Veterinary nurses, technologists and technicians may interact with clients in a range of contexts: when performing reception duties, answering telephone calls, admitting and discharging patients, providing and/or discussing cost estimates, and when providing client education (Prendergast, 2011). In the UK and Ireland, nurses may also share responsibility for obtaining informed consent from clients with the veterinarians (Gray and Cripps, 2005).
The value of nurse consultations or clinics in topics such as nutrition, wellness, preventative health care and behaviour and training has also been highlighted (Jevring, 1993; Bower, 2001). Furthermore, employers may possess high expectations for both the technical and interpersonal skills of veterinary support personnel (Ruby and DeBowes, 2007).
Communication skills are best explored within the context of intentional, systematic, and experiential training (Kurtz et al, 2005). Although the authors are aware of a number of established communication skills training initiatives for veterinary nurses and technologists in both the UK and North America respectively, a review of the literature yielded limited published research related to communication skills training for veterinary healthcare support personnel.
The 3-year Bachelor of Applied Science (Veterinary Technology) programme has been offered at The University of Queensland since 2001 (Clarke, 2004). A professional communication workshop involving simulated clients (actors) was introduced in the final year of the programme in 2008 to augment a previously didactic approach. The aim of this study was to explore student perceptions of this workshop in relation to their own communication skills.
Methodology
Study overview
This study was conducted in 2010. Workshop participants were asked to complete a questionnaire both prior to and following an experiential client interaction workshop (outlined below). Questionnaires were distributed and collected within class time with participants allowed approximately 15 minutes to complete their responses on each occasion. The pre-workshop questionnaire was conducted immediately prior to the workshop and the post-workshop questionnaire was conducted 1 week following completion of the workshop. Pre- and post-workshop responses were matched and compared.
Prior to participation in the workshop, students had attended lectures related to effective communication skills, the human–animal bond, grief and euthanazia. Students had previously been allocated to one of the cases (described below) and had attended a 1 hour preparatory session with the facilitators to discuss clinical information related to each case.
Workshop outline and materials
For the workshop, students (N=13) worked in three self-selected small groups of three and one group of four students. The groups attended the workshop for a staggered 2 hour period (i.e. two groups were in attendance for the first 2 hours with the remaining groups attending for the second 2 hour block). The group comprising four students was scheduled to attend for the second session with a longer period of contact (2.5 hours).
The purpose-built communication facility consisted of two consultation rooms and a central observation area, linked by one-way mirrors. The central observation area was equipped with headsets so that student observers could both see and hear the student–client interactions. Each student was allocated 30 minutes for their case which included approximately 15 minutes to conduct their interaction followed by a 15 minute de-brief where students reflected on their performance and received feedback from peers, the simulated client and the facilitator. Immediately prior to their interaction, students were encouraged to nominate specific areas for peer and facilitator feedback. During the interaction, students were able to ‘time-out’ for advice, to collect their thoughts, or for the opportunity to replay a particular element of the interaction.
Students completed one of four possible scenarios including a client seeking general puppy care advice, a client picking up their dog following routine neuter surgery, a client seeking nutritional/feeding advice for their healthy dog and a client wishing to make an appointment with the veterinarian for euthanazia of their terminally ill dog. Each student completed one scenario and observed their peers completing at least two other scenarios. Scenarios were created on the basis of clinical experiences and following review of case examples provided by the National Unit for the Advancement of Veterinary Communication Skills (2008). The simulated clients were two professional actors, briefed on the objectives of the workshop and the principles of constructive feedback, and experienced in the delivery of a similar workshop run for the veterinary students.
Following the workshop, students completed a reflective assignment consisting of three items: ‘What are your strengths when it comes to client communication skills?’; ‘What elements of your client communication skills would you like to improve?’ and ‘Outline a plan for how you will improve on your client communication skills prior to graduation’.
Survey tool Pre-training measure
A paper-based questionnaire, comprising 18 Likertscale items was developed from the learning objectives of the course ANIM2038 ‘Animal Ethics, Codes of Practice and Legislation’. The pre-workshop questionnaire consisted of items phrased as statements about the student's communication skills, written in the first person and ranging from 1 ‘strongly agree’ to 5 ‘strongly disagree’.
Post-training measure
The post-training questionnaire was identical, but also asked for student perceptions of the workshop with an additional 14 Likert-scale items and four open-ended questions: ‘What were the strengths of the workshop in relation to your learning?’, ‘What were the limitations of the workshop in relation to your learning?’, ‘What could improve the workshop for future students?’ and ‘If you could sum up your perceptions of the workshop in a couple of words, what would they be?’
For both questionnaires, participants entered a personal identification code to facilitate matching of pre- and post-training questionnaire responses while maintaining their anonymity from the researchers. Students were assured that participation or non-participation in the study would not affect their results in the course, that participation in the surveys was entirely voluntary, that all responses would be anonymous, and that we intended to publish the results. Informed consent for participation was obtained by students completing the questionnaires.
Statistical analysis
As pre- and post-training responses were matched, and not Normally distributed, Wilcoxon signed-rank tests were used to compare the distributions of student responses with the pre- and post-training questionnaires for each item. Of the 13 students who participated in the workshop, 13 completed the pre-workshop questionnaire and ten completed the post-workshop questionnaire. One post-workshop questionnaire did not include a personal identification code so was unable to be matched. Therefore, nine pre- and post-workshop responses were able to be matched and compared, representing 69% of the student cohort. Matched (N=9) and unmatched (N=4) pre-workshop responses were compared using Mann-Whitney U-tests. Statistical analyses were performed using Stata version 11.2 (StataCorp, College Station, Texas, USA).
Results
Student perceptions of professional communication skills pre and post the workshop
Student (N=9) perceptions of competence related to a variety of professional communication skills improved significantly (p<0.05) when post-workshop responses were compared to pre-workshop responses (Table 1). Following the workshop students were significantly more confident in using a range of skills including: greeting clients and pets; responding to non-verbal cues; using language that clients could understand; acknowledging the human–animal bond; asking open and closed questions; encouraging client participation; communicating care and concern; discussing basic puppy or kitten care, and providing basic emotional support to grieving clients.
| Number of respondents | ||||||||
|---|---|---|---|---|---|---|---|---|
| Strongly agree | Agree | Unsure | Disagree | Strongly disagree | % that agreed† | p value* | ||
| I am confident discussing general puppy or kitten care and prophylaxis with a client | Pre | 0 | 6 | 2 | 0 | 1 | 67 | 0.046 |
| Post | 1 | 7 | 0 | 1 | 0 | 89 | ||
| Effective professional communication is essential to my career | Pre | 6 | 3 | 0 | 0 | 0 | 100 | 0.317 |
| Post | 7 | 2 | 0 | 0 | 0 | 100 | ||
| I am confident providing nutritional advice to the owner of a dog or cat | Pre | 0 | 4 | 4 | 0 | 1 | 44 | 0.180 |
| Post | 1 | 4 | 3 | 1 | 0 | 56 | ||
| I am aware of my strengths when it comes to professional communication | Pre | 0 | 2 | 6 | 1 | 0 | 22 | 0.011 |
| Post | 2 | 6 | 1 | 0 | 0 | 89 | ||
| When communicating within a professional environment, I can confidently introduce myself and greet clients and pets warmly | Pre | 0 | 5 | 4 | 0 | 0 | 56 | 0.017 |
| Post | 4 | 5 | 0 | 0 | 0 | 100 | ||
| I am aware of areas I could improve when it comes to my professional communication | Pre | 0 | 4 | 3 | 2 | 0 | 44 | 0.008 |
| Post | 6 | 3 | 0 | 0 | 0 | 100 | ||
| When communicating within a professional environment, I can effectively respond to nonverbal signals from the client | Pre | 0 | 0 | 9 | 0 | 0 | 0 | 0.003 |
| Post | 0 | 9 | 0 | 0 | 0 | 100 | ||
| When communicating within a professional environment, I can use language that clients can understand | Pre | 0 | 7 | 2 | 0 | 0 | 78 | 0.014 |
| Post | 4 | 5 | 0 | 0 | 0 | 100 | ||
| I am confident performing a patient discharge consultation following the surgical neuter of a dog or cat | Pre | 0 | 7 | 1 | 0 | 1 | 78 | 0.103 |
| Post | 3 | 4 | 1 | 1 | 0 | 78 | ||
| When communicating within a professional environment, I can explore the nature of, and acknowledge, the human–animal bond | Pre | 0 | 1 | 8 | 0 | 0 | 11 | 0.027 |
| Post | 1 | 5 | 3 | 0 | 0 | 67 | ||
| When communicating within a professional environment, I can communicate empathy for the client's situation and concerns | Pre | 0 | 5 | 4 | 0 | 0 | 56 | 0.103 |
| Post | 1 | 7 | 1 | 0 | 0 | 89 | ||
| Role play and simulations are an effective way to develop professional communication skills | Pre | 2 | 5 | 1 | 1 | 0 | 78 | 0.016 |
| Post | 7 | 1 | 1 | 0 | 0 | 89 | ||
| When communicating within a professional environment, I can ask both open and closed questions, plus use each appropriately | Pre | 0 | 1 | 7 | 1 | 0 | 11 | 0.010 |
| Post | 0 | 8 | 1 | 0 | 0 | 89 | ||
| I am confident providing basic emotional support to a grieving client | Pre | 0 | 1 | 8 | 0 | 0 | 11 | 0.046 |
| Post | 0 | 5 | 4 | 0 | 0 | 56 | ||
| When communicating within a professional environment, I can encourage client participation and involvement by inviting them to ask questions** | Pre | 0 | 4 | 5 | 0 | 0 | 44 | 0.010 |
| Post | 3 | 5 | 0 | 0 | 0 | 100 | ||
| Effective communication skills cannot be taught and learned, you either have them or you do not | Pre | 0 | 0 | 1 | 7 | 1 | 0 | 0.655 |
| Post | 0 | 0 | 1 | 6 | 2 | 0 | ||
| When communicating within a professional environment, I can display effective body language and tone of voice to show care and concern | Pre | 0 | 3 | 6 | 0 | 0 | 33 | 0.014 |
| Post | 0 | 9 | 0 | 0 | 0 | 100 | ||
| I have received adequate opportunities to practice my oral communication skills over the programme so far | Pre | 0 | 1 | 3 | 5 | 0 | 11 | 0.098 |
| Post | 0 | 3 | 5 | 1 | 0 | 33 | ||
When post-workshop responses were compared with pre-workshop responses, student self awareness of their communication skills was also heightened, with significant improvement in the following items: ‘I am aware of my strengths when it comes to professional communication’ and ‘I am aware of areas I could improve when it comes to my professional communication’. No students at either time point believed that: ‘Effective communication skills cannot be taught and learned, you either have them or you do not’.
Pre-workshop student perceptions of professional communication skills - matched versus non-matched participants
There were several significant differences detected when the views of students who were able to be matched pre- and post-workshop (N=9) were compared to those who were unable to be matched or did not complete the post-workshop questionnaire (N=4) and therefore did not contribute to the analysis above. Compared to matched participants, non-matched students were significantly more confident in their ability to confidently greet clients and their pets (p=0.026), effectively respond to non-verbal signals from the client (p=0.001), explore the nature of and acknowledge the human-animal bond (p=0.003), display effective body language and tone of voice to show care and concern (p=0.033), and believed that they had received adequate opportunities to practice their oral communication skills over the programme to date (p=0.008).
Student perceptions of the workshop
The workshop was well received by participants – viewed as an enjoyable and effective learning exercise (Table 2).
| Please indicate your level of agreement with the following statements: | Strongly agree | Agree | Unsure | Disagree | Strongly disagree | % that agreed† |
|---|---|---|---|---|---|---|
| The workshop was enjoyable, on the whole | 5 | 4 | 0 | 1 | 0 | 90 |
| The workshop stretched me beyond my comfort zone | 5 | 3 | 1 | 1 | 0 | 80 |
| Observing and providing feedback to other students was beneficial for my learning | 4 | 5 | 1 | 0 | 0 | 90 |
| Feedback from my peers, the client and the facilitator was beneficial for my learning | 8 | 2 | 0 | 0 | 0 | 100 |
| It was helpful to ‘practice’ my communication skills prior to graduation | 6 | 3 | 1 | 0 | 0 | 90 |
| The simulated client workshop was a valuable learning experience | 6 | 3 | 0 | 1 | 0 | 90 |
| The simulated client workshop motivated me to revise my technical knowledge | 3 | 6 | 0 | 1 | 0 | 90 |
| Participation in this workshop has encouraged me to further develop my professional communication skills | 4 | 4 | 1 | 1 | 0 | 80 |
| Exposure to a greater number and variety of scenarios would be beneficial for my learning | 6 | 3 | 1 | 0 | 0 | 90 |
| The reflective task helped to consolidate my learning and action plans from this workshop* | 2 | 5 | 1 | 1 | 0 | 70 |
| I would like to see the workshop continue to be offered for future students | 6 | 3 | 1 | 0 | 0 | 90 |
| I would like this workshop (or others like it) scheduled earlier in the programme | 5 | 5 | 0 | 0 | 0 | 100 |
| I had adequate preparation time for the workshop | 3 | 6 | 0 | 1 | 0 | 90 |
| The workshop has helped to prepare me for the ‘real world’ following graduation | 5 | 4 | 1 | 0 | 0 | 90 |
Percentage of students who answered either Strongly agree or Agree; *Response missing for one participant
Post-workshop open-ended items
Nine responses were received for the item ‘What were the strengths of this workshop, in relation to your learning?’:
Eight responses were received for the item ‘What were the limitations of the workshop, in relation to your learning?’:
Seven responses were received for the item ‘What could improve the workshop for future students?’:
In relation to the item ‘If you could sum up your perceptions of the workshop in a couple of words, what would they be?’ eight responses were received:
Discussion
This study explored student perceptions related to an experiential communication skills workshop delivered to a small cohort of final year veterinary technology students at The University of Queensland. The workshop was linked to significant improvements in students’ perceptions of a range of professional communication skills. Following the workshop, responses indicated that students who completed both questionnaires had a greater self awareness of their communication strengths and areas for improvement. The workshop was perceived as a valuable learning experience despite placing students outside of their comfort zone and being described as ‘stressful’ by several respondents. The students who either did not complete the post-workshop questionnaire, or for whom the questionnaires could not be matched, were more confident in many aspects of their communication skills. This would suggest that the results from the matched analysis may be more generalizable to students who are less confident in their skills prior to such an intervention.
Despite several students commenting that the experience was ‘scary’ or ‘stressful’, the great majority asked for greater exposure to this type of learning. This suggests that experiential learning is certainly the key learning in this context, and regardless of how challenging it was perceived to be, the students felt that it was highly beneficial on reflection. Experiential learning helps to prepare students for transition to veterinary practice by accepting responsibility for their own learning within a real context and in real time, before reviewing outcomes (Dale et al, 2008). This type of learning forms a basis for the ongoing self assessment of future learning needs as adult learners and professionals committed to lifelong learning. Feedback from students indicated that many grasped the relevance of the experiential learning cycle, and reflection, for the development of their own communication skills. Students were significantly more aware of their communication strengths, and areas for improvement, following the workshop compared with their responses on their pre-workshop survey. Learning about themselves (self assessment) through reflection and receiving feedback were all valued elements of the workshop. Reflection is the ability to step back from an experience and critically analyze it in an objective manner (Adams et al, 2006). Self and peer evaluation (Epstein, 1999) and reflection, alone or in groups, assist with the development of self awareness (Novack et al, 1997). Self awareness is described as an ability to attend to one's own emotions, attitudes and behaviours and to appreciate how these can affect interactions with others (Benbassat and Baumal, 2005). This definition underscores the relevance of this attribute for veterinary support personnel when interacting with clients and other members of the healthcare team. Reflective practice and self awareness are considered to be essential for the growth in personal attributes for veterinary support personnel (Clarke, 2010).
Student feedback received as part of this study has assisted the review and development of the programme. The majority of post-workshop respondents believed that more exposure to this type of learning would be useful, and all agreed that offering similar workshops earlier in the programme would be ideal. Hence, this study stimulated reflection on the content, delivery and timing of communications training offered for the students.
Pertinent limitations to the generalizability of these findings relate to the small sample size. As has already been discussed, findings from this study may be most representative of students who are less confident in their communication skills prior to such an intervention. Another important limitation for this study was the lack of ‘control students’ who did not attend the workshop. Before/after study designs (also known as test-retest designs), such as the design used, are prone to serious confounding due to concurrent changes in other variables that affect outcomes of interest. For example, the changes in participant perceptions may have resulted from other student activities that were unrelated to the workshop. However, the authors believe the training was the major influence on these changes because the pre- and post-workshop surveys were performed immediately before and within a week of the intervention and the training was specifically designed to improve student's professional communication skills.
Conclusion
This study revealed that an experiential communication skills workshop delivered to a small cohort of final year veterinary technology/nursing students was well received and linked to significant improvements in perceptions of their professional communication skills. Following the workshop, students were significantly more aware of their communication strengths and areas for improvement. This study adds to the small body of literature related to communication skills training for veterinary support personnel. Feedback from this cohort of students may be of interest to other institutions developing or enhancing strategies used for client communication skills training for veterinary support personnel both in Australia and internationally. Further research to compare student self rating of abilities with objective measures of their communication skills would be of value.