A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 1: demographic and work-related factors.

Occupational stressors are commonly encountered in small animal veterinary practice and have been associated with burnout. The working context of veterinarians differs by specialty, and this can potentially lead to variable exposures to risk factors for burnout. The aim of this study was to explore differences in demographic and working conditions of veterinary general practitioners (GPs) and emergency practitioners (EPs) to compare exposure to different potential stressors. An anonymous, online survey was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 participant responses were analyzed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Significant differences (P < 0.05) in the demographics and work-related exposures were found between the two groups. GPs were found to be older than EPs with a greater number of years of experience in their field (P < 0.001). Most veterinary GPs worked only day shifts (207/236, 87.7%); where EPs worked a greater variety of shift patterns, with "only day shifts" being the least common shift pattern (P < 0.001). Most GPs worked a set and predictable roster pattern (195/236, 83.6%), while most EPs did not (51/83, 61.5%). EPs worked more weekends and public holidays (P < 0.001). The EP group performed more hours of work each week but worked less overtime. The main contributing factors for overtime were scheduling factors for GPs and staffing issues for EPs. EPs were commonly not able to take meal-breaks and GPs' meal-breaks were commonly interrupted by work. EPs were more frequently exposed to patient death, euthanasia (including for financial reasons), emotionally distressed clients and delivering negative news (P < 0.001). Both groups indicated that most work environments were collegiate and supportive, and a minority reported toxic colleagues (11.8%) or management teams (26.9%). Just under one-half of respondents reported having witnessed or experienced workplace bullying. Of our respondent group, 52.0% (166/319) were not satisfied with their remuneration. Desire to leave their principal area of practice was prevalent among this survey group (192/319, 60.2%) with approximately one-third considering leaving the veterinary profession. We discuss the implications of these workplace factors, including mitigation strategies.

A comparison between veterinary small animal general practitioners and emergency practitioners in Australia. Part 2: client-related, work-related, and personal burnout.

Burnout is reported to be common among veterinarians. However, there is limited research investigating the relationship between specific types of veterinary practice and burnout. A previous study found significant differences in work exposures between veterinary general practitioners (GPs) and emergency practitioners (EPs). The primary aim of this study was to investigate whether Australian veterinary EPs suffer from a higher level of burnout compared to veterinary GPs. The secondary aim of this study was to explore if the previously reported differences between GP and EP groups were positively associated with burnout. An anonymous, online survey incorporating the Copenhagen Burnout Inventory (CBI) was administered to veterinary GPs and EPs practicing in metropolitan regions of Australia. In total, 320 responses were analysed (n = 237, 74.2% GPs and n = 83, 25.9% EPs). Both groups suffered from moderate levels of burnout, but there were no significant differences in the severity of CBI burnout scores between the two groups. From the multivariable analysis four investigated factors were found to be significantly associated (p < 0.05) with the work-related CBI subscale: frequency of finishing work on time; adequate staffing; work satisfaction and seriously considering leaving their principal area of practice. Five factors were significantly associated (p < 0.05) with the client-related CBI subscale: position in practice; frequency of client adherence; work satisfaction; frequency of interacting with emotionally distressed clients and seriously considering leaving their principal area of practice. Four factors were significantly associated (p < 0.05) with the personal burnout CBI subscale: gender; seriously considering leaving their principal area of practice; frequency of interacting with emotionally distressed clients and the workplace environment. The total burnout score was also significantly associated (p < 0.05) with four factors: position in practice, workplace environment, appropriate staffing in the past week and client adherence. Future studies should focus on investigating effective strategies to mitigate these risk factors for both GPs and EPs, to reduce career attrition.

The moral deliberation pathway in veterinary practice: a qualitative study.

BACKGROUND: Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised. METHODS: Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians. RESULTS: The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort. LIMITATIONS: Self-selection of participants and possible recollection bias may have biased the findings. CONCLUSIONS: The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.

Why do veterinarians leave clinical practice? A qualitative study using thematic analysis.

BACKGROUND: Veterinarians have an important role in society and having an adequate veterinary workforce is important not only for their communities but also nationwide. Lately, there have been anecdotal reports regarding veterinary practices struggling to find clinicians as well as evidence of mental ill-health in veterinarians. Furthermore, the Australian Veterinary Association annual workforce survey shows an increased percentage of veterinarians intending to leave practice from 2017 to 2019. Although many factors for attrition have been described in other professions, reasons for veterinarians to leave practice are not well understood. METHODS: This study investigated why veterinary clinicians leave clinical practice by using Thematic Analysis to analyse 26 semi-structured interviews of former veterinary clinicians in relation to their work experiences and reasons for leaving. Interviews were done from February-April 2018 either face to face, via teleconferencing, or telephone. Participants were recruited from each Australian state except for New South Wales. RESULTS: The results showed that a combination of personal and work-related factors influenced the participants to leave clinical practice. In Personal Factors, participants described the internal and external circumstances that impacted on their personal lives such as personal relationships, experiencing negative thoughts and emotions, physical and mental health, core motivations and beliefs, alternative professional and personal interests. On the other hand, Work Experiences described situations, experiences, and statements directly related to the participant's veterinary clinical work such as workplace relationships, employment conditions including remuneration and working hours and clinical experiences such as negative clinical outcomes. Furthermore, interlinkages between these two themes were revealed in participants' responses. CONCLUSION: This study highlights factors that contribute to attrition from veterinary clinical practice. The narrative indicates that the interlinking of such factors influenced the decision-making process to leave clinical practice in this cohort of former veterinary clinicians. Further research is required to understand the full implications for veterinary clinical practice and inform intervention strategies for retention.

Employability as a Guiding Outcome in Veterinary Education: Findings of the VetSet2Go Project.

This paper presents a mini-review of employability as a guiding outcome in veterinary education-its conceptualisation, utility, core elements and dimensions, and pedagogical approaches-through a summary of the findings of a major international project with the same aims (the VetSet2Go project). Guided by a conception of the successful veterinary professional as one capable of navigating and sustainably balancing the (sometimes competing) needs and expectations of multiple stakeholders, the project integrated multiple sources of evidence to derive an employability framework representing the dimensions and capabilities most important to veterinary professional success. This framework provides a useful complement to those based in narrower views of competency and professionalism. One notable difference is its added emphasis on broad success outcomes of satisfaction and sustainability as well as task-oriented efficacy, thus inserting "the self" as a major stakeholder and bringing attention to resilience and sustainable well-being. The framework contains 18 key capabilities consistently identified as important to employability in the veterinary context, aligned to five broad, overlapping domains: veterinary capabilities (task-oriented work performance), effective relationships (approaches to others), professional commitment (approaches to work and the broader professional "mission"), psychological resources (approaches to self), plus a central process of reflective self-awareness and identity formation. A summary of evidence supporting these is presented, as well as recommendations for situating, developing, and accessing these as learning outcomes within veterinary curricula. Though developed within the specific context of veterinarian transition-to-practise, this framework would be readily adaptable to other professions, particularly in other health disciplines.

Resilience of veterinarians at different career stages: The role of self-efficacy, coping strategies and personal resources for resilience in veterinary practice.

BACKGROUND: The aim of this study was to determine the effect of demographic and psychological factors on resilience in new graduate-, mid- and late-career veterinarians working in Australia. METHOD: An online cross-sectional survey of 800 veterinarians collected demographic and descriptive data in two stages from late 2015 to 2017, such as gender, average hours worked per week, type and region of practice and intention to leave veterinary medicine. Psychological factors were measured utilising the Brief Resilience Scale, the Veterinary Resilience Scale-Personal Resources, the Brief COPE and General Self-Efficacy measures. RESULTS: Using a full-factorial univariate General Linear Model, no significant difference in general resilience was evident between the three career-stage groups (p > 0.05). However, higher self-efficacy, higher personal resources for resilience in veterinary practice, and lower problem-focused, higher emotion-focused and lower dysfunctional coping strategies were related to higher resilience. In the model for mid- and late-career veterinarians, a weak positive relationship existed between higher average hours worked per week and higher resilience, while intention to leave veterinary practice was also related to lower resilience in mid- and late-career veterinarians. CONCLUSION: This study supports the value of personal resources, rather than career stage, gender or region of work, as influential in developing veterinarian resilience.

Is veterinary work more than satisfying? A critical review of the literature.

Despite the rise of positive psychology in recent times, research continues to emphasise the risks and negative outcomes associated with veterinary work. Understanding these challenges and risks is imperative in helping those affected and preventing or limiting exposure for future veterinarians. However, it is vital that positive factors associated with their well-being are concomitantly addressed. Drawing on an organisational psychology perspective and associated theories, this review critically analyses the literature on veterinary well-being, job satisfaction and the role of positive emotions at work. This perspective prompts a call to researchers to investigate the positive aspects of veterinary work and offers many suggestions for future research and associated implications. Drawing on an extensive evidence base of research pertaining to positive emotions and well-being in veterinarians, the development, implementation and validation of workplace interventions should follow. The veterinary profession is a highly rewarding one and a focus on pleasure in veterinary work and ways to encourage this, will only help veterinarians flourish and help to promote the profession in the way it deserves.

Sources of pleasure in veterinary work: A qualitative study.

BACKGROUND: Despite the rise in positive psychology within organisational settings, less is known about the positive factors associated with veterinary work and veterinarian well-being. This qualitative study investigated sources of pleasure for veterinarians. METHOD: A subset of archival data from a larger study on veterinary well-being was analysed. The current study was based on data from 273 veterinarians responding to a Ten Statements Test (TST) and demographic questions. In the TST, participants provided up to 10 responses to the prompt, 'I derive pleasure in my work as a veterinarian when…'. RESULTS: Using the job demands-resources model as a framework, a total of 2536 responses were manually coded into themes relating to resources (positive responses) or demands (responses indicating a negative factor). In order of frequency, job resources are related to professional expertise (22%), positive outcomes (20%), job characteristics (19%), relationships (16%), recognition (10%), helping (7%) and personal resources (3%). Top job demands are related to stress and fatigue (17%) and poor work-life balance (16%). CONCLUSION: The results suggest that there are an abundance of positive factors in veterinary work associated with feelings of pleasure, which may support veterinarian well-being.

Mental Health Disease or Preventable Problem? Australian Dog Trainers' Opinions about Canine Separation Anxiety Differ with Training Style.

Separation anxiety is common. Many dog owners do not seek help from a veterinarian but might consult a trainer. The objective of this study was to investigate Australian trainers' opinions about separation anxiety. An online survey was distributed via training organisations, resulting in 63 completed surveys. Descriptive statistics and Fisher's exact tests were applied. Respondents were grouped into reward-based (n = 41) and balanced (n = 22) trainers. Most trainers (82.5%) used multiple methods to identify separation anxiety but only 7.9% referred to a veterinarian for diagnosis. Reward-based trainers ranked assistance from a veterinarian and owner's willingness to try medication as more important than balanced trainers (p < 0.05). More balanced trainers reported that medication was rarely necessary in the cases they saw: 50% balanced compared with 4.9% reward-based trainers, with 95% CIs of [28.2, 71.8] and [0.6, 16.5], respectively. Almost all (95.5%) balanced trainers believed separation anxiety was preventable compared with 52.6% of reward-based trainers (p < 0.05). We conclude that opinions about separation anxiety varied between reward-based and balanced trainers. Trainers are not taught, expected, or legally allowed to diagnose anxiety disorders. This study showed that balanced trainers were less likely to recommend involvement of veterinarians who can make a diagnosis and rule out other causes of observed behaviours.

Development and validation of a contextualised measure of resilience in veterinary practice: the Veterinary Resilience Scale-Personal Resources (VRS-PR).

BACKGROUND: This article reports on the development and validation of a contextualised measure of personal resources for resilience in veterinary practice. METHODS: Exploratory factor analysis and structural equation modelling were used to evaluate data from two surveys of veterinary practitioners. RESULTS: Exploratory factor analysis of the first survey (n=300) revealed six items comprising the Veterinary Resilience Scale-Personal Resources (VRS-PR). These items focused on flexibility, adaptability, optimism, building strengths, enjoying challenges, and maintaining motivation and enthusiasm at work. Structural equation modelling using the second survey (n=744) confirmed the factor structure of the VRS-PR and established convergent validity with an established measure of general resilience, the Brief Resilience Scale. Examination of the mean and standard deviation of the combined survey data enabled scores on the VRS-PR to be provisionally classified into 'low', 'moderate' and 'high' (reported by approximately 13%, 72% and 15% of respondents, respectively). Respondents also reported results spanning 'low', 'moderate' and 'high' classifications for the Brief Resilience Scale (approximately 34%, 57% and 9%, respectively). CONCLUSION: The VRS-PR may be used to evaluate the extent to which respondents draw upon the personal resources captured in the scale and identify areas for improvement.

Challenging identity: development of a measure of veterinary career motivations.

BACKGROUND: While little is known about the motivations underpinning veterinary work, previous literature has suggested that the main influences on veterinary career choice are early/formative exposure to animals or veterinary role models. The aim of this study was to develop and provisionally validate a veterinary career motivations questionnaire to assess the strength of various types of career motivations in graduating and experienced veterinarians. METHODS: A cross-sectional sample of experienced veterinarians (n=305) and a smaller cohort of newly graduated veterinarians (n=53) were surveyed online using a long-form questionnaire. Exploratory factor analysis (EFA) was used to iteratively derive a final, short-form questionnaire for survey of a second cross-sectional sample of experienced veterinarians (n=751). RESULTS: EFA derived a final questionnaire with 22 items loading onto six factors (social purpose, animal orientation, vocational identity, challenge and learning, career affordances, and people orientation). While motivations based on animal orientation were predictably strong, those based on vocational identity were not universal and were weaker in younger and graduate veterinarians; both of these motivations were rated lower by male veterinarians. Motivations based on challenge and learning emerged as some of the strongest, most universal and most influential; people orientation and social purpose were also important, particularly for older veterinarians. CONCLUSION: The major motivations for pursuing a veterinary career may best be represented as an intrinsic passion for animal care and for learning through solving varied challenges. These motivations are largely intrinsically oriented and autonomously regulated, thus likely to be supportive of work satisfaction and wellbeing.

An Exploration of the Career Motivations Stated by Early-Career Veterinarians in Australia.

Despite the critical influence of motivation on education and work outcomes, little is known about the motivations driving people to become and remain veterinarians. This qualitative study explored the career motivations stated by Australian veterinary graduates (n = 43) using a free-response Ten Statements Test (TST) at graduation, with follow-up interviews 6-8 months later (n = 10). TST responses were coded using an alternate inductive-deductive approach that tested their fit against existing theories of motivation. Results showed that the stated motivations were predominantly oriented to perceived value, rather than self-beliefs such as expectancy of success. About a quarter of the statements were animal-related, principally themed around intrinsic animal orientation (e.g., I like animals) or extrinsic animal-related purpose (e.g., I want to help animals). However, many non-animal themes also emerged, including both intrinsic (e.g., love of learning, challenge/problem solving, variety, social relatedness) and extrinsic (e.g., helping people, social contribution, career opportunity) motivations. Interview data revealed a motivational narrative of early formative influences, with some interviewees describing a later transition toward more people- or goal-oriented motivations. This exploratory study, outlining a broad taxonomy of veterinary career motivations and their alignment to self-determination theory in particular, may provide a useful framework for exploring career motivations in veterinary education.

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.

Investigating risk factors that predict a dog's fear during veterinary consultations.

Attending the veterinary clinic is an integral part of the physical welfare of every companion dog. However, some dogs experience their veterinary visits negatively, which poses a risk of injury to the veterinary staff, their guardian (owner) and themselves. It may also influence the regularity of non-urgent veterinary appointments. To date there have been conflicting reports relating to the proportion of dogs that show fear during their veterinary visits. In this study, we explored the risk factors associated with fear during veterinary examination and in novel situations (including first time at the veterinary clinic) from 26,555 responses in the Canine Behavioral Assessment and Research Questionnaire database. According to their guardians, 41% of companion dogs displayed mild to moderate fearful behaviour when examined by a veterinarian, and 14% exhibited severe or extreme fear. A similar trend was observed with dogs responding fearfully when in unfamiliar situations, including the dog's first time at the veterinary clinic. Chi-squared tests showed every bivariate relationship between fear and the environmental and demographic factors measured was significant (p < 0.05). The most important predictors of fear in a veterinary examination were, in order: the dog's breed group (27.1%), their history of roles or activities (16.7%), where they were sourced (15.2%), their weight (12%), the age of other dogs in the household (9.5%) and dog owner experience (6.3%). However, combined these risk factors only explain a total of 7% of variance of fear observed during veterinary examination. This suggests that fear exhibited during veterinary visits is common in dogs, but that the environment or human-animal interactions are likely to contribute more to prevalence and severity of this problem than the demographic factors measured here. We conclude by highlighting opportunities for future research aimed at facilitating less stressful veterinary visits for dogs and their guardians.

Cross-sectional analysis of veterinary student coping strategies and stigma in seeking psychological help.

Veterinary education can result in high levels of academic stressors for students. Students are also susceptible to non-academic stressors, including relationship issues and financial concerns. These can all result in mental ill health, which may impair the student's ability to complete their studies and go on to a successful professional career. Finding and using strategies early on to help alleviate mental health problems is critical to successful management of these problems, but seeking help may be impeded by the stigma associated with mental health problems. Using a cross-sectional online survey of a sample of Australian veterinary students, the aim of the current study was to investigate the type and frequency of their coping strategies as well as to explore relationships between self-stigma and coping strategies. Female veterinary students reported more use of instrumental and emotional support as coping strategies, while male veterinary students demonstrated more use of humour. Self-stigma was related to less instrumental support, greater self-blame and gender, while males who employed more humour as a coping strategy reported more self-stigma. Improving the coping strategies of veterinary students and reducing the self-stigma surrounding mental ill health is important to improve the wellbeing and resilience of the veterinary profession.

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.

Finding the Balance: Uncovering Resilience in the Veterinary Literature.

Resilience is an issue of emerging importance in veterinary education and research, as in other professional contexts. The aim of this study was to perform an appraisal of how resilience is portrayed in the contemporary (1995-present) research and education literature around veterinary mental health, and to attempt a provisional synthesis informing a conception of resilience in the veterinary context. Qualitative analysis of the literature (59 sources included) revealed a dominant emphasis on mental health problems, particularly stress, which outweighs and potentially obscures complementary approaches to well-being and resilience. We found the construct of resilience underdeveloped in the veterinary literature and in need of further research, but provide a preliminary synthesis of key themes emerging from the current literature (emotional competence, motivation, personal resources, social support, organizational culture, life balance, and well-being strategies). We advocate for greater balance between complementary perspectives in veterinary mental health education and research, and propose that an increasing focus on resilience (here endorsed as a dynamic and multi-dimensional process involving personal and contextual resources, strategies, and outcomes) will help to address this balance.

The Prevalence of Compassion Fatigue among Veterinary Students in Australia and the Associated Psychological Factors.

Compassion fatigue, compassion satisfaction, and other characteristics such as mindfulness and mental health stigma have not been investigated in veterinary students. The aims of this study were twofold: first to determine the prevalence of compassion, satisfaction, burnout, and secondary traumatic stress among Australian veterinary students and second to investigate the association between these factors and self-stigma, coping, empathy, and mindfulness. A cross-sectional online survey consisting of demographic questions and four validated psychological measures sampled 828 students, with a response rate of 31% (255/828). We obtained a usable sample of completed surveys from 193 of 828 (23%) veterinary students from six of the seven Australian veterinary schools. Bivariate correlations and multiple regression analyses were used to examine associations between the psychological predictors and the outcome variables. Approximately 30% of veterinary students were at high risk of burnout, 24% were at high risk of secondary traumatic stress, and 21% reported low compassion satisfaction. High empathic concern, low personal distress, female gender, and employment history at a veterinary clinic were associated with high compassion satisfaction. High dysfunctional coping, low nonjudgmental and acting-with-awareness mindfulness, and lack of previous employment at a veterinary clinic were associated with high burnout. High dysfunctional coping, low acting-with-awareness mindfulness, high self-stigma, and high personal distress were associated with high secondary traumatic stress. As a result of these findings, certain emotional characteristics can be identified as targets for intervention to minimize the frequency and potentially negative impact of compassion fatigue and burnout in veterinary students.

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.