Basic science knowledge underlies clinical science knowledge and clinical problem solving: evidence from veterinary medicine.

Medical sciences education emphasizes basic science learning as a prerequisite to clinical learning. Studies exploring relationships between achievement in the basic sciences and subsequent achievement in the clinical sciences generally suggest a significant positive relationship. Basic science knowledge and clinical experience are theorized to combine to form encapsulated knowledge- a dynamic mix of information that is useful for solving clinical problems. This study explores the relationship between basic science knowledge (BSK), clinical science knowledge (CSK), and clinical problem-solving ability, as measured within the context of four veterinary colleges using both college-specific measures and professionally validated, standardized measures of basic and clinical science knowledge and problem-solving ability. Significant correlations existed among all variables. Structural equation modeling and confirmatory factor analysis were used to produce models showing that newly acquired BSK directly and significantly predicted BSK retained over time and newly acquired CSK, as well as indirectly predicted clinical problem-solving ability (mediated by newly acquired CSK and BSK retained over time). These findings likely suggest a gradual development of schema (encapsulated knowledge) and not an isolated development of biomedical versus clinical knowledge over time. A broader implication of these results is that explicitly teaching basic science knowledge positively and durably affects subsequent clinical knowledge and problem-solving ability independent of instructional strategy or curricular approach. Furthermore, for veterinary colleges specifically, student performance as measured by both course-level and standardized tests are likely to prove useful for predicting subsequent academic achievement in classroom and clinical settings, licensing examination performance, and/or for identifying students likely in need of remediation in clinical knowledge.

Predicting Academic Difficulty in Veterinary Medicine: A Case-Control Study.

A veterinary education is costly and time-consuming, so it is in the best interests of applicants and colleges alike that admissions processes be fair and select applicants who are likely to succeed. We employed a case-control study to explore whether any of 28 admissions variables used by a veterinary college located in the Midwest region of the United States predicted which students would encounter academic difficulty in the veterinary curriculum. Participants were selected from the veterinary classes admitted between 2008 and 2017. We defined academic difficulty cases (n = 55) as any students dismissed from the program or placed on academic probation. Controls (n = 220) were selected at random from the same classes, excluding the academic difficulty cases, students with honor code violations, or any who had exited the program early for any reason other than participation in a concurrent program. Admissions variables included gender, citizenship, underrepresented status, state of residence, age, interview scores, GPA (science), GRE scores, undergraduate credits, participation in honors courses, community college credits, repeats/withdrawals of required undergraduate courses, course load, and admissions committee review criteria including work experience, animal/vet experience, references, essays, leadership, personal development, special circumstances, and overall committee score. Zero-order correlations for academic difficulty were significant for underrepresented status, age, GPA (science), verbal and quantitative GRE scores, repeats/withdrawals, and references. When combined in logistic regression, only science GPA, verbal GRE, and references significantly and independently predicted struggler status.

Development of core entrustable professional activities linked to a competency-based veterinary education framework.

Purpose: Despite the adoption of competency-based education in some veterinary schools over the past 15 years, only recently has a concerted effort been directed toward this in veterinary education internationally.Methods: In 2015, educational leaders from the Association of American Veterinary Medical Colleges (AAVMC) member schools came together with a strong call to action to create shared tools for clinical competency assessment.Results: This resulted in the formation of the AAVMC Competency-Based Veterinary Education (CBVE) Working Group, which then embarked on the creation of a shared competency framework and the development of eight core entrustable professional activities (EPAs) linked to this framework.Conclusions: This paper will report on the development of these EPAs and their integration with the concurrently-developed CBVE Framework.

Flipped Classroom Use in Veterinary Education: A Multinational Survey of Faculty Experiences.

Active teaching approaches such as the flipped classroom are linked to better quality student learning outcomes across health care disciplines, with the potential to support students' preparedness for practice. In the flipped classroom instructional approach, students engage in significant pre-class preparation to learn foundational knowledge and skills, then undertake instructional activities in the classroom that require them to integrate, apply and extend their learning to new contexts. This study reports the results of a multinational survey of flipped classroom use in veterinary education. Participants' ( n = 165) familiarity with and extent of use of the flipped classroom technique were investigated, together with the teaching strategies used and the perceived benefits and barriers to implementation. Relationships between respondent characteristics and flipped classroom use were also explored. The results indicated that 95% of participants were familiar with the flipped classroom technique, although fewer (64%) used it in their teaching. Pre-class activities included reviewing online and printed material, and engaging in preparatory learning activities such as quizzes, case analyses, reflective assignments and group activities. A variety of active learning strategies were used in class, including discussions, presentations, quizzes, group activities, problem solving and laboratory/practical exercises. Most participants perceived that the flipped classroom technique benefited student learning, with some also identifying benefits for the faculty involved. A range of student-, faculty- and institution-related barriers to implementing the flipped classroom technique were identified. These barriers need to be considered and addressed by teachers and administrators seeking to improve students' preparedness for practice by implementing flipped classrooms in veterinary education.

Undergraduate Rigor Scores: Do They Predict Achievement in Veterinary School?

The relations between potential indicators of undergraduate rigor and subsequent achievement in professional school are not clear; some studies have shown that greater undergraduate selectivity is associated with greater achievement in medical science programs, while others have not. We sought to determine the extent to which indicators of undergraduate rigor were associated with achievement in veterinary school. Participants were graduates from three cohorts. The predictors were undergraduate GPA (UGPA), plus five rigor scores-degree or number of undergraduate credits, number of honors courses, number of withdrawals from or repeats of prerequisite science courses, number of part-time semesters, and ratio of community college credits to total college credits. The outcomes were the veterinary medicine cumulative GPA (CVM GPA), Qualifying Exam scores, and North American Veterinary Licensing Exam scores. Using correlations corrected for range restriction, we regressed each outcome on the five rigor scores and UGPA for each of the three graduating cohorts. In most cases, indicators of undergraduate rigor did not predict subsequent achievement in veterinary school; however, in two comparisons, number of honors courses taken as an undergraduate predicted subsequent achievement. UGPA, as expected, predicted CVM GPA. Admissions committees may want to reevaluate whether they include undergraduate rigor when considering admission to their programs, with the caveat that our findings are specific to our institution and are not generalizable.

Efficacy of Teaching the Gambee Suture Pattern Using Simulated Small Intestine versus Cadaveric Small Intestine.

OBJECTIVE: To determine if instruction using simulated small intestine (SSI) is as effective as using cadaveric small intestine to teach the Gambee suture pattern to second year veterinary students. STUDY DESIGN: Prospective, randomized, blinded study. SAMPLE POPULATION: Second year veterinary students (n=59). METHODS: Students were randomly assigned to groups using SSI or equine cadaver small intestine (CSI) to learn the Gambee suture pattern. The same educator, an experienced surgical instructor, instructed all students. Instruction consisted of verbal description of the technique with a schematic diagram followed by a demonstration. Students then practiced the technique with supervision and verbal feedback. One week later, 3 board certified surgeons experienced in surgical instruction evaluated each student suturing equine CSI and scored them using a rubric developed and validated for surgical skills assessment. RESULTS: Fifty-nine students were enrolled (4 students were absent for the lab during which the assessment was performed; 55 students were available for evaluation). Of the 55 students evaluated, 26 were in the SSI group and 29 were in the CSI group. There was no significant difference between CSI and SSI groups in ability to perform the Gambee suture pattern using equine CSI 1 week following training. CONCLUSION: SSI is as effective as equine cadaveric small intestine tissue to teach the Gambee suture pattern to second year veterinary students. If cadaver tissue is unavailable or undesirable, SSI could be used to instruct suture placement techniques.

Utility of an Equine Clinical Skills Course: A Pilot Study.

Recent publications have revealed inadequacies in the veterinary training of future equine practitioners. To help address this problem, a 2-week Equine Clinical Skills course was designed and implemented to provide fourth-year veterinary students with opportunities to have hands-on experience with common equine clinical skills using live animals and cadavers. Alumni and employers of alumni were surveyed to determine whether or not students participating in the course were more competent performing clinical skills during their first year post-graduation than those who had not participated in the course. Students who participated in the course were also surveyed before and after completing the course to determine whether or not their self-assessed skills improved during the course. Alumni who had taken the course rated their ability to perform the clinical skills more highly than alumni who had not taken the course. Similarly, students participating in the course indicated that they were significantly more able to perform the clinical skills after the course than when it began. Employers did not indicate a difference between the clinical skills of those who had taken the course and those who had not. Because this study involved a limited number of respondents from one institution, further studies should be conducted to replicate these findings and determine their generalizability.

Predictors of employer satisfaction: technical and non-technical skills.

Employers of 2007-2009 graduates from Iowa State University College of Veterinary Medicine were asked to respond to a survey regarding their overall satisfaction with their new employees as well as their new employees' preparation in several technical and non-technical skill areas. Seventy-five responses contained complete data and were used in the analysis. Four technical skill areas (data collection, data interpretation, planning, and taking action) and five non-technical skill areas (interpersonal skills, ability to deal with legal issues, business skills, making referrals, and problem solving) were identified. All of the skill area subscales listed above had appropriate reliability (Cronbach's alpha>0.70) and were positively and significantly correlated with overall employer satisfaction. Results of two simultaneous regression analyses indicated that of the four technical skill areas, taking action is the most salient predictor of employer satisfaction. Of the five non-technical skill areas, interpersonal skills, business skills, making referrals, and problem solving were the most important skills in predicting employer satisfaction. Hierarchical regression analysis revealed that all technical skills explained 25% of the variation in employer satisfaction; non-technical skills explained an additional 42% of the variation in employer satisfaction.

A study of depression and anxiety, general health, and academic performance in three cohorts of veterinary medical students across the first three semesters of veterinary school.

This study builds on previous research on predictors of depression and anxiety in veterinary medical students and reports data on three veterinary cohorts from two universities through their first three semesters of study. Across all three semesters, 49%, 65%, and 69% of the participants reported depression levels at or above the clinical cut-off, suggesting a remarkably high percentage of students experiencing significant levels of depression symptoms. Further, this study investigated the relationship between common stressors experienced by veterinary students and mental health, general health, and academic performance. A factor analysis revealed four factors among stressors common to veterinary students: academic stress, transitional stress, family-health stress, and relationship stress. The results indicated that both academic stress and transitional stress had a robust impact on veterinary medical students' well-being during their first three semesters of study. As well, academic stress negatively impacted students in the areas of depression and anxiety symptoms, life satisfaction, general health, perception of academic performance, and grade point average (GPA). Transitional stress predicted increased depression and anxiety symptoms and decreased life satisfaction. This study helped to further illuminate the magnitude of the problem of depression and anxiety symptoms in veterinary medical students and identified factors most predictive of poor outcomes in the areas of mental health, general health, and academic performance. The discussion provides recommendations for considering structural changes to veterinary educational curricula to reduce the magnitude of academic stressors. Concurrently, recommendations are suggested for mental health interventions to help increase students' resistance to environmental stressors.

Relationships among common measures of student performance and scores on the North American Veterinary Licensing Examination.

OBJECTIVE: To determine relationships among several common measures of performance prior to and during veterinary school (ie, Graduate Record Examination [GRE] scores, undergraduate grade point average [UGPA], Qualifying Examination [QE] scores, overall grade point average during veterinary school [VGPA], and scores for the North American Veterinary Licensing Examination [NAVLE]). DESIGN: Longitudinal retrospective study. SAMPLE POPULATION: 192 students from the Iowa State University College of Veterinary Medicine and 152 students from the University of Minnesota College of Veterinary Medicine. PROCEDURES: Student UGPA, VGPA, and GRE score data were gathered during the normal admissions and academic processes. The QE was administered as a low-stakes examination at both institutions for the purposes of curricular assessment. Scores on the NAVLE were provided with student permission by the National Board of Veterinary Medical Examiners. Path analysis was used to explore hypothesized relationships among variables. RESULTS: GRE scores and UGPA predicted NAVLE scores indirectly through QE scores and VGPA, whereas QE scores and VGPA directly predicted NAVLE scores. The resulting models explained 58% to 62% of the variance in NAVLE scores, with QE score being the strongest predictor. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that for veterinary school students, GRE scores, UGPA, VGPA, and QE scores could be used to predict scores on the NAVLE. This suggests that these measures could prove useful to veterinary schools when admitting students or preparing them for the NAVLE.

Key Assumptions Underlying a Competency-Based Approach to Medical Sciences Education, and Their Applicability to Veterinary Medical Education.

This perspective explores six key assumptions of a competency-based approach to medical-sciences education, as they relate to veterinary medical education. Those assumptions, derived from characteristics of competency based medical education (CBME) identified by CBME proponents are: (1) There are sufficient shortcomings in the medical competence of graduate veterinarians that solutions are necessary, and changes in the way we teach veterinarians will address those problems. (2) It is feasible to identify generally accepted core competencies in veterinary medical practice. (3) Teaching to defined learning outcomes will produce greater achievement for learners than approaches that do not emphasize clearly defined outcomes. (4) In veterinary medical education, it is possible to articulate the development of competence sequentially in a manner that is relatively consistent across learners, and carefully planning and sequencing learning activities will produce better learning outcomes. (5) Competency-focused instruction, which tailors the pace and progression of instruction to learners, is feasible in veterinary medical education, and will produce better outcomes than instruction that moves all students through an equivalent process in a set time frame. (6) Programmatic Assessment, including numerous direct observations with feedback, will improve learning outcomes, and is feasible in veterinary medical education. While available research does not unequivocally support all six assumptions, overall the potential benefits of adopting a competency-based approach seem promising for veterinary medical education.

GRE and Undergraduate GPA as Predictors of Veterinary Medical School Grade Point Average, VEA Scores and NAVLE Scores While Accounting for Range Restriction.

We explored the relation between Undergraduate GPA (UGPA) and Graduate Record Examination (GRE) Verbal scores and several indices of achievement in veterinary medical education across five cohorts of veterinary students (N per model ranging from 109 to 143). Achievement indices included overall grade point average in veterinary school (CVMGPA), scores on the North American Veterinary Licensing Examination (NAVLE) and scores on the Veterinary Educational Assessment (VEA). We calculated zero order correlations among all measures, and corrected correlations for range restriction. In all cases, corrected correlations exceeded uncorrected ones. For each index of achievement, we conducted hierarchical regressions using the corrected correlations as input, entering UGPA in the first step and GRE Verbal in the second step. Overall, UGPA and GRE Verbal combined explained from 70 to 84% of variance in CVMGPA, 51-91% of variance in VEA scores, and 41-92% of variance in NAVLE scores. For 12 of 15 comparisons, the second step (including GRE Verbal scores) significantly improved R 2. Our results reaffirm the value of UGPA scores and GRE Verbal scores for predicting subsequent academic achievement in veterinary school.

Peer assessment of a final-year capstone experience for formative evaluation of a pathology curriculum.

In spring of 2005, the authors implemented and evaluated a process at the Iowa State University College of Veterinary Medicine in which third-year students evaluated fourth-year students' performances on an advanced case-analysis assignment. This assignment, called the case correlation assignment, required a thorough integration and explanation of all ante- and post-mortem data for a specific hospital patient. Using a 21-point rubric, the necropsy course instructor and third-year students rated these assignments. Fourth-year students' performances on this assignment were used as an indicator of the success of the pathology curriculum. The authors evaluated the assessment process for feasibility, reliability, and validity. Many-facet Rasch analysis was used to determine item, case, and rater agreement. The assessment process produced good agreement among items and cases (VM4 student competence). Furthermore, most third-year students were able to reliably rate the case correlation assignments with no special training. The evaluation process was cost effective and occurred in the context of regular course assignments, thereby making it feasible. A case can be made that the overall process provides a valid measure of the pathology program's success in preparing students in the area of veterinary pathology.

A novel educational tool for teaching diagnostic reasoning and laboratory data interpretation to veterinary (and medical) students.

The Diagnostic Pathfinder was designed to help students learn diagnostic problem solving by supporting them in explaining relationships among history and physical examination findings, data abnormalities, and the underlying mechanisms of disease. The Pathfinder has been used to teach diagnostic problem solving to veterinary students since 2001 and is currently in use at 10 colleges of veterinary medicine. This article describes how the Pathfinder works and summarizes results from studies exploring the effect of Pathfinder use on learning and satisfaction. Pathfinder characteristics are described in terms of their influence on cognitive load, and strategies are provided for effective implementation.

Mechanism-based diagnostic reasoning: thoughts on teaching introductory clinical pathology.

Teaching introductory clinical pathology to veterinary students is a challenging endeavor that requires a shift in learning strategies from rote memorization to diagnostic reasoning. Educational research has identified discrete cognitive stages required to achieve the automated, unconscious thinking process used by experts. Building on this knowledge, we developed a case-based approach to clinical pathology instruction that actively engages students in the learning process and links performance with positive reward. Simulated cases provide context and create a structure, or "schema", which enhances the learning process by enabling students to synthesize facts and link them with their causal mechanism to reach a defensible diagnostic conclusion. Web-based tools, including the "Problem List Generator" and tutorials, have been developed to facilitate this process. Through the collaborative Biomedical Informatics Research Group, we are working to further develop and evaluate Web-based instructional tools and new educational methods, to clarify the diagnostic reasoning processes used by experienced clinical pathologists, and, ultimately, to better educate our future students to be effective diagnosticians.