Volume 45 Issue 4, Winter 2018, pp. 464-479

Animal cruelty is the antithesis of animal welfare. Because veterinarians take an oath to protect animal welfare, they are professionally obligated to report animal cruelty. Several US states have mandatory reporting laws for veterinarians, and both the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association support reporting. Some state veterinary practice acts, such as Arizona's, also require reporting. Despite this, animal cruelty is not always emphasized in veterinary curricula. As a result, not all veterinary students and graduates feel comfortable recognizing signs of animal cruelty and may not be aware of the resources that are available to them when considering reporting. AVMA suggests that practices develop their own protocols for identifying signs that patients may have been victims of cruelty and consulting on cases with senior colleagues with regard to when to report. To enhance student comfort with these conversations, Midwestern University College of Veterinary Medicine developed a standardized client encounter titled “Grizabella's Final Fight.” I hope that other colleges of veterinary medicine will adapt this teaching tool to allow students the opportunity to practice discussions surrounding animal cruelty reporting in the context of state-specific legislation that guides their code of professional conduct.

Animal Cruelty, Defined

There is no universal definition of animal cruelty.4 How animals are treated is in large part influenced by societal and cultural norms.5 The North American and European perspectives overlap in their consideration of animal cruelty as “socially unacceptable behavior that intentionally causes unnecessary pain, suffering or distress to and/or death of a non-human animal.”6(p.51),7 Under the umbrella term of animal cruelty are several different subtypes that are recognized by law, including, but not limited to, neglect, intentional abuse, animal hoarding, and organized abuse.8 In the United States, all subtypes are ultimately defined by the legal system. Statutory language varies between states and even by jurisdiction not only in how cruelty, neglect, and abuse are defined, but also in what constitutes an animal.

Incidence of Animal Cruelty in the United States

The incidence of cruel acts against animals is difficult to determine because no federally mandated, national reporting systems are in place to track cases.9,10

Linking Animal Cruelty to Cruelty to People

Violent acts against animals are particularly concerning because this behavior has been linked to subsequent violence against people.9,1116 For example, of the 11 perpetrators who participated in nine school shootings in the United States from 1996 to 1999, 45% were alleged to have abused animals earlier in life.11 In addition to murder, violent acts such as arson, sexual predation, and other forms of interpersonal assault, including domestic violence, have been linked to animal cruelty.7,1725 Although it is important to note that engagement in acts of cruelty alone does not predestine one to a lifetime of violence, abusing animals is considered a warning sign.26

Role of the US Veterinarian in Reporting Animal Cruelty

Every graduate of a college of veterinary medicine accredited by the American Veterinary Medical Association (AVMA) takes an oath to protect animal health and welfare and alleviate animal suffering.1 When animal welfare is in jeopardy, as through acts of animal cruelty, the AVMA “considers it the responsibility of every veterinarian to report animal abuse to appropriate authorities, even when such reporting is not mandated by law or local ordinance.”27

Although animal cruelty is considered to be a felony in all 50 US states and in the District of Columbia, only 11 states have legislation at the state level that mandates veterinarians to report suspicions of animal cruelty.2,28,29 Veterinarians are responsible for familiarizing themselves with the statutory language of the state in which they practice as well as with city and county ordinances, which may vary widely within the same state.30,31 Should a veterinarian in a mandatory reporting state fail to report, she or he will be subject to disciplinary action that may include a warning letter, license suspension, or even license revocation.30

In addition to state law regarding mandatory reporting, state-specific veterinary practice laws may also require reporting.30 In addition, other states provide infrastructure for voluntary reporting and may even encourage it.31

Reporting veterinarians must abide by the state-specific process for reporting,31 which may require the reporting veterinarian to provide the date of examination and a description of the animal in question, in addition to the owner's name and residence.30 The agency with the authority to take reports varies between states, but case investigations may involve cooperation among animal control, humane societies, agricultural departments, and law enforcement officers.31 Reporting veterinarians are not required to provide a guarantee that abuse took place; they are merely responsible for conveying their suspicions.3,29

Reporting veterinarians may or may not be provided immunity from civil and criminal liability for good-faith reporting.30 In states that include provisions for immunity, the court will assume that the reporting veterinarian used “the proper degree of care and skill and [acted] under the honest belief that [this action] will benefit the animal.”30(p.686)

Challenges Associated with Reporting in the United States

Veterinarians may be professionally or legally obligated to report, but they may also be handicapped by their perceived lack of training or resources.32,33 Veterinarians have expressed discomfort with identifying animal abuse because of the lack of standardization of definitions and the lack of uniform guidelines by which to critique an animal's condition.30,3335 Veterinarians may also be conflicted as to how to juggle mandatory reporting with their obligation to maintain client confidentiality.30 In most cases, there is no actual legal conflict: For instance, the State of Arizona has mandatory reporting, but it does not have a confidentiality statute in place to protect veterinarian–client communication.30 Despite this, veterinarians may still feel torn about breaching their clients' trust. They may also feel pressured not to report the suspicions of colleagues who may fear that reporting will have an adverse impact on the practice's bottom line.30

Veterinarians are not alone with regard to their concerns about reporting. A 2013 study by Creevy et al.24 found that, although more than 86% of veterinary students agree that they have an ethical obligation to report animal cruelty, their perceived lack of training in this content area impedes their understanding of how to initiate and follow through with reporting. To enhance student comfort with the subject and to practice having difficult conversations with colleagues about reporting, Midwestern University's College of Veterinary Medicine (MWU CVM) developed a standardized client (SC) encounter titled “Grizabella's Final Fight.”

History of Standardized Client Encounters in Veterinary Education

The concept that SCs could be incorporated into the veterinary communications curriculum to enhance experiential learning was borrowed from human medical educators. As medical educators' perception of communication evolved and they began to view it as a teachable skill,3648 they recognized the utility of having standardized patients (SPs) in medical teaching.37,4960 These so-called SPs allowed students to learn through practice and repetition in a safe, constructive environment.6164 Initially, SPs were used to portray various disease states.37,49,50,52 However, their role has subsequently expanded to include sensitivity training,37,5358 particularly when it comes to the delivery of bad news.59,60

Student role-plays preceded the use of SCs in veterinary education.6568 Not until the late 1990s and early 2000s did SCs formally became a part of the veterinary curriculum, beginning with Ontario Veterinary College.62,69,70 This innovative approach to veterinary education paved the way for US-based colleges of veterinary medicine to follow suit, including Colorado State University,71 Michigan State University,72 Washington State University,73 Ross University,74 and Western University of Health Sciences' College of Veterinary Medicine.75 The data published in the current veterinary medical literature are limited with regard to the thematic content of these encounters. What has been published has emphasized basic aspects of clinical communication in the examination room such as note taking, history taking, and agenda setting.75 Few programs advertise that they make use of simulation-based education to work through the delivery of bad news and ethical dilemmas.76 To my knowledge, the use of animal cruelty cases as the backdrop for pre-clinical exercises in US-based colleges of veterinary medicine is infrequent.

History of Standardized Client Encounters at Midwestern University College of Veterinary Medicine

“Grizabella's Final Fight” is one of 27 SC encounters that MWU CVM students participate in over eight consecutive pre-clinical quarters. Each quarter (fall, winter, spring) spans 10 consecutive weeks, and each class year contains roughly 100 students. All encounters are conducted in mock examination rooms equipped with microphones and audiovisual recording devices, with the capacity for long-term data storage of audiovisual data and SC feedback through health care–based Learning Space software (CAE Healthcare, Sarasota, FL).77

The breadth and depth of simulation-based education at MWU CVM promotes student exposure to cases that progress in intensity.77 The primary objectives of these encounters are to provide students with the opportunity to (a) experience veterinary clinical scenarios in a safe and supportive learning environment and (b) practice Calgary–Cambridge guide communication skills.48,7882

Students are also routinely grouped so that they benefit not only from directly participating in encounters but also from witnessing classmates experience similar case scenarios. A common set-up for simulation-based education at MWU CVM involves five concurrent cases. Each student in a group of five is randomly assigned to lead one case as the sole interviewer and observes his or her classmates in the other four.

Case Design for “Grizabella's Final Fight”

“Grizabella's Final Fight” debuted in December 2016, during the final (eighth) pre-clinical quarter, as one of five encounters that emphasized difficult conversations. “Grizabella's Final Fight” was preceded by VMED 1605, a required course that introduced the topic of animal cruelty, and was supported by concurrent enrollment in VMED 1709, a required course that discussed state-specific statutes for Arizona and mandatory reporting. Students were taught that Arizona has mandatory reporting written into law for practicing veterinarians.30 Specifically, Arizona Statute 32–2239 stipulates that

a veterinarian who reasonably suspects or believes that an animal has been a victim of abuse, cruelty or neglect or has been involved in animal fighting shall report that suspicion, or cause a report to be made, to law enforcement within forty-eight hours after treatment or examination.83

Veterinary colleagues who may not have examined the patient but have reason to believe that the patient has been abused are equally responsible for filing a report. Reporting veterinarians are subsequently immune from civil liability provided that the report was made in good faith.83

“Grizabella's Final Fight” was designed to test students' understanding of Arizona-specific legislation by tasking them with convincing the SC—in this case, their employer—that they were bound by law to report their suspicion that a deceased patient of theirs was a victim of animal cruelty. “Grizabella's Final Fight” is scripted. The script includes an opening statement, pertinent background information, key phrases, “triggers” (student statements that would amplify the emotional intensity of the case), and “defusers” (student statements that would de-escalate the situation). Scripts were distributed to SCs, but not to the students, two weeks before the encounter (Table 1).


Table 1: Script for “Grizabella's Final Fight”

Table 1: Script for “Grizabella's Final Fight”

Type of simulation Individual within a group: 1 student clinician leads the case and 4 peers observe
Section 1: case overview
Role of the student clinician Associate veterinarian in general practice
Goals of simulation Students will effectively use their repertoire of foundational and core clinical communication skills to manage dissent within the veterinary team when a colleague or boss vocalizes his or her opposition to the attending clinician's decision to report a case of suspected animal abuse.
Communication-based learning objectives for this event
  1. Pick up on your colleague's verbal and nonverbal cues to recognize his or her emotional state.

  2. Use appropriate nonverbal behavior to develop rapport.

  3. Elicit your colleague's perspective.

  4. Acknowledge and address your colleague's concerns.

  5. Ask for permission to share your perspective on the case.

  6. Share your line of reasoning with your colleague to help him or her understand the situation and why you are compelled to act in a certain way.

  7. Outline what options are available in this case and validate your colleague's frustration that the situation is less than ideal.

  8. Establish mutual understanding with your colleague regardless of whether she or he ultimately agrees with your decision.

  9. During a post-simulation group debriefing session, identify 1 communication skill that was effectively used by each student and give a concrete example of each.

  10. During a postsimulation group debriefing session, identify 1 communication skill that each student could improve on and give a concrete example of how this could be achieved.

Section 2: general case information
Owner's name Mrs. Andi Webber
Type of client Long-term client of the student clinician's practice
The student clinician has met the family before to treat its duo of cats (Mr. Mistoffelees and Skimbleshanks) for “high-rise syndrome,” but in all of the previous conversations with the family, the student clinician does not ever recall Mrs. Webber saying that she owned a dog.
Patient's name Grizabella
Patient's signalment 10 mo. female intact American Pit Bull Terrier
Presenting complaint Dead on arrival
Cause of death Wounds inflicted in dog fight
Backstory Refer to “Door Chart” (case synopsis; Table 2)
Section 3: SC details
SC's name Dr. Eliot
Relationship of SC to student clinician The SC is the student clinician's employer.
Sex Male
Preferred age range 50+ years old
Hygiene Professionally groomed
Attire Business
Background history
  • Dr. Eliot is nearing retirement and rough around the edges. He is, quite frankly, tired of drama. He wants to come to work and do his job—no more, no less. He takes pride in his duties as a veterinarian but has set clear boundaries to define what is within his purview and what is not. He believes that he is there to treat the patient, not the client. He has a tendency to roll his eyes at new graduates who come out of school with so-called “soft skills”—training in the art of clinical communications, among other “touchy-feely” subjects that, in his mind, have no place in the veterinary curriculum.

  • When he went to vet school, he was taught science, business, and management. He was taught a trade. He worked hard. He logged long hours. He knew what his job was and what it wasn't. He perceives this “new-age” veterinary curriculum as “fluffy” and watered down. He sees new vets as too eager to delve deep into their clients' lives. He worries that to do so is to overstep one's role in the examination room.

  • Sure, his associates have tried to convince him that to know the client is to know the pet and the lifestyle and, therefore, have better insight into what treatment options are best for the family unit as a whole. But he isn't buying that. He just sees it as one more invasion of privacy.

Employment history He owns the practice New Lives and Second Chances Veterinary Hospital
Medical background
  • Dr. Eliot is a seasoned primary care veterinarian in small animal practice. He graduated in the top of his class 20 years ago and was one of the first among his classmates to dream of (and eventually own) his own practice. Dr. Eliot practices good-quality medicine—always has, always will. His skills have not faded, only the efficiency with which he is able to use them. He is slower than he used to be, that is, in surgery, but he still has much talent in teaching medicine to up-and-coming new grads of the veterinary profession. He is especially savvy when it comes to business. He could not have done as well has he has without a solid background in finance and without the MBA that he secured before matriculation.

  • No one can criticize Dr. Eliot's standard of care when it comes to medical training: He has kept up his knowledge base with continuing education and has always believed in the importance of keeping up to date in his field.

  • Where Dr. Eliot falls short is in the realm of client care and clinical communications. Clients have stuck it out with him because of his expertise, but they haven't always found him the easiest to relate to. His interpersonal skills are lacking. He is very set in his ways. He is cut and dry. He doesn't exude empathy. He calls it like it is. He doesn't cushion blows. And he doesn't ask clients for their perspective. He is the “sage on the stage,” the expert in the room. He expects clients to listen when he tells them what to do.

Financial status Financially sound and secure. Planning to retire within the next 1–2 years with no financial barriers to that plan. Even if Dr. Eliot does not immediately sell his practice, he is in good shape financially and will be able to live comfortably. Selling the practice will only do him good by adding significantly to his retirement savings. Doing so will allow him to afford the niceties and luxuries that he aspires to have on hand. He looks forward to a life of leisure postretirement. He envisions spending early mornings on the putting green working on his golf game. He dreams of traveling to exotic locales. He wants a collection of vintage cars. He is a material goods guy.
Client behavior and affect
  • Initially, matter-of-fact. As soon as he finds out about the student clinician's plans to report a case of suspected animal cruelty, he becomes frustrated. Exasperated. It's not up to the colleague to go rooting around in someone else's home life, in someone else's business. The dog is dead. The dog can't be resuscitated. There is nothing more that can be done. So let it be. Nothing good can come of this situation. And without proof, all the colleague is acting on is suspicion. It isn't right and it isn't fair for them to go on this wild goose chase. It isn't right and it isn't fair to be speculating. Don't they know what damage they can do to potentially innocent lives? Not to mention the business. If word gets out that this practice is a busybody and thrives on reporting potential nothings and policing its clients, business may suffer.

  • Adamant that reporting this case is the wrong move. He truly believes he is right. He truly believes that not reporting this case is the right thing to do. He stands tall—shoulders back, chest forward, head and neck held high. Maintains direct eye contact. May use hand gestures to emphasize exasperation. May stomp foot once or twice on floor or may slam fist down on table or counter for effect. May run hand through hair or rub his temple out of frustration. Likely to shake his head with disapproval.

Voice Normal to loud volume. Tone of voice reflects annoyance and frustration. Voice carries an air of authority: the typical voice of a boss telling someone what to do. Voice demands respect.
Body language Refer to “Client Behavior” section. In addition, Dr. Eliot should have a closed-off body posture (arms crossed or folded across chest). Dr. Eliot should not be seated. He should be standing at all times. He may invade the student clinician's personal space—that is, stand too close, in an attempt to tower over the student.
What does Dr. Eliot know about the Webber family going into this situation?
  • Dr. Eliot knows of the Webber family. He met Andi briefly when a few months back she presented the two family cats to him on an emergency basis. Come to think of it, the only interactions that he or any of his staff have ever had with the Webber family have been in an emergency setting. He has never met Andi's husband, Lloyd. He has, however, met the two kids. If he recalls correctly, the kids are typical kids—always coming in with bumps, scrapes, cuts, and bruises—but then again isn't that just part of being a kid?

  • Dr. Eliot is aware that the student clinician personally managed both family cats as kittens for presumptive high-rise syndrome: Both cats had reportedly chased each other off of an indoor second-floor balcony, and neither landed (correctly) on their feet. Both sustained unilateral femoral fractures that were treated conservatively with cage rest because the client's financial constraints at the time prevented surgical repair.

  • Like the student clinician, Dr. Eliot was not aware that the Webber family owned a dog.

What (if any) past experiences does Dr. Eliot have that may influence his reaction to this particular situation?
  • Ten years ago, Dr. Eliot was reported to the state veterinary board by an employee (an animal caretaker) on suspicion of substance abuse (alcohol). The employee had found vodka on the premises and had wrongly assumed that Dr. Eliot had been drinking on the job. She was afraid to broach the conversation with Dr. Eliot. Had she simply asked him, Dr. Eliot would have been truthful with her: The vodka was kept in the event of ethylene glycol toxicity. Indeed, it was an “old-school” treatment option compared with the current standard of care (i.e., 4-methylpyrazole or 4-MP). But, bottom line, it worked and was affordable.

  • Instead of asking Dr. Eliot, the caretaker went straight to the board with her concern, and the board was obligated to investigate. Dr. Eliot fully cooperated with the board, which found no proof of substance abuse. The animal caretaker ended up resigning, and the whole ordeal blew over—in everyone's mind but Dr. Eliot's. The costs to him (in terms of his time, his energy, and his reputation) were not forgotten. He swore that he'd never do to another what had been done to him. Ever.

Section 4: scripted SC responses
Opening statement “What was that all about?”
  • Once the student clinician explains what she or he has decided about filing the report, Dr. Eliot will say, “You're not going to report this case. I want you to leave this alone. Let it be. It's not your business, and I don't pay you to make it your business.”

Additional key phrases the SC should make a point of saying Comments about the student clinician's decision to report the case:
  • “You've crossed the line.”

  • “You've gone too far.”

  • “You've lost your way.”

  • “You've forgotten what is and isn't your business.”

  • “This isn't your responsibility. Your responsibility was to the dog and the dog is dead.”

  • “Don't go stirring up trouble. There's enough trouble in the world to go around without you adding to it.”

  • “Let it be. This isn't your fight to fight. You can't save everyone.”

  • “How do you know for sure? You don't! So let it go.”

  • “Think before you speak. You could end up doing more damage.”

What (if any) phrases said by the clinician will trigger the client to react a certain way? The situation will escalate if the student clinician becomes defensive:
  • “Don't blame me!”

  • “This isn't my fault!”

  • “Do you think I wanted to see what I did?”

  • “I don't need this right now!”

The situation will escalate if the student clinician blames Dr. Eliot:
  • “Maybe if you were more supportive then you'd help me through this instead of fighting me.”

  • “I wouldn't be in this mess if you had stepped up and been willing to see the case for me.”

  • “I really don't want to have to do this, but you're giving me no choice. You're forcing my hand by refusing to take an appropriate stance yourself.”

The situation will escalate if the student clinician uses nonempathic statements:
  • “I know how you feel.”

  • “Calm down.”

  • “You need to stop freaking out about this.”

  • “It's not really that bad.”

  • “Everything's gonna be okay.”

  • “What you're worried about is nothing.”

What (if any) phrases said by the clinician will serve as a diffuser to de-escalate the situation? The situation will de-escalate if the student clinician demonstrates empathy:
  • “I sense that you feel very strongly about this topic.”

  • “I sense this is very difficult for you.”

  • “I can't imagine what it's like to have to balance the needs of the business with the needs of your clients. It can't be easy.”

  • “I sense that this situation puts you in a very bad situation and it can't be easy to have that amount of stress on your shoulders.”

The situation will de-escalate if the student clinician elicits Dr. Eliot's perspective:
  • “Can you help me to understand where you're coming from?”

  • “I'd like to better understand why you are so opposed to me reporting this case.”

  • “I get the impression that you've had to go through something like this before and it didn't end well. Do you want to talk about it?”

  • “How can I help you to better understand where I'm coming from?”

  • “How can I work with you to get through this situation?”

  • “How can I get you to see that I don't have a choice?”

The situation will de-escalate if the student clinician asks permission:
  • “May I explain why this case is so important to me?”

  • “May I tell you why I feel so strongly about reporting this case?”

  • “May I share why I am compelled to do what I have to do?”

Note. This case is copyrighted by Ryane E. Englar and Midwestern University College of Veterinary Medicine. It may not be used without their permission.

SC = standardized client.

All names and descriptions in the script are fictitious.

Logistics of the Encounter

Third-year veterinary students were randomly assigned to groups of five. Each student within a group of five was randomly assigned to be the sole interviewer or student clinician for one of five cases. Of 93 students, 19 were assigned to the role of interviewer for “Grizabella's Final Fight.” Students received a synopsis of the case 2 weeks before the event (Table 2). The synopsis was intended to provide them with a backstory so that they could initiate a dialogue with the SC. Students were instructed that the SC would be playing the role of the employer rather than the client. Therefore, the interaction for which they were prepping was solely student doctor:employer rather than the more typical arrangement of student doctor:client.


Table 2: Case synopsis for “Grizabella's Final Fight”

Table 2: Case synopsis for “Grizabella's Final Fight”

Patient-specific data Details
Patient's name Grizabella
Patient's signalment 10 mo. old intact female American Pit Bull Terrier
Vital signs Deceased
***NOTE: Student doctors will not actually be interacting with the patient. The patient has been described here to provide sufficient background.***
Owner's name Mrs. Andi Webber
***NOTE: Student doctors will not actually be interacting with the owner of the patient. The owner of the patient has been described here to provide sufficient background.***
Role played by SC The student clinician's employer, Dr. Eliot
***NOTE: Student doctors will be interacting with the SC in the aforementioned role (employer).***
Case summary:
A long-time client presents a young (<1 y old) intact female American Pit Bull Terrier as a walk-in emergency. The patient is dead on arrival, with full-thickness lacerations along all four limbs and has been partially disemboweled. The student clinician notices that the client has a black eye and that one of her children appears to have a broken arm. The student clinician suspects animal cruelty and domestic violence, but when she or he tries to press the client for details, the client flees. The student clinician must explain to his or her boss why it is his or her obligation to report his or her suspicion.
The Backstory:
You are an associate veterinarian at New Lives and Second Chances Veterinary Hospital. It is almost closing time. You are putting your finishing touches on the last few charts of the day when the front door flies open. In runs Mrs. Andi Webber, accompanied by her two young children, Gus and Victoria. You have met the family before to treat its duo of cats (Mr. Mistoffelees and Skimbleshanks) for high-rise syndrome, but you do not recognize the mangled creature that Mrs. Webber is cradling in her arms. In all of your previous conversations with the family, you don't recall Mrs. Webber ever saying that she owned a dog.
“Please do something,” she cries out, pushing Grizabella the pit bull into your arms.
You suspect before you have the full weight of the limp body in your arms that Grizabella is deceased, but you auscultate the dog's chest to be sure. The only sound you hear is Mrs. Webber crying and her kids.
“I'm so sorry,” you say, looking up to meet Mrs. Webber's gaze. “She's gone.”
Mrs. Webber gasps, then collapses to her knees. “Grizzy,” she sobs. “Oh, Grizzy, I shouldn't have let him hurt you.”
Something about the way she says it raises a red flag. You take a closer look at Mrs. Webber, as she strokes this dog gently, lovingly—a dog you never knew she had—and notice what was hidden before. As the tears streak through her makeup, there is no mistaking the emergence of the trace of a black eye. Where the top of her shirt has come undone, there is an obvious bruise at the collarbone, and she is wearing long sleeves despite the full-out heat of Arizona summer, as if to cover up what her arms otherwise might reveal to the world. Your watchful eye takes in the two kids as well. You notice that Vicky's right arm is in a sling.
Your focus shifts, finally, to Grizabella. She is significantly underweight and undermuscled for what appears to be a young adolescent, heavily muscled breed of dog. All 4 of her distal limbs are covered in open wounds in an assortment of slashes, cuts, scrapes, rips, and tears that bear striking resemblance to dogfight wounds in bait dogs. A multitude of scars create a map of old wounds that pepper what little part of her body is intact. Her abdominal wall has been compromised. She looks as though she's been partially disemboweled.
You return your gaze to Mrs. Webber, and you put your hand gently on her forearm. She jumps.
“Mrs. Webber,” you say with compassion, “Has someone done something to hurt Grizzy?”
You pause. “Has someone done something to hurt you or the kids?”
Mrs. Webber stops crying as if on command, blinks back the remaining tears, and dries her face on her forearm.
“No,” she says, with a panicked tone. “No, of course not.”
“But mom!” Vicky says. “Daddy was angry!”
You kneel down to Vicky's level. “What does your dad do when he's angry?”
But you never get your answer. Mrs. Webber cuts you off. “Look, this was a mistake. We were never here. Do you understand me?”
She turns to the kids. “Come on, let's go.”
“But. . . .” Vicky says.
“Enough!” Mrs. Webber exclaims.
They are out the door as quickly as they came in, leaving Grizzy's mangled body behind as the only tangible evidence that they were ever truly there.
You stand there for a moment, in shock yourself, reeling over the events—what you saw, what you heard, and what it means.
Your colleague and the owner of the practice, Dr. Eliot, steps out of his office just in time to snap you out of your mental anguish. “What was that all about?” he asks.
Your Task:
To engage in a conversation about a difficult case with a colleague who may disagree with your plan of attack.
You will need to explain to Dr. Eliot why you have no choice but to report the case to the authorities.

Note: Students receive this document 2 wk before the encounter.

SC = standardized client.

On the day of the encounter, each student group spent 40 minutes on “Grizabella's Final Fight.” The first 10 minutes preceded the actual encounter and were used for brainstorming: In the absence of the SC, the interviewing student presented the case to his or her classmates and coach and identified learning objectives for the encounter. Then the interviewing student interacted with the SC for up to 20 minutes. After the encounter, the interviewing student initiated a debrief by self-reflecting on his or her performance. Each participant (SC, classmates, and coach, in that order) was then responsible for providing one example of what worked well followed by an example of constructive criticism. Handwritten feedback was also provided to the interviewing student by the classmates and faculty coach. SCs were responsible for providing typed feedback that was stored in Learning Space for subsequent review by the interviewing student. Each interviewing student was also granted access to the audiovisual recording of the encounter via Learning Space to encourage self-reflection.

Pre- and Post-Event Surveys for “Grizabella's Final Fight”

After receiving institutional review board approval by MWU, I prepared pre- and post-encounter surveys for all five cases, including “Grizabella's Final Fight.” Pre-encounter surveys were designed to capture students' anticipatory reactions to the upcoming event, whereas post-encounter surveys were designed to capture students' reactions to the encounter after the fact (Table 3).


Table 3: Student pre- and post-encounter survey questions for “Grizabella's Final Fight” and mean score based on 23/25 completed pre- and post-encounter surveys

Table 3: Student pre- and post-encounter survey questions for “Grizabella's Final Fight” and mean score based on 23/25 completed pre- and post-encounter surveys

Question Mean score (out of 10)
Pre-event survey
Heading into this encounter, how prepared are you to discuss the medical aspects of the case with the SC? (1=not at all prepared; 5=adequately prepared; 10=exceptionally well-prepared) 8.22
Heading into this encounter, how prepared are you to discuss the interpersonal/emotional aspects of the case with the SC? (1=not at all prepared; 5=adequately prepared; 10=exceptionally well-prepared) 6.33
Heading into this encounter, how anxious do you feel about participating in the case? (1=not at all anxious; 5=neutral; 10=exceptionally anxious) 6.22
Post-event survey
Now that this encounter is complete, in retrospect, how challenging was it to discuss the medical aspects of the case with the SC? (1=not at all challenging; 5=neutral; 10=very challenging) 4.39
Now that this encounter is complete, in retrospect, how challenging was it to discuss the interpersonal and emotional aspects of the case with the SC? (1=not at all challenging; 5=neutral; 10=very challenging) 6.06
Now that this encounter is complete, how would you rate your anxiety if you had to experience a similar scenario tomorrow? (1=not at all anxious; 5=neutral; 10=exceptionally anxious) 4.72
Additional comments: what worked well
Additional comments: even better yet or constructive criticism
Additional comments: other

SC=standardized client.

Pre-encounter surveys were made available at the check-in desk in the reception area of the MWU CVM Clinical Skills Center, where students were required to report 15 minutes before their assigned encounter time. All completed pre-encounter surveys were turned in to an on-site senior administrative assistant (SAA) before the start time of the encounter. Immediately after the encounter, post-encounter surveys were distributed, collected, and forwarded to me by the SAA. Students were informed that there was no financial or grade incentive to complete either survey and that the SAA was not in any way responsible for grading student performance during the encounter or for inputting students' grades after the encounter.

Reporting Animal Cruelty

All 19 “Grizabella's Final Fight” encounters (100%) concluded with the interviewing student telling the reluctant employer that she or he was going to proceed with making a report to the appropriate authorities.

Pre- and Post-Encounter Surveys

Eighteen pre- and post-encounter surveys were collected for “Grizabella's Final Fight” (response rate = 94.7%; 18/19).

The mean responses for Likert scale questions on the pre- and post-encounter surveys are listed in Table 3. Comparing pre- and post-encounter responses, student mean responses demonstrated improved preparedness to discuss the medical and interpersonal aspects of the case, in addition to reduced anxiety after the encounter (see Table 3).

The majority of students (16/18; 88.9%) felt prepared to discuss the legal issues surrounding the case. The minority of students had residual concerns about legal ramifications, specifically with regard to whether they had immunity in a court of law and whether they could be protected from retribution if they did indeed go against their employer's wishes by reporting (Table 4).


Table 4: Student free-text responses to pre-and post-encounter surveys with insight into emerging themes pertaining to animal cruelty reporting as experienced in this encounter

Table 4: Student free-text responses to pre-and post-encounter surveys with insight into emerging themes pertaining to animal cruelty reporting as experienced in this encounter

Themes Example quotations
Legal aspects and ramifications of the case
The discussion is clear-cut. “My obligation to report is very clear.”
“I understand what my legal responsibility is.”
“I am very familiar with the laws in Arizona that involve animal abuse.”
Some level of uncertainty exists. “Do I owe my boss an explanation?”
“Can my boss fire me for reporting this case?
“Am I liable if I report this case and my suspicions are mistaken?”
Interpersonal aspects of the case
The topic of animal abuse is uncomfortable. “It is unsettling to discuss animal abuse.”
“This is not something I want to have to talk about.”
The topic of animal abuse may incite confrontation. “Animal abuse is likely to stir up conflict.”
“Confrontation is scary because it is not a strength of mine.”
“What if my colleague's counterargument would simply be a ‘because I said so' type of position?”
“What if it becomes a ‘he said/she said' with my boss?”
“I don't know how to tell my boss that he is wrong.”
“It bothers me to have to tell my boss that he is wrong.”
Managing dissent within the veterinary team
It is difficult to engage in conflict with someone when there is a power differential. “During the encounter, my employer frequently cut me off or spoke over me. I let him speak out of respect because he is my boss; however, after this happened several times, I wish I would have spoken up for myself. I could have politely asked him to let me finish my explanations. I could have explained to him that I could better answer his questions if he gave me a chance to respond fully.”
Eliciting the perspective of a team member may diffuse tension. “I wish I would have asked for his insight a little sooner and partnered better with him. This may have made him feel more like he was contributing to the decision, and we could have ended on better terms.”
Finding a way to partner with a team member may facilitate the act of coming to a mutual understanding. “I could have asked for his help in necropsy and a thorough physical examination to get a second opinion. This partnership may have convinced the employer of the need to report suspicion of animal cruelty once he'd actually seen the body of the maimed terrier.”

Pre- and post-encounter anxiety scores were largely linked to concerns about having to engage in conflict: Dissent within the veterinary team was mentioned by 38.9% (7/18) of students as a source of anxiety (Table 4). In particular, students expressed concerns about how to handle a clinical case that involved a difference in opinion between team members in which one team member (the employer) held authority over the other. Students had to not only navigate the emotional dynamic of the situation but also maintain professionalism in spite of dissent. Eliciting their employer's perspective and creating opportunities for partnership appeared to defuse tension and reduce dissent (see Table 4).

Of 19 students, 16 (84.2%) pinpointed at least one statement or action that they would have altered if they had the opportunity to repeat the encounter. In particular, they wanted to appear more confident by increasing eye contact, taking control of the conversation, and clearly outlining the legal issues at hand: “I would have informed [my employer] that he is just as responsible for reporting these cases [as I am].”

Standardized Client Feedback

Through written feedback to the students, SCs for “Grizabella's Final Fight” confirmed that 19 of 19 students successfully demonstrated transparency and unconditional positive regard. All 19 also effectively elicited the SC's perspective, used appropriate medical jargon, and contracted for the next steps (Table 5).


Table 5: Standardized client written feedback free-text responses in response to student performance in “Grizabella's Final Fight”

Table 5: Standardized client written feedback free-text responses in response to student performance in “Grizabella's Final Fight”

Skill Text
19 of 19 students (100%) effectively demonstrated the following communication skills:
Transparency “You told me point-blank, ‘I have to do this and so I will.”
“There was no question in my mind as to what you felt you had to do.”
Unconditional positive regard “You were respectful in your attitude toward me.”
“You were respectful to me as a boss and what this might do to the clinic I had spent a lifetime building.”
“You commented about valuing my advice and considering me a real mentor.”
Eliciting the client's perspective “You asked me what I would have done.”
“You asked why I felt the way I did.”
“You asked if I had handled something like this before.”
Using appropriate medical jargon “You said that ‘the dog was disemboweled' as opposed to ‘the dog's intestines were falling out.'”
Contracting for the next steps “You said you were going to contact the client to get more information.”
“You said you would keep me out of it.”
The majority of students effectively demonstrated the following communication skills:
Empathy (17/19; 89.5%) “You were empathetic regarding the impact this might have on the business.”
“You understood how hard I had worked to build this practice.”
“You told me that you understood why I felt the way that I did.”
Nonverbals (16/19; 84.2%) “You maintained a confident posture.”
“You were able to stay calm and remain seated even as I tried to tell you that you were wrong.”
“You maintained good eye contact throughout the encounter, which was an indicator that you were confident in your abilities and in what you had to say.”
Partnership (16/19; 84.2%) “You offered partnership when you wanted my opinion of the situation.”
“You said that you enjoyed our partnership and working at the clinic, so much so that you wanted my insight into how to proceed.”

The majority of students effectively used body language, empathy, and partnership (see Table 5). When student interviewers mentioned finding employment elsewhere, SCs noted that it worked against partnership: “It made me question your commitment to my practice.” When a lack of eye contact occurred, SCs noted that it created a barrier to nonverbal communication: “I would have liked you to look up more and at me to demonstrate greater confidence in yourself.”

SCs also suggested that students be more forthright in addressing the legal issues relevant to the case. SCs noted that in roughly one-quarter of the encounters (21.1%; 4/19), students had a tendency to skirt around the uncomfortable issues surrounding animal cruelty reporting and dissent within the veterinary team. SCs felt that it would have been appropriate for students to display more confidence in upholding the law rather than hedging around their legal responsibilities as if hoping the employer would fill in the blanks:

Students should not shy away from legality as the law, in this case, ties the students' hands in terms of how they have to proceed. They have no choice. They have to report. This needed to have been said and made blatantly clear in order to strengthen their argument and support their plan of action.

Taking into account all of the communication skills that students used, SCs were asked at the conclusion of the encounter to assess, on a scale ranging from 1 to 5, how well the student ultimately defused the conflict surrounding the case. The mean was 3.63 out of 5 (1 = could benefit from significant improvement; 3 = adequate/acceptable; 5 = exceptional).

“Grizabella's Final Fight” was built into the curriculum to address animal cruelty reporting in the context of colleague–employer dialogue, recognizing that both cruelty and dissent within the veterinary team may be difficult to navigate. Not all veterinarians feel adequately trained to identify cases of animal cruelty, and not all are aware of their legal responsibilities.32,33 Veterinarians may also worry about team members' reactions if reporting has an adverse impact on the practice's bottom line.30 Veterinary students have expressed similar views of feeling handicapped by what they do not know about initiating and following through with reporting.24 The AVMA suggests that junior veterinarians consult with senior colleagues on cases when there is any question of whether or when to report, but the AVMA does not provide suggestions for how to initiate that conversation.3 The goal of “Grizabella's Final Fight” was to provide third-year veterinary students with the opportunity to practice having a discussion about animal cruelty in a safe, low-stakes environment. The hope was that student interviewers would (a) draw on the legal information that they had been exposed to in class to bolster their decision to report and (b) use Calgary–Cambridge guide communication skills to diffuse conflict with their employer.

With regard to their legal responsibility to report in the State of Arizona, 100% of students recognized that the case was reportable and affirmed to the SC that they would in fact proceed with reporting. The majority of students (88.9%) also felt prepared to discuss the legal issues underlying “Grizabella's Final Fight.” This confirms that the students understood the Arizona Practice Act84 and, more specifically, their duties when a case of animal cruelty is suspected. Moreover, students understood that these duties trumped any level of anxiety that they may have had over the prospect of airing a dispute with an employer. A handful of students expressed residual concerns about immunity and whether they could in fact face retribution for an accusation that was made in good faith. This suggests that students may require and benefit from additional curricular exposure to the consequences of animal cruelty reporting, particularly whether they could be held liable. Given that their concern over liability could ultimately affect their decision to report, it is critical for veterinary educators to provide that level of detail so as to take away any uncertainty. If students are left to fill in the details for themselves, they may reference inaccurate resources or make assumptions that inappropriately alter their course of action. They could also be more easily swayed by a colleague's concerns about reporting, even if those concerns are unfounded.

Future developments in the veterinary curriculum could increase the time that students spend on navigating difficult conversations with colleagues. “Grizabella's Final Fight” accounted for just 1 of 27 SC encounters in the MWU CVM curriculum, and only 19 students had the opportunity to practice this discussion. Ideally, every student should have the opportunity to work through an encounter that involves dissent within the veterinary team. Power differentials work both ways, such that veterinary educators would be wise to consider the insertion of colleague–subordinate encounters in addition to colleague–employer encounters. Disagreeing with an authority figure and disagreeing as an authority figure carry different communication challenges, and the new graduate can expect to encounter both in clinical practice.

Acts of animal cruelty violate the principle of animal welfare and induce suffering. Because veterinarians take an oath to protect animal welfare and alleviate suffering,1 they are professionally obligated and in some states legally required to report suspicious activity that may constitute animal cruelty.2 Yet compared with other public servants such as teachers and social workers, veterinarians are much less likely to report animal cruelty. Although 88% of veterinarians have suspected animal cruelty at least once in their professional career, only one-quarter of veterinarians have followed through with reporting.85 This lack of follow-through has been attributed to a perceived lack of training among veterinarians with regard to how to handle animal cruelty cases in clinical practice. To address this concern among graduates, veterinary educators are exploring ways to emphasize animal cruelty in the curriculum so that students learn how to navigate these situations before they arise in practice. “Grizabella's Final Fight” was an attempt by MWU CVM to reinforce course-based discussions about mandatory reporting in the State of Arizona through an SC encounter. The encounter also doubled as a real-world scenario for the student to practice conflict management and resolution with a team member who disagreed about reporting. Although “Grizabella's Final Fight” would benefit from refinement so that all students, rather than a select number, have the opportunity to experience the clinical scenario, it successfully opened the door to initiating dialogue about animal cruelty reporting even in the face of dissent within the veterinary team.

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