Collaborative Development of Core Entrustable Professional Activities for Veterinary Education.

Entrustable professional activities (EPAs) have been proposed as a practical framework for the implementation of competency-based education. As veterinary education moves toward a competency-based approach, core EPAs provide a context for assessment of workplace activities. This article reports on the development of eight core clinical EPAs for veterinary education created through multi-institutional collaboration, with international input from veterinary educators and veterinary educational leaders. These core EPAs are intended as minimal expectations for clinical activities that should be assessed for every graduate of Association of American Veterinary Medical Colleges member institutions. Adoption of the core EPAs and the associated Competency-Based Veterinary Education (CBVE) framework by veterinary schools is intended to promote Day One graduate competence and thereby enhance patient care and client service.

Collaborative Development of a Shared Framework for Competency-Based Veterinary Education.

Competency-based medical education is an educational innovation implemented in health professions worldwide as a means to ensure graduates meet patient and societal needs. The focus on student-centered education and programmatic outcomes offers a series of benefits to learners, institutions and society. However, efforts to establish a shared, comprehensive competency-based framework in veterinary education have lagged. This article reports on the development and outcome of a competency-based veterinary education (CBVE) framework created through multi-institutional collaboration with international input from veterinary educators and veterinary educational leaders. The CBVE Framework is designed to reflect the competencies expected of new graduates from member institutions of the Association of American Veterinary Medical Colleges (AAVMC). The CBVE Framework consists of nine domains of competence and 32 competencies, each supplemented with illustrative sub-competencies to guide veterinary schools in implementing competency-based education in their local context. The nine domains of competence are: clinical reasoning and decision-making; individual animal care and management; animal population care and management; public health; communication; collaboration; professionalism and professional identity; financial and practice management; and scholarship. Developed through diverse input to facilitate broad adoption, the CBVE Framework provides the foundation for competency-based curricula and outcomes assessment in veterinary education internationally. We believe that other groups seeking to design a collective product for broad adoption might find useful the methods used to develop the CBVE Framework, including establishing expertise diversity within a small-to-medium size working group, soliciting progressive input and feedback from stakeholders, and engaging in consensus building and critical reflection throughout the development process.

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.

The Veterinary Identity: A Time and Context Model.

The nature of professionalism teaching is a current issue in veterinary education, with an individual's identity as a professional having implications for one's values and behaviors, as well as for his or her career satisfaction and psychological well-being. An appropriately formed professional identity imparts competence in making complex decisions-those that involve multiple perspectives and are complicated by contextual challenges. It enables an individual to act in a way that aligns with his or her professional values and priorities, and imparts resilience to situations in which one's actions are dissonant to these personal beliefs. There are challenges in professionalism teaching that relate to student engagement and faculty confidence in this area. However, these cannot be addressed without first defining the veterinary professional identity-in effect, the aim of professionalism teaching. In this article, existing identity models from the wider literature have been analyzed through a veterinary lens. This analysis was then used to construct a model of veterinary professional identity that incorporates the self (personal morals and values), social development (learning from the workplace environment), and professional behaviors. Individuals who form what we have termed self-environment-behavior connections are proposed to be able to use workplace learning opportunities to inform their identity development, such that environmental complexity does not obstruct the link between values and behaviors. Those who fail to connect with the environment in this way may perceive that environmental influences (e.g., the client, financial limitations) are obstructive to enacting their desired identity, and they may struggle with decision making in complex scenarios.

Developing a Professional Studies Curriculum to Support Veterinary Professional Identity Formation.

Professional studies teaching in medical and veterinary education is undergoing a period of change. Traditional approaches, aiming to teach students professional values and behaviors, are being enhanced by curricula designed to support students' professional identity formation. This development offers the potential for improving student engagement and graduates' mental well-being. The veterinary professional identity associated with emotional resilience and success in practice incorporates complexity in professional decision making and the importance of context on behaviors and actions. The veterinarian must make decisions that balance the sometimes conflicting needs of patient, clients, veterinarian, and practice; their subsequent actions are influenced by environmental challenges such as financial limitations, or stress and fatigue caused by a heavy workload. This article aims to describe how curricula can be designed to support the development of such an identity in students. We will review relevant literature from medical education and the veterinary profession to describe current best practices for supporting professional identity formation, and then present the application of these principles using the curriculum at the Royal Veterinary College (RVC) as a case study. Design of a "best practice" curriculum includes sequential development of complex thinking rather than notions of a single best solution to a problem. It requires managing a hidden curriculum that tends to reinforce a professional identity conceived solely on clinical diagnosis and treatment. It includes exposure to veterinary professionals with different sets of professional priorities, and those who work in different environments. It also includes the contextualization of taught content through reflection on workplace-learning opportunities.

Discipline-Specific Compared to Generic Training of Teachers in Higher Education.

A recurrent theme arising in the higher education sector is the suitability and effectiveness of generic versus discipline-specific training of university teachers, who are often recruited based on their disciplinary specialties to become teachers in higher education. We compared two groups of participants who had undergone training using a generic post-graduate certificate in higher education (PGCertGeneric) versus a discipline-specific course in veterinary education (PGCertVetEd). The study was conducted using a survey that allowed comparison of participants who completed PGCertGeneric (n=21) with PGCertVetEd (n=22). Results indicated that participants from both PGCertGeneric and PGCertVetEd considered teaching to be satisfying and important to their careers, valued the teaching observation component of the course, and identified similar training needs. However, the participants of the PGCertVetEd felt that the course made them better teachers, valued the relevance of the components taught, understood course design better, were encouraged to do further courses/reading in teaching and learning, changed their teaching as a result of the course, and were less stressed about teaching as compared to the PGCertGeneric participants (p<.05). It is likely that the PGCertVetEd, which was designed and developed by veterinarians with a wider understanding of the veterinary sector, helped the participants perceive the training course as suited to their needs.

Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students.

The Hidden Curriculum of Veterinary Education: Mediators and Moderators of Its Effects.

The "hidden curriculum" has long been supposed to have an effect on students' learning during their clinical education, and in particular in shaping their ideas of what it means to be a professional. Despite this, there has been little evidence linking specific changes in professional attitudes to the individual components of the hidden curriculum. This study aimed to recognize those components that led to a change in students' professional attitudes at a UK veterinary school, as well as to identify the attitudes most affected. Observations were made of 11 student groups across five clinical rotations, followed by semi-structured interviews with 23 students at the end of their rotation experience. Data were combined and analyzed thematically, taking both an inductive and deductive approach. Views about the importance of technical competence and communication skills were promoted as a result of students' interaction with the hidden curriculum, and tensions were revealed in relation to their attitudes toward compassion and empathy, autonomy and responsibility, and lifestyle ethic. The assessment processes of rotations and the clinical service organization served to communicate the messages of the hidden curriculum, bringing about changes in student professional attitudes, while student-selected role models and the student rotation groups moderated the effects of these influences.

Usefulness of Crossword Puzzles in Helping First-Year BVSc Students Learn Veterinary Terminology.

Appropriate terminology is essential for successful communication among health professionals. However, students have traditionally been encouraged to learn terminology by rote memorization and recall, strategies that students try to avoid. The use of crossword puzzles as a learning tool has been evaluated in other education disciplines, but not for terminology related to veterinary science. Hence, the objective of this study was to test whether crossword puzzles might be an effective aid to learning veterinary terminology. Forty-two first-year students enrolled in a Bachelor of Veterinary Science program were randomly divided into two groups and their previous knowledge of veterinary terms tested. One group received a list of 30 terms with their definitions. The other group received the same list plus six specially designed puzzles incorporating these 30 terms. After 50 minutes, both groups completed a post-intervention test and the results were compared statistically. The results showed that the students using the crossword puzzles performed better in the post-intervention test, correctly retaining more terms than the students using only rote learning. In addition, qualitative data, gathered through an electronic survey and focus group discussions, revealed a positive attitude among students toward the use of crossword puzzles.

Scaffolded Active Learning: Nine Pedagogical Principles for Building a Modern Veterinary Curriculum.

Veterinary discipline experts unfamiliar with the broader educational literature can find the adoption of an evidence-based approach to curriculum development challenging. However, greater societal and professional demands for achieving and verifying Day One knowledge and skills, together with continued progress in information generation and technology, make it all the more important that the defined period for initial professional training be well used. This article presents and discusses nine pedagogical principles that have been used in modern curricular development in Australia, the United Kingdom, and the United States: (1) outcomes-based curriculum design; (2) valid and reliable assessments; (3) active learning; (4) integrated knowledge for action; (5) tightly controlled core curriculum; (6) "just-in-time" rather than "just-in-case" knowledge; (7) vertical integration, the spiral curriculum, and sequential skills development; (8) learning skills support; and (9) bridges from classroom to workplace. Crucial to effective educational progress is active learning that embraces the skills required by the modern professional, made possible by tight control of curricular content. In this information age, professionals' ability to source information on a "just-in-time" basis to support high quality reasoning and decision making is far more important than the memorization of large bodies of increasingly redundant information on a "just-in-case" basis. It is important that those with responsibility for veterinary curriculum design ensure that their programs fully equip the modern veterinary professional for confident entry into the variety of roles in which society needs their skills.

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.

Teacher development: a patchwork-text approach to enhancing critical reflection in veterinary and para-veterinary educators.

Reflection is an essential component of teacher-development programs, and reliable, valid methods to teach, assess, and evaluate reflection are critical. However, it is important that appropriate methods are created for and evaluated across multiple disciplinary backgrounds, as the participants' backgrounds are a major factor in the development of critical reflection. The patchwork-text approach is a narrative process that is predominantly focused on the personal development of the individual. The current study used the patchwork-text approach for the development of reflection in participants with a science background who had not used a reflective approach for personal development before. Twenty summative essays and 103 formative essays from 21 participants who underwent a 1-year higher-education teacher-development program were analyzed to assess whether the quality and quantity of reflective writing was enhanced through a regular, iterative process of reflective writing with feedback. The analysis of the essays involved the use of a predefined set of criteria for identifying the different reflective levels from 1 to 4 and the calculation of a reflective score to evaluate the overall development. The results show a clear improvement of higher-level critical thinking as the participants progressed through their course. Higher levels of reflection were achieved particularly where a unit focused on a familiar area for the participant as opposed to one in which the participant had less experience. The analysis provides evidence that the patchwork text is a useful method for development and evaluation of reflection in participants with a veterinary/animal-science base.

Clinical reasoning and case-based decision making: the fundamental challenge to veterinary educators.

Confusion about the nature of human reasoning and its appropriate application to patients has hampered veterinary students' development of these skills. Expertise is associated with greater ability to deploy pattern recognition (type 1 reasoning), which is aided by progressive development of data-driven, forward reasoning (in contrast to scientific, backward reasoning), analytical approaches that lead to schema acquisition. The associative nature of type 1 reasoning makes it prone to bias, particularly in the face of "cognitive miserliness," when clues that indicate the need for triangulation with an analytical approach are ignored. However, combined reasoning approaches, from the earliest stages, are more successful than one approach alone, so it is important that those involved in curricular design and delivery promote student understanding of reasoning generally, and the situations in which reasoning goes awry, and develop students' ability to reason safely and accurately whether presented with a familiar case or with a case that they have never seen before.

Factors influencing clinical students' perceptions of an embedded research project and associated publication output.

In this article, we describe student perceptions of the value of a short, compulsory research project embedded in a clinical degree program, the research output in terms of publications, and the factors influencing this. It was hypothesized that student attitudes toward the project, student perceptions of how much the project contributed to their generic skills, and the number of publications submitted or prepared for submission would be associated with perceived quality of supervision, perceived difficulty of the project, career plans, and attitude before commencement of the project. We explored this using a questionnaire comprising 30 questions that included demographics, Likert scales, and categorical responses. Student attitudes toward research were found to be associated with student attitude before the start of the project, perceived difficulty of the project, perceived quality of supervision, and perceived relevance to the profession. Students thought that the research project contributed most to the skills of "information gathering" and "critical evaluation" and the least to "teamwork," "problem solving," and "oral communication." Research output was significantly linked to perceived quality of supervision and the help students received with data analysis and data collection, though not with the project report itself. In conclusion, although the success of the research project was influenced by many factors, the perceived quality of supervision influenced all three outcome measures. Therefore it is clear that optimization of this aspect offers the most scope for enhancing the student learning experience.

Benefits and limitations of an employer-led, structured logbook to promote self-directed learning in the clinical workplace.

A structured logbook, consisting of a competency log and a learning contract, was designed and implemented as part of a two-week structured work placement for final-year veterinary students to help them become more self-directed in the workplace. The competency log encompassed 48 core skills and, along with the learning contract, was reviewed at the start and end of the placement. To assess their perceptions of the logbook in promoting self-directed learning, students and supervisors were asked to complete a questionnaire pre- and post-placement and to participate in focus groups (students) and interviews (supervisors) after the placement. The study found significant increases pre- to post-placement in students' perceived levels of competence in all 48 skills and their confidence in being self-directed. However, student attitudes toward the logbook significantly decreased in terms of it encouraging supervisors to take a clearly designed role in structuring learning and facilitating alignment of employer and student expectations. Although supervisors were generally positive about the logbook, some had not been able to review it with their students, which affected students' perceptions of the logbook's usefulness. Some supervisors felt they had not received enough training, and most, erroneously, believed the logbook to be an external research initiative rather than having been designed by the head of their own organization. This study demonstrated that a structured logbook may be useful in helping students become more self-directed; however, supervisor support for the logbook is critical. To facilitate this, supervisors require training and support from senior management.

Expert visual assessment strategies for equine lameness examinations in a straight line and circle: A mixed methods study using eye tracking.

BACKGROUND: A large number of lameness indicators have been suggested for the visual equine lameness assessment. However, it remains unknown which of these are commonly used by experts. METHODS: Twenty-four expert lameness assessors from 10 leading UK institutions viewed 28 video clips of sound and mildly lame horses (median score 2/10). Horses were shown at trot in a straight line (rear and front view) and circle (side view, left and right rein). Eye tracking data were collected at 60 Hz while participants evaluated each clip. A questionnaire captured contextual information. RESULTS: During assessment on the straight line, participants consistently looked mostly at the head and pelvis. On the circle, many participants consistently looked at the head, yet the subsequent choice, weighting and order of examined body regions was unsystematic between and within participants, and there was a bias towards prolonged assessment of the horse's front region. Questionnaires revealed different descriptions of lameness indicators for the same body region and different approaches to decision making under uncertainty. CONCLUSION: In contrast to reasonably high similarity on the straight line, expert veterinarians have not developed a consistent assessment approach when evaluating horses on the circle. The reliability of various lameness indicators on the circle requires a stronger evidence base for a more systematic, repeatable approach.

Robustness of five different visual assessment methods for the evaluation of hindlimb lameness based on tubera coxarum movement in horses at the trot on a straight line.

BACKGROUND: The evaluation of hindlimb lameness remains a major challenge in everyday clinical practice. In the absence of clear guidelines, veterinarians use different visual assessment methods for this task whose robustness is unknown. OBJECTIVES: Determination of the robustness of five visual hindlimb lameness assessment methods based on the comparison of left and right tuber coxae movement. STUDY DESIGN: Validated mathematical hindlimb lameness model based on experimental data from the literature. METHODS: Vertical movement of left (LTC) and right (RTC) tuber coxae was simulated for the range of common hindlimb lameness movement patterns that horses present within practice. Lameness severity ranged from sound to moderately lame (0% to 60% motion asymmetry). The scenarios of a pelvis held tilted and asymmetrical pelvic roll were included to reflect possible adaptations in pelvic rotation. Across all conditions, the outcomes for five different visual assessment methods based on comparative tubera coxarum movement were quantified, including hip hike, -drop and range of motion. The robustness of each assessment method was established through comparison to sacrum-based overall motion asymmetry as the ground truth. RESULTS: Tubera coxarum-based lameness assessment was highly sensitive to all the unique lameness patterns and changes in pelvic rotation which a lame horse may adopt. None of the five visual lameness assessment methods was 100% robust across all conditions tested. For everyday clinical practice, comparing the upward movement amplitude of the RTC before right hind foot contact and of the LTC before left hind foot contact (Hip_hike_diff) would be the most robust single tubera coxarum-based visual assessment method. MAIN LIMITATIONS: In the absence of published data regarding the frequency of different movement patterns and hip rotation adaptations in clinical practice, this study cannot indicate the proportion of assessments that would be incorrect for a given visual assessment method. CONCLUSIONS: Using a single tubera coxarum-based visual hindlimb lameness assessment method may lead to incorrect clinical judgement. Therefore, using multiple assessment methods would be beneficial to substantiate impressions.

Effect of gamified perceptual learning on visual detection and discrimination skills in equine gait assessment.

BACKGROUND: Visual assessment of equine lameness is an everyday veterinary task suffering from poor diagnostic accuracy. The aim of this study was to quantify the impact of the perceptual learning game 'LamenessTrainer' on skill development. METHODS: Thirty-six undergraduate veterinary students engaged in four game modules teaching the assessment of fore- and hindlimb lameness. Computer animations of horses in this game displayed 0% (sound) to 70% (moderately lame) vertical movement asymmetry of head and pelvis. Performance, learning effects, diagnostic accuracy, detection thresholds and survey responses were analysed. RESULTS: Following staircase learning, more than 80% of students reliably classified horses with ≥20% asymmetry for forelimb lameness, ≥40% asymmetry for simplified hindlimb lameness and ≥50% asymmetry for realistic hindlimb lameness. During random presentation, on average 82% of sound and 65% of lame horses were assessed correctly during forelimb lameness evaluation, dropping to 39% of sound and 56% of lame horses for hindlimb lameness. CONCLUSION: In less than two hours, systematic perceptual learning through deliberate practice can develop visual assessment skills to an accuracy level comparable to expert assessors scoring the same animations. Skills should be developed further to improve misclassifications of sound and mildly lame horses, especially for hindlimb lameness evaluation.

Fostering integrated learning and clinical professionalism using contextualized simulation in a small-group role-play.

Teaching and learning in a clinical setting is important in veterinary and medical training but presents many challenges, including providing enough hands-on experience while not putting patients (animal or human) at risk. Some of the issues have been addressed with the introduction of clinical skills laboratories and communication skills training using role play. However, in both instances skills are learned in isolation, whereas the real task requires the integration of many skills including technical competencies, effective communication, decision making, and professionalism. In our study, we trialed "contextualized simulation" by combining role play with a simulator, the haptic cow, in a small-group tutorial, the Simulated Fertility Visit. Students took turns as the veterinarian; they had to establish the cow's history from the farmer (a role player), palpate the simulation, make a diagnosis, and decide on treatment, if appropriate. We included scenarios varying from common cases to challenging situations. The tutorial was introduced in the farm-animal clinical rotation, and feedback was gathered from students by means of a questionnaire. The tutorial was attended by 178 students (98% of that year's students), and 151 questionnaires were returned (85% response rate). Students reported that the tutorial was a positive learning experience and recognized that it presented an opportunity to integrate the skills needed for clinical work. Student feedback suggests that contextualized simulation provides a valuable complement to clinical cases, and we recommend extending this teaching method to other clinical scenarios and species, particularly because it provides a safe environment in which to experience, and learn from, mistakes.

Assessment of technical skills: best practices.

Assessment is an important aspect of veterinary education from the point of view of setting standards, driving learning, providing feedback, and reassuring society that veterinarians are competent to assume the responsibilities entrusted to them. However, no single format exists that can, by itself, assess the complex mixture of knowledge and skills essential to the veterinarian's role. The areas that are most challenging to assess are those involving behaviors and attitudes. These include the various technical skills required for diagnosis and treatment. One approach, aimed at retaining validity but improving reliability compared with traditional, more subjective methods, first described in medicine 35 years ago, is the Objective Structured Clinical Examination (OSCE), which has been introduced into veterinary education as the Objective Structured Practical Veterinary Examination (OSPVE) and run at the Royal Veterinary College since 2004. This approach is good for the assessment of competence in relation to isolated techniques and whole procedures but has been criticized for the way in which these are tested out of context. However, further development of structured clinical assessments, such as the mini-Clinical Examination and the Direct Observation of Procedural Skills, may help address some of these limitations, and the use of multi-source feedback, particularly client feedback, may allow the further domains of professional behaviors, attitudes, and communication to be judged and developed.