Trained to cut? A literature review of veterinary surgical resident training.

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Retention of basic surgical skills in veterinary students.

OBJECTIVE: To quantify veterinary students' retention of surgical skills after a 5-month period without practice. STUDY DESIGN: Prospective longitudinal descriptive study. SAMPLE POPULATION: Convenience sample of second year veterinary students (n = 57). METHODS: Students practiced ovariohysterectomy (OVH) on a model during 4 clinical skills laboratories during spring 2021. Students were assessed performing OVH on their model using a validated 22-item rubric. Students not meeting expectations repeated their assessment 2 weeks later. All students had a 5-month period, including summer break, without skills practice. Students were again assessed performing OVH on their model in the fall. Students' rubric scores and pass rates were compared before and after summer break. RESULTS: Students scored lower on their retention test in fall (median = 43) than at the spring assessment (median = 56, P < .001). No difference was detected between lower and higher performing students. Five students (9%) did not meet expectations on their first assessment; more students (17/57, 30%) failed to meet expectations on their retention test (P = .004). CONCLUSION: Students experienced a decay in the surgical skills required to perform OVH after a 5-month period without practice, regardless of the quality of their initial performance. CLINICAL SIGNIFICANCE: Veterinary educators should emphasize the importance of continual practice to maintain skills and should consider assisting students in regaining skills during review sessions on models to improve surgical skill retention after a prolonged break.

Toward Global Harmonization of Training and Certification of Specialists in Laboratory Animal Veterinary Medicine.

Laboratory animal medicine (LAM) is a corner stone of animal-based research and has been a veterinary specialty for over 60 y. Today 5 Colleges of LAM (American, European, Japanese, Korean, and Indian) that certify specialists (Diplomates) in LAM are members of the International Association of Colleges of LAM (IACLAM). Goals of IACLAM are to support the development of new Colleges of LAM, to harmonize expectations for the knowledge and skills of newly certified LAM Diplomate, and to harmonize the standards (best practices) for training and examination of candidates among the member Colleges. IACLAM recently conducted an in-depth review and comparison of oversight, training, credentialing, and examination standards in the 5 Colleges as part of an initiative to create a framework for harmonization and consistency for these activities across the 5 Colleges. The process has led to an agreement on recommendations for knowledge and skill requirements for a newly certified Diplomate, as described by each College in a detailed role delineation document (RDD). The RDD is based on task analyses of the work responsibilities of laboratory animal veterinary Diplomates. This agreement is an important step toward the goal of global harmonization of LAM Diplomate training. Further efforts are planned for areas such as training, research, publication, and examination. This paper describes the role and content of the RDD and lists the differences and similarities among the RDDs of 5 Colleges of LAM.

[Evaluation of examination preparation methods in veterinary students]. / Untersuchung zur Prüfungsvorbereitung von Studierenden der Veterinärmedizin.

OBJECTIVE: As part of a study on competence-based assessment, students of the University of Veterinary Medicine, Hannover (TiHo), were asked to fill in an online questionnaire regarding their exam preparation and common examination formats. The aim of this investigation was to attain the students' opinion on different exam formats as well as the intensity and method of their preparation in order to further improve and develop the assessment formats. PARTICIPANTS, MATERIAL AND METHODS: Data was collected using an online questionnaire developed in LimeSurvey® (LimeSurvey GmbH, Hamburg, Germany) which included 29 questions and 3 follow-up questions. A link to the questionnaire was sent to all veterinary students at the TiHo by e-mail. RESULTS: A total of 215 questionnaires were completed and entered the evaluation. It was shown that the duration of the exam preparation depended on the specific exam format. Students' preparation time for an oral exam was longer than for a written-electronic exam. In the students' view, the assessment contents of oral examinations appeared to be more "relevant for later professional life". Electronic exams, on the other hand, were perceived as being more "fair" and less stressful. 30.3 % of respondents indicated to be suffering from test anxiety. CONCLUSION: Based on these findings, new recommendations for the development of teaching/learning materials may be derived. The opinions of students collected in this investigation provide an up-to-date insight into their perception of examinations. These results may serve as a valuable contribution to the optimization of examination scenarios in veterinary education. In addition, such surveys contribute to university-wide quality management of the examination systems.

Using evidence for patient-centred care.

This month Rachel Dean sets out why information given at CPD courses needs to be assessed for relevance and bias, and how a move from 'eminence-based' to evidence-based will lead to better patient care.

Teaching Cultural Humility and Implicit Bias to Veterinary Medical Students: A Review and Recommendation for Best Practices.

Cultural humility, with its concomitant understanding of the importance of the influences of diversity and inclusion, improves health outcomes in the human medical field. Recent changes to the American Veterinary Medical Association Council on Education requirements in veterinary medicine include teaching the impact of implicit bias on the delivery of veterinary medical services. Because overt enhancement of self-awareness is not fodder for traditional veterinary medical education delivery systems, in this article we review existing literature on the impact of recognition of implicit bias on health care and offer insights on ways to help veterinary students learn this skill, drawing on evidence from an inter-professional intervention called WisCARES (Wisconsin Companion Animal Resources, Education, and Social Services).

Veterinary Behavior: Assessment of Veterinarians' Training, Experience, and Comfort Level with Cases.

Studies of US animal shelters consistently indicate that behavior is often a major reason for relinquishment and, thereby, euthanasia of millions of dogs and cats annually. Even though this is an area in which veterinarians can intervene to support the human-animal bond, prior research has documented that they frequently do not bring the topic up during appointments. This study explored veterinarians' training in animal behavior and behavioral medicine, along with their level of comfort in treating common behavioral problems. An online survey of practicing veterinarians (N = 1,085) found that only 42.8% felt they'd received a significant amount of training in this field during veterinary school, but the majority reported participating in continuing education sessions about behavior. Almost all respondents reported seeing patients with behavioral issues (99.6%), even when the initial appointment was made for other reasons. Participants felt most comfortable discussing inappropriate elimination and begging for food but were least comfortable treating issues involving aggression. Most veterinarians treat their own behavior cases, using a combination of behavior modification techniques and medication. Only 22.1% refer cases needing behavioral therapy to a specialist. Given the prevalence of behavioral problems in companion animals and the potential for early veterinary intervention to play a significant role in animal health, it is important for veterinary schools to include this topic in their curricula. At present, 73% of schools require a course in animal behavior. The release of the new Competency-Based Veterinary Education framework is anticipated to support a greater teaching emphasis in this area.

Evaluation of a Human Virtual-Reality Endoscopy Trainer for Teaching Early Endoscopy Skills to Veterinarians.

Competency in flexible endoscopy is a major goal of small animal internal medicine residency training programs. Hands-on laboratories to teach entry-level skills have traditionally used anesthetized laboratory dogs (live dog laboratory [LDL]). Virtual-reality endoscopy trainers (VRET) are used for this purpose in human medicine with the clear benefits of avoiding live animal use, decreasing trainee stress, and allowing repeated, independent training sessions. However, there are currently no commercially available veterinary endoscopy simulators. The purpose of the study was to determine whether a human VRET can be a reasonable alternative to a LDL for teaching early veterinary endoscopy skills. Twelve veterinarians with limited or no endoscopy experience underwent training with a VRET (n = 6) or a LDL (n = 6), performed two recorded esophagogastroduodenoscopies (EGD) on anesthetized dogs for evaluation purposes (outcomes laboratory), and then underwent training with the alternative method. Participants completed questionnaires before any training and following each training session. No significant differences were found between training methods based on: measured parameters from the outcomes laboratory, including duration of time to perform EGD; evaluators' assessment of skills; and, assessment of skills through blinded review of the esophageal portion of EGD recordings. The VRET was less stressful for participants than the LDL (p = .02). All participants found that the VRET was a useful and acceptable alternative to the LDL for training of early endoscopy skills. Based on this limited study, VRET can serve as a reasonable alternative to LDL for teaching endoscopy skills to veterinarians.

Monitoring the Curriculum through the Student Perspective.

Student input was deliberately included as part of the curriculum implementation and assessment plan at the University of Minnesota College of Veterinary Medicine. The new curriculum included design features to encourage deeper learning such as a spiral curriculum with cross-course integration, increased open time, and more active learning. Student well-being was seen as a simultaneous need. To gather overall perceptions of workload and well-being, student volunteers from each cohort were surveyed weekly starting in 2013. Survey questions asked about out-of-class work time, level of integration, extracurricular activities, student well-being habits, paid employment, and other factors. Survey questions were combined with course data to get a full picture of week quality, total course work time, extracurricular activities, and the effects of integration. Many of our hypotheses about curricular and extracurricular impacts on week quality were disproven. Week quality was most positively affected by student factors of sleep and exercise, whereas the curricular factors of out-of-class work time, total course work time, and examination hours had the strongest negative effects. A surprising finding was that open time, in-class hours, and paid employment hours had a minimal effect on week quality. Students identified excessively heavy semesters and uneven semester workloads that resulted in early revisions to the new curriculum. Student feedback provided a view of the curriculum that was not otherwise available and resulted in early and significant impacts on the new curriculum, and they provided insight into whether planned changes had occurred and how effective various factors were in reaching the curricular goals.

Effect of Instructional Format on Veterinary Students' Task Performance and Emotional State during a Simulation-Based Canine Endotracheal Intubation Laboratory: Handout versus Video.

Video- versus handout-based instructions may influence student outcomes during simulation training and competency-based assessments. Forty-five third-year veterinary students voluntarily participated in a simulation module on canine endotracheal intubation. A prospective, randomized, double-blinded study investigated the impact of video (n = 23) versus handout (n = 22) instructions on student confidence, anxiety, and task performance. Students self-scored their confidence and anxiety before and after the simulation. During the simulation laboratory, three raters independently evaluated student performance using a 20-item formal assessment tool with a 5-point global rating scale. No significant between- or within-group differences (p > .05) were found for both confidence and anxiety scores. Video-based instructions were associated with significantly higher (p < .05) total formal assessment scores compared with handout-based instructions. The video group had significantly higher scores than the handout group on 3 of the 20 individual skills (items) assessed: placement of tie to the adaptor-endotracheal tube complex (p < .05), using the anesthetic machine (p < .01), and pop-off valve management (p < .001). Inter-rater reliability as assessed by Cronbach's α (.92), and Kendall's W (.89) was excellent and almost perfect, respectively. A two-faceted crossed-design generalizability analysis yielded G coefficients for both the handout (Ep2 = .68) and the video (Ep2 = .72) groups. Video instructions may be associated with higher performance scores than handout instructions during endotracheal intubation simulation training. Further research into skill retention and learning styles is warranted.

Success at Veterinary School: Evaluating the Influence of Intake Variables on Year-1 Examination Performance.

A major challenge in admissions to veterinary medical degrees is to select those students most suitable for clinical training programs and careers from a large pool of applicants with very high academic ability. Predicting the success of students in a veterinary course is challenging, and relatively few objective studies have been undertaken to identify factors that facilitate progression through this educational experience. Prior educational attainment is considered by some to be a good predictor of success at undergraduate level. The aims of this study were to analyze intake data such as educational history and demographic factors of students entering the University of Edinburgh and to investigate possible relationships between these data and academic performance in the first year at veterinary school. Data were collated for three veterinary intakes, including school qualification, subjects, grades, grade point average (GPA), degree classification, domicile, gender, and age. Performance was measured by marks achieved in first-year veterinary degree examinations. Relationships between marks and the influence of intake variables were statistically analyzed via ANOVA. For school-leaving entrants, the presence of straight A grades in school was linked to better exam performance. Students with an A grade in Chemistry or Biology performed better; A grades in Mathematics and Physics did not show such a consistent linkage with performance. Higher GPA was associated with better performance in first year for students in a graduate entry program. This study shows prior educational attainment does appear to be linked with subsequent performance in the first year at veterinary school.

A Competency-Guided Veterinary Curriculum Review Process.

Competencies can guide outcomes assessment in veterinary medical education by providing a core set of specific abilities expected of new veterinary graduates. A competency-guided evaluation of Colorado State University's (CSU) equine veterinary curriculum was undertaken via an alumni survey. Published competencies for equine veterinary graduates were used to develop the survey, which was distributed to large animal alumni from CSU's Doctor of Veterinary Medicine program. The results of the survey indicated areas for improvement, specifically in equine business, surgery, dentistry, and radiology. The desire for more hands-on experiences in their training was repeatedly mentioned by alumni, with the largest discrepancies between didactic knowledge and hands-on skills in the areas of business and equine surgery. Alumni surveys allow graduates to voice their perceived levels of preparation by the veterinary program and should be used to inform curriculum revisions. It is proposed that the definition and utilization of competencies in each phase of a curricular review process (outcomes assessment, curriculum mapping, and curricular modifications), in addition to faculty experience and internal review, is warranted.

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.

Inter-Rater Reliability of Grading Undergraduate Portfolios in Veterinary Medical Education.

The reliability of high-stakes assessment of portfolios containing an aggregation of quantitative and qualitative data based on programmatic assessment is under debate, especially when multiple assessors are involved. In this study carried out at the Faculty of Veterinary Medicine, Utrecht University, the Netherlands, two independent assessors graded the portfolios of students in their second year of the 3-year clinical phase. The similarity of grades (i.e., equal grades) and the level of the grades were studied to estimate inter-rater reliability, taking into account the potential effects of the assessor's background (i.e., originating from a clinical or non-clinical department) and student's cohort group, gender, and chosen master track (Companion Animal Health, Equine Health, or Farm Animal/Public Health). Whereas the similarity between the two grades increased from 58% in the first year the grading system was introduced to around 80% afterwards, the grade level was lower over the next 3 years. The assessor's background had a minor effect on the proportion of similar grades, as well as on grading level. The assessor intraclass correlation was low (i.e., all assessors scored with a similar grading pattern [same range of grades]). The grades awarded to female students were higher but more often dissimilar. We conclude that the grading system was well implemented and has a high inter-rater reliability.

Evaluation of peer teaching and deliberate practice to teach veterinary surgery.

OBJECTIVE: To assess the impact of peer teaching and deliberate practice on surgical skills acquisition and retention in first- and second-year veterinary students. STUDY DESIGN: Randomized, prospective, comparative study. SAMPLE POPULATION: Eighteen first-year and 25 second-year students from 1 college of veterinary medicine who had previously demonstrated proficiency in basic surgical skills. METHODS: Forty-three participants were divided into 3 groups: the test group (group A, n = 15), who participated in a structured peer-assisted learning program using deliberate practice; the time-practice control group (group B, n = 15), who participated in an unstructured peer-supported environment; and the assessment-only control group (group C, n = 13), who participated in the assessments. Participants performed a subcutaneous mass removal on a cadaver model and were assessed via a global rating system. Three assessment points were evaluated: pretraining, immediate posttraining, and retention. RESULTS: The number of participants who achieved acceptable or excellent grand total scores in group A increased after training. Among all participants, 22% in group A, 35% in group B, and 38% in group C did not achieve an acceptable total score at the retention assessment. CONCLUSION: The study population improved in skill level and retention through the use of standardized video and peer instruction with attention to effective learning strategies, particularly deliberate practice. CLINICAL SIGNIFICANCE: Use and enhancement of the format introduced in this study could augment veterinary surgical education.