Veterinary undergraduates' attitudes to and understanding of clinical skills learning.

BACKGROUND: The study investigated student understanding of development of their clinical skills learning, focusing on personal experiences of the learning strategies they employ and their experiences of judging their own competency, integrating skills and transferring skill knowledge. METHODS: Twenty-nine veterinary students from two veterinary schools took part in semi-structured interviews investigating their perceptions of clinical skills importance and development. Thematic analysis of transcribed interviews was used for data analysis. RESULTS: Themes that were developed were: (1) Students understand clinical skills to be individual technical practical skills but also understand how skills are combined to achieve complex tasks. (2) Students understand the concept of competency development and learn skills, review their progress and self-audit their skill competency in similar ways throughout the course. (3) Personal confidence, success and positive communication with peers and supervisors are critical to learn clinical skills. CONCLUSION: Students understand clinical skills learning and use reflective skills widely to track developing skills competency. Prioritising individual feedback within practical sessions and training on integration of skills and communicating with supervisors ahead of clinical placements would be beneficial. Training in clinical skills study techniques, reflection and resilience will enable students to be proactive and to manage their feelings around uncertainty.

Use of Inductive, Problem-Based Clinical Reasoning Enhances Diagnostic Accuracy in Final-Year Veterinary Students.

Despite tremendous progression in the medical field, levels of diagnostic error remain unacceptably high. Cognitive failures in clinical reasoning are believed to be the major contributor to diagnostic error. There is evidence in the literature that teaching problem-based, inductive reasoning has the potential to improve clinical reasoning skills. In this study, 47 final-year veterinary medicine students at the Royal Veterinary College (RVC) were presented with a complex small animal medicine case. The participants were divided into two groups, one of which received a prioritized problem list in addition to the history, physical exam, and diagnostic test results provided to both groups. The students' written approaches to the case were then analyzed and assigned a diagnostic accuracy score (DAS) and an inductive reasoning score (IRS). The IRS was based on a series of predetermined characteristics consistent with the inductive reasoning framework taught at the RVC. No significant difference was found between the DAS scores of each group, indicating that the provision of a prioritized problem list did not impact diagnostic accuracy. However, a significant positive correlation between the IRS and DAS was illustrated for both groups of students, suggesting increased use of inductive reasoning is associated with increased diagnostic accuracy. These results contribute to a body of research proposing that inductive, problem-based reasoning teaching delivered in an additive model, can enhance the clinical reasoning skills of students and reduce diagnostic error.

Perceptions of the feedback process: a case study of veterinary residents and supervisors.

BACKGROUND: Appraisal of resident clinical performance is critical during training. The most common method for this is feedback to residents based on impressions of supervising clinicians. How effective these practices are for veterinary residents remains unknown. This study focused on establishing perceptions of veterinary residents and supervisors regarding the feedback process. METHODS: A qualitative case study format was chosen to investigate the perceptions and experiences within a well-developed residency programme. The study cohort consisted of veterinary residents and supervisors from the same specialties. Qualitative data were collected through individual semistructured interviews continuing iteratively until theoretical saturation was reached (14 in total). RESULTS: Mismatches in resident and supervisor perceptions were evident regarding positive feedback delivery and the importance of dialogue. The nature of the resident/supervisor relationship and the efficacy of feedback were closely interlinked. The development of a feedback-friendly culture would be beneficial. Residents perceived that feedback on teaching was lacking. Milestones were perceived to be lacking. CONCLUSION: The results highlight a need for change away from the 'no news is good news' culture. Development of training workshops, formation of closer relationships between supervisors and residents, and a transition to competency-based education may be necessary.

The Use of Contextualized Standardized Client Simulation to Develop Clinical Reasoning in Final-Year Veterinary Students.

Clinical reasoning is an important skill for veterinary students to develop before graduation. Simulation has been studied in medical education as a method for developing clinical reasoning in students, but evidence supporting it is limited. This study involved the creation of a contextualized, standardized client simulation session that aimed to improve the clinical reasoning ability and confidence of final-year veterinary students. Sixty-eight participants completed three simulated primary-care consultations, with the client played by an actor and the pet by a healthy animal. Survey data showed that all participants felt that the session improved their clinical decision-making ability. Quantitative clinical reasoning self-assessment, performed using a validated rubric, triangulated this finding, showing an improvement in students' perception of several components of their clinical reasoning skill level from before the simulation to after it. Blinded researcher analysis of the consultation video recordings found that students showed a significant increase in ability on the history-taking and making-sense-of-data (including formation of a differential diagnosis) components of the assessment rubric. Thirty students took part in focus groups investigating their experience with the simulation. Two themes arose from thematic analysis of these data: variety of reasoning methods and "It's a different way of thinking." The latter highlights differences between the decision making students practice during their time in education and the decision making they will use once they are in practice. Our findings suggest that simulation can be used to develop clinical reasoning in veterinary students, and they demonstrate the need for further research in this area.

An Investigation into the Clinical Reasoning Development of Veterinary Students.

Clinical reasoning is a fundamental skill for veterinary clinicians and a competency required of graduates by the Royal College of Veterinary Surgeons. However, it is unknown how veterinary students develop reasoning skills and where strengths and shortcomings of curricula lie. This research aimed to use the University of Nottingham School of Veterinary Medicine and Science (SVMS) as a case study to investigate the development of clinical reasoning among veterinary students. The analysis was framed in consideration of the taught, learned, and declared curricula. Sixteen staff and sixteen students from the SVMS participated separately in a total of four focus groups. In addition, five interviews were conducted with recent SVMS graduates. Audio transcriptions were used to conduct a thematic analysis. A content analysis was performed on all curriculum documentation. It was found that SVMS graduates feel they have a good level of reasoning ability, but they still experience a deficit in their reasoning capabilities when starting their first job. Overarching themes arising from the data suggest that a lack of responsibility for clinical decisions during the program and the embedded nature of the clinical reasoning skill within the curriculum could be restricting development. In addition, SVMS students would benefit from clinical reasoning training where factors influencing "real life" decisions (e.g., finances) are explored in more depth. Integrating these factors into the curriculum could lead to improved decision-making ability among SVMS graduates and better prepare students for the stressful transition to practice. These findings are likely to have implications for other veterinary curricula.