consultations. The highest overall score was for "Structuring" (of the consultation), whereas the lowest scores were for "Client Worries," "Psychological Impact," and "Empathy." This initial assessment of the adapted VR-COPE suggests it may be helpful in measuring content, process, and structuring skills related to relationship-centredness in veterinary consultations. It may also help uncover aspects of relationship-centredness that are unique from those uncovered by other tools. Further research is needed to fully assess the role of VR-COPE in veterinary communication research and the contributions it can make to relationship-centredness in veterinary consultations.

Implications of a Novel Method for Analyzing Communication in Routine Veterinary Patient Visits for Veterinary Research and Training

The patient-centered clinical method (PCCM), a model developed to characterize communication during patient-physician visits in the 1980s, identifies elements of patient-orientated, physician-orientated, and shared dialogue during the encounter. The model also includes elements that reflect the emotional aspects of these interactions, recognizing expressions of feelings and exchanges related to both personal and medical interests. Fifty-five routine veterinary patient visits in the United Kingdom and United States were analyzed using the novel application of a PCCM adapted for veterinary patient visits. The patient visits were video recorded, transcribed, coded, and analyzed for frequency and proportion of PCCM elements observed. Elements representing the greatest proportion of patient visits were related to gathering information and shared decision making. Those representing the smallest proportion were related to signs of the presenting condition and effects of the condition on the clients' lives. Dialogue during the patient visits flowed iteratively and back and forth between the veterinarian and the client perspective. The findings suggest that patient visits are focused more on gathering information and planning rather than exploring effects of the health problem on the client's life, and that patient visits flow very iteratively and randomly between veterinarian and client perspectives. Both of these topics should be studied further and given emphasis in the way that communication models are developed and taught in order to enhance client-centeredness in veterinary patient visits.

An integrated review of the role of communication in veterinary clinical practice

BACKGROUND

There is a growing interest in exploring the nature of communication in veterinary medicine and understanding how veterinary practitioners communicate with their clients and other professionals. This is the first integrative review of literature on veterinary communication. Applying the PRISMA model, the PubMed, PsychInfo and ERIC databases were searched using keywords such as 'veterinary', 'vet', 'communication' and 'interaction' for related articles published between 1 January 2000 and 31 December 2018.

RESULTS

Keyword searching through the databases yielded 1572 related studies. Only 48 of these studies were included in our analysis after an in-depth review by two independent reviewers using the critical appraisal skills Programme frameworks with high inter-rater reliability (Cohen's kappa coefficient κ > 0.8). The existing body of research on veterinary communication can be classified into three major areas: (a) client-veterinarian communication, (b) cross-disciplinary communication in a professional veterinarian team and (c) training of veterinary communication skills. This review details the complexity and heterogeneity of agenda in the field of veterinary communication. The included studies indicate that veterinary practitioners are not equipped with specific communication skills to address different agendas in veterinary communication. The veterinary curriculum should include a component on communication training that can help veterinary students acquire necessary communication skills that allow them to effectively communicate with clients and other professionals CONCLUSION: This review detailed the complexity of agendas in the field of veterinary communication. The results indicate that veterinary practitioners can further benefit from training on specific communication skills that address the agendas found in veterinary communication research. Furthermore, the veterinary curriculum should include a component on communication training that equips veterinary students with the necessary communication skills that allow them to effectively communicate with different stakeholders such as clients and colleagues with and across the field of veterinary science.

Veterinary Behavior: Assessment of Veterinarians' Training, Experience, and Comfort Level with Cases

Studies of US animal shelters consistently indicate that behavior is often a major reason for relinquishment and, thereby, euthanasia of millions of dogs and cats annually. Even though this is an area in which veterinarians can intervene to support the human-animal bond, prior research has documented that they frequently do not bring the topic up during appointments. This study explored veterinarians' training in animal behavior and behavioral medicine, along with their level of comfort in treating common behavioral problems. An online survey of practicing veterinarians (N = 1,085) found that only 42.8% felt they'd received a significant amount of training in this field during veterinary school, but the majority reported participating in continuing education sessions about behavior. Almost all respondents reported seeing patients with behavioral issues (99.6%), even when the initial appointment was made for other reasons. Participants felt most comfortable discussing inappropriate elimination and begging for food but were least comfortable treating issues involving aggression. Most veterinarians treat their own behavior cases, using a combination of behavior modification techniques and medication. Only 22.1% refer cases needing behavioral therapy to a specialist. Given the prevalence of behavioral problems in companion animals and the potential for early veterinary intervention to play a significant role in animal health, it is important for veterinary schools to include this topic in their curricula. At present, 73% of schools require a course in animal behavior. The release of the new Competency-Based Veterinary Education framework is anticipated to support a greater teaching emphasis in this area.

Dairy farmers' decision-making to implement biosecurity measures: A study of psychosocial factors

Biosecurity measures are a set of management procedures that prevent the risk of introducing and spreading infectious diseases to a farm, although these measures are rarely implemented in dairy farms. There are some studies that have identified that the decision to implement biosecurity measures can be influenced by several psychosocial factors (attitudes and behaviours). Thus, the objective of this study was to examine the psychosocial factors (and their interactions) influencing the implementation of biosecurity measures in dairy farms in Spain, through the views of dairy farmers and veterinarians from Catalonia (northeast Spain) and Galicia (northwest Spain). Face‐to‐face in‐depth interviews were performed with 16 dairy farmers (nine from Catalonia and seven from Galicia) and 16 veterinarians (eight from Catalonia and eight from Galicia). Grounded theory analysis was performed on the transcripts, following the subtopics of: information sources, individual factors of the farmer, social dynamics, official veterinary services and other factors. The study identified the importance of veterinarians as a source of information, including their communication skills, the individual experiences of farmers, traditions of the farms and availability of time and space in the dairy farmer's decisions making. Further, it suggests the need to deepen the knowledge of the farm workers and the obligatory biosecurity measures. This research represents a starting point to develop future strategies to improve the implementation of biosecurity measures in dairy farms.

Moral distress in veterinarians

Moral distress is a psychological state of anguish that has been widely studied in healthcare professionals. Experiencing moral distress can lead to problems including avoidance of patients and increased staff turnover. Moral distress in veterinarians has not yet been explored to the extent seen in the human medical field, and there is limited data regarding moral distress in veterinarians. However, it is expected to be prevalent in these professionals. So far, it has been reported that veterinarians commonly experience moral conflict, ethical challenges and ethical dilemmas during their career. These conflicts in association with other modifying factors such as personality traits can lead to the experience of moral distress. In a profession with known levels of occupational stress and reported mental health problems, exploring the area of moral distress and its effects on the professional wellbeing of veterinarians is important. Further studies such as developing a moral distress scale to measure this issue are needed in order to evaluate the incidence of this problem in veterinary professionals. Furthermore, assessing a possible relationship between moral distress, mental illness and attrition in veterinarians would be useful in developing intervention strategies to minimise the experience of moral distress and its associated negative consequences in veterinarians.

Impact of dealing with bereaved clients on the psychological wellbeing of veterinarians

BACKGROUND

Research has identified that members of the veterinary profession are at high risk of occupational stress, burnout, poor psychological wellbeing and an elevated rate of suicide. Although scholarly interest in veterinarians has increased in recent years, relatively few studies have specifically examined the emotional work in veterinary interactions and what effect dealing with companion animal owners' grief has on the wellbeing of veterinarians. The purpose of this study was to determine if dealing with bereaved clients affected the psychological wellbeing of veterinarians. The concept of compassion fatigue was explored, including whether veterinarians believed that their training had equipped them for communicating with grieving clients.

METHODS

Veterinary surgeons registered in South Australia in 2015 were invited to complete an online survey, with 105 participants responding.

RESULTS

Many participants, particularly female and younger veterinarians, were experiencing mild to severe psychological distress and nearly half of the sample was experiencing high to very high levels of compassion fatigue. No participants reported seeking psychological or other professional mental health support and the majority had not referred a grieving client to a psychologist or other mental health professional. A significant proportion of veterinarians felt their own mental health was affected by dealing with clients grieving the loss of a companion animal.

DISCUSSION

The findings are discussed in terms of increasing the wellbeing of veterinarians through improved curriculum training and workplace health promotion, particularly considering the high suicide rate reported for the profession.

The modern UK veterinary profession: photo-elicitation interviewing reveals that small animal and surgical images dominate

More than 80 per cent of vets are employed in clinical practice but other veterinary roles are vital for society. However, even clinical practice does not seem to fulfil some modern graduates, and an increasing number of veterinarians are leaving the profession to pursue other careers. Research suggests that less than 50 per cent of veterinarians would choose to undertake their career path again, so the profession faces a 'workforce crisis'. Through semi-structured photo-elicitation interviewing, this study has explored the image that students embarking on veterinary education have of the profession. The students' dominant image of the profession, and their perception of the public image, was small animal practice. A large proportion (n=16, 80 per cent) of participants saw themselves working in clinical practice, with many (n=8, 40 per cent) aspiring to focus on surgery. The image of the veterinary profession has changed since the 1970s when the James Herriot mixed practice model was well known to the public. The dominant small animal and surgical image emerging demonstrates a need for members of the profession to work together to educate public and entrant perception, emphasising the diversity of veterinary careers and their value to society, to allow aspiring veterinary entrants to develop a range of career goals.

Communication identity in veterinary medicine: a grounded theory approach

It is well established that communication skills are a core competence in veterinary medicine. Most studies in the field of veterinary medicine have focused on communication as an interpersonal skill. Much less is known about communication in the context of professional identity formation. Semistructured interviews with practitioners from companion and farm animal practice, veterinary industry, veterinary research and government service were conducted in Germany in 2016. A grounded theory approach as described by Strauss and Corbin was used to identify characteristics associated with professional communication identity formation in veterinarians. According to the current study, the identity formation process occurs in three steps: existing personal communication identity, socialisation and professional communication identity. Essentials of interpersonal communication, communication interaction experiences at work, acquisition of communication skills and subjective clarification of veterinary communication ability and skills are the key factors associated with this formation process. Since communication skills are of uttermost importance for all fields of veterinary medicine, communication education, and supporting undergraduate students in the process of communication identity formation, should be an important part of the veterinary curriculum. Furthermore, integrating communication skills training in continuing education courses could foster professionalism in veterinary medicine.

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.

Analysing how negative emotions emerge and are addressed in veterinary consultations, using the Verona Coding Definitions of Emotional Sequences (VR-CoDES)

OBJECTIVE

To explore the applicability, need for modifications and reliability of the VR-CoDES in a veterinary setting while also gaining a deeper understanding of clients' expressions of negative emotion and how they are addressed by veterinarians.

METHODS

The Verona Coding Definitions of Emotional Sequences for client cues and concerns (VR-CoDES-CC) and health provider responses (VR-CoDES-P) were used to analyse 20 audiotaped veterinary consultations. Inter-rater reliability was established. The applicability of definitions of the VR-CoDES was identified, together with the need for specific modifications to suit veterinary consultations.

RESULTS

The VR-CoDES-CC and VR-CoDES-P generally applied to veterinary consultations. Cue and concern reliability was found satisfactory for most types of cues, but not for concerns. Response reliability was satisfactory for explicitness, and for providing and reducing space for further disclosure. Modifications to the original coding system were necessary to accurately reflect the veterinary context and included minor additions to the VR-CoDES-CC.

CONCLUSION

Using minor additions to the VR-CoDES including guilt, reassurance and cost discussions it can be reliably adopted to assess clients' implicit expressions of negative emotion and veterinarians' responses.

PRACTICE IMPLICATIONS

The modified VR-CoDES could be of great value when combined with existing frameworks used for teaching and researching veterinary communication.

Difficulties experienced by veterinarians when communicating about emerging zoonotic risks with animal owners: the case of Hendra virus

BACKGROUND

Communication skills are essential for veterinarians who need to discuss animal health related matters with their clients. When dealing with an emerging zoonosis, such as Hendra virus (HeV), veterinarians also have a legal responsibility to inform their clients about the associated risks to human health. Here we report on part of a mixed methods study that examined the preparedness of, and difficulties experienced by, veterinarians communicating about HeV-related risks with their clients.

METHODS

Phase 1 was an exploratory, qualitative study that consisted of a series of face-to-face, semi-structured interviews with veterinary personnel from Queensland, Australia (2009-10) to identify the barriers to HeV management in equine practices. Phase 2a was a quantitative study that surveyed veterinarians from the same region (2011) and explored the veterinarians' preparedness and willingness to communicate about HeV-related risks, and the reactions of their clients that they experienced. The second study included both multiple choice and open-ended questions.

RESULTS

The majority of the participants from Phase 2a (83.1%) declared they had access to a HeV management plan and over half (58.6%) had ready-to-use HeV information available for clients within their practice. Most (87%) reported "always or sometimes" informing clients about HeV-related risks when a horse appeared sick. When HeV was suspected, 58.1% of participants reported their clients were receptive to their safety directives and 24.9% of clients were either initially unreceptive, overwhelmed by fear, or in denial of the associated risks. The thematic analysis of the qualitative data from Phases 1 and 2a uncovered similar themes in relation to HeV-related communication issues experienced by veterinarians: "clients' intent to adhere"; "adherence deemed redundant"; "misunderstanding or denial of risk"; "cost"; "rural culture"; "fear for reputation". The theme of "emotional state of clients" was only identified during Phase 1.

CONCLUSION

Warning horse owners about health and safety issues that may affect them when present in a veterinary work environment is a legal requirement for veterinarians. However, emerging zoonoses are unpredictable events that may require a different communication approach. Future training programs addressing veterinary communication skills should take into account the particular issues inherent to managing an emerging zoonosis and emphasise the importance of maintaining human safety. Veterinary communication skills and approaches required when dealing with emerging zoonoses should be further investigated.

Resilience in Veterinary Students and the Predictive Role of Mindfulness and Self-Compassion

Resilience is a dynamic and multifaceted process in which individuals draw on personal and contextual resources. In difficult situations, resilient people use specific strategies to learn from the situation without being overcome by it. As stressors are inherent to veterinary work, including long work hours, ethical dilemmas, and challenging interactions with clients, resilience is an important component of professional quality of life. However, while resilience in other health professionals has received attention, it has received little in the veterinary field. In this cross-sectional study, veterinary students from six veterinary schools in Australia completed an online survey, with 193 responses (23%). Very few veterinary students (6%) reached the threshold to be considered highly resilient using the Brief Resilience Scale, and approximately one third classified as having low levels of resilience. In the final linear multiple regression model, predictors of resilience included nonjudgmental and nonreactive mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Neff Self-Compassion Scale). Students with higher nonjudgmental and nonreactive mindfulness and self-compassion had higher resilience scores. These findings indicate that fostering these qualities of mindfulness and self-compassion may be aligned with strengthening veterinary student resilience. Importantly, if the factors that help veterinary students develop a capacity for resilience can be identified, intervention programs can be targeted to educate future veterinary professionals with a high quality of life, both professional and personal.

Comparison of veterinary health services expectations and perceptions between oncologic pet owners, non-oncologic pet owners and veterinary staff using the SERVQUAL methodology

AIM

Client satisfaction gained great importance in health care as a measurement of service quality. One of the most popular methods to evaluate client satisfaction is the SERVQUAL inquiry which measures service quality by evaluating client expectations and services towards a service in five dimensions: Tangibles, Empathy, Assurance, Reliability and Responsiveness.

MATERIALS AND METHODS

In order to evaluate if owners of pets with cancer constitute a distinctive group from the general pet owner population and if these differences were perceived by the hospital staff we applied a SERVQUAL questionnaire to 51 owners of pet with cancer, 68 owners from the general pet population and 14 staff members.

RESULTS

Owners of oncologic pets had different expectations of an ideal service granting importance to Assurance questions (6.75 vs 6.5, p= 0.045) while showing unmet needs in Reliability and Empathy dimensions. Veterinarians failed to understand these specificities and over evaluated characteristics of Tangible dimension (6.75 vs 6.25, p=0.027).

CONCLUSION

Owners of pet with cancer seem to constitute a specific subpopulation with special needs and veterinary staff should invest resources towards Assurance instead of privileging tangible aspects of veterinary services. By aligning professionals expectations with those of pet owners veterinarians can achieve better client satisfaction, improved compliance and stronger doctor-owner relationships.

Expectations of Graduate Communication Skills in Professional Veterinary Practice

Good communication skills are an important entry-level attribute of graduates of professional degrees. The inclusion of communication training within the curriculum can be problematic, particularly in programs with a high content load, such as veterinary science. This study examined the differences between the perceptions of students and qualified veterinarians with regards to the entry-level communication skills required of new graduates in clinical practice. Surveys were distributed to students in each of the four year levels of the veterinary science degree at the University of Melbourne and to recent graduates and experienced veterinarians registered in Victoria, Australia. Respondents were asked to rank the relative importance of six different skill sets: knowledge base; medical and technical skills; surgical skills; verbal communication and interpersonal skills; written communication skills; and critical thinking and problem solving. They were then asked to rate the importance of specific communication skills for new graduate veterinarians. Veterinarians and students ranked verbal communication and interpersonal skills as the most important skill set for an entry-level veterinarian. Veterinarians considered many new graduates to be deficient in these skills. Students often felt they lacked confidence in this area. This has important implications for veterinary educators in terms of managing the expectations of students and improving the delivery of communication skills courses within the veterinary curriculum.

An evaluation of the experiences of guide dog owners visiting Scottish veterinary practices

Guide dogs and their owners will visit a veterinary practice at least twice a year. The aim of this study was to evaluate what guide dog owners thought about these visits, in order to identify areas of good practice which could be incorporated into the undergraduate curriculum. Nine guide dog owners volunteered to take part in the study and were interviewed by the primary researcher. Thematic analysis was carried out and several themes were identified: good experiences were highlighted where staff had an understanding of visual impairment and the work of a guide dog; the importance of good communication skills involving the owner in the consultation; the need for veterinary professionals to understand the bond between an owner and guide dog; how medication and information could be provided in a user-friendly format for someone affected by a visual impairment and concerns about costs and decision making for veterinary treatment. This work highlights the importance for veterinary staff to talk to, empathise with and understand the individual circumstances of their clients and identifies areas that should be included in veterinary education to better prepare students for the workplace.

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

Effective communication in health care benefits patients. Medical and veterinary schools not only have a responsibility to teach communication skills, the American Veterinary Medical Association (AVMA) Council on Education (COE) requires that communication be taught in all accredited colleges of veterinary medicine. However, the best strategy for designing a communications curriculum is unclear. The Calgary-Cambridge Guide (CCG) is one of many models developed in human medicine as an evidence-based approach to structuring the clinical consultation through 71 communication skills. The model has been revised by Radford et al. (2006) for use in veterinary curricula; however, the best approach for veterinary educators to teach communication remains to be determined. This qualitative study investigated if one adaptation of the CCG currently taught at Midwestern University College of Veterinary Medicine (MWU CVM) fulfills client expectations of what constitutes clinically effective communication. Two focus groups (cat owners and dog owners) were conducted with a total of 13 participants to identify common themes in veterinary communication. Participants compared communication skills they valued to those taught by MWU CVM. The results indicated that while the CCG skills that MWU CVM adopted are applicable to cat and dog owners, they are not comprehensive. Participants expressed the need to expand the skillset to include compassionate transparency and unconditional positive regard. Participants also expressed different communication needs that were attributed to the species of companion animal owned.

Veterinarian-Client Communication Skills: Current State, Relevance, and Opportunities for Improvement

Communication is increasingly recognized as a core skill for veterinary practitioners, and in recent years, attention to communication competency and skills training has increased. To gain an up-to-date assessment of the current state of veterinary communication skills and training, we conducted a survey among veterinary practitioners in the United Kingdom and United States in 2012/2013. The questionnaire was used to assess the current state, relevance, and adequacy of veterinary communication skills among veterinary practitioners, to assess interest in further training, and to understand perceived challenges in communicating with clients. There was an overall response rate of 29.6% (1,774 of 6,000 recipients), with a higher response rate for UK-based practitioners (39.7%) than practitioners in the US (19.5%). Ninety-eight percent of respondents agreed that communication skills were as important as or more important than clinical knowledge. Forty-one percent of respondents had received formal veterinary communication skills training during veterinary school, and 47% had received training post-graduation. Thirty-five percent said their veterinary communication skills training during veterinary school prepared them well or very well for communicating with clients about the health of their pets, compared to 61% of those receiving post-graduate training. Forty percent said they would be interested in further veterinary communication skills training, with the preferred methods being simulated consultations and online training. While there has been increased emphasis on communication skills training during and after veterinary school, there is a need for more relevant and accessible training.

Survey of US Veterinary Students on Communicating with Limited English Proficient Spanish-Speaking Pet Owners

Veterinary schools and colleges generally include communication skills training in their professional curriculum, but few programs address challenges resulting from language gaps between pet owners and practitioners. Due to shifting US demographics, small animal veterinary practices must accommodate an increasing number of limited English proficient (LEP) Spanish-speaking pet owners (SSPOs). A national survey was conducted to assess the interest and preparedness of US veterinary students to communicate with LEP SSPOs when they graduate. This online survey, with more than 2,000 first-, second-, and third-year US veterinary students, revealed that over 50% of students had worked at a practice or shelter that had LEP Spanish-speaking clients. Yet fewer than 20% of these students described themselves as prepared to give medical information to an LEP SSPO. Over three-fourths of respondents agreed that communication with LEP SSPOs was important for veterinarians in general, and two-thirds agreed that communication with LEP SSPOs was important for themselves personally. Ninety percent of students who described themselves as conversant in Spanish agreed that they would be able to communicate socially with SSPOs, while only 55% said they would be able to communicate medically with such clients. Overall, two-thirds of students expressed interest in taking Spanish for Veterinary Professionals elective course while in school, with the strongest interest expressed by those with advanced proficiency in spoken Spanish. Bridging language gaps has the potential to improve communication with LEP SSPOs in the veterinary clinical setting and to improve patient care, client satisfaction, and the economic health of the veterinary profession.