An Investigation into the Clinical Reasoning Development of Veterinary Students.

Claire E.K Vinten,Kate A Cobb,Liz H Mossop,Sarah L Freeman

doi:10.3138/jvme.0815-130r1

Abstract

Clinical reasoning is a fundamental skill for veterinary clinicians and a competency required of graduates by the Royal College of Veterinary Surgeons. However, it is unknown how veterinary students develop reasoning skills and where strengths and shortcomings of curricula lie. This research aimed to use the University of Nottingham School of Veterinary Medicine and Science (SVMS) as a case study to investigate the development of clinical reasoning among veterinary students. The analysis was framed in consideration of the taught, learned, and declared curricula. Sixteen staff and sixteen students from the SVMS participated separately in a total of four focus groups. In addition, five interviews were conducted with recent SVMS graduates. Audio transcriptions were used to conduct a thematic analysis. A content analysis was performed on all curriculum documentation. It was found that SVMS graduates feel they have a good level of reasoning ability, but they still experience a deficit in their reasoning capabilities when starting their first job. Overarching themes arising from the data suggest that a lack of responsibility for clinical decisions during the program and the embedded nature of the clinical reasoning skill within the curriculum could be restricting development. In addition, SVMS students would benefit from clinical reasoning training where factors influencing "real life" decisions (e.g., finances) are explored in more depth. Integrating these factors into the curriculum could lead to improved decision-making ability among SVMS graduates and better prepare students for the stressful transition to practice. These findings are likely to have implications for other veterinary curricula.

Highlights

Clinical reasoning can be defined as ‘‘the cognitive processes physicians use to diagnose and manage patients.’’1(p.248) It involves the decision processes required for diagnosis and treatment planning, alongside influential contextual and situational factors.[2]
Codes in reference to extramural studies (EMS) occur infrequently throughout all of the documentation. This is despite coding two student manuals dedicated to EMS. This suggests either that EMS is not expected to be a source of clinical reasoning exposure, or that staff did not feel the need to make clinical reasoning involvement with EMS explicit in materials produced about it
The study findings indicate that the School of Veterinary Medicine and Science (SVMS) is producing graduates that can function as veterinary surgeons and are confident in certain aspects of decision making, but who are by no means ‘‘skilled.’’ As a result of this, they may need to significantly develop their reasoning ability once in practice

Summary

Introduction

Clinical reasoning can be defined as ‘‘the cognitive processes physicians use to diagnose and manage patients.’’1(p.248) It involves the decision processes required for diagnosis and treatment planning, alongside influential contextual and situational factors.[2]. Clinical reasoning is a fundamental skill for veterinary surgeons.[4] In contrast to human medicine, there have been very few studies dedicated to understanding the process of veterinary clinical reasoning.[5,6] As a result, veterinary educators are uncertain how to extrapolate medical research findings to their own field, and where differences between the disciplines affect decision making. These uncertainties, combined with the embedded nature of the skill within curricula, make developing clinical decision making a ‘‘formidable challenge to veterinary educators and their students.’’7(p.200)

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