By mandating outcomes assessment as a part of the accreditation process, the AVMA's Council on Education and other accrediting groups have led schools and colleges of veterinary medicine to begin to document their learning objectives and provide evidence that their graduates have met those objectives. Professional education programs have multiple learning objectives, but all would include the goal of educating graduates who are proficient in entry-level veterinary practice. A list of professional skills and attributes expected of new veterinary graduates has been developed by a committee of the Royal College of Veterinary Surgeons as a framework for future educational programs.1 The report was modified by the Royal College of Veterinary Surgeons and is used as part of their assessment of veterinary degree courses.2 In addition, a set of expected skills for new veterinary graduates has been developed and a Web-based database established that enables new graduates to measure their progress.3 Current AVMA guidelines for outcomes assessment are less prescriptive, with the result that North American schools and colleges of veterinary medicine have, to date, taken more individualized approaches.
Outcome assessment instruments should be based on those activities and procedures frequently performed by practicing veterinarians and the expectations of those hiring recent graduates. The activities and procedures performed in small animal practice and food animal practice in North America and the level of proficiency expected of graduates in those areas have been reported.4,5,6,7,8 In contrast, the activities and procedures performed in equine practice and the level of proficiency expected of new graduates are less well described. A workload survey9 of Dutch veterinarians revealed that the bulk of equine practice activities consisted of lameness consultations, follicle checks, pregnancy diagnosis, vaccinations, prepurchase examinations, radiology, dental examinations, and colic consultations. The authors could find no reports describing employer expectations for those entering equine practice. To gain a better understanding of equine practice, the authors designed a survey to determine the activities and procedures that are commonly performed by veterinarians in private equine practice in North America, the frequency with which those activities and procedures are performed, and the level of proficiency equine practitioners expect entry-level veterinarians to have.
Materials and Methods
An initial list of activities and procedures performed by veterinarians in private equine practice was developed by the authors and members of the equine faculty of the Department of Veterinary Clinical Sciences of The Ohio State University College of Veterinary Medicine. This list was edited and amended by members of the Equine Veterinary Education Task Force and Board of Directors of the American Association of Equine Practitioners. Each of the 151 activities and procedures that were identified was subsequently classified into 1 of 11 categories (medical knowledge, examinations, techniques, reproduction, radiology, anesthesia, surgery, dentistry, husbandry techniques, client education and regulatory, and the business of veterinary medicine). In addition, each of the activities and procedures was assigned to 1 of 3 task clusters (cognitive, physical, and a combination of cognitive and physical) by the authors to further examine potential learning and retention strategies.
The list of activities and procedures was then incorporated into a survey designed to collect information on how frequently veterinarians in equine practice performed each task and how proficient they expected entry-level veterinarians to be in performing each task. The survey was entered into a proprietary survey management system,a and electronic messages with an embedded link to the survey were sent to all members of the American Association of Equine Practitioners who had e-mail addresses on file with the association (n = 7,462). The initial message contained a note from the president of the American Association of Equine Practitioners explaining the reasons for the survey and requesting and encouraging participation. A reminder message was sent 14 days later. Responses were accepted for up to 67 days. Each respondent could complete the survey only once. Sur-were other activities or procedures that should have vey respondents were asked to indicate the frequency been included in the list. with which they performed each activity or procedure For analysis of survey responses, frequency of per-(daily, weekly, monthly, or not done) and level of pro-formance responses were weighted (daily = 200, weekly ficiency they expected of new veterinary school grad-= 50, monthly = 12, and not done = 0) on the basis of uates in their practices (able to perform unsupervised, approximate number of times the task would be per-able to perform with little supervision, able to perform formed during a year. Mean frequency scores were then with much supervision, or no proficiency expect-calculated for each task, and tasks were assigned to 1 ed). Respondents were also asked to provide demo-of 3 groups: weekly activities (ie, tasks with mean fregraphic information and to indicate whether there quency scores of 50 to 200), monthly activities (ie, tasks with mean frequency scores of 12 to 49.9), and activities that were infrequently or not performed (ie, tasks with mean frequency scores of 0 to 11.9). Responses to the expected proficiency of entry-level veterinarians were weighted on a 100-point scale (able to perform unsupervised = 100, able to perform with little supervision = 75, able to perform with much supervision = 25, and no proficiency expected = 0).
Results
Of the 7,462 equine veterinarians to which the survey was sent, 846 (11.3%) responded. Mean frequency scores for individual tasks ranged from 191.6 (effectively communicate over the telephone) to 1.8 (perform bone marrow aspiration and prepare a sample and smears). Seventy-seven of the 151 tasks were classified as being performed weekly (Table 1), 59 were classified as being performed monthly (Table 2), and 15 were classified as being performed infrequently or not at all (Table 3). Mean scores for expected level of proficiency ranged from 97.2 (administer medication PO as a paste) to 7.7 (repair a rectovaginal fistula). Mean expected proficiency scores for tasks performed weekly, monthly, and infrequently were 76.5, 56, and 27.7, respectively.
There were 259 responses to the open-ended question on additional activities and procedures. Activities and procedures entered by a minimum of 5 respondents were professionalism (31 responses), communication (28), personnel management (19), knowledge of when to refer or seek assistance (18), horsemanship (16), safe driving skills (11), understanding of the industry (10), ability to remove a horseshoe (9), ability to use per rectal palpation to diagnose colic (7), map reading (6), understanding the jargon of the equine industry (5), doses of common drugs (5), and the proper use of restraint as a part of euthanasia (5). The demographics of the respondents were similar to those provided to the authors by the executive director of the American Association of Equine Practitioners. Therefore, respondents were considered representative of equine practitioners in general.
Thirty-two of the 77 tasks performed by equine veterinarians on a weekly basis were classified as cognitive, such as taking a medical history and performing a physical examination. Twenty-eight were classified as physical, such as administration of an IM injection and application of a bandage to a foot. The remaining 17 tasks were classified as representing a combination of cognitive and physical skills. Examples included obtaining and interpreting radiographs, anesthetizing a horse for a short procedure, and cleaning and débriding a wound. Monthly tasks included 13 cognitive skills, 24 physical skills, and 22 combination skills. Infrequently performed tasks included 10 physical skills and 5 combination skills.
Discussion
Veterinarians in private equine practice perform a wide variety of tasks with widely varying frequency. The survey described in the present report allowed us to identify 136 tasks that equine veterinarians perform at least monthly, providing information that should prove valuable to schools and colleges of veterinary medicine as they establish outcomes assessments for their curricula. The proficiency expected of entry-level veterinarians was greater for those tasks that were performed more frequently, with respondents expecting that en-try-level veterinarians would be able to perform 51 of the 151 tasks unsupervised or with minimal supervision (ie, mean proficiency score ≥ 75). Most of the additional tasks listed by respondents were modifications of tasks originally included in the survey.
Activities and procedures included in the survey described in the present report represented a combination of cognitive and physical skills. Cognitive skills are those requiring perceptual input (eg, acquisition of information, observation, identification, and location), mental operations (eg, compare and contrast information, organize, analyze, generate hypotheses, and apply principles), and output and response (eg, make decisions, solve problems, make judgments, and evaluate).10 Physical skills are those involving muscular strength (eg, exert force, apply speed and power, lift, and pull), endurance (eg, sustained physical activity resulting in increased heart rate), and coordination (eg, flex, twist, or bend limbs; maintain balance; and coordinate movements in a skilled action).10 Many of the cognitive tasks are shared by other types of veterinary practice, but some are specific to equine practice, including development of plans to treat colic and estimating age by examining the dentition. Similarly, the physical tasks have various degrees of application across practice types. This has important implications for schools and colleges of veterinary medicine, as it indicates that some skills, whether cognitive or physical, can be applied across species but that others must be acquired in the species of interest.
Acquisition of species-specific physical skills is a challenge for educators because of a number of factors including time, expense, social expectations for animal use, and student safety.11 Medical educators teaching endotracheal intubation reported that students attained baseline competency after 15 repetitions and that their skills declined significantly over a 4-month period if not practiced.12 The more complex the procedure, the flatter the learning curve, as exemplified by attainment of only an 80% success rate after 90 attempts by medical anesthesia residents performing epidural anesthesia.13 Deliberate practice is an important determinant of success and involves repetition and timely feedback.14 The number of instruction episodes required to attain a given success rate for most veterinary procedures has not been identified, but a single exposure is likely insufficient. Differences in student learning rates and the rate of forgetting (decline in skill) once a skill has been acquired all add to the complexity of program development.15 The use of simulations and computer modeling in the instruction of veterinary techniques is in its infancy but is expected to be of benefit particularly for skills that require multiple repetitions to be attained.16
Skill acquisition and retention has implications for practitioners as well as educators. Studies of paramedical training indicate that 50% to 60% of attained physical skill proficiency is lost over a 2-year period, although didactic knowledge diminishes by only 10%.17 There is an increase in the amount of physical skill decay as the length of the nonpractice interval increases, with retraining intervals of 2 to 3 months suggested if skills are to be retained.18 Mental practice can be used to partially maintain physical skills but is less effective than actual task performance.10 This has implications individually for veterinarians and collectively for the veterinary profession when considering the development of continuing education requirements and courses.
With the present survey, we identified a greater number of tasks that are frequently performed in private equine practice than previous studies4,5,6,7,8 found for bovine and small animal practice. The differences are principally related to survey design, with earlier investigations gathering multiple items such as IV, IM, and SC injections into a single category (administration of injections). The frequently performed activities and procedures identified in the present survey include those identified by the Royal College of Veterinary Surgeons as day 1 competencies for general and equine veterinarians and those performed frequently by Dutch veterinarians.1,2,9 The year 1 competencies for equine veterinarians listed by the Royal College of Veterinary Surgeons include some activities, such as thoracocentesis and biopsy of the liver, rectum, and lung, that according to results of our survey are performed infrequently or not at all by equine veterinarians in North America.3 As reflected by the authors of the Dutch study,9 “the backbone of most equine practices is formed by a relatively few activities.”
A variety of nontechnical competencies underlie success in veterinary practice.19,20 Business acumen, communication skills, managing people and processes, and satisfying clients have been identified as important components regardless of practice type and in most instances are species independent. Fourteen of the 77 skills identified in the present survey as being performed weekly by equine veterinarians involved client education and the business of veterinary medicine. In addition, the 3 tasks most frequently added to the list by respondents were professionalism, communication, and personnel management. Clearly, demonstrations of technical competence for the limited number of physical tasks performed repeatedly in equine practice represent only 1 portion of the complete assessment of an educational outcome.
In summary, results of the present survey provide educators and employers with information that should help them determine the set of skills that are important for entry-level veterinarians. The exposure to procedures and the acquisition of skills during the veterinary curriculum are only the first steps toward career success. As mentioned by many graduation speakers, the ceremonies are titled “commencement” exercises because they represent a beginning.
Zoomerang, Markettools, San Francisco, Calif.
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