Objective: To describe the clinical characteristics and outcomes in a population of dogs with neg... more Objective: To describe the clinical characteristics and outcomes in a population of dogs with negative-pressure pulmonary edema (NPPE) and to identify the main causes of the disease. To evaluate any associations with morbidity and mortality. Design: Retrospective study. Setting: Three university teaching hospitals and two private referral centers. Animals: Thirty-five client-owned dogs presented with NPPE. Measurements and Main Results: Data collected included patient characteristics, clinical history, clinicopathological abnormalities, radiographic features, treatments and outcome. Median age was 4 months (range 2-90) and median weight was 7.1 kg (range 1.7-37.2). There were many causes of NPPE including leash tugs, near hanging, accidental choking, anatomical obstruction to airflow and purposeful airway obstruction by people. The most common cause of NPPE was accidental choking (40% of cases). Dogs with an anatomical obstruction were older than 24 months. Hypoxemia with an increased alveolar-arterial gradient was common on presentation. The majority of thoracic radiographs (65.7%) showed an alveolar or interstitial pattern in the caudodorsal area as previously described in the literature. Oxygen therapy was administered to 33 (94.3%) dogs. Furosemide was administered to 18 (51.4%) dogs. Median length of hospitalization was 2 days (range 0-14). Twenty-eight (80%) dogs survived to discharge. Seven dogs were mechanically ventilated and only 2 of them (28.6%) survived to discharge. Requirement for mechanical ventilation (p<0.001) was the only parameter associated with mortality. Conclusions: Most cases of NPPE occur in juvenile dogs. Different incidents associated with upper airway obstruction can produce an episode of NPPE. Choking on food or toys and near hanging have not been previously described in the veterinary literature as inciting causes of NPPE. The overall prognosis is good.
Trotting a horse in circles is a standard and important part of the subjective equine lameness ex... more Trotting a horse in circles is a standard and important part of the subjective equine lameness examination, yet objective data on this form of locomotion are sparse. The aim of this study was to investigate the effect of trotting in a circle on head and trunk movement symmetry. Vertical movements of the head, withers, os sacrum and left and right tuber coxae were measured using inertial sensors as 12 sound horses were trotted on a hard surface in a straight line and in a circle on both reins. Seven asymmetry measures and hip hike were calculated for each horse for at least nine strides of comparable stride duration across the three conditions (deviation on horse level ≤3.7% stride duration). Trotting in a circle introduced systematic changes to the movement pattern of all five body landmarks, affecting most asymmetry measures. On average the asymmetry magnitude was comparable for midline locations between reins and for the tuber coxae on opposite reins with few exceptions, although ...
Veterinary schools have been moving toward competency-based education and assessment for the past... more Veterinary schools have been moving toward competency-based education and assessment for the past 15 or more years. In 2015, educational leaders from Association of American Veterinary Medical Colleges (AAVMC) member schools came together with a strong call to action to create shared tools for clinical competency assessment. This resulted in the formation of the AAVMC Competency-Based Veterinary Education (CBVE) Working Group, which then embarked on the creation of a shared competency framework and the development of eight core entrustable professional activities (EPAs) linked to this framework. This paper will report on the development of these EPAs and discuss their role in competency-based veterinary education and assessment. Practice Points Entrustable professional activities (EPAs) integrate multiple competencies to create opportunities for workplace-based assessment. The AAVMC Competency-Based Veterinary Education (CBVE) EPAs describe eight core workplace activities in veterinary clinical practice. Each EPA includes a description, brief commentary, and elements of the activity. Each EPA is mapped to the most relevant competencies in the CBVE Competency Framework.
Journal of veterinary medical education, Jan 13, 2018
Professional studies teaching in medical and veterinary education is undergoing a period of chang... more Professional studies teaching in medical and veterinary education is undergoing a period of change. Traditional approaches, aiming to teach students professional values and behaviors, are being enhanced by curricula designed to support students' professional identity formation. This development offers the potential for improving student engagement and graduates' mental well-being. The veterinary professional identity associated with emotional resilience and success in practice incorporates complexity in professional decision making and the importance of context on behaviors and actions. The veterinarian must make decisions that balance the sometimes conflicting needs of patient, clients, veterinarian, and practice; their subsequent actions are influenced by environmental challenges such as financial limitations, or stress and fatigue caused by a heavy workload. This article aims to describe how curricula can be designed to support the development of such an identity in stude...
A recurrent theme arising in the higher education sector is the suitability and effectiveness of ... more A recurrent theme arising in the higher education sector is the suitability and effectiveness of generic versus discipline-specific training of university teachers, who are often recruited based on their disciplinary specialties to become teachers in higher education. We compared two groups of participants who had undergone training using a generic post-graduate certificate in higher education (PGCertGeneric) versus a discipline-specific course in veterinary education (PGCertVetEd). The study was conducted using a survey that allowed comparison of participants who completed PGCertGeneric (n=21) with PGCertVetEd (n=22). Results indicated that participants from both PGCertGeneric and PGCertVetEd considered teaching to be satisfying and important to their careers, valued the teaching observation component of the course, and identified similar training needs. However, the participants of the PGCertVetEd felt that the course made them better teachers, valued the relevance of the componen...
Despite the concept's lack of familiarity to many veterinary surgeons, reflection should be a... more Despite the concept's lack of familiarity to many veterinary surgeons, reflection should be an important aspect of our professional lives, both during our daily work and when we have opportunities to take stock of what we have achieved. Reflection aids the transfer of existing skills to unfamiliar contexts, informs learning, and supports continued enhancement of the quality of the work we undertake. In contrast to scientific analysis, reflection embraces our actions and ourselves as actors, and both the rational and emotional aspects of our thinking. Importantly, reflection is appreciative as well as critical and, through cognitive reappraisal, it helps us to judge what we can reasonably expect of ourselves. Ultimately, this contributes to reduced stress and enhanced personal wellbeing.
Journal of Interprofessional Education & Practice, 2016
Facilitators to interprofessional practices included hierarchy, trust and value, different perspe... more Facilitators to interprofessional practices included hierarchy, trust and value, different perspectives, formal infrastructure and professionalisation. Challenges included hierarchy, spatial and temporal work patterns, professional motivations, and error and blame. Conclusion Veterinary and human healthcare fields face similar interprofessional challenges. Real life observations, as described here, can provide important insight relevant to the design of IPE initiatives.
Objective: To highlight the importance of evidence-based research, not only for the consideration... more Objective: To highlight the importance of evidence-based research, not only for the consideration of clinical diseases and individual patient treatment, but also for investigating complex healthcare systems, as demonstrated through a focus on veterinary interprofessional working.Background:Evidence-Based Veterinary Medicine (EBVM) was developed due to concerns over inconsistent approaches to therapy being delivered by individuals. However, a focus purely on diagnosis and treatment will miss other potential causes of substandard care including the holistic system. Veterinary services are provided by interprofessional teams; research on these teams is growing.Evidentiary value:This paper outlines results from four articles, written by the current authors, which are unique in their focus on interprofessional practice teams in the UK. Through mixed methods, the articles demonstrate an evidence base of the effects of interprofessional working on the quality of service delivery.Results:Th...
Journal of veterinary medical education, Jan 25, 2016
Appropriate terminology is essential for successful communication among health professionals. How... more Appropriate terminology is essential for successful communication among health professionals. However, students have traditionally been encouraged to learn terminology by rote memorization and recall, strategies that students try to avoid. The use of crossword puzzles as a learning tool has been evaluated in other education disciplines, but not for terminology related to veterinary science. Hence, the objective of this study was to test whether crossword puzzles might be an effective aid to learning veterinary terminology. Forty-two first-year students enrolled in a Bachelor of Veterinary Science program were randomly divided into two groups and their previous knowledge of veterinary terms tested. One group received a list of 30 terms with their definitions. The other group received the same list plus six specially designed puzzles incorporating these 30 terms. After 50 minutes, both groups completed a post-intervention test and the results were compared statistically. The results s...
The Fundamentals of a Profession At the start we are faced with a perplexing paradox. All of Soci... more The Fundamentals of a Profession At the start we are faced with a perplexing paradox. All of Society and the profession itself have an interest in the well-being of the veterinary profession for the quality of our food, the disease status of this country and dealing with serious outbreaks of disease, as well as the health and welfare of our own livestock and the companion animals with which we share our lives. However, we should be under no illusions. It is highly unlikely that the veterinary profession would be created in its current form if it did not already exist. In our modern market economy it has been pointed out that "the acceptance of the authority of professional knowledge is a hard won cultural and political achievement, and one that is threatened in contemporary society" (Edgar 2011). And yet, the founders of our profession and their successors progressively accrued privileges to the veterinary profession, and latterly the veterinary nursing profession, based on the public good that we offered and that we continue to offer. Fundamental to the arguments from the start have been the six key elements that together make a profession stand out from other lines of work (Thistlethwaite and Spencer 2008). These are: the presence of a skill based on specialist knowledge, the provision of specific education and training, the assessment of competence before entry to a profession, a register of members, adherence to a code of conduct, and, last but not least, the provision of a service for which the veterinary surgeon and veterinary nurse has a right to be paid but which is not focused on financial reward nor, in particular, on extracting the maximum fee possible from the client. As for medicine, arguments based solely on technical expertise are weak when it comes to any defence our privileged monopoly on animal care (Sullivan 2000). However, a broader focus on our services to and protection of the public, and their animals, has been recognised in achieving the recognition and reputation that the profession has earned, and we must all understand and be capable of arguing this if our profession is not just to survive, but thrive as we move forward. A central feature of this is all veterinarians being competent and up-to-date in their chosen area of activity, and fundamental to this is our initial clinical education and our continuing professional development (RCVS 2014). Educational Expertise One of the problems with education is that we all think we are experts and in many ways we are. However, often our "expertise" is heavily biased by our own experience. We have often rationalised after the event and we can easily mislead ourselves into drawing outrageous conclusions about education with no sound evidence base, a process that we would be ashamed to use if we were working on a clinical problem. We are also easily seduced by popular myths promoted through the media (see box 1). Therefore, recognising the importance of the quality of veterinary education for us all, and the requirement for an evidence-based approach, we need to
ABSTRACTSThe inflammatory process is described with particular reference to the cardinal signs, t... more ABSTRACTSThe inflammatory process is described with particular reference to the cardinal signs, the microcir‐culatory changes and the mediators and modulators of inflammation. Mediators and modulars comprise targets for therapeutic intervention; and the arachidonic acid pathway, generating the eicosanoid group of compounds, is considered in detail. Most non‐steroidal anti‐inflammatory drugs (NSAIDs) of both carboxylic and enolic acid subgroups act partly and in some cases perhaps soley through inhibition of the enzyme cyclo‐oxy‐genase which is concerned with the generation of an important subgroup of eicosanoids, the prostaglandins. The wanted (therapeutic) and unwanted (side‐effects) actions of NSAIDs are considered together with their pharmacokinetic properties. The clinical pharmacology and therapeutic uses of NSAIDs in dogs and cats are described.
The professionalization of veterinary medicine in Britain has been little studied by social scien... more The professionalization of veterinary medicine in Britain has been little studied by social scientists, although as a classic instance of an occupation that has achieved exclusionary social closure it merits examination from a neo-Weberian perspective. Therefore, this paper explores how it has attained this position through state action in an historical and contemporary context using neo-Weberianism as a theoretical lens. In charting the different stages and forms of professional regulation in veterinary medicine, group self-interest is identified as a central driver, following the neo-Weberian idiom. However, contrary to the position adopted by some neo-Weberians, the professionalization process is seen as being more complex than simply being interest-based, with the public interest being upheld. As such, through the case of veterinary medicine, it is claimed professional self-interests and the public interest can be co-terminous and mutually achieve a dynamic equilibrium. They do...
Competency at graduation, in a variety of physical and attitudinal skills, is an essential outcom... more Competency at graduation, in a variety of physical and attitudinal skills, is an essential outcome measure for courses training veterinary surgeons. The approach adopted by the Royal Veterinary College, London, to identify and define the expected skill competencies required of our veterinary undergraduates by the time of graduation is described. In addition, we demonstrate how this skill set was built into a framework that was aligned with other student learning objectives. This two-year project resulted in the publication of a day-one skills handbook, which was introduced to the college staff and students in 2007.
A structured logbook, consisting of a competency log and a learning contract, was designed and im... more A structured logbook, consisting of a competency log and a learning contract, was designed and implemented as part of a two-week structured work placement for final-year veterinary students to help them become more self-directed in the workplace. The competency log encompassed 48 core skills and, along with the learning contract, was reviewed at the start and end of the placement. To assess their perceptions of the logbook in promoting self-directed learning, students and supervisors were asked to complete a questionnaire pre- and post-placement and to participate in focus groups (students) and interviews (supervisors) after the placement. The study found significant increases pre- to post-placement in students' perceived levels of competence in all 48 skills and their confidence in being self-directed. However, student attitudes toward the logbook significantly decreased in terms of it encouraging supervisors to take a clearly designed role in structuring learning and facilitat...
Hoy en día hay una mayor concienciación de que los profesores de formación profesional y educació... more Hoy en día hay una mayor concienciación de que los profesores de formación profesional y educación superior deben ser capacitados en la enseñanza, aprendizaje y evaluación para apoyar el aprendizaje más eficaz de los estudiantes. Sin embargo, existen retos en la formación de estos profesores, que son especialistas disciplinares con grandes cargas de trabajo y no disponen de tiempo para estudiar. Como la “educación” es una disciplina con su propia epistemología, la participación de estos profesores implica demostrar esta diferencia desde el principio, y proporcionar oportunidades para que puedan integrar su propia práctica, específica de su disciplina, para personalizar la formación. En este artículo se describe un curso de certificado de postgrado que fue diseñado para la formación específica para los profesores en los sectores veterinario y paraveterinario. Los participantes se sometieron a un ciclo de aprendizaje experiencial al convertirse en “estudiantes”, y tuvieron experi...
Veterinary discipline experts unfamiliar with the broader educational literature can find the ado... more Veterinary discipline experts unfamiliar with the broader educational literature can find the adoption of an evidence-based approach to curriculum development challenging. However, greater societal and professional demands for achieving and verifying Day One knowledge and skills, together with continued progress in information generation and technology, make it all the more important that the defined period for initial professional training be well used. This article presents and discusses nine pedagogical principles that have been used in modern curricular development in Australia, the United Kingdom, and the United States: (1) outcomes-based curriculum design; (2) valid and reliable assessments; (3) active learning; (4) integrated knowledge for action; (5) tightly controlled core curriculum; (6) “just-in-time” rather than “just-in-case” knowledge; (7) vertical integration, the spiral curriculum, and sequential skills development; (8) learning skills support; and (9) bridges from c...
Much attention has been paid to the link between students' approaches to study and the qualit... more Much attention has been paid to the link between students' approaches to study and the quality of their learning. Less attention has been paid to the lifelong learner. We conceptualized a tripartite relationship between three measures of learning preference: conceptions of knowledge (construction and use vs. intake), need for cognition (high vs. low), and approach to study (deep vs. surface) and hypothesized that an individual's profile on these three measures—reconceptualized as a preference for complexity versus simplicity—would affect their attitude toward continuing professional development (CPD). A questionnaire was mailed to 2,000 randomly selected, home-practicing UK veterinarians to quantify their learning preferences, motivation to engage in CPD, and perception of barriers to participation and to assess the relationships between these constructs. Analysis of 775 responses (a 38.8% response rate) confirmed our tripartite model of learning and showed that a preference...
This paper argues the case for the increased application of adult learning principles to veterina... more This paper argues the case for the increased application of adult learning principles to veterinary education. It encapsulates evidence from the United Kingdom, Europe, North America, and Australia to explain why it has taken veterinary schools so long to transform their curricula to best facilitate the development of lifelong learning skills, such as independent and self-directed learning, problem solving, and critical thinking. Despite the variation in training programs in these different regions, the paper identifies common issues—conflicting educational paradigms and the need for faculty development—and ultimately concludes that professional and continuing education should be viewed as a continuous process, supporting the adult learner's cognitive development and facilitated through experiential learning.
Despite periodic debate implying that modern veterinary graduates are less competent than their p... more Despite periodic debate implying that modern veterinary graduates are less competent than their predecessors, analysis of educational inputs and learning outcomes suggests that they continue to qualify with an excellent knowledge and skill set. However, increased public expectations of veterinarians have led to the need for better-designed, more integrated curricula with increased attention to communication and other professional skills and to elements of individual specialization. The need for revision of curricular content will continue. A more overriding reason for reducing content, however, is the effect this has on students’ learning. Content overload in all disciplines leads to a superficial acquisition of facts, which overwhelms any drive toward understanding and extracting meaning. Unfortunately, many modern assessment methods permit replication to masquerade as problem solving, leading to short-term gains in grades at the cost of the development of information sourcing and ...
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Papers by Stephen May