A scoping review on the use of reflection and reflective portfolio learning in veterinary education.

Introduction: In veterinary education, reflection and reflective portfolio learning aim to enhance professional development. Although reflection and reflective portfolio learning are widely used in teaching and healthcare, their demonstrable impact on veterinary education is unclear. Although the benefits are uncertain, reflection may provide potential for self-development and help to prepare students for clinical practice. The aim of this work was to review research into reflective practice and reflective portfolio learning, to find evidence for its use in teaching, to confirm how it is best implemented to optimise professional development and to identify gaps for future research. Methods: This scoping review was conducted according to the Joanna Briggs Institute guidelines adhering to review methodology. Ten databases were searched and screened for reflection and portfolio learning as a primary source of data. Of 29,933 texts identified by title and/or abstract, 51 final works were screened in full. Of these, 16 papers that gathered evidence on reflection were included. Results: The results confirmed a growing evidence base for reflection in the veterinary field. In total, six works demonstrated a positive impact on professional development. Written reflective assignments were the most common methods of implementation, with 11 papers referencing their use. Other methods included group discussion and facilitated reflection. Conclusions: This review identified numerous gaps for research, including validating the methods of implementation, exploring the efficacy of methods other than written reflection, examining how reflection is used at different stages of the veterinary career and study of different models of reflection to identify which are most useful.

Veterinary Curriculum Leaders: Motivators, Barriers, and Attributes.

Curriculum leaders (individuals with responsibility for an institution's veterinary curriculum) play a vital role in driving local curriculum priorities, development, and accreditation. This study aimed to describe the career paths of curriculum leaders, and identify what motivates them, the barriers they face, and the knowledge, skills, and attributes they perceive as essential for the role. Self-determination theory was used to identify tensions experienced within the role. An international online survey targeted at those identifying as curriculum leaders was completed by 45 participants. 91% of participants held a doctoral level qualification and/or clinical Boards; 82% had additional training in leadership; 38% had additional formal training in education. Motivators included a desire to make a difference, personal satisfaction with teaching and working with students, and social influences. Participants experienced barriers relating to self-development and achievement of their curriculum goals; participants described essential knowledge (of the profession, educational theory, and wider higher education context) and skills (leading teams, change management, and communication). Attributes considered important related both to self (open-minded, patient, resilient, able to see the big picture as well as detail) and relationships with others (approachable, listener, respectful and respected, supportive, credible). Tensions arose in participants' need for autonomy (experiencing barriers to achieving their goals), in their social relatedness (achieving curriculum goals while working with colleagues with conflicting priorities), and in perceptions of necessary competence (a need, but lack of opportunity, for advanced training in educational theory). The findings may help institutions more effectively support and train current and future curriculum leaders.

Assessment of health and welfare in a small sample of dogs owned by people who are homeless.

BACKGROUND: Pet ownership is common among homeless people, with dogs the most frequently reported pets. However, homeless people receive considerable criticism for keeping pets due to public perception of poor care provision. MATERIALS AND METHODS: A convenience, cross-sectional sample of 19 homeless people, owning a total of 21 dogs were recruited, and their dogs' health and wellbeing assessed using the PDSA Petwise MOT (P-MOT). RESULTS: The dogs compared favourably with conventionally owned pets in most areas, including exercise and companionship. Problems included being overweight/obese (although at lower prevalence than the general population). Some owners had difficulty in accessing veterinary care. Behavioural concerns were reported for 61.9% of the dogs, most commonly separation-related distress. DISCUSSION: Being unable to safely leave their pets may impair owners' access to services. Provision of accessible veterinary care, behavioural support and pet-friendly services could improve the health of homeless owners and their pets.

Employability as a Guiding Outcome in Veterinary Education: Findings of the VetSet2Go Project.

This paper presents a mini-review of employability as a guiding outcome in veterinary education-its conceptualisation, utility, core elements and dimensions, and pedagogical approaches-through a summary of the findings of a major international project with the same aims (the VetSet2Go project). Guided by a conception of the successful veterinary professional as one capable of navigating and sustainably balancing the (sometimes competing) needs and expectations of multiple stakeholders, the project integrated multiple sources of evidence to derive an employability framework representing the dimensions and capabilities most important to veterinary professional success. This framework provides a useful complement to those based in narrower views of competency and professionalism. One notable difference is its added emphasis on broad success outcomes of satisfaction and sustainability as well as task-oriented efficacy, thus inserting "the self" as a major stakeholder and bringing attention to resilience and sustainable well-being. The framework contains 18 key capabilities consistently identified as important to employability in the veterinary context, aligned to five broad, overlapping domains: veterinary capabilities (task-oriented work performance), effective relationships (approaches to others), professional commitment (approaches to work and the broader professional "mission"), psychological resources (approaches to self), plus a central process of reflective self-awareness and identity formation. A summary of evidence supporting these is presented, as well as recommendations for situating, developing, and accessing these as learning outcomes within veterinary curricula. Though developed within the specific context of veterinarian transition-to-practise, this framework would be readily adaptable to other professions, particularly in other health disciplines.

Qualitative Research in Veterinary Medical Education: Part 1-Principles of Qualitative Design.

Qualitative methodologies are relative newcomers to health sciences education research. While they may look very different to their quantitative counterparts in terms of size and scope, when well-applied they offer a fresh perspective and generate valuable research findings. Although qualitative research is being increasingly conducted in veterinary medical education, there are few contextualized resources to assist those who would like to develop their expertise in this area. In this article, we address this by introducing the principles of qualitative research design in a veterinary medical education context. Drawing from a range of contemporary resources, we explore the types of research goals and questions that are amenable to qualitative inquiry and discuss the process of formulating a worthwhile research question. We explain what research paradigms are and introduce readers to some of the methodological options available to them in qualitative research. Examples from veterinary medical education are used to illustrate key points. In a second companion article, we will focus on the decisions that need to be made regarding data sampling, collection, and analysis. We will also consider how qualitative research is evaluated, and discuss how qualitative findings are applied. Taken together, the two articles build an understanding of qualitative research, illuminate its potential to contribute to the scholarship of teaching and learning in veterinary medical education, and equip readers with an improved capacity to appraise its value.

Qualitative Research in Veterinary Medical Education: Part 2-Carrying Out Research Projects.

This is the second of two articles that together comprise an orientation and introduction to qualitative research for veterinary medical educators who may be new to research, or for those whose research experience is based on the quantitative traditions of biomedicine. In the first article (Part 1-Principles of Qualitative Design), we explored the types of research interests and goals suited to qualitative inquiry and introduced the concepts of research paradigms and methodologies. In this second article, we move to the strategies and actions involved in conducting a qualitative study, including selection and sampling of research sites and participants, data collection and analysis. We introduce some guidelines for reporting qualitative research and explore the ways in which qualitative research is evaluated and the findings applied. Throughout, we provide illustrative examples from veterinary and human medical education and suggest useful resources for further reading. Taken together, the two articles build an understanding of qualitative research, outline how it may be conducted, and equip readers with an improved capacity to appraise its value.

Attitudes of UK veterinary students towards careers in the production animal sector: A mixed methods approach.

BACKGROUND: Within the production animal sector, it has long been forecast that demand for veterinary services could outstrip supply. This study aims to identify factors influencing veterinary undergraduates' attitudes towards a career in farm animal veterinary practice and how those factors may be influenced by their experiences during their time as an undergraduate. METHODS: An online survey was distributed to all vet schools in the UK and Ireland. Thematic analysis and descriptive data analysis were performed on the 1146 responses received. RESULTS: Seven themes were identified: relationships, preferences and interest, fit, direct experience, fear, ethics and values and lifestyle. When considering first job choice, extra mural studies (EMS) and personal interest (60% and 75% of respondents respectively) were very influential. Factors that appeal or put off respondents from a career in farm animal varied dependent on anticipated first job (p < 0.001), but working hours and out of hours were consistently identified as barriers. CONCLUSION: The results highlight the importance of EMS being more transparent about the profession and using the opportunity to discuss undergraduate concerns regarding farm animal practice.

Perceptions of Assessment Literacy among Current and Prospective Veterinary Students.

Developing assessment literacy is important for veterinary students because the demands of a veterinary medicine course require students to rapidly adapt to new ways of learning and assessment. In this study, we investigate the understanding of assessments at university from applicants and current veterinary students and how this understanding can be improved and developed throughout the course. Data were gathered from three groups-applicants, naïve veterinary students, and experienced veterinary students-using questionnaire-based surveys. Of the applicants, 69% expected university assessments to be different from those at school, whereas only 13% agreed they had a good idea of what assessments would be like at university. More than 50% of students in their first term agreed they had a good understanding of assessments at university, although students had no significant improvement in their understanding of assessments as they progressed through the course. All three groups agreed that having a better understanding of assessments would make them feel more confident about exams. We conclude that more could be done to prepare prospective veterinary students for different styles of assessments and that current veterinary students would benefit from the opportunity to develop their assessment literacy. An assessment literacy curriculum is therefore proposed to develop students' assessment literacy from high school through graduation. Further research could investigate the development of assessment literacy interventions aimed at both applicants and veterinary students.

Qualitative Research in Veterinary Medical Education: Part 1-Principles of Qualitative Design.

Qualitative methodologies are relative newcomers to health sciences education research. While they may look very different to their quantitative counterparts in terms of size and scope, when well-applied they offer a fresh perspective and generate valuable research findings. Although qualitative research is being increasingly conducted in veterinary medical education, there are few contextualized resources to assist those who would like to develop their expertise in this area. In this article, we address this by introducing the principles of qualitative research design in a veterinary medical education context. Drawing from a range of contemporary resources, we explore the types of research goals and questions that are amenable to qualitative inquiry and discuss the process of formulating a worthwhile research question. We explain what research paradigms are and introduce readers to some of the methodological options available to them in qualitative research. Examples from veterinary medical education are used to illustrate key points. In a second companion article, we will focus on the decisions that need to be made regarding data sampling, collection, and analysis. We will also consider how qualitative research is evaluated, and discuss how qualitative findings are applied. Taken together, the two articles build an understanding of qualitative research, illuminate its potential to contribute to the scholarship of teaching and learning in veterinary medical education, and equip readers with an improved capacity to appraise its value.

Measuring satisfaction in the small animal consultation and its relationship to consult length.

BACKGROUND: Measuring satisfaction is a useful metric of success of any interaction, but very few validated instruments exist for measuring the satisfaction of the veterinary surgeon (vet) and the client in veterinary consultations. Additionally, there has been no research examining the impact of consultation length on satisfaction. The aim of this observational study was to investigate the use of a single-question graphic scale to assess vet and client satisfaction and the impact of consultation length on satisfaction. METHODS: Information on consultation timing was collected for 65 health problem consultations across six practices. These measurements were compared with postconsultation measurements of client and vet satisfaction. RESULTS: A comparison between the long-form and single-question satisfaction instruments demonstrated significant correlation for both vet and client tools (ρ=0.609, P<0.005 and ρ=0.483, P<0.005, respectively). The average client satisfaction with the consultation was high; however, vet satisfaction levels were significantly lower (U=1073, P<0.005). Increased consult length was associated with increased vet satisfaction (ρ=0.332, P=0.007) but not increased client satisfaction. CONCLUSION: These results demonstrate that the graphic scale is an appropriate proxy for the pre-existing long-form questionnaires available for both vets and clients. Further research is required to examine the disparity identified between vet and client satisfaction.

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.

Appointment scheduling and cost in first opinion small animal practice.

Approximately half of first opinion, small animal consultations exceed their allocated time and there's a growing call in the UK for longer consults. The aim of this study was to investigate and describe allocated appointment length in first opinion, small animal practice in the UK. Almost half (49.8%) of consults were scheduled for 15 min, with a further 39.4% scheduled for 10 min. Nearly all participants (97.1%) reported flexibility when booking appointments, scheduling longer appointments for conditions predicted to require more time. However, the majority (68.1%) reported no additional cost charged to the client for a longer consult. Furthermore, 54.7% of the survey respondents offered nurse appointments free of charge. A restructured approach to consult scheduling for both Veterinary Surgeon and Registered Veterinary Nurse (RVN) consultations could help to improve workforce wellbeing, utilise the vast knowledge and skill sets of RVNs and improve financial metrics.

The future of cattle veterinary practice: insights from a qualitative study.

The British livestock sector is constantly changing due to environmental and economic pressures, consequentially causing a shift in demand on farm veterinary services. The aim of this study was to explore the future of cattle veterinary practice, using a qualitative approach. Telephone interviews were organised with key opinion leaders within the cattle farm and veterinary sectors to discuss their opinions on the future of the profession. The interviews were recorded and transcribed, and thematic analysis was used to interpret the data. The analysis of these interviews resulted in the development of six key themes that emerged as being important in the future of cattle veterinary practice; veterinary business structure, veterinary practice income, collaboration, the changing role of the cattle vet, the vet-farmer relationship and the new generation of cattle vets. The study identified that the role of the cattle veterinary practitioner in the UK is changing with an increasing focus on data handling, people management and training and advisory skills. It is important that these findings are accounted for in the development of undergraduate and postgraduate veterinary training.

'Care about my animal, know your stuff and take me seriously': United Kingdom and Australian clients' views on the capabilities most important in their veterinarians.

Success in veterinary practice requires careful balancing of stakeholder needs. The aim of this study was to investigate the current expectations and needs of veterinary clients across a range of practice types. Interviews and focus groups were undertaken with veterinary clients to identify the capabilities of veterinarians that result in the best client experience, generating a 'Veterinary Capability Framework'. This comprised six main capabilities each containing 4-10 behavioural indicators: client relationships; professionalism; communication skills; decision-making and problem solving; commitment to animal welfare; and commitment to quality and the profession. An online survey was then conducted to validate the importance of these capabilities, which was completed by 1446 mostly UK and Australian clients. The data have allowed us to develop a 'Client Hierarchy of Needs' which emphasises the fundamental importance of commitment to animal welfare and veterinary capabilities to the client experience. This study is part of the VetSet2Go project, a collaborative international project to define the capabilities most important for employability and success in the veterinary profession today.

Student Perceptions of Veterinary Anatomy Practical Classes: A Longitudinal Study.

Using cadaveric material to teach veterinary students poses many challenges. However, little research exists on the contribution of this traditional approach to student learning. This longitudinal study aimed to investigate student perceptions of cadaver-based anatomy classes in a vertically integrated veterinary curriculum at the University of Nottingham's School of Veterinary Medicine and Science. Likert-scale statements and free-text boxes were used in a questionnaire distributed to second-year veterinary students (response rate 59%, 61/103). The same questionnaire was subsequently distributed to the same cohort 2 years later, in the students' fourth year of study (response rate 68%, 67/98). Students agreed that cadaver-based activities aid their learning, and they particularly value opportunities to develop practical skills while learning anatomy. There are few changes in perception as undergraduates progress to clinical years of teaching. Students perceive anatomy to be important, and feel that their learning has prepared them for clinical placements. This study emphasizes the importance of using cadaveric materials effectively in anatomy teaching and, in particular, using clinical skills training to enhance the anatomy curriculum.

Measuring the success of specific health problem consultations in cats and dogs: a systematic review.

Consultations are complex interactions, are central to achieving optimal outcomes for all stakeholders, yet what constitutes a successful consultation has not been defined. The aim of this systematic review was to describe the scope of the literature available on specific health problem consultations and appraise their identified success measures. Searches of CAB Abstracts and MEDLINE were performed in May 2016 using species and consultation terms. Systematic sorting of the results allowed identification of consultation 'success factors' cited in peer-reviewed veterinary literature which were appraised using an appropriate critical appraisal tool (AXIS). Searches returned 11 330 results with a total of 17 publications meeting the inclusion criteria, of which four measured consultation success. Journal of the American Veterinary Medical Association was the most common journal of publication (9 of 17) and the majority of included papers had been published since 2010 (12 of 17). Success factors measured were compliance, client satisfaction and veterinary surgeon satisfaction, and publications primarily used communication analysis tools to measure success. The review highlights the paucity of peer-reviewed literature examining small animal, health problem veterinary consultations. The available evidence is of variable quality and provides weak evidence as to which factors contribute to a successful consultation.

Student Perceptions of Veterinary Anatomy Practical Classes: A Longitudinal Study.

Using cadaveric material to teach veterinary students poses many challenges. However, little research exists on the contribution of this traditional approach to student learning. This longitudinal study aimed to investigate student perceptions of cadaver-based anatomy classes in a vertically integrated veterinary curriculum at the University of Nottingham's School of Veterinary Medicine and Science. Likert-scale statements and free-text boxes were used in a questionnaire distributed to second-year veterinary students (response rate 59%, 61/103). The same questionnaire was subsequently distributed to the same cohort 2 years later, in the students' fourth year of study (response rate 68%, 67/98). Students agreed that cadaver-based activities aid their learning, and they particularly value opportunities to develop practical skills while learning anatomy. There are few changes in perception as undergraduates progress to clinical years of teaching. Students perceive anatomy to be important, and feel that their learning has prepared them for clinical placements. This study emphasizes the importance of using cadaveric materials effectively in anatomy teaching and, in particular, using clinical skills training to enhance the anatomy curriculum.

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.

Students' perceptions of the Script Concordance Test and its impact on their learning behavior: a mixed methods study.

The Script Concordance Test (SCT) is increasingly used in postgraduate and undergraduate education as a method of summative clinical assessment. It has been shown to have high validity and reliability but there is little evidence of its use in veterinary education as assessment for learning. This study investigates some students' perceptions of the SCT and its effects on their approaches to learning. Final-year undergraduates of the School of Veterinary Medicine and Science (SVMS) at the University of Nottingham participated in a mixed-methods study after completing three formative SCT assessments. A qualitative, thematic analysis was produced from transcripts of three focus group discussions. The quantitative study was a survey based on the analyses of the qualitative study. Out of 50 students who registered for the study, 18 participated in the focus groups and 28 completed the survey. Clinical experience was regarded as the most useful source of information for answering the SCT. The students also indicated that recall of facts was perceived as useful for multiple-choice questions but least useful for the SCT. Themes identified in the qualitative study related to reliability, acceptability, educational impact, and validity of the SCT. The evidence from this study shows that the SCT has high face validity among veterinary students. They reported that it encouraged them to reflect upon their clinical experience, to participate in discussions of case material, and to adopt a deeper approach to clinical learning. These findings strongly suggest that the SCT is potentially a valuable method for assessing clinical reasoning and enhancing student learning.

Teaching and assessing veterinary professionalism.

The teaching and assessment of professional behaviors and attitudes are important components of veterinary curricula. This article aims to outline some important considerations and concepts which will be useful for veterinary educators reviewing or developing this topic. A definition or framework of veterinary professionalism must be decided upon before educators can develop relevant learning outcomes. The interface between ethics and professionalism should be considered, and both clinicians and ethicists should deliver professionalism teaching. The influence of the hidden curriculum on student development as professionals should also be discussed during curriculum planning because it has the potential to undermine a formal curriculum of professionalism. There are several learning theories that have relevance to the teaching and learning of professionalism; situated learning theory, social cognitive theory, adult learning theory, reflective practice and experiential learning, and social constructivism must all be considered as a curriculum is designed. Delivery methods to teach professionalism are diverse, but the teaching of reflective skills and the use of early clinical experience to deliver valid learning opportunities are essential. Curricula should be longitudinal and integrated with other aspects of teaching and learning. Professionalism should also be assessed, and a wide range of methods have the potential to do so, including multisource feedback and portfolios. Validity, reliability, and feasibility are all important considerations. The above outlined approach to the teaching and assessment of professionalism will help ensure that institutions produce graduates who are ready for the workplace.