The moral deliberation pathway in veterinary practice: a qualitative study.

BACKGROUND: Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised. METHODS: Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians. RESULTS: The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort. LIMITATIONS: Self-selection of participants and possible recollection bias may have biased the findings. CONCLUSIONS: The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.

Comparative Effectiveness of Training with Simulators Versus Traditional Instruction in Veterinary Education: Meta-Analysis and Systematic Review.

One of the greatest challenges in veterinary education is adequately preparing students with the clinical skills they need to be successful health care providers. Integration of simulators, devices used to represent real world phenomena under test conditions, into the veterinary curriculum can help address challenges to clinical instruction. The use of simulators in veterinary education is increasing; however, their effectiveness remains unclear. This meta-analysis seeks to synthesize the evidence for simulator training in veterinary education to provide a consensus of effect, guide the integration of simulators into the curriculum, and direct the development of future simulation-based research in veterinary medicine. A systematic search identified 416 potential manuscripts from which 60 articles were included after application of inclusion criteria. Information was extracted from 71 independent experiments. The overall weighted mean effect size for simulator training was g = 0.49 for the random-effects model. The outcome measures of knowledge, time, process, and product all produced statistically significant mean effect sizes favoring simulation (d = 0.41, 0.35, 0.70, 0.53, respectively). A moderator analysis revealed that study characteristics and instructional design features moderated the effectiveness of simulator training. Overall, the results indicate that simulator training in veterinary education can be effective for knowledge and clinical skill outcomes.

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.

Why do veterinarians leave clinical practice? A qualitative study using thematic analysis.

BACKGROUND: Veterinarians have an important role in society and having an adequate veterinary workforce is important not only for their communities but also nationwide. Lately, there have been anecdotal reports regarding veterinary practices struggling to find clinicians as well as evidence of mental ill-health in veterinarians. Furthermore, the Australian Veterinary Association annual workforce survey shows an increased percentage of veterinarians intending to leave practice from 2017 to 2019. Although many factors for attrition have been described in other professions, reasons for veterinarians to leave practice are not well understood. METHODS: This study investigated why veterinary clinicians leave clinical practice by using Thematic Analysis to analyse 26 semi-structured interviews of former veterinary clinicians in relation to their work experiences and reasons for leaving. Interviews were done from February-April 2018 either face to face, via teleconferencing, or telephone. Participants were recruited from each Australian state except for New South Wales. RESULTS: The results showed that a combination of personal and work-related factors influenced the participants to leave clinical practice. In Personal Factors, participants described the internal and external circumstances that impacted on their personal lives such as personal relationships, experiencing negative thoughts and emotions, physical and mental health, core motivations and beliefs, alternative professional and personal interests. On the other hand, Work Experiences described situations, experiences, and statements directly related to the participant's veterinary clinical work such as workplace relationships, employment conditions including remuneration and working hours and clinical experiences such as negative clinical outcomes. Furthermore, interlinkages between these two themes were revealed in participants' responses. CONCLUSION: This study highlights factors that contribute to attrition from veterinary clinical practice. The narrative indicates that the interlinking of such factors influenced the decision-making process to leave clinical practice in this cohort of former veterinary clinicians. Further research is required to understand the full implications for veterinary clinical practice and inform intervention strategies for retention.

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.

Resilience of veterinarians at different career stages: The role of self-efficacy, coping strategies and personal resources for resilience in veterinary practice.

BACKGROUND: The aim of this study was to determine the effect of demographic and psychological factors on resilience in new graduate-, mid- and late-career veterinarians working in Australia. METHOD: An online cross-sectional survey of 800 veterinarians collected demographic and descriptive data in two stages from late 2015 to 2017, such as gender, average hours worked per week, type and region of practice and intention to leave veterinary medicine. Psychological factors were measured utilising the Brief Resilience Scale, the Veterinary Resilience Scale-Personal Resources, the Brief COPE and General Self-Efficacy measures. RESULTS: Using a full-factorial univariate General Linear Model, no significant difference in general resilience was evident between the three career-stage groups (p > 0.05). However, higher self-efficacy, higher personal resources for resilience in veterinary practice, and lower problem-focused, higher emotion-focused and lower dysfunctional coping strategies were related to higher resilience. In the model for mid- and late-career veterinarians, a weak positive relationship existed between higher average hours worked per week and higher resilience, while intention to leave veterinary practice was also related to lower resilience in mid- and late-career veterinarians. CONCLUSION: This study supports the value of personal resources, rather than career stage, gender or region of work, as influential in developing veterinarian resilience.

Sources of pleasure in veterinary work: A qualitative study.

BACKGROUND: Despite the rise in positive psychology within organisational settings, less is known about the positive factors associated with veterinary work and veterinarian well-being. This qualitative study investigated sources of pleasure for veterinarians. METHOD: A subset of archival data from a larger study on veterinary well-being was analysed. The current study was based on data from 273 veterinarians responding to a Ten Statements Test (TST) and demographic questions. In the TST, participants provided up to 10 responses to the prompt, 'I derive pleasure in my work as a veterinarian when…'. RESULTS: Using the job demands-resources model as a framework, a total of 2536 responses were manually coded into themes relating to resources (positive responses) or demands (responses indicating a negative factor). In order of frequency, job resources are related to professional expertise (22%), positive outcomes (20%), job characteristics (19%), relationships (16%), recognition (10%), helping (7%) and personal resources (3%). Top job demands are related to stress and fatigue (17%) and poor work-life balance (16%). CONCLUSION: The results suggest that there are an abundance of positive factors in veterinary work associated with feelings of pleasure, which may support veterinarian well-being.

Gatorbulin-1, a distinct cyclodepsipeptide chemotype, targets a seventh tubulin pharmacological site.

Tubulin-targeted chemotherapy has proven to be a successful and wide spectrum strategy against solid and liquid malignancies. Therefore, new ways to modulate this essential protein could lead to new antitumoral pharmacological approaches. Currently known tubulin agents bind to six distinct sites at α/ß-tubulin either promoting microtubule stabilization or depolymerization. We have discovered a seventh binding site at the tubulin intradimer interface where a novel microtubule-destabilizing cyclodepsipeptide, termed gatorbulin-1 (GB1), binds. GB1 has a unique chemotype produced by a marine cyanobacterium. We have elucidated this dual, chemical and mechanistic, novelty through multidimensional characterization, starting with bioactivity-guided natural product isolation and multinuclei NMR-based structure determination, revealing the modified pentapeptide with a functionally critical hydroxamate group; and validation by total synthesis. We have investigated the pharmacology using isogenic cancer cell screening, cellular profiling, and complementary phenotypic assays, and unveiled the underlying molecular mechanism by in vitro biochemical studies and high-resolution structural determination of the α/ß-tubulin-GB1 complex.

Bifunctional Doscadenamides Activate Quorum Sensing in Gram-Negative Bacteria and Synergize with TRAIL to Induce Apoptosis in Cancer Cells.

New cyanobacteria-derived bifunctional analogues of doscadenamide A, a LasR-dependent quorum sensing (QS) activator in Pseudomonas aeruginosa, characterized by dual acylation of the pyrrolinone core structure and the pendant side chain primary amine to form an imide/amide hybrid are reported. The identities of doscadenamides B-J were confirmed through total synthesis and a strategic focused library with different acylation and unsaturation patterns was created. Key molecular interactions for binding with LasR and a functional response through mutation studies coupled with molecular docking were identified. The structure-activity relationships (SARs) were probed in various Gram-negative bacteria, including P. aeruginosa and Vibrio harveyi, indicating that the pyrrolinone-N acyl chain is critical for full agonist activity, while the other acyl chain is dispensable or can result in antagonist activity, depending on the bacterial system. Since homoserine lactone (HSL) quorum sensing activators have been shown to act in synergy with TRAIL to induce apoptosis in cancer cells, selected doscadenamides were tested in orthogonal eukaryotic screening systems. The most potent QS agonists, doscadenamides S10-S12, along with doscadenamides F and S4 with partial or complete saturation of the acyl side chains, exhibited the most pronounced synergistic effects with TRAIL in triple negative MDA-MB-231 breast cancer cells. The overall correlation of the SAR with respect to prokaryotic and eukaryotic targets may hint at coevolutionary processes and intriguing host-bacteria relationships. The doscadenamide scaffold represents a non-HSL template for combination therapy with TRAIL pathway stimulators.

Evaluating a Multimodal Clinical Anesthesia Course Integrated Into an Existing Veterinary Curriculum.

INTRODUCTION: This study evaluated a multimodal, simulation-based course in veterinary anesthesia integrated into an existing veterinary curriculum. METHODS: A simulation-based, multimodal training course in clinical anesthesia was evaluated using outcomes from multiple levels of the Kirkpatrick Model of Training Evaluation. Cognitive and affective outcomes were evaluated before and after instruction. Head-mounted cameras were used to record clinical performance during students' first live patient anesthesia experience in the curriculum. RESULTS: Pretest-posttest analysis of cognitive and affective outcomes for course participants revealed significant increases in knowledge and self-efficacy. Course participants received higher ratings on clinical task performance and professional skills (ie, communication and collaboration) compared with a matched control group when evaluated by blinded, external raters using a standardized rubric. CONCLUSIONS: These findings indicate that implementing a multimodal anesthesia simulation-based course directly into the curriculum can enhance cognitive and affective outcomes and prepare students for subsequent anesthesia-related patient care experiences.

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.

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.

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.

Development and validation of a contextualised measure of resilience in veterinary practice: the Veterinary Resilience Scale-Personal Resources (VRS-PR).

BACKGROUND: This article reports on the development and validation of a contextualised measure of personal resources for resilience in veterinary practice. METHODS: Exploratory factor analysis and structural equation modelling were used to evaluate data from two surveys of veterinary practitioners. RESULTS: Exploratory factor analysis of the first survey (n=300) revealed six items comprising the Veterinary Resilience Scale-Personal Resources (VRS-PR). These items focused on flexibility, adaptability, optimism, building strengths, enjoying challenges, and maintaining motivation and enthusiasm at work. Structural equation modelling using the second survey (n=744) confirmed the factor structure of the VRS-PR and established convergent validity with an established measure of general resilience, the Brief Resilience Scale. Examination of the mean and standard deviation of the combined survey data enabled scores on the VRS-PR to be provisionally classified into 'low', 'moderate' and 'high' (reported by approximately 13%, 72% and 15% of respondents, respectively). Respondents also reported results spanning 'low', 'moderate' and 'high' classifications for the Brief Resilience Scale (approximately 34%, 57% and 9%, respectively). CONCLUSION: The VRS-PR may be used to evaluate the extent to which respondents draw upon the personal resources captured in the scale and identify areas for improvement.

Is a Picture Worth a Thousand Words? Evaluating the Design of Instructional Animations in Veterinary Education.

Empirical evidence demonstrates that student learning outcomes improve when animations are developed in alignment with the design principles of the cognitive theory of multimedia learning (CTML). The extent to which these principles are used in the design of veterinary instructional animations is unknown. In this study, we reviewed the veterinary education literature for articles that discussed specific veterinary medical animations as learning resources. The 30 referenced animations accessed through this search were analyzed to determine whether they used the CTML's 11 major design principles. Analysis revealed that the animations most commonly adhered to only 4 principles: coherence, redundancy, modality, and spatial contiguity. The majority of the 11 CTML principles were used in fewer than 40% of the animations. We also examined the alignment between raters' perceptions of the effectiveness and enjoyment of the animations and adherence to the design principles. Analyses revealed that the animations deemed by raters as most enjoyable and effective did not utilize more design principles than animations they viewed as least enjoyable and effective. The results of this study indicate many missed opportunities to increase learning by developing animated learning resources according to empirically based design principles. Decisions to include specific animations in instruction should be based on whether the resources include elements that have been shown to increase learning rather than subjective perceptions of effectiveness and enjoyment.

Challenging identity: development of a measure of veterinary career motivations.

BACKGROUND: While little is known about the motivations underpinning veterinary work, previous literature has suggested that the main influences on veterinary career choice are early/formative exposure to animals or veterinary role models. The aim of this study was to develop and provisionally validate a veterinary career motivations questionnaire to assess the strength of various types of career motivations in graduating and experienced veterinarians. METHODS: A cross-sectional sample of experienced veterinarians (n=305) and a smaller cohort of newly graduated veterinarians (n=53) were surveyed online using a long-form questionnaire. Exploratory factor analysis (EFA) was used to iteratively derive a final, short-form questionnaire for survey of a second cross-sectional sample of experienced veterinarians (n=751). RESULTS: EFA derived a final questionnaire with 22 items loading onto six factors (social purpose, animal orientation, vocational identity, challenge and learning, career affordances, and people orientation). While motivations based on animal orientation were predictably strong, those based on vocational identity were not universal and were weaker in younger and graduate veterinarians; both of these motivations were rated lower by male veterinarians. Motivations based on challenge and learning emerged as some of the strongest, most universal and most influential; people orientation and social purpose were also important, particularly for older veterinarians. CONCLUSION: The major motivations for pursuing a veterinary career may best be represented as an intrinsic passion for animal care and for learning through solving varied challenges. These motivations are largely intrinsically oriented and autonomously regulated, thus likely to be supportive of work satisfaction and wellbeing.

An Exploration of the Career Motivations Stated by Early-Career Veterinarians in Australia.

Despite the critical influence of motivation on education and work outcomes, little is known about the motivations driving people to become and remain veterinarians. This qualitative study explored the career motivations stated by Australian veterinary graduates (n = 43) using a free-response Ten Statements Test (TST) at graduation, with follow-up interviews 6-8 months later (n = 10). TST responses were coded using an alternate inductive-deductive approach that tested their fit against existing theories of motivation. Results showed that the stated motivations were predominantly oriented to perceived value, rather than self-beliefs such as expectancy of success. About a quarter of the statements were animal-related, principally themed around intrinsic animal orientation (e.g., I like animals) or extrinsic animal-related purpose (e.g., I want to help animals). However, many non-animal themes also emerged, including both intrinsic (e.g., love of learning, challenge/problem solving, variety, social relatedness) and extrinsic (e.g., helping people, social contribution, career opportunity) motivations. Interview data revealed a motivational narrative of early formative influences, with some interviewees describing a later transition toward more people- or goal-oriented motivations. This exploratory study, outlining a broad taxonomy of veterinary career motivations and their alignment to self-determination theory in particular, may provide a useful framework for exploring career motivations in veterinary education.

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.