Setting up a veterinary medicine skills lab in Germany.

The amendments introduced to the current Veterinary Licensing Ordinance (TAppV) by the Veterinary Licensing Regulation (TAppO) have brought a high degree of skills orientation to fill the gap between academic study and preparing for a wide range of professional skills. In order to improve the veterinary skills of students while conveying fundamental methods in a structured and reproducible way, the University of Veterinary Medicine Hannover, Foundation, has set up the first central veterinary skills lab in Germany. Practical training is provided by means of a three-tier delivery approach. This involves around 40 simulators on an area of approx. 800 m(2) under the guidance of 6-8 staff members, along with supplementary resources such as posters, text instructions and YouTube videos. Since it opened in March 2013, there have been 769 visits to the skills lab and 30,734 hits on YouTube. Initial results show that the skills lab helps to maintain student motivation by teaching them practical skills at an early stage of the basic study-based acquisition of knowledge, whilst reinforcing skills acquisition per se in competence-based teaching. It enables veterinary students to prepare for their first examinations and treatments of live patients in a manner compliant with animal welfare.

Introduction

In recent years, veterinary studies in Germany have changed greatly with the various amendments to the training regulations introduced by the Veterinary Licensing Regulation (TAppO [1]) to the current Veterinary Licensing Ordinance (TAppV [2]). This has brought a high level of skills orientation to fill the gap between academic study and preparing for a wide-range of practical professional skills. Veterinary studies give students the scientific knowledge to enable them to practise in a wide range of areas. More than 58% of students go on to practise as veterinary surgeons after graduating [3]. Practising veterinarians often complain of the low levels of clinical skills that recent graduates bring with them when they are first appointed [4]. In the past, clinical skills were only taught in the last third of veterinary courses, primarily by means of demonstrations which only gave a small number of students the opportunity for hands-on practice. The first step to improving the teaching of practical skills was the introduction of a practical year incorporating external placements with checklists to be completed [5], [6]. The European Association of Establishments for Veterinary Education (EAEVE) evaluates and accredits veterinary educational establishments and has defined the aims of veterinary studies in terms of "day-one skills". These aims, in addition to important competences such as knowledge and attitudes, focus largely on practical skills [http://www.eaeve.org/fileadmin/downloads/sop/SOP_Annex4.pdf]. Various concepts and orientation aids are being set up and evaluated for this purpose [7], [8](see table 1 (Tab. 1)).

Table 1

Thematic summary of practical skills classed as day-one skills for veterinary medicine (taken from the recommendations of the European Association of Establishments for Veterinary Education, EAEVE; X = training/teaching stations in the skills lab

Aim

The aim of the project is to set up a skills lab to convey clinical skills in veterinary teaching in Germany for educational and training purposes.

Description

Veterinary studies at the University of Veterinary Medicine Hannover, Foundation (TiHo), cover the statutory 3,850 teaching hours as well as providing 1,100 extra hours in external placements (clinical training, nutritional studies, animal welfare etc.). Practical clinical teaching on live animals accounts for 382 hours. In addition to hands-on teaching, students spend 460 hours at clinics and institutes in their clinical practice year. This provides a total of 842 hours of practical studies where students gain first-hand experience of a wide range of activities, in particular during the “practical year”, during which they get as much hands-on experience as possible [http://www.tiho-hannover.de/studium-lehre/studium-der-veterinaermedizin/downloads/]. Because of the large number of students (1,608 during the winter semester 2011/2012) compared with the number of animals that welfare regulations allow the university to house, not all students can be given the same opportunities to independently and repeatedly practise their skills on all animal species [9]. When they start their studies, they only have a small amount of clinical practice and few classes on general procedures with animals, with practical teaching being confined mainly to semesters 4-11. However, it has been shown that early introduction of practical activities and dealing with issues of veterinary practice help to maintain the high initial levels of student motivation throughout their period of study, in spite of their considerable workload [10]. This process can be facilitated by setting up a veterinary skills lab to additionally prepare students for their external placements and the practical year.

The aims of the TiHo skills lab are:

Early and ongoing practical exposure over the course of study

Acquisition of practical skills before performing interventions on live animals

Building and developing clinical practice competences in veterinary education

In human medicine, clinical skills have been taught in skills labs for many years now [11], [12], [13]. Numerous studies have confirmed their effectiveness in conveying practical skills in tandem with the possibility of checking the competences acquired [14], [15], [16], [17]. As well as the variety of training opportunities on offer, it has also been shown that the concept of training students in skills labs contributes to an improvement in procedural competences [18]. As well as delivering the required theoretical knowledge, the acquisition of practical skills requires intensive practice with the possibility of repetition. In order to teach basic veterinary techniques and skills in a structured and reproducible way, students should be increasingly offered opportunities to acquire practical skills and to train. To this end, a training programme based on the "day-one skills" concept recommended by the EAEVE was developed and integrated into a structured concept (seeTable 2 (Tab. 2) [http://www.eaeve.org/fileadmin/downloads/sop/SOP_Annex4.pdf]). In agreement with individual clinics and institutions, learning aims were defined and arranged in a three-tier delivery approach for skills acquisition. The aim of the approach is to develop a dynamic structure by which clinical skills can be taught and acquired. To this end, a wide variety of skills will be arranged and taught in a three-tier system (general clinical skills, special clinical skills, professional clinical skills). Didactic methodological guidance will be implemented to impart the skills required by the relevant target groups at each particular stage of their studies. These skills will then be offered either as optional subjects or incorporated into the existing mandatory curriculum.

Table 2

Clinical skills lab delivery concept; MCQ = Multiple choice test; OSCE = Objective structured clinical examination; POL = Problem-oriented learning; Workshops* max. 8 participants

Results

The delivery approach combines elective courses in basic veterinary techniques for complementary or recurring aspects of studies with mandatory training provided in collaboration with TiHo clinics and institutes. However, elective practice and reinforcement of practical skills in small groups and the possibility of intensive preparation and follow-up of teaching content through independent study are still the main tools for learning. The increasing inclusion of self-teaching elements will focus increasingly on the acquisition of practical competencies. The approach will incorporate various forms of teaching, including peer-assisted teaching, cognitive apprenticeships, workshops (with a maximum of 8 students per group) and problem-oriented learning (POL). To this end, special teaching materials (guidance notes, display panels, posters, case studies etc.) are designed and complemented by open educational resources (OERs). This involves using resources such as WikiVet [19], [20]. Some documents (text, images and videos) will be made available to other universities under creative commons (CC) licences via WikiVet, Vetipedia or in the form of e-books. Existing video podcasts produced by the skills lab will be the focus of the OERs. Clinical skills learning through simulations on models (low-fidelity, medium-fidelity) will be accompanied and complemented by videos available from the YouTube channel (http://www.youtube.com/user/TiHoVideos) which was set up in April 2012. Training videos for classes and to demonstrate particular skills on models/simulators and on live patients are continuously being created. To date, 52 videos have been created with 116 subscribers and 30,734 hits (see Figure 1 (Fig. 1), as at 30 September 2013). The videos are useful not only as preparation for a session in the skills lab, but also as a chance to verify or reinforce particular skills.

Figure 1

Hits for videos on the YouTube channel (TiHoVeodeos) from April 2012 to September 2013. A total of 30,734 hits were recorded for 52 videos (as at 30 September 2013).

The skills lab opened in February 2013 and since then has been available to students during and between semesters. Initial evaluations of the 769 visits to the teaching stations from March to September 2013 show that there was a high level of interest, and not just during semesters, in the elective teaching on offer in the skills lab of the University of Veterinary Medicine Hannover, Foundation (se Figure 2 (Fig. 2)). The largest user group is students in semesters 7-8, as they are approaching the practical year in semesters 9-10.

Figure 2

Analysis of the number of visits to all of the teaching stations in the skills lab at the University of Veterinary Medicine Hannover, Foundation, from March to September 2013 (total number of visits: 769).

At the time of writing, our investigations have not found any other veterinary educational establishments in Germany with skills labs, in contrast with other countries (both in Europe and further afield), which offer numerous training centres and use veterinary simulators as part of their curriculum [21], [22], [23], [24], [25], [26], [27]. To date, there are no reports or experiments on establishing training centres in application of the Veterinary Licensing Ordinance (TAppV). The reasons for this can only be speculated – on the one hand, the TAppV and the related range of competency requirements is diverse, and not all day-one skills can be taught in a skills lab [7], [28]; on the other, veterinary studies in the past tended to focus exclusively on imparting knowledge, while practical education and skills training was normally carried out at the initiative of the universities themselves, using their own animals and patients in their own clinics [6], [29]. The required resources and the specific nature of local structures are decisive when setting up a skills lab. In addition to the cost of the necessary premises, the equipment itself (simulators, devices etc.) and the overheads (staff, consumables etc.) are very costly [11], [18]. Currently the TiHo skills lab has more than 40 models. In addition, devices and diagnostic equipment (ultrasound, endoscopy etc.) as well as a haptic trainer for transrectal examinations are provided [24]. The estimated costs totalled some EUR 480,000. 6-8 student research assistants are currently engaged in the maintenance and coordination of the teaching content, along with one full-time member of the teaching staff who provides veterinary guidance in the skills lab. We were only able to cover this significant outlay thanks to financial support from the Federal Ministry of Education and Research (BMBF) as part of the teaching quality package (Qualitätspakt Lehre). Thanks to the transfer of the Small Animals Clinic, some 21 clinical standards-compliant rooms with a total floor area of 800 m2 became available for the skills lab.

Discussion

The inclusion of a skills lab as part of the training for veterinary students as described in this project should improve teaching outcomes and students’ practical skills. The benefits are earlier training in hands-on skills, a structured delivery concept and supervision of students, whilst simultaneously ensuring that all training in clinical skills can be constantly repeated in a motivating atmosphere [17], [30]. This also serves to improve animal welfare, as direct interventions on animals can be either reduced or, where they are carried out by students, performed as more routine interventions thanks to the repeatability of individual skills [31]. The continuous and elective nature of the training offer as well as an earlier start to practical skills (from semester 1) mean that the teaching concept is not time-restricted with regard to skills acquisition on different study routes. The future effectiveness and increase in the competences of students will lie decisively in individual teaching outcomes derived from the EAEVE's catalogue of day-one skills. In future, in accordance with the "Praktische Fertigkeiten im Medizinstudium“ [Practical Skills in Medical Studies] consensus statement, all learning goals will be set based on fixed levels of experience of clinical skills [32]. The benefits of the skills lab concept are its established structure and the possibility of standardised practical training achieved through simulations. However, the inclusion of simulation-based teaching in medical curricula does have certain limitations [30], [33]. Not all models and simulators provide sufficient feedback to allow them to replace conventional classes. Clinical training on patients and the interrelation between complex clinical processes cannot be taught in a skills lab or by using simulators alone [34], [35]. On the other hand, the use of models in structured learning concepts for the acquisition of practical competences is highly suited for incorporation in skills lab training. A recent study has shown that training provided in a skills lab can help to reduce anxiety about surgical interventions among veterinary students [36]. Other benefits of skills labs include the efficiencies provided by standardised practical training and the positive impact such training has on the surgical performance and learning outcomes of students [12], [14], [15], [18], [27], [37]. Future evidence-based studies will have to show whether comparable effects can be achieved through the use of veterinary skills labs. Discussions on the extent to which skills labs can and should be implemented in veterinary medicine curricula are currently underway in Germany and on an international level [38], [39].

Conclusions

By implementing the measures described in this project, the teaching of practical skills to students in treating domestic and farm animals can be carried out with improved levels of animal welfare. Incorporating independent learning elements into veterinary studies prepares students early for the lifelong learning which veterinarians are obliged to undergo even after they have been awarded their licences.

Competing interests

The authors declare that they have no competing interests.