Dr Jenny Routh

Background The alignment of student and workplace supervisors’ perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences. Methods A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests. Results ‘Honesty, integrity and dependability’ was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students’ awareness of their own and others’ mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher). Limitations Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution. Conclusion There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Learning theories are abstract descriptions which help us make sense of educational practice. Multiple theories can inform our understanding of a single concept, in this case: veterinary workplace clinical training (WCT), which occurs just prior to students' graduation as competent veterinary surgeons. The competency movement has strongly influenced reforms in veterinary education and is considered important. In reflection of this, the term “preparedness” is operationalised here as a measure of the likelihood that the veterinary student is going to be a competent learner and participant during WCT. Preparedness itself is therefore important because it directly impacts performance. Workplace clinical training is explored through the lenses of cognitivist, social constructivist and socio-culturalist learning theories and used to inform student preparedness characteristics (“tools”) in terms of their behaviours, personal attributes, knowledge and skills, and awarenesses to optimise learning and participation. These form a new conceptual framework—the “Preparedness Toolkit.”

Veterinary students, academics, and clinical supervisors are likely to have different perspectives on what it takes to be prepared for workplace clinical training (WCT). Differing expectations could confuse students if they receive conflicting messages about the skills and attributes to which they should aspire. Furthermore, they may struggle to engage with the affordances that workplaces provide for learning if unprepared. Using a survey, we ranked 91 preparedness characteristics and seven preparedness themes for WCT for importance, according to clinical supervisors, academics, and final-year veterinary students before and after undergoing WCT in a UK veterinary school employing a distributive model of WCT. Statistical analyses were used to determine 1) rank alignment and 2) significant differences in characteristic and theme rank among groups. The correlation among characteristic rankings was strongest between students and clinical supervisors, and weakest between clinical supervisors and academics. Honesty, integrity and dependability was the most important characteristic for students and clinical supervisors, whereas students’ awareness that perfection is not expected was the most important characteristic for academics. The “knowledge” theme was ranked as significantly more important for academics compared to students pre-WCT. Therefore, differences in the expectations of students starting WCT have been demonstrated in this study. As the educational setting transitions from “classroom to clinic”, academics and students must adapt their notions of preparedness to align with conceptions of learning and teaching in the workplace, while supervisors should be mindful of students’ pre-existing expectations. Continuous communication and expectation alignment are necessary for a cohesive curriculum strategy.

Summary The objectives of this study were to compare horses’ gaits in hand and when ridden; to assess static and dynamic saddle fit for each horse and rider; to apply the Ridden Horse Pain Ethogram (RHpE) and relate the findings to gait abnormalities consistent with musculoskeletal pain, rider position and balance and saddle fit; and to document noseband use and its relationship with mouth opening during ridden exercise. Data were acquired prospectively from a convenience sample of horses believed by their owners to be working comfortably. All assessments were subjective. Gait in hand and when ridden were evaluated independently, by two assessors, and compared using McNemar’s test. Static tack fit and noseband type were recorded. Movement of the saddle during ridden exercise, rider position, balance and size relative to the saddle was documented. RHpE scores were based on assessment of video recordings. Multivariable Poisson regression analysis was used to determine factors which influenced the RHpE scores. Of 148 horses, 28.4% were lame in hand, whereas 62.2% were lame ridden (P

Background There is a lack of understanding of the pathological and/or physiological nature of lumbosacral region pain. Objectives To describe the gross variations of the osseous and soft tissues of the lumbosacral region and report the histological findings of sections of nerve tissue in affected and control horses. Study design Descriptive post-mortem case series. Methods All horses had undergone full clinical and gait assessment, including ridden exercise. Horses with a substantial response to infiltration of local anaesthetic solution around the sacroiliac joint regions were included in the affected group (n = 27). Horses for which the source(s) of pain was confirmed by diagnostic anaesthesia to be distant to the lumbosacral region were included in the control group (n = 5). The pelvic regions were isolated and the soft tissues were assessed grossly. Sections of the lumbosacral plexus and cranial gluteal, sciatic and obturator nerves were examined histologically. The osseous specimens were evaluated for anatomical variants and abnormalities. Data were analysed using descriptive statistics. Results Gross discolouration of the sciatic or obturator nerves was observed in 7 (26%) affected and no control horses. Grade 3/3 histological abnormality scores were assigned in 22% of nerve sections from affected horses compared with 3% from control horses. Several osseous variants (bifid sacral spinous processes, straight-shaped sacroiliac joint surface, short arrow-shaped sacral alae, left-right asymmetry of sacral alae, sacral curvature, absence of the fourth to fifth and ankylosis of the fifth to sixth lumbar articular process joints, left-right asymmetry of caudocranial position of the fourth to fifth and lumbar-sacral articular process joints) and abnormalities (sacroiliac enthesopathy, extra ventral sacroiliac joint surface, lumbosacral symphyseal periarticular modelling, lumbosacral intertransverse joint pitting lesions) were more frequently observed in affected horses. Main limitations Both control and affected horses may have had preclinical abnormalities. Conclusions Lumbosacral region pain may reflect the presence of a number of pathological changes. Neural pain may play an important role in some horses.

Summary Background Reasons for abnormal behaviour during tacking‐up and mounting are poorly documented. Objectives To relate behavioural abnormalities during tacking‐up or mounting to epaxial muscle hypertonicity or pain, girth region hypersensitivity, ill‐fitting tack, rider position and balance, or equine musculoskeletal pain. Study design Prospective observational study; convenience sample of 193 horses. Methods The behaviour of horses in a stable or tied up was observed for ≥8 min before systematic palpation of the thoracolumbosacral and girth regions. Owners were asked to tack‐up and mount using their normal regime. A purpose‐designed protocol for assessment of behaviour during tacking‐up and mounting was applied. Lameness was evaluated in‐hand and during ridden exercise. Static and dynamic saddle‐fit were assessed. A static saddle‐fit score was the sum of any saddle‐fit abnormality. Rider position in the saddle, balance and size relative to the saddle were evaluated during ridden exercise. Multivariable negative binomial regression modelling was used to assess the relationship between the sum of tacking‐up and mounting behaviours and horse, rider and tack‐fit variables. Results Riding School horses comprised only 12% of the sample population, but had higher rates of abnormal behaviours during both tacking‐up (P

AIMS: To determine the frontal plane position of the ground reaction force vector at its centre of pressure under the hoof of walking horses, and its projection through the distal limb joints, and to relate this to hoof geometric measurements. METHODS: Reflective markers were glued to the forelimb hooves and skin of 26 horses, over palpable landmarks representing centres of the coffin, fetlock and carpal joints, and the dorsal toe at its most distal point. A 4-camera kinematic system recorded the position of these markers as the horse walked in hand across a force platform, to generate a frontal plane representation of the ground reaction force vector passing between the markers at the joints. The position of the vector was calculated as the relative distance between the lateral (0%) and medial (100%) markers at each joint. Digital photos were taken of the hoof in frontal and sagittal views to determine hoof geometric measurements. Associations between these and the position of the force vector at each joint were examined using Pearson correlation coefficients. RESULTS: Mean vector position for both forelimbs at the toe, coffin, fetlock and carpal joint was 50.1 (SD 8.9), 53.0 (SD 9.2), 54.6 (SD 11.4) and 50.5 (SD17.3)%, respectively, of the distance between the lateral and medial sides of the joint in the frontal plane. Across all four joints, the vector position was slightly more medial (2-4%) for the right than left limb (p>0.05). Medial hoof wall angle was correlated (p

Background Causes of abnormal behaviour during tacking-up or mounting are multifactorial, but may be associated with an ill-fitting saddle, a rider sitting on the caudal third of the saddle, or lameness. Objectives To determine whether: (1) owners believed their horse showed abnormal behaviour when tacked-up or mounted; (2) this agreed with observations by a veterinarian. Study design Cross-sectional study; convenience sample. Methods Horses were undergoing prepurchase examinations, investigation of poor performance, or were recruited by invitation. Owners were asked if their horse showed abnormal behaviour when tacked-up or mounted and subsequently whether they showed specific behaviours (yes/no) during bridling, saddling, girthing and mounting. Each horse was observed during tacking-up and mounting by one veterinarian who recorded the occurrence of each behaviour. Agreement between the owners and the veterinarian was evaluated using intraclass correlation (ICC) coefficients with 95% confidence intervals (CI). Results Overall 34.2% (66/193) of owners reported that their horse showed behavioural abnormalities during tacking-up or mounting. There was poor to good agreement between the owners and veterinarian for horses putting their head up to avoid bridling (ICC 0.53, CI 0.37, 0.64) and being reluctant to open their mouth for the bit (ICC 0.52, CI 0.36, 0.64). There was poor to fair agreement for evading noseband tightening (ICC 0.41, CI 0.21, 0.56), elevating the head (ICC 0.24, CI 0.00, 0.43) and teeth grinding (ICC 0.23, CI 0.00, 0.42). For attempts to bite, there was fair to excellent agreement during saddling (ICC 0.67, CI 0.56, 0.75) and good to excellent agreement during girthing (ICC 0.73, CI 0.64, 0.79). Results for some behaviours suggested potential systematic disagreement between the veterinarian and owners. Main limitations Potential bias of volunteers recruited by invitation. Day-to-day variation of behaviours is unknown. Conclusions The majority of owners were unaware that their horses showed behavioural abnormalities during tacking-up or mounting.

Background There has been no large-scale, evidence-based study on horses' behaviour while being tacked -up or mounted. Objectives To describe equine behaviour during tacking-up and mounting. Study design Cross-sectional, prospective observational study, using a convenience sample. Methods A purpose-designed protocol for documenting behaviour during tacking-up and mounting was developed. Horses were recruited from 11 locations, from both amateur and professional riders. Horses (n = 193) were observed during acquisition of predefined information from the owners. Behaviour data were recorded during bridling, placement of the saddle, girthing and mounting. Results The majority (67%) were bridled first. The median sum of abnormal behaviours during tacking-up was 10/64 (interquartile range [IQR] 7.13; range 0.33). There was an equal frequency of abnormal behaviours during bridling and saddling in 52% of horses; 34% of horses showed more abnormal behaviours during saddling than bridling; 15% of horses showed more abnormal behaviours during bridling than saddling. The duration of abnormal behaviours related to total tacking-up time was 25-75% in 51% of horses. There was a positive relationship between the sum of abnormal behaviours and the duration of abnormal behaviours (P = 0.0001). Repeatedly chomping on the bit occurred most frequently during bridling (67%). Ears back (57-65%) and an intense stare (54-62%) were similar in all phases. Fidgeting was more common during saddle placement (32%) and girthing (21%), than bridling (9%). Tail swishing was more frequent during saddle placement (20%) and girthing (34%), than bridling (10%). Turning the head to the girth was only seen during saddle placement and girthing (11 and 40%, respectively), in addition to attempting to bite (5 and 15%, respectively) and rubbing the nose (8 and 21%, respectively). The median sum of abnormal behaviours during mounting was 1/30 (IQR 1.3; range 0.12). Main limitations: Absence of many nonlame horses with correctly fitting tack. Conclusion Abnormal behaviour during tacking-up and mounting was common.

Background Medical specialties hold varying degrees of prestige, stemming from the existence of stereotypes among them. These have been shown to lead to prejudice against specific specialists, which not only influences career choices but also affects the perception of equality among specialties. Method The aim of the research was to determine the presence of stereotypes in the UK veterinary community. Using an online questionnaire, participants were asked to provide an adjective that best characterises 15 specialties, in addition to their perceptions on prestige and gender association. Word cloud analysis coupled with sentiment analysis in Python using the language processing software Natural Language Toolkit (NLTK) was used to assess sentiments with respect to the adjectives. Results There were 665 questionnaire respondents, and there was evidence of their construction of specialty-specific stereotypes. Some specialties were perceived more negatively than others, including equine general practitioners, surgeons, pathologists, dermatologists and public health veterinarians/epidemiologists. Gender bias was identified within this study, most prominently within production animal and behavioural medicine veterinarians. The most prestigious specialties were neurology, surgery and cardiology. Conclusion Specialty-specific stereotypes exist within the veterinary community. Acknowledging their existence is a first step to recognising the influence they have on career choices.

Simple Summary The Covid-19 pandemic has significantly impacted the provision of veterinary education. The principal challenges and mitigating approaches have focussed on the delivery of material online, but given the practical and professional outcomes required of veterinary graduates, innovative ways to provide some in person teaching have been sought also. The public health implications of the Covid-19 pandemic have caused unprecedented and unexpected challenges for veterinary schools worldwide. They are grappling with a wide range of issues to ensure that students can be trained and assessed appropriately, despite the international, national, and local restrictions placed on them. Moving the delivery of knowledge content largely online will have had a positive and/or negative impact on veterinary student learning gain which is yet to be clarified. Workplace learning is particularly problematic in the current climate, which is concerning for graduates who need to develop, and then demonstrate, practical core competences. Means to optimise the learning outcomes in a hybrid model of curriculum delivery are suggested. Specific approaches could include the use of video, group discussion, simulation and role play, peer to peer and interprofessional education.