What makes a 'good group'? Exploring the characteristics and performance of undergraduate student groups.

Group work forms the foundation for much of student learning within higher education, and has many educational, social and professional benefits. This study aimed to explore the determinants of success or failure for undergraduate student teams and to define a 'good group' through considering three aspects of group success: the task, the individuals, and the team. We employed a mixed methodology, combining demographic data with qualitative observations and task and peer evaluation scores. We determined associations between group dynamic and behaviour, demographic composition, member personalities and attitudes towards one another, and task success. We also employed a cluster analysis to create a model outlining the attributes of a good small group learning team in veterinary education. This model highlights that student groups differ in measures of their effectiveness as teams, independent of their task performance. On the basis of this, we suggest that groups who achieve high marks in tasks cannot be assumed to have acquired team working skills, and therefore if these are important as a learning outcome, they must be assessed directly alongside the task output.

Assessing and enhancing quality through outcomes-based continuing professional development (CPD): a review of current practice.

Numerous professional bodies have questioned whether traditional input-based continuing professional development (CPD) schemes are effective at measuring genuine learning and improving practice performance and patient health. The most commonly used type of long-established CPD activities, such as conferences, lectures and symposia, have been found to have a limited effect on improving practitioner competence and performance, and no significant effect on patient health outcomes. Additionally, it is thought that the impact of many CPD activities is reduced when they are undertaken in isolation outside of a defined structure of directed learning. In contrast, CPD activities which are interactive, encourage reflection on practice, provide opportunities to practice skills, involve multiple exposures, help practitioners to identify between current performance and a standard to be achieved, and are focused on outcomes, are the most effective at improving practice and patient health outcomes.

What is the veterinary professional identity? Preliminary findings from web-based continuing professional development in veterinary professionalism.

Professionalism and professional skills are increasingly being incorporated into veterinary curricula; however, lack of clarity in defining veterinary professionalism presents a potential challenge for directing course outcomes that are of benefit to the veterinary professional. An online continuing education course in veterinary professionalism was designed to address a deficit in postgraduate support in this area; as part of this course, delegates of varying practice backgrounds participated in online discussions reflecting on the implications of professional skills for their clinical practice. The discussions surrounding the role of the veterinary professional and reflecting on strengths and weaknesses in professional skills were analysed using narrative methodology, which provided an understanding of the defining skills and attributes of the veterinary professional, from the perspectives of those involved (i.e. how vets understood their own career identity). The veterinary surgeon was understood to be an interprofessional team member, who makes clinical decisions in the face of competing stakeholder needs and works in a complex environment comprising multiple and diverse challenges (stress, high emotions, financial issues, work-life balance). It was identified that strategies for accepting fallibility, and those necessary for establishing reasonable expectations of professional behaviour and clinical ability, are poorly developed.

Veterinary team interactions, part 2: the personal effect.

Modern veterinary practices consist of multiple professions/occupations, often spread over multiple branches. Within these teams are identifiable 'key people' who are central to information and resource flow. Key people are frequently the appointed leaders, such as practice managers, but also include emergent leaders. Veterinary surgeons are commonly involved in the flow of higher order interactions such as problem solving, while administrators are often involved in information interactions. These key people are repeatedly boundary spanners, sharing resources across physical boundaries such as branches. Their marginal status (belonging to multiple groups) also allows them to interact across professional boundaries. Lower order interactions including asking for information and advice are often interprofessional; however, higher order interactions tend to be intraprofessional. Analysis of interaction reciprocity between professions demonstrated the prevalence of a profession based hierarchy, with veterinary surgeons at the top. Being social outside of work with a colleague is also linked to work based interactions. The results of this paper demonstrate the need for practices to consider key people and support them appropriately. Further to this, they suggest that, to promote an effective team, interactions should be based on experience as much as professional status, and that social interactions should be encouraged.

Errors in veterinary practice: preliminary lessons for building better veterinary teams.

Case studies in two typical UK veterinary practices were undertaken to explore teamwork, including interprofessional working. Each study involved one week of whole team observation based on practice locations (reception, operating theatre), one week of shadowing six focus individuals (veterinary surgeons, veterinary nurses and administrators) and a final week consisting of semistructured interviews regarding teamwork. Errors emerged as a finding of the study. The definition of errors was inclusive, pertaining to inputs or omitted actions with potential adverse outcomes for patients, clients or the practice. The 40 identified instances could be grouped into clinical errors (dosing/drugs, surgical preparation, lack of follow-up), lost item errors, and most frequently, communication errors (records, procedures, missing face-to-face communication, mistakes within face-to-face communication). The qualitative nature of the study allowed the underlying cause of the errors to be explored. In addition to some individual mistakes, system faults were identified as a major cause of errors. Observed examples and interviews demonstrated several challenges to interprofessional teamworking which may cause errors, including: lack of time, part-time staff leading to frequent handovers, branch differences and individual veterinary surgeon work preferences. Lessons are drawn for building better veterinary teams and implications for Disciplinary Proceedings considered.

Veterinary team interactions, part one: the practice effect.

Veterinary practices have evolved since the era of solo practitioners working on one site. Today veterinary practices tend to include veterinary surgeons, veterinary nurses, receptionists and business managers, leading to the notion of the veterinary team and the rise of interprofessional working. In addition, practices have grown in size and frequently include several branches, creating a distributed team. Research regarding veterinary teamwork is lacking. This paper uses Social Network Analysis (SNA) to address this issue. SNA measures interactions between members of a network. The types of interactions in practice and the effects of practice size and location (branches) are considered. Information sharing and asking for advice are straightforward, lower order interactions. Problem solving and being influenced by another are complex, higher order interactions. Smaller practices have higher densities of interactions, implying a more cohesive team. However, individuals in smaller practices still do not interact with everyone and therefore actively choose with whom to interact. Practices with little staff rotation across branches experience limited interactions across locations. The results of this study have implications for practices aiming to expand their team, either in a single site or by acquiring more branches. Suggestions for ways to maintain and improve interactions are made.

Understanding hind limb lameness signs in horses using simple rigid body mechanics.

Hind limb lameness detection in horses relies on the identification of movement asymmetry which can be based on multiple pelvic landmarks. This study explains the poorly understood relationship between hind limb lameness pointers, related to the tubera coxae and sacrum, based on experimental data in context of a simple rigid body model. Vertical displacement of tubera coxae and sacrum was quantified experimentally in 107 horses with varying lameness degrees. A geometrical rigid-body model of pelvis movement during lameness was created in Matlab. Several asymmetry measures were calculated and contrasted. Results showed that model predictions for tubera coxae asymmetry during lameness matched experimental observations closely. Asymmetry for sacrum and comparative tubera coxae movement showed a strong association both empirically (R(2)≥ 0.92) and theoretically. We did not find empirical or theoretical evidence for a systematic, pronounced adaptation in the pelvic rotation pattern with increasing lameness. The model showed that the overall range of movement between tubera coxae does not allow the appreciation of asymmetry changes beyond mild lameness. When evaluating movement relative to the stride cycle we did find empirical evidence for asymmetry being slightly more visible when comparing tubera coxae amplitudes rather than sacrum amplitudes, although variation exists for mild lameness. In conclusion, the rigidity of the equine pelvis results in tightly linked movement trajectories of different pelvic landmarks. The model allows the explanation of empirical observations in the context of the underlying mechanics, helping the identification of potentially limited assessment choices when evaluating gait.

Continuing professional development: learning that leads to change in individual and collective clinical practice.

The lack of effectiveness of traditional models of continuing professional development is increasingly recognised. While they can lead to increased knowledge of participants, research suggests that there is a general failure to produce meaningful and sustained changes in clinician behaviours. The aim of this study was to explore the effect of the Royal College of Veterinary Surgeons' (RCVS) new individual outcomes-focused approach to delivery of continuing professional development (CPD) through the reflective accounts of participant experiences. Content analysis of 12 summaries of their learning, produced by early pioneers of the Professional Key Skills (PKS) Module of the RCVS Certificate in Advanced Veterinary Practice, revealed that the benefits of the PKS-related professional development is best understood through 'a framework of 'stakeholder' dynamics', with impact and behavioural change at the individual participant level having an effect on practice team behaviours, leading to patient, owner and business benefits. It can be concluded that, at least for these early pioneers, this new model for CPD has resulted in changes that have gone beyond knowledge accumulation to changed practitioner behaviours and recognisable patient, owner and business benefits.

Motivating factors and perceived barriers to participating in continuing professional development: a national survey of veterinary surgeons.

Although continuing professional development (CPD) is regarded as mandatory by the Royal College of Veterinary Surgeons, it is not yet a statutory requirement. To understand what motivates veterinary surgeons to engage in CPD and perceived barriers to participation, a national survey was administered to a sample of the profession. The study sought to report overall opinion and to compare the views of different groups in terms of decade of graduation, gender, employment status, area of employment and position in the workplace. The results of the study are encouraging in that recent graduates would like to engage in more CPD, compared with their predecessors, and are the most intrinsically and extrinsically motivated. However, significant barriers to participation exist, including personal barriers, a lack of workplace support and a lack of CPD activities at a suitable time, location or level. Part-time workers reported higher barriers than full-time workers. Although the majority (90 per cent) of respondents receive all or part of their CPD funding from employers, a significant proportion (41 per cent) are required to fund at least part of their CPD. First-opinion practitioners reported significantly less access to a professional library, which has implications for lifelong learning and the practice of evidence-based veterinary medicine.

Veterinary career ambitions correlate with gender and past experience, with current experience influencing curricular perspectives.

The Royal Veterinary College's 'Teaching Quality Survey' was completed by 261 recent graduates (six months after graduation) from 2005 to 2011 (26.8 per cent response rate). The results were used to compare veterinarians' background information with current position and career ambition, and to investigate perceptions of curriculum balance. There was a significant difference between males' and females' current positions and career ambitions with comparatively lower percentages of females in farm animal and farm and equine practices. There was also a significant difference between individuals from different childhood areas; individuals from urban areas preferred small animal practice, in comparison to those from rural areas who are more likely to choose farm animal practices. Compared with their peers, individuals engaged in a specific area of work tend to think that their area was under-represented in the professional curriculum. Taken alongside the feminisation and urbanisation of the profession, the results of this study indicate that food animal careers need to be promoted as an attractive option for new graduates and those going into mixed practice initially. Also, those involved in curriculum design using graduate surveys should take into account the current careers of the respondents in order to avoid biased results.

Views of professionalism: a veterinary institutional perspective.

In many western countries, there has been a marked change in the demographic profile of those entering the veterinary profession, with a shift from a predominantly male to a predominantly female intake. There have been parallel changes in society, with greater emphasis on human rights and work-life balance. It is, therefore, timely to consider what constitutes correct professional conduct for the profession, as there is the potential for problems to arise over the interpretation of 'professionalism' due to cultural and generational differences. A cross-section of staff and students within one veterinary institution were invited to take part in a survey exploring their prioritisation of 10 aspects of the professional role. A cluster analysis was performed, and four distinctly different profiles were established according to the views held by the cluster members. Cluster membership was found to significantly correlate to career stage, with altruism and social justice progressively giving way to professional autonomy and dominance. All four clusters in this educational environment prioritised technical and interpersonal competences above all other aspects of the professional role.

Care and Justice orientations to moral decision making in veterinary students.

An adapted version of the Moral Justification Scale was used to assess moral decision-making orientation in veterinary students, comparing sex and year of study. The Scale consists of vignettes and related statements, each of which was classified as Justice, Care for People or Care for Animals. The importance of each statement in the decision-making process was rated by 204 students on a 10-point Likert Scale. An average score of importance for Justice, Care for People and Care for Animals related statements were calculated for each individual. General inclination scores were calculated by subtracting an individual's average Care score from their average Justice score. Inclination scores suggested that two-thirds of students have a balanced approach, using Justice and Care almost equally in approaching ethical dilemmas. The majority of students, however, show an overall Justice orientation. The attitude towards the importance of Justice did not vary between students of different years or sexes. Students' attitudes towards the importance of Care for People in their decision making were, however, significantly lower for final-year students. Reasons hypothesised include the start of placements. Care for Animals scores were affected by sex, whereby females give more importance to such statements than males.

Attitudes to animal euthanasia do not correlate with acceptance of human euthanasia or suicide.

Several reasons have been suggested for the elevated risk of suicide experienced by those in the veterinary profession. The current study aimed to investigate possible links between veterinarians' attitudes to 'convenience' or non-justified animal euthanasia and attitudes towards human euthanasia and suicide. Veterinary students and graduates had a negative attitude towards convenience animal euthanasia, but their attitudes changed over time (pre-clinical studies, clinical studies and recently graduated). A greater tolerance to euthanasia was displayed in the later years of study and post qualification - primarily by males. Attitudes towards both human euthanasia and suicide, however, remained stable over time and indicated on average a neutral stance. No correlations were found between attitudes to convenience euthanasia and either human euthanasia or suicide, suggesting a tolerance to convenience euthanasia of animals does not lead to desensitisation in valuing human life and a changed attitude to human euthanasia or suicide, or vice versa. Attitudes to human euthanasia and suicide were predictably correlated, perhaps suggesting an overarching attitude towards control over human death. The results of the current study throw into question the argument that it is the changes in attitudes to animal life that affect veterinarian's attitudes to human life and contribute to the high suicide rate.

Proximal hindlimb flexion in the horse: effect on movement symmetry and implications for defining soundness.

REASONS FOR PERFORMING THE STUDY: Flexion tests are a common tool during the prepurchase and clinical lameness examination, yet studies quantifying the effect of flexion, apart from distal forelimb flexion in sound horses, are sparse. OBJECTIVES: To investigate the effect of proximal hindlimb flexion on perceivable and measurable changes in movement symmetry in horses with objective movement symmetry falling within the margins of 'sound'. METHODS: Thirteen horses, selected based on objective movement symmetry, were instrumented with inertial sensors on left and right tuber coxae and over the os sacrum. Vertical movement symmetry was quantified at trot before and after proximal hindlimb flexion, with a repeat of flexion after 5 min. Video recordings of the horses were assessed visually. RESULTS: Proximal hindlimb flexion introduced additive changes in movement symmetry to the individual baseline movement, with a tendency towards smaller effects with increasing stride number. The main systematic effect was a decrease in upward movement of the os sacrum following mid-stance of the flexed limb and an increase in upward movement following mid-stance of the nonflexed limb, also manifesting in a 'hip hike' of the flexed limb; these findings reflected increased movement asymmetry following flexion. Depending on individual baseline asymmetry, flexion can also increase movement symmetry. CONCLUSIONS: Proximal hindlimb flexion can exacerbate subtle asymmetry when performed carefully. Variation in measured symmetry following flexion within and between horses showed that the individual response to flexion is highly variable. POTENTIAL RELEVANCE: Proximal hindlimb flexion may elevate the asymmetry of a slightly lame limb above the threshold for visibility, thus assisting in the clinical gait examination. Further work is needed to examine the causes for a positive response to flexion and possible differences between sound and lame horses as well as horses of different athletic disciplines.

Web 2.0 and the veterinary profession: current trends and future implications for lifelong learning.

The NOVICE project is an EU initiative under the Lifelong Learning Programme, which aims to develop an online, professional network to promote informal, lifelong learning within the veterinary profession, using Web 2.0 tools. To inform the development of the network, a need analysis study was undertaken with relevant stakeholders. Focus group discussions were undertaken with veterinary students and veterinarians and a survey was administered to first-year students and recent graduates. The results indicate that use of computers and the internet is ubiquitous among junior members of the profession and that use of Web 2.0 tools is increasing. Concerns raised in relation to participation in online communities include verifying the quality of information and issues around professionalism. Compared with face-to-face communities, online communities were perceived to offer a number of advantages. These include convenient access to expert advice on an international scale, as well as helping to alleviate certain barriers to participation in formal, continuing education such as time, distance and cost.

Influences on the decision to study veterinary medicine: variation with sex and background.

A questionnaire was developed to look at attitudes to veterinary medicine as a career choice among students at different stages of the veterinary course at the Royal Veterinary College. Traditional-entry first-year and final-year students, as well as entry-level 'Gateway' (widening participation) students, were invited to participate. Wanting to work with animals and exposure to a veterinary role model through taking a sick animal to visit a veterinary surgeon appeared to be major factors in choosing a veterinary career for all undergraduates, regardless of their socioeconomic background. Overall, women were more strongly influenced by owning animals (P=0.014), and men were more positively influenced by the challenging reputation of the course (P=0.028). When the students were asked to indicate their top three reasons for wanting to become a vet, men were 9.5 times as likely as women to select 'Want to train as a scientist', 5.3 times as likely to select 'Join a profession' and 13.2 times as likely to select 'Hardest course to get in to'; the top choice for both sexes was 'Want to work with animals'. Thirty-one per cent of the students felt their careers adviser had been a negative influence on their decision to become a vet.

Veterinary students' understanding of a career in practice.

Lack of a clear perception of the realities of a career in veterinary medicine could adversely affect young graduates' satisfaction with the profession and their long-term commitment to it. Veterinary students' understanding of a career in practice were explored. Traditional-entry first-year and final-year students, as well as entry-level 'Gateway' (widening participation) students, were invited to complete a questionnaire exploring their pre-university experiences and their understandings of a career in general practice. Broadly speaking, the undergraduate students taking part in the survey (the majority of whom were entry-level students) had a realistic view of average weekly working hours, out-of-hours duties and the development of their remuneration packages over the course of their careers. The main attractions of the profession were working with animals and the perception of a rewarding job. The main concerns were making mistakes and balancing work and home life. The vast majority of students wanted to pursue a career in general practice, and other career opportunities did not appear to be well understood, particularly by entry-level students.

Intra- and interobserver agreement in the interpretation of navicular bones on radiographs and computed tomography scans.

REASONS FOR PERFORMING STUDY: Criteria for the radiographic evaluation of navicular bones in horses have been published to standardise classification of radiographic signs. However, intra- and interobserver agreement have not been established. OBJECTIVE: To determine intra- and interobserver agreement in the evaluation of radiographic and computed tomographic (CT) navicular changes. It was hypothesised that: 1) intraobserver agreement would be better than interobserver agreement; 2) agreement would be better for CT than for radiography; and 3) pathological changes would be recognised with greater certainty with CT. METHODS: Radiographs and CT scans of 60 cadaver navicular bones were evaluated by 3 observers using published criteria. A subset of 30 studies was evaluated twice by one observer. Agreement was tested using the kappa statistic. Certainty about pathological changes was evaluated by giving the observers the option to choose 'not sure'. RESULTS: Agreement varied from poor to almost perfect for radiographic evaluation and from poor to substantial for CT evaluation. For radiographic evaluation mean interobserver agreement was fair, as it was for CT evaluation. For radiographic evaluation mean intraobserver agreement was moderate as it was for CT evaluation. Pathological changes were evaluated with greater certainty on CT scans compared to radiographs; however, this was not associated with improved agreement. CONCLUSIONS: Variations in classification of navicular lesions in radiographic and CT studies were considerable between and within observers and challenge the use of such studies for diagnostic and prognostic purposes. POTENTIAL RELEVANCE: The results of this study allowed the identification of evaluation criteria with sufficient precision to be useful for navicular bone evaluation.

Approaches to defining day-one competency: a framework for learning veterinary skills.

Competency at graduation, in a variety of physical and attitudinal skills, is an essential outcome measure for courses training veterinary surgeons. The approach adopted by the Royal Veterinary College, London, to identify and define the expected skill competencies required of our veterinary undergraduates by the time of graduation is described. In addition, we demonstrate how this skill set was built into a framework that was aligned with other student learning objectives. This two-year project resulted in the publication of a day-one skills handbook, which was introduced to the college staff and students in 2007.

Accuracy of non-invasive ICP assessment can be increased by an initial individual calibration.

OBJECTIVE: In a formerly introduced mathematical model, intracranial pressure (ICP) could be non-invasively assessed using cerebral blood flow velocity (FV) and arterial blood pressure (ABP). The current study attempts to check whether the accuracy of the non-invasive ICP assessment (nICP) improves after an initial individual calibration by implanted ICP probes. METHODS: Thirteen patients with brain lesions (35-77 years, mean: 58 +/- 13 years) were studied. FV, ABP and ICP signals were recorded at days 1, 2, 4 and 7. nICP was calculated and compared to ICP. In the first recording of each patient the (invasively assessed) ICP signal was used to calibrate the nICP calculation procedure, while the follow-up recordings were used for its validation. FINDINGS: In 11 patients 22 follow-up recordings were performed. The mean deviation between ICP and the original nICP (+/- SD) was 8.3 +/- 7.9 mmHg. Using the calibrated method this deviation was reduced to 6.7 +/- 6.7 mmHg (P < 0.005). CONCLUSIONS: Initial individual calibration of nICP assessment method significantly improves the accuracy of nICP estimation on subsequent days. This hybrid method of ICP assessment may be used in intensive care units in patients with initially implanted ICP probes. After removal of the probes, ICP monitoring can be continued using the calibrated nICP assessment procedure.