Comparison of Community Practitioner and Clinical Educator Expectations of Veterinary Graduates.

One goal of veterinary curricular development and revision is to ensure graduating veterinarians meet entry-level competencies to perform successfully in their community. Most curricula are developed by clinical educators in a university setting; therefore, we must determine whether clinical educators can predict community practitioner expectations. This article evaluates practitioners' expectations of new graduate independence in veterinary tasks and compares these expectations with those of clinical educators at the University of Wisconsin-Madison School of Veterinary Medicine (UW-SVM). A survey was designed to measure expectations of graduate-level independence within nine technical and three non-technical categories. Members of the Wisconsin Veterinary Medical Association (WVMA) and UW-SVM clinicians were invited to participate. Expected levels of independence were compared between these two populations and between WVMA specialists and generalists. Results indicated significant differences in the expected levels of graduate independence between UW-SVM clinicians and WVMA members, with UW-SVM clinicians generally expecting higher levels of independence for both technical and non-technical tasks. Although most SVM clinicians are specialists, this difference does not appear to reflect a difference in expectations between specialists and generalists, as WVMA specialists had lower expectations of graduate independence for most technical and non-technical tasks than did WVMA generalists. These results suggest that academic clinicians are not able to predict practitioners' graduate expectations or that graduates in practice are not meeting the levels of independence expected by their clinical educators. Further investigation into the differences in expectations will enable fruitful partnerships between academic clinicians, practitioners, and students in curricular design and revision.

Evaluation of the Bachelor of Veterinary Medicine (BVM) Curriculum at Sokoine University of Agriculture in Tanzania: Mapping to OIE Veterinary Graduate 'Day 1 Competencies'.

The World Organisation for Animal Health (OIE) provides the requirements needed for graduating veterinary professionals to be competent in the delivery of animal health services. However, significant differences in veterinary curricula across countries-attributable to differing animal health priorities and predominant types of veterinary practice-provide a challenge for veterinary schools to address these competencies adequately. As part of the OIE's veterinary education establishment Twinning Project activities, the College of Veterinary Medicine and Biomedical Sciences (CVMBS) of Sokoine University of Agriculture (SUA) in Tanzania undertook a curriculum mapping and gap analysis to assess the extent to which the veterinary curriculum addresses OIE's 'Day 1 Competencies' for graduating veterinarians. Results of the analysis indicated that all the OIE's Day 1 Competencies (general, specific, and advanced) are addressed to some degree by the courses present in the curriculum. However, gaps in the depth and breadth of instruction were found for a number of competencies in all three categories. These findings indicate a need for addressing the gaps in the next curriculum review. This will allow the development of a stronger curriculum that will efficiently meet the national and international animal health requirements.

An Inter-Institutional Collaboration to "Make Teaching Matter": The Teaching Academy of the Consortium of West Region Colleges of Veterinary Medicine.

Veterinary medical education is a relatively small community with limited numbers of institutions, people, and resources widely dispersed geographically. The problems faced, however, are large-and not very different from the problems faced by (human) medical education. As part of an effort to share resources and build a community of practice around common issues, five colleges in the westernmost region of the United States came together to form a regional inter-institutional consortium. This article describes the processes by which the consortium was formed and the initiation of its first collaborative endeavor, an inter-institutional medical/biomedical teaching academy (the Regional Teaching Academy, or RTA). We report outcomes, including the successful launch of three RTA initiatives, and the strategies that have been considered key to the academy's success. These include strong support from the consortium deans, including an ongoing financial commitment, a dedicated part-time Executive Coordinator, regular face-to-face meetings that supplement virtual meetings, an organization-wide biennial conference, an effective organizational structure, and a core group of dedicated leaders and RTA Fellows. The western consortium and RTA share these processes, insights, and outcomes to provide a model upon which other colleges of veterinary medicine can build to further leverage inter-institutional collaboration.

Student and Institutional Achievements during an OIE Veterinary Education Twinning Project Collaboration between Sokoine University of Agriculture and Kansas State University.

This collaborative partnership aimed to enhance the quality of veterinary education at both Sokoine University of Agriculture (SUA), College of Veterinary Medicine and Biomedical Sciences (Tanzania), and Kansas State University (KSU), College of Veterinary Medicine (United States), by facilitating exchange of knowledge, experience, and ideas. One project objective was to integrate the World Organisation for Animal Health (OIE) Guidelines on Veterinary Education Core Curriculum into the SUA education program so veterinary graduates would be equipped with the minimum competencies needed to support their National Veterinary Services (OIE Day 1 Competencies). Curriculum mapping revealed that partners addressed different OIE Day 1 Competencies to varying degrees and they had complementary strengths and weaknesses. The partners' practical and educational experiences were also complementary, providing each opportunities to learn from the other and a solid basis for long-term mutually beneficial collaboration. Through structured exchanges, the collaboration allowed SUA and KSU students and faculty to broaden their perspectives by exposing them to veterinary medicine, culture, ecosystems, teaching environments, and farming systems in each other's country. Visiting faculties and students from both universities were exposed to different livestock systems, varying dynamics at the human-livestock-wildlife interface, different teaching systems, and a veterinary profession with a different culture and focus than that in their own country. Students and faculty learned about the relative social and economic importance of different types of animal production in each country and their influence on veterinary education priorities. Partnership outcomes include a continuing professional development course at SUA for private and public sector veterinarians and a clinical club to expose students at both colleges to a broader range of clinical cases and knowledge.

Effect of Short- Versus Long-Term Video Game Playing on Basic Laparoscopic Skills Acquisition of Veterinary Medicine Students.

The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.

Cognitive Functioning in Formerly Opioid-Dependent Adults after At Least 1 Year of Abstinence: A Naturalistic Study.

This study is an evaluation of cognitive functioning in formerly opioid-dependent adults after at least 1 year of abstinence. Participants (45 formerly opioid-dependent patients, referred to as abstainers, and 45 matched healthy controls) completed a structured screening and subsequent cognitive test battery covering intelligence, learning and memory, attention, and executive functions. Many cognitive functions were comparable between long-term abstainers and healthy controls, and we found few relevant differences. Long-term abstainers seem to have subtle deficits in recognition performance. Based on our and earlier findings, opioid maintenance treatment may be seen as relatively safe with respect to cognitive dysfunction and cognitive functioning is of great relevance for the rehabilitation and daily functioning of substance-dependent people.

[Prevalence and Therapy of Crystal Methamphetamine Dependence]. / Prävalenz und Therapie bei Abhängigkeit von Methamphetamin ("Crystal").

Following a short overview on the epidemiology and clinical correlates of amphetamine abuse and dependence, with special emphasis on metamphetamine ("crystal"), current treatment concepts and recent results of therapy research are discussed. The efficacy of two inpatient treatment models for methamphetamine dependence are currently studied in a study funded by the German Ministry of health. The study concept is given and possible implications are discussed.

In Vitro Biomechanical Testing of the Tube Knot.

OBJECTIVE: To compare in vitro biomechanical properties of the tube knot (TB) to a crimp clamp (CC) system, and square knot (SQ) using 3 monofilament materials. STUDY DESIGN: In vitro biomechanical study. SAMPLE POPULATION: Suture loops (n=20 per material/knot construct). METHODS: Monotonic tensile loading (300 mm/min single pull to failure) was performed on knots tied using 3 knots (TB, 5-throw SQ, and CC system) with each of 3 materials (40# Securos® nylon, #2 polypropylene, and #2 nylon). Ultimate tensile strength, elongation, and stiffness were measured and compared by sequential 1- and 2-way ANOVA. RESULTS: Ultimate tensile strength was greatest with 40# nylon CC (mean ± SD, 293.6 ± 26.2 N), followed by TB (289.8 ± 9.2 N) and SQ (252.2 ± 8.5 N) with no significant difference between CC and TB. TB with #2 polypropylene (158.1 ± 7.4 N) and #2 nylon (126.3 ± 5.5 N) had significantly greater tensile strength than SQ with #2 polypropylene (143.6 ± 5.3 N) and #2 nylon (110.7 ± 6.2 N). Elongation at failure was significantly greater in 40# nylon TB (25.3 ± 3.2 mm) and SQ (10.8 ± 1.6 mm) compared to CC (5.3 ± 1.0 mm). Both material and knotting method had an effect on ultimate tensile strength, elongation at failure, and stiffness, based on 2-way ANOVA. CONCLUSION: Ultimate tensile strength of TB was equivalent to that of CC; however, elongation at failure was greatest for TB, which may be of concern for clinical applications.

Integrating Genomic Data Sets for Knowledge Discovery: An Informed Approach to Management of Captive Endangered Species.

Many endangered captive populations exhibit reduced genetic diversity resulting in health issues that impact reproductive fitness and quality of life. Numerous cost effective genomic sequencing and genotyping technologies provide unparalleled opportunity for incorporating genomics knowledge in management of endangered species. Genomic data, such as sequence data, transcriptome data, and genotyping data, provide critical information about a captive population that, when leveraged correctly, can be utilized to maximize population genetic variation while simultaneously reducing unintended introduction or propagation of undesirable phenotypes. Current approaches aimed at managing endangered captive populations utilize species survival plans (SSPs) that rely upon mean kinship estimates to maximize genetic diversity while simultaneously avoiding artificial selection in the breeding program. However, as genomic resources increase for each endangered species, the potential knowledge available for management also increases. Unlike model organisms in which considerable scientific resources are used to experimentally validate genotype-phenotype relationships, endangered species typically lack the necessary sample sizes and economic resources required for such studies. Even so, in the absence of experimentally verified genetic discoveries, genomics data still provides value. In fact, bioinformatics and comparative genomics approaches offer mechanisms for translating these raw genomics data sets into integrated knowledge that enable an informed approach to endangered species management.

Training Veterinary Students to Perform Ovariectomy Using theMOOSE Spay Model with Traditional Method versus the Dowling Spay Retractor.

Educators understand the importance of developing safe and effective methods to teach veterinary students basic surgical skills. Ovariectomy (OVE) is a procedure that employs many of the skills agreed to be vital for a newly graduated veterinarian. This study endeavored to compare two methods of teaching OVE on a model based on assessment of procedure time and skill performance scores. Students' opinions regarding their experience are also reported. Students performed the Dowling Spay Retractor (DSR) method more quickly (p<.001) but with performance scores similar to the traditional (T) method depicted in textbooks. Students responded positively when surveyed regarding their experience with the training and the DSR method.

The use of fluoxetine by veterinarians in dogs and cats: a preliminary survey.

OBJECTIVE: To describe the prescribing habits of a sample of small animal veterinarians pertaining to use of fluoxetine in dogs and cats. DESIGN: Exploratory descriptive survey using a questionnaire, available on paper and through email, distributed to small animal veterinarians by convenience sampling. PARTICIPANTS: Veterinarians practicing small animal medicine in North America contacted by email and at local veterinary meetings. RESULTS: Of 127 initial respondents, 106 prescribed fluoxetine for dogs and/or cats. The majority (91 per cent) indicated the drug be given once every 24 hours. Respondents used one or more formulations of fluoxetine. Of those who prescribed fluoxetine for both dogs and cats (57 per cent), 80 per cent used a generic form. A third prescribed fluoxetine only for dogs (31 per cent) and 72 per cent of these prescribed the US Food and Drug Administration approved product that was available at that time. The primary use of fluoxetine was related to behaviour problems. Overall for dogs, uses of fluoxetine were organised into five major categories by the investigators: Anxieties, Aggression, Compulsive Disorders, Phobias/Fear and Other, Anxieties being the most common. Of those who prescribed fluoxetine, 12 per cent did so only for cats and the majority of these prescribed generic (58 per cent) and or compounded (42 per cent) forms. Overall for cats, uses of fluoxetine were organised into six major categories: Elimination behaviours, Anxieties, Aggression, Dermatologic/Grooming, Compulsive Disorders and Other, Elimination behaviours being most common. CONCLUSIONS: This study indicates that practitioners prescribed fluoxetine in generic, proprietary and compounded formulations for a variety of behaviour problems of dogs and cats. The broad use by the respondents suggests how important psychotropic drugs are in veterinary medicine. Research, information and continuing education regarding such drugs and animal behaviour should be made available to the general practitioner.

Comparison between Training Models to Teach Veterinary Medical Students Basic Laparoscopic Surgery Skills.

The objective of this study was to compare the effectiveness of two different laparoscopic training models in preparing veterinary students to perform basic laparoscopic skills. Sixteen first- and second-year veterinary students were randomly assigned to a box trainer (Group B) or tablet trainer (Group T). Training and assessment for both groups included two tasks, "peg transfer" and "pattern cutting," derived from the well-validated McGill University Inanimate System for Training and Evaluation of Laparoscopic Skills. Confidence levels were compared by evaluating pre- and post-training questionnaires. Performance of laparoscopic tasks was scored pre- and post-training using a rubric for precision and speed. Results revealed a significant improvement in student confidence for basic laparoscopic skills (p<.05) and significantly higher scores for both groups in both laparoscopic tasks (p<.05). No significant differences were found between the groups regarding their assessment of the video quality, lighting, and simplicity of setup (p=.34, p=.15, and p=.43, respectively). In conclusion, the low-cost tablet trainer and the more expensive box trainer were similarly effective in preparing pre-clinical veterinary students to perform basic laparoscopic skills on a model.

Decision making and impulsiveness in abstinent alcohol-dependent people and healthy individuals: a neuropsychological examination.

BACKGROUND: Alcohol dependence is associated with deficits in decision making and increased impulsiveness. Therefore, we compared decision making in abstinent alcohol-dependent people ("abstainers") and matched healthy individuals ("comparison group") to determine whether impulsiveness or personality traits play a role in decision making. METHODS: Abstainers (n = 40) were recruited from treatment facilities in and around Munich, Germany, and the comparison group (n = 40) through personal contacts and social media. We assessed decision making with the Iowa Gambling Task (IGT), impulsiveness with the Barratt Impulsiveness Scale (BIS-11) and personality traits with the NEO Five-Factor Inventory (NEO-FFI). RESULTS: The comparison group performed significantly better in the IGT (mean profit € 159.50, SD 977.92) than the abstainers (mean loss - € 1,400.13, SD 1,362.10; p < .001) and showed significantly less impulsiveness in the BIS-11 (comparison group: mean 56.03, SD 7.80; abstainers: mean 63.55, SD 11.47; p < .001). None of the five personality traits assessed with the NEO-FFI differed significantly between the groups. CONCLUSION: The results confirm that abstinent alcohol-dependent people do not perform as well as healthy individuals in decision-making tasks and show greater impulsiveness, but in this study did not affect their decision-making ability.

Buprenorphine-naloxone treatment in opioid dependence and risk of liver enzyme elevation: results from a 12-month observational study.

BACKGROUND: Some case series mention possible liver toxicity in opioid-dependent patients under buprenorphine treatment. METHODS: This 12-month prospective observational follow-up study in opioid-dependent patients under buprenorphine-naloxone treatment assessed outcome and safety issues. At baseline, 337 eligible datasets were available; 181 patients completed the 12-month study. Liver enzymes were tested at baseline and after 12, 24, and 52 weeks' treatment. RESULTS: One to two percent of patients showed mostly discrete elevations of liver enzymes, but no patient met the criteria for drug-induced liver injury. No serious liver-related adverse events occurred, but two non-serious cases of liver enzyme increase were recorded. No patient dropped out of treatment for liver-related disorders. CONCLUSION: This study is in line with some recent studies and provides further evidence that buprenorphine-naloxone is relatively safe with respect to liver injury.

Distributive veterinary clinical education: a model of clinical-site selection.

The distributive model at the Western University of Health Sciences College of Veterinary Medicine (WesternU-CVM) utilizes third-party clinical sites rather than a traditional on-campus teaching hospital during years 3 and 4 of the curriculum. All veterinary schools are required by the American Veterinary Medical Association's accreditation standards to ensure that students are exposed to a diverse case load of sufficient number with active participation in the diagnostic work-up and treatment of patients. With one centralized teaching hospital, monitoring this aspect of the student experience is relatively straightforward. The distributive model of clinical veterinary education poses several challenges not encountered in a teaching hospital due to the number of clinical sites involved in delivering the curriculum. This article describes a clinical-site and preceptor selection process and the guidelines currently used to evaluate whether clinical sites and preceptors are suitable for initial inclusion in the program at WesternU-CVM. Outcomes data regarding the number and variety of student case exposures, student involvement in case management, and student evaluations of clinical experience are presented. These data suggest that the recruitment and selection process described here results in diverse and ample case-load exposure opportunities in a distributive model of veterinary education.

Using educational games to engage students in veterinary basic sciences.

Educational games are an example of an active learning teaching technique based on Kolb's learning cycle. We have designed multiple games to provide concrete experiences for social groups of learners in the basic sciences. "Antimicrobial Set" is a card game that illustrates global patterns in antimicrobial therapy. "SHOCK!" is a card game designed to enhance student understanding of the four types of hypersensitivity reactions. After each game is played, students undergo a structured debriefing session with faculty members to further enhance their self-reflective skills. "Foodborne Outbreak Clue" utilizes the famous Parker Brothers® board game as a means to practice skills associated with outbreak investigation and risk assessment. This game is used as a review activity and fun application of epidemiologic concepts. Anecdotal feedback from students suggests that they enjoyed the activities. Games such as these can be easily implemented in large- or small-group settings and can be adapted to other disciplines as needed.

High rehospitalization rate in alcohol-induced psychotic disorder.

Little is known about the prevalence and in particular the outcome of alcohol-induced psychotic disorder (AIPD). Data from hospital statistics of the BARMER GEK, one of the major health insurance companies in Germany, show a low overall prevalence of AIPD. An analysis of readmission rates for patients hospitalized for AIPD in 2005 (N = 462) and 2006 (N = 404) for the period up to 2010 revealed very high readmission rates. Only a minority of patients were without relapse [144 (31.2%) of the 2005 sample; 152 (37.6%) of the 2006 sample]. Thus, AIPD appears to be a rare complication of the alcohol use disorder but to have an extremely high rehospitalization rate, probably indicating a more chronic course and worse prognosis than previously thought. More follow-up studies are needed to elucidate this syndrome.

Validation of a scenario-based assessment of critical thinking using an externally validated tool.

With medical education transitioning from knowledge-based curricula to competency-based curricula, critical thinking skills have emerged as a major competency. While there are validated external instruments for assessing critical thinking, many educators have created their own custom assessments of critical thinking. However, the face validity of these assessments has not been challenged. The purpose of this study was to compare results from a custom assessment of critical thinking with the results from a validated external instrument of critical thinking. Students from the College of Veterinary Medicine at Western University of Health Sciences were administered a custom assessment of critical thinking (ACT) examination and the externally validated instrument, California Critical Thinking Skills Test (CCTST), in the spring of 2011. Total scores and sub-scores from each exam were analyzed for significant correlations using Pearson correlation coefficients. Significant correlations between ACT Blooms 2 and deductive reasoning and total ACT score and deductive reasoning were demonstrated with correlation coefficients of 0.24 and 0.22, respectively. No other statistically significant correlations were found. The lack of significant correlation between the two examinations illustrates the need in medical education to externally validate internal custom assessments. Ultimately, the development and validation of custom assessments of non-knowledge-based competencies will produce higher quality medical professionals.

Risk profiles of treatment noncompletion for inpatients and outpatients undergoing alcohol disorder rehabilitation treatment.

BACKGROUND: Rehabilitation treatment noncompletion is considered a risk factor for long term relapse in alcohol-dependent individuals. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to identify social, mental, and somatic risk profiles for treatment noncompletion. METHODS: A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (personality disorders, anxiety, depression, and impulsivity) at treatment admission, with termination at 12 months follow-up. Participants were subdivided into treatment completers and noncom-pleters for any reason. RESULTS: A total of 10.2% of inpatients and 16.1% of outpatients did not complete treatment. Compared with treatment completers, noncompleters had a significantly lower rate of continuous abstinence at 1-year follow-up, more recent alcohol consumption before admission, and a higher rate of borderline personality disorders. Among inpatients, an elevated rate of lifetime mental disorders, depression, and suicide attempts was found among treatment noncompleters; among outpatients, treatment noncompleters were more often than completers to be married but live separated. CONCLUSION: Rates of treatment noncompletion in inpatient and outpatient rehabilitation programs correspond to results from previous research. Noncompletion is a significant correlate of relapse 1 year after treatment, and noncompleters show an elevated level of psychopathology. These findings may help rehabilitation treatment facilities to tailor specific therapies for these individuals to reduce risk for treatment noncompletion.

Predictive value of obsessive-compulsive drinking scale (OCDS) for outcome in alcohol-dependent inpatients: results of a 24-month follow-up study.

BACKGROUND: The present study examined whether craving as measured by the obsessive-compulsive drinking scale (OCDS) predict long-term outcome in alcohol-dependent inpatients. METHODS: This was a 24-month prospective, observational study in 198 alcohol-dependent inpatients treated under standardized conditions. The primary outcome criterion was abstinence, defined as no subjective report or objective indication of alcohol consumption since discharge from treatment. The patients self-rated their craving for alcohol at the 6- and 12-month follow-ups by using the German version of the OCDS, which measures obsessive and compulsive aspects of craving. Univariate and logistic regression analyses with covariates were performed. RESULTS: Of the 104 patients interviewed at the 24-month follow-up, 60% (n = 62) were abstinent. We found significant associations between total OCDS scores at 6 months and outcome at 12 months and between total OCDS scores at 12 months and outcome at 24 months: the higher the OCDS total score at one follow-up evaluation, the less likely patients were to be abstinent at the subsequent one. The same association was found for each of the two OCDS subscales, control and consequences and drinking obsessions. CONCLUSIONS: These results support earlier findings that OCDS scores can predict outcome in alcohol-dependent patients. This information can be used for the timely development of protective resources. Hence, decisions over the use of resources can be made on the basis of objectified parameters to develop a personalized treatment concept. Consequently, economic considerations can induce a reduction of high medical costs.