Veterinary Clinical Skills. Группа авторов

       A six‐step model developed by David Kern provides fundamental, yet flexible, principles of curricular design

       Student, societal, professional, and accreditation needs should be considered

       A backward design process, with initial attention to the desired outcomes, will focus curricular design

       A prioritized Day‐One Competencies list and identified core Entrustable Professional Activities will further drive the design process

       Learning objectives for clinical skills must be as specific and measurable as possible

       A variety of educational methods may be used to teach clinical skills, which are not restricted to clinical skills laboratories or clinical settings

       Implementation of a clinical curriculum will depend on available resources, buy‐in from stakeholders, and a properly planned management and roll‐out plan

       Evaluation of the implemented clinical curriculum must be done early and repeated as needed

Introduction

The goal of veterinary curricula is to educate students to be optimally prepared to enter the veterinary profession with entry‐level medical knowledge and appropriate mastery of an array of clinical skills (Read and Hecker, 2013; Dilly et al., 2017; Thomson et al., 2019; Duijn et al., 2020). Not only will the qualified veterinary professional be expected to display knowledge and mastery of skills, but he or she will also have to function as part of the veterinary team, working with veterinary nursing professionals where both the veterinarian and veterinary nurse (or “vet tech”) have input into patient care and treatment (Kinnison et al., 2011). Good veterinary interprofessional practice may have benefits for the practice, the individual team members, the client, and the patient (Kinnison et al., 2014). It can, and should, be argued that this relationship between members of the professional team should be nurtured and developed from an early stage, ideally at the level of educating students. While published studies in interprofessional education interventions are sparse, it must be acknowledged that at teaching institutions where the two groups of students are educated together, opportunities for integrated curriculum design are ample and should be fostered. Even if these opportunities do not exist because of physical separation of teaching facilities, it must be kept in mind that there are many more similarities in designing clinical skills curriculum for veterinary and veterinary nursing/veterinary technology students, than there are differences. This chapter will discuss processes in the design of clinical curricula that are similar for veterinary and veterinary nursing (or veterinary technology, as called in Australia and United States) students.

      The veterinary degree, perhaps more than any of the other health science degrees, poses a challenge to curricular design due to the breadth of material that must be covered, expectations of the level of competence at graduation, and the variety of career options available to veterinarians. By recognizing the close correlation between the veterinary knowledge and clinical skills also expected of newly qualified veterinary nursing professionals, it follows that near‐similar challenges are posed to the design of curricula for veterinary nurses.

      Despite its importance, it is easy to slip into a pattern of ad hoc curricular development with little attention to desired outcomes (Schneiderhan et al., 2018). Therefore, contemporary veterinary curricula must refocus on the fundamental knowledge, skills and behaviors required of graduates and utilize modern methods grounded in educational theory to best achieve these (Hodgson and Ilkiw, 2017).

      In the broadest sense, a curriculum is defined as the totality of student experiences that occur in the educational process (Wiles, 2009), but any planned educational experience is also considered to be an example of a curriculum (Kern et al., 2016) with this latter definition being applicable for a section of a veterinary curriculum focused on clinical skills development. Although a clinical skills curriculum would not be the totality of veterinary training, the same principles of curricular design should be adhered to when developing, or evaluating, a clinical skills curriculum for veterinarians and veterinary nurses.

      There are several fundamental tenets when approaching curricular design that have been well articulated by Kern (2016): “First, educational programs have aims or goals, whether or not they are clearly articulated. Second, medical educators have a professional and ethical obligation to meet the needs of their learners, patients and society. Third, medical educators should be held accountable for the outcomes of their interventions. And fourth, a logical, systematic approach to curricular development will help achieve these ends.”

To help achieve the last of these principles, Kern developed a six‐step model for curricular development in medical education (Kern et al., 2016) (see Figure 2.1). This model will be used as a framework for this chapter as all the steps are equally relevant to a veterinary clinical skills curriculum, for both veterinary and veterinary nursing students, with some modifications for the different educational contexts. Further, these principles of curricular design are fundamental, yet flexible enough to yield different types of curricula in different hands, depending on the local environment and the available resources in which the clinical skills curriculum is developed.

Steps in Clinical Skills Curricular Design

      Step 1: Needs Assessment and Statement

The prompts for the development or review of a clinical skills curriculum can be multifactorial including both extrinsic (e.g. accreditation) and intrinsic (e.g. student performance evaluations) factors. A needs assessment will help answer “What are you trying to achieve, why is it important, and who will benefit?” The answers to these questions should point to the distinction between the current teaching content and strategies surrounding a learning need, and what should change about it (Kern et al., 2016).

Figure 2.1 Kern's six step model for curricular design.

      Source: Based on Kern et al., 2016.

      At the start, it is wise to consider whose needs are the priority. This may start with learners' needs (either skills or knowledge‐based needs, readiness to learn, or time available for learning) but likely extends to the patients and communities whom the learner will be serving (Kern et al., 2016). Furthermore, when justifying changes to time or funding, an articulation of how this curriculum, or curricular change, might meet regulatory or board requirements may be useful (Schneiderhan et al., 2018). To help with this step, it may also be helpful to develop a Clinical Skills Development or Review committee, as this has been a successful strategy used by some veterinary colleges (Read and Hecker, 2013; Morin et al., 2020).

      The mechanics of a needs assessment includes utilizing readily available information, as well as the collection of new information (Kern et al., 2016). The acquisition of this information can be structured (e.g. surveys), semi‐structured (e.g. series of discussions with stakeholders), research/data‐driven (data on learner's performance or clinical quality data) or based on regulatory requirements (Schneiderhan et al., 2018). While a needs assessment will differ between institutions, there is some information available for veterinary clinical skills that may help inform this process.

      Student Needs

Feedback from faculty, staff, and veterinary and veterinary nursing students may help indicate the students' needs for clinical skills review and revision. In a recent review by Malone (2019), it was noted that while graduating students do show improvement in confidence and competence from the start of the clinical year, they remain less than confident in many technical skills and abilities at graduation, which is echoed in other studies (Lofstedt, 2003). Similarly, only 69% of 2008 University of Queensland veterinary graduates felt satisfied