Together, we look forward to further innovations that will make even more confident and competent day‐one graduates who will be better prepared to treat the animals in their care.
About the Companion Website
This book is accompanied by a companion website:
www.wiley.com/go/read/veterinary
There you will find valuable material designed to enhance your learning, including:
Appendices 1 and 2 from the book as downloadable PDF
1 What Is a Clinical Skill?
Emma K. Read1 and Sarah Baillie2
1 College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
2 Bristol Veterinary School, University of Bristol, Bristol, UK
Historically in veterinary medicine, degree programs have been based upon the Flexner model described in medical education, with two basic blocks: two to three years of preclinical training and one to two years of clinical training (Flexner, 1910). Approximately 10–15 years ago, a trend developed in veterinary education to include more hands‐on training during veterinary programs, often beginning in the start of the first year, with an emphasis on teaching day‐one skills necessary for success in practice (Hubbell et al., 2008; Doucet and Vrins, 2009; Welsh et al., 2009; Smeak et al., 2012; Dilly et al., 2017 RCVS, 2020;). The idea of moving clinical training earlier in the program and further emphasizing integration of knowledge and other skills into the clinical workplace led to current veterinary programs being more like two inverse wedges rather than two blocks placed one on top of the other as separate units of the same program (Figure 1.1).
Formal veterinary clinical skills training programs, which emphasized the use of models and simulators and constructed dedicated clinical skills centers for teaching, began in the early to mid‐2000s as a way to accommodate this need for earlier training (Baillie et al., 2005; Scalese and Issenberg, 2005; Pirkelbauer et al., 2008; Read and Hecker, 2013; Dilly et al., 2017). Reports of objective structured clinical examinations (OSCEs) that are used to assess learners' hands‐on skills, and descriptions of best practices for implementing skills curricula, began to follow (Smeak, 2007; Rhind et al., 2008; May and Head, 2010; Hecker et al., 2010; Read and Hecker, 2013; Dilly et al., 2017).
Concurrently, over the last 10 years, there has been a recognition of the need to incorporate more professional skills training (NAVMEC, 2011; Cake et al., 2016). Today's employers are not only searching for confidence and technical competence in new graduates but good communication abilities as well (Perrin, 2019). Rather than simply being competent in one's hands‐on skills alone, effective integration of professional communication and technical skills performance is crucial for successful practice (NAVMEC, 2011; Rhind et al., 2011). Other “marketable skills” described in a recent report of the characteristics most often sought by employers posting job advertisements in the United Kingdom included enthusiasm, special interest, communication, all‐rounder, client care, team player, autonomous, caring, ambitious, and high clinical standards (Perrin, 2019). These “skills” are important to employers and are key to minimizing dissonance and dissatisfaction for the graduates as well (May, 2015; Perrin, 2019).
Figure 1.1 Flexner model (with separation between preclinical and clinical blocks) versus the more recent curricular models that are more like inverse wedges introducing clinical content earlier into the start of the curriculum.
The Royal College of Veterinary Surgeons (RCVS) Day One Competences and the American Association of Veterinary Medical Colleges’ (AAVMC) North American Veterinary Medical Education Consortium (NAVMEC) report are both recognized as early frameworks that defined competencies across a number of areas that lead to graduate success (NAVMEC, 2011 RCVS, 2020;). More recently, there have been other developments toward employability of new graduates and improved teaching of professional skills. The VetSet2Go project represents an international collaboration of educators (https://www.vetset2go.edu.au), who surveyed employers, clients, new graduates, and other stakeholders before combining this information with what was already published in the literature. The resulting white paper and framework have been used to guide development of resources, as well as tools for educators and learners (Cake et al., 2016; Hughes et al., 2018). This framework highlights professional identity formation, skills needed for practice career longevity, and development of resilience. More recently, outcomes‐based frameworks have been described (Bok et al., 2011; Molgaard et al., 2019; Matthew et al., 2020). The AAVMC's competency‐based veterinary education (CBVE) framework is currently being considered and implemented across multiple international veterinary schools simultaneously, which brings exciting opportunities for conducting comparative analysis of students and graduates across schools. Having a shared framework of competencies, entrustable professional activities, milestones, and terminology is critical for training educators, comparing learners, and generalizing results across programs (Molgaard et al., 2018a; Molgaard et al., 2018b; Salisbury et al., 2019). With schools historically only focusing on their own programs, this opportunity has not existed in veterinary medicine to date.
In the strictest sense, veterinary clinical skills are psychomotor tasks that can be assessed in a simulated environment (satisfying “shows how” on Miller's pyramid of clinical competence) or within the actual clinical workplace (satisfying “does” on Miller's pyramid of clinical competence, see Figure 5.1) (Miller, 1990). Obvious examples might include donning and doffing a surgical gown, suturing skin, performing venipuncture, safely restraining a patient, or performing a complete physical examination. But what about interpreting herd records, observing animal behavior, or designing an isolation facility? Recently, authors have argued that the pinnacle of Miller's pyramid of clinical competence is not just related to technical skill competence as Miller originally described but is actually “is trusted” (to perform on one's own) (ten Cate et al., 2020) or “is” (to incorporate the development of professional identity) (Cruess et al., 2016).
During curriculum development or program revision to incorporate further clinical skills training, there can be heated debate among educators and practitioners about what skills are the most necessary to teach, or even about what constitutes a “clinical skill.” Before the more recent rise of competency‐based education, some educators and practitioners used Delphi‐like processes and developed lists of skills to be taught in veterinary programs such as Day 1 Skills, first published in 2002 (RCVS, 2020). These practitioners tended to focus on what they believed was important for their own daily practice and based the skills list on what might be needed for their particular geographical location. Practitioners also focused on what they wished to be taught to students who were soon to become their employees and colleagues. Educators tended to focus more on their own areas of specialty and what they believed new graduates should be able to perform based on past teaching experience.
The
