XI Международная студенческая научная конференция Студенческий научный форум - 2019

The recognition that communication skills are as important in veterinary medicine as they are in human medicine, and therefore must be taught in veterinary curricula, is a relatively new concept and research is limited [1]. By contrast, there is a substantial body of literature in human medicine spanning several decades [2]. In human medicine myriad studies consider the definition of communication skills and competencies, how they can be translated into clinical practice, what impact they have on clinical outcomes, and how they can be best incorporated into undergraduate, postgraduate and professional training, including continuing professional development.

Some scholars, notably Jane Shaw [3], Cindy Adams and colleagues [4,5] have applied human medicine communication skills research and training methods to veterinarians and veterinary students, highlighting the parallels and similarities between the two professions. Both are service providers and health care professionals who work to improve patient health. In both professions success and satisfaction are dependent on interactions with humans. Shaw and colleagues [6] proposed that the structure and content of interviews with patients/clients is similar, and thus the measures used to assess and evaluate medical interactions can also apply to veterinarians.

Parallels have been observed not only in skills, but also in their delivery. For example, Shaw and colleagues [7] have demonstrated that women veterinarians are more relationship focused during consultations, with better skills in establishing and building rapport, as compared with men. This gender difference replicates findings in human medicine [7]. In a focus group study by Coe et al. [8] communication skills competencies needed when working with clients and companion animals mirrored that of human medicine: educating clients; providing choices; use of two way communication between the practitioner and the client; breakdowns in communication that impair the interaction; and challenges in communication such as discussion of finances, client misinformation, more than one client in the interaction and time constraints. It is also clear that as with human medicine, where there are breakdowns in communication, the relationship is adversely affected [8].

However, veterinary medicine is not the same as human medicine. The veterinary consult can be described as tripartite, involving the owner, patient and the veterinarian [9]. Shaw and colleagues [3] acknowledge that whilst there are similarities there are also contextual differences. The most obvious, of course, is that the patient is an animal. Radford and colleagues [9] included the need to attend to the animal’s comfort, establishing the role and purpose of the animal to the owner and using the animal to build a relationship with the client. Shaw et al. [3] also list aspects of the human-animal bond, which might be comparable to, but are not the same as the parent-child bond; euthanasia and the challenges that brings for both the client and also the veterinarian; the death of patients, which is far more frequent for veterinarians than most medical practitioners (dependent on specialty); and financial considerations which might result in the withholding of treatment or the euthanasia of an animal, situations that do not occur as a matter of course in human medicine. Of relevance too, is the fact that whilst many doctors run their practice as a business, many work in public hospital settings and have access to government funded health schemes for payment to which veterinarians do not have access. Indeed, research has been conducted that specifically considers the monetary aspects of veterinary care [10] with stronger communication competency related to higher financial returns [11].

The veterinarian-animal-client situation is considered to be comparable to the pediatrician-child-parent situation [3, 12]. Pediatrics, it has been argued, requires communication that rarely involves a dyad and is a specialty that is unique and distinct from other areas of human medicine. Pediatricians usually work within a triad (doctor-child-parent), other family members may also be involved, the age of the child impacts communication (for example preverbal as compared with the child able to use and understand language), family dynamics affecting the interaction, including decision making, plus parents and children having different needs in the consultation. Parents value physicians who try to understand their perspectives, pay adequate attention and respect to their concerns about the child, and who build a partnership in which the child’s feelings and the parents are taken into consideration. Ways in which the child can be compared with the animal in veterinary practice are obvious. This is especially so given that in contemporary Western society companion animals are often-times viewed as members of the family [12] and specifically children.

Whilst it may be true that some of the communication skills needed in veterinary medicine are the same as those needed in human medicine, there is little research that specifically considers these skills in relation to the unique contexts commonly encountered in veterinary practice. To explore communication skills in the context of veterinary practice and implications for veterinary medical education there has been carried out a survey in the state of South Australia where the University of Adelaide School of Animal and Veterinary Sciences has a pool of veterinary practices that provide clinical placements for veterinary students in their clinical years of training. At the time of this study, approximately one hundred local practices offered placements. Purposeful sampling was used to ensure a range of practices from urban and rural locations were targeted from within this pool of practices. Practice owners and some of their associates were involved into a study on communication skills in veterinary training for which qualitative research methods were used. Individual interviews were chosen in preference to focus groups due to practical limitations of participants being able to attend focus groups at a given time.

All participants discussed at length the meaning of “communication skills” in as they relate to veterinary practice. All participants believed that good communication skills are an essential attribute for veterinarians and all were able to articulate what “communication skills” are in practice. Some of their definitions parallel the conceptualization of communications skills and competencies as they are viewed in human medicine [13]. The skills articulated by participants, included communication skills relating to: opening the discussion, building the relationship, gathering information, explanation and planning, structuring the consult and closing the session and tailoring the communication specifically to the client’s needs. However, veterinarians raised four interesting contextual differences:

communication with the animal

An important communication skill in veterinary medicine is to make the animal relaxed. Communication with the animal commences as soon as the veterinarian enters the waiting room. A genuine interest in the animal is deemed important in being able to achieve this, including addressing the animal by name, if the animal has one. To communicate with the animal the veterinarian should draw upon different sensory modalities: looking, listening, smelling, touching, and hearing.

selling service

A challenge for practitioners, participants explained, is being skilled in communication so that the emotional side of pet ownership can be respected alongside providing service to the client, but also considering the commercial aspects of running a business.

communicating about money, decisions and related costs

Discussing costs of care could be associated with confrontation and complaints. Knowing when to be compassionate and when to be stern when clients argued about fees and charges, particularly when this may compromise the welfare of the animal is important skill for veterinarians. Empathy is an essential communication skill when talking with clients about cost. Making sure that costs are not unexpected, and clients are aware that some treatments can be cost prohibitive, particularly in relation to costs and benefits to the animal is a part of communication skills.

communicating about euthanasia

Good communication skills are important when speaking to clients about euthanasia. The age of the client, the meaning of the animal to the client, and the clients’ religious and cultural backgrounds are factors that should be considered when talking about ending an animal’s life. It is important to take time to explain the reasons for euthanasia as well as the process. Explanations to children were viewed as requiring specific skills, but for all clients, they may cause distress if the appropriate terminology is not used.

Veterinary practitioners require high level communication skills. Education and training in veterinary medicine may be better tailored to reflect the unique context of the veterinary profession. The study contributes to this need by identifying the skills that veterinarians have recognized as relevant to their profession, and through identification of those that should be incorporated into undergraduate and postgraduate curricula and continuing professional development.

Demands on veterinarians to master communication skills have never been so great, in light of the challenges faced by the profession. Poor communication skills not only have the potential to threaten job satisfaction, professional and personal success as well as the clinical outcomes of encounters, but may lead to litigation and distress for the client. In some instances, this distress could be quite significant. The ability to recognize normal human emotional reactions, and assess where there is a need for referral to another professional, for example, a general practitioner or psychologist, cannot be considered an optional skill. It is important that veterinarians receive enough training that will prepare them for the demands of the profession.

Список использованных источников:

1. Shaw DH, Ihle SL. Communication skills training at the Atlantic Veterinary College, University of Prince Edward Island. J Vet Med Educ. 2006;33(1):100–4. [PubMed]

2. Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001;76(4):390–3. [PubMed]

3. Shaw JR, Adams CL, Bonnett BN. What can veterinarians learn from studies of physician-patient communication about veterinarian-client-patient communication? J Am Vet Med Assoc. 2004;224(5):676–84. [PubMed]

4. Adams CL, Kurtz SM. Building on existing models from human medical education to develop a communication curriculum in veterinary medicine. J Vet Med Educ. 2006;33(1):28–37. [PubMed]

5. Adams CL, Kurtz S. Coaching and feedback: enhancing communication teaching and learning in veterinary practice settings. J Vet Med Educ. 2012;39(3):217–28. doi: 10.3138/jvme.0512-038R. [PubMed] [CrossRef]

6. Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Use of the roter interaction analysis system to analyze veterinarian-client-patient communication in companion animal practice. J Am Vet Med Assoc. 2004;225(2):222–9. [PubMed]

7. Shaw JR, Bonnett BN, Roter DL, Adams CL, Larson S. Gender differences in veterinarian-client-patient communication in companion animal practice. J Am Vet Med Assoc. 2012;241(1):81–8. doi: 10.2460/javma.241.1.81. [PubMed] [CrossRef]

8. Coe JB, Adams CL, Bonnett BN. A focus group study of veterinarians' and pet owners' perceptions of veterinarian-client communication in companion animal practice. J Am Vet Med Assoc. 2008;233(7):1072–80. doi: 10.2460/javma.233.7.1072. [PubMed] [CrossRef]

9. Radford A, Stockley P, Silverman J, Taylor I, Turner R, Gray C. Development, teaching, and evaluation of a consultation structure model for use in veterinary education. J Vet Med Educ. 2006;33(1):38–44. [PubMed]

10. Coe JB, Adams CL, Bonnett BN. A focus group study of veterinarians' and pet owners' perceptions of the monetary aspects of veterinary care. J Am Vet Med Assoc. 2007;231(10):1510–8. doi: 10.2460/javma.231.10.1510. [PubMed] [CrossRef]

11. Kogan LR, Butler CL, Lagoni LK, Brannan JK, McConnell SM, Harvey AM. Training in client relations and communication skills in veterinary medical curricula and usage after graduation. J Am Vet Med Assoc. 2004;224(4):504–7. [PubMed]

12. Shaw JR, Barley GE, Hill AE, Larson S, Roter DL. Communication skills education onsite in a veterinary practice. Patient Educ Couns. 2010;80(3):337–44. doi: 10.1016/j.pec.2010.06.012. [PubMed] [CrossRef]

13. International journal of medical education [Электронныйресурс]. – Режимдоступа: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216729/#A25068R19 (датаобращения: 14.03.2019)