Dutch veterinary graduates leaving practice: A mixed-methods analysis of frequency and underlying reasons.

BACKGROUND: This study aimed to evaluate the frequency of veterinarians graduated between 2009 and 2019 in the Netherlands leaving practice, their reasons for leaving and the relative importance of these reasons. METHODS: Study 1 (focus group sessions, n = 14) of this project was aimed at defining the reasons Dutch veterinarians have for leaving veterinary practice within 10 years of graduation. In study 2, the frequency of veterinarians leaving veterinary practice and the relative importance of the reasons for leaving identified in study 1 were investigated through a cross-sectional digital survey. A career in veterinary practice was defined as working in first- or second-line veterinary practice. Leaving practice was defined as ending employment in veterinary practice. RESULTS: The results of study 1 yielded 20 reasons given by veterinarians to leave veterinary practice within 10 years of graduation. One of the reasons obtained by this study was not mentioned in literature before: leaving veterinary practice as a pre-planned career path. Study 2 demonstrated that the mean percentage of respondents from graduation years 2009 to 2014 who left practice within 5 years of graduation was 16.8%. The most important reasons respondents gave for this career move were poor work-life balance, excessive workload, insufficient remuneration and perceived lack of employer support. CONCLUSION: A substantial number of veterinarians leave veterinary practice within 5 years of graduation. The most important reasons for this decision are excessive job demands or insufficient job resources. Furthermore, these reasons are a result of negative experiences regarding organisation of work, management and remuneration.

Assessment Tools for Feedback and Entrustment Decisions in the Clinical Workplace: A Systematic Review.

BACKGROUND: Entrustable Professional Activities (EPAs) combine feedback and evaluation with a permission to act under a specified level of supervision and the possibility to schedule learners for clinical service. This literature review aims to identify workplace-based assessment tools that indicate progression toward unsupervised practice, suitable for entrustment decisions and feedback to learners. METHODS: A systematic search was performed in the PubMed, Embase, ERIC, and PsycINFO databases. Based on title/abstract and full text, articles were selected using predetermined inclusion and exclusion criteria. Information on workplace-based assessment tools was extracted using data coding sheets. The methodological quality of studies was assessed using the medical education research study quality instrument (MERSQI). RESULTS: The search yielded 6,371 articles (180 were evaluated in full text). In total, 80 articles were included, identifying 67 assessment tools. Only a few studies explicitly mentioned assessment tools used as a resource for entrustment decisions. Validity evidence was frequently reported, and the MERSQI score was 10.0 on average. CONCLUSIONS: Many workplace-based assessment tools were identified that potentially support learners with feedback on their development and support supervisors with providing feedback. As expected, only few articles referred to entrustment decisions. Nevertheless, the existing tools or the principals could be used for entrustment decisions, supervision level, or autonomy.

The Development of Entrustable Professional Activities for Competency-Based Veterinary Education in Farm Animal Health.

Entrustable professional activities (EPAs) are professional tasks that can be entrusted to a student under a given level of supervision once he or she has demonstrated competence in these tasks. The EPA construct was conceived to increase transparency in objectives for clinical workplace learning and to help ensure patient safety and the quality of care. A first step in implementing EPAs in a veterinary curriculum is to identify the core EPAs of the profession. The aim of this study was to develop EPAs for farm animal health. An initial set of 36 EPAs for farm animal health was prepared by a team of six veterinarians and curriculum developers and used in a modified Delphi study. In this iterative process, the EPAs were evaluated until higher than 80% agreement was reached. Of 83 veterinarians who participated, 39 (47%) completed the Delphi procedure. After two rounds, the panel reached consensus. A small expert group further refined and reorganized the EPAs for educational purposes into seven core EPAs for farm animal health and 29 sub-EPAs. This study is an important step in optimizing competency-based training in veterinary medicine. Future steps are to implement EPAs in the curriculum and train supervisors to assess students' ability to perform EPAs with increasing levels of independence.

When to trust our learners? Clinical teachers' perceptions of decision variables in the entrustment process.

INTRODUCTION: Clinical training programs increasingly use entrustable professional activities (EPAs) as focus of assessment. However, questions remain about which information should ground decisions to trust learners. This qualitative study aimed to identify decision variables in the workplace that clinical teachers find relevant in the elaboration of the entrustment decision processes. The findings can substantiate entrustment decision-making in the clinical workplace. METHODS: Focus groups were conducted with medical and veterinary clinical teachers, using the structured consensus method of the Nominal Group Technique to generate decision variables. A ranking was made based on a relevance score assigned by the clinical teachers to the different decision variables. Field notes, audio recordings and flip chart lists were analyzed and subsequently translated and, as a form of axial coding, merged into one list, combining the decision variables that were similar in their meaning. RESULTS: A list of 11 and 17 decision variables were acknowledged as relevant by the medical and veterinary teacher groups, respectively. The focus groups yielded 21 unique decision variables that were considered relevant to inform readiness to perform a clinical task on a designated level of supervision. The decision variables consisted of skills, generic qualities, characteristics, previous performance or other information. We were able to group the decision variables into five categories: ability, humility, integrity, reliability and adequate exposure. DISCUSSION: To entrust a learner to perform a task at a specific level of supervision, a supervisor needs information to support such a judgement. This trust cannot be credited on a single case at a single moment of assessment, but requires different variables and multiple sources of information. This study provides an overview of decision variables giving evidence to justify the multifactorial process of making an entrustment decision.

Am I ready for it? Students' perceptions of meaningful feedback on entrustable professional activities.

BACKGROUND: Receiving feedback while in the clinical workplace is probably the most frequently voiced desire of students. In clinical learning environments, providing and seeking performance-relevant information is often difficult for both supervisors and students. The use of entrustable professional activities (EPAs) can help to improve student assessment within competency-based education. This study aimed to illustrate what students' perceptions are of meaningful feedback viewed as conducive in preparing for performing EPA unsupervised. METHODS: In a qualitative multicentre study we explored students' perceptions on meaningful feedback related to EPAs in the clinical workplace. Focus groups were conducted in three different healthcare institutes. Based on concepts from the literature, the transcripts were coded, iteratively reduced and displayed. RESULTS: Participants' preferences regarding meaningful feedback on EPAs were quite similar, irrespective of their institution or type of clerkship. Participants explicitly mentioned that feedback on EPAs could come from a variety of sources. Feedback must come from a credible, trustworthy supervisor who knows the student well, be delivered in a safe environment and stress both strengths and points for improvement. The feedback should be provided immediately after the observed activity and include instructions for follow-up. Students would appreciate feedback that refers to their ability to act unsupervised. CONCLUSION: There is abundant literature on how feedback should be provided, and what factors influence how feedback is sought by students. This study showed that students who are training to perform an EPA unsupervised have clear ideas about how, when and from whom feedback should be delivered.