Veterinary Clinical Teaching: History
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Subjects: Education & Educational Research
Contributor:
Kiro Petrovski

The aim of clinical teaching in veterinary medicine is preparing graduates to meet all required veterinary graduate attributes. The veterinary learner needs to understand the various potential constraints in their clinical education. In addition to government and professional regulations, the animal and their welfare are essential considerations, as is the impact of food animal clinical practice on food safety. Indeed, the environmental considerations around repercussions of veterinary products (e.g., diclofenac and the Asian Vulture Crisis) parallel food safety and welfare.
 

  • animal science
  • clinical activities
  • clinical practice
  • teaching
  • traditional academic setting
  • veterinary learners
  • work-based learning

1. Introduction

The aim of clinical teaching in veterinary medicine is preparing graduates to meet all required veterinary graduate attributes. As illustrated in Figure 1, there are many factors to consider when designing or assessing veterinary clinical education. The veterinary learner needs to understand the various potential constraints in their clinical education. In addition to government and professional regulations, the animal and their welfare are essential considerations, as is the impact of food animal clinical practice on food safety. Indeed, the environmental considerations around repercussions of veterinary products (e.g., diclofenac and the Asian Vulture Crisis) parallel food safety and welfare [1][2].
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Figure 1. Factors to consider in veterinary clinical education and practice.
Clinical teaching methodology should not be restricted to the ‘clinical years’ but rather be addressed throughout the curriculum, as we have discussed previously [3]. Veterinary school accreditation bodies and some registration authorities tightly regulate the minimum requirements of experiential learning of veterinary learners. Many of these requirements are historic, before animal welfare standards and other ethical responsibilities were set. Over time, a number of factors have changed the learning environment (Box 1) and now alternative approaches to delivering some of the experiential learning may need to be considered.
Box 1. Factors that have led to the need for alternative methods of delivery of clinical teaching in lieu of exposure to real-life practice. AAVMC—American Association of Veterinary Medical Colleges (North America); EAEVE—European Association of Establishments for Veterinary Education (Europe); RCVS—Royal College of Veterinary Surgeons (United Kingdom); VSCAAC—Veterinary Schools Accreditation and Advisory Committee (Australasia).
  • Accreditation/Regulatory Requirements (e.g., AAVMC, EAEVE, RCVS, VSAAC)
  • Alternative approaches for learners refusing clinical teaching with live animals, which is a growing concern
  • Animal rights activism
  • Availability of animal models in Lab skills in order to avoid the use of live animals
  • Caseload per clinical instructor
  • Demand for exposure to different settings
  • Departmental pressure
  • Following the example from other areas of the OneHealth initiative
  • Increasing learner numbers
  • Increasing specialization at university veterinary hospitals
  • Interruptions to delivery (e.g., Covid-19 pandemic)
  • Minimal access to live animals, including restrictions on availability of shelter animals
  • Staff shortages
Cited literature [4][5][6][7][8][9][10][11]
One of the considerations should be the involvement of community-based veterinary service providers in clinical teaching of veterinary learners, both for clinical setting and work-based learning. Many veterinary schools have taken advantage of these opportunities with some having completely dispersed their clinical teaching off site, whilst others have restricted such exposure only to work-related learning. Independently of the approach to the experiential learning delivery, it is important to maintain the integrity of training within prescribed ethical limits.
Unfortunately, despite a significant proportion of veterinary medical education occurring in clinical settings, the literature describing teaching approaches during exposure to practice are limited. Therefore, we felt that this review could facilitate discussion and/or research in this area.
Clinical teaching can be delivered in a variety of settings [4][3][11][12][13] with successful clinical teaching depending on a variety of factors, including the complex interplay between personalities, beliefs and teaching settings [12][14]. Achieving the learning objectives and attaining the graduate attributes of veterinary learners are less affected by the setting where the clinical encounter occurs but more important are the skills of the clinical instructor to deliver the clinical teaching using a multidimensional approach [7][12]. Additionally, clinical teaching can provide the connection between universities and veterinary health providers [6].
Finally, the importance of mental health support in veterinary practice should not be forgotten. Veterinary learners/practitioners are three times more likely to commit suicide compared to the general population [15]. Clinical teaching could play a vital role in legitimizing that veterinary practice can take various emotional tolls, which also translate to physical repercussions [15][16].

2. Structuring Clinical Teaching for High Efficacy

Clinical teaching should be structured in a way that ensures effective teaching and stimulates deep-learning [17][7][18][19][20] (Table 1). The number of cases seen appears to be less important than the opportunity to be involved [4][9][12][21]. A real involvement of the learner would provide opportunity for development of clinical reasoning skills. There must be opportunities to develop deep learning [21] which may be achieved by traditional delivery or blended delivery of the clinical teaching [22][23][24]. The opportunity to teach others should be utilized [21][25]. This should be independent of the type of case (e.g., case-based scenario or a ‘real’ clinical case, either carefully selected or ‘whatever comes through the door’ (the ‘clinical encounter’). For stimulation of deeper learning, the management of the case encounter can utilize a clinical teaching model, such as the Five microskills model, including debriefing with elements of reflection [3].
Table 1. Structuring the clinical teaching for high efficacy.
Strategy Attributes
Clinical encounter Case-based/Real/Simulated; Carefully selected to allow progression of the learner from ‘simple’ to ‘more complex’; Stimulate teamwork
Independent learning Case of the day/week; Case/Exit/Grand rounds; Question banks; Poster; Project; Report
Orientation Discuss the usual approaches; Find out learners’ expectations/level of knowledge and expertise; Introduce facility; Introduce team; Set time for feedback; Set expectations; Set levels of responsibility
Planning Debriefing after dealing with client/patient; Levels of responsibility when dealing with client/patient; How/What/When/Where/Who/Why when dealing with client/patient; Responsibility for veterinary medical records
Reflection Debriefing on every case; What went well; What could be improved
Cited literature [7][26][27][28][29][30].

3. Potential Strategies to Minimize the Impact of Alternative Settings and Approaches on Learner Outcomes

The main perceived deficit of the alternatives to exposure to real clients and patients is the lack of a ‘clinical encounter’. To minimize the potential negative impact of alternative approaches to exposure to practice, these must be viewed as complimentary rather than being relied on as a single approach to delivery [26]. For any of the proposed strategies to be effective, it is important they be clearly elaborated in the orientation of learners. In that way, learners are aware of the process, expectations and responsibilities. Strategies to minimize the impact of alternative approaches on the learner’s experience and training during the curriculum must address the efficacy of the clinical teaching through addressing
  • Clinical teaching skills of instructors;
  • Teaching settings;
  • Time spent per site, and in total, on experiential learning.

3.1. Clinical Teaching Skills of Instructors

  • Training of instructors in both delivery of clinical teaching and pedagogy-based approaches. Trained clinical instructors are better at delivering clinical teaching and are usually more satisfied [5][10][31][32][33]. Currently, veterinary instructors rarely, if ever, receive official training in clinical teaching, and there are no standardized requirements. This has been identified as an important gap in both veterinary [34][35] and human medical education [10][32][35][36][37][38]. Veterinary schools should provide opportunities to all professional staff for training in education, particularly staff delivering clinical teaching. In some geographical areas, on-line courses in general education become attractive [38][39]. However, it is recognized that general training may not be attractive or satisfying for veterinary clinical educators. Discipline teaching is preferred [38][40]. Indeed, some schools have developed discipline-specific, context-relevant partial programs to complete the clinical instructor development program [40], including the school at which we teach.
  • Official recognition of clinical instructors. Official recognition of clinical instructors may take the form of being given title-holder status or, even better, a special qualification as a clinical instructor, after completing a specified training course/module/curriculum [26]. Training can be managed at departmental level, and it is easy to achieve.
  • Promotion and career advancement of clinical instructors. The possibility of promotion of clinical instructors within a university setting is limited [11][32][41]. This is often due to the lack of a research component by many of the clinical instructors [42][43][44]. Promotion is primarily managed at the university, not departmental, level using the same rigid requirements as traditional academics. This makes the recognition by promotion and career advancements of clinical instructors more difficult and limited [41]. Therefore, for promotion and career advancement of clinical instructors, universities must consider having a special track for clinical instructors in veterinary medicine. Indeed, career progression is important also in partner clinics and this is an important area that needs to be addressed by the industry.

3.2. Strategies to Improve Clinical Teaching in Different Teaching Settings

3.2.1. Traditional Academic Settings

Even the best approach to clinical teaching, in isolation, cannot replace clinical exposure. The difference between doing things and trying to simulate all that may happen during a clinical encounter should be considered. Hence, traditional academic settings should be utilized to facilitate development of clinical reasoning skills in conjunction with clinical exposure [11][45].
Case-based learning (CBL). The CBL is a clinical teaching method usually applicable for earlier stages of the learner’s development. However, skillfully used, it is also suitable in advanced learning. The advantage of the CBL is it is a less time-consuming approach to delivery of clinical teaching. The role of the clinical instructor, who is the ‘expert in the field’ is to correct, direct, and provide feedback [46].
○ Incorporation of simulation models within a case-based scenario rather than a practical class only, e.g., when using a bovine venipuncture simulation model, the scenario would look like: “A cow presented with progressively decreasing milk yield and exercise intolerance”. The scenario should guide learners to gather additional information
■ Obtain health interview information from the client (for teaching purposes it should be available on request in a full format or summarized but without interpretations);
■ Clinical examination results of the patient (for teaching purposes it should be available on request in a full format or summarized but without interpretations);
■ Findings should indicate a clinical anemia. To confirm the anemia, the learners would hopefully arrive at the need to collect a blood sample;
■ At that moment learners can be allowed to approach the model and carry out the skill;
■ These points are summarized in Figure 2.
 
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Figure 2. An example of incorporation of a simulation model within a case-based scenario rather than a practical class only using a decision-making algorithm.
  • Day One competencies (graduate attributes) addressed. Learners prefer seeing practice that is closer to what they will be seeing in their future clinical practice. Therefore, experiential learning should include diverse cases, particularly those that are common in general practice [8][14]. Learners prefer community-based clinical encounters, but with this approach only, there is often a lack of continuity of care. Thus, a variety of teaching settings are the preferred option.
  • Elements of ‘teach-others’. ‘Teaching’ others significantly increased knowledge retention and capacity to implement experience from one-to-another clinical situation in the future [21][25][47] (Figure 3). Teach-others learning may be used during discussion with the client, when implementing peer-assisted learning [9], or utilizing mini-lecture discussions [21]. Indeed, peer-assisted learning may also be a valuable tool for feedback on performance, frequently accepted as less confronting than when provided by the clinical instructor [9][22][46]. It is worth noting that peer-based feedback only is not preferred, as learners appreciate expert opinion on their performance and progress. Hence, a combination of peer- and expert-feedback is needed.

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Figure 3. The effect of teaching method on the retention of knowledge by learners demonstrating the need of a component of ‘teach others’ by learners in the clinical teaching. Adapted from [47]. AV—Audio-visual.
  • Psychomotor activity within the case-solving. For example, use of simulation models rather than only presenting a case for solving.
    ○ Simulation in a variety of forms should be utilized as much as possible, including but not restricted to [48][49][50][51][52]:
    ■ High-fidelity examination simulators;
    ■ Single-task models (e.g., skin suturing model, model for venipuncture);
    ■ Standardized patient encounters;
    ■ Virtual reality models (e.g., ‘haptic cow/horse’).
  • Team-based learning (TBL). Although TBL is a teaching method aimed at delivery of clinical teaching to early stages of development of learners in veterinary and medical sciences, it is assumed to be very suitable for clinical teaching in advanced years [23][46][53]. Team-based learning clinical teaching has been praised for three elements of clinical teaching, inclusion of development of clinical reasoning, team work from learner’s perspective [22], and time efficiency. It usually consists of in-contact activities of 2 h duration, but preparation time is required. For efficacy, TBL should be properly executed, namely learners should be carefully allocated to groups. There should be a proper pre-activity preparation (e.g., readings, pre-recorded lectures) and individual- and group-level testing should be incorporated (i.e., readiness assurance tests), followed by immediate feedback on performance. Use of the four S approach (significant problem, same problem, specific choice and simultaneous reporting) during the activity is relevant for reflection, clinical reasoning and problem-solving [22][46][53][54]
  • Combination of any of the above proposed strategies.

4. Conclusions

From the literature reviewed, herein conclude that effective veterinary clinical teaching of graduates is central to post graduate clinical success. Herein have presented various clinical settings and strategies affecting clinical teaching and learning and recommend that, as far as possible, the employment of a mixture of strategies (blended delivery) will enhance student satisfaction and clinical success. Indeed, delivery of clinical teaching must be cognizant of animal welfare requirements and the 3 Rs (Reduction, Refinement and Replacement) of using animals in research and teaching [55]. Herein have proposed some strategies for clinical teaching but learner satisfaction and employer opinion, as well as instructor and learner wellbeing with the incorporation of a blended clinical teaching approach, are yet to be measured (e.g., using anonymous on-line surveys or targeted interviews).

This entry is adapted from the peer-reviewed paper 10.3390/vetsci9010017

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