Veterinary Student Competence and Confidence in Calving Cows after Simulator Training in a Blended Learning Approach

Orr, J. , Mihm Carmichael, M. and Kelly, R. (2023) Veterinary Student Competence and Confidence in Calving Cows after Simulator Training in a Blended Learning Approach. British Cattle Veterinary Congress 2023, Telford, UK, 19-21 October 2023.

Abstract

Background New graduates are challenged by problem calvings often presenting as emergencies out of hours, and thus may not consider going into farm animal practice. Case exposure and practice opportunities are limited during the veterinary programme especially given recognised challenges with Extra Mural Studies (EMS) (RCVS, 2021); however, many of the veterinary accrediting bodies state that calving a cow is a Day One Competence (ECCVT, 2019; Molgaard et al., 2018; RCVS, 2022; Salisbury et al., 2019). Simulation has been successfully used in large animal veterinary education (Anderson et al., 2021; Baillie et al., 2005; Ferreira et al., 2021; Nagel et al., 2015), but integrating simulator practice into the curriculum using a blended approach together with online material has more limited evidence within the literature. Aims The aim of this study was to investigate the success of the blended approach on student confidence levels (CONF) and competence (COM) in calving a cow, and importantly, what students are concerned about and what they looked forward to when considering calving cows. An additional aim was to explore any demographic factors that influence CONF and COM. Materials and Methods Out of the 347 eligible fourth year veterinary students over three academic study years, 300 gave consent for their data to be used. The study took place over 3.5 weeks within a six-week teaching period in each study year. Before any teaching, consenting students were allocated to one of four teaching groups and received: lectures (delivered in previous years) only (LEC, n = 60), online video material on calving using the high-fidelity simulator (computer assisted learning, CAL, n = 59), calving simulator practical for 1.5 hours (SIM, n = 96) and the blended approach, CAL preparation before the practical, CAL&SIM (n = 85). Before and after exposure to teaching, students were asked to complete a questionnaire with three sections: 1. Demographic questions (gender, age, country of origin, calving experience levels and intention following graduation) 2. Calving CONF which was self-assessed on a scale of 1-5 for 13 specific calving tasks (e.g. assessing for room, extracting the calf) 3. Free text response questions asking students what they were concerned about and what they looked forward to in relation to calving cows, and what would increase their CONF and COM. Student COM was assessed in a formative calving OSCE which was scheduled 3.5 weeks into the teaching period (so half of the students had received the simulator practical). Multiple logistic binary regression was applied to determine any effect of teaching group, demographic or CONF ratings on OSCE Pass outcome, and effect of teaching group, demographic or before teaching CONF ratings on CONF after teaching. Free text responses were analysed using thematic analysis. Results Of the 300 consenting students, 77.3% were female, 22% were male and 0.3% would rather not say their gender. The average age was 23.4 years (95% CI 23.0 – 23.8). Most of the students were from Europe (54%) with students also from North America (32%), Asia (12%) and Africa (2%). One third (32%) had minimal/no calving experience and two thirds (68%) declared some or even lots of experience. Forty two percent of students would encounter a cow calving based on their career intention following graduation. For CONF, 295 consenting students had a complete data set. Self-assessed calving CONF before teaching was 34.3/65 (95% CI 33.41 to 35.29). After teaching, higher CONF were seen after exposure to the SIM (42.3, 95% CI 40.9 – 43.8) alone or blended with the CAL (44.3, 95% CI 42.8 – 45.7) when compared to both the LEC (33.3, 95% CI 31.2 – 35.5) and CAL (35.4, 95% CI 33.5 – 37.4) teaching groups. CAL exposure did not lead to increased CONF. Multivariable logistic regression identified teaching group as influencing CONF after teaching, with the delivery of the SIM alone or with the CAL enhancing CONF compared to LEC (SIM OR 10.9, 95% CI 4.5 – 26 and CAL&SIM 18.4, 95% CI 7.4 – 45.8 respectively, p <0.05). Prior calving experience and rating more confident before teaching slightly enhanced CONF after teaching (OR 2.5, 95% CI 1.34 – 4.64, and 3, 95% CI 1.34 – 6.32 respectively, p <0.05). For COM, 298 consenting students had a complete data set. The proportion of pass and excellent students in the LEC teaching group (40%) was lower compared to all other teaching groups (CAL 73%, SIM 84%, CAL&SIM 87%). Adding the SIM to the CAL also led to a higher proportion of passes, but the proportions of passes were similar between the SIM and CAL&SIM groups. Having the SIM practical tended to lead to more students passing the OSCE compared with video resources alone (CAL). Multivariable logistic regression identified that teaching group and OSCE assessor type (e.g. internal staff, peer assessor, external practitioner) influenced OSCE pass rates (PR), with the greatest increase in OSCE PR observed after CAL&SIM compared to LEC (OR 11.5, 95% CI 4.7 – 27.9, p <0.05). Before teaching, students looked forward to success, doing a good job and being competent at calving cows while also improving animal welfare. Concerns were raised about not managing, not having enough experience/confidence and having to deal with difficult cases and complications. After SIM delivery students were more specific with their concerns, such as doing harm to the cow/calf, stating issues related to the size of the calf and the implication for the farmer:vet relationship if the calving did not go well. The majority of students felt that additional practice would improve their CONF and COM. Conclusion Implementation of a SIM to teach students how to calve cows has a very positive impact on self-assessed student confidence and allows them to voice specific technical concerns. The SIM as part of a blended learning approach also improves the outcome of a calving skill assessment. The magnitude and significance of these effects during real calving scenarios, and impact on cow/calf health and welfare, still warrants further investigation. This study also highlights the importance of students being involved in calvings while on EMS both in relation to skill and confidence, crucial for practice choice upon graduation.

• Item Type: Conference or Workshop Item
• Status: Published
• Refereed: No
• Glasgow Author(s) Enlighten ID: Kelly, Mr Rob and Mihm Carmichael, Dr Monika and Orr, Miss Jayne
• Authors: Orr, J., Mihm Carmichael, M., and Kelly, R.
• College/School: College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine