Journal of Veterinary Medical Education, Vol 35, Issue 2, 281-287
DOI: 10.3138/jvme.35.2.281
Copyright © 2008 by Association of American Veterinary Medical Colleges
Teaching Nutrition in the Veterinary Sciences |
Teaching and Assessing Nutrition Competence in a Changing Curricular Environment
Sarah K. Abood
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ABSTRACT
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In the past, the required introductory veterinary nutrition course at Michigan State University's College of Veterinary Medicine (MSU-CVM) has provided 29 hours of didactic lectures, with student performance evaluated by short-answer or multiple-choice questions. Because of a 50% reduction in allotted course credits and a change in prerequisites for admission, the course is being redesigned to focus on three of 29 nutrition competencies outlined by the American College of Veterinary Nutrition. Professional communication skills will be developed through small-group learning experiences, case-based problems, and videotaped interviews with standardized clients to teach and assess nutrition competencies. Assessment strategies will differ from traditional multiple-choice examinations and include pre- and post-course self-efficacy ratings, written evaluations from trained standardized clients, and oral and written evaluations from coaches or facilitators.
Key Words: nutrition • competencies • communication • assessment
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INTRODUCTION
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Twenty years ago, an approach to teaching veterinary nutrition was described that emphasized expanding instruction beyond year 1 of a four-year veterinary curriculum by including more than 60 lecture hours during the years 2 and 3.1 Prior to that time, most veterinary nutrition courses were similar to those developed for animal science nutritionists, but delivered in an abbreviated format. The new approach stressed increasing exposure to nutrition by integrating it with other courses, but it did not offer methods of student evaluation other than "students were tested over the material covered."1
Until the 2007–2008 academic year, the faculty of the Department of Animal Science at Michigan State University (MSU) taught a required two-credit nutrition course in year 1 of the veterinary curriculum. Twenty-nine hours of lecture were delivered, and student performance was measured using short-answer or multiple-choice questions on four quizzes, one mid-term examination, and one final examination. The course content was an abbreviated version of the four-credit nutrition course for professional animal science nutritionists, although accommodations were made to address the changing interests and needs of veterinary students. The course provided a strong foundation in nutrient metabolism and in feeds and feeding principles for several domestic species, a critical need in a program without a prerequisite nutrition course. While fulfilling this need, however, the course was limited in its ability to prepare students to apply nutrition principles clinically.
The American College of Veterinary Nutrition (ACVN) has developed a list of 29 nutrition-related competencies for veterinarians, for the express purpose of providing a basis for discussion of the nutrition education needs of veterinary students2 (see Table 1). These competencies were intended to serve as a foundation for developing higher-order skills, but little has been done to incorporate or institutionalize them into most veterinary school curricula. Recently a survey was conducted with veterinary nutritionists from 16 veterinary schools and one veterinary technology program from the United States, Europe, and India;3 at a conference where the results of the survey were presented, survey respondents were then asked which of the 29 ACVN competencies they considered core (Table 1). Respondents agreed on three core skills: obtaining a complete diet history, accurately assigning a body condition score, and prescribing a feeding protocol suitable to maintain an animal's appropriate body condition within the client's lifestyle. The survey and the follow-up poll helped to identify core competencies in nutrition, but questions on how competencies could be measured or how learning objectives could be assessed were not included. This article addresses how selected nutrition competencies can be taught and assessed at an introductory level in a professional training program.
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OBJECTIVES FOR REVISED NUTRITION COURSE
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The veterinary faculty at MSU (MSU-CVM) reviewed requirements for the pre-veterinary, pre-clinical, and clinical phases of the curriculum and recommended that a two- or four-credit course in the principles of nutrition be added to the pre-veterinary curriculum. Content for these pre-requisite courses would be expected to include information about nutrient requirements and metabolic uses of essential nutrients. The new veterinary curriculum, which includes a one-credit course in nutrition, took effect with the entrance of the class of 2011 in late August 2007. Systems courses, clinical skills courses, and integrative courses designed to apply basic science knowledge to clinical medicine would be continued in semesters 2 through 5 of the pre-clinical curriculum, and general and detailed information on the role of nutrition in disease management would continue to be incorporated into several courses by developing and sharing didactic material, hands-on exercises, and case-based scenarios, as well as during sit-down rounds in clinical clerkships and through clinical consultations with individual patients.
The existing required nutrition course in the second semester of the pre-clinical phase of the professional program was reduced to a one-credit course. Information on basic biochemical and metabolic concepts of nutrition, now taught in prerequisite courses, will be accessible for review using online self-learning modules for those students needing to fill gaps or to review their knowledge base. The revised course, Comparative Life Stage Nutrition, will include teaching materials and assessment tools for three of the 29 ACVN nutrition competencies and facilitate experiential learning in the application of nutrition concepts at varying stages of life (growth, gestation/lactation, adult maintenance, geriatrics, production, performance). Students will gain experience using a systematic approach to animal assessment (see Figure 1), dietary assessment, and evaluation of feeding-management practices in several case-based problems or simulated events. The goal of the redesigned course is to prepare students to enter the clinical phase of training with specific skills that can be applied to any patient in any setting (health or disease; at home, on farm, or in the hospital). Outcome measures will include student self-efficacy ratings and documentation of skills in taking a diet history, assigning body condition scores, and crafting dietary recommendations for healthy animals.
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Figure 1: Completing the "circle of nutrition" involves an iterative process to assess animal factors, dietary factors, and feeding management factors
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LIFE STAGE NUTRITION DEFINED
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Life stage nutrition is defined as meeting the nutritional needs of each physiological stage of an animal's life, with specific nutrient needs recognized for gestation and lactation, growth, adult maintenance, geriatrics, production (meat, milk, eggs, wool), and performance (or work). The ACVN has developed an iterative problem-solving approach that can be used with any species at any life stage.4 The iteration begins with assessment of the animal, the diet, and the feeding method (Figure 1), after which recommendations for food and feeding methods (if warranted) are developed.5 This two-step process is repeated as needed to determine the effectiveness of any initial recommendations. In the revised Comparative Life Stage Nutrition course, case-based examples will be developed for online self-learning modules and small-group discussions, and hands-on exercises will be developed for learning body condition scoring. Four faculty members with advanced training in nutrition and two with board certification from the ACVN will develop self-learning modules, cases and exercises, and training materials for small-group facilitators. Students will be expected to demonstrate competence in written and oral formats using a consistent problem-solving method for assessing an animal, its diet and environment, and the feeding methods used by the owner (i.e., the "Circle of Nutrition").
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INCORPORATING COMMUNICATION SKILLS
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Communication skills are essential to all aspects of veterinary medicine.6 The revised year 1 course will devote time to improving professional communication skills, because these are directly linked to the three core competencies. When communication skills are taught in an informal or unstructured manner, professional students view them as redundant, unnecessary, or unspecialized, but a structured model for teaching doctor–patient (or doctor–client) communication skills can help students see this part of their education as relevant and valuable.7 Various models and methods for effective instruction have been described, including communication modules, videotaped interviews with standardized clients, role-playing, and feedback from trained facilitators.6,8 Well-developed, structured content, as well as both written and oral feedback, will be used to teach and assess communication skills.a Professional communication and listening skills will be emphasized during the analysis of recordings of students collecting and recording diet histories from trained standardized clients. Students will be required to set the agenda for at least one interview and to use both open- and closed-ended questions, ascertain the reasons for the client visit, and address any questions that the standardized client may have. Students will also apply content knowledge and practice role-playing with case-based examples in small-group settings. These activities will promote development across several competency areas, including problem solving, experiential knowledge, scientific knowledge, professionalism, self-motivation, and open-mindedness. In a separate recorded exercise, students will practice teaching standardized clients to assign a body condition score to large or small animals. Facilities supporting experiential learning through videotaped and simulated learning events include a learning assessment center shared by the colleges of veterinary medicine, human medicine, osteopathic medicine, and nursing; this facility has 18 examination rooms and four hospital rooms, each with recording cameras and computers. Students and standardized patients or clients can complete Web-based evaluations for training exercises or formal assessments.b
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CHALLENGES FOR COURSE REDESIGN
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The most significant challenge in course development has been establishing clear objectives and developing content that does not exceed the assigned time. The MSU model for a one-credit course is two hours of contact time—two hours in class, or one hour in class and one hour outside of class—during each week of a 15-week semester. This time restriction demands that content and assessments be carefully aligned with teaching objectives and that no component be present in excess. All course content in year 1 focuses on normal structure and function, and thus the revised course should be restricted to the application of nutritional concepts to healthy animals during growth, gestation/lactation, adult maintenance, geriatrics, production, and performance.
A second challenge has been the traditional lecture format, which, in conjunction with a large class size, can result in a lack of meaningful student engagement. Instructors of large classes tend to be viewed as "talking heads," and little active learning may take place.9 Similarly, excessive instructional detail is counterproductive to learning and can lead to less critical thinking and more memorization.10 Adult learners are driven to learn when presented with new information that builds on what they know and when they can see the relevance or applicability of what they are learning.11 Success in maintaining students’ interest in the role of nutrition seems more likely to be achieved by increasing experiential (or shared) learning in group work and decreasing the number of didactic lectures.
A third challenge involves resource needs. Although maximizing resources and effective strategies for small-group work can be daunting for faculty, students regularly report a high level of satisfaction in working with peers in small-group settings.11,12 Space for multiple small groups to meet simultaneously can be limited, and coordinating facilitators for regular training, with appropriate preparation and debriefing sessions, is an ongoing challenge.13
The fourth major challenge is effective assessment of learning. How do we best assess each student's preparedness? How should we assess how far each student has moved along the continuum of competence by the end of the course? Who will do the assessments, and how do we ensure objectivity, control, and validity, especially if using student self-assessment, peer teaching, standardized client evaluations, or written facilitator evaluations (particularly when facilitators have limited expertise in nutrition)?
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INCLUDING OUTCOMES ASSESSMENT IN CURRICULAR CHANGES
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Recent changes in health professions education have been influenced by public concerns about medical competence and by an emphasis on outcomes assessment. Graduates of North American medical schools must complete clinical skills competency testing (including communication skills) as a requirement of national medical licensure. The American Veterinary Medical Association's Council on Education has recently added a new standard for accreditation, requiring "outcome assessment measures that address the college mission" and produce results that "must be used to improve the college programs."14 How these goals will be achieved has not been determined.
The Comparative Life Stage Nutrition course will include an identification of baseline knowledge and will apply new concepts through experiential or active learning exercises. Assessment of learning will include a variety of tools, such as mind maps or concept maps to evaluate scientific knowledge and online short-answer questions and case-based problems to measure application of new knowledge.15 In addition, questionnaires will be used to measure student self-efficacy before and after skill-building exercises. Supporting methods of assessment will include giving and receiving oral feedback in small groups; receiving written and oral feedback from small-group facilitators; and receiving written feedback from standardized clients trained to deliver structured feedback on process and content material.
Students entering veterinary programs are adult learners with various levels of experience in interpersonal communications and in feeding animals. Clearly explaining the course objectives and determining each student's educational status at the beginning will assist both course moderator and co-instructors in adapting their instruction to the range of knowledge and experience in the class. A pre-assessment completed by each student will point out where gaps in nutrition-related competencies occur. In two different videotaped events, students will rate their confidence and assess their communication skills before and after a structured interview (see Table 2). Standardized clients will provide written feedback on the process and quality of communication skills (see Table 3), and facilitators will provide feedback on the process and on the information delivered or collected. At the time of writing, methods for measuring what and how learning has taken place are still under development. Questionnaires assessing students’ self-efficacy in all 29 ACVN competencies have been piloted by the author (see Table 4). Although student self-efficacy as a measure of competence has been extensively studied, there remain distinct, but not insurmountable, challenges to correlating these results with objective measures of defined skill competencies.16
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Table 2: Example of veterinary student self-efficacy questionnaire administered prior to simulated interview with standardized client
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Table 3: Example of a feedback form completed by standardized clients after simulated interviews with veterinary students
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FUTURE CURRICULAR DEVELOPMENTS
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Several one-credit-hour electives are available in semesters 4 and 5 of the pre-clinical curriculum for students interested in pursuing additional experience in a variety of subjects, including nutrition. These courses provide an opportunity to introduce comparative or species-directed clinical nutrition in years 2 and 3 and to reinforce the role of nutrition in the management of production-animal, equine, or companion-animal diseases. Additionally, a one-credit elective option may be created to enhance professional communication skills, with structured modules devoted to dealing with difficult people, informed consent, monetary issues, veterinary ethics, and talking to clients about euthanasia. A three-credit elective clerkship in small-animal clinical nutrition will continue to be offered to year 3 and 4 students during the clinical phase. Students interested in pursuing experiences in food-animal or equine nutrition will have opportunities to develop expertise through current required or elective clerkships.
Some veterinary schools do not have faculty with advanced training in nutrition. Developing one or more online nutrition courses, to be taught in conjunction with trained nutrition faculty, would provide a means to support programs that lack personnel and time in their curricula. A successful model for this is the Web-based graduate-level Animal Welfare Assessment course developed by the Animal Behavior and Welfare Group at MSU, which is funded through a higher education challenge grant by the US Department of Agriculture.17 This course serves as a model for collaboration using experts from different institutions, software, and media and enabling students to interact with course content. Using similar educational resources, nutrition faculty could collaborate and help bridge the gaps for those institutions not currently teaching to established nutrition competencies.
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Footnotes
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AUTHOR INFORMATION
Sarah K. Abood, DVM, PhD, is Coordinator for Student Programs and an assistant professor in the Department of Small Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, Room G-155 Veterinary Medical Center, East Lansing, MI 48824 USA. E-mail: aboodsar{at}cvm.msu.edu. Her current research interests include small-animal clinical nutrition, and communication skills development.
NOTES
a As a participant in the Bayer Animal Health Communication Project, the author was a member of the first cohort to receive comprehensive educational training in the area of veterinarian–client communication. The details of this faculty development program have been described elsewhere,8 and more than 104 faculty members from 30 schools of veterinary medicine in the United States and Canada have participated in the week-long training session, including three board-certified veterinary nutritionists. Faculty at MSU-CVM have used one or more of the communication modules in four pre-clinical courses and two clinical electives since 2003. More information about the Bayer Animal Health Communication Project is available at <http://www.healthcarecomm.org/bahcp/homepage.php>. 
b More information about the MSU Learning Assessment Center can be found at <http://lac.msu.edu/>.
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ABSTRACT
INTRODUCTION