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A Guide to Veterinary Clinical Skills Laboratories A Guide to Veterinary Clinic

A Guide to Veterinary Clinical Skills Laboratories A Guide to Veterinary Clinical Skills Laboratories Authors: Sarah Baillie, Naomi Booth, Alison Catterall, Nicki Coombes, Emma Crowther, Marc Dilly, Robin Farrell, Rikke Langebæk, Máire O’Reilly and Emma Read This work is licensed under the Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International License. http://creativecommons.org/licenses/by-nc-nd/4.0/ Authors and Contact Details Sarah Baillie BVSc, CertCHP, MSc(IT), PhD, PFHEA, MRCVS Professor of Veterinary Education and Veterinary Programme Director School of Veterinary Sciences, University of Bristol, Langford, Bristol, BS40 5DU, UK sarah.baillie@bristol.ac.uk Naomi Booth BSc, BVSc, MMedSci Dist (Med Ed), MRCVS Teaching Associate (Veterinary Clinical Skills) School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Leicestershire, LE12 5RD, UK naomi.booth@nottingham.ac.uk Alison Catterall Clinical Skills Laboratory Manager School of Veterinary Sciences, University of Bristol, Langford, Bristol, BS40 5DU, UK a.j.catterall@bristol.ac.uk Nicki Coombes MSc VetEd, PgCert MedEd, RVN, FHEA Manager of the Clinical Skills Centre: Clinical Educator and OSCE Coordinator Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK ncoombes@rvc.ac.uk Emma Crowther BVSc, MRCVS Research Assistant in Veterinary Education School of Veterinary Sciences, University of Bristol, Langford, Bristol BS40 5DU, UK emma.crowther@bristol.ac.uk Marc Dilly, DVM, PhD Director, Clinical Skills Lab University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173 Hannover, Germany Marc.Dilly@tiho-hannover.de Robin Farrell DVM Assistant Professor of Clinical Skills Ross University School of Veterinary Medicine, P.O. Box 334, St. Kitts, West Indies rfarrell@rossvet.edu.kn Rikke Langebæk, DVM, PhD Assistant Professor Department of Veterinary Clinical and Animal Sciences, University of Copenhagen Dyrlægevej 16, 1870 Frederiksberg C, Denmark ril@sund.ku.dk Máire O'Reilly RVN, DipAVN (Surgical) Clinical Skills Laboratory Manager Veterinary Clinical Sciences, University College Dublin, Dublin 4, Ireland maire.oreilly@ucd.ie Emma K. Read, DVM, MVSc, DACVS Chair, Clinical Skills Program and Senior Instructor, Equine Surgery University of Calgary Faculty of Veterinary Medicine, Calgary, Alberta, Canada ekread@ucalgary.ca Editing and proof reading by: Sarah Baillie, Gillian Brown (Higher Education Academy, UK), Emma Crowther and Julie Williams (Bristol Dental School, UK). Acknowledgements The idea to write and publish a guide to veterinary clinical skills laboratories was the brainchild of Marc Dilly and we are all indebted to his foresight in suggesting that we collaborate to share our experiences. The authors and editors wish to thank the numerous members of the clinical skills communities who have shared expertise and driven the extraordinary growth of veterinary clinical skills teaching and facilities worldwide in recent years. We would also like to thank our clinical, academic and technical colleagues as well as the many students who have inspired, and often helped with, our work. We would like to acknowledge and thank Susan Rhind and Sheena Warman for agreeing to allow the inclusion of some text from a section (originally authored by Sarah Baillie) in the 2nd Edition of ‘A Guide to Assessment in Veterinary Medicine’ in the assessment section of this booklet (Chapter 9). The project to produce this booklet was supported by a grant from the UK Higher Education Academy (HEA) for which we are very grateful. Note: There are a number of ways to describe a clinical skills facility e.g. clinical skills laboratory, clinical skills centre, clinical simulation laboratory, etc. and in some cases there are a number of rooms in different places or buildings rather than all being in one site. For simplicity a single term has been used throughout the booklet: Clinical skills laboratory (CSL). Table of Contents Chapter 1: Introduction .............................................................................................. 1 Chapter 2: What to Teach in a Clinical Skills Laboratory ........................................... 3 Chapter 3: Where to Set Up a Clinical Skills Laboratory ............................................ 6 Chapter 4: Equipping a Clinical Skills Laboratory ...................................................... 9 Chapter 5: Managing a Clinical Skills Laboratory .................................................... 12 Chapter 6: Supporting Resources ........................................................................... 14 Chapter 7: Effective Learning of Practical Clinical Skills .......................................... 17 Chapter 8: Integrating Clinical Skills into the Curriculum ......................................... 22 Chapter 9: Assessment of Clinical Skills .................................................................. 25 Chapter 10: Short Reviews ...................................................................................... 28 A: Peer Assisted Learning (PAL) ......................................................................... 29 B: An Online Forum: ‘Veterinary Clinical Skills & Simulation’ Group in NOVICE .. 30 C: Are Students Learning Useful Skills? .............................................................. 31 D: Student Emotions When Learning Surgical Skills ............................................ 32 E: Contextualised Simulation ............................................................................... 33 References and Further Reading ............................................................................ 34 Appendix I: A Page from a Clinical Skill Station Instruction Booklet ......................... 40 Appendix II: Example Clinical Skills Laboratory Layouts .......................................... 41 Appendix III: An Example OSCE Score Sheet ......................................................... 42 1 Chapter 1: Introduction Co-authors: Sarah Baillie, Emma Read Clinical and practical skills are an essential part of the competences required of veterinary graduates (European Association of Establishments for Veterinary Education (EAEVE) 2014, Royal College of Veterinary Surgeons (RCVS) 2014 American Veterinary Medical Association (AVMA) 2014, North American Veterinary Medical Educators Consortium (NAVMEC) 2011) and clinical skills laboratories (CSLs) are playing an increasingly important role in veterinary curricula around the world. Clinical training used to rely entirely on an apprenticeship model, as described in medical education over 100 years ago (Halsted, 1904), where the trainee shadows a clinician, initially watching and then performing the procedure under the expert’s supervision. Although such teaching is still central to medical and veterinary training, recent changes in veterinary education, including increasing student numbers and an expectation that where possible, the use of animals in teaching should be reduced, mean that there is a need to find additional ways to support learning. There are a number of challenges when trying to ensure students master clinical and practical skills. These include providing sufficient opportunities for students to practise especially as the modern clinical workplace tends to be busier and finding time to teach can be difficult. Also many veterinary schools focus on providing referral level, rather than first-opinion, services; the latter often provide more suitable learning opportunities for novices. Learning depends not only on repetitive practice but also, and preferably, being in an environment without undue stress. However, in the clinic and operating theatre students may be anxious about making mistakes in front of the clinician or owner and worried about the potentially serious consequences for the patient. Additionally, there needs to be enough time and suitable opportunities to provide feedback to learners and for them to act upon suggestions made for improvement. A CSL is a designated area where students can practise a range of practical and clinical skills and provides a means of addressing many of the above issues while complementing the use of animals in teaching. As a result students should be better prepared for, and able to optimise their learning in, the clinical setting, whether at veterinary school, in affiliated practices or on extramural work-placements e.g. on farms. The CSL is a student-centred space and affords a number of specific benefits including having access to timely feedback and being able to practise repeatedly in a safe and relatively stress-free environment, where there is no risk of harming animals. The student can make mistakes and learn from them, which is an important part of the learning process. Additionally, compared to the somewhat opportunistic learning in clinics, the CSL provides more consistent, accessible training. Students can tailor their learning needs to address specific skill deficiencies or be strategic in relation to the veterinary course e.g. by revisiting the CSL in preparation for an upcoming surgical rotation. 2 There are a number of advantages for veterinary schools in having, and providing training in, a CSL. Practical sessions can be pre-planned, organised and comprehensive i.e. a set of skills can be taught to all students in a standardised way, learning outcomes can be mapped to graduate competences, and assessed using validated methods e.g. Objective Structured Clinical Examinations (OSCEs). For optimal benefits, the use of the CSL should be integrated into the curriculum so that the skills build upon each other. Initially the student learns basic animal handling or individual clinical skills, which are then combined to perform procedural skills. At a more advanced level, technical skills can be combined with professional skills such a communication, decision-making and team work. As repetitive practice is crucial to mastery of clinical skills, in addition to taught practical classes, it is helpful to allow students open access to the CSL or to provide drop-in sessions. Despite the obvious benefits of a CSL, there are a number of considerations when designing a new facility, making improvements to an existing one and when having to plan annual budgets. There is considerable knowledge and evidence to draw upon, particularly from medical education and other health professions. The medical literature documents best practice and is an excellent source of tips, providing opportunities to learn from others’ experiences and mistakes. However, veterinary schools are unlikely to have access to similar levels of funding, which means there is a need for resourcefulness (and as the veterinary community often proves, ‘necessity is the mother of invention’) and sharing. The willingness of those who already have a veterinary CSL to host visitors, the emergence of online communities e.g. NOVICE (for more information about joining the forum see Chapter 10) and an increasing number of veterinary clinical skills conferences and workshops, has already assisted in the rapid growth uploads/Litterature/ csl-guide.pdf