Preliminary testing of psychometric properties of the 'student perceptions of veterinary interprofessional education and work scale' (SP-VIEWS).

Responsibility for the provision of veterinary care and services is increasingly shared between veterinary surgeons/veterinarians and registered veterinary nurses/veterinary technicians. Interprofessional education of these clinical professionals is not widespread but is growing. Understanding students' perceptions of veterinary interprofessional education and working is therefore important; however, no validated scale exists to assess this. This study aimed to create and test the psychometric properties of a 'Student perceptions of veterinary interprofessional education and work scale' (SP-VIEWS). A scale was built using scales previously validated in other contexts, plus statements informed by veterinary interprofessional research, and sent to veterinary and veterinary nursing students at six UK institutions. Exploratory Factor Analysis (EFA) on a randomly-selected half of the responses (n = 260) suggested a model with 16 items grouped within three factors: 'Benefits of learning with the other profession', 'Leadership and speaking up' and 'Teams and benefits of teamwork'. Confirmatory Factor Analysis (CFA) on the remaining 260 responses demonstrated appropriate fit based on conventional parameters, such as goodness of fit index. Overall internal consistency was good (Cronbach's alpha 0.82). CFA demonstrated that SP-VIEWS showed adequate, though not excellent, fit to the data. Future research should evaluate SP-VIEWS in other universities and countries.

Developing Inter-Professional Education Initiatives to Aid Working and Learning Between Veterinarians and Veterinary Nurses/Vet Techs.

The veterinary workplace consists of different professionals working together in inter-professional teams. Previous work has explored the benefits of effective veterinary teamwork for multiple stakeholders. In this teaching tip article, we outline the underlying educational theories and tips for developing inter-professional teaching to foster students' appreciation of the different roles and responsibilities of veterinarians and veterinary nurses/vet techs. Inter-professional education (IPE) requires students to learn with, about, and from each other and implies recognition of social learning as an underpinning approach. It involves developing learning opportunities to address students' potential misunderstandings of each other's motivations, to allow them to explore issues present in the other profession's practice, and to clarify sometimes overlapping roles and responsibilities. Students are given opportunities to explore the complexity of inter-professional teamwork in a safe environment using real-life topics as context for their collaboration. Two veterinary examples of IPE at the Royal Veterinary College (RVC) are provided to explore different teaching methods and topics that have proved successful in our context: dentistry and directed learning scenarios. We describe how RVC has developed an IPE team consisting of faculty members who champion IPE, which has, in turn, inspired students to create a student-led IPE club, hosting extracurricular educational events. This is an example of an effective student-teacher partnership. A number of challenges exist in embedding IPE, but the benefits it offers in integrating clinical and professional elements of the curricula make it worthy of consideration.

Evaluating #VetFinals: Can Twitter help students prepare for final examinations?

Twitter is increasingly used in education. In this article, Twitter was evaluated for its potential to aid veterinary students in their preparation for final examinations. "#VetFinals" revision sessions were facilitated by experts on a variety of topics. The initiative was evaluated through consideration of potential participants, session content and student experiences. In analysis of nine sessions, 52 students participated from eight veterinary schools. During a session, the facilitator tweeted 66 times on average, primarily asking a general question. Students on average tweeted 84 times, mostly in response to facilitators. They also asked novel questions and responded to fellow students. Focus groups and interviews with 11 students suggested that: sessions are useful for preparation/self-testing to succeed in exams; the facilitator and session style impact on learning; the sessions feel like personalized learning; there are elements of safety and exposure leading to some fear of tweeting; peer-learning promotes competition; a community of learners was formed; Twitter has become a part of normal professional life. Whilst not all students will take part in this type of social media use, many found it beneficial. The importance of the facilitator suggests the need for faculty development.

Teaching Tip: Developing an Intercollegiate Twitter Forum to Improve Student Exam Study and Digital Professionalism.

#VetFinals has been developed as a novel online Twitter teaching event designed to support intercollegiate veterinary teaching using social media. Previous studies in other fields have suggested that Twitter use within universities may have benefits for undergraduate education. This "teaching tip" paper describes a project using Twitter to host online exam study sessions. The project has been a highly successful collaborative effort between the Royal Veterinary College and Nottingham Veterinary School in the UK. Over 4 years, the #VetFinals project has developed into a long-term, self-sustaining enterprise. This initiative provides a semi-structured means for student exam preparation with direct real-time input from a faculty member. It also creates a network of peers both horizontally across institutions and vertically throughout year groups. Based on similar initiatives in other disciplines, an anticipated outcome of this project was to contribute to student online professionalism. This could help address the veterinary community's recently highlighted problems with professional conduct and appropriate use of social media. Analysis of the success of this endeavor will be available in a future publication.

Inter-professional practice: from veterinarian to the veterinary team.

Animal health care is being delivered by an increasing number of professions and occupations. This article takes an inward look at the veterinary team, focusing on the day-to-day life of veterinarians and those with whom they work, such as veterinary technicians/nurses, physical therapists, and farriers. The evolution of the work of the veterinarian should be explored alongside the evolution of closely related occupations, as the current working practice of veterinarians is affected by the practice of these other occupations. An example is given of UK veterinary nurses (similar to veterinary technicians in North America) who are currently undergoing professionalization. Seminal implementations have included a register (2007), disciplinary procedures (2011), a declaration of professional responsibilities (2012), and required continuing professional development for registered veterinary nurses (RVNs). These implementations result in veterinary nurses who are now accountable for their actions. There are many potential benefits to good inter-professional practice for the practice itself, individual team members, clients, and patients, including better results produced by the whole team rather than the sum of the parts, financial benefits to using individuals in lower-paid occupations for shared roles, and greater client satisfaction regarding increased options for treatment. There are, however, many challenges to inter-professional working that center on the interlinked themes of hierarchy (power, status, and the understanding/appreciation of professional roles) and communication (lack of/poor). Inter-professional education (IPE) is suggested as a potential means to overcome these challenges; however, research into IPE exclusively related to the veterinary team is lacking.

Mental health of veterinary nurses and student veterinary nurses: A scoping review.

BACKGROUND: Research has shown that veterinarians around the world are at high risk of mental health problems, but far less research has examined the mental health of veterinary nurses (VNs) and student veterinary nurses (SVNs). This scoping review aimed to map existing evidence on this topic and identify knowledge gaps. METHODS: Literature searches of MEDLINE, PsycINFO, PubMed, Web of Science and Google Scholar were conducted, and a structured screening and selection procedure was applied. To be included, studies had to be peer reviewed, report relevant results specific to VNs and/or SVNs, and provide descriptive statistics if using quantitative methods. RESULTS: Of the 2118 publications identified, only 13 journal articles met the inclusion criteria. The findings were summarised in five categories: mental health and wellbeing, burnout, stress, compassion fatigue and moral distress. While the findings of five of the studies suggested that some VNs and SVNs experienced some form of poor mental health, these studies lacked generalisability or transferability for multiple reasons. There was also inconsistency and ambiguity in the interpretation of findings, as well as incompatible or oversimplified definitions of mental health problems. LIMITATIONS: Our review excluded grey literature, such as reports, theses and conference presentations, as a preliminary search found very little empirical research on VNs' and SVNs' mental health in this type of publication. CONCLUSIONS: More research is needed to address the gaps in the existing evidence supporting our understanding of VN and SVN mental health. This should establish baseline measures and include comparisons with other occupational and national populations.

Development of the Animal Management and Husbandry Online Placement Tool.

The workplace provides veterinary students with opportunities to develop a range of skills, making workplace learning an important part of veterinary education in many countries. Good preparation for work placements is vital to maximize learning; to this end, our group has developed a series of three computer-aided learning (CAL) packages to support students. The third of this series is the Animal Management and Husbandry Online Placement Tool (AMH OPT). Students need a sound knowledge of animal husbandry and the ability to handle the common domestic species. However, teaching these skills at university is not always practical and requires considerable resources. In the UK, the Royal College of Veterinary Surgeons (RCVS) requires students to complete 12 weeks of pre-clinical animal management and husbandry work placements or extramural studies (EMS). The aims are for students to improve their animal handling skills and awareness of husbandry systems, develop communication skills, and understand their future clients' needs. The AMH OPT is divided into several sections: Preparation, What to Expect, Working with People, Professionalism, Tips, and Frequently Asked Questions. Three stakeholder groups (university EMS coordinators, placement providers, and students) were consulted initially to guide the content and design and later to evaluate previews. Feedback from stakeholders was used in an iterative design process, resulting in a program that aims to facilitate student preparation, optimize the learning opportunities, and improve the experience for both students and placement providers. The CAL is available online and is open-access worldwide to support students during veterinary school.

Misconceptions of Antibiotics as a Potential Explanation for Their Misuse. A Survey of the General Public in a Rural and Urban Community in Sri Lanka.

Reducing the growth of antimicrobial resistance (AMR) through public understanding is a goal of the World Health Organization. It is especially important in countries where antibiotics are widely available for common ailments without prescription. This study assessed understanding of antibiotics and AMR alongside perception of antibiotic usage among the general public in two diverse Sri Lankan communities: ordinary urban and indigenous rural. A cross-sectional questionnaire survey was conducted, gaining 182 urban and 147 rural responses. The majority of urban respondents (69.2%) believed that they had very good or good knowledge about antibiotics compared to 40.1% of rural respondents. Belief about knowledge and actual knowledge (measured via a test question) were correlated (r = 0.49, p = 0.001) for rural respondents, but not for urban respondents. Several misconceptions about antibiotics were highlighted, including that Paracetamol, a painkiller, was thought to be an antibiotic by more than 50% of both urban and rural respondents. In addition, 18.5% of urban and 35.4% of rural participants would keep and re-use what they perceived as leftover antibiotics. It is urgent that we pay attention to educating the general public regarding the identified misconceptions of these powerful drugs and their appropriate use.

Exploring Barriers to One Health Antimicrobial Stewardship in Sri Lanka: A Qualitative Study among Healthcare Professionals.

Antimicrobial resistance (AMR) is a global health threat, but little is known about the perceptions regarding antimicrobials and AMR among healthcare professionals in Sri Lanka. This research aimed to take a One Health approach to explore the knowledge, attitudes and perceptions of antibiotic stewardship and AMR among healthcare professionals in Sri Lanka. A qualitative study, using telephone interviews, allowing for an in-depth exploration of attitudes, beliefs and perspectives was conducted. Healthcare professionals from both the medical and veterinary sectors were included (n = 29). Interviews were conducted by an independent interviewer and were audio-recorded and transcribed. Conventional qualitative content analysis was undertaken. Four main categories were identified: (1) understanding of AMR and observing AMR, (2) barriers to antimicrobial stewardship, (3) personal factors in, and as a result of, inappropriate antibiotic usage and (4) how to tackle AMR. Healthcare professionals showed poor awareness regarding the spread of AMR and identified inappropriate prescribing behaviours by their inter- and intra-professional colleagues. Patient demands and the influence of pharmaceutical companies were factors contributing to poor prescribing behaviour. Suggestions for the future are stricter regulation of AMR control policy, effective government involvement, and awareness campaigns for healthcare professionals and the public.

Survey investigating factors affecting recruitment and retention in the UK veterinary nursing profession.

BACKGROUND: Recruitment and retention have been identified as contributing factors to workforce shortages in the veterinary team. METHODS: Results from veterinary nurses to an online questionnaire regarding recruitment and retention were analysed. RESULTS: Veterinary nurses had few job changes (median 2); however, 53.8% (n = 1060) reported they were likely or very likely to leave their employment within 2 years. Respondents who were recently qualified (p < 0.001) and on lower salaries (p < 0.001) were significantly more likely to plan to leave. The most frequently chosen reasons to stay in a position were team, location and working hours, while reasons to leave were salary, management and work-life balance. Respondents most disliked 'dealing with people', remuneration and work-life balance and would like to change the salary, management and team aspects. Employers reported difficulty in employing an experienced veterinary nurse. LIMITATIONS: A questionnaire simplifies the nature of retention. Also, a comparatively low number of responses was received, with overrepresentation of some groups. It was conducted in 2018; however, it still provides a useful comparison for studies regarding recent world events. CONCLUSION: The shortage of veterinary nurses is due in part to the lack of retention within the profession. Adequate recompense for work undertaken and value attributed to the role are suggested as contributing factors.

The transition into veterinary practice: opinions of recent graduates and final year students.

BACKGROUND: The transition from veterinary student to member of the veterinary profession is known to be challenging. This study aimed to determine and compare the opinions of final year veterinary students and recent graduates on graduate attributes that ease this transition. METHODS: The study was carried out across 3 veterinary schools in the United Kingdom. Paper based or electronic surveys were used. Final year students in the 3 schools were surveyed either electronically (school A) or on paper (schools B and C). Student cohort sizes were 112, 227 and 102 respectively. Recent graduates were contacted either at a reunion event (school A) or electronically from database records (school B and school C). Cohort sizes of contacted graduates were 80, 175 and 91 respectively. Respondents were asked to rate 42 individual attributes on a 5 point Likert scale. Focus groups with final year students and recent graduates and telephone interviews with recent graduates were carried out. Data were analysed by two researchers through a combination of manual coding and thematic analysis. Data were grouped into broad themes then sorted into narrower themes. Data were then searched for counter examples. RESULTS: Response rates for final year students were 34% (school A), 36% (school B) and 40% (school C). Response rates for recent graduates were 56% (school A), 20% (school B) and 11% (school C). There was a high level of agreement between the cohorts with respect to communication skills, problem solving and decision making skills, recognition of own limitations and the ability to cope with pressure all rated unanimously important or very important. Business acumen, knowledge of veterinary practice management and research skills were the 3 attributes ranked at the bottom of the list. Nine attributes were identified with a significantly different (p < 0.05) ranking between the cohorts. Final year students ranked veterinary clinical knowledge, knowledge of veterinary public health and zoonotic issues, veterinary legislation and veterinary practice management, commitment to continuing professional development and ability to evaluate information higher than recent graduates. Recent graduates ranked the attributes of integrity, friendliness and compassion higher than final year students. CONCLUSIONS: Recent graduates and final year students rate highly the attributes which help foster the client/veterinarian relationship. Recent graduates reflect that a focus on knowledge based attributes is less important once in practice when compared to final year. The study confirms the importance to recent graduates and final year students of attributes considered as non-technical in the transition to working in the veterinary profession.

Piloting interprofessional education interventions with veterinary and veterinary nursing students.

Interprofessional education (IPE) has received little attention in veterinary education even though members of the veterinary and nursing professions work closely together. The present study investigates veterinary and veterinary nursing students' and practitioners' experiences with interprofessional issues and the potential benefits of IPE. Based on stakeholder consultations, two teaching interventions were modified or developed for use with veterinary and veterinary nursing students: Talking Walls, which aimed to increase individuals' understanding of each other's roles, and an Emergency-Case Role-Play Scenario, which aimed to improve teamwork. These interventions were piloted with volunteer veterinary and veterinary nursing students who were recruited through convenience sampling. A questionnaire (the Readiness for Interprofessional Learning Scale [RIPLS]) was modified for use in veterinary education and used to investigate changes in attitudes toward IPE over time (pre-intervention, immediately post-intervention, and four to five months afterward). The results showed an immediate and significant positive change in attitude after the intervention, highlighting the students' willingness to learn collaboratively, their ability to recognize the benefits of IPE, a decreased sense of professional isolation, and reduced hierarchical views. Although nearly half of the students felt concerned about learning with students from another profession before the intervention, the majority (97%) enjoyed learning together. However, the positive change in attitude was not evident four to five months after the intervention, though attitudes remained above pre-intervention levels. The results of the pilot study were encouraging and emphasize the relevance and importance of veterinary IPE as well as the need for further investigation to explore methods of sustaining a change in attitude over time.

Developing an online professional network for veterinary education: the NOVICE project.

An online professional network for veterinarians, veterinary students, veterinary educationalists, and ICT (Information and Communication Technology) educationalists is being developed under the EU (European Union) Lifelong Learning Programme. The network uses Web 2.0, a term used to describe the new, more interactive version of the Internet, and includes tools such as wikis, blogs, and discussion boards. Focus groups conducted with qualified and student veterinarians within the project's five founding countries (The Netherlands, Germany, United Kingdom, Hungary, Romania) demonstrated that online professional communities can be valuable for accessing information and establishing contacts. Online networks have the potential to overcome common challenges to face-to-face communities-such as distance, cost, and timing-but they have their own drawbacks, such as security and professionalism issues. The Network Of Veterinary ICt in Education (NOVICE) was developed using Elgg, an open-source, free social networking platform, after several software options had been considered. NOVICE aims to promote the understanding of Web 2.0, confidence to use social software tools, and participation in an online community. Therefore, the Web site contains help sections, Frequently Asked Questions, and access to support from ICT experts. Five months after the network's launch (and just over one year into the project) 515 members from 28 countries had registered. Further research will include analysis of a core group's activities, which will inform ongoing support for and development of informal, lifelong learning in a veterinary context.

Preparing veterinary students for extramural clinical placement training: issues identified and a possible solution.

Extramural clinical placement training is an important part of many veterinary degree programs and provides students with valuable learning experiences in private practice, often focusing on the management of typical first-opinion cases. In the United Kingdom, the Royal College of Veterinary Surgeons (RCVS) has a mandatory requirement that students take 26 weeks of clinical placement or extramural studies (EMS) before graduation. However, if students are to maximize their learning opportunities during these placements, it is important that they be adequately prepared. In response to recent topical issues surrounding EMS in the United Kingdom, the current project undertook an iterative consultation process with key stakeholders, including students and placement providers, to identify key issues associated with students attending placements. These findings then informed the development and content of a computer-aided learning (CAL) package titled "The EMS Driving Licence" that aimed to improve the preparation of students for placements. The CAL package included sections covering the main identified areas of concern: Preparation (including what to take), Working With People (staff and clients), Professionalism (including confidentiality), Frequently Asked Questions (from students), and Top Tips (from practitioners). The CAL package was evaluated by students, and feedback was gathered by means of a questionnaire. Students recognized that the content addressed many of their concerns, and all reported that they would recommend the package to others. The CAL package has been made available to all UK veterinary schools and has received backing from the RCVS as part of their current recommendations on EMS to the UK veterinary profession.

Conflict Between Direct Experience and Research-Based Evidence Is a Key Challenge to Evidence-Based Respiratory Medicine on British Racing Yards.

Inflammatory airway disease (IAD) is a commonly diagnosed but variably defined syndrome of equine lower airway inflammation. The most recent American College of Veterinary Internal Medicine (ACVIM) consensus statement, informed by research evidence, recommends a case definition based on clinical signs (poor performance or occasional coughing of at least 3 weeks duration), increased endoscopically-visible tracheal mucus, and bronchoalveolar lavage cytology, and proposes that the condition should be termed 'mild-moderate equine asthma' (mEA). In British Thoroughbred racehorses, research to date has focused on airway inflammation defined by increased tracheal mucus and inflammatory tracheal wash sample cytology. It has been unclear whether or to what extent the ACVIM consensus statement has influenced the practice of British racing veterinarians. The aim of this qualitative study was to characterize and understand rationales for current practices relating to diagnosing and managing airway inflammation in British racehorses. Audio-recorded focus group discussions were conducted with 25 participants from four veterinary practices in England. Practices were purposively selected to represent those responsible for different types of racehorse, in different geographical regions. Thematic analysis of transcripts identified (i) an over-arching theme of serving the racing industry within which two further themes (ii) disregarding of the consensus and (iii) the pragmatic clinician were nested. The requirement to serve the racing industry was a key driver of clinical approaches, strongly influenced in particular by the trainer. Participants widely disregarded the consensus case definition of IAD/mEA for British racehorses because of perceived differences in etiology, perceived lack of practicability, particularly of BAL sampling, and perceived lack of understanding of the British racing context by consensus authors. Participants shared a strong professional identity as pragmatic clinicians providing an individualized clinical approach based on direct experience, which was often prioritized as the most valuable evidence with which to inform clinical decision-making. Lack of alignment with international consensus presents a barrier to practicing and furthering evidence-based medicine. Improved dialogue and partnership in research would be valuable and further research tailored for this population, including continuing development of contextually acceptable diagnostic methods, may be required.

Women in veterinary leadership positions: their motivations and enablers.

BACKGROUND: Despite now having higher numbers of women than men within the veterinary profession, there are substantially less women in leadership roles. Research, primarily in other professions, has focussed on barriers to leadership and sometimes overlooked facilitators and motivators. This study aimed to explore the motivating factors for female veterinary surgeons to become leaders, to identify potential strategies to increase female leadership. METHODS: Sixteen female leaders from academia, professional bodies, industry and clinical practice took part in semistructured interviews. Interviews were analysed using a thematic analysis approach. RESULTS: Two themes were developed: 'Potential for positive influence' and 'Requirement of external enablers'. Participants wanted to influence change for themselves, including work-life balance and developing their role, and for others through a position of influence. They wanted to inspire and mentor the future generation of leaders. External enablers allowed this transition to occur, including formal mentors and informal support systems, opportunities for growth and increased responsibility, and leadership training. CONCLUSION: Potential strategies to increase female leaders include the promotion of female role models, increasing awareness of training and increasing work flexibility. The profession could improve its support of the next generation of leaders and celebrate the successful female leaders we already possess.

Investigation of factors affecting recruitment and retention in the UK veterinary profession.

BACKGROUND: Recruitment and retention is currently of major concern and has resulted in the veterinary profession being returned to the UK's Shortage Occupation List in 2019. METHODS: An online questionnaire of veterinary employees and employers investigating factors contributing to leaving/staying in current employment and the profession. The questionnaire was distributed via specialist veterinary associations' email lists and social media from September to October 2018. RESULTS: Respondents had few job changes (median 3), however, 43.7 per cent (n=2390) reported that they were likely or very likely to leave their employment within two years. Vets who were recently qualified, on lower salaries and female were more likely to plan to leave. Most frequently chosen reasons to stay in a position were: team, location and family. Most commonly cited reasons to leave were: work-life balance, management and salary. Respondents most disliked dealing with people, work-life balance and the physical/emotional impacts of the job. They would most like to change the hours worked, team aspects and management. Employers suggested that it was difficult to employ a veterinary surgeon, especially an experienced individual. CONCLUSION: The current retention crisis is due in part to the differing requirements between modern-day veterinary employees, their employers, the public and the profession.

Mindset and its relationship to anxiety in clinical veterinary students.

This study investigated anxiety, one aspect of mental wellbeing, in fourth year veterinary students before the final clinical section of their course (intramural rotations (IMR)). It explored the relationship between reported anxiety and 'mindset': an individual's view on the ability to develop (eg, improve intelligence). Questionnaires were completed by 130 students. Students were mindset typed for ability and personality and rated their anxiety towards IMR. Students with different overall mindsets ('strong growth', 'growth' and 'fixed') were invited to participate in focus groups, to discuss causes of their anxieties. Quantitative results indicated 63.1 per cent of students had strong growth or growth mindsets overall, and that females were more fixed mindset-oriented than males. Females reported significantly greater anxiety than males. A fixed mindset view overall, and of ability, were significantly correlated with increased anxiety, while mindset view of personality was not. Students provided various reasons for their anxieties, which differed with mindset. Fixed mindset students (n=2) focused on concerns about knowledge, whereas growth students (n=6) were also anxious about work-life balance and future work. Growth students saw clinicians as future colleagues, rather than intimidating teachers. Students reported an awareness of being graded, although growth students were aware that IMR are learning opportunities.

Continuing professional development: researching non-technical competencies can support cognitive reappraisal and reduced stress in clinicians.

Generic professional capabilities (non-technical competencies) are increasingly valued for their links to patient outcomes and clinician well-being. This study explores the emotional change, and practice-related outcomes, of participants of a veterinary professional key skills (PKS) continuing professional development (CPD) module. Reflective summaries produced by participants were analysed. A change in emotion, from 'negative' to 'positive', was the focus of analysis. Sections regarding these emotions were thematically analysed. Analysis was performed on 46 summaries. Three themes were identified: 'the PKS module' (centred on reluctance becoming surprise and stimulation), 'developing non-technical competencies' (unease to confidence) and 'stress and coping through a reflective focus' (anxiety to harmony). The changing emotions were connected to positive cognitive reappraisal and often behaviour changes, benefitting self, practice, clients and patients. The PKS module teaches participants to reflect; a new and challenging concept. The consequences of this enabled participants to understand the importance of professional topics, to be appreciative as well as critical, and to enjoy their job. Importantly, the module stimulated coping responses. Better understanding of roles led to participants having more reasonable expectations of themselves, more appreciation of their work and reduced stress. This research supports more attention to professional skills CPD for health professions.

Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate.

At a time where high levels of stress are reported in the veterinary profession, this study explores the challenges that veterinary graduates encounter when they enter general (first opinion) practice. Participants had written reflective accounts of their 'Most Puzzling Cases' for the postgraduate Professional Key Skills module of the Certificate in Advanced Veterinary Practice, offered by the Royal Veterinary College. Reasons that a case was puzzling, or became challenging, were thematically analysed. Fifteen summaries were analysed. Three core themes were identified: 'clinical reasoning', centred on the limitations of pattern recognition and the methods used to overcome this; the 'veterinary healthcare system', focusing on the need for continuity of care, time pressure and support in the transition to practice; and the 'owner', looking at the broader clinical skills needed to succeed in general practice. Clinical reasoning was raised as an issue; discussion of when pattern recognition is not appropriate and what to do in these cases was common. A lack of experience in general practice case types, and how to best operate in the resource-constrained environment in which they present, is the likely cause of this, suggesting that a greater focus on the primary care paradigm is needed within veterinary education.