Tooth Brushing Learning Methods: Differential or Conventional? - A Randomized Controlled Clinical Trial.

INTRODUCTION: Proper tooth brushing is a complicated process for children. Therefore, the aim of this study was to investigate the effect of differential learning to improve tooth brushing in children. METHODS: In this prospective, controlled, single-blinded, randomized clinical trial, 58 children between 3 and 8 years of age (mean: 5.7 ± 1.5 years; 29 female) were randomly assigned to test or control group through the child's self-drawing of an unlabeled envelope from a box. All children received oral hygiene instructions and information in these sealed envelopes and were asked to follow the corresponding instructions at home for 28 days. Children in the test group received instructions with exercises using the differential learning method, whereas the children in the control group received the usual tooth brushing instructions. RESULTS: At baseline and planned follow-ups after 4 and 12 weeks, plaque and gingival indices (QHI, PBI) were recorded in both groups by 2 calibrated and blinded investigators. At baseline, there were no significant differences between the test and control groups regarding plaque and gingival indices (QHI: 4.1 ± 0.5 vs. 4.1 ± 0.4; p = 0.7; PBI: 0.6 ± 0.3 vs. 0.6 ± 0.3; p = 0.7). At the 1st and 2nd follow-up, both groups showed improved oral health indices, but there was an overall better improvement in the test group. While the difference in gingival indices was statistically significant in the 1st recall (PBI/test: 0.1 ± 0.2 vs. control: 0.3 ± 0.2; p < 0.001), the difference in plaque indices was not (QHI/test: 2.1 ± 0.9; control: 2.6 ± 0.9; p = 0.07). At the 2nd recall (mean week = 19.5 weeks), the test group showed statistically significant and clinically relevant better oral health indices than the control group (2nd recall, QHI/test: 2.1 ± 0.9 vs. control: 3.2 ± 1; p < 0.001; PBI/test: 0.1 ± 0.2 vs. control: 0.5 ± 0.2; p < 0.001). CONCLUSION: In conclusion, differential learning leads to oral hygiene improvement in children with high caries risk and initially poor oral hygiene, which was superior to the conventional learning method through repetition in the medium term.

An Accessible Nephrectomy and Cystotomy Simulator for Use in Teaching Small Animal Surgery.

The use of simulators in veterinary education has been increasing over the last few years. This is fundamental for surgical classes, as simulators can provide a better learning environment for the students. Two procedures commonly taught in veterinary surgical practical classes are nephrectomy and cystotomy. However, the lack of simulators for use in these classes limits the training options to the use of cadavers, which have a number of associated disadvantages, including the potential for autolysis. The aim of this study was to develop and assess the value of a simple nephrectomy and cystotomy simulator that could replace the use of cadavers in surgical practical classes. The simulator, which represented the abdominal cavity, bladder, kidneys, ureter, vessels and adipose tissue, was constructed by using synthetic materials. To evaluate its usefulness and acceptance by the students, the learning outcomes and student satisfaction, for both the simulator and an ethically sourced dog cadaver, were compared. The students completed a Likert scale questionnaire, and the answers were evaluated by using the Diagnostic Content Validation (DCV) model. The simulator was well accepted by the students, with the best scores achieved for the ureter divulsion and ligation procedures; good results were also recorded for the kidney vessel ligature and urinary bladder suture practice. The scores showed that the simulator provided an acceptable experience during the training process and increased the confidence of the students in performing the procedure.

Students' Approaches to Learning during Pre-clinical and Clinical Phases of a Veterinary Curriculum, Their Motivations and Their Correlation with GPA.

This study was conducted to determine if veterinary students adopt a different approach to learning in the clinical compared to pre-clinical phase, and what factors motivate their approach. We also sought to determine if the learning approach adopted correlates with grade point average (GPA). Two questionnaires were administered to the same cohort of students (112 students) at the end of the pre-clinical and at the end of the clinical phase. A total of 87 students completed at least one questionnaire. The questionnaires included the Approaches and Study Skills Inventory for students, which was used to provide scores for three learning approaches: surface (focus on memorization), strategic (focus on optimum grades), and deep (focus on understanding). The questionnaires also included open-ended questions probing for motivations behind adopting learning approaches. Statistical analyses were performed on the data to detect correlations between variables. Students were more likely to adopt a surface approach in the pre-clinical phase than in the clinical phase, although other learning approaches were not different between phases. No strong correlations existed between learning approach and GPA. Students who adopted a deep approach were typically motivated by higher-level motivations than those who adopted a surface approach, especially in the clinical phase. Time constraints, the desire to get good grades, and passing classes were the main reasons for adopting the surface approach. The results of the study can be beneficial for students, by allowing them to identify those pressures that could prevent them from adopting a deeper approach earlier in the curriculum.

Life, Death, and Humanity in Veterinary Medicine: Is it Time to Embrace the Humanities in Veterinary Education?

Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.

Co-constructive Veterinary Simulation: A Novel Approach to Enhancing Clinical Communication and Reflection Skills.

Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction with simulated participants (SPs) can become performative or circumscribed to evaluative assessments. This article describes co-constructive veterinary simulation (CCVS), an adaptation of a novel approach to participatory simulation that centers on learner-driven goals and individually tailored scenarios. CCVS involves a first phase of scriptwriting, in which a learner collaborates with a facilitator and a professional actor in developing a client-patient case scenario. In a second phase, fellow learners have a blinded interaction with the SP-in-role, unaware of the underlying clinical situation. In the final part, all learners come together for a debriefing session centered on reflective practice. The authors provide guidelines for learners to gain maximal benefit from their participation in CCVS sessions and describe thematic possibilities to incorporate into the model, with specific case examples drawn from routine veterinary practice. Finally, the authors outline challenges and future directions toward implementing CCVS in veterinary medical education toward the ultimate goal of professional growth and co-evolution as veterinary practitioners.

Comparison of Attempts Needed for Veterinary Students to Reach Proficiency in a Basic and Advanced Robotic Simulator Task.

Surgical training of students is one of the most difficult aspects of veterinary medical education. Competing interests of house officers, owner's wishes, and ethical concerns have led to increasing use of inanimate models for basic surgical skills training. Robotic simulators have benefits for psychomotor training but have not been previously investigated in veterinary medicine. Understanding the necessary practice time for new training devices is important when determining their potential value. The aim of this study was to compare the number of attempts needed for veterinary students to reach proficiency in both a basic and advanced robotic simulator task, and to assess the predictive nature of performance variables. Each student performed a basic and advanced tasks on the Mimic dV-Trainer™ until proficiency was reached. Students required a median of eight attempts (95% CI = 7-8, range: 6-11) to reach proficiency for the basic task versus 22 attempts (95% CI = 20-26, range: 11-62) for the advanced task. The median time required to complete training for the basic and advanced task was 13.5 minutes (range: 8-24 minutes) and 26.5 minutes (range: 11-82 minutes) respectively. The difference in task attempts supports the training protocol and confirms proficiency can be attained in a short period of time. The number of attempts to reach proficiency correlated with specific performance variables which can be used by educators to aid in training students on a robotic simulator. Continued investigations on robotic simulators should be performed to investigate their use in improving psychomotor skills in veterinary students.

Comparison of Traditional Didactic vs. Additional Hands-on Simulation Training in the Performance of Basic Life Support in Veterinary Students - A Prospective, Blinded, Randomized Study.

Cardiopulmonary resuscitation (CPR) is a critical skill for veterinarians, but the most effective training methods and techniques are still unknown. In human medicine, simulation training enhances both knowledge and performance of basic life support CPR. This study evaluated the comparative effectiveness of didactic versus a combination of didactic and simulation training on performance and understanding of basic life support techniques in second-year veterinary medical students.

Novel 3D Custom-Made Silicone Tumor Model as a Support for Teaching Surgical Oncology Principles.

Alternative laboratory teaching methods are becoming increasingly desirable and effective in medical education environments. While ethical concerns associated with the use of live animals in terminal surgery laboratories have been reduced with cadaveric models, availability, and lack of pathology can limit their ability to adequately convey surgical principles and replicate clinical training. We have developed a three-dimensional (3D) custom-made silicone soft tissue tumor model using 3D-printed molds derived from canine soft tissue sarcoma computed tomography images. This novel teaching model allows users to apply surgical oncology principles and perform basic technical tasks such as incisional biopsy, margin demarcation, marginal and wide surgical excision, and inking of surgical margins. A large cohort of students in addition to a small number of professional veterinarians at different levels of specialty training followed the laboratory guidelines and evaluated the simulated tumor model based on a qualitative survey. All participants were able to successfully complete the practical training. The model also allowed the students to identify and correct technical errors associated with biopsy sampling and margin dissection, and to understand the clinical impacts related to those errors. Face and content validity of the model were assessed using Likert-style questionnaires with overall average instructors' scores of 3.8/5 and 4.6/5, respectively. Content validity assessment of the model by the students approximated instructors' evaluation with an overall average score of 4.4/5. This model development emphasizes the efficacy of alternative non-cadaveric laboratory teaching tools and could become a valuable aid in the veterinary curricula.

Simulating Ovariohysterectomy: What Type of Practice Promotes Short- and Long-Term Skills Retention?

Simulation-based surgical training allows students to learn skills through deliberate practice without the patient risk and stress of operating on a live animal. This study sought to determine the ideal distribution of training sessions to improve short- and long-term retention of the skills necessary to perform a simulated ovariohysterectomy (OVH). Fourth-semester students (n = 102) were enrolled. Students in the weekly instruction group (n = 57) completed 10 hours of training on the OVH simulator, with sessions held at approximately weekly intervals. Students in the monthly instruction group (n = 45) completed the same training with approximately monthly sessions. All students were assessed 1 week (short-term retention test) and 5 months following the last training session (long-term retention test). Students in the weekly instruction group scored higher on their short-term assessment than students in the monthly instruction group (p < .001). However, students' scores in the weekly instruction group underwent a significant decrease between their short- and long-term assessments (p < .001), while the monthly group did not experience a decrease in scores (p < .001). There was no difference in long-term assessment scores between weekly and monthly instruction groups. These findings suggest that if educators are seeking maximal performance at a single time point, scheduling instructional sessions on a weekly basis prior to that time would be superior to monthly sessions, but if educators are concerned with long-term retention of skills, scheduling sessions either on a weekly or monthly basis would accomplish that purpose.

Development and Evaluation of an Experiential Career Planning Assignment to Train Students to Assess Organizational Fit.

Determining if an employment opportunity will be a good match can feel daunting, especially for veterinary graduates entering the workforce. To ease this transition, veterinary educators traditionally have attempted to provide career support through interspersed didactic lectures on career options and the preparation of employment documents. While well intended, this approach fails to address the multiple dimensions of effective career planning or the reality that career planning is a lifelong endeavor. For a career planning teaching modality to be effective, it must address all stages of career planning and provide a framework that can be adapted throughout a career. Here we describe how a four-stage career-planning model, utilized throughout higher education, was employed to create a career planning assignment for guiding students in assessing organizational fit. We describe how student feedback was used to inform revisions, resulting in an improved educational experience as measured by students' perceptions of the utility of the assignment. Additional recommendations based on instructor reflection are provided to guide creation and implementation of future assignments. Given the growing support for professional skills training in veterinary medical education, we view incorporation of such learning activities as essential to preparing students to enter the modern veterinary workplace.

Self-Efficacy and Student Satisfaction in a Clinical-Year Diagnostic Imaging Course Using an Online Instruction Format.

Accurate interpretation of radiographic images is critical to diagnosing clinical patients. Remote instruction in radiology has become more common at veterinary colleges as academic institutions struggle to fill open veterinary radiologist positions and as a result of the COVID-19 pandemic. This study sought to gather the feedback of fourth-year veterinary students via pre- and post-study surveys (n = 45) and focus groups (n = 7) about a newly implemented 2-week long radiology rotation. Ninety-eight percent of students reported having taken an online course before, and on both pre- and post-study surveys, students commonly reported feeling interested, determined, and attentive. On average, students reported that they were neither more nor less engaged than they would have been in an in-person course and that they understood the material neither better nor worse than they would have in an in-person course. Students reported that the key to their success was primarily hard work; secondarily, instructor availability and student ability were important. Students did not rate luck as having much influence on their success. Although diagnostic imaging can be a challenging subject to master, students effectively learned this subject through online instruction. They provided feedback for the course's continued improvement; their comments centered around improved interactivity, including providing automated quiz questions' answers and increased instructor availability. Data collected in this study will help to guide further development of the radiology course.

Graphical education and appropriate time before elective colonoscopy make better bowel preparation.

Background: Inadequate bowel preparation leads to lower polyp detection rates, longer procedure times and lower cecal intubation rates. However, there is no consensus about high-quality bowel preparation, so our study evaluated graphical education and appropriate time before elective colonoscopy. Patients and Methods: We performed a secondary analysis of a national colorectal cancer screening programme of 738 patients. The patients were divided into a group given a graphical information manual (n = 242) or a word-only one (n = 496). They were also divided into groups according to the interval between bowel preparation and colonoscopy: 6-8 h (Group 1, n = 106), 9-12 h (Group 2, n = 228) and 13-17 h (Group 3, n = 402). All patients were scored according to the Boston Bowel Preparation Scale (BBPS) during the examination. Results: The bowel preparation of the graphical group was significantly better than the text group (P < 0.001). After adjustment, the bowel preparation score of Group 1 and Group 2 were both significantly higher than that of Group 3 (P = 0.012 and P = 0.032). Maximum BBPS was 6.31 when the interval time was 6.52 h (95% confidence interval: 5.95-6.66), and when the interval was <10 h, the BBPS was ≥6. Conclusion: High-quality bowel preparation was linked to graphical education and appropriate time before colonoscopy. We suggest that the interval between taking the first laxative and colonoscopy should be <10 h, preferably 6.5 h. Prospective multicentre research is needed to give more evidence of high-quality bowel preparation methods.

Phronesis in Veterinary Medicine: Navigating the Complexity of Practice with Wisdom.

With the knowledge explosion currently occurring in veterinary medicine, it is difficult to impart to our learners all the actions that can be done, let alone teach them how to determine what should be done. Ethics curricula can provide an essential part of this answer but leave it incomplete. This can result in the disengagement of veterinary learners from the situational understanding that leads to the most appropriate actions. Phronesis is a practical understanding with sound judgment and ethical orientation. It has recently become a talking point in medicine as a framework of support for health professionals that brings together the goals of ethical care with clinical judgment. We can work to incorporate it more effectively into our curricula by evaluating how phronesis is already used in veterinary medicine. This will give learners the opportunity to practice phronetic judgment and support practical wisdom in clinical settings.

Single Pedicle Advancement Flap Models for Teaching Veterinary Reconstructive Surgical Techniques.

Reconstructive surgical techniques are used in both general and referral veterinary practice to facilitate closure of challenging wound defects. During veterinary studies, there are often limited opportunities for students to practice these techniques on live patients or cadavers. Surgical models, including suture pads and ovariohysterectomy models, have been successfully incorporated into veterinary teaching, providing students with additional practice. Models to simulate veterinary reconstructive surgical techniques are lacking. In the current study, a single pedicle advancement flap model was designed. The design consisted of a silicone model secured by a plate, providing tension. Fifth-year veterinary science students (n = 34) were surveyed to assess the model's impact on surgical technique and confidence. Students were also assessed to determine surgical technique using the models. It was hypothesized that students who had two additional practice sessions using the models (Trial group, n = 17) would show greater improvement in technique than students who had no practice sessions between assessments (Control group, n = 17). Students strongly agreed (median score 5/5) that using the model helped to reinforce the subdermal plexus flap technique and improved their confidence in performing a subdermal plexus flap. Students from both groups performed significantly better in the follow-up assessment compared to the initial assessment. No significantly greater improvement was observed in technique between the control and the trial groups. Results suggest that the students' reconstructive surgical technique improved after a single practice session and that the single pedicle advancement flap model can be used synergistically with other teaching methods.

Comparative Effectiveness of Training with Simulators Versus Traditional Instruction in Veterinary Education: Meta-Analysis and Systematic Review.

One of the greatest challenges in veterinary education is adequately preparing students with the clinical skills they need to be successful health care providers. Integration of simulators, devices used to represent real world phenomena under test conditions, into the veterinary curriculum can help address challenges to clinical instruction. The use of simulators in veterinary education is increasing; however, their effectiveness remains unclear. This meta-analysis seeks to synthesize the evidence for simulator training in veterinary education to provide a consensus of effect, guide the integration of simulators into the curriculum, and direct the development of future simulation-based research in veterinary medicine. A systematic search identified 416 potential manuscripts from which 60 articles were included after application of inclusion criteria. Information was extracted from 71 independent experiments. The overall weighted mean effect size for simulator training was g = 0.49 for the random-effects model. The outcome measures of knowledge, time, process, and product all produced statistically significant mean effect sizes favoring simulation (d = 0.41, 0.35, 0.70, 0.53, respectively). A moderator analysis revealed that study characteristics and instructional design features moderated the effectiveness of simulator training. Overall, the results indicate that simulator training in veterinary education can be effective for knowledge and clinical skill outcomes.

Pre- and Post-Course Self-Assessments to Promote Recognition of Learning in Veterinary Students.

Students benefit from recognition of their achievements as learners. A simple tool to help students reflect on their own learning is the use of pre- and post-course self-assessments based on authentic veterinary interactions. The use of this tool in three courses over 2 years consistently demonstrated an increase in the confidence of the students in their ability to use the course content in realistic settings.

Implementing Digital Pathology into Veterinary Academics and Research.

The advantages of digital pathology (DP) have been recognized as early as 1963, but only within the last decade or so have the advancements of slide scanners and viewing software made the use and implementation of DP feasible in the classroom and in research. Several factors must be considered prior to undertaking the project of implementing the DP workflow in any setting, but particularly in an academic environment. Sustained and open dialogue with information technology (IT) is critical to the success of this enterprise. In addition to IT, there is a multitude of criteria to consider when determining the best hardware and software to purchase to support the project. The goals and limitations of the laboratory and the requirements of its users (students, instructors, and researchers) will ultimately direct these decisions. The objectives of this article are to provide an overview of the opportunities and challenges associated with the integration of DP in education and research, to highlight some important IT considerations, and to discuss some of the requirements and functionalities of some hardware and software options.

Remote Assessment of Veterinary Clinical Skills Courses During the COVID-19 Pandemic.

In spring 2020, the COVID-19 pandemic forced educators to adjust the delivery and assessment of curriculum. While didactic courses moved online, laboratory courses were not amenable to this shift. In particular, assessment of clinical skills courses through common methods including objective structured clinical examinations (OSCEs) became inadvisable. This article describes decisions made for first-, second-, and third-year veterinary students (n = 368) with respect to clinical skills at one US college. This includes the remote completion of a surgical skills curriculum using instructional videos and models and the delaying of laboratory sessions deemed impossible to deliver remotely. First- and third-year students were subsequently assessed using modified remote OSCEs. Second-year students were assessed using the standard surgical skills examination, video-recorded. All first- and third-year students successfully passed their OSCE upon either first attempt or remediation. Two second-year students failed their remediation examination and were offered additional faculty tutoring and another remediation attempt at the start of the fall semester. The remediation rate on the surgical skills examination was not different from that of previous years. One incident of suspected academic dishonesty occurred in the first-year OSCE. Students learned surgical skills successfully at home by practicing on models and receiving feedback of their skills on video recordings. While disappointing, one case of academic dishonesty among the 368 total students tested was not surprising. Remote assessment using modified OSCEs and surgical skills exams appears feasible and fair when in-person testing is not possible.

Professional Skills Teaching within Veterinary Education and Possible Future Directions.

Once ignored for their potential to take up precious time within the veterinary curriculum at the expense of hard science and technical competencies, professional skills such as ethical conduct, professional conduct, and communication skills are now considered essential in the creation of successful and employable graduates. Despite the requirement to include professional skills in veterinary curricula, limited communication among colleges and inconsistent documentation of curricular developments have led to a wide range of teaching and assessment methods with no consistent standards existing among colleges. Integration of professional competency teaching into the general curriculum is lauded widely, but barriers such as faculty buy-in have kept many colleges from moving toward a standard in which professional competencies are integrated into the general curriculum. The aim of this article is to provide veterinary educators and curriculum designers with an understanding of the rationale for including professional skills teaching within the curriculum while also presenting currently used, as well as recommended, strategies for effective instruction of professional skills.

Expert Veterinarians Should Be Trained Expertly: Fostering the Development of Adaptive Expertise in Veterinary Students through Faculty Development for Veterinary Educators.

The field of health professions education is rapidly evolving, and with it the field of veterinary education. This discussion piece amalgamates literature across health professions education to provide a picture of what a veterinary clinician-educator is, why there is a need for veterinary clinician-educators when developing learners with adaptive expertise, and how faculty development can support the growth of clinicians into clinician-educators. It is intended to outline the best practices for fostering the development of adaptive expertise in veterinary students through faculty development for veterinary educators.