Veterinary Clinical Skills. Группа авторов

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survey of eight US veterinary colleges in 2009 generated a list of over 900 different, individual clinical skills, of which approximately three quarters were considered core by college faculty, but only 105 were shared by half or more of the colleges (Lizette Hardie, personal communication). Consideration, therefore, should be given to those skills considered essential for a Day‐One veterinarian versus those that may be better learnt or mastered by a subset of students, or after graduation, for example in clinical practice or in continuing education programs (Malone, 2019; Duijn et al., 2020). This consideration should also take into account those skills that may be life‐saving if done correctly, and those that might be life‐endangering if done incorrectly (Malone, 2019). In this context, a short list of crucial skills could be valuable and could ensure we are “teaching to the common uncommonly well” (Henry J. Heinz), rather than providing exposure but not necessarily competence (Malone, 2019).

      Finally, consideration should be given not only to the skills that should be included in this list, but also to the opportunities for students to master these skills. For example, the skills on a school's prioritized list of clinical skills may not be the set of skills they are exposed to in a high‐level referral teaching hospital. It is essential students are given time to learn and practice these skills in the curriculum, and that this is structured to prepare them for the next stage, for example progressing from learning basic skills to more complex procedures, or in readiness for the clinical year or work placements such as extra‐mural studies. Monitoring both students' confidence and competence in these skills would help ensure graduates are meeting the minimum standards expected.

      Backward Curricular Design

      One methodology that may help with generation of an appropriate list of core clinical skills that should be included in a curriculum is “backward design.” This emerging theme in medical education has been driven by the thought that curricular design should begin at the end, rather than at the beginning (Harden, 2014). With this technique, the outcomes of the educational process are specifically determined first, then the curriculum is designed to achieve these outcomes. This is in contrast to historical approaches where the content that faculty believed should be taught was often developed at the front of the curriculum and arranged without regard for a student's ability to perform the required activities of veterinarians or veterinary nurses as a result of the teaching. A shift to competency‐based education helps address this problem as this model is based on clearly defined and measurable competencies, together with student demonstration that these have been achieved. A number of competency frameworks have been developed for veterinary education, which have helped define the expected outcomes of veterinary curricula (Bok et al., 2011; Shung and Osburn, 2011; AVMA, 2017; Matthew et al., 2020; RCVS, 2020).

       Entrustable Professional Activities (EPAs), Nested EPAs, and Clinical Skills

      An EPA is a core task which a learner can be entrusted to perform independently at a certain stage of their training when they seem ready. The EPA should be carried out within a given time frame, be observable and measurable, and allow for focused entrustment decisions (ten Cate et al. 2015), or where multiple methods exist for entrustment decisions (Duijn et al., 2019b) include the use of entrustment scales, mini‐clinical evaluation exercise (mini‐CEX), and direct observation of procedural skills (DOPS). In this way, EPAs operationalize observable competencies in a practical setting, because several competencies within multiple domains must be integrated simultaneously to execute the EPA (Englander et al., 2017).

      Since EPAs are the routine activities that learners should be expected to perform in a clinical or workplace‐based setting without direct supervision at graduation, it could be argued that these should drive curricular design for a clinical skills curriculum in the same way competencies drive curricular design and content for the entire veterinary curriculum. Recently, a number of sets of EPAs have been developed in veterinary education that focus on either core activities of graduates (Molgaard et al., 2019), those that focus on farm animals (Duijn et al., 2019a), and those that focus on surgical skills for companion animal practice (Favier et al., 2020). Additional sets of EPAs have been created for postgraduate students, such as the ones developed by Graves et al. (2020) for large animal interns.

      Lastly, regardless of whether competency frameworks or EPAs in tandem with competencies are used in curricular design, it is important that the required competencies (rather than individual faculty expectations) drive curricular content and the choice of logical priorities for inclusion.

      Step 3: Writing Goals and Objectives

      Goals are a broad overview of the content to be covered and the knowledge or skill to be obtained, while objectives are specific, measurable statements that identify the who, the what, and the when of the goal. Evidently, in a clinical skills curriculum, the focus is more on the objectives, where it is important to indicate to students the expected level of competence and how it is achieved.

Schematic illustration of the relationship between EPAs, nested EPAs, and clinical skills.

      When writing learning objectives for clinical skills, they need to be as specific and measurable as possible and must appropriately reflect what the student “will be able to do” at the end of the learning session, with as few interpretations as possible. The verbs chosen to be used in the objective must also be relevant for each aspect of the clinical


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