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The Future of Veterinary Medicine

Educational Session IV

Saturday, March 15, 2014, 1:30 p.m.–5:30 p.m.

1:30–1:45 p.m. Development and Use of a Zoonotic Disease Outbreak Scenario as a Professional Development Training Tool
Alicia Humlicek

Disease outbreaks impact the health of our nation, causing significant morbidity and mortality to humans and animals. These impacts may be mitigated by utilizing a multidisciplinary response that relies on effective communication and coordination between public health and animal health. Optimization of this operational approach to One Health requires strengthening core competencies of veterinary and public health epidemiologists to maximize the effectiveness of multidisciplinary response teams. Case studies and scenario-based trainings are valuable tools for developing and delivering active, experiential One Health competency based education and training for mid-career professionals. The U.S. Department of Agriculture’s Veterinary Services (VS) is developing a standardized approach to outbreak investigation training for veterinary epidemiologists that relies heavily on case studies as a method of delivering competency based training. A scenario was developed based on a foodborne disease outbreak involving animals, humans and wildlife, and will be utilized in a tabletop training course for VS epidemiologists to improve response to zoonotic disease outbreaks. This scenario was developed by a graduate student pursuing a Master of Public Health degree and has the dual purpose of providing VS with a useful professional development training tool while also fulfilling the student’s graduate program requirements. This outbreak scenario training tool is the successful culmination of graduate student involvement in the development of a professional training tool and the advancement of VS’ efforts to develop and strengthen both epidemiologic and “One Health” core competencies of veterinary epidemiologists. Development of an outbreak scenario case study to be used for training is an ideal project for graduate students to meet a MPH capstone requirement as well as a valuable teaching tool for professional development.

1:45–2:00 p.m. Getting our Feet Wet: Converting to Online and the Infusion of One Health and Interdisciplinary Views into an Aquatic Animal Conservation Course
Iskande Larkin, University of Florida

The majority of Chief Academic Officers consider distance learning fundamental in long-term strategic planning. However, significant concern exists about educational quality, integrity, and effectiveness in online classrooms. This has initiated a nationwide (and global) conversation that is likely to improve all classroom settings by emphasizing instructional design based upon pedagogical theory. With this in mind, the Aquatic Animal Health Program at the University of Florida cautiously entered into online education. In our courses we utilized technology (recorded lectures, online videoconferencing/discussion, and survey tools) to increase participation by expert lecturers (biologists, veterinarians, and government employees provide content), diversify students in the course (veterinary students are now benefitting from graduate student and professional perspectives), evaluate student satisfaction (including expansion of course content to more relevant, and engage material such as incorporating more environmental issues into animal health discussions) 
Students enrolled in our online courses provided feedback (N = 132) on each format/tool. Students responded favorably to the recorded lectures and online discussion sessions with the majority noting a similar level of learning as a classroom-based course (N = 69 and 80, respectively). Furthermore, a strong proportion responded that they learned more or significantly more with recorded lectures (N = 46). Overall, the technologies used are viewed as successful methodologies for learning. The vast majority of students felt the technology allowed them to understand the material better (N = 94) and half felt it increased their interest in the subject matter (N = 71). Thus, program resources will continue to be allocated for further development of distance education curricula and additional technologies will be explored for continued improvements in education within this specialized field.

2:00–2:10 p.m. Integrating One Health into Medical and Veterinary Medical Education:  From Trunk to Tail and Head to Toe
Mary Elizabeth Herring, Texas A&M University

Texas A&M University faculty and students from the College of Veterinary Medicine and Biomedical Sciences and College of Medicine are introducing One Health to professional students from both colleges through innovative social and educational opportunities that span the curriculum from first year to senior year.  Initial exposure for first year students in medicine and veterinary medicine is through an interdisciplinary club which explains the concept of One Health and the importance of interprofessional cooperation. Second year medical students have a unique elective course offering which is team taught by veterinary and medical faculty involved with One Health. In the senior year, a combined veterinary/medical college required course in disaster preparedness and management gives graduating students an opportunity to collaborate on actual disaster plans and participate in specialized training to equip them with the skills needed to prepare for and respond to an emergency situation such as a hurricane, tornado, explosion, or wildfire.

2:10–2:20 p.m.  Compelling Convergence: The Added Societal Value of a One Health Certificate Program
Merrideth Holub, Texas A&M University

Educating our current students for their future endeavors in the veterinary medical field and allowing them to open their minds to the realm of One Health is of upmost importance. The availability of a One Health Certificate program allows students to become educated on team work and transdisciplinary collaborative work within their fields. The objective of the certificate program is to provide broad subject matter knowledge to professional and graduate students in topics of wide ranging significance to human, animal, and environmental health such as infectious diseases, epidemiology, food safety, public health, water, role of architecture and engineering, fundamentals of leadership, and policy. The twelve credit hour certificate program is available to all graduate and professional students on the Texas A&M University campus.

The program is encompassed by two initial courses that have students from multiple disciplines and professions enrolled together, allowing the students to converge and learn from one another.  At the conclusion of the two courses, students will have the option to choose the route of their second half of the program.  The students have the option to participant in a research project in a discipline of their choosing or take an additional two courses outside of their immediate field, allowing them to expand their horizons and give them the ability to experience another field of their interest.

2:20–2:30 p.m.  From Concept to Assessment: Developing a One Health Learning Community
Merrideth Holub, Texas A&M University

The importance of exposing students to the very broad concept of One Health at this early point in their education is imperative so as they move forward the One Health concept is something they use throughout their education. The development process for an undergraduate One Health learning community is very adaptable to other universities. Throughout the presentation the participants will be guided through a development process of concept, implementation, and an assessment tool for the conclusion of the learning community.  The undergraduate learning community offers students an opportunity to explore the One Health research, education, and outreach realm through hands-on experiential learning opportunities across campus through numerous colleges.  

The TAMU Undergraduate One Health Learning Community is built from a volunteer faculty member, an advisory committee, and the assistance of the One Health program coordinator.  This team developed a 16 week program for twenty-five students to attend one-hour weekly educational opportunities.  The educational opportunities were interdisciplinary ranging from human and animal medicine, architecture, animal reproduction, water, climate change, food safety, and engineering. The assessment was developed from the volunteer faculty member and feedback was provided from all students.

2:30–2:45 p.m. Impact of an Interprofessional Course on the Knowledge, Attitudes and Beliefs of Health Sciences Students on One Health
Malika Kachani, Western University of Health Sciences

Inter-sectoral collaboration is crucial for disease prevention and control. The One Health approach should be applied by health professionals when addressing health issues in order to save resources and share benefits. Western University provides an excellent forum for evaluating the impact of an Inter-professional Education course on student knowledge, attitudes and beliefs (KAB) around One Health. With a mandatory 1st year course, it brings together over 1200 students from multiple health professions for 5 inter-sectoral and inter-disciplinary case-based scenarios and accompanying discussion of health issues. 

The objective of this study is to evaluate differences in student KAB before and after having taken the course. A voluntary pre- and post-survey questionnaire was administered electronically to the entire student body. Considering the broad course competencies, the study delineates the specific added value of the One Health approach. Multiple variables were assessed and included changes in student knowledge regarding areas where the One Health approach is relevant.

2:45–3:00 p.m. An Exclusively Veterinary Perspective on Interprofessional Working, Learning and Education
Tierney Kinnison, Royal Veterinary College

Interprofessional working, learning and education within a One Health context implies veterinarians collaborating with members of human healthcare due to factors such as zoonotic diseases and comparative medicine. This session however describes another perspective of interprofessional interactions, purely between veterinary related professions and occupations. The session aims to highlight the need for inward looking research into the veterinary team. 

Throughout the world, veterinary care is being delivered by an increasing number of professions or occupations. Historically a veterinarian may have been likely to work on their own. In the modern era, they are more likely to work alongside occupations such as veterinary technicians/nurses, practice managers, physical therapists and animal behaviourists. This session suggests that the evolution of the work of the veterinarian should be explored alongside the evolution of closely related occupations, because current working practice of veterinarians is affected by the practice of these other occupations.

The session describes the current situation between veterinarians and veterinary nurses in the UK as an example of veterinary interprofessional interactions. The relationship between these two groups is interesting due to the historical dominance of the veterinarian, which may be challenged by the professionalization of veterinary nurses. Registered veterinary nurses are now accountable for their actions which means that the buck no longer stops automatically with the veterinarian. 

Reasons for veterinary interprofessional working, its benefits (for the practice, individual team members, the client and the patient) and its challenges (due to issues of hierarchy and communication) are explored. Interprofessional education is suggested as a potential means to overcome the current challenges of this style of work. A brief overview of the authors’ current research into exploring veterinary interprofessional working and learning is provided. These insights into the modern day veterinary team will be used to make recommendations for future undergraduate interprofessional education.

3:00–3:15 p.m. Collaborative, Interprofessional Care: What Can We Learn from Each Other to Improve the Health of Animal Patients, Human Patients, and Population Health?
John Tegzes, Western University of Health Sciences
Laura Molgaard, University of Minnesota

Interprofessional education (IPE) occurs when learners from two or more professions learn from, with, and about each other in order to improve patient care and outcomes. Human patient-centered, collaborative care is usually the primary focus. For veterinary medicine, this allows us to showcase a One Health approach while highlighting inter-species issues. How can our professions learn best-practices from each other to improve the health of individual human patients, individual animal patients, and population health? Can we extend the focus of veterinary medicine to provide client-centered care? This presentation will explore examples of “lessons learned” across the health professions. It will also explore how interprofessionalism can impact animal-owners, or clients, who are challenged with health issues, and will focus on veterinary education techniques that help to instill a client-service focus in clinical practice. While the scope of practice of veterinary medicine does not include human beings, there are opportunities where veterinary practice can and should focus on ensuring that animal owners are able to adequately care for their animals in spite of health challenges they may be facing. Thus, IPE can be used to explore ways in which veterinarians can make referrals for collaborative care with other health professions for the sake of the clients.

3:15–3:45 p.m. Break

3:45–4:00 p.m. Interprofessional Initiatives between the Human Health Professions and Veterinary Medical Students: A Scoping Review
Molly Courtenay, University of Surrey

This paper presents the findings of a scoping review designed to identify the extent, nature, and range of literature on interprofessional education (IPE) initiatives between the human health professions and veterinary medical students, which is particularly important to advance One Health education and research.  Nine published articles were identified. The websites of six universities were searched in order to collect further information. Interventions vary widely with regards to their structure and delivery, their objectives, the participants involved, and outcome measures. Healthcare professional programs focus upon interprofessional collaborative practice in the human healthcare setting. By contrast, postgraduate programs focus upon topics under the One Health paradigm but make little mention of interprofessional collaboration. Evidence of the impact of interventions on team processes at the human, animal, and environmental interface is extremely limited.   In order to enhance our understanding of what constitutes effective IPE between veterinary medical students and the human health professions, guide intervention development, and the development of outcome measures, there is a need to further explore, define, differentiate and validate some of the terms and concepts used to describe interprofessional interventions.

4:00–4:15 p.m. A Nurse among Veterinarians? The One Health Residency Program in Uganda
Jacinta Waila, Makerere University

The One Health Residency Program at Makerere University-Uganda has three pilot residents; two veterinarians and one nurse. The aim of the program is to equip the residents with various One Health core competencies which will enable them spearhead the One Health approach implementation. Being the only non-veterinarian initially felt like I was losing my identity as a nurse. I often felt misplaced when my colleagues talked so passionately about animals. While I come from the human health perspective, their focus on animals caused me some doubt; the One Health concept in theory did not seem to work in practice!

All that changed with my involvement in the Veterinary Medicine-Nursing-Public Health field practicum organized by Makerere University last April in which students from the three disciplines worked as a team. Seeing how the three disciplines complement each other in addressing public health issues was fulfilling. The identity issue I initially had manifested itself and it became evident to me that this is a fear we all have to overcome when we are collaborators and not competitors.

Participating in activities focusing on the One Health approach has transformed my perception of health. My definition of health now extends beyond the small borders of the hospital or community outreach, bringing farms and processing units on board hence recognizing veterinarians as key stakeholders in human health. The focus shifts from curative to preventive with most of the zoonotic diseases being controlled at the animal level, reducing transmission to humans. Getting aspiring professionals acquainted with the role other disciplines play in attaining total health for humans, animals, and the environment is crucial in determining the success of the One Health Concept. 

4:15–4:45 p.m. Experiencing One Health in Action: Creating a Transformative Learning Environment
Emma Read, University of Calgary

Creating transformative experiential learning in One Health for DVM students at the Faculty of Veterinary Medicine, University of Calgary, Canada, is being achieved through the Distributed Veterinary Learning Community and especially through the Area of Emphasis Ecosystem and Public Health.   We begin in Year 1 with field experiences in various animal industries followed by a course on Animals, Health and Society. Year 4 culminates with a suite of experiential electives. We will highlight the One Health/Global Health Field School in Tanzania with the Faculty of Medicine where the concepts of transdisciplinary research will be described. The core concepts of community-based, capacity building and interdisciplinary field research will be described. The other highlighted elective will be the Northern Aboriginal Community Health rotation exemplifying veterinary outreach and community engagement. Through the service, educational and research projects on-going in these two key rotations, students gain key competencies associated with respecting communities and cultures, capacity building principles versus aide,  and experiencing firsthand the interactions of animals, people and their shared ecosystem services. The discussion will engage attendees on how to assess the competencies learned, and how do veterinary educators evaluate the “added value” of experiences in One Health. Please come with the tools you use to evaluate competencies learned by students in One Health experiential learning curricula.

4:45–5:15 p.m. Enhancing One Health Learning Through Experiential Learning
Katey Pelican, University of Minnesota
Larissa Minicucci, University of Minnesota
Shamilah Namusisi, Makerere University

As the One Health paradigm deals with complex, real-world situations, it is vital that educational methods employed to teach students reflect the dynamics of actual events accurately and realistically.  The colleges across the University of Minnesota have a rich history of employing field-based experiential learning for One Health.  Through these field-based educational activities, students navigate real world scenarios through onsite investigation,  interviews, and interaction with diverse One Health stakeholders including local and federal government agencies, the private sector, and faculty from multiple disciplines and, where possible, cultures. Ultimately, student deliverables emphasize One Health core competencies including communicating with diverse audiences and decision-makers, managing and motivating trans-disciplinary and cross-sectoral teams, engaging communities, and utilizing and advocating for evidence-based decision making to address complex challenges.  This session will highlight several examples of One Health experience-based training programs and their role in advancing One Health competencies both in the US and overseas.

5:15–5:30 p.m. The Four S's of a Shelter Medicine Rotation: Students, Shelters, Suburban and Sonic
Brenda Stevens, North Carolina State University

Shelter medicine is a rapidly developing field of great importance to a One Health mission in veterinary medicine, and shelters themselves provide abundant training opportunities for veterinary medical students. Students trained in shelter medicine have opportunities to practice zoonotic and species-specific infectious disease control, behavioral evaluation and management, primary care, as well as animal welfare, ethics, and public policy considerations affecting animal shelters. Sheltering itself is changing and a range of sheltering systems now exist, from brick-and-mortar facilities to networks of foster homes with no centralized facility. Exposure to a single shelter setting may not allow students to understand and experience the full range of sheltering systems that exist, however a community classroom approach balances the opportunity to introduce students to a diverse array of sheltering systems, while gaining practical experience. This session will present the details and results of a series of two-week, elective clinical rotations with a focus on field and service-learning in animal shelters. 

The overall aims of these rotations were to provide opportunities for students that focused on familiarizing students with sheltering systems and providing primary care training to benefit student learning and animal health. Other priorities included the One Health goals of increasing awareness of public health concerns, the ability to evaluate a shelter on design, protocols, and infectious disease control and enrichment as well as offering opportunities for community outreach. Students were required to participate in topic rounds, and complete a project, of their choosing, that addressed a need recognized during the rotation. Information provided in this session will include costs associated with the rotation, a blueprint for how the rotation was carried out at our institution, details of numbers of shelters visited and animals treated, including a breakdown of treatments provided. Also discussed will be the student projects and student feedback on this valuable clinical experience.

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