Objectives—To determine perceptions of veterinary
technical and professional skills among veterinary students
and recent graduates.
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
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
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)
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.
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.
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)
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.
Sample Population—90 owners of dogs prescribed
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
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.
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.
To describe client and veterinarian perceptions of client-centeredness during euthanasia discussions and assess agreement between measures of these perceptions.
Stratified random sample of 32 companion animal veterinarians in southern Ontario.
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.
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.
Objective—To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet.
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.