A Pathway to Better Veterinary Medical Education

Veterinarians, over the course of a career, are estimated to participate in over 100,000 consultations with clients. Despite well-intentioned efforts, decisions surrounding case management can often be subject to stereotypes, biases, and assumptions that can affect trust in the veterinarian-client-patient relationship (VCPR). One step toward addressing and correcting suboptimal veterinarian-client interactions is to train future veterinarians to effectively communicate and partner with their clients to provide the most effective care, and then evaluate overall the curricula’s strategic approach and long-term success. The University of Arizona College of Veterinary Medicine is continuously developing ways to best prepare students to be excellent communicators with diverse clientele. A key piece of this effort comes to life in a recently accepted for publication, ahead-of-print article authored by CVM’s Executive Director of Veterinary Skills Development and Associate Professor of Practice, Ryane Englar, DVM, DABVP, and Interim Senior Associate Dean of Student Affairs, Diversity, and Inclusion, Teresa Graham Brett, JD, titled, “Evaluating Communication Training at AVMA COE-Accredited Institutions and the Need to Consider Diversity in Simulated Client Pools.” The study focuses on communication training at veterinary colleges that make use of simulated client (SC) experiences and confirms that SC diversity is scarce. There is a need to diversify SC pools. According to Dr. Englar, “how we partner with clients influences decision-making, case management, and patient outcomes,” so teaching communication skills is crucial for colleges preparing future veterinarians. 

Communication skills have garnered recent attention as “concerns about deficiencies in interpersonal skills inspired a push for curricular reform by the AVMA, the American Animal Hospital Association, and the American Association of Veterinary Medical Colleges,” according to the article. Considering this, most veterinary colleges in America are trending toward requiring classes in communication. The Arizona College of Veterinary Medicine is unique in that students are required to take six consecutive pre-clinical semesters of interactive learning through the Professional Skills (VETM 802A, 802B, 802C, and 802D) and Advanced Professional Skills (VETM 815A and 815B) courses. The sequential series developed by Englar and Brett intentionally weaves communication as an integral thread throughout the curriculum, prioritizing self-reflections on personal, social, and professional identities. Learners understand what it means to participate in constructive dialogue and feedback; recognize and shift assumptions and biases; demonstrate reflective listening, empathy, and regard for others; solicit others’ perspectives; invite information-sharing about past and present experiences; and take on an other-oriented approach of cultural humility and openness towards others’ values and belief systems. 

A common way to train veterinary students in this area is to allow them to engage in simulated encounters that involve actors portraying veterinary clients. In these scenarios, students refine communication skills in a safe, supportive environment where they are free to make and learn from “mistakes”. The curricular emphasis on Diversity and Inclusion within the Professional Skills courses has broadened the desire to deliver coursework that simulates not only the diversity in caseload in clinical practice but also the diversity in clientele. If the goal of embedding simulated clients within the curriculum is to simulate real life, then the SCs should mirror the population of veterinary clients in surrounding communities. Based on past experiences developing communication curricula at previous universities, Englar hypothesized that diversity among SCs was lacking. Englar and Brett set out to test this hypothesis by soliciting data from veterinary colleges about their SC pools. Supported by their research team, Elizabeth Soltero, MLS, and Graduate Teaching Associate César D. Villalobos, M.A., Englar, and Brett disseminated an electronic questionnaire to primary contacts at AVMA/COE Accredited Colleges of Veterinary Medicine, totaling 21 institutions represented within the data set. Participating institutions were asked to identify known characteristics of their SCs in terms of gender identity, sexual orientation, age, racial identity, ethnic identity, disability status and primary language. Sixteen respondents agreed with the statement: “I do not feel that our SC pool is adequately diverse.” Respondents shared barriers to diversifying SC pools and proposed strategies for reducing them.  

The study found that although SC encounters attempt to simulate real-life client interactions, they are, unfortunately, limited by the demographics of the actors cast in SC roles: 

  “Among institutions that track SC demographics, SCs are primarily monolingual English-speaking (77%), non-disabled (94.2%), white (90.4%), non-Hispanic/Latinx (98.6%) women (57%) over the age of 56 (64%). Sixteen participating institutions agreed with the statement: ‘I do not feel that our SC pool is adequately diverse.’ Respondents shared that lack of time and capacity for recruitment are barriers to diversifying SC pools and proposed strategies to improve outreach.”  

This lack of diversity means there exists a significant opportunity for colleges of veterinary medicine to improve communication training and allow students to learn how to serve more diverse populations. If students engage with a more diverse SC pool, they will have more practice and confidence in providing excellent care, hearing and learning from clients of all identities. 

To be prepared to serve the next generation of clients, the next generation of veterinarians needs their education to reflect today’s needs and to empower future veterinarians to make connections with their whole community. The research team shared,  

“Diverse personal and social identities are essential components of who we are. They are what make our experiences and perspectives unique as veterinarians. Diversity is also vital because it represents the vast populations that veterinarians serve. Effective [care for] all clients requires educators to prepare students with the skills, knowledge, and awareness to serve all sectors of society.”  

Because data now exists about the demographics of simulated client pools, veterinary medical programs can begin considering ways to alter their practices to allow students the greatest opportunity to learn how to communicate effectively and compassionately with the people they will daily encounter. CVM’s team expressed hope that further inquiries can be made into the “barriers that prevent underrepresented demographic and social groups from seeking representation as SCs.” Barriers may be unique to each social identity and group and engaging in mutual dialogue with multiple groups is essential to understanding individuals and the communities they represent. After exploring the various barriers identified, researchers can then consider the role of SCs in simulation-based education and how we can ensure that underrepresented populations are both accurately depicted and compensated. Using this essential data, veterinary medical programs can strategically alter recruitment to attract a wide range of identities. Examples of possible strategies include changing pay structures, offering online events to allow students to simulate telehealth interactions with SCs, or even creatively tailoring situations to meet specific individual or regional needs. These efforts are crucial to ensure educators can provide experiences that mirror what veterinarians see in practice, because “they may be able to work with learners to acknowledge and actively engage in dialogue about aspects of Diversity and Inclusion that have historically not been included within veterinary curricula.”  

As a young program, we have had the unique advantage of crafting our curriculum from the ground up and establishing an environment in which effective communication is intentionally built into every aspect of our program. New and groundbreaking research from our program and others are available to inform our practices and advance our innovative model in ways that transform student learning and, ultimately, the veterinarian-client-patient-relationship. Experiential and active learning that is carefully built and layered over time is the hallmark of CVM’s teaching of crucial professional and clinical skills over six consecutive semesters. Continuous development and honing of students’ skills provides them with a practical framework for how they can immediately enact their knowledge as inclusive, compassionate practitioners serving real-world clients and forming vital connections with their communities.