Catching up with communication

For three decades, researchers and educators in the medical profession have been studying medical communication, and it is becoming a key issue in assessment and licensing of physicians.

The veterinary profession has not kept pace with the medical profession in cultivating communication skills. But a new initiative is under way.

As a new veterinarian practicing companion animal medicine in northern New Jersey in 1994, Dr. Jane Shaw realized she lacked some of the skills she needed to meet the demands of her job. What she struggled with most were delicate client interactions—such as euthanasia of a pet, or client frustration or anger over a medical outcome.

After a period on the Cornell University faculty, Dr. Shaw went on to complete her PhD degree in epidemiology at the Ontario Veterinary College, University of Guelph, writing her thesis on "Communication Skills and the Veterinarian-Client-Patient Relationship." This past May, she joined the Western University of Health Sciences College of Veterinary Medicine as an assistant professor of epidemiology.

At OVC, Dr. Shaw's graduate adviser was Cindy Adams, PhD, an epidemiologist with a social work background. While Dr. Shaw was collecting information from general practitioners for her communication thesis, Dr. Adams was developing a communication module that was integrated into all four years of the veterinary curriculum at OVC.

After Dr. Shaw's thesis was ready for publication and Dr. Adams had completed development of the module, they turned their attention to another goal—assembling other stakeholders doing work in communication, to form a support network.

The medical profession has held communication conferences for years. In 2002, Drs. Shaw and Adams attended the one in Warwick, England. "Some of the communication issues in human medicine can be extrapolated or have a nice generalization to veterinary medicine," Dr. Shaw said, "but there are a lot of things that are different about our profession—such as the fact that our patients are animals, the human/animal bond, the fact that it's out-of-pocket expenses, and the issues around euthanasia. We felt that we needed a conference of our own."

The First International Conference on Communication in Veterinary Medicine was held June 13-16 in Ontario, Canada. Dr. Adams was the chairperson, and members of the steering committee were Dr. Shaw; Suzanne Kurtz, PhD, University of Calgary Faculties of Education and Medicine; Dr. John Tait, OVC; and Donal Walsh, PhD, University of California-Davis. They say it is the first conference on medical communication in veterinary medicine to be held anywhere in the world.

The conference incorporated adult learning techniques to create an active, experiential learning environment for veterinarians attending the practice, education, and research workshops. The objective was twofold. First was to provide a continuing education environment for veterinary practitioners and tools they could use in their practices. Second was to provide educators from industry, organized veterinary medicine, and veterinary colleges with skills to build educational programs for veterinary students.

Veterinary communication is much broader than just communicating with clients, Dr. Shaw noted. Veterinarians communicate with colleagues when referring a case, having a telephone consultation, or using telemedicine. They offer educational programs and conduct community service activities through their practices. They make presentations to school and civic groups, and make media appearances. "The toolbox can be generalized to many situations to be an effective communicator," she said.

There were three keynote speakers. Dr. Tait spoke to the practitioners, Dr. Kurtz to the educators, and Richard Frankel, PhD, of Indiana University School of Medicine, to the researchers.

About 145 people attended the first conference, including representatives from Australia and England. Practitioners constituted the largest group, followed by educators and then researchers. To Dr. Adams, merging those three areas is of utmost importance.

"Whereas practitioners tend to move together into various meetings, here they were chatting with the educators and having an impact on some of the thinking around what students need to learn to be better prepared for practice," Dr. Adams noted. "They really liked that, and vice versa—educators hearing what practitioners' challenges are, and then how they consider that in teaching in the curriculum."

Dr. Shaw said, "The reason for the phenomenal response is that many of us have been working in vacuums." At the conference, they met counterparts with whom they can exchange ideas, collaborate on projects, and identify existing resources. They also received a validation of support for the work they're doing.

"We had a number of researchers from human medicine that have been working alongside Jane and me in our efforts," Dr. Adams said, "so they're keen to see how we develop in our profession."

Dr. Adams is often invited to speak at medical conferences to share aspects of communication that have been peculiar to veterinary medicine. At the medical communication conference in Brugge, Belgium, this past September, she was asked to talk about euthanasia. If human euthanasia is legalized in Belgium and the Netherlands, the medical community is concerned about patient communication and other challenges.

They hope to make the conference an annual event, and to alternate locations to maximize the international facet. In 2005, there are tentative plans to return to Ontario. In 2006 it may be held in England, and in 2007, the United States.

Other possibilities were discussed during a forum at the end of the conference. Among the ideas suggested were creating a listserv, establishing a communication organization, developing a communication journal, and forming collaborations for developing educational programs and conducting research.

One project that is moving forward is a compilation of papers from the conference. Dr. Walsh, editor of the Journal of Veterinary Medical Education, said, "The journal will be publishing a theme devoted to the conference. I have commitments from all the top speakers and a number of the other groups or presentations—so, somewhere in the neighborhood of 18 papers directed from the conference, covering multiple issues of communication."

He expects to publish them in the quarterly JVME toward the end of 2005. Dr. Walsh, who served on the conference advisory committee, said, "It was a great conference."

"Communication is an emerging discipline in veterinary medicine," Dr. Shaw said.

She said that veterinary colleges and schools that are developing their curriculum around core competencies—such as those at Guelph, the University of California-Davis, and the University of Sydney, Australia—have identified communication as one competency needed to be a successful graduate. Results of studies such as those by KPMG, PDI, Brakke Management, and recently, Greenfield et al, are creating a drive for teaching nontechnical skills to veterinary students, she said.

The medical profession has found that the best way to teach communication is to provide experiential exercises. At OVC, Dr. Adams developed a simulated training laboratory where actors or professionals play the role of clients, and students practice communication skills in a safe, supportive laboratory, before they receive real clients in the third or fourth year of the curriculum.

At WesternU, one of Dr. Shaw's duties as a faculty member is to develop a communication curriculum. Most veterinary schools offer communication in their curriculum, but the emphasis, time devoted, and techniques used differ among schools. In response to the new information on nontechnical competencies, many schools are rethinking their curricula.

In the self-study the AVMA Council on Education requires as part of the accreditation process, veterinary schools must provide information on how they teach communication and other "clinical techniques and skills."

Bayer Animal Health provided the major funding for the conference. According to Dr. Adams, Bayer Animal Health in Canada and OVC are leading partners in the effort to move veterinary communication forward in practice and education. The company provides half the funding for her laboratories. Fiona McLellan of Bayer said she has seen the difference in the level of communication of the 2004 OVC graduating class, the first to go through the entire communication curriculum.

The Bayer Institute for Health Care Communication is teaching communication at veterinary colleges across North America. With funds from Bayer Animal Health, the nonprofit institute developed eight communication modules covering a range of veterinarian-client communication topics, and plans to produce four more. Kathleen Bonvicini of the Bayer Institute is leading this initiative, which began in 2002. She said that faculty from six schools are invited each year to the institute to learn how to teach communication and implement the modules and training techniques into their curricula. They engage in interactive exercises such as those at OVC in which actors simulate clients. So far, the institute has trained faculty from 11 colleges and the Animal Medical Center in New York City.

Drs. Shaw and Adams have seen an increase in the speaking invitations they've received from organizers of major veterinary meetings since the veterinary communication conference.

Dr. Adams said, "The 2004 conference has elevated the status of communication in veterinary medicine."