Veterinary Clinical Skills. Группа авторов
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pressure in a dog is a clinical skill that is expected of graduates, the following objectives could be appropriate, but may be located in different learning strategies (see Step 4).
At the end of the learning session, the student will be able to:
| Learning objective | Skill required |
|---|---|
| Identify times when it is necessary to monitor blood pressure in a dog and the equipment needed to perform this procedure | Underpinning (declarative) knowledge |
| Apply a blood pressure cuff in the correct manner to the limb of a dog and read the output | Procedural skill and knowledge |
| Interpret the results of blood pressure readings as normal or abnormal and identify the required responses to abnormal readings | Clinical reasoning |
When selecting verbs to include in learning objectives, words such as “learn,” “understand,” “know” or “appreciate” are vague, will be difficult to measure and should not be used (Schneiderhan et al., 2018). Additionally, verbs that imply recall of knowledge would not be appropriate for the objectives focused on procedural abilities e.g. “list,” “identify,” “differentiate.” Better verbs for these objectives include “execute,” “perform,” “prepare,” “calculate” etc.
Step 4: Selecting Teaching/Educational Strategies and Design
Although we traditionally think of teaching clinical skills in a laboratory setting or in clinics, a number of different educational methods and strategies may be used to teach these skills, including lectures, laboratory classes, and flipped classroom techniques. Each of these methods has its own advantages and disadvantages in relation to teaching clinical skills. Regardless of the method selected, application of educational theory should underpin the delivery of the learning strategy. For example, teaching methods that promote active rather than passive learning should be encouraged. Active learning occurs when students engage in activities that promote analysis, reflection, and problem‐solving. Further, any educational method that includes an appropriate motivational context, a high degree of student activity, interaction with peers and teachers, and a well‐structured knowledge base will encourage a deep approach to learning. Conversely, any teaching method that has a heavy workload, high contact hours, excessive material, or an emphasis on coverage is likely to push students to a superficial approach to learning (Grant, 2013).
Educational Strategies
Lectures and Whole‐Class Activities
Although lectures and whole‐class techniques are generally less applicable for learning clinical skills, they may be an effective and efficient tool for learning if used properly. Their primary role is often information transfer, which may include the underpinning knowledge required for performing a clinical skill, understanding when a clinical skill is indicated, and how results of a procedure may be interpreted. During lectures, active learning may be encouraged with the use of classroom exercises that promote engagement, such as short quizzes using audience response systems or quick peer discussions (e.g. “Think‐Pair‐Share”). Alternatively, group based, clinical problem‐solving activities can be planned around the whole‐class activities as described in team‐based learning (Michaelsen et al., 2014). In one study, open discussion (rather than lecture) improved medical student scores on both essay and multiple choice questions regarding surgical disorders, without adding additional time (Sirikumpiboon, 2014).
Careful consideration must be given, however, when determining if a lecture regarding a clinical knowledge or skill is needed. For example, when anatomy lecture time was cut by 25% but laboratory time was spared, medical students performed similarly, despite the change in teaching hours (Petersen and Tucker, 2005).
Laboratory Classes, Including Clinical Skills Laboratories and Simulations
Laboratory classes provide necessary hands‐on experiences and are essential in the development of the clinical skills required of a Day‐One veterinarian or veterinary nurse. Clinical skills laboratories provide many benefits, including providing student‐centered learning in a (usually) stress‐free environment, supporting animal welfare, providing standardized training, and they are the ideal venues to run multi‐station Objective Structured Clinical Examination (OSCE) circuits (Dilly et al., 2017). These labs provide a setting where students gain confidence and competence through deliberate and repeated practice and can receive both formative feedback and summative assessment (Morin et al., 2020). Fundamental technical skills and procedures can be taught much earlier during the curriculum than in the past, and students' technical experience at graduation will therefore not only be determined by exposure to cases encountered during final year clinical rotations, with obvious benefits on student‐readiness to enter veterinary practice (Morin et al., 2020). Skills laboratories provide ample opportunities for students to learn under faculty supervision before they enter less‐controlled work environments as part of their later training (Dilly et al., 2017). Furthermore, skills laboratories promote self‐directed learning and peer teaching and can take advantage of new technologies and tools to enhance learning (Morin et al., 2020).
Skills laboratories are also time consuming, are often personnel‐intense, and can be expensive to build and maintain, with facility development and staffing often being the largest expenses (Dilly et al., 2017). Careful consideration should be given as to how to best utilize clinical skills laboratories in order to ensure maximal efficiency of their use.
Flipped Classrooms and Additional Teaching Resources
As laboratory time is precious, it is best spent with hands‐on learning. Therefore, if students can arrive ready to start practice, better utilization of the instructional team and the time available may be gained (Malone, 2019). A wide array of resources has been developed to facilitate self‐directed learning, including micro‐lectures that can be delivered online, learning guides, videos (including YouTube videos), audiovisual aids, and self‐ and peer‐assessment checklists (Read and Hecker, 2013; Dilly et al., 2014; Malone, 2019; Morin et al., 2020). The information that can be included in the learning guides can comprise the name of the activity, reason the skill or procedure is important in veterinary practice, step‐by‐step instructions for performing the activity, descriptions of common errors, suggested resources, relevant Day‐One skills, and a sample evaluation form (Morin et al., 2020). These resources are now typically combined in an online mini‐course or flipped classroom for students to complete prior to the practical lab session, resulting in better preparation and use of class time (Frendo Londgren et al., 2020), and enhanced performance on OSCEs (Decloedt et al., 2020).
Videos and computer‐assisted learning modules have been used successfully to teach a variety of basic, as well as advanced, clinical skills in medical education (Malone, 2019). In veterinary education, students using a self‐learning computer module to learn nasogastric intubation in a horse out‐performed those taught via lecture plus live demonstration as assessed through knowledge tests, time to successful intubation, and confidence levels (Abutarbush et al., 2006). In another study, Langebaek and colleagues (Langebaek et al., 2016) evaluated which resources veterinary students used most frequently for a castration laboratory and found the students preferred videos to texts, reviewed the video repeatedly while many did not open the text documents, and recalled material from the videos better than from other sources. In a study involving veterinary nursing students, Dunne et al. (2015) found that teaching clinical skills by means of video clips and practical classes were preferred over live animal practical laboratories or demonstrations, as students felt safer with these controlled methods/environments as a first introduction to a practical procedure or clinical skill. However, in most situations the skills taught by either micro‐lecture and/or video‐only do not effectively substitute