|Volume 21, Number 2||Fall, 1994|
Involving students in production medicine investigations is a way of helping them learn how, when, and why to apply knowledge attained elsewhere in the veterinary curriculum. Acquiring general problem-solving abilities, and learning to diagnose and treat individual animals is essential (1-3) if graduates are to become production consultants (4-7).
Defining the possible causes of reduced food animal production efficiency or profitability requires highly specialized, multidisciplinary and comprehensive strategies. The situations are typically complex, requiring approaches that differ from the traditional strategies (5). In most other areas of clinical veterinary medicine (for example, pet practice) the main purpose is the diagnosis and treatment of individual animals. In production medicine, it is the diagnosis and treatment of population problems. Medical conditions of individual animals are signs and symptoms of broader production problems which need to be the main investigational focus.
Being an integral part of a food animal production investigation has much to offer veterinary students, regardless of their career interests and aspirations. Before, during, and following an on-farm investigation, the instructor can both model what a proficient veterinary investigator does and coach the students as they participate substantively in the investigation (8). It is helpful for veterinary students who are interested in food animal production medicine to have real experiences rather than merely reading about or imagining such investigations prior to graduation. Meaningful involvement can broaden the perspectives of other veterinary students by complementing what they have learned about the diagnosis and treatment of individual animals, providing them with insights into economic and environmental concerns, and demonstrating how veterinarians should deal with complex and ill-defined situations (9).
Historical Needs for New Instructional Methods
As production medicine teaching and service programs evolved within colleges of veterinary medicine (7), faculty specialists became increasingly sought after for on-farm consultations. This increased service activity by faculty can detract from professional student clinical education unless both the service needs of the clients and the educational needs of the student are adequately addressed in the design and implementation of the investigation.
Student experience should not be limited to observation and providing assistance with specific tasks; they needed to become integrally involved in the real-life problem identification and problem-solving aspects of investigations (10). Experiences are likely to be of minimal educational value when the students are viewed only as a labor force (11) or are relegated to the role of observers instead of productive team members.
We believe that the design of on-farm investigations, orchestrated through veterinary teaching hospitals, must accommodate both service and instructional needs. Referral investigations must provide high quality service, or the reputation of the faculty member(s) and the veterinary college are compromised. At the same time, the educational opportunity requires emphasis by expanding the experiential learning activities. There is also need for learning on the part of the others, i.e., the owners and local veterinarians, involved in the investigation. For production medicine investigations to emphasize education, faculty experts require a method to demonstrate how to select an appropriate investigational strategy. To do so, those strategies must be made explicit in a form that is readily accessible and understandable by all concerned.
Within this article, we describe our system for the delivery of service and instruction, the strategies and tactics that students can learn when they become an integral rather than a peripheral part of referral investigations, and the tools developed to assist students with the process of strategy selection. Our system is illustrated in the specific area of dairy herd reproductive inefficiency, however, it is generally applicable to problems involving other production disciplines and species.
Table 1. The Experimental Investigation Frame.Invest- Location Participants Activities igational of Event Event
Previsit campus campus team Brief student participants Conference Define initial complaints, clues Plan for possible on-farm procedures Preliminary on-farm whole team Define all complaints and clues Conference List and rank problems Determine investigational scope Select diagnostic strategy Diagnostic on-farm campus team Conduct diagnostic procedures Procedures Amend the problem list Wrap-up on-farm whole team Summarize investigation (to date) Conference State expectations of campus team Data campus campus team Analyze date and notes collected Analysis on farm Submit diagnostic samples Develop the final problem list Postvisit campus campus team Provide written summary of the Conference investigation; highlight problem areas on Table 2 Include recommendations, detail future problem-solving efforts Follow-up campus Discussions, follow-up visits and and on-farm Activities data analysis, as needed
Overview of Experiential Investigation System
Central to our system is the concept of creating an investigational team. The clinical professor and the veterinary students constitute the campus-based members of the investigation team. All of the following can be involved in various phases of investigations and thus become part of the team: the herd owner, herd manager, other employees, referring veterinarian and other consultants such as agriculture extension agents and nutritionists. The clinical professor does not yield control of the investigational scope and direction; rather, the students and other members of the team make decisions under his/her leadership. In order for students to be integrally involved in the investigation, they must learn about this system and its application prior to the farm visit. Moreover, the clinician must be prepared to actively coach during the entire process. Table 1 provides an overview of our system. Specified in its frame format (12) are the location, participants, and activities that occur during referral investigations.
A description of the system plus tables and forms used as tools (13) are given to each student that participates in reproductive investigations. These tools evolved during a year of field testing that included 13 reproductive investigations on dairy farms. Their format underwent considerable change in direct response to student suggestions.
Integral student involvement should not depend on students' knowledge base from preclinical instruction. Students are briefed about the main causes of reproductive inefficiency by introducing a tool that we refer to as a diagnostic MAP. It serves as a "prompt," efficiently communicating reminders of need-to-know knowledge in a map-like format (14). Cells within the MAP frame are arranged by columns representing the problematic categories for dairy reproductive inefficiency. Cells within specific columns prompt the user through those management and health-related problems that are commonly associated with each major category. Changes in and additions to this MAP are made as new knowledge is gained from clinical practice, scientific research, and its use in clinical investigations in which students are integral participants. The often naive but insightful questions and suggestions of the student participants constitute an asset to investigations (15), serving as a check and balance to the current MAP specifics.
Active student participation in our experiential investigation system does not require inductive determination of normal values and procedures. Before using the MAP, students are verbally provided with reminders of what the terms and phrases within specific cells mean. Normal values for dairy reproductive records are discussed, and possible diagnostic and investigational procedures are reviewed. This tool permits the main educational emphasis, during all phases of the investigation, to be on strategies and tactics rather than merely on factual recall and low level skill development. In effect, students are allowed to be legitimate and integral participants (16) in an actual application of food animal production medicine instead of a watered down or student-invented version.
Production Medicine investigations designed to have students as integral participants typically proceed through a common sequence of events. The events, referred to in Table 1, easily incorporate the steps generally recommended by epidemiologists (17) for disease outbreak investigations. The use of Table 1 in preparing students to participate before, during, and following the on-farm investigation helps them understand the entirety of the process and the role of each specific step.
Usually, production investigations are requested by the local veterinary practitioner following acknowledgment of some pattern of negative occurrence. After agreeing that a farm visit would be helpful, a date is scheduled, farm records are requested for previsit analysis, and a formal investigation is initiated. Often, part of the previsit homework is to generate summary records from raw, individual cow data. Students must either become directly involved at this step or be subsequently briefed.
Previsit Conference. During the previsit conference, the campus team estimates what may be wrong with reproduction in the herd. What is known about the situation is mainly based upon verbal complaints received from the referring veterinarian. We use the term "situation" when referring to the broad, sometimes vague, set of conditions and diseases that define the reduced production efficiency or profitability. When possible, evaluation of farm reproductive records provides an additional source of information for the campus team to consider while initially defining the situation. Obvious discrepancies between the current values for common reproductive indicators and expected norms are "clues" to what is wrong with the herd reproduction. Until their accuracy has been determined, however, summary records provide no more than early and somewhat questionable clues.
A simple complaint frame is built and used during the previsit and preliminary conferences. All available sources of complaints and clues are listed as column headings on this complaint frame. These include each noncampus member of the investigative team and the summary records. As specific complaints and clues become known, they are compared to the details contained within the MAP. Specific cells are identified that are most similar to the complaints and clues. Map coordinates, cell titles, or phrases from within the cells are recorded under the appropriate sources.
The Preliminary Conference. The key tactic, during an on-farm, preliminary conference, is to seek out and listen to each person who could be an important source of information for better describing and understanding the situation. All sources tend to have somewhat different points of view and insights. Under the leadership of the clinical professor, the whole team is assembled and the complaint frame begun earlier during the previsit conference is completed. The campus team presents the available records-based clues. The use of our complaint frame is very important to the success of any investigation. It represents the main opportunity to demonstrate to all individuals that their view of the situation was taken seriously and influenced the subsequent investigational strategy.
The information from the complaint frame is summarized and an initial, ranked problem list is agreed upon by the investigative team. The pattern of complaints, compared to specific MAP cells, is carefully noted and discussed. Next, the investigational scope is determined. The scope of a farm situation can be perceived as focused, comprehensive, and all-inclusive. Of course, one can also perceive that there really is no problem. Students select among described (18) investigational problem-solving strategies that are dependent upon the scope.
On-farm Diagnostic Procedures. The agreed upon strategy is implemented during this part of the investigation. The team plans the division of investigational duties, organizes equipment, completes needed diagnostic procedures, and collects any samples for laboratory submission. Using the MAP, decisions are made regarding which procedures, such as palpations, ultrasonography, vaginoscopy, culturing, body condition scoring, collection of additional individual cow records, and direct observation of management techniques, are to be performed.
New problem(s) may be identified while doing the diagnostic procedures. If so, the initial problem list is amended and again prioritized. If the new problem seems to be central to understanding the over-all situation, it is usually investigated immediately.
On-farm Wrap-up Conference. When the on-farm strategy has been completed, the various educational tools are used to assist with summarizing the status of the investigation. Often, data collected during the visit must be analyzed before finalizing findings and conclusions. A useful tactic is to demonstrate areas of investigational emphasis on a copy of the MAP. Areas that require further work-up and areas already known to be problematical are highlighted. This copy of the MAP becomes a tangible summary of the on-farm investigation to leave with the client, pending the formal written evaluation.
Postvisit Data Analysis and Conference. Necessary postvisit data analysis is conducted by the campus team. The purpose is to continue on-farm diagnostic efforts and confirm diagnostic conclusions; new problems may be identified. Students play a major role in postvisit data analysis.
After discussing the results, decisions are made regarding what to include in the written report to the owner and the referring veterinarian. A detailed summary, statement of conclusions, suggestions for further work-up and a list of recommendations is minimal. The various instructional tools assist the student investigators to prepare a draft summary of the investigation that reviews the logic of each investigational step. Coaching continues into this last procedural step.
Follow-up Activities. To the extent possible, students should be involved in follow-up activities. These can include subsequent farm visits to perform further diagnostic activities and monitoring. The absolute goal of any on-farm investigation is problem solving. However, an initial visit may only accomplish rigorous problem identification. The follow-up required will vary from case to case.
Based upon student evaluations, the students' role in the entire process improved because: factual and procedural knowledge was available to them when needed and they were included in determining the nature and scope of perceived problems as well as deciding upon and implementing the investigational strategies to be used. We have found that, when this experiential system was utilized, complex animal production situations are effective laboratories for teaching veterinary students. When our system is used correctly, students can understand and deal with production situations before, during, and following the on-farm portions of the investigations. Student investigators do not merely watch performances by the clinicians; they become involved; they understand what is going on; and they enhance the quality of service provided.
References and Endnotes
1. O'Neil EH: Trends in veterinary medical education. J Vet Med Educ 18:2-5, 1991.
2. Pritchard WR: Strategic positioning of the veterinary profession for the needs of the 1990s and beyond. J Vet Med Educ 18:6-10, 1991.
3. Talbot RB: Veterinary medical informatics. JAVMA 199:52-57, 1991.
4. Welser JR: What industry needs: A broad, problem-solving education in animal health. JAVMA 200:298-301, 1992.
5. Leman AD: Diagnosis and treatment of food animal educational diseases. JAVMA 193:1066-1068, 1988.
6. Herrick JB: Turning out food animal practitioners to meet the needs of the 21st century. JAVMA 199:712-713, 1991.
7. Troutt HF: Food animal production medicine and management. J Vet Med Educ 18:38-39, 1990.
8. Farmer JA, Johnson AL, Troutt HF: Handbook for Food Animal Production Medicine Clinical Educators. 2nd edition. Food Animal Production Medicine Consortium, College of Veterinary Medicine, University of Illinois, 1992, pp 29-31.
9. Lippert FG, Farmer JA: Psychomotor Skills in Orthopedic Surgery. Baltimore: Williams and Wilkins, 1984, pp 40-41.
10. Kolb DA: Experiential Learning. New York: Prentice-Hall, Inc, 1984, p 21.
11. Lave J, Wenger E: Situated Learning: Legitimate Peripheral Participation. Cambridge, MA: Cambridge University Press, 1991, pp 76-77.
12. West CK, Farmer JA, Wolff PM: Instructional Design: Implications from Cognitive Science. Englewood Cliffs: Prentice Hall, 1991, pp 58-77.
13. Copies of the instructional materials referred to are available directly from the authors.
14. An original flowchart version of the Days Open Map was developed in cooperation with Dr. Ray Nebel, Department of Dairy Science, Virginia Tech University, Blacksburg, VA.
15. Lave J, Wenger E: Situated Learning: Legitimate Peripheral Participation. Cambridge, MA: Cambridge University Press, 1991, p 117.
16. Lave J, Wenger E: Situated Learning: Legitimate Peripheral Participation. Cambridge, MA: Cambridge University Press, 1991, p 54.
17. Lessard PR, Perry BD: Investigation of Disease Outbreaks and Impaired Productivity. The Veterinary Clinics of North America: Food Animal Practice, vol 4, Philadelphia: WB Saunders Co, 1988, pp 17-32.
18. Vinacke WE: The Psychology of Thinking. New York: McGraw-Hill, 1972, pp 202-203.
Support was provided through the Interinstitutional Food Animal Production Medicine Program funded by the Pew National Veterinary Education Program to the Food Animal Production Medicine Consortium, College of Veterinary Medicine, University of Illinois, Champaign, IL 61820.