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Roadmap to Success: Continuous improvement key to student and curricular development

A roadmap is key to any journey. It not only pinpoints the destination, it provides direction and highlights important steps along the way. When the ultimate goal is competent, confident student veterinarians, a map is key to defining success.
 
Over their respective terms, Dr. Peter Conlon, Associate Dean, Students, and Dr. Kerry Lissemore, Associate Dean, Academic, have been integral guides in navigating the route to curricular and student success at the Ontario Veterinary College (OVC) over the past 25 years. Both completed their terms in 2018.
 
At the helm in Student Affairs since 1995, first as Assistant Dean then later as Associate Dean, Conlon spearheaded a number of initiatives to enhance student confidence, wellbeing and success.
 
Lissemore, who became Assistant Dean, Academic in 2003, before moving to the Associate Dean position in 2007, has been a steady guide to continuous improvement in curricular development.
 
He was on the ground floor of OVC’s adoption of the DVM 2000 curriculum introduced in the early 2000s. Since that time, the Doctor of Veterinary Medicine (DVM) program has benefitted from steady refinements to ensure students receive a competency-based skill set and assure continual accreditation success for the college. Phased in over four years, the new approach included outcome-based assessments, particularly evident over the last 10 years as structured clinical exams were incorporated into each year of the program.
 
This focus on continuous improvement, along with advances in the admissions process for DVM applicants, an enhanced approach to all aspects of primary healthcare, wellness, experiential learning and psychomotor skills, are important touchpoints over Conlon’s and Lissemore’s tenures.
 
[Editor's note: In recognition of the remarkable contributions Drs. Peter Conlon and Kerry Lissemore have made to the Ontario Veterinary College and the student veterinarians whose lives and careers have been shaped by their service to education, the College has launched a scholarship fund in each of their names. Learn more about Peter Conlon's scholarship.  Learn more about Kerry Lissemore's scholarship.]
 

Start with a destination

The road to success begins with a set destination. Define the expectation of the confident, competent veterinarian upon graduation from OVC and work backwards to determine not only what students will need to learn each year, but the skills, knowledge and attributes they will need when admitted into the four-year veterinary program.
 
A move to Multiple Mini Interviews (MMI) in 2009 from a panel style interview marked a significant change in the admissions process at OVC. A growing body of literature from medical schools in the 2000s indicated the MMI approach for admissions was valuable as a predictor of future characteristics of accepted students and prompted the change, says Conlon.
 
The MMI incorporate scenarios structured to draw on the DVM applicants’ ability to think on their feet, communicate opinions and ideas, critically appraise information and demonstrate advanced understanding of issues facing the profession. During the MMI each May, 200 candidates independently interpret scenarios for 16 paired assessors who evaluate the candidates based on a scoring rubric.
 
As veterinary medicine becomes more complex, so do the scenarios. “We ask them about veterinary medicine and client scenarios, but over the years we’ve expanded these to ask them to think through more society-wide situations,” says Conlon.
 
“It’s been an important evolution of admissions. When we compare the MMI results to characteristics that we measure in first year Art of Veterinary Medicine communications labs, we have found a strong and direct correlation of the MMI’s predictive value in choosing communication and problem-solving skills.”
It’s also a valuable engagement opportunity with alumni and students. Last year the number of assessors rivaled the number of candidates, with 60 alumni, 95 student veterinarians and 23 faculty interviewing through the week for a total of more than 800 volunteer hours. 
 
A lot of alumni come back each year, says Elizabeth Lowenger, Manager, Student Affairs, who recruits each assessor. Some participate in a few sessions, others are involved for one or more full days of interviews. The mix of alumni from veterinary practices and industry provides a variety of expertise and perspectives to the selection process.
 
 

Hands-on learning in primary healthcare

An enhanced primary healthcare component initiated in 2010 marked a pivotal moment in OVC’s curriculum. Most visible with the opening of the Hill’s Pet Nutrition Primary Healthcare Centre (Hill’s PHC), developed as part the OVC Masterplan under the vision and leadership of past OVC dean Dr. Elizabeth Stone, this new focus brought with it increased opportunities for experiential learning.
 
The enhanced approach to companion animal primary healthcare through the Hill’s PHC was a game changer, exposing students to work life in a general practice and managing appointments focused on wellness, nutrition, client communications and the importance of the relationship between veterinary teams, pets and clients.
 
“The philosophy of experiential learning in the Hill’s PHC is to provide structured feedback in the moment as much as possible, with students taking responsibility for the appointments and building their confidence through a very supportive environment,” says Conlon.
 
Every student veterinarian spends time at the Hill’s PHC within each year of the program, culminating with a three-week mandatory rotation in fourth-year. “This is where we ask students to integrate medicine, surgery, nutrition, communications, and other knowledge, skills, and attributes to provide the best patient and client care possible,” says Conlon, who served as the Director of the Hill’s PHC since 2011. Central to this is the entire veterinary practice and faculty team who create the supportive learning environment.
 
 “These curricular pieces help achieve much more than confidence for our students,” Conlon says. “If you feel confident to make decisions, to think through issues, to talk to clients and apply strong hands-on experiential skills, all of that goes to self-assurance and a stronger sense of mental wellbeing.”
 
 

Practice, practice, practice

Practicing key technical and clinical psychomotor skills, particularly in surgery and anesthesia, is key to building student confidence and another example of how the curriculum was strengthened under Dean Stone’s tenure.
 
“This is a piece we’ve really worked on developing through the Clinical Medicine courses and surgical exercises within each year of the DVM program,” says Lissemore.
 
Beginning in first year, students are introduced to surgical skills, instrument handling and suture patterns, along with gowning and draping skills through a variety of lab-based exercises. Students progressively build their technical skills, beginning with low-fidelity foam and rubber models, then moving to more sophisticated high-fidelity models to learn and refine advanced skills such as intubation before progressing through the four-year program to live animals. Surgery and anesthesia training in third year provides students additional hands-on opportunities while servicing humane society and animal shelter spay needs.
 
“By breaking technical skills down into smaller tasks, students can practice a procedure or process multiple times until they are comfortable, increasing their competence and confidence,” he notes. “Students learn the proper techniques under faculty supervision and have the opportunity to practice them on their own and at their own pace.”
 
The enhanced focus on psychomotor skills is the impetus for the new enhanced clinical skills facility due to be completed in 2019.  Here students will have access to a dedicated clinical skills space, a library of clinical models, new communications teaching labs and flexible teaching space.
 

Wellbeing in all its forms

Wellbeing encompasses every aspect of veterinary care — including the patient, the client and the caregivers — and has become a significant discussion point within the veterinary profession.
 
“At OVC, we are really trying to encourage a culture change towards wellbeing,” says Conlon.
 
Growing research looking at veterinary mental health, as well as the veterinary profession’s advancing interest to talk about their experiences, has been a driving force behind this important conversation at OVC.
 
“We are an evidence-based and evidence-driven community; the evidence was clear there was a need for wellbeing initiatives in our curriculum,” he notes.
For Conlon, his own mental health challenges as a student and in practice underpins his passion for this area. “At that time, it wasn’t easy to find resources and they weren’t tailored to student veterinarians,” he recalls. “It is a privilege to be in a position where I can try to make a difference and I think it gives me more insight into our students’ struggles, having been there myself.”
 
Wellbeing topics are incorporated in the curriculum, starting with a focus on wellbeing during Orientation Week, continued with the first-year Art of Veterinary Medicine and an elective resiliency rotation in fourth year. All components are complemented by important co-curricular aspects such as Wellness Wednesday talks and an OVC Peer Helper program, which was started by Conlon in 1995.
 
This focus extends to the students’ personal support network.
 
“It’s all about connections, communications and a network of support right from day one,” says Conlon. For this reason, he has been an advocate over the years in fostering opportunities for friends, family members and mentors to have a chance to interact with the college and develop an understanding of what life is like as a student veterinarian.  This includes the annual Family and Friends Day and Professional Welcome Ceremony (initiated by Conlon in 1997 and 2004, respectively) during the students’ first year, and the White Coat Ceremony in third year.
 

Continual assessment critical for continuous improvement

Successful navigation sometimes means correcting your course. Formal student assessments are critical to assure students achieve the competencies required at each phase level and provide the data needed to ensure continuous curricular improvement.
 
But they are only one part of assessment. Regular surveys of in-course DVM students, one and five-year-out graduates and their employers are also vital.
In-course student surveys at the start and end of each academic year consistently show increases in confidence in performance, preparedness, planning, analysis, conducting veterinary activities and professionalism.“We have student assessment data, student-employer-graduate data and student confidence data to complete formal outcome-based evaluations,” says Lissemore. “You have to look at the data from multiple aspects to see if there is alignment. This is part of our continuous improvement, to determine student successes and their challenges.”
 
Veterinary college accreditation requirements are always changing. It is critical to stay informed to ensure the curriculum and facilities are on the mark.
“You have to balance needs with available budget and resources and recognize where opportunities are available,” Lissemore says. “Veterinary medicine is constantly changing as are the issues it encompasses. Our students need to be able to address these areas and the curriculum must continually evolve to include them.”
 
Successful curricular design is an evolution not a revolution, building on existing strengths in order to navigate to new and uncharted destinations.
 
Originally published in the Winter/Spring 2019 Crest Magazine