Curricular Design
In addition to the methods used to teach in a clinical skills curriculum, consideration should also be given to how these are placed in the overall curriculum. For example, are clinical skills best taught in stand‐alone courses, or should they be integrated in other courses within the curriculum? Furthermore, should skills be taught in a stepwise manner or in an intensive training block?
Stand‐Alone Courses or Integrated into Existing Courses
Clinical skills may be taught as stand‐alone courses or their instruction may be integrated into existing ones, and there is no evidence to suggest that one design is better than the other. Regardless of the type of course in which they are taught, it is important to map where, and potentially how, these skills are taught, as well as when and how they are assessed. Furthermore, there should be a logical sequence to skill development that aligns with building toward the final level of clinical competence that has been determined as being core for a curriculum. An additional advantage to curricular mapping is that it allows identification of material that is included, as well as any uncoordinated or unplanned repetition. Mapping may also identify skills that may be redundant, irrelevant, or unsuitable for a Day‐One veterinarian or veterinary nurse.
Spiral (Distributed) versus Block (Intensive) Training
Most skills programs describe a spiral curriculum, where skills are taught in a stepwise building fashion and become more complex at each iteration, providing reinforcement and integration (Harden, 1999; Malone, 2019). For example, early laboratories may concentrate on basic animal handling skills to ensure students can safely work with the range of species they are likely to encounter later in their training and in the eventual workplace. For clinical skills, initially individual items such as surgical scrubbing and gloving are the focus, while over time these skills are added together to develop procedural competence. In this way, patient preparation, surgeon and assistant scrubbing and gloving, and patient draping can be combined to simulate the initial steps of surgery (Malone, 2019). Furthermore, this progression may include advancing from the use of low‐fidelity models to the use of high‐fidelity models to the use of live animals (Read and Hecker, 2013; Carroll et al., 2016).
Spiral training usually takes place over an extended time frame (e.g. months to years) and is an iterative process, with practice of the basic procedures often preceding addition of new procedures. Taught this way, multicomponent skills can be broken into parts and practiced either sequentially or in random order (Malone, 2019), and this is the most common method currently employed in veterinary education (Read and Hecker, 2013; Carroll et al., 2016).
An alternate model is to teach all the skills required for a procedure in an intensive block of time, as has been described in medical education (Gershuni et al., 2013). This method is often used in postgraduate professional development training due to its time efficiency (Malone, 2019). In one study in medical education, a distributed training program for suturing skills was compared to intensive block training where the distributed program included more practice opportunities and resulted in better skills retention (Gershuni et al., 2013).
Step 5: Implementation
The implementation phase can be divided into several different steps, starting with the identification of resources. Resources fall into four basic categories that include personnel, time, facilities, and funding (Kern et al., 2016). Utilizing existing resources (faculty and staff already employed, educational materials already developed, time already put aside in a curriculum, rooms already dedicated to teaching) can lower costs and increase likelihood of success (Schneiderhan et al., 2018).
Resources
Personnel
Personnel involved in teaching or supporting a clinical skills laboratory may include teaching faculty (including residents, interns, graduate students, and adjunct faculty), staff (including licensed veterinary nurses, technical and administrative support), and information technologists (if needed for computerized modules). The number of people in each of these categories is highly variable between institutions depending on the teaching load and the availability of facilities and equipment. However, it is now common practice to have a supervisor and/or director of the facility, which may be full‐ or part‐time faculty appointment, as well as a manager, which is frequently a full‐ or part‐time staff appointment (Morin et al., 2020). Staffing needs may be inconsistent depending on the timing of the laboratory sessions, the number of students being taught, and the proximity to assessments. Therefore, it may be preferable to have multiple part‐time personnel and fewer full‐time personnel.
Sufficient staffing by competent, approachable teachers coupled with readily accessible resources for self‐directed learning are critical to the success of a clinical skills laboratory (Dilly et al., 2017). Veterinarians who have been in primary care practice and experienced veterinary technicians can be good instructors for Day‐One skills (Morin et al. 2020), while peer‐ or near‐peer teaching has also been used to help staff their clinical skills laboratories (Baillie et al., 2009; Read and Hecker, 2013; Bates et al., 2016; Carroll et al., 2016; ten Cate et al., 2018).
Time
Time is often one of the most precious resources and includes the time required for the students, as well as the time of the teachers, including faculty and staff (Schneiderhan et al., 2018). The amount of time reported for teaching clinical skills in veterinary curricula is highly variable. For example, at the University of Minnesota, laboratory training (including nonclinical skills training) comprises 13–15% of the curriculum depending on the student's track (Malone, 2019). Others report having had to cut core laboratory hours and replace these with optional sessions (Carroll et al., 2016). In contrast, another program reported reducing didactic content in years 1 and 2 by 25%, which enabled them to add clinical practical courses focused on fundamental clinical skills (Morin et al., 2020). Similarly, the University of Calgary, with a very strong emphasis on clinical skills training, reports 20% of the curriculum devoted to skills training (Read and Hecker, 2013). Regardless of the time allocated in a program to teach these skills, it is often necessary to have creative and efficient training of clinically appropriate knowledge and skills given the constraints on available time in the curriculum (Thomson et al., 2019).
An additional consideration when allocating time for a clinical skills curriculum is how students should progress. Most professional programs move students through training programs as cohorts in a time‐based manner. However, students enter a professional curriculum with vastly different backgrounds, experiences, innate abilities, and interests. Conversely, students may leave a program with a different set of skills depending on their rate of learning and their area of interest (e.g. track). Does it make sense to assume students should progress at the same speed and need the same learning opportunities, particularly with the high cost of laboratory teaching (Malone, 2019)?
The corollary to this concept is a curriculum that focuses on competency (i.e. time independent), which is one of the fundamental tenets of competency‐based medical curricula (ten Cate et al., 2018). However, given the current administrative restrictions for veterinary programs, this could be difficult to achieve for individual students. A possible alternative would be to offer those students demonstrating proficiency in a given core set of skills opportunities to learn additional, more advanced skills and for these to be acknowledged through a portfolio or “badging” system and which could be used to enhance employability. This approach could be utilized in earlier years of the curriculum, as well as during the clinical years.
Facilities
Facilities are the spaces such as classrooms or clinic sites where the learning will take place (Schneiderhan et al., 2018). Laboratory