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Abstract

Objectives—To determine perceptions of veterinary technical and professional skills among veterinary students and recent graduates.

Design—Cross-sectional study.

Sample Population—281 students and 142 recent graduates from the Ontario Veterinary College.

Procedure—A survey was designed and administered to first- through fourth-year students and veterinarians who had graduated either 1 or 6 years before survey administration.

Results—Overall response rate was 70%. Learning about technical and professional skills was highly valued. Most participants felt they had not received instruction about professional skills, but those who had felt more competent about them. Perceptions of competence increased slightly with increased comfort discussing emotional veterinary issues with instructors. Neither gender nor increased age was related to increased feelings of competence. Almost all fourth-year students felt competent and comfortable about examining an animal with the client present, assessing suffering, diagnosing parvovirus infection, performing surgery, and working as group members. However, many did not feel competent or comfortable about delivering bad news, setting time limits yet providing quality service, helping clients with limited funds make treatment decisions, dealing with demanding people, and euthanasia. Feelings of competence and comfort were closely related but were not identical.

Conclusions and Clinical Relevance—In the interests of best preparing entry-level veterinarians, technical and professional skills need to be emphasized in a learning environment where students feel comfortable discussing emotional veterinary issues. A professional skills curriculum addressing underlying selfawareness, communication, and interpersonal issues, as well as procedural matters, would likely increase the proportion of fourth-year students who feel competent and comfortable about professional skills by the end of their undergraduate training. (J Am Vet Med Assoc 2001;219:924–931)

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Abstract

Objective—To measure veterinarian satisfaction with companion animal visits through an adaptation of a previously validated physician visit satisfaction scale and to identify demographic, personality, appointment, and communication factors that contribute to veterinarian visit satisfaction.

Design—Cross-sectional descriptive study.

Sample—Random sample of 50 companion animal practitioners in southern Ontario, Canada, and convenience sample of 300 clients and their pets.

Procedures—For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed by use of the Roter interaction analysis system. The physician satisfaction scale, Rosenberg self-esteem scale, and interpersonal reactivity index were used to measure veterinarian visit satisfaction, self-esteem, and empathy, respectively. Linear regression analysis was conducted to study the relationship between factors and veterinarian visit satisfaction.

Results—Veterinarian visit satisfaction ranged from 1 to 5 (mean ± SD, 3.97 ± 0.99) and differed significantly between wellness appointments (mean scale score, 4.13) and problem appointments (mean scale score, 3.81). Various elements of client and veterinarian communication as well as personality measures of veterinarian self-esteem and empathy were associated with veterinarian satisfaction. The specific factors differed depending on the nature of the appointment.

Conclusions and Clinical Relevance—Results suggested that veterinarian visit–specific satisfaction is enhanced through the use of communication that builds relationships with clients and is associated with degrees of veterinarian empathetic concern and veterinarian self-esteem. The implications extend to overall job satisfaction and its potential link to the health and well-being of individual veterinarians.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the relationship between veterinarian and client genders and veterinarian-client-patient communication.

Design—Cross-sectional descriptive study.

Sample—Random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.

Procedures—For each practitioner, 6 clinical appointments were videotaped, and the resulting 300 videotapes were analyzed with the Roter interaction analysis system (RIAS). Linear regression was conducted to study the relationship between demographic factors, measures of veterinarian-client-patient communication, and gender of the veterinarian and client.

Results—Female veterinarians conducted more relationship-centered appointments, provided more positive and rapport-building statements, talked more to the patient, and were perceived as less hurried or rushed, compared with male veterinarians. Clients were more likely to provide lifestyle-social information to female veterinarians. Same-gender veterinarian-client interactions were relationship centered and included client provision of more lifestyle-social information.

Conclusions and Clinical Relevance—Gender influenced veterinarian-client-patient communication, and previously described physician gender differences in medical communication were largely replicated in the veterinary context.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To identify specific components of veterinarian- client-patient communication during clinical appointments in companion animal practice.

Design—Cross-sectional descriptive study.

Sample Population—A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.

Procedure—For each practitioner, 6 clinical appointments (3 wellness appointments and 3 appointments related to a health problem) were videotaped, and the Roter interaction analysis system (RIAS) was used to analyze the resulting 300 videotapes. Statements made during each appointment were classified by means of a communication framework reflecting the 4 essential tasks of the appointment (ie, data gathering, education and counseling, relationship building, and activation and partnership).

Results—57% of the veterinarians contacted (50/87) and 99% of the clients contacted agreed to participate in the study. Mean duration of the appointments was 13 minutes. Typically, veterinarians contributed 62% of the total conversation and clients contributed 38%. Fifty-four percent of the veterinarian interaction was with the client, and 8% was with the pet. Data gathering constituted 9% of the veterinarian-to-client communication and was primarily accomplished through closed-ended questioning; 48% of veterinarian-to-client communication involved client education and counseling, 30% involved relationship building, and 7% involved activation and partnership (the remaining 6% constituted orientation).

Conclusions and Clinical Relevance—Results suggest that the RIAS was a reliable method of assessing the structure, process, and content of veterinarianclient-patient communication and that some veterinarians do not use all the tools needed for effective communication. (J Am Vet Med Assoc 2004;225:222–229)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To describe the degree of and variability in the level of client compliance and identify determinants of client compliance with short-term administration of antimicrobial medications to dogs.

Design—Prospective study.

Sample Population—90 owners of dogs prescribed antimicrobials.

Procedure—Eligible clients were invited to participate when antimicrobial medications were dispensed. Data were collected during a follow-up appointment by use of a client questionnaire, residual pill count, and return of an electronic medication monitoring device. Attending veterinarians also completed a questionnaire that asked them to predict client compliance. Methods of assessing compliance were compared with nonparametric tests. Generalized estimating equations were used to investigate potential determinants of compliance.

Results—Median compliance rates of 97% of prescribed container openings, 91% of days when the correct number of doses were given, and 64% of doses given on time as assessed by the electronic medication monitoring devices were significantly lower than the median compliance rates of 100% for client self-report of missing doses and pill count. Veterinarians were unable to predict client compliance. The dosage regimen significantly determined compliance. Clients giving antimicrobials once or twice daily were 9 times more likely to be 100% compliant, compared with 3 times daily dosing.

Conclusions and Clinical Relevance—The combination of reported missed doses and pill counts was a significant predictor of compliance as measured by electronic monitoring. Electronic monitoring caps provided useful information only when they were used appropriately. Asking clients about missed doses and performing pill counts are the most practical assessments of compliance in practice. (J Am Vet Med Assoc 2005;226:567–574)

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To compare the clinical interview process, content of the medical dialog, and emotional tone of the veterinarian-client-patient interaction during wellness appointments and appointments related to a health problem in companion animal practice.

Design—Cross-sectional descriptive study.

Sample Population—A random sample of 50 companion animal practitioners in southern Ontario and a convenience sample of 300 clients and their pets.

Procedure—For each practitioner, 6 clinical appointments (3 wellness appointments and 3 problem appointments) were videotaped. The Roter interaction analysis system was used to analyze the resulting 300 videotapes.

Results—Wellness appointments were characterized by a broad discussion of topics, with 50% of data-gathering statements and 27% of client education statements related to the pet's lifestyle activities and social interactions. Wellness appointments included twice as much verbal interaction with the pet as did problem appointments, and the emotional atmosphere of wellness appointments was generally relaxed. There were more social talk, laughter, statements of reassurance, and compliments directed toward the client and pet. In contrast, during problem appointments, 90% of the data gathering and client education focused on biomedical topics. Coders rated veterinarians as hurried during 30 of the 150 (20%) problem appointments; they rated clients as anxious during 39 (26%) problem appointments and as emotionally distressed during 21 (14%).

Conclusions and Clinical Relevance—Results suggested that veterinarian-client-patient communication differed between wellness and problem appointments. Owing to the emphasis on biomedical content during problem appointments, veterinarians may neglect lifestyle and social concerns that could impact patient management and outcomes, such as client satisfaction and adherence to veterinarian recommendations.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine the role of veterinary team effectiveness regarding job satisfaction and burnout in companion animal veterinary practice.

Design—Cross-sectional observational study.

Sample—48 companion animal veterinary health-care teams.

Procedures—274 team members participated in an online survey. Overall job satisfaction was evaluated with a 1-item measure, and the 3 dimensions of burnout (exhaustion, cynicism, and professional efficacy) were measured with the Maslach Burnout Inventory-General Survey. Team effectiveness was assessed with a survey developed for this study. Demographic and team effectiveness factors (coordinated team environment, toxic team environment, team engagement, and individual engagement) associated with job satisfaction and burnout were evaluated.

Results—Overall mean job satisfaction score was 5.46 of 7 (median, 6.00); veterinary technicians and kennel attendants had the lowest scores. According to the Maslach survey results, 22.4% of participants were in the high-risk category for exhaustion, 23.2% were in the high-risk category for cynicism, and 9.3% were in the high-risk category for professional efficacy. A coordinated team environment was associated with increased professional efficacy and decreased cynicism. A toxic team environment was negatively associated with job satisfaction and positively associated with exhaustion and cynicism. Individual engagement was positively associated with job satisfaction and professional efficacy and negatively associated with exhaustion and cynicism.

Conclusions and Clinical Relevance—Results suggested the effectiveness of a veterinary team can significantly influence individual team members’ job satisfaction and burnout. Practices should pay specific attention to the effectiveness with which their veterinary team operates.

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in Journal of the American Veterinary Medical Association

Abstract

OBJECTIVE

To describe client and veterinarian perceptions of client-centeredness during euthanasia discussions and assess agreement between measures of these perceptions.

DESIGN

Descriptive study.

SAMPLE

Stratified random sample of 32 companion animal veterinarians in southern Ontario.

PROCEDURES

2 case scenarios (a geriatric dog with worsening arthritis and a cat with inappropriate urination) designed to initiate euthanasia discussions were presented by 2 different undisclosed standardized clients (USCs) to study veterinarian communication during clinical visits. At the end of appointments, the USC's identity was disclosed, and questionnaires to measure veterinarian and client perceptions of client-centeredness were completed. Agreement was assessed by statistical methods.

RESULTS

Data were analyzed from 60 appointments (30/scenario). Of 10 questions, significant agreement was found between veterinarians and USCs for only 1 (extent to which relevant personal and family issues were discussed; κ = 0.43) for the dog scenario and 3 (extent of discussion of respective roles [κ = 0.43], better preparedness of the USC to make a euthanasia decision [κ = 0.42], and discussion of relevant personal and family issues [κ = 0.25]) for the cat scenario. When the USC and veterinarian disagreed, the veterinarian perceived that the client-centeredness components were addressed more thoroughly than did the USC.

CONCLUSIONS AND CLINICAL RELEVANCE

Lack of agreement was found between USC and veterinarian perceptions, with USCs perceiving less client-centeredness in euthanasia discussions. This communication gap suggested the need for training of veterinarians in eliciting client perspectives and assessing lifestyle-social information, including client social support systems.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet.

Design—Descriptive study.

Sample Population—32 companion animal veterinarians (16 males and 16 females) in southern Ontario.

Procedures—During 2 clinic visits, 2 cases (a geriatric dog with worsening arthritis and a cat with inappropriate urination) designed to stimulate discussion regarding euthanasia of a pet were presented by different USCs (individuals trained to consistently present a particular case to veterinarians without disclosing their identity). Discussions were audio recorded and analyzed by use of the measure of patient-centered communication (MPCC [a tool to assess and score physician communication behaviors]). Veterinarian and client statements were classified by means of 3 patient-centered components: exploring both the disease and the illness experience, understanding the whole person, and finding common ground.

Results—60 usable recorded discussions were obtained (31 veterinarians; 30 discussions/case). Overall, MPCC scores were significantly lower for the geriatric dog case. For both cases, veterinarians scored highest on finding common ground and lowest on exploring both the disease and the illness experience. Lack of exploration of client feelings, ideas, and expectations and the effect of the illness on the animal's function resulted in low scores among veterinarians.

Conclusions and Clinical Relevance—Results indicated that the use of USCs and the MPCC are feasible methods for analysis of veterinarian-client communication during companion animal euthanasia discussions. Findings suggested that some veterinarians do not fully explore client concerns or facilitate client involvement in euthanasia decision making.

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in Journal of the American Veterinary Medical Association