The teaching and assessment of communication competency are a necessary inclusion in veterinary school curricula. There is a robust body of evidence demonstrating that a successful and safe graduate transition to practice is associated with communication competency development in health professions, including medicine [1] and veterinary science ^[2][3][2,3]. Veterinary schools around the world no longer view communication competency as an optional inclusion or as a set of skills that are learned by example in the curriculum. This is because these skills are amongst the most highly valued and necessary workplace skills for new graduates ^{[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]}[4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21], and accrediting bodies explicitly require that these competencies be demonstrated by all graduates ^[22][23][24][22,23,24].

In the packed modern veterinary curriculum, there is a need to explicitly and purposefully embed learning activities and the assessment of communication competency. Explicit communication curriculum frameworks developed from other disciplines such as medicine [25] are widely used as the foundation from which communication skills are taught and assessed in many veterinary curricula [8]. This includes the veterinary curriculum at the University of Sydney, where the skills curriculum has been developed and refined over two decades. With respect to clinical consultation skills (CCSs), the widely accepted framework based on the Guide to the Veterinary Consultation based on the Calgary–Cambridge Model (GVCCCM) ^[3][8][16][3,8,16] is used to teach and assess CCSs at most veterinary schools in Australia. Clinical consulting skills in a veterinary setting are those behaviours that are demonstrated when undertaking a consultation with a client and include structuring the interaction, developing a rapport and building a relationship, active listening, reflecting, explaining, responding, and concluding with spoken and written interactions. It is expected that the teaching and assessment of CCSs are integrated and sequentially developed within an education program that provides students opportunities to apply these skills in simulated and authentic clinical encounters ^{[26][27][28][29][30]}[26,27,28,29,30]. This is to ensure that students are well prepared to communicate with clients during clinical placements and can demonstrate communication competency at the time of graduation. While the emphasis today is on competency-based education, a review of the medical education literature flags the important link between confidence and competence. With scaffolded experiences and feedback, competency develops over time. As such, activities that enhance students’ confidence contribute to competency development, and, as described in medical education [31], this ultimately helps with a safe transition to professional practice.

Veterinary curricula at the University of Sydney have been adapted to address the significant impact of technology and client expectations on the role of veterinarians. 

In the early years of the DVM at the University of Sydney, the focus is on pre-clinical areas of study, and in these pre-clinical years, CCSs are first taught and assessed. CCS training should represent current clinical practice so that students can translate these competencies into a workplace context. This includes the use of clinical skills laboratories where students can practice their skills in safe and structured environments. The curricular revisions described in this rpapesearch r have focused on strengthening the ways in which students learn CCSs through their experiences, and this was guided by an evaluation of graduate outcomes. Communication skills training plays a significant role in developing veterinarians’ professional identities [32]. As such, course design needs to include resources and environments that afford students authentic opportunities to learn, practice, receive feedback, and be assessed ^{[3][8][10][26][27][33]}[3,8,10,26,27,33]. Resources such as case studies or scenarios are widely used in different ways in veterinary curricula. This includes their use as a stimulus in workshop discussions, tutorials, problem-based learning activities, and communication skills training. Authentic opportunities to learn and assess CCSs can range from low-fidelity simulations such as role-plays with case scenarios facilitated in a physical classroom (in a clinical skills laboratory or virtually via videoconference) through to immersion in authentic clinical settings where students are supported and supervised whilst applying their communication skills and knowledge in ways expected for a novice veterinarian. The university’s veterinary teaching services are a major site for these authentic environments, where students’ communication skills are then assessed. These experiences are usually in the context of practicing “gold standard” care or a highly specialised approach to veterinary medicine.

A spectrum of care (SoC) approach has recently been recognised as an essential component of practice readiness that requires specific communication strategies ^[34][35][34,35]. To keep pace with industry standards and community expectations, veterinary schools must provide authentic learning activities that reflect a full range of care options, that is, where there is provision and adaptation of veterinary care that suits clients’ preferences, limitations, and relationship with their pet, for example, through shelter medicine or community clinical services ^[34][35][34,35]. With respect to CCSs, veterinary schools are well placed to design case scenarios that reflect complex clinical presentations across a broad range of species and in situations where communication may be challenging. Situated in an environment where research drives the pursuit of new knowledge and innovative practice, highly specialised veterinary teaching hospitals are equipped to scaffold skill and knowledge development that represents a gold standard of care, including advanced diagnostic and therapeutic services. However, veterinary schools must also spend time and resources on the communications skills required for common presentations and routine cases with accreditation bodies in the UK, Australia, and New Zealand, now requiring a substantial focus on common, entry-level practice ^[22][24][22,24]. In practice, the goal of veterinarians is to provide valued services to meet the needs of clients and the animals in their care. So, while offering the best standard of care available to them, their clients will expect to have a range of options communicated to them and receive guidance in the selection of the treatment plan most appropriate to their needs. Clients may experience significant financial or practical constraints or simply have different priorities in what health care they are able to support for their animals ^[34][36][37][34,36,37]. As such, it is important for veterinary schools to include the teaching and assessment of communication techniques that help the veterinarian navigate this SoC approach.

Opportunities to apply clinical knowledge and skills in a spectrum of authentic professional practice environments are a critical component of veterinary education programs, and these are most effective when they build students autonomy and decision making in a supported environment. These holistic experiences afford students the opportunity to integrate communication skills with the full range of technical and non-technical competencies expected of a veterinarian. Veterinary schools achieve this in a variety of ways, including the involvement of veterinary teaching hospitals within the university in contracted practices as well as supervised practice with external partners in the industry. This presents a range of challenges, one of which is ensuring that there is vertical alignment between formal teaching and assessment activities and what is then subsequently expected of students when they apply their skills in authentic clinical encounters. Clinical placements in the final years of a veterinary program are recognised to be an effective way to link theory to practice [38]. However, research investigating work-integrated learning environments in other disciplines (health, education, psychology, and law) has shown that aligning authentic assessment activities in this complex context is challenging and problematic [39]. For example, when confronted with an actual clinical case in veterinary practice, information is often incomplete, or the veterinarian is presented with a client that has limited funds or does not have the capacity to understand or adhere to the recommended therapeutic plan. Communication with clients is impacted by the student’s ability to manage time, reach probabilistic decisions, and explain these as they guide the client’s treatment choices. How students experience the practice of communication skills in clinical placements and how well clinical teachers’ and supervisors’ assessment and feedback align with underpinning theoretical frameworks such as the GVCCCM is not well understood and remains an ongoing challenge with respect to consistency in feedback and assessment by clinical teachers and supervisors.

The challenge for veterinary schools is to make sure that curriculum review and renewal reflect industry and community expectations. Over the past 30 years, innovations in the way we communicate have been phenomenal: the general public has access to a vast amount of information via the internet, and they bring this with them to the consultation room; the widespread use of social media impacts the veterinarian–client relationship in varying ways; the role, skills, and daily work of veterinarians are much better understood due to extensive exposure through documentaries on television; telehealth is now widely practiced in human health; and the use of technology has revolutionised the way in which veterinarians record their consultations and communicate with their clients. In sum, clinical communication skills are not static competencies. This was starkly illustrated during the recent COVID-19 pandemic. As universities and veterinary schools grappled with the required shift to online teaching and learning, the same social distancing requirements led to the rapid industry uptake of telehealth consultations. That is, as the teaching and assessment of CCSs moved online, veterinarians were moving to telehealth consultations. This presented a unique opportunity to explore and review the way in which many aspects of the veterinary curriculum were taught and assessed, both in terms of educational value and industry currency.

Since 2015, at the University of Sydney, CCSs have been formally taught and assessed in the first and second years of the DVM program of study (DVM1 and DVM2). Opportunities to practice, demonstrate competency, and be assessed on these skills are subsequently provided in community spey-neuter clinics in the third year of the DVM (DVM3), in teaching hospitals, and in external placement rotations of final year (DVM4). The formal teaching of CCSs is first integrated into a professional practice Unit of Study (UoS), and this is followed by a series of small workshops in a module that sits within a larger, first-year Professional Skills UoS in the DVM program. Workshops are conducted throughout the first semester in DVM1 and the second semester in DVM2.

In the first year of the DVM program, the formal clinical communication curriculum involves an introductory lecture and a large-group workshop that is then followed by a series of small-group workshops (5–6 students per group). The small-group workshops are facilitated by veterinarians who have recent or current clinical experience. It is intended that the introductory lecture on clinical communication focus on understanding the generic skills required for effective communication as well as describing models for effective clinical consultations. The first large-group workshops (20–24 students per group) take place after the introductory lecture and involve several activities and group discussions. These explore elements of the clinical consultation framework and include activities that examine specific communication skills such as empathy, non-verbal communication, and the use of proxemics when communicating in a consultation. The subsequent small-group workshops involve students conducting simulated consultations as both a veterinarian and a client for a range of common companion animal health issues that include advice on desexing procedures, weight management recommendations, dental care, guidance on rabbit husbandry, and an equine health issue. Students conduct the simulated consultations for a standardised series of cases, and during the workshops, they reflect on their achievement against their own communication SMART goals, that is, goals that are Specific, Measurable, Action-oriented, Realistic, and Time-limited [40]. Students then receive structured feedback from their peers and their facilitator using the GVCCCM framework. At the end of the workshop series, students are allocated an assessment case from one of the health issues that they have been introduced to, and they conduct a simulated consultation with a professional actor taking on the role of a client. The facilitator then assesses student competency based on the core clinical consultation skills that are mapped to the GVCCCM.

In the second year of the DVM program, students’ second professional practice UoS has a focus on some more challenging elements associated with clinical consultations. Students then practice their communication skills and receive feedback in a series of workshops that spotlight more challenging clinical consultations. In these workshops, the standardised cases now focus on issues such as revisit, euthanasia, emergencies, and discharge consultations for complex cases. Hospital teaching placements during Professional Skills UoS in DVM1 and DVM2, pre-clinical placements in DVM3, the community spey-neuter clinic in DVM3, and the final year placements provide students with opportunities to apply their CCSs in authentic clinical encounters that vary based on species and context.

The authors explore the dynamic evolution of CCS education in veterinary medicine since its inception in the DVM curriculum at the University of Sydney. Three key developments are presented, and their implications are critically evaluated. These developments include:

1. Enhancing contextualisation through skills laboratories: a close examination of CCS sessions in DVM1 and DVM2, embracing the spectrum of care approach.

2. Navigating the era of online CCSs: analysing the impact of COVID-19 restrictions on CCSs, with insights into telehealth and future pedagogical implications.

3. Bridging theory and practice: an in-depth evaluation of the application of CCS training in authentic clinical environments throughout the DVM program, tackling the challenge of ‘minding the gap.’