Faculty development with integration of low stress pet handling techniques into a veterinary school curriculum

As low stress pet handling methods become more mainstream and expected by pet owners, there is a need for skilled instructors teaching these methods in veterinary medical and veterinary technical curricula. This paper describes the integration of practical techniques for low stress pet handling into a veterinary school curriculum. As this represents a shift in pet handling philosophy, faculty consensus-building, continuing education, and integration of new skills is emphasized.


Introduction
The relationship between humans and companion animals, such as dogs and cats, is changing. The importance of the human-animal bond is increasingly being supported by current research (Barker and Wolen 2008;Walsh 2009). Animals, although legally seen as property, are steadily gaining family member status; a recent study indicated that 89% of cat owners considered their pet to be part of their family (Howell et al. 2016). As the human-pet relationship is changing, pet owners' perceptions of acceptable handling techniques are also evolving. Veterinarians are expected to have well-developed skills in handling companion animals, but handling techniques vary significantly. A small but growing segment of the veterinary profession aims to shift the pet handling paradigm from restraint and control to gentler handling recommendations designed to minimize the pet's stress (Becker 2015;Lloyd 2017). These methods include providing food rewards and positive reinforcement, maximizing environmental comfort for the pet, minimizing stress associated with overzealous restraint or brusque veterinary examinations, and use of sedatives when appropriate (Yin 2009;Rodan et al. 2011). Due to the need to ensure competency in clinical teaching (Lane and Strand 2008) this article documents the development and delivery of continuing professional education to veterinary faculty clinicians for the purpose of improving their knowledge and skills in companion animal handling, specifically low stress techniques at one veterinary school. Faculty proficiency in the topic supports quality teaching of companion animal handling in veterinary students' clinical skills laboratories and during routine patient care. Faculty development includes relaying relevancy, establishing instructor consensus in teaching and practice methods, and delivering feedback to address some of the needs of adult learners (McLeod et al. 2003;Steinert and Mann 2006). The stages of development of this faculty continuing education program included an exploration of the program's context; assessment of the needs of faculty, students, and animals; design and delivery of the program's content; evaluation of the experience; and plans for on-going faculty development.

Context & Needs Assessment
Located in Harrogate, Tennessee and established in 2014, Lincoln Memorial University College of Veterinary Medicine (LMU-CVM) prioritizes skills-based learning with the goal of producing a day one graduate who is competent and confident to enter general practice. As psychomotor skills are learned through repetitive practice with feedback that leads towards mastery (Ericsson 2004), LMU-CVM clinical skills laboratory sessions are typically taught at a faculty to student ratio of 1:6 to 1:8, which ensures adequate oversight of students' skills and allows instructors to provide specific feedback to each student. Laboratory sessions include instructor demonstrations, multimedia resources, and student practice of skills including companion animal physical examination, diagnostic sample collection and evaluation, medication administration, use of diagnostic imaging modalities, induction and maintenance of anesthesia, surgeries common to general practice, and maintenance of quality medical records. In order to perform these skills, students must first become competent at safely and humanely handling companion animals.
LMU-CVM faculty clinicians are a diverse group arising from a number of different veterinary schools internationally. As a result of training at different institutions, they have learned and practiced a variety of companion animal handling techniques including some that could be classified as low stress and some that consist of more traditional restraint. Faculty focus group meetings were held to collect opinions on whether to apply these low stress handling techniques consistently to the LMU-CVM patients as the only way of teaching, as opposed to 'yet another' way of teaching dog and cat handling. Through a consensus-building process, faculty teaching companion animal handling reached an agreement that low stress handling practices are progressive and appropriate given the changing demands of modern pet owners and the research data supporting gentle handling methods (Volk et al. 2011). Faculty identified a need for some degree of standardization in the way that LMU-CVM companion animals were handled in order to avoid a hidden curriculum where students observe handling methods that contradict what they are formally taught in their animal handling laboratory sessions.
Animal patients come to LMU-CVM through the Shelter Outreach to the Appalachian Region (SOAR) program, which assists shelters in providing veterinary care in an otherwise underserved region. Shelter animals differ from owned animals in their general degree of distress due to institutionalization, transport, and wariness of human contact. Our goal is to minimize patient fear while creating a positive interaction in a veterinary hospital setting (Overall 2013

Design & Delivery
A faculty champion with advanced training in low stress handling techniques was appointed to assist faculty during their transition to low stress handling techniques. Several opportunities for faculty training were identified, including summer workshop sessions and pre-laboratory meetings for companion animal handling sessions.

Summer workshop
Each summer a two day faculty development workshop is required for instructors teaching in the clinical skills laboratories. This workshop was implemented in order to promote curricular integration, faculty professional development and consistency in teaching clinical skills laboratories. The workshop includes a two hour hands-on session on low stress animal handling techniques. After an update on new developments in animal handling, instructors discuss the skills for integration or continued use in the animal handling laboratories. Instructors then have the opportunity to practice non-invasive low stress handling techniques on participants' pets. Workshop instructors provide individualized feedback to attendees, answer questions, and consider attendees' suggestions for improvements to the students' animal handling laboratory sessions.

Pre-laboratory sessions
Prior to every clinical skills laboratory a thirty-minute instructor overview session is held with the aims of improving organization, flow, and instructor effectiveness. During these sessions any changes to the laboratory plan from prior semesters are addressed and instructor questions are answered. Instructors have the opportunity to practice laboratory techniques and review laboratory materials including handouts, videos and articles or related material, which are also made available to instructors prior to the pre-laboratory session. For the animal handling laboratories, instructors have the opportunity to review and practice any restraint techniques that they may not otherwise perform during their daily work, such as towel wraps for cats or standing restraint for lateral saphenous venipuncture in dogs (Yin 2009). Instructors become familiar with any models used and have input into the laboratory material. Instructors review the assessment tasks or quiz for the laboratory and establish consistency with what is an acceptable student skill demonstration.

Program Evaluation & Future Plans
All faculty already had significant experience handling companion animals, so during the summer workshop each person practiced the specific techniques with which they were least familiar. One challenge was the temperament of the animals used during the workshop session. Some of the volunteer pets were far more tolerant than a typical shelter animal would be. While it was convenient that most of the pets allowed prolonged practice of techniques without resistance, it did raise the question of whether animal handling skills are best learned on docile pets or on slightly more apprehensive and potentially resistant patients. Informal faculty feedback after the summer workshop was positive. Additional workshops on low stress animal handling are planned to be included in each year's summer workshop in order to provide updates on techniques, skills practice, feedback, and discussion.
Pre-laboratory sessions coordinating the procedures and flow of lab, instructor techniques, and assessment criteria proved critical for effective instructor involvement in laboratory sessions and will be continued. The addition of monthly veterinary education rounds sessions that address relevant topics, such as providing feedback, problembased learning, clinical learning, teaching skills and rubric based assessment, have facilitated on-going faculty

Take Home Messages
With properly trained instructors, low stress animal handling techniques can be integrated throughout students' clinical skills laboratories beginning in semester one with animal handling and body language assessment. As veterinary students move to more complex skills including anesthesia, surgery, and dentistry, low stress animal handling skills continue to be practiced and honed. The repetitive practice of low stress handling methods allows new veterinary graduates to enter small animal practice with the experience to meet the demands of today's pet owners. In order to effectively teach low stress handling methods to students, instructors need to undergo training to ensure that they are adhering to low stress handling as opposed to utilizing other methods.

Notes On Contributors
Jennifer T. Johnson, DVM is Assistant Professor, College of Veterinary Medicine, Lincoln Memorial University. She has a silver certification in companion animal low-stress handling and serves on the Fear Free Advisory Board.