Volume 48 Issue 1, February 2021, pp. 33-47

Education in veterinary medicine, as in other allied health care–health science professions and academia in general, has been subject to the public call for accountability for the quality of its student learning outcomes. A principal stakeholder in veterinary medicine is the American Veterinary Medical Association–Council on Education (AVMA–COE). AVMA–COE has adopted program accreditation standards requiring veterinary colleges to provide evidence that they are measuring and assessing the clinical competency of students before graduation and again shortly after graduation. Schools and colleges are required to develop relevant measures to validate scientific knowledge, skills, and values aligned with North American Veterinary Medical Education Consortium (NAVMEC) core competencies. Beginning in May 2012, the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University modified the professional veterinary medical curriculum by including a required clinical rotation centered on veterinary emergency preparedness and response. A distinguishing major component of the instructional design of the clinical rotation includes Second Life, a commercially obtained computer-generated multi-user virtual simulation learning environment. The virtual reality situations require high-volume, mass-casualty medical triage decision making. The interpersonal communications and interactivity among students, faculty, and third-party actors enable faculty and instructor observers and simulation facilitators to evaluate students actively engaged in critical thinking and complex problem solving while demonstrating skill in the NAVMEC professional competencies. The Second Life virtual simulation has been adopted as a primary tool for direct measurement of student learning objectives outcomes achieved in this clinical rotation and is being implemented in other clinical teaching platforms.

In May 2012, the College of Veterinary Medicine and Biomedical Sciences (CVM) at Texas A&M University updated the curriculum for the fourth-year professional veterinary medical program to include a mandatory clinical rotation called Community Connections. This rotation was designed to be a composite of an animal shelter management practicum and a veterinary emergency preparedness and response practicum. The addition of the clinical rotation was in part an outcome of the experience gained by faculty, staff, and students who participated as part of the organized mobilization of Texas A&M veterinary medical assets during the 2011 Bastrop (TX) Complex wildfire. The fire’s scale was of record-setting proportions and has been described as the most destructive in Texas history. It enveloped more than 32,000 acres and destroyed more than 1,700 structures.1 The emergency medical treatment of burned animals was provided by the Texas A&M Veterinary Emergency Team (VET) over a 10-day period. The VET’s response was lauded by the many county and state agencies involved and specifically by the Texas Task Force 1 Urban Search and Rescue team for the support the VET provided for their working canines in the extreme conditions.

A second but no less significant reason for modifying the curriculum came from reading the personal reflection essays of fourth-year veterinary medical students that described the very positive experience and value added to their professional education as a result of being deployed with the VET during the response to the wildfires. Veterinary student comments included the realization that veterinarians working in private clinical practice needed basic training in how to help prepare themselves personally but also in how to protect their professional financial investment while serving their community as part of an emergency response effort on behalf of animals affected by a disaster.

In addition to these very profound experiential reasons, discussions between the CVM and the Texas Animal Health Commission were ongoing to consider reorganization and reassignment of responsibilities for oversight of the planning of companion animal evacuation and emergency sheltering operations mandated by both federal and Texas laws. In particular, the reorganization of emergency response pertaining to animals was preceded by the Robert T. Stafford Disaster Relief and Emergency Assistance Act (1988), as amended by the Pets Evacuation and Transportation Standards Act of 2006, and Texas House Bill 88, known as Simba’s Law.24 The amendments and changes required local governmental jurisdictions (i.e., city, county, regional) to construct plans and prepare response operations for the emergency evacuation and sheltering of companion animal household pets and service animals during periods of natural or man-made disasters.

The instructional design for the clinical rotation is framed with a systems-centered practicum that meets the characteristic description of problem-based learning in that it (a) possesses ill-structured, unresolved problems; (b) is student centered in the instructional approach; (c) is facilitated by instructors (faculty); and (d) is grounded in authentic problems requiring resolution that have real-world significance.57 The instructional design has two overarching student learning objectives: (a) development of the professional core competencies for veterinarians described by the North American Veterinary Medical Education Consortium (NAVMEC) by application of their unique education and problem-solving skills and (b) strengthening veterinarians’ future capability to assist their home communities through a better understanding of the emergency response system and through a proactive integration into the emergency response system before issues arise.8

Proactive integration includes participating in the construction of evacuation, large-scale emergency animal sheltering, and veterinary medical operations plans for Texas communities or counties. Experience has shown that veterinary input is critical to the success of emergency response plans. The clinical rotation in veterinary emergency preparedness and response is one of a dozen rotations designated as mandatory for graduation. Every clinical rotation for fourth-year students (i.e., elective for track, required for track, mandatory for graduation regardless of track) lasts 2 weeks, with every student completing a total of 24 clinical rotations. A detailed description of a typical clinical rotation for Community Connections—Veterinary Emergency Preparedness and Response is shown in Table 1.

Table

Table 1: Community Connections clinical rotation design for introducing a systems-based approach to emergency preparedness and response, by day and week

Table 1: Community Connections clinical rotation design for introducing a systems-based approach to emergency preparedness and response, by day and week

Week Monday Tuesday Wednesday Thursday Friday Saturday and Sunday
Week 1 (preparedness) Orientation
ICS review
VET overview
Creation of avatars for Second Life
Shelter 3:00–5:00 p.m.
Risk analysis
Personal and practice preparedness discussion
Introduction to city or county in which we are working on a project
Shelter 3:00–5:00 p.m.
Travel to county to meet officials
Tour facilities
Understand problems
Work on project; students divide into teams of 2 to work on specific sections Work on project, present draft to county officials (web)
Intro to S&R canines
Shelter 3:00–5:00 p.m.
Travel to disaster city to spend day working with TXTF1 US&R canines
Week 2 (response) Vets’ role in disaster response
Triage
Second Life training
Shelter 3:00–5:00 p.m.
Field triage
Euthanasia in disasters
Risk and disaster communications
Medical cache considerations
Shelter 3:00–5:00 p.m.
Second Life simulations Second Life simulation and review session(s) Second Life review
Shelter
Canine training if not on 1st weekend (only 1 training event or rotation)

Note: This is the current rotation design (this will change when VET deploys). Current rotation is 75% emergency preparedness and response and 25% shelter management and medicine. Rotation is 2 weeks (all 4th-year rotations are currently 2 weeks) and is required for all 4th-year veterinary students. Curricular revision is underway, which will make this rotation 100% emergency preparedness and response starting in 2019, and it may include a change in rotation length (under discussion for all rotations).

ICS = Incident Command System; VET = Veterinary Emergency Team; S&R = search and rescue; TXTF1 US&R = Texas A&M Task Force 1 Urban Search and Rescue.

The emergency preparedness and response clinical rotation still remains the first and only educational experience of its kind in veterinary colleges across the nation. As of May 2019 more than 1,000 Texas A&M veterinary students, including a small number of students each year from Ross University School of Veterinary Medicine (Basseterre, St. Kitts and Nevis, West Indies) and St. George’s University College of Veterinary Medicine (Grenada, West Indies), have graduated after completing the emergency preparedness and response rotation. The clinical rotation is both unique and innovative in its design, with the emphasis on preparation in the first week, and response in the second week (Table 1). The main component of instructional design during the first week includes practical application of critical thinking and problem solving through the development of an emergency plan for a local jurisdiction in Texas. On request of the local jurisdiction to the VET teaching team, the students on the clinical rotation, together with guidance from the instructors, develop a written plan customized to address the host jurisdiction’s needs, including (a) plans for a veterinary medical triage or treatment base of operations or (b) plans for the emergency evacuation of animals and emergency sheltering of household pets, livestock, or displaced pets as the result of a natural or man-made disaster. The veterinary students assemble the relevant needs assessment, collectively construct solutions or guidance to mitigate the problem conditions, and write the plan to an established planning standard, based on county or state format standards.

During the second week of the required rotation, the focus becomes the veterinarian’s role in response. A popular computer-based multi-user virtual learning environment (MUVE), Second Life (Linden Laboratories, San Francisco, CA), was selected to create an innovative learning environment for this aspect of the rotation. The choice of Second Life was made in part because it has an established record of being able to provide the prerequisite virtual environment, enabling a robust interactivity between students and between students and faculty,9 and it had been reported elsewhere to be a chosen medium for delivery of instruction to nursing students in human health care systems grounded in problem-based learning concepts, including communication (sight, verbal, text), collaboration, real-life problem solving, and motivation.10

The Second Life scenario developed for the veterinary emergency response clinical rotation was custom designed to replicate a pair of recent natural disasters for which access to actual case material was available, one that was hurricane centered (Hurricane Ike, Texas coast, in 2008) and one that was tornado centered (Moore, OK, tornado in 2013). The case material was provided by the VET teaching team to a programmer and a designer with Second Life experience who were contracted to build the virtual world disaster scenario (from pictures), the avatars (instructors and actors), and the animal avatars (the animals affected by the disaster itself).

In the virtual disaster simulation, the veterinary students assume an avatar character personage that enables each student to interact with others and the animal avatars. On entering the simulation, the students in their avatar form are organized by the teaching team into small strike teams (three to four students per team) with a mission objective of providing an emergency response field assessment of the physical hazards remaining 24 hours post-disaster. The students self-assign a team leader, a team media person, and a team medical records person, and they further organize themselves to meet the demands of the mission they are given. Different locations and conditions scripted in the simulation call for complex problem-solving skills on both an individual and a collective team basis.

Problem sets the students encounter during the simulation include:

  • medical problems for multiple species in both the base of operations and field situations;

  • personal conflict interactions of multiple types and complexities;

  • ethical dilemmas;

  • medical triage of companion animals and livestock, including making life-or-death decisions;

  • medical treatment of both companion animals and livestock with a basic medical cache and minimal diagnostic capability;

  • determining the most appropriate place to transfer animals for care given minimal advanced care (hospitalization) options; and

  • making critical decisions about animal welfare that include euthanasia as an end point.11

Throughout the exercise, the veterinary students are subject to being engaged by third-party character avatars that have been pre-scripted to enter the scene and present new conditions or exacerbate the current conditions by adding human element variables represented by emotion, misinformation, challenges to authority, sociocultural conflict, and moral or ethical conflicts (Table 2).

Table

Table 2. Instructor guide to variables that affect the assessment of verbal interactions and communication

Table 2. Instructor guide to variables that affect the assessment of verbal interactions and communication

Voice Emotion Attitude Characterization Outcome
Context Depressed Determined Inquiring Understanding
Detail Anxious Obstinate Situationally aware Compassionate
Emphasis Hysterical Resistant Leadership presence Caring
Volume Angry Cooperative Conflict arbitrator Empathetic
Enunciation Apathetic Agreeable Respectful Remorseful
Pitch Exciting Pleasant Problem solver Guiding
Clarity Calming Detached Laggard Problem resolved
Encouraging Uncaring Role self-identity
Reassuring Argumentative Uninformed

Note: This table is used as a guide for the instructor in assessing students’ responses to the scripted avatar actor interactions in the Second Life disaster simulation. These variables are used in a rubric developed to give a scaled grade (Appendix 2 shows a portion of the grading rubric relevant to the Second Life aspect of the rotation grade).

The adoption and use of MUVEs as instructional tools has been reported with increasing frequency across a range of disciplines and professions that traditionally require teamwork, decision making, critical thinking, and complex problem solving, particularly those professional competencies routinely encountered in engineering, medicine, and veterinary medicine.10,12 This specific technology has been in use for training veterinary students at Texas A&M since the inception of the required clinical rotation in veterinary emergency preparedness and response in 2012.

The virtual learning environment Second Life provides a platform that enables interactive problem-based learning using sight, voice, and text communication between and among students, faculty, and scripted actors. The situational landscape for the veterinary medical simulation used at Texas A&M has been designed to present integrated complex problems that have medical, physical hazards, or human sociocultural-based origins. The students enter the virtual disaster environment in avatar form. They become the primary problem solvers and decision makers responsible for the resolution, mitigation, or containment of the adverse conditions with which they are presented. The collective assembly of Second Life program functions (i.e., sight, voice, text) and student avatar group interactivity establishes the conditions that have been described as the framework of the community of inquiry in which the concepts of reflection and critical thinking are advanced with online learning.9

Students are assigned to teams and required to operate as a member of a team at all times. There are fundamental reasons that justify the team concept; two of the principal reasons are that (a) requiring students to function in teams reinforces the operational concerns that shape real-life practices, procedures, techniques, and tactics adopted for teams deployed during an emergency response and (b) teams naturally stimulate the interactive exchange of ideas and problem analysis between members. The vocal interaction between team members is a desired dynamic that helps to reinforce the pedagogical concepts of problem-based learning, especially because students are required to accept or accommodate the views or opinions of another while attempting to present a plausible understanding of their own opinion.5

Student teams average three members but may occasionally have as few as two or as many as four members. No team will ever exceed four members regardless of the total number of students assigned to a clinical rotation. This limitation on team size is an instructional management tool intended to prevent the inadvertent exclusion of a student or students from the main topic or primary problem under consideration in a particular scenario. Team leaders are generally self-determined by the students but may occasionally be appointed by the faculty to encourage leadership opportunities for students who may not readily self-assign this role. The leaders are expected to manage and assume accountability for all decisions made and for new responsibilities assigned.12

During the simulation play, the two strike teams are actively engaged in the simulation simultaneously. Each team is separated by location and duties or mission objectives that are organized along large animal and companion animal species lines. Each student-led strike team, on direction of the faculty, will move between locations within the simulation to complete the medical triage and initiate emergency care for separate animal species (Table 3). The large animal team conducts medical assessments, triage, and treatment of primarily livestock and horses in field conditions (they may or may not be contained, may or may not be easily accessible, and may or may not be in safe conditions for care), in contrast to the companion animal team, who occupies temporary medical facilities providing medical triage and treatment of animals presented to the facility, termed the base of operations (tents set up as medical facilities).

Table

Table 3. Presentation of sim problems by sequencing of period and location

Table 3. Presentation of sim problems by sequencing of period and location

Period (2–2.5 hr/location in sim) Base of operations (companion animals) Field operations (FA, equine, livestock)
Period 1 (typically morning, but can be any 3 hr time slot) Strike Team 1 (2–4 students) Strike Team 2 (2–4 students)
Period 2 (typically afternoon, but can be next day; again a 3 hr slot) Strike Team 2 Strike Team 1

Note: This table demonstrates a typical presentation plan for the Second Life simulation. The 4th-year students enter the sim at either the base or in the field and work the problems in that location for 2–2.5 hr (maximum time in sim). Then a break occurs, followed by a switch in roles to enter the other aspect of the simulation. During the break, the sim work from the 1st period is collected and downloaded, the sim is reset, and all students change roles. All students work the same cases but in a different sequence, under different avatar actor circumstances, and with different roles.

sim = simulation; FA = food animal

The majority of the medical problems are re-created for the simulation by case material presented to the teaching team by veterinarians who experienced the disaster in real life. The medical problems (medical cases) are presented through avatar animals that have been linked in the program to a heads-up display (HUD) electronic clipboard that shows a photo of the actual animal and the medical condition that must be assessed and triaged. Treatment decisions are then made on the basis of the limited time and basic physical exam data available. Along with the photo of the affected animal, students are able to view patient information in the form of signalment, vital signs, and a description of the medical problem or, if available, the situation that was briefed to the first responders (Figure 1).

Figure 1: Screen image of inside the base of operations tent showing an avatar person, an avatar dog, and the HUDs for the patient problem and the medical cache used for treatment of the patient.

A second electronic clipboard allows the student to view and select categories of triage (minor, green; urgent, yellow; immediate or critical, red; and expectant or dying, black), determine medical supplies on hand, prescribe or outline a course of action, and issue treatment instructions (Figure 1, Figure 2). The decision pathway includes final dispositions in the form of medical evacuation to a facility offering a higher level of care (the number of these is variable and can be adjusted according to the situation at hand), treatment and evacuation to a shelter, or euthanasia. Treatment notes and medical decisions are saved and reviewed in clinical rounds by students and faculty during a post-simulation after-action review. The virtual environment simulation was designed with a sufficient number of cases in companion animal, equine, and bovine species such that each team is able to spend at least 2 hours in each species group location. Each simulation exercise for a student rotation group is a scheduled activity that normally requires an average of 8 hours to complete (including prep, avatar scheduling, and action in the simulations) and another 4–6 hours for the review sessions for each species or location.

Figure 2: Screen image of the field team at a site where one of the equine avatars is being examined by the avatar person. The HUDs are showing the injury on the left and the medical HUD for selection of the treatment options from the cache.

Faculty are given opportunity to observe and assess the students demonstrating skill and strength of the NAVMEC competencies (leadership, interpersonal communication, collaboration, management [team, system, self], life-long learning, diversity and multicultural awareness, public health and one-health knowledge, multi-species clinical expertise, and adapting to changing environments) as a result of the personal interactivity that is constantly ongoing between veterinary student avatars or between veterinary student avatars and third-person non-veterinary avatars.13 The third-person non-veterinary avatar actors initiate the situation for a selected NAVMEC competency that requires problem solving or decision making by a student.

The behavior-based competencies expectedly receive broad subjective interpretation and qualification in the grading of the strength of personal attributes—conditions that are not recordable or measurable with the HUD technology. The need to account for the variance associated with grader subjectivity resulted in the adoption of qualitative-methods-based assessment measures to assess the learning outcomes. The use of the avatar actors, development of competency-centered objectives and scripts, and the development of grading rubrics have become the primary tools enabling standardization of the assessment of the NAVMEC competencies (see Appendices 1 and 2). Overall, the qualitative metric is based on four core conditions:

  1. Context: The actors must come together as a result of a purpose or need that has content relevance within the scope of a larger problem requiring resolution. For example, a veterinary student avatar in a leadership position managing two other team members is trying to medically triage a large number of injured animals and is unexpectedly confronted by a frantic search-and-rescue (S&R) dog handler presenting a critically distressed search dog. Within seconds, the veterinary student is also confronted by the owner of a critically injured dog just rescued from the disaster scene by that owner and who is similarly only concerned with receiving immediate care for their pet. In this scenario, the NAVMEC competency outcome objective is management centered (team, system, self), and the assessment is measuring the veterinary student’s competency in gaining control of a very stressful situation, reassigning priorities and managing the medical assets available, delegating appropriate authority with commensurate responsibility to the other team members to help resolve the medical problems that were introduced by S&R dog handler and the private animal owner, and communicating instructions to the team along with information and reassurance to the handler and the owner of the dogs. Clear scripting allows evaluation of the veterinary student’s response to the problem because the problem is presented in the context of the NAVMEC competencies. The larger problem should realistically exist with its own need for resolution.7

  2. Stated objective outcomes: Interactivity between avatar characters starts from a scripted point of origin that is grounded in a specific NAVMEC professional competency (i.e., management, collaboration, leadership). The scripting is intended to eliminate or prevent a random event creating distractions within the virtual simulation. The avatar actors are given an overview of the scripted situation before their entry into the scene to enable them to mentally identify with and assimilate their character with the same conditions that the veterinary student avatar is being required to adapt to in the simulation. The scripted notes provide the avatar actor with the situation overview, the expected avatar interaction, identification of the primary objective and description of the effect that the avatar actor is expected to have on the behavior of the veterinary student avatar in that specific interactive moment, and guidance for assessing the outcome of the veterinary student’s response or behavior resulting from the interaction with the avatar actor. Once the scripted interaction is initiated, the faculty who have oversight of the scene may communicate using instant messaging text options to direct the actor with follow-on questions or prompt changes in character emotions in an effort to alter the situational conditions in which the veterinary student avatar must operate. Instant messaging group texts are a highly relied-on and versatile tool used by faculty and instructors to advance the scripted interactions that occur between avatar actors and veterinary student avatars. This allows the teaching team, typically Dr. Bissett in the field, Dr. Zoran at the base of operations, and Dr. Espitia in simulation as the avatar actor manager, to have situational awareness of the scene that is being generated.

  3. Standard: An assessment standard to rate the outcome must be agreed on and accepted among the faculty who facilitate the simulation. The required clinical rotation at Texas A&M has developed (and continues to develop) a grading rubric that is aligned with the NAVMEC professional competencies, the clinical rotation syllabus, and the curriculum map for the fourth-year professional veterinary medical program learning outcomes objectives.

  4. Reflective thinking (after-action review; AAR): The reflective thinking or AAR review is a standard process that follows each simulation exercise session. This activity closes the loop for feedback to students with time prioritized exclusively for collective self-examination of their problem-solving and decision-making process, and it provides similar feedback to the faculty with critical review of instructional design, student achievement of learning objectives, and strategies for going forward.5,7 The first simulation session AAR will normally focus on the use of the technology and identification of any problems with technology that may have occurred and caused disruption or interference with the intended exercise. In conjunction with the review of the technology, questions and discussion will also include the review of the veterinary students’ understanding and application of the basic operational components associated with effective command and control of team elements in an austere disaster-precipitated environment. After the final session, the AAR will once again review the technology and operational command and control applications and will then proceed to review in depth the clinical medical problems, the medical decision making and treatments, and the individual interactions exhibiting the NAVMEC competencies that were experienced during the simulation. The AAR is normally performed in a dedicated session that lasts an average of 3 hours, with all students participating and being encouraged to offer opinions or alternative courses of action for each problem being reviewed.

The objective of this article was to present an overview of innovative instructional design for a required clinical rotation in veterinary emergency preparedness and disaster response for fourth -year veterinary medical students at Texas A&M University and to describe the design method for assessing student learning outcomes in the NAVMEC grounded professional veterinary medical competencies. Complex systems-centered problem-based learning forms the core of the instructional design, with the MUVE serving as a mainstay for the delivery of instruction. Actual situations and problems experienced by responders during natural and industrial disasters provide authenticity and lend support to construct validity. The foundation for the assessment of student skill in the identified NAVMEC competencies is framed with the interactions between actor avatars and veterinary student avatars in the MUVE.

The return on a modest investment in Second Life as an instructional platform has been affirmed many times over the past 5 years, with the most recent affirmation received in September 2017 during the response to Hurricane Harvey. A former faculty member of the VET reported after returning from a mission to assist with the emergency evacuation of animals that they found themselves in a situation reminiscent of a scripted scenario presented in the Second Life simulation, and their response to the situation was improved by having had the prior simulated experience. Each rotation, the members of the teaching team are reinforced in the power of this simple but powerful platform by observing the student interactions (both positive and negative) in both medical and communications scenarios and by watching students grow in their ability to work in teams, make decisions in the absence of certainty, develop a confident voice in communicating with others, and demonstrate empathy and compassion during very stressful circumstances. We look forward to developing new simulation scenarios and to developing this simulation (currently a work in progress) to allow students to practice exam room communication and problem-solving skills.

1. Texas Parks & Wildlife Department. “Life after the wildfire: the future of the Bastrop State Park” [Internet]. Austin (TX): The Department; 2011 Sept 4. Available from: https://tpwd.texas.gov/spdest/findadest/parks/bastrop/fire. Google Scholar
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Grading Rubric for Emergency Management Aspect of Community Connections Rotation

This rubric is only a portion of the entire grading rubric for the rotation because the portions for the planning and shelter aspects are not included.

General Comments for Student: This section allows instructors to individualize comments for each student.

Table

NGO 6: emergency and intensive care case management

NGO 6: emergency and intensive care case management

Score % of grade Rating Suggested comments Dimension comments
- 15

Excellent

Satisfactory

Needs improvement

Unsatisfactory

Excellent:

  1. Student can perform rapid, efficient examination and perform triage for an emergency patient in a disaster setting without assistance or guidance.

  2. Student confidently recognizes patients requiring immediate vs. delayed care.

  3. Student can accurately and independently create and implement an appropriate therapeutic plan for a patient in a disaster setting.

Satisfactory:

  1. Student is capable of performing an examination or triaging an emergent patient but may require faculty assistance in a disaster setting and lacks confidence to perform without assistance.

  2. Student is able to complete a treatment plan for an emergent patient in a disaster setting without faculty support in most cases.

  3. Student can recognize patients requiring immediate vs. delayed care in a disaster setting in most cases.

Needs improvement:

  1. Student requires faculty assistance to triage a patient in a disaster setting or needs improvement in completing an examination on an emergent patient in a disaster setting.

  2. Student needs improvement in recognizing patients requiring immediate or delayed care in a disaster setting.

  3. Student inconsistently demonstrates knowledge of basic medical therapy and requires faculty support or encouragement to create a therapeutic plan for a patient in a disaster setting.

Unsatisfactory:

  1. Student is unable to properly examine or triage an emergent patient in a disaster setting even with faculty guidance.

  2. Student is unable to recognize or provide care for a patient in a disaster setting requiring immediate vs. delayed care.

  3. Student lacks the knowledge to discuss basic principles of medical therapy or to create a basic therapeutic plan for an emergency patient in a disaster setting.

Table

NGO 8: communication, ethical conduct, and professional behavior

NGO 8: communication, ethical conduct, and professional behavior

Score % of grade Rating Suggested comments Dimension comments
- 20

Excellent

Satisfactory

Needs improvement

Unsatisfactory

Excellent:

  1. Student is an articulate, succinct, and confident communicator.

  2. Student demonstrates a high level of professional confidence and the ability to self-reflect to improve professional performance.

  3. Student is highly effective through verbal communication.

  4. Student clearly possesses empathy, which is easily demonstrated in interactions with clients or others.

  5. Student demonstrates extraordinary collegiality and willingness to assist colleagues with patient care.

  6. Student displays professional demeanor, punctuality, and attire at all times.

Satisfactory:

  1. Student demonstrates acceptable communication skills but will benefit from experience.

  2. Student clearly demonstrates growing professional confidence and the ability to self-reflect to improve professional success.

  3. Student demonstrates good verbal communication skills.

  4. Student demonstrates empathy for clients in most situations.

  5. Student is collegial and volunteers to assist colleagues with patient care on some occasions.

  6. Student demonstrates acceptable professional demeanor, punctuality, and/or attire in most situations.

Needs improvement:

  1. Student needs improvement in communication skills and additional experience to become a more effective communicator.

  2. Student inconsistently demonstrates an appropriate level of professional confidence and needs improvement in the ability to self-reflect to improve performance.

  3. Student needs improvement in verbal communication skills to become an effective communicator.

  4. Student fails to consistently demonstrate appropriate empathy for clients or others.

  5. Student fails to demonstrate collegiality and will assist colleagues only when asked.

  6. Student lacks consistent demonstration of professional demeanor, punctuality, or attire.

Unsatisfactory:

  1. Student demonstrates an unacceptable level of client communication skills and will require considerable experience to improve skills to an appropriate level.

  2. Student lacks professional confidence and is unable to self-reflect to improve personal performance.

  3. Student demonstrates unacceptable verbal communication skills.

  4. Student lacks the ability to demonstrate empathy for patients.

  5. Student refuses to provide collegial support or assist colleagues.

  6. Student routinely fails to demonstrate professional demeanor, punctuality, and/or attire.

Table

NGO 10: team collaboration, leadership, and practice management

NGO 10: team collaboration, leadership, and practice management

Score % of grade Rating Suggested comments Dimension comments
20

Excellent

Satisfactory

Needs improvement

Unsatisfactory

Excellent:

  1. Student interacts in an enthusiastic and highly effective manner with all members of the health care team.

  2. Student seeks opportunities for leadership and acts as a role model for colleagues through strong leadership skills.

  3. Student works extremely well under pressure, maintains work ethic, and manages stressful situations with ease.

  4. Student willingly works autonomously and clearly accepts personal responsibility.

  5. Student demonstrates strong understanding of practice management principles and works with others to share this knowledge.

Satisfactory:

  1. Student interacts in a positive manner with most members of the health care team.

  2. Student can perform as a leader and willingly accepts the leadership role if it arises.

  3. Student can maintain work ethic under pressure with minimal personal stress.

  4. Student is able to work autonomously when necessary and is capable of accepting personal responsibility.

  5. Student demonstrates an appropriate understanding of practice management principles.

Needs improvement:

  1. Student fails to consistently interact in a positive manner with members of the health care team.

  2. Student lacks strong leadership skills and will assume a leadership role only when prompted by clinician.

  3. Student fails to consistently maintain work ethic under the pressure of basic case management and is easily stressed when in intense situations.

  4. Student is uncomfortable working autonomously and fails to consistently accept personal responsibility.

  5. Student needs improvement in understanding basic practice management principles.

Unsatisfactory:

  1. Student is unable to positively interact with members of the health care team.

  2. Student demonstrates poor leadership skills, avoids leadership opportunities, and appears uncomfortable assuming a leadership role.

  3. Student fails to maintain work ethic under pressure and displays negative behaviors and clear signs of stress under the pressure of basic case management.

  4. Student is unable to work autonomously or accept personal responsibility.

  5. Student demonstrates poor understanding of practice management principles.

Table

NGO 11: multicultural awareness and self-management

NGO 11: multicultural awareness and self-management

Score % of grade Rating Suggested comments Dimension comments
15

Excellent

Satisfactory

Needs improvement

Unsatisfactory

Excellent:

  1. Student explores and embraces the diversity and cultural differences of fellow students, instructors, and the community.

  2. Student demonstrates a high level of cultural competence and communicates with exceptional cultural sensitivity.

  3. Student is highly organized and demonstrates effective management of personal time, resources, and work assignments.

Satisfactory:

  1. Student demonstrates acceptance of the diversity and cultural differences of fellow students, instructors, and community.

  2. Student demonstrates cultural competence and communicates with acceptable cultural sensitivity.

  3. Student demonstrates acceptable organizational skills and management of personal time, resources, and work assignments.

Needs improvement:

  1. Student requires prompting but is able to acknowledge diversity and cultural differences of fellow students, instructors, and community.

  2. Student requires encouragement to demonstrate cultural competence and to communicate cultural sensitivity.

  3. Student needs improvement in both organizational and personal management skills.

Unsatisfactory:

  1. Student demonstrates a lack of acceptance of the diversity or cultural differences of fellow students, instructors, or community.

  2. Student lacks understanding of cultural competence and fails to communicate with cultural sensitivity despite instructor encouragement.

  3. Student demonstrates poor organizational skills and lacks appropriate management of personal time, resources, or assignments.

Table

NGO 13: animal welfare

NGO 13: animal welfare

Score % of grade Rating Suggested comments Dimension comments
15

Excellent

Satisfactory

Needs improvement

Unsatisfactory

Excellent:

  1. Student effectively and consistently applies knowledge of animal behavior to improve safety of the patient and health care team.

  2. Student clearly recognizes when euthanasia is an appropriate option for a patient and can clearly discuss principles of euthanasia.

  3. Student effectively addresses client grief regarding euthanasia without clinician prompting.

Satisfactory:

  1. Student is able to demonstrate knowledge of animal behavior to improve safety of the patient and team in most situations.

  2. Student recognizes when euthanasia is an appropriate option for most patients.

  3. Student is able to manage client grief but may require clinician prompting to initiate support.

Needs improvement:

  1. Student demonstrates inconsistent knowledge of animal behavior and needs improvement in selection of appropriate restraint methods.

  2. Student fails to recognize euthanasia as an appropriate option for a patient but may be able to discuss the principles of euthanasia.

  3. Student fails to demonstrate appropriate mechanisms for mediating client grief unless prompted by clinician.

Unsatisfactory:

  1. Student demonstrates inappropriate knowledge of animal behavior or consistently makes poor selections for appropriate restraint mechanisms for patients.

  2. Student is unable to recognize when euthanasia is an appropriate option for a patient and is unable to discuss the principles of euthanasia.

  3. Student fails to provide or initiate management of client grief even with clinician prompting.

Note: This grading rubric is used to assess student’s work for the entire rotation, so some elements are not relevant to the Second Life/disaster response portion, and those elements have been removed for purposes of this document.

NGO = non-governmental organization (or charitable organization)

Scripted Notes: Second Life Avatar Actor Interactions

This appendix contains several examples of scripted notes for the use of avatar actors in the assessment of veterinary student performance and competencies in the Second Life simulation.

Location 1: Equine pasture with approximately 24 horses post-tornado

North American Veterinary Medical Education Consortium (NAVMEC) Professional Competency: Collaboration

Situation: Veterinary students assigned to a field strike team have been directed to enter the pasture and begin assessing the health condition of the horses that have survived the tornado. The strike team must rapidly begin assigning triage classifications and making medical decisions for treatment or euthanasia that are consistent with the initial assessments.

Avatar Interactions: Avatar BlueBlitzen should enter the field without waiting for an invitation or without waiting for a directed signal indicating that it is okay to advance forward by any of the strike team members. BlueBlitzen should attempt to engage the strike team members while they are grouped and immediately through conversation and questions try to capture the attention or redirect the attention of the strike team members. BlueBlitzen should be insistent that the strike team member direct attention to her questions and need for assistance. BlueBlitzen’s stated reason for being in the field and requesting assistance is that her horse, which was located in another pasture before the tornado, is missing and presumed to be somewhere close by and assumed to be injured (BlueBlitzen will at first be requesting but, if not immediately satisfied, becomes more demanding). BlueBlitzen should direct questions and needs for all sorts of information to the strike team member and remain engaged one on one with the strike team member for as long as that individual allows her- or himself to be distracted from responsibility for medically assessing and triaging horses. BlueBlitzen should attempt to bring the other members into the conversation and cause others to be taken off their objective if possible using any mix of conversation redirection questions, requests for help in finding the missing horse, and demanding they leave their primary objective and take on the new objective. BlueBlitzen should be insistent, may be coy, and could appear helpless and hapless at the same time.

Objective: The primary objective is to cause the strike team member to regroup or reorganize her or his work plan (testing the member’s collaboration and reassigning the member’s roles to handle the primary objective and deal with the demands of BlueBlitzen) and cause the strike team leader to redirect her or his efforts and attempt to solve both problems. If at all possible, BlueBlitzen should attempt to convince the strike team member to leave the horse pasture and go to another pasture to search for her horse (the other pasture doesn’t exist, so BlueBlitzen should be prepared to act without knowledge of the location but still be convincing enough to lead a team member off the objective).

Veterinary Student Assessment Outcomes: BlueBlitzen should observe the strike team member’s response to try to determine what verbal communication skills were applied to convince BlueBlitzen that she should leave the area or that help would best be obtained from another source. BlueBlitzen should be watching for cues that indicate that the strike team member was concerned for her (showed compassion for BlueBlitzen and her horse) but at the same time communicated individual and team discipline and command of the situation with respect to fulfilling the mission that the strike team was dispatched to complete. BlueBlitzen should be able to recognize that the strike team member was professional and respectful of a person in distress and offered helpful guidance in directing BlueBlitzen to the proper location for requesting help from someone other than the strike team, while at the same time controlling the conversation and communicating effectively that assessing and triaging the horses remained the mission priority. In the second part of the assessment, BlueBlitzen should watch for cues or clues that the strike team member gave instructions to the team to continue with their work while BlueBlitzen’s personal needs were being addressed. BlueBlitzen should listen to the conversations that may take place between the strike team members to ascertain whether the members added rational suggestions or presented helpful information to BlueBlitzen.

Location 2: Treatment tent at the base of operations

NAVMEC Professional Competency: Professional Leadership and Ethics

Situation: Veterinary students assigned to the base of operations treatment and triage units will be assessing and treating companion animals and search and rescue dogs that have been admitted as patients under emergency conditions. The veterinary students are expected to provide emergency service in a directed team effort to efficiently and accurately assess conditions and prioritize treatment under rapidly changing conditions.

Avatar Interactions: Avatar BlueBlitzen should enter one of the tents without waiting for an invitation or without waiting for a directed signal indicating that it is okay to advance forward by any of the strike team members. BlueBlitzen should at first wander in the tent without an identified purpose or without attempting to engage in conversation with any of the attending veterinary students; the initial purpose is to determine how long it takes before a challenge or inquiry regarding need is issued by one of the veterinary students. Once contact or communication is made, BlueBlitzen should state that she was told (but not say who told her) that she should seek help from someone in charge at the base of operations to obtain help with determining the location and condition of her dog. BlueBlitzen should appear distraught and upset that no one seems to care about her dog and no one seems to be taking responsibility for addressing her needs. At this point, the objective for BlueBlitzen will be to draw a declaration from any of the students identifying who is the team leader and then engaging the identified leader in a series of questions about the management of the triage operation such that the veterinary student becomes preoccupied with BlueBlitzen and must double task to accommodate BlueBlitzen while managing the flow of patient treatment and transfer between the triage tent and the treatment tent. Once interaction between BlueBlitzen and the team leader has been opened, BlueBlitzen should begin changing her course of conversation away from the dog she is seeking information about and begin instead to trying to get a second dog vaccinated and checked for a suspected infection and refill of antibiotics, previously prescribed by her family veterinarian, that she does not want to pay for. This type of back-and-forth interaction should continue until a mutually agreeable resolution is reached or until a directed course of action is presented by the team leader that puts an end to the discussion. BlueBlitzen should allow herself to be directed or coaxed away from the treatment tent when the conditions indicate that the team leader has command of her or his responsibilities and provides clear instruction regarding what BlueBlitzen should do to help solve her two stated conditions or problems.

Objective: The primary objective is to determine how quickly the leadership at the base of operations reveals itself through their own assumption of responsibility (i.e., do the veterinary students know and do they assume responsibility). The secondary objective is to determine whether the leadership is able to manage multitasking responsibility and whether the leadership responds correctly by denying requests for professional services that suggest unethical or professionally unacceptable conduct (agreeing to dispense prescription drugs without having examined an animal).

Veterinary Student Assessment Outcomes: BlueBlitzen should observe the response of the base of operations team leader to ascertain how quickly she or he self-identified and how the team leader asserted control of the situation. The team leader should also be assessed on how well she or he retained control of the competing multitask role responsibilities for managing the other team members while responding to requests for free veterinary services for an uninjured, privately owned dog that is not being seen by the emergency response team.

Location 3: Equine pasture with approximately 24 horses post-tornado.

NAVMEC Professional Competency: Communication

Situation: Veterinary students assigned to a field strike team have been directed to enter the pasture and begin assessing the health condition of the horses that have survived the tornado. The strike team must rapidly begin assigning triage classifications and making medical decisions for treatment or euthanasia that are consistent with the initial assessments.

Avatar Interactions: Avatar BlueBlitzen should enter the field without waiting for an invitation or without waiting for a directed signal indicating that it is okay to advance forward by any of the strike team members. BlueBlitzen should attempt to engage one of the strike team members who seems to be least involved with the field medical assessment (i.e., no visible signal of talking about the case or appears to be standing farther back from or aside of the other team members) and immediately through conversation and questions try to capture the attention or redirect the attention of that strike team member. BlueBlitzen should be insistent that the strike team member direct attention to her questions and needs for assistance. BlueBlitzen’s stated reason for being in the field and requesting assistance is that her horse is missing and presumed to be somewhere close by, possibly injured (BlueBlitzen will at first be requesting but, if not immediately satisfied, then becomes more demanding). BlueBlitzen should direct questions and needs for all sorts of secondary information concerning veterinary treatment (i.e., who is responsible for payment or are services free, can routine medical services be obtained for wellness checks) to the strike team member and remain engaged one on one with the strike team member for as long as the individual allows her- or himself to be distracted from responsibility for medically assessing and triaging horses. BlueBlitzen should attempt to bring the other members into the conversation and cause others to be taken off their objective if possible using any mix of conversation redirection questions, requests for help in finding the missing horse, and demanding that they leave their primary objective and take on the new objective. BlueBlitzen should be insistent, may be coy, and could appear helpless and hapless at the same time.

Objective: The primary objective is to cause the strike team member to disengage from participating in the medical assessment of the horse and redirect her or his efforts to fulfill constructive objective-driven tasks. If at all possible, BlueBlitzen should attempt to convince the strike team member to leave the horse pasture and go the residential disaster zone to search for the missing horse.

Veterinary Student Assessment Outcomes: BlueBlitzen should observe the strike team member’s response to try to determine what verbal communication skills were applied to convince BlueBlitzen that she should leave the area or that help would best be obtained from another source. BlueBlitzen should be watching for cues that indicate that the strike team member was concerned for her (showed compassion for BlueBlitzen and her horse while responding to the secondary series of questions and concerns) but at the same time communicated individual and team discipline and command of the situation with respect to fulfilling the mission that the strike team was dispatched to complete. BlueBlitzen should be able to recognize that the strike team member was professional and respectful of a person in distress and offered helpful guidance in directing BlueBlitzen to the proper location for requesting help from someone other than the strike team, while at the same time controlling the conversation and communicating effectively that assessing and triaging the horses remained the mission priority.