Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study.

BACKGROUND: The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences. METHODS: A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests. RESULTS: 'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher). LIMITATIONS: Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution. CONCLUSION: There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Rating and ranking preparedness characteristics important for veterinary workplace clinical training: a novel application of pairwise comparisons and the Elo algorithm.

Quantitatively eliciting perspectives about a large number of similar entities (such as a list of competences) is a challenge for researchers in health professions education (HPE). Traditional survey methods may include using Likert items. However, a Likert item approach that generates absolute ratings of the entities may suffer from the "ceiling effect," as ratings cluster at one end of the scale. This impacts on researchers' ability to detect differences in ratings between the entities themselves and between respondent groups. This paper describes the use of pairwise comparison (this or that?) questions and a novel application of the Elo algorithm to generate relative ratings and rankings of a large number of entities, on a unidimensional scale. A study assessing the relative importance of 91 student "preparedness characteristics" for veterinary workplace clinical training (WCT) is presented as an example of this method in action. The Elo algorithm uses pairwise comparison responses to generate an importance rating for each preparedness characteristic on a scale from zero to one. This is continuous data with measurement variability which, by definition, spans an entire spectrum and is not susceptible to the ceiling effect. The output should allow for the detection of differences in perspectives between groups of survey respondents (such as students and workplace supervisors) which Likert ratings may be insensitive to. Additional advantages of the pairwise comparisons are their low susceptibility to systematic bias and measurement error, they can be quicker and arguably more engaging to complete than Likert items, and they should carry a low cognitive load for respondents. Methods for evaluating the validity and reliability of this survey design are also described. This paper presents a method that holds great potential for a diverse range of applications in HPE research. In the pursuit quantifying perspectives on survey items which are measured on a relative basis and a unidimensional scale (e.g., importance, priority, probability), this method is likely to be a valuable option.

A Survey-Based Study Into the Use of Peripheral Nerve Blocks for Pelvic Limb Surgery Among Veterinary Professionals With an Interest in Anesthesia.

Peripheral nerve blocks are commonly recommended as perioperative analgesia for orthopedic procedures. We aimed to determine the prevalence of use of techniques and drugs among veterinary professionals with an interest in anesthesia. Veterinary professionals were contacted via an email (ACVA-list) and newsletter (Association of Veterinary Anesthetists) containing a link to an online survey. Surveys completed in full were used for analysis. Analysis found that peripheral nerve blocks (PNBs) and epidural analgesia techniques were the preferred techniques of 46% and 38% of individuals, respectively. Of those using PNBs, nerve stimulator techniques were most common, used by 72% of individuals. Bupivacaine was used by 71% of individuals. Adjuvants were used by 37% of respondents; most commonly an alpha-2 agonist. Severe adverse effects were reported by 11 respondents, while 49% of individuals had not witnessed any adverse effects. More experienced veterinary anesthetists (>100 blocks performed) were more likely to have seen adverse effects. In conclusion, PNBs are utilized by anesthetists for pelvic limb orthopedic surgery, with nerve stimulation being the most commonly used PNB technique. Bupivacaine was the most commonly used local anesthetic however, diversity in both the techniques and drugs used was evident among respondents.

Comparison of arterial blood pressure measurements obtained invasively or oscillometrically using a Datex S/5 Compact monitor in anaesthetised adult horses.

OBJECTIVE: To assess agreement between noninvasive blood pressure (NIBP) oscillometrically-derived values from a multiparameter monitor (Datex Ohmeda S/5 Compact) with those obtained by invasive blood pressure (IBP) measurement in anaesthetised horses undergoing elective surgery. STUDY DESIGN: Prospective clinical study. ANIMALS: A total of 40 healthy adult horses. METHODS: Horses were anaesthetised with various anaesthetic protocols (based on clinical requirements). Depending on positioning, cannulation of the facial or lateral metatarsal artery was performed for IBP measurement. The cannula was connected via a transducer to the monitor. An appropriately sized NIBP cuff was placed around the tail base and connected to the same monitor. Systolic (SAP), mean (MAP) and diastolic (DAP) arterial blood pressures were continuously recorded from the invasive system, and at 3 minute intervals from the oscillometric system, throughout the surgical procedure using a Datex iCollect program. An appropriate arithmetic correction factor was applied to the oscillometric results where the cuff was not level with the heart. Assessment of the degree of agreement between invasive and noninvasive readings at each time point was performed using a modified Bland-Altman analysis. RESULTS: While in many horses there was relatively close correlation between the values obtained over time, there was substantial variability in individual animals which resulted in wide Bland-Altman limits of agreement. The oscillometric device over-reads by approximately 32, 23 and 22 mmHg, and under-reads by 26, 17 and 19 mmHg for SAP, MAP and DAP, respectively, compared with the IBP values. However, using the mean difference and standard deviation, the device conforms to American College of Veterinary Internal Medicine (ACVIM) standards. CONCLUSIONS AND CLINICAL RELEVANCE: Oscillometric blood pressure measurement using the Datex Ohmeda S/5 Compact multiparameter monitor conforms to ACVIM standards when the NIBP cuff is placed on the tail. However, because of the wide variability in measurements, we cannot recommend this technique to guide therapy in anaesthetised adult horses.

Clinical effects of midazolam or lidocaine co-induction with a propofol target-controlled infusion (TCI) in dogs.

OBJECTIVE: To evaluate the propofol requirement, cardiovascular and respiratory variables using midazolam or lidocaine with a propofol target-controlled infusion (PTCI) for induction of anaesthesia in healthy dogs. STUDY DESIGN: Prospective, randomized, controlled blinded clinical trial. ANIMALS: Sixty client-owned dogs [American Society of Anesthesiologists (ASA) I-II] undergoing surgical procedures. METHODS: Thirty minutes after premedication with acepromazine (0.03 mg kg(-1) ) and morphine (0.2 mg kg(-1) ), PTCI was started and maintained at a plasma target concentration of 1 µg mL(-1) . Three minutes later, dogs (n = 20 per group) received either 5 mL 0.9% sodium chloride (SG), 2 mg kg(-1) of lidocaine (LG) or 0.2 mg kg(-1) of midazolam (MG) intravenously (IV) as a co-induction agent. Two minutes later, suitability for endotracheal intubation was assessed. If intubation was not possible, the propofol target was increased by 0.5 µg mL(-1) every 60 seconds until it was successfully achieved. Heart rate (HR), respiratory rate (fR ), and oscillometric systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure (DAP) were recorded immediately prior to commencing PTCI (B0), prior to intubation (BI), immediately after (T0), and at 3 (T3) and 5 (T5) minutes post-intubation. End-tidal partial pressures of carbon dioxide (PE(') CO2 ) were recorded at T0, T3 and T5. The occurrence of excitement at any time point was noted. RESULTS: The median (range) propofol target concentration for endotracheal intubation was significantly lower in MG, 1.5 (1.0-4.0) µg mL(-1) compared with LG, 2.5 (1.5-4.5) µg mL(-1) or SG, 3.0 (2.0-5.0) µg mL(-1) . Heart rate, MAP, fR and PE(') CO2 were similar in the three groups at all time points. No excitement was reported in any dog. CONCLUSIONS AND CLINICAL RELEVANCE: Midazolam, but not lidocaine, provided a significant reduction in PTCI requirement for induction of anaesthesia thereby allowing successful intubation. However, cardiovascular and respiratory effects were not different between the groups.

An evaluation of anaesthetic induction in healthy dogs using rapid intravenous injection of propofol or alfaxalone.

OBJECTIVE: To evaluate quality of anaesthetic induction and cardiorespiratory effects following rapid intravenous (IV) injection of propofol or alfaxalone. STUDY DESIGN: Prospective, randomised, blinded clinical study. ANIMALS: Sixty healthy dogs (ASA I/II) anaesthetized for elective surgery or diagnostic procedures. METHODS: Premedication was intramuscular acepromazine (0.03 mg kg(-1) ) and meperidine (pethidine) (3 mg kg(-1) ). For anaesthetic induction dogs received either 3 mg kg(-1) propofol (Group P) or 1.5 mg kg(-1) alfaxalone (Group A) by rapid IV injection. Heart rate (HR), respiratory rate (f(R) ) and oscillometric arterial pressures were recorded prior to induction, at endotracheal intubation and at 3 and 5 minutes post-intubation. The occurrence of post-induction apnoea or hypotension was recorded. Pre-induction sedation and aspects of induction quality were scored using 4 point scales. Data were analysed using Chi-squared tests, two sample t-tests and general linear model mixed effect anova (p < 0.05). RESULTS: There were no significant differences between groups with respect to sex, age, body weight, f(R) , post-induction apnoea, arterial pressures, hypotension, SpO(2) , sedation score or quality of induction scores. Groups behaved differently over time with respect to HR. On induction HR decreased in Group P (-2 ± 28 beats minute(-1) ) but increased in Group A (14 ± 33 beats minute(-1) ) the difference being significant (p = 0.047). However HR change following premedication also differed between groups (p = 0.006). Arterial pressures decreased significantly over time in both groups and transient hypotension occurred in eight dogs (five in Group P, three in Group A). Post-induction apnoea occurred in 31 dogs (17 in Group P, 14 in Group A). Additional drug was required to achieve endotracheal intubation in two dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Rapid IV injection of propofol or alfaxalone provided suitable conditions for endotracheal intubation in healthy dogs but post-induction apnoea was observed commonly.

Two doses of dexmedetomidine in combination with buprenorphine for premedication in dogs; a comparison with acepromazine and buprenorphine.

OBJECTIVE: To assess as premedicants, the sedative, cardiorespiratory and propofol-sparing effects in dogs of dexmedetomidine and buprenorphine compared to acepromazine and buprenorphine. STUDY DESIGN: Prospective, randomised, blinded clinical study. ANIMALS: Sixty healthy dogs (ASA grades I/II). Mean (SD) body mass 28.0 ± 9.1 kg, and mean age 3.4 ± 2.3 years. METHODS: Dogs were allocated randomly to receive 15 µg kg(-1) buprenorphine combined with either 30 µg kg(-1) acepromazine (group 1), 62.5 µg m(-2) dexmedetomidine (group 2), or 125 µg m(-2) dexmedetomidine (group 3) intramuscularly. After 30 minutes, anaesthesia was induced using a propofol target controlled infusion. Heart rate, respiratory rate, and oscillometric arterial blood pressure were recorded prior to induction, at endotracheal intubation and at 3 and 5 minutes post-intubation. Induction quality and pre-induction sedation were scored on 4 point scales. Propofol target required for endotracheal intubation was recorded. Data were analysed using Chi-squared tests, Kruskal-Wallis, one way and general linear model ANOVA (p<0.05). RESULTS: Age was significantly lower in group 1 (1.0 (1.0-3.8) years) than group 2 (5.0 (2.0-7.0) years), (median, (IQR)). There were no significant differences in sedation or quality of induction between groups. After premedication, heart rate was significantly lower and arterial blood pressures higher in groups 2 and 3 than group 1, but there was no significant difference between groups 2 and 3. Propofol targets were significantly lower in group 3 (1.5 (1.0-2.5) µg mL(-1) ) than group 1 (2.5 (2.0-3.0) µg mL(-1) ); no significant differences existed between group 2 (2.0 (1.5-2.5) µg mL(-1) ) and the other groups (median, (interquartile range)). CONCLUSIONS AND CLINICAL RELEVANCE: When administered with buprenorphine, at these doses, dexmedetomidine had no advantages in terms of sedation and induction quality over acepromazine. Both doses of dexmedetomidine produced characteristic cardiovascular and respiratory effects of a similar magnitude.

A comparison of the effects of two different doses of ketamine used for co-induction of anaesthesia with a target-controlled infusion of propofol in dogs.

OBJECTIVE: To assess the cardiorespiratory and hypnotic-sparing effects of ketamine co-induction with target-controlled infusion of propofol in dogs. STUDY DESIGN: Prospective, randomized, blinded clinical study. ANIMALS: Ninety healthy dogs (ASA grades I/II). Mean body mass 30.5 +/- SD 8.6 kg and mean age 4.2 +/- 2.6 years. METHODS: All dogs received pre-anaesthetic medication with acepromazine (0.03 mg kg(-1)) and morphine (0.2 mg kg(-1)) administered intramuscularly 30 minutes prior to induction of anaesthesia. Heart rate and respiratory rate were recorded prior to pre-medication. Animals were allocated into three different groups: Group 1 (control) received 0.9% NaCl, group 2, 0.25 mg kg(-1) ketamine and group 3, 0.5 mg kg(-1) ketamine, intravenously 1 minute prior to induction of anaesthesia, which was accomplished using a propofol target-controlled infusion system. The target propofol concentration was gradually increased until endotracheal intubation was possible and the target concentration at intubation was recorded. Heart rate, respiratory rate and noninvasive blood pressure were recorded immediately prior to induction, at successful intubation and at 3 and 5 minutes post-intubation. The quality of induction was graded according to the amount of muscle twitching and paddling observed. Data were analysed using a combination of chi-squared tests, Fisher's exact tests, Kruskal-Wallis, and anova with significance assumed at p < 0.05. RESULTS: There were no significant differences between groups in the blood propofol targets required to achieve endotracheal intubation, nor with respect to heart rate, noninvasive blood pressure or quality of induction. Compared with the other groups, the incidence of post-induction apnoea was significantly higher in group 3, but despite this dogs in this group had higher respiratory rates overall. CONCLUSIONS AND CLINICAL RELEVANCE: Under the conditions of this study, ketamine does not seem to be a useful agent for co-induction of anaesthesia with propofol in dogs.

The effects of preoperative extradural bupivacaine and morphine on the stress response in dogs undergoing femoro-tibial joint surgery.

OBJECTIVE: To evaluate the efficacy of preoperative extradural bupivacaine and morphine in attenuating the stress response in dogs undergoing femoro-tibial joint surgery. STUDY DESIGN: Prospective clinical study. Animal population Twelve client-owned dogs undergoing surgery for either repair of cruciate ligament rupture (ten) or correction of luxating patella (two). Body masses ranged from 12 to 45 kg (mean: 28.58 +/- 18.38). Age ranged from 19 to 121 months (mean: 66.5 +/- 49.5). MATERIALS AND METHODS: Six of the dogs received extradural bupivacaine (up to 1.5 mg kg(-1)) combined with morphine (0.1 mg kg(-1); ED) while the other six received no extradural analgesia (C). The levels of cortisol, acute phase proteins (APPs), and red and white blood cell variables were measured in both groups of dogs before, and at various times after surgery. Pain was also assessed at various times after surgery. The number of postoperative morphine doses required, and their time of administration, was recorded for each animal. Method of statistical analysis Data were analysed using anova for repeated measures with p-values of <0.05 considered significant. RESULTS: Cortisol levels in the ED group were significantly (p < 0.05) lower than those of the control group at the end of surgery. No statistically significant differences were found in APPs or red and white cell variables between dogs receiving, and those not receiving extradural bupivacaine and morphine. Four dogs in the control group and one in the ED group required postoperative morphine. CONCLUSIONS AND CLINICAL RELEVANCE: Pre-emptive extradural bupivacaine and morphine was effective in lowering the neuroendocrine stress response (cortisol) in the ED group but had no effect on the inflammatory response (acute phase response).