The function of the pituitary-testicular axis in dogs prior to and following surgical or chemical castration with the GnRH-agonist deslorelin.

Chemical castration, that is the reduction of circulating testosterone concentrations to castrate levels by administration of a GnRH-agonist implant, is a popular alternative to surgical castration in male dogs. Detailed information concerning the pituitary-testicular axis following administration of a GnRH-agonist implant is still scarce. Therefore, GnRH-stimulation tests were performed in male dogs, prior to and after surgical and chemical castration. This approach also allowed us to determine plasma concentrations of testosterone and oestradiol in intact male dogs for future reference and to directly compare the effects of surgical and chemical castration on the pituitary-testicular axis. In intact male dogs (n = 42) of different breeds GnRH administration induced increased plasma LH, FSH, oestradiol and testosterone concentrations. After surgical castration basal and GnRH-induced plasma FSH and LH concentrations increased pronouncedly. Additionally, basal and GnRH-induced plasma oestradiol and testosterone concentrations decreased after surgical castration. After chemical castration, with a slow-release implant containing the GnRH-agonist deslorelin, plasma LH and FSH concentrations were lower than prior to castration and lower compared with the same interval after surgical castration. Consequently, plasma oestradiol and testosterone concentrations were lowered to values similar to those after surgical castration. GnRH administration to the chemically castrated male dogs induced a significant increase in the plasma concentrations of LH, but not of FSH. In conclusion, after administration of the deslorelin implant, the plasma concentrations of oestradiol and testosterone did not differ significantly from the surgically castrated animals. After GnRH-stimulation, none of the dogs went to pre-treatment testosterone levels. However, at the moment of assessment at 4,4 months (mean 133 days ± SEM 4 days), the pituitary gonadotrophs were responsive to GnRH in implanted dogs. The increase of LH, but not of FSH, following GnRH administration indicates a differential regulation of the release of these gonadotrophins, which needs to be considered when GnRH-stimulation tests are performed in implanted dogs.

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.

Development and validation of teacher and student questionnaires measuring inhibitors of curriculum viability.

BACKGROUND: Curriculum viability is determined by the degree to which quality standards have or have not been met, and by the inhibitors that affect attainment of those standards. The literature reports many ways to evaluate whether a curriculum reaches its quality standards, but less attention is paid to the identification of viability inhibitors in different areas of the curriculum that hamper the attainment of quality. The purpose of this study is to develop and establish the reliability and validity of questionnaires that measure the presence of inhibitors in an undergraduate medical curriculum. METHODS: Teacher and student questionnaires developed by the authors were sent to medical educationalists for qualitative expert validation and to establish their content validity. To establish the response process validity, cognitive interviews were held with teachers and students to clarify any confusion about the meaning of items in the questionnaires. Reliability and construct validity of the questionnaires were established by responses from 575 teachers and 247 final-year medical students. RESULTS: Qualitative expert validation was provided by 21 experts. The initial teacher and student questionnaires containing respectively 62 items to measure 12 theoretical constructs, and 28 items to measure 7 constructs, were modified to improve their clarity and relevance. The overall scale validity index for the questionnaires was, in order, .95 and .94. Following the cognitive interviews, the resultant teacher and student questionnaires were reduced to respectively 52 and 23 items. Furthermore, after the confirmatory analysis, the final version of the teacher questionnaire was reduced to 25 items to measure 6 constructs and the student questionnaire was reduced to 14 items to measure 3 constructs. Good-for-fit indices were established for the final model and Cronbach alphas of, in order, .89 and .81 were found for the teacher and student questionnaire. CONCLUSION: The valid and reliable curriculum viability inhibitor questionnaires for teachers and students developed in this study can be used by medical schools to identify inhibitors to achieve standards in different areas of the curriculum.

Student participation in governance of medical and veterinary education: experiences and perspectives of student representatives and program directors.

Student participation in governance of education is of growing interest. However, it remains unclear what factors render this participation in institutional governance a success or a failure. Another question is: what are the perceived benefits for schools and students? We empirically explored experiences and perspectives of student representatives and program directors of all (8) medical and (1) veterinary schools in the Netherlands on factors that influence student participation in institutional governance and its values and challenges for schools and student representatives. A constructivist grounded theory study was performed. A theoretical sample of student representatives was invited to fill out an explorative, qualitative questionnaire. Next, focus groups with student representatives and interviews with all program directors were conducted. Data was analyzed using open, axial and selective coding by all authors. Experiences and perspectives of students and program directors were remarkably similar in both perceived influences and values. Four main categories of influences could be distinguished in student participation: (1) individual student characteristics, (2) individual staff characteristics, (3) the organization of student representatives and (4) the school's organization, including its culture and policy regarding student participation. A cohesive, well-organized and independent student organization has crucial impact on student participation in educational governance processes. For representatives, major benefits of participation are personal and career development. Challenges are low effectiveness and efficiency of their actions. A clear school policy on student participation and better introduction, feedback and coaching of representatives should be provided to improve student participation in governance processes.

Determining 'curriculum viability' through standards and inhibitors of curriculum quality: a scoping review.

BACKGROUND: A curriculum is dynamic entity and hence, metaphorically, can be considered 'alive'. Curricular diseases may impair its quality and hence its viability. The quality of a curriculum is typically assessed against certain quality standards only. This approach does not identify the inhibitors impeding the achievement of quality standards. The purpose of this study is to identify not only standards but also inhibitors of curriculum quality, allowing for a more comprehensive assessment of what we coin 'curriculum viability'. METHODS: We performed a scoping review of 'curriculum viability', after which 13 articles were found eligible through a meticulous search and selection process. We first identified 1233 studies based on matching keywords, title and abstract; 36 of which met our inclusion criteria. After application of the Qualsyst criteria, two independent reviewers performed a thematic analysis of the 13 articles that remained. RESULTS: While all studies reported on standards of quality, only two studies described both standards and inhibitors of quality. These standards and inhibitors were related to educational content and strategy, students, faculty, assessment, educational/work environment, communication, technology and leadership. CONCLUSIONS: The framework of curriculum viability thus developed will help identify inhibitors adversely affecting the curriculum viability and remaining hidden or un-noticed when curriculum evaluation is done.

Feedback-giving behaviour in performance evaluations during clinical clerkships.

CONTEXT: Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and provision of feedback, but little is known about how these factors influence teachers' feedback-giving behaviour. In this study, we investigated teachers' use of mini-CEX in performance evaluations to provide narrative feedback in undergraduate clinical training. METHODS: We designed an exploratory qualitative study using an interpretive approach. Focusing on the usage of mini-CEX instruments in clinical training, we conducted semi-structured interviews to explore teachers' perceptions. Between February and June 2013, we conducted interviews with 14 clinicians participated as teachers during undergraduate clinical clerkships. Informed by concepts from the literature, we coded interview transcripts and iteratively reduced and displayed data using template analysis. RESULTS: We identified three main themes of interrelated factors that influenced teachers' practice with regard to mini-CEX instruments: teacher-related factors; teacher-student interaction-related factors, and teacher-context interaction-related factors. Four issues (direct observation, relationship between teacher and student, verbal versus written feedback, formative versus summative purposes) that are pertinent to workplace-based performance evaluations were presented to clarify how different factors interact with each other and influence teachers' feedback-giving behaviour. Embedding performance observation in clinical practice and establishing trustworthy teacher-student relationships in more longitudinal clinical clerkships were considered important in creating a learning environment that supports and facilitates the feedback exchange. CONCLUSION: Teachers' feedback-giving behaviour within the clinical context results from the interaction between personal, interpersonal and contextual factors. Increasing insight into how teachers use mini-CEX instruments in daily practice may offer strategies for creating a professional learning culture in which feedback giving and seeking would be enhanced.

Factors Influencing Seminar Learning and Academic Achievement.

Many veterinary curricula use seminars, interactive educational group formats in which some 25 students discuss questions and issues relating to course themes. To get indications on how to optimize the seminar learning process for students, we aimed to investigate relationships between factors that seem to be important for the seminar learning process, and to determine how these seminar factors account for differences in students' achievement scores. A 57-item seminar evaluation (USEME) questionnaire was administered to students right after they attended a seminar. In total, 80 seminars distributed over years 1, 2, and 3 of an undergraduate veterinary medicine curriculum were sampled and 988 questionnaires were handed in. Principal factor analysis (PFA) was conducted on 410 questionnaires to examine which items could be grouped together as indicators of the same factor, and to determine correlations between the derived factors. Multilevel regression analysis was performed to explore the effects of these seminar factors and students' prior achievement scores on students' achievement scores. Within the questionnaire, four factors were identified that influence the seminar learning process: teacher performance, seminar content, student preparation, and opportunities for interaction within seminars. Strong correlations were found between teacher performance, seminar content, and group interaction. Prior achievement scores and, to a much lesser extent, the seminar factor group interaction appeared to account for differences in students' achievement scores. The factors resulting from the present study and their relation to the method of assessment should be examined further, for example, in an experimental setup.

Investigating teaching performance in seminars; a questionnaire study with a multi-level approach.

BACKGROUND: Teachers play an important role in seminars as facilitators and content experts. However, contextual factors like students' preparation, group size, group interaction, and content appear to influence their performance. Understanding the impact of these contextual factors on students' perception of teaching performance may help to further understand seminar teaching. Besides that, it may help curriculum organisers and teachers to get more insight in how to optimise their versatile role in seminars. The aim of this study is to investigate how students' perception of teaching performance in seminars is explained by students' extent of preparation, seminar group size, group interaction, and content. METHODS: The Utrecht Seminar Evaluation (USEME) questionnaire was used to collect information on teaching performance and the aforementioned explanatory variables. To account for intra-student, intra-seminar, and intra-teacher correlation in the data, multilevel regression was used to analyse 988 completed questionnaires in 80 seminars with 36 different teachers. RESULTS: Group interaction and seminar content had large (B = 0.418) and medium (B = 0.212) positive effects on perceived teaching performance scores, whereas the effects of students' preparation (B = -0.055) and group size (B = -0.130) were small and negative. CONCLUSIONS: This study provides curriculum organisers and teachers indications on how to optimise variables that influence perceived teaching performance in seminars. It is suggested that teachers should search for the most appropriate combination of motivating and challenging content and facilitation method within seminars to optimise discussion opportunities between students.

Clarifying students' feedback-seeking behaviour in clinical clerkships.

CONTEXT: Why and how do students seek feedback on their performance in the clinical workplace and which factors influence this? These questions have remained largely unanswered in research into workplace learning during clinical clerkships. Research on feedback has focused mainly on feedback providers. Whether and how feedback recipients actively seek feedback are under-examined issues. Research in organisational psychology has proposed a mechanism whereby feedback seeking is influenced by motives and goal orientation mediated by the perceived costs and benefits of feedback. Building on a recently published model of resident doctors' feedback-seeking behaviour, we conducted a qualitative study to explore students' feedback-seeking behaviours in the clinical workplace. METHODS: Between April and June 2011, we conducted semi-structured face-to-face interviews with veterinary medicine students in Years 5 and 6 about their feedback-seeking behaviour during clinical clerkships. In the interviews, 14 students were asked about their goals and motives for seeking feedback, the characteristics of their feedback-seeking behaviour and factors influencing that behaviour. Using template analysis, we coded the interview transcripts and iteratively reduced and displayed the data until agreement on the final template was reached. RESULTS: The students described personal and interpersonal factors to explain their reasons for seeking feedback. The factors related to intentions and the characteristics of the feedback provider, and the relationship between the feedback seeker and provider. Motives relating to image and ego, particularly when students thought that feedback might have a positive effect on image and ego, influenced feedback-seeking behaviour and could induce specific behaviours related to students' orientation towards particular sources of feedback, their orientation towards particular topics for and timing of feedback, and the frequency and method of feedback-seeking behaviour. CONCLUSIONS: This study shows that during clinical clerkships, students actively seek feedback according to personal and interpersonal factors. Perceived costs and benefits influenced this active feedback-seeking behaviour. These results may contribute towards the optimising and developing of meaningful educational opportunities during clerkships.

Teachers' perceptions of aspects affecting seminar learning: a qualitative study.

BACKGROUND: Many medical schools have embraced small group learning methods in their undergraduate curricula. Given increasing financial constraints on universities, active learning groups like seminars (with 25 students a group) are gaining popularity. To enhance the understanding of seminar learning and to determine how seminar learning can be optimised it is important to investigate stakeholders' views. In this study, we qualitatively explored the views of teachers on aspects affecting seminar learning. METHODS: Twenty-four teachers with experience in facilitating seminars in a three-year bachelor curriculum participated in semi-structured focus group interviews. Three focus groups met twice with an interval of two weeks led by one moderator. Sessions were audio taped, transcribed verbatim and independently coded by two researchers using thematic analysis. An iterative process of data reduction resulted in emerging aspects that influence seminar learning. RESULTS: Teachers identified seven key aspects affecting seminar learning: the seminar teacher, students, preparation, group functioning, seminar goals and content, course coherence and schedule and facilities. Important components of these aspects were: the teachers' role in developing seminars ('ownership'), the amount and quality of preparation materials, a non-threatening learning climate, continuity of group composition, suitability of subjects for seminar teaching, the number and quality of seminar questions, and alignment of different course activities. CONCLUSIONS: The results of this study contribute to the unravelling of the 'the black box' of seminar learning. Suggestions for ways to optimise active learning in seminars are made regarding curriculum development, seminar content, quality assurance and faculty development.

Case Report: Medical Management of Prolonged Gestation of a Mummified Fetus in a Bitch.

A 3-year-old female rough coated collie was presented at day 69 (D69) after the first mating. She was mated on 2 consecutive days based on ovulation timing by the referring veterinarian. At day 30 post breeding, a single, live embryo was seen on ultrasound by this veterinarian. On D69, the bitch was presented to us because she lacked signs of impending parturition such as vulvar discharge or nest building behavior. On general examination, the bitch appeared clinically healthy and no prodromi were present. On abdominal palpation a small, firm structure and a slightly enlarged uterus were detected. There was no vulvar discharge. Using vaginoscopy we could not see any signs of cervical dilatation. Additionally, ultrasonography revealed the presence of a collapsed fetus in the uterus with a moderate amount of echogenic fluid surrounding it and the plasma progesterone concentration was 2.6 ng/ml. A parturition induction protocol was initiated: a progesterone receptor antagonist was administered, followed by PGF2α to induce cervical relaxation and uterine contractions. The fetus was expelled 3 days later, without noticeable damage to the reproductive tract of the dam. The bitch subsequently delivered two more litters without complications. To our knowledge this is the first clinical report that demonstrates a successful non-surgical treatment to expel a mummified fetus after prolonged gestation. The pharmacological treatment did not affect the future fertility of the breeding dog, which is an important outcome for breeders.

Curriculum Viability Indicators: A Delphi Study to Determine Standards and Inhibitors of a Curriculum.

Curriculum evaluation is typically done by using quality standards defined by accrediting bodies. This does not include inhibitors that hinder the achievement of standards. Hence, to address both standards and inhibitors, we have coined the new concept of "curriculum viability." This study establishes consensus among experts on curriculum viability indicators, i.e. standards and inhibitors, and aims to provide a framework for evaluating the curriculum viability. The study was done in two phases. In the first phase, a consensus was established on the curriculum viability indicators using the Modified Delphi Technique using two rounds. In the first round of the Delphi process, 25 experts participated, which were reduced to 19 in the second round. After two rounds, experts developed a consensus on 40 out of 44 items. These included 27 standards and 13 inhibitors. In the second phase, 18 experts rank-ordered the indicators according to their relative importance in the areas of educational content and strategies, faculty, leadership, assessment, students, educational/working environment, communication, and technology. The list of indicators provides a framework for evaluating the curriculum viability, and their ordering enables curriculum managers to prioritize them during curriculum evaluation.