veterinary research paper conclusion

An official website of the United States government

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Publications
• Account settings
• Advanced Search
• Journal List

Communication identity in veterinary medicine: a grounded theory approach

Silke gaida, andrea tipold.

• Author information
• Article notes
• Copyright and License information

Correspondence to Silke Gaida; [email protected]

Series information

Received 2018 Aug 7; Revised 2018 Nov 4; Accepted 2018 Nov 9; Collection date 2018.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

It is well established that communication skills are a core competence in veterinary medicine. Most studies in the field of veterinary medicine have focused on communication as an interpersonal skill. Much less is known about communication in the context of professional identity formation. Semistructured interviews with practitioners from companion and farm animal practice, veterinary industry, veterinary research and government service were conducted in Germany in 2016. A grounded theory approach as described by Strauss and Corbin was used to identify characteristics associated with professional communication identity formation in veterinarians. According to the current study, the identity formation process occurs in three steps: existing personal communication identity, socialisation and professional communication identity. Essentials of interpersonal communication, communication interaction experiences at work, acquisition of communication skills and subjective clarification of veterinary communication ability and skills are the key factors associated with this formation process. Since communication skills are of uttermost importance for all fields of veterinary medicine, communication education, and supporting undergraduate students in the process of communication identity formation, should be an important part of the veterinary curriculum. Furthermore, integrating communication skills training in continuing education courses could foster professionalism in veterinary medicine.

Keywords: communication, identity, grounded theory, education, veterinary profession

‘How we communicate is just as important as what we say’ is a guiding principle of Kurtz and coauthors (2016) 1 (p 14), supporting the view that communication is an important component in practising nursing, medicine and dentistry. 2–4 Communication between physician and patients can influence the patient’s satisfaction, 5 6 reduce patient anxiety and direct the choice of doctor. 7 8 Furthermore, a good relationship between physician and patient increases physician satisfaction and results in stress reduction. 9

The importance of communication skills has been studied in detail in human medicine: most of patient concerns are identified by only a minority of health professionals. 10 Moreover, careful history taking contributes to the diagnosis even more than the physical examination. 11 12 In addition, patients claim that they would like to get more information from their physicians. 13 It is well known that information, affection, building relationship, empathy and greater patient-centredness increase patient’s satisfaction. 4 6 In contrast, patient anxiety rises with a lack of empathy and respect. 14 Ineffective communication can even result in increased costs because of non-compliance regarding medication. 1

However, communication skills are not only important in human-related healthcare professions, they are also a core competence in veterinary medicine. 15 16 Science and technology skills alone are not sufficient to be a successful veterinarian. Additional important skills include working in a team, business expertise, understanding of cultural differences, and communication skills with clients, staff and colleagues. 17 18 Furthermore, good working atmosphere and teamwork are important for the satisfaction of practitioners. 19  Gelberg and Gedberg 20 mention that academic veterinarians need such skills as well in order to manage interpersonal relationships and business aspects. 20 Furthermore, veterinary medicine entails the complex relationship between veterinarian and client, animals, society and employers. 21

There is overwhelming evidence that medical, 22–28 dental, 29 nursing 30 and veterinary students (undergraduate and postgraduate) 31–33 can learn different communication skills through specific training. After graduation, a variety of possibilities are open to veterinarians, including work in private practice, research, industry, academia and in government services. Communication skills are vital tools for all fields. 34

To prepare graduates for future careers, the North American Veterinary Medical Education Consortium mentioned communication as a professional competence in their road map for veterinary medical education in the 21th century, 35 identifying communication as one of nine core competences for career-ready veterinary graduates. 36 Likewise, the European Association of Establishments for Veterinary Education included effective communication with clients, public and colleagues with using an appropriate language in their recommended graduation competencies. 37

A goal of any professional curriculum should be to include guidance on professional conduct and behaviour, that is, forming a professional identity (PI). PI describes the awareness of oneself as a professional including the ethical principles important for interpersonal and human–animal interactions. 38 PI is formed during the educational process, and develops continually during a career. Therefore, the educational approach to development of PI is crucial. 39 Studies of veterinary graduates have shown a lack of professional skills. 16 As a result, subsequently developed curricula 40 have included training in these necessary skills. Specifically, Mossop suggested, ‘this curricular component could be strengthened by including the teaching of professionalism as a concept.’ 41 (p.97)Beyond this, the concept of PI has been explored using web-based discussions with practising veterinarians. The results showed that communication skills within the team and with clients are an essential factor of veterinary PI. 42 Participants in a study by May and Kinnison realised the benefit of communication skills, interpersonal relations and teamwork in veterinary practice while they completed a professional skills module. 43

Professional identity formation (PIF) in medicine was studied in the last decade. 44 Jarvis-Selinger et al  describe the formation of identities as a process that occurs ‘at two levels: (1) at the level of the individual, which involves the psychological development of the person and, (2) at the collective level, involving socialization of the person into appropriate roles and forms of participation in the community’s work.’ 45 (p.1186)Cruess  et al oriented their description of PIF around the stages of identity formation of Kegan’s framework. 46

Most studies in the field of veterinary medicine have focused on communication as an interpersonal skill. Much less is known about forming a communication identity in veterinary medicine in the context of PIF.

Therefore, the current study aims to explore how veterinarians from several working fields in Germany are shaped by socialisation leading to their professional communication identity. This qualitative research question guides the analysis following the grounded theory approach. In contrast to other research methodologies, the theory arose from analysis of the data resulting from this research.

Materials and methods

Study design.

In this explorative study, qualitative research methods according to the grounded theory approach of Strauss and Corbin were used, as seen in figure 1 . 47 The report of this study is oriented on the Consolidated Criteria for Reporting Qualitative Research reporting guidelines. 48

Study design with data collecting semistructured interviews and grounded theory approach.

Study population

The first author (SG) contacted nationwide veterinary practices, companies of veterinary industry and veterinary government service offices by telephone or email for participants who were selected purposively. Whenever someone agreed to participate in the study, further demographic information was collected and decided, if this participant fitted the sampling criteria. The sampling was discussed in the research team. It was emphasised that participation was voluntary. Veterinarians with at least five years’ work experience within one of the working fields of veterinary medicine were included (n=20). The single interviews were performed via telephone or face-to-face by SG. After 16 interviews, saturation was reached. Saturation is defined as the status when no new categories or important themes emerge and the properties and dimensions of the categories are well developed 49 . Within our study no new aspects emerged out of the material after including interview number 15. Therefore, we defined the point of saturation after including 16 transcripts of interviews.

Demographic information was collected using a paper questionnaire. Half of the participants were male (n=8) and the other half female (n=8) ( table 1 ) which represents gender distribution in Germany. 50 The mean age was 46 years (min 33 to max 63 years) (SD±8.66 years), the average working experience is 19.5 years (min 8 to max 34 years) (SD±7.75 years).

Interview participants (n=16) divided according to different working fields

Research team

The research team consists of three persons (SG, MD, AH) with experience in the fields of veterinary medicine, higher education and communication.

Semistructured interviews

To collect information about the development of a professional communication identity of German veterinarians, semistructured interviews were conducted. 51 52 An interview guide was used to provide a consistent structure of all interviews. Applying the SPSS (collecting, considering, sorting, subsuming) principle to develop an interview guide, the authors reviewed questions and optimised the structure of the interview guide in an interactive process until consensus was reached. 53 The interview guide consisted of seven main questions ( box 1 ) and multiple questions for detailed information.

Box 1. Main questions of the interview guide.

What do you understand by veterinary competence in communication?

Which communication skills do veterinarians need on your perspective?

When you think back, what influenced your communication skills most?

When you receive the opportunity to decide, how and when should communication skills be learned?

What are the challenges for graduates in your working field in the future?

Do you see a connection/link between your communication skills and your salary?

From your point of view, do you see a connection/link between your communication skills and your satisfaction at work?

At the start of each interview the format of a semistructured interview was explained, and the interviewer motivated the participants to add special ideas. In semistructured interviews, mainly open-ended questions are used. 54 The mean of the interview duration was 36 minutes with a minimum of 20 minutes and a maximum of 50 minutes, all interviews were audiotaped. The interviews were conducted in German and verbatim transcripts were anonymously performed by SG. For transcription, the MAXQDA software V.12 (Verbi, Berlin, Germany) was used. All interview citations in this paper were translated verbatim. With regard to the interview guide, every interviewee was asked the same questions.

The data (transcripts) were analysed by SG using the grounded theory approach by Strauss and Corbin. 49 Grounded theory is a method characterised by simultaneous data collection and analysis, based on comparative methods and aims to build a theory grounded in the data. 55 In contrast to most other methods and methodologies used in veterinary medicine education research, the theory is the result and not the starting point. Additionally, the leading question for the research will be developed during the process, following the steps of the grounded theory approach. We started with the question: ‘How are competencies in professional communication in veterinary medicine used in several fields of work?’ 49 The analysis consists of three types of coding: open coding, axial coding and selective coding. Inductive category building as in figure 2 by Strauss and Corbin was conducted to analyse the data. 49

Inductive category building (open coding) adapted from Strauss and Corbin. 47

Starting the analysis with open coding, inductive categories were created out of the data. After finishing the open coding, axial coding was performed including the comparison between the subcategories to potentially connect the categories. 47 During the selective coding, analyses of conceptual level, the main categories were connected with the core category ‘professional relationship’, and the final framework was developed step by step, including new aspects and insights. During the whole analysis process, memos were written and diagrams were created. Formulation of the main question became more and more concrete. In each step of analysis, meetings with the entire team were conducted and emerging categories were critically discussed and ambiguities or disagreements in coding were resolved by consensus. This procedure ensures constant reflection of the first author (SG). Finally, the emerged framework was compared with the findings from the literature and was integrated in existing theories about PIF.

In the current study, the understanding of veterinarians about competences in veterinary communication was analysed to provide new information about the development of a professional communication identity in veterinarians from several working fields. Our core question is: How do veterinarians develop a professional communication identity? The analysis demonstrated that most of the participants had no precise perception or detailed definition about their communication competences. Nevertheless, the majority had an implicit understanding of communication competences. When interviewees were asked about their understanding of competence in communication, they often became concerned about their true understanding of the term: for example, one interviewee stated, ‘ […] but so the wording [competence in communication] does not make sense for me right now ’ (CAP 1). In the following section, we would like to point out the identified themes instrumental in helping veterinarians create their professional communication identity, as seen in figure 3 .

Professional communication identity formation and influencing factors sorted in categories in the context of the environment veterinarians belong to.

Existing personal communication identity

The existing personal communication identity is influenced by family and social environment as well as education and experiences in school. It is developed largely during childhood. Participants pointed out that experiences during this life period became the cornerstone of their contemporary communication. ‘ Of course, my parents' home was the basis ’ (VI 2), a finding already identified by the research of Schwartz et al . 56

Socialisation

The next step of the formation of communication identity is called ‘Socialization’. Socialisation belongs to the process when a person is influenced by persons or institutions outside the family, 45 56 such as school and higher education institutions. It progresses when contacting role models and professionals. For instance, telephone communication training during the veterinary nursing apprenticeship period was mentioned as a core factor in this development stage. “ During my training period for veterinary assistant I was sent to two seminars on ‘phone skills’ ” (CAP2). Completion of communication training led to a more focused view on communication in daily veterinary medicine. ‘ I can only recommend such training to anyone who works a lot on the phone […] ’ (CAP2).

Furthermore, any experiences during veterinary study can influence the socialisation process. In this regard, participants described communication with different types of persons (eg, extroverted, excited) as challenging. Similar experiences were reported relating to an examination. ‘… as a student, I did so poorly in the first oral exam, but much better in the second with another [examiner]. […] You get an idea that communication […] can run differently and that you can influence it… ’ (VI1). Additionally, similar experiences while working with different types of persons on their doctoral thesis were reported. ‘… already during the dissertation, […] I already noticed that there are different types of people who have to be treated differently ’ (VI1). Correspondingly, an adaptation of one’s communication style is needed to communicate equally and effectively to different people.

As seen above interpersonal communication influences socialisation. This interaction of two individuals is further described in the category ‘ basic essentials of interpersonal communication ’ ( figure 4 ). The characterising properties as shown in figure 4 describe all factors of communication that relate to personal properties of the conversational partners together with communication behaviour and attitudes.

‘Basic essentials of interpersonal communication’ and properties with dimensions of this category.

The properties of this category are described with the following themes: characteristics of the dialogue partner, way of behaving, communication attitude, relationship of the conversational partners, as well as choice of language, communication channels and non-verbal communication. All properties of this category are connected as described below.

Professional behaviour as a veterinarian describes the interaction of veterinarians with conversational partners. The dimension of this behaviour can range from professional distance to an amicably close relationship. These manners are directly influenced by their relationship to the conversational partners (hierarchical to equal). This correlation was highlighted by one leader of a farm animal practice. When one is of or is treated as having equal professional status with another person, more effective feedback is possible. ‘ We have a very flat hierarchy […]. If something is not going well and you discuss potential problems, this request remains much more impressive than instructions by an imperious boss ’ (FAP 4). Additionally, the aspects of non-verbal communication skills are emphasised regarding face-to-face communication. Such skills are not only important in the communication with clients, it is also important for scientific lectures or other forms of public communication (eg, interviews). ‘ Communication is, of course, linguistic and physical. So, communication begins with one’s appearance, communicating a certain level of competence as I appear before the owner. […] how do I open, for example, lectures? How do I behave in public situations? How can I present myself there? ’ (CAP 2). One other important property for the interpersonal communication is the choice of language. Therefore, an adaptation of language consistent with the conversational partners is required. ‘ In practice I was working with the farmer and had to seek a very different level of conversation than that used at the university. I realized, that I had to explain factual relationships in a simpler manner, so that they are ultimately understood by the pet owner ’ (GS1).

‘ Communication interaction experiences at work ’ is another category that refers to socialisation. This includes interpersonal interactions as well as the interaction of persons and animals at work, as shown in figure 5 . Interestingly, participants mentioned little comments about the interactions with animals when they were asked about their communication during work.

‘Communication interaction experiences at work’ and properties with dimensions of this category.

Nevertheless, the importance of interactions with animals and the influence on the human–human interaction was emphasised by one participant when a memory of his internship was described:

So, I’ve watched […] how the vet […] deals with the animals and with the pet owners. […] The interesting thing was to see people delighted when the vet said, ‘what a pretty animal, it looks great’ and that’s made people (owner) so proud that they (vets) get everything they want. (CAP 1)

Much more suggestions were made about the interactions between veterinarians and other people at work. On the one hand, these interactions were often described as stressful particularly in emotional situations (eg, euthanasia). ‘ If you have to tell unpleasant things to the pet owner, whether the animal is seriously ill or if it comes to the point to talk about putting the animal to sleep. You learn to deal with it over time but ((inhales)) this is ((exhales)) not always so easy ’ (CAP 1). On the other hand, constructive interactions were perceived as relaxed interactions. ‘ I do not work alone, but in a team and the exchange with colleagues is very important and I say the friendlier and more constructive and smoother that works the easier it is to work and the more fun it is ’ (VR 2).

‘ Acquisition of communication skills ’ is an additional factor during the socialisation of veterinarians and their communication identity formation. Such acquisition could proceed in different ways, as shown in figure 6 .

‘Acquisition of communication skills’ properties and dimensions of this category.

The analysis differentiates between intentional and unintentional acquisition of communication skills. Courses where communication skills are the central outcome are summarised as intentional acquisition of communication skills. All participants had no explicit communication education during their veterinary study. However, often, these courses are taken as part of continuing education. On the contrary, interviewees who had participated in one or more training courses on communication skills found it helpful for the rest of their career helping them to develop their communication identity. “ […] If one recognizes the importance of communication, almost everyone comes sometime in his professional career to the point […] that ‘I have to work on my communicative abilities because then I have more joy in my job dealing with people and reach my goal more easily ’” (VI 1). The other type of training can be the unintentional acquisition of communication skills such as learning by watching others or learning by doing it. ‘ Of course, it is also plenty of learning by… watching others… ’ (VR 1).

The acquisition of communication skills further could influence ‘ hindrance in the communication ’. If somebody is aware of the possibilities of hindrance which can arise during a communication interaction, the hindrance could be prevented. These hindrances may regard to people (eg, misunderstanding), the environment (eg, loudness) or animals (eg, aggressiveness). Their manner of handling hindrances in interpersonal interactions shapes the future communication interactions in a positive or negative way. These hindrances of communication could be minimised. ‘… that could also be conflicts in the practice team or so. I think I could also reach improvement in the whole work environment, if there were more communication skills among the vets ’ (VI 1).

The ‘ value of communication on behalf of the veterinary profession ’ is an important factor. In all interviews, the majority of people agreed that communication is one of the most important skills in all areas of veterinary medicine. ‘ Not all veterinarians are in practice, and communication skills are also important in other areas of the facet of this profession. Without communication, nothing works ’ (VR 2). Communication plays a central role for veterinarians working in private practice, especially in taking history and giving information after diagnostic examinations. ‘ I consider it absolutely essential for a correct diagnosis or even for a proper history-taking ’ (GS 2). Interestingly, the communication with clients was evaluated more seriously than the examination of the animals. ‘ We can take care of the animals and examine animals, but we have to talk to the people that belong to it (animal) otherwise we will not achieve anything ’ (FAP 1).

Professional communication identity

Starting with an existing personal communication style in combination with complex socialisation processes, the professional communication identity arises. This communication identity defines the individual professional communication style. The aim/result of the professional communication identity is to build professional relationships with the persons you work together in every field of veterinary medicine. If this is neglected, it can have negative consequences. ‘ We are depending on [team conversation] that we take note of certain undesirable developments and this essentially happens through the conversation ’ (GS 1).

The ‘ subjective clarification of veterinary communication ability and skills ’ develops from socialisation of the veterinarian. The professional communication identity is an expression of the subjective communication skills. Furthermore, the subjective clarification of veterinary communication skills can be seen in the interaction with the public. For example, the professional commitment is easier to manage with a well-formed professional communication identity as shown in the following citation. ‘ […] in our case, in livestock practice with our relationship to agriculture […], socially relevant positions are about the use of antibiotics and animal welfare aspects […] this does not affect everyone, but our positions […] we have to communicate facts with the public ’ (FAP 4).

Finally, building a good relationship with clients and colleagues is the basis of a successful communication interaction and results in greater satisfaction at work. ‘ The work is fun, one is satisfied about treatment success […] additionally the working climate with colleagues is important ’ (FAP 3).

In this study, using the grounded theory analysis allowed the development of the first framework of formation of professional communication identity in the various fields of veterinary medicine. The methodology was chosen to find coherences between single-coded categories to build up a theory grounded in the data. 47

This analysis explored how individual veterinarians understand competence in communication and how their development of communication identity is influenced by socialisation. Furthermore, this study highlights the veterinary curricular importance of development of identity.

The current study offered one possible explanation of how veterinarians in various working fields build their PI of communication. An initial objective of the project was to identify the meaning of competence in communication for veterinarians. Recognising that most respondents did not have an implicit understanding of communication competence, the focus on the development of a communication identity arose gradually for most participants, taking place in the context of the profession and work organisation with its duties and limits and society with its values. This professional communication identity can be formed in a process which is characterised by three main influencing factors. Starting with the personal communication identity in early childhood, continued with the socialisation during studies and on-the-job training, and finalised with the formation of a PI during the whole career. Similar findings are reported for the PIF in teaching. 57 There were social experience, role models and teaching environment mentioned as influencing factors during the formation of teaching identity. 57 These findings are consistent with the findings of Cruess et al and Bebeau who described the identity formation in medicine and dentistry. 58 59

The findings of this study showed that the veterinarian behaviour is directly influenced by the relationship with the conversational partner. Therefore, it seems crucial to train behaviour skills for a good professional relationship which is required as a goal for an effective conversation. 60 There are similarities between the behaviour as a veterinarian professional and perceptual communication skill (what you are thinking and feeling), 17 both describing the attitude and respect of the veterinarian. 61 Furthermore, perceptual skills incorporate values, integrity and personal capacities for compassion. 61 Thus, it can be suggested that teaching communication skills effectively, equal attention to perceptual skills as to content and process communication skills are essential. 62 Additionally, language choice was identified as one important property of basic essentials of interpersonal communication in our study. Depending on different conversational partners an adaptation of language is necessary. This finding correlates with the skills-based approach to communication, in particular process skills (how you communicate) which are part of the Calgary Cambridge Guide. 60 Another interesting finding is the influence of veterinary–animal interaction on relationship of veterinarian and client. If the veterinarian pays attention to the animal and interacts with it in a friendly way, the client will show confidence in the veterinarian which is essential for a good/close relationship. Surprisingly, in contrast with the study of Hamood et al , the relevant factor of communication between the veterinarian and the animal was not often highlighted nor mentioned in this study. The previous study pointed out that communication with animals is specific for veterinary medicine in comparison to human medicine. 63 A possible explanation might be that the interviewees in this study were unaware of their communication with the animals and did not focus on this topic during the interviews.

Another interesting finding was the influence of interactions with different types of persons during and after graduation. This important socialisation factor of human–human interactions supports further the idea of learning from models proposed by Bandura. 64 Considering that, an adaptation of the ‘hidden curriculum’, that is, unstated but training associated with the learning environment, is important. 65 Students are highly influenced by role models and peers; therefore, it is suggested that implicit teaching should correlate with explicit teaching goals or learning impact will be diminished. 21 Adams and Kurtz emphasised acceptance by the faculty at large as an important need for successful communication training. 60 According to the result of the study by Engelskirchen et al , explicit instruction on history taking communication was more effective than assuming that such skills will be conveyed implicitly. 32 33

Furthermore, the value of communication in the veterinary profession was emphasised as very important for all working fields and could be as important as the examination of the animal supporting the fact that mandatory communication skills training is crucial in a curriculum. 1 62 66 A curriculum should support the beginning of the development of professional communication identity in a constantly changing working environment and society. Therefore, it seems necessary to support students during their studies in order to facilitate their development of a professional communication identity. For this support, the author recommends an integrated longitudinal (from the first day on) communication training in which all three types of communication skills are taught and trained using role-playing with constructive video feedback. 32 60 67 68 With a longitudinal curriculum combined with increasing complexity in skills, a greater overall effectiveness will be achieved. 69 70 With this approach, it is possible to harmonise the knowledge and communication skills of students. Furthermore, by creating an effective communication training, a realistic environment and different learning types should be considered. Therefore, an experiential learning theory approach by Kolb can serve as a basis that combines different learning styles. 71 72 Additionally, formative assessment for the successful verification of training and students’ development of communication skills is necessary.

The most obvious finding of the analysis was that directed acquisition of communication skills is important for the formation of a PI. This result seems to be consistent with other research which found that communication skills are learnable and a core clinical skill for veterinarians. 1 17 31 73 However, participants without experience in directed acquisition of communication skills often acquired communication skills indirectly. This might be not as effective as explicit learning approaches as it is well known that watching experts and knowing about a skill is not enough to improve one’s own skill. 62 Furthermore, communication sessions during clinical practice are needed to develop clinical communication skills to a professional level. 67 In addition, communication is an essential part of PIF and means of expression of professionalism. 39 If communication skills are taught and learned, consequently it will result in a professional communication style, itself an expression of professionalism. PIF, although a lifelong process, 46 74 is not a gradual process enhanced by crisis or clinical experiences. 45 Therefore, formation of a professional communication identity in veterinary medicine could not be expected at graduation. 58 Correspondingly, postgraduate communication training is helpful to support the formation process during the veterinary career. Therefore, specific training with main emphasis on authentic role-plays should be provided. Adams and Kurtz 62 described the learning and teaching of communication skills as an ever-increasing helix. 62 Furthermore, they emphasise that appropriate curricular and postcurricular design of programmes could emanate from the established guides for veterinary communication. 62 68  Wald et al 75 stressed two teaching models for PIF to bridge from theory to practice. They pointed out two learning courses: on the one hand, ‘resilient responses to difficult clinical interactions’ and, on the other hand, ‘mindful clinical practice’. 75 Both modules promote clinical reasoning, communication with patients and development of a reflective PI. Moreover, they discuss the importance of supporting students during study to prevent work-related stress. 75 Furthermore, mental health could be influenced positively when a veterinarian is confident with communication skills in difficult situations. Additionally, education and practice can provide PIF but there is hazard for damaging a healthy PI resulting in high burnout rates. 76 77 Moreover, it is suggested that the appropriate state of mind is as important as practical competence for preparing students for the world of practice. 78 Today’s practitioner must pay greater attention to their clients’ needs, and adjust to the change from small one-man practices to bigger specialised clinics. In this situation, cooperation and communication is much more important regarding teamwork and cooperation between specialists. 42

Strengths and limitations

Interviews via telephone have limitations in recognising non-verbal signals of the interviewees which can be important for interpretation of meaning. Optimising interpretation was reached by adding paraverbal signals into transcription. However, using single interviews via telephone enabled a nationwide selection of interviewees which enhance the sampling of participants. One strength of this study is the grounded theory analysis by a deliberately mixed research team that systematically ensured both consistency and diversity of analysis of the collected data in team discussions. The aim of the study is not the development of a general empirical proved theory. The aim is to develop one possible theory to explain how the development of the professional communication identity of veterinarians happens. The generalisability of the findings may be limited and will probably depend on the working fields and duties of veterinarians as well as the education of veterinary students by that time. The gender sampling of the interviewees in each working field may lead to limitations. Relating sampling to the statistic of German veterinarians, in farm animal practice the majority of veterinarians are male and the other way round in the industry the women make up the majority. 50 However, in this study, no gender differences occur in the gender mixed working fields and over all participants genders are equally represented. Nonetheless, this is the first framework of professional communication identity formation in veterinary medicine and further research would be necessary to prove this theory. Additionally, communication differs personally, this theory might not be appropriate for every individual veterinarian.

The results of this study indicate that a communication identity formation is an important process for all veterinarians. The professional communication identity arises during a lifelong process and is influenced by, among other things, acquisition of communication skills, essentials of interpersonal communication and experiences at work. This process can be supported during the study time by explicit training on communication skills. A longitudinal integrated communication curriculum with experimental learning strategies in an authentic environment and video-based feedback is required to prepare veterinary students for work-life. It is essential to revise curricula lacking communication skills training to include enhanced reflection on communication within the profession. Despite existing communication curricula in veterinary medicine, this study suggests greater emphasis could be placed on development of perceptual skills in communication in all stages and fields of the veterinarian’s career. Veterinary academia should pay attention and adjust aspects of the ‘hidden curriculum’ to conform with the explicitly taught communication curriculum to maximise impact for better veterinary medicine. 65

Acknowledgments

The authors thank all the participating veterinarians for their contribution to this study. In addition, all authors thank Professor Duncan C Ferguson, University of Illinois at Urban-Champaign, for his valuable support in reading and editing the paper for proper English.

Funding: The research was partly funded by the German Federal Ministry of Education and Research. This publication was supported by the Deutsche Forschungsgemeinschaft and University of Veterinary Medicine Hannover, foundation within the funding programme Open Access Publishing.

Competing interests: SG is a research assistant at Clinical Skills Lab, University of Veterinary Medicine, Foundation. Her interests include communication skills, clinical skills and simulation. AH is a research assistant at the Medical Faculty of Augsburg University. She is responsible for faculty development and is experienced in workshops and courses for faculty and students in the areas of medical education, communication and basic research skills. AT is a professor for veterinary neurology at the Small Animal Clinic, University of Veterinary Medicine, Foundation. Her interests include veterinary neurology and education, e-learning, continuing education and assessments. MD is head of the scil vet academy, scil animal care. His interests include clinical skills and simulation, continuing education, mental health in veterinary medicine and learning strategies.

Ethics approval: This study was reviewed and approved by the University of Veterinary Medicine Hannover doctoral thesis committee, ensuring procedures met ethical guidelines regarding research with human participants. Furthermore, the data protection officer of the University of Veterinary Medicine Hannover verified the observance of the data protection law. All participants gave written informed consent to be part of this study and to accept the audio recording.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data sharing statement: The Interview guide in detail (in German) and additional data can be made available by the corresponding author on request.

• 1. Kurtz S, Silverman J, Draper J. The ’why': a reationale for communication skills teaching and learning : Kurtz S, Silverman J, Draper J, Teaching and learning communication skills in medicine: CRC press, 2016:14–27. [ Google Scholar ]
• 2. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J 2010;10:38–43. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 3. Woelber JP, Deimling D, Langenbach D, et al. . The importance of teaching communication in dental education. A survey amongst dentists, students and patients. Eur J Dent Educ 2012;16:e200–e204. 10.1111/j.1600-0579.2011.00698.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 4. Chant S, Jenkinson T, Randle J, et al. . Communication skills: some problems in nursing education and practice. J Clin Nurs 2002;11:12–21. 10.1046/j.1365-2702.2002.00553.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 5. Okullo I, Astrøm AN, Haugejorden O. Influence of perceived provider performance on satisfaction with oral health care among adolescents. Community Dent Oral Epidemiol 2004;32:447–55. 10.1111/j.1600-0528.2004.00183.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 6. Williams S, Weinman J, Dale J. Doctor-patient communication and patient satisfaction: a review. Fam Pract 1998;15:480–92. 10.1093/fampra/15.5.480 [ DOI ] [ PubMed ] [ Google Scholar ]
• 7. Baron RS, Logan H, Kao CF. Some variables affecting dentists' assessment of patients' distress. Health Psychol 1990;9:143–53. 10.1037/0278-6133.9.2.143 [ DOI ] [ PubMed ] [ Google Scholar ]
• 8. Vick S, Scott A. Agency in health care. Examining patients' preferences for attributes of the doctor-patient relationship. J Health Econ 1998;17:587–605. 10.1016/S0167-6296(97)00035-0 [ DOI ] [ PubMed ] [ Google Scholar ]
• 9. Ramirez AJ, Graham J, Richards MA, et al. . Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996;347:724–8. 10.1016/S0140-6736(96)90077-X [ DOI ] [ PubMed ] [ Google Scholar ]
• 10. Maguire P, Faulkner A, Booth K, et al. . Helping cancer patients disclose their concerns. Eur J Cancer 1996;32A:78–81. 10.1016/0959-8049(95)00527-7 [ DOI ] [ PubMed ] [ Google Scholar ]
• 11. Hampton JR, Harrison MJ, Mitchell JR, et al. . Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. Br Med J 1975;2:486–9. 10.1136/bmj.2.5969.486 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 12. Peterson MC, Holbrook JH, Von Hales D, et al. . Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992;156:163–5. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 13. Jenkins V, Fallowfield L, Saul J. Information needs of patients with cancer: results from a large study in UK cancer centres. Br J Cancer 2001;84:48–51. 10.1054/bjoc.2000.1573 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 14. Abrahamsson KH, Berggren U, Hallberg L, et al. . Dental phobic patients' view of dental anxiety and experiences in dental care: a qualitative study. Scand J Caring Sci 2002;16:188–96. 10.1046/j.1471-6712.2002.00083.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 15. Bristol DG. Using alumni research to assess a veterinary curriculum and alumni employment and reward patterns. J Vet Med Educ 2002;29:20–7. 10.3138/jvme.29.1.20 [ DOI ] [ PubMed ] [ Google Scholar ]
• 16. Brown JP, Silverman JD. The current and future market for veterinarians and veterinary medical services in the United States. J Am Vet Med Assoc 1999;215:161–83. [ PubMed ] [ Google Scholar ]
• 17. 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;224:676–84. 10.2460/javma.2004.224.676 [ DOI ] [ PubMed ] [ Google Scholar ]
• 18. Chadderdon LM, King LJ, Lloyd JW. The skills, knowledge, aptitudes, and attitudes of successful veterinarians: a summary of presentations to the NCVEI subgroup (Brook Lodge, Augusta, Michigan, December 4-6, 2000). J Vet Med Educ 2001;28:28–30. 10.3138/jvme.28.1.28 [ DOI ] [ PubMed ] [ Google Scholar ]
• 19. Kersebohm JC, Lorenz T, Becher A, et al. . Factors related to work and life satisfaction of veterinary practitioners in Germany. Vet Rec Open 2017;4:e000229 10.1136/vetreco-2017-000229 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 20. Gelberg HB, Gelberg S. Perspectives on academic veterinary administration. J Am Vet Med Assoc 2001;219:734–40. 10.2460/javma.2001.219.734 [ DOI ] [ PubMed ] [ Google Scholar ]
• 21. Mossop LH, Cobb K. Teaching and assessing veterinary professionalism. J Vet Med Educ 2013;40:223–32. 10.3138/jvme.0113-016R [ DOI ] [ PubMed ] [ Google Scholar ]
• 22. Rutter D, Maguire G. History-taking for medical students: II—evaluation of a training programme. The Lancet 1976;308:558–60. [ DOI ] [ PubMed ] [ Google Scholar ]
• 23. Maguire GP, Clarke D, Jolley B. An experimental comparison of three courses in history-taking skills for medical students. Med Educ 1977;11:175–82. 10.1111/j.1365-2923.1977.tb00588.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 24. Schreier A, Dub B. Teaching interpersonal communication skills in paediatrics with the help of mothers. S Afr Med J 1981;59:865–6. [ PubMed ] [ Google Scholar ]
• 25. Evans BJ, Coman GJ, Goss B. Consulting skills training and medical students' interviewing efficiency. Med Educ 1996;30:121–8. 10.1111/j.1365-2923.1996.tb00729.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 26. Evans BJ, Stanley RO, Mestrovic R, et al. . Effects of communication skills training on students' diagnostic efficiency. Med Educ 1991;25:517–26. 10.1111/j.1365-2923.1991.tb00105.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 27. Campbell E, Weeks C, Walsh R, et al. . Training medical students in HIV/AIDS test counselling: results of a randomized trial. Med Educ 1996;30:134–41. 10.1111/j.1365-2923.1996.tb00731.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 28. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002;325:697–700. 10.1136/bmj.325.7366.697 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 29. Dunning DG, Lange BM. The effect of feedback on student use of interpersonal communication skills. J Dent Educ 1987;51:594–6. [ PubMed ] [ Google Scholar ]
• 30. Daniels TG, Denny A, Andrews D. Using microcounseling to teach RN nursing students skills of therapeutic communication. J Nurs Educ 1988;27:246–52. [ DOI ] [ PubMed ] [ Google Scholar ]
• 31. Latham CE, Morris A. Effects of formal training in communication skills on the ability of veterinary students to communicate with clients. Vet Rec 2007;160:181–6. 10.1136/vr.160.6.181 [ DOI ] [ PubMed ] [ Google Scholar ]
• 32. Shaw JR, Barley GE, Hill AE, et al. . Communication skills education onsite in a veterinary practice. Patient Educ Couns 2010;80:337–44. 10.1016/j.pec.2010.06.012 [ DOI ] [ PubMed ] [ Google Scholar ]
• 33. Engelskirchen S, Ehlers JP, Tipold A, et al. . Vermittlung kommunikativer Fertigkeiten im Tiermedizinstudium am Beispiel der Anamneseerhebung während des Praktischen Jahres an der Klinik für Kleintiere der Stiftung Tierärztliche Hochschule Hannover. Tierärztliche Umschau 2016;71:270–6. [ Google Scholar ]
• 34. Humble JA. Improving listening skills of food animal practitioners. J Am Vet Med Assoc 1996;209:1067–8. [ PubMed ] [ Google Scholar ]
• 35. Andrews K. Roadmap for veterinary medical education in the 21st century: responsive, collaborative, flexible, 2013. [ Google Scholar ]
• 36. Hodgson JL, Pelzer JM, Inzana KD. Beyond NAVMEC: competency-based veterinary education and assessment of the professional competencies. J Vet Med Educ 2013;40:102–18. 10.3138/jvme.1012-092R [ DOI ] [ PubMed ] [ Google Scholar ]
• 37. EAEVE EAoEfVE. List of subjects and day one competences, 2016. [ Google Scholar ]
• 38. Allister R. Questions of identity. Vet Rec 2015;176:431–2. 10.1136/vr.h2059 [ DOI ] [ PubMed ] [ Google Scholar ]
• 39. Apker J, Eggly S. Communicating professional identity in medical socialization: considering the ideological discourse of morning report. Qual Health Res 2004;14:411–29. 10.1177/1049732303260577 [ DOI ] [ PubMed ] [ Google Scholar ]
• 40. Lloyd JW, King LJ, Mase CA, et al. . Future needs and recommendations for leadership in veterinary medicine. J Am Vet Med Assoc 2005;226:1060–7. 10.2460/javma.2005.226.1060 [ DOI ] [ PubMed ] [ Google Scholar ]
• 41. Mossop LH. Is it time to define veterinary professionalism? J Vet Med Educ 2012;39:93–100. 10.3138/jvme.0411.041R1 [ DOI ] [ PubMed ] [ Google Scholar ]
• 42. Armitage-Chan E, Maddison J, May SA. What is the veterinary professional identity? Preliminary findings from web-based continuing professional development in veterinary professionalism. Vet Rec 2016;178:318 10.1136/vr.103471 [ DOI ] [ PubMed ] [ Google Scholar ]
• 43. May SA, Kinnison T. Continuing professional development: learning that leads to change in individual and collective clinical practice. Vet Rec 2015;177:13 10.1136/vr.103109 [ DOI ] [ PubMed ] [ Google Scholar ]
• 44. Cruess RL, Cruess SR, Boudreau JD, et al. . A schematic representation of the professional identity formation and socialization of medical students and residents: a guide for medical educators. Acad Med 2015;90:718–25. 10.1097/ACM.0000000000000700 [ DOI ] [ PubMed ] [ Google Scholar ]
• 45. Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med 2012;87:1185–90. 10.1097/ACM.0b013e3182604968 [ DOI ] [ PubMed ] [ Google Scholar ]
• 46. Kegan R. The evolving self: Harvard University Press, 1982. [ Google Scholar ]
• 47. Strauss AL, Corbin JM, Niewiarra S. Grounded theory: grundlagen qualitativer sozialforschung. Beltz: Psychologie-Verlag-Union, 1996. [ Google Scholar ]
• 48. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349–57. 10.1093/intqhc/mzm042 [ DOI ] [ PubMed ] [ Google Scholar ]
• 49. Corbin J, Strauss A, Strauss AL. Basics of qualitative research: Sage, 2014:65–86. [ Google Scholar ]
• 50. Statistik B. Tierärzteschaft in der Bundesrepublik Deutschland. Deutsches Tierärzteblatt 2017;5:616–21. [ Google Scholar ]
• 51. Brinkmann S, Kvale S. Interviews: learning the craft of qualitative research interviewing, 2015:147–61. [ Google Scholar ]
• 52. Liamputtong P, Serry T. The In-depth interviewing Method in Health In: Liamputtong P, ed Research methods in health: foundations for evidence-based practice, 2013:39–53. [ Google Scholar ]
• 53. Helfferich C. Konstruktion von Instrumenten – der Weg zu einem Leitfaden : Helfferich C, Die Qualität qualitativer Daten. 4th edn: Springer, 2011:178–89. [ Google Scholar ]
• 54. Ng S, Lingard L, Kennedy TJ. Qualitative research in medical education: methodologies and methods : Swanwick T, Understanding medical education: Evidence, theory and practice: John Wiley & Sons, 2013:371–84. [ Google Scholar ]
• 55. Charmaz K, Thornberg R, Keane E. Evolving grounded theory and social justice inquiry : Denzin NK, Lincoln YS, The SAGE handbook of qualitative research: SAGE Publications, 2017:411–43. [ Google Scholar ]
• 56. Schwartz SJ, Luyckx K, Vignoles VL. Toward an integrative view of identity : Schwartz SJ, Luyckx K, Vignoles VL, Handbook of identity theory and research: Springer, 2011:1–23. [ Google Scholar ]
• 57. Beijaard D, Meijer PC, Verloop N. Reconsidering research on teachers’ professional identity. Teach Teach Educ 2004;20:107–28. 10.1016/j.tate.2003.07.001 [ DOI ] [ Google Scholar ]
• 58. Bebeau MJ. Chapter 4: evidence-based character development. Lost virtue: Emerald Group Publishing Limited, 2006:47–86. [ Google Scholar ]
• 59. Cruess RL, Cruess SR, Boudreau JD, et al. . Reframing medical education to support professional identity formation. Academic Medicine 2014;89:1446–51. 10.1097/ACM.0000000000000427 [ DOI ] [ PubMed ] [ Google Scholar ]
• 60. 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;33:28–37. 10.3138/jvme.33.1.28 [ DOI ] [ PubMed ] [ Google Scholar ]
• 61. Silverman J, Kurtz S, Draper J. Defining what to teach and learn: an overview of the communication skills curriculum In: Silverman J, Kurtz S, Draper J, eds Skills for communicating with Patients, 2005:7–21. [ Google Scholar ]
• 62. Adams CL, Kurtz S. Communication : Hodgson JL, Pelzer JM, Veterinary medical education: a practical guide. 1st edn: Wiley, 2017:357–77. [ Google Scholar ]
• 63. Hamood WJ, Chur-Hansen A, McArthur ML. A qualitative study to explore communication skills in veterinary medical education. Int J Med Educ 2014;5:193–8. 10.5116/ijme.542a.975d [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 64. Bandura A. Lernen am modell: Ansätze zu einer sozial-kognitiven Lerntheorie: Klett, 1976:229. [ Google Scholar ]
• 65. Mossop L, Dennick R, Hammond R, et al. . Analysing the hidden curriculum: use of a cultural web. Med Educ 2013;47:134–43. 10.1111/medu.12072 [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 66. Bok HGJ, Jaarsma DADC, Teunissen PW, et al. . Development and validation of a competency framework for veterinarians. J Vet Med Educ 2011;38:262–9. 10.3138/jvme.38.3.262 [ DOI ] [ PubMed ] [ Google Scholar ]
• 67. Adams CL, Kurtz S. Coaching and feedback: enhancing communication teaching and learning in veterinary practice settings. J Vet Med Educ 2012;39:217–28. 10.3138/jvme.0512-038R [ DOI ] [ PubMed ] [ Google Scholar ]
• 68. Silverman J. Teaching clinical communication: a mainstream activity or just a minority sport? Patient Educ Couns 2009;76:361–7. 10.1016/j.pec.2009.06.011 [ DOI ] [ PubMed ] [ Google Scholar ]
• 69. van Dalen J, Kerkhofs E, van Knippenberg-van den Berg BW, et al. . Longitudinal and concentrated communication skills programmes: two dutch medical schools compared. Advances in Health Sciences Education 2002;7:29–40. 10.1023/A:1014576900127 [ DOI ] [ PubMed ] [ Google Scholar ]
• 70. Dalen J, Zuidweg J, Collet J. The curriculum of communication skills teaching at Maastricht Medical School. Med Educ 1989;23:55–61. 10.1111/j.1365-2923.1989.tb00812.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 71. Kolb DA. Experience as the source of learning and development. Experiential learning. Englewood Cliffs, NJ: Prentice-Hall, Inc, 1984. [ Google Scholar ]
• 72. Meehan MP, Menniti MF. Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb’s experiential learning theory. J Vet Med Educ 2014;41:371–83. 10.3138/jvme.1213-162R1 [ DOI ] [ PubMed ] [ Google Scholar ]
• 73. McDermott MP, Tischler VA, Cobb MA, et al. . Veterinarian–client communication skills: current state, relevance, and opportunities for improvement. J Vet Med Educ 2015;42:305–14. 10.3138/jvme.0115-006R [ DOI ] [ PubMed ] [ Google Scholar ]
• 74. Forsythe GB, Snook S, Lewis P, et al. . Making sense of officership: developing a professional identity for 21st century army officers In: Matthews LJ, ed The future of the army profession, 2002:357–78. [ Google Scholar ]
• 75. Wald HS, Anthony D, Hutchinson TA, et al. . Professional identity formation in medical education for humanistic, resilient physicians: pedagogic strategies for bridging theory to practice. Academic Medicine 2015;90:753–60. [ DOI ] [ PubMed ] [ Google Scholar ]
• 76. Jennings ML. Medical student burnout: interdisciplinary exploration and analysis. J Med Humanit 2009;30:253–69. 10.1007/s10912-009-9093-5 [ DOI ] [ PubMed ] [ Google Scholar ]
• 77. Hatch PH, Winefield HR, Christie BA, et al. . Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J 2011;89:460–8. 10.1111/j.1751-0813.2011.00833.x [ DOI ] [ PubMed ] [ Google Scholar ]
• 78. Dornan T, Boshuizen H, King N, et al. . Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning. Med Educ 2007;41:84–91. 10.1111/j.1365-2929.2006.02652.x [ DOI ] [ PubMed ] [ Google Scholar ]
• View on publisher site
• PDF (741.1 KB)
• Collections

Similar articles

Cited by other articles, links to ncbi databases.

• Download .nbib .nbib
• Format: AMA APA MLA NLM

Add to Collections

• Research article
• Open access
• Published: 19 October 2020

An integrated review of the role of communication in veterinary clinical practice

• Jack K. H. PUN   ORCID: orcid.org/0000-0002-8043-7645 1  

BMC Veterinary Research volume  16 , Article number:  394 ( 2020 ) Cite this article

47k Accesses

35 Citations

16 Altmetric

Metrics details

There is a growing interest in exploring the nature of communication in veterinary medicine and understanding how veterinary practitioners communicate with their clients and other professionals. This is the first integrative review of literature on veterinary communication. Applying the PRISMA model, the PubMed, PsychInfo and ERIC databases were searched using keywords such as ‘veterinary’, ‘vet’, ‘communication’ and ‘interaction’ for related articles published between 1 January 2000 and 31 December 2018.

Keyword searching through the databases yielded 1572 related studies. Only 48 of these studies were included in our analysis after an in-depth review by two independent reviewers using the critical appraisal skills Programme frameworks with high inter-rater reliability (Cohen’s kappa coefficient κ > 0.8). The existing body of research on veterinary communication can be classified into three major areas: (a) client–veterinarian communication, (b) cross-disciplinary communication in a professional veterinarian team and (c) training of veterinary communication skills. This review details the complexity and heterogeneity of agenda in the field of veterinary communication. The included studies indicate that veterinary practitioners are not equipped with specific communication skills to address different agendas in veterinary communication. The veterinary curriculum should include a component on communication training that can help veterinary students acquire necessary communication skills that allow them to effectively communicate with clients and other professionals

This review detailed the complexity of agendas in the field of veterinary communication. The results indicate that veterinary practitioners can further benefit from training on specific communication skills that address the agendas found in veterinary communication research. Furthermore, the veterinary curriculum should include a component on communication training that equips veterinary students with the necessary communication skills that allow them to effectively communicate with different stakeholders such as clients and colleagues with and across the field of veterinary science.

Communication has always been an important pillar for veterinarians [ 1 ]. The ability to communicate effectively leads to better clinical outcomes, such as client satisfaction during the veterinary visit and increased client compliance with the veterinarian’s recommendations [ 2 ]. Many factors are known to drive the quality of client–veterinarian communication such as the veterinarians’ communication skills and clients’ expectations [ 3 ]. A ‘client-centred’ approach has been promoted to facilitate clients’ adherence, aiming to make more clients decide upon a treatment option in line with the veterinarian’s recommendations. Failure to effectively communicate with clients may result in health, safety and legal repercussions for veterinarians [ 4 , 5 ]. The quality of communication has a direct impact on the quality of care [ 1 , 6 ]. In particular, in the field of veterinary communication, there is a growing interest in 1) the ways of delivering difficult news to clients [ 7 , 8 ], 2) the role of communication skills in the veterinary education curriculum [ 9 , 10 , 11 ] and 3) the application of client-centred communication approach within the veterinarian–client relationship [ 12 , 13 , 14 ].

Researchers have suggested that a systematic approach of teaching effective communication skills should be included in the veterinary education curriculum. The importance of communication skill education has been highlighted by Haldane et al. [ 15 ], whose study indicates that both veterinary practitioners and students ranked verbal communication and interpersonal skills as the most vital abilities for potential veterinary practitioners hoping to join the industry. Moreover, in English speaking countries, the Calgary–Cambridge model is adopted in all veterinary institutions to strengthen the communication skills of the students and consequently improve the outcomes for clients [ 16 ]. Psychology courses that include effective communication skills to interact with clients and help them handle bereavement issues have also been incorporated in some veterinary programmes [ 17 ]. However, many important communication topics remain missing from the existing veterinary education curriculum, such as ways to provide social support to clients who have lost their pets [ 18 ]. Additionally, recent research reveals that communication training in veterinary education is lacking, especially in content-heavy programmes [ 15 ], and has revealed that some veterinary students and practitioners possess inadequate communication skills in clinical encounters. Multiple studies have also stressed the need for post-educational training to enhance veterinary practitioners’ clinical communication skills [ 13 , 19 , 20 ].

How veterinarians deliver difficult news to their clients is one of the most researched areas in this field [ 7 , 8 ]. As summarised by Nickels and Feeley [ 21 ], the issues that require communication of bad news to clients in veterinary medicine include 1) pets’ chronic or terminal illness, 2) treatment or treatment failure, 3) unexpected outcomes during the surgery, 4) emergency cases, 5) euthanasia discussions and 6) other potential medical situations. While delivering difficult news, veterinarians often adopt several strategies to ensure the psychological well-being of their clients, such as a careful use of language, the use of open-ended questions, non-verbal skills, relational strategies, developing rapport and empathy with clients, sharing their own experience, respecting the autonomy of clients and avoiding implications of guilt [ 21 ]. If veterinarians use such a client-centred approach to communication in extensive discussions with clients, they could better understand the clients’ decisions and address their expectations regarding the care of their pet [ 16 , 22 ].

Although several studies have recently focused on the above-mentioned three areas in the field of veterinary communication, there seems to be a knowledge gap in this field, as limited studies have taken a holistic approach to study the role of communication in veterinary practices and explore the interactions between veterinarians, clients and other related professionals. To fill in this gap, this integrated review aims to answer the following research questions:

(1) What are the characteristics of veterinary communication reported in these studies?

(2) What are the major findings on veterinary communication?

Search strategy

The PRISMA model, an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses, was applied for reporting this review [ 23 ] (see Fig.  1 ). Our search revealed an upsurge in the studies on veterinary communication after 2000; therefore, we focused our search on veterinary communication studies published between 1 January 2000 and 31 December 2018. After discussing with veterinarians and a group of researchers in veterinary science, keywords such as ‘veterinary’, ‘vet’, ‘communication’ and ‘interaction’ were selected as search terms to identify relevant articles.

Integrated review of the study

Inclusion and exclusion criteria

All included secondary research articles peer-reviewed and selected based on relevant studies related to the topic of the role of communication in veterinary practices in English-speaking countries. After screening the relevant articles, the following three recurring themes were identified and coded by two independent reviewers (the author and a research assistant): (a) client–veterinarian interaction, (b) cross-disciplinary communication in a veterinarian professional team and (c) training of veterinarian communication skills. The following articles were excluded: (a) studies focusing on topics unrelated to veterinary medicine (e.g. the role of pets in human medicine), (b) descriptive studies without the support of any empirical evidence, (c) non-English language articles and (d) non-peer-reviewed studies.

Selection process

The ERIC, PubMed and PsychInfo databases were searched in the initial screening process to identify relevant studies using the following search terms: ‘veterinary’ or ‘vet’, ‘communication’ and ‘interaction’. Studies that met the inclusion criteria were included for review, and duplicate articles were removed. In addition, a hand search was performed for related studies, and the bibliographies of the included articles were also checked for possible relevant studies. The title, abstract and key information of each included article were reviewed independently by the two reviewers based on inclusion criteria. Each study was then examined by the author and a research assistant. Disagreements were resolved by discussion between the two reviewers. If disagreement persisted, a third person who was a veterinary researcher was consulted to make the final decision. The inter-rater agreement was expressed using Cohen’s kappa coefficient.

Quality assessment

The quality of the included studies was assessed separately by the author, one research assistant and a group of students with a veterinary background to attain an agreement between the author and other researchers. The Critical Appraisal Skills Programme (CASP) [ 24 , 25 , 26 , 27 ], a series of standardised and validated checklists that are commonly adopted by scholars in the field of health communication, was used to evaluate the quality of the included studies [ 28 ].

A two-step coding approach was applied in the review process. All included articles were read three times to allow the reviewers to familiarise themselves with the results of each study. First, the author read the abstract of each article and decided which articles to include based on the inclusion criteria. Based on the key information from the abstracts and scanning the full texts, the objectives, participant characteristics, study design, method(s) and key findings of each study were summarised (Table  2 in Appendix ). Second, each study was examined by the author and a research assistant, and their findings were coded independently according to the research questions for this review analysis: 1) What are the characteristics of veterinary communication reported in these studies? 2) What are the major findings on veterinary communication?

To address these research questions, a subset of coding questions was developed for coding the data into themes, including Participants, Context, Purpose, Method, Data collection and Types of analysis. These themes were checked, repeated, compared and organised for their thematic connections between the annotated notes of the recurring themes. The author and research assistant constantly compared the annotated notes of each study with the rest of the included studies to identify the emerging topics. Subsequently, the second researcher checked and reviewed the included articles.

Included articles

The initial screening revealed 1572 related article titles based on our keyword searches, 1524 of which were excluded after reviewing the abstracts as they did not fulfil the inclusion criteria. The resulting 48 articles were subjected to further in-depth review (see Fig. 1 ). In addition, the following procedures were implemented for ensuring quality of the included studies: screening using keywords, screening the titles, reviewing abstract details, examining the full text and extracting data. For in-depth data extraction, the author and research assistant read the articles in depth and independently filled in a data extraction form [ 24 , 25 , 26 , 27 , 28 ].

For all of the included studies ( n  = 48), the responses to the five evaluative questions were ‘yes’. Similarly, in most of the included studies, ‘yes’ was the answer to at least eight questions from the CASP checklists. This indicates that the included studies were of good quality. No included study was removed because of poor quality. To understand the studies’ contribution to the topic of veterinary communication and the weight of evidence (WOE) of the studies, we also developed an in-depth account of the 48 studies, and only those that met the inclusion criteria have been described and justified below. The account aimed to address the differences in the rating of quality assurance evaluation (i.e. High, Medium or Low) between studies, as well as in each study’s contribution to the review questions, in terms of the following aspects of WOE: 1) relevance of the focus of the study; 2) appropriateness of the study’s research design for addressing the review questions; 3) trustworthiness of the study’s overall methodology; and 4) contribution of the study (as a result of the previous 1–3) to the review questions.

Both the author and research team then checked the completed in-depth review to resolve any identified dissimilarities. The quality evaluation was performed based on each study’s contribution to the review questions (see ‘WOE’ below). The inter-rater reliability of the data extracted by the two independent reviewers was calculated. The result of quality judgement was high, with less than 2.0% disagreement.

The weight of evidence (WOE)

The WOE was measured based on the following four aspects: (1) the relevance of each study to the review; (2) the appropriateness of the research design; (3) the trustworthiness of the reported research findings; and (4) the contribution of the study to this review. Despite the degree of subjectivity in the process of WOE measurement, a fairly representative picture of the overall research in veterinary communication can be observed in Table  1 . Among the included articles, 83% ( n  = 40) were found to have high or medium relevance to this review and 46% ( n  = 22) used research designs that were considered as highly appropriate in addressing the review questions. Furthermore, 27% ( n  = 13) of the articles showed a powerful contribution in addressing the review questions and 56% ( n  = 27) showed a fair contribution. These results indicate that regardless of the increasing research interest in communication in veterinary science, more future studies with a rigorous research methodology are warranted.

The included studies

The details of the 48 studies that fulfilled the inclusion criteria are summarised in Table 2 in Appendix . The number of published articles on veterinary communication increased between 2007 and 2017. Most of the included studies were found in the United States ( n  = 19), the United Kingdom ( n  = 14), Canada ( n  = 4), Australia ( n  = 3), and other European countries ( n  = 8) such as the Netherlands (n = 3). This finding can be explained by the number of representative veterinary-related professions and universities with veterinary colleges in these countries. In terms of the methodology, qualitative interviews and quantitative surveys were the most common tools used in the studies to record the personal experiences of veterinarians and assess their communication skills [ 56 ].

Themes of the included studies

As thematic analysis can be adapted to the aims of the research, instead of using a set of pre-assigned themes in this review, the author sorted, identified and explored the thematical relationships of the coded issues from each study, which were categorised into the following broader categories: 1) client–veterinarian communication; 2) cross-disciplinary communication in a professional veterinarian team; 3) training of veterinary communication skills. Categorised themes were subjected to the common steps of thematic analysis (familiarisation, coding, generating themes, reviewing themes, defining and naming themes, and writing up) [ 57 ].

Client–veterinarian communication

Client–veterinarian communication was found to be the most recurring theme in the selected studies. Clinical communication skills were mostly investigated by comparison between human medicine [ 9 , 58 ]. The client-veterinary interaction is delineated in an initial greeting, history taking, performing physical examination, explaining diagnosis, offering treatment options and closing the interaction. Trust and rapport are built up throughout the process through the veterinarian’s usage of communication strategies and interpersonal skills.

Although several steps of consultation are common between veterinary and human medical consultations (e.g. treatment plans), fundamental differences exist between them. One is that pets cannot verbalise their medical concerns to the veterinarian, and thus, the veterinarian relies on the owners’ explanations or clinical examinations to determine the pet’s illness. Admittedly, this is a situation comparable to paediatrician-patient communication, as young children are also not able to communicate their concerns clearly, rendering healthcare practitioners dependent on communication with caretakers [ 59 , 60 ]. Therefore, development of trust in a client–veterinarian relationship is crucial as it will not only enhance the quality of history taking but also will allow better clinical diagnosis and subsequent treatment care.

Further, several studies have emphasised the constraints of insufficient consultation time [ 11 , 12 , 31 ]. On average, veterinarians spend only 24 min per case [ 11 ], and many veterinarians have to deliver all the necessary information within this time. This prompts some clients to search for further veterinary information online, which could be misleading and incorrect [ 12 ]. To prevent clients from receiving unreliable information, veterinarians should educate clients about ways to identify reliable sources of information online [ 12 ]. For example, the overuse of antibiotics is a real concern for many veterinarians. Despite increasing awareness about the development of resistance due to antibiotic overuse, most clients still have misconceptions about the appropriate use of antibiotics [ 39 ]. Another challenge faced by many veterinarians is that some clients ignore the veterinarian’s recommendations. If the clients do not adhere to the professional advice and prescribed diet, the results could be life-threatening for the pet. One study suggested that clients with a closer relationship with their veterinarian were more willing to follow their veterinarian’s suggestions and pay for their pet’s treatments because they understand the recommendations well [ 6 ]. This can be achieved with long-term trust between the clients and their veterinarian. One approach to develop trust is to share personal experiences and inform all possible options. Clients can then feel assisted instead of being forced to make certain decisions [ 21 ]. When the veterinarians show their willingness to help, the clients are more likely to select the recommended treatment options. Another approach is to avoid misunderstanding; the veterinarians can spend more time with their clients to ensure that the clients understand the explanations. Such a careful approach would help build a trustful and reliable relationship between the two parties [ 12 ]. Absence of trust in any client–veterinarian relationship can lead to miscommunication and no adherence to treatments, which is likely to reduce the client’s satisfaction and put animal safety at risk [ 41 ].

The importance of nonverbal communication within client-veterinarian communication should also be acknowledged. Sutherland [ 61 ] writes that these nonverbal cues during a conversation may be far more important than the verbal content, as nonverbal communication can alter the meaning of a statement. As such, it is important for veterinary practitioners to develop the ability to pick up nonverbal cues from patients and alter their actions accordingly as this skill will prove useful in various contexts, such as when the veterinarians need to respond to clients’ emotions. For example, the veterinarians can maintain good eye contact, spend time with the client and listen to their needs, all of which can improve history taking and consequently the prescription of a more comprehensive care plan and recommendations [ 1 , 21 ]. Clients’ negative emotions can also be identified by veterinarians who understand subtle cues or overtly shared verbal concerns. Veterinarians can also use nonverbal communication for delivering a message to the client, utilizing facial expressions and body language to promptly provide emotional support using a mix of appropriate and effective verbal and non-verbal communication [ 33 ]. Veterinarians should consider four forms of non-verbal cues while communicating with clients: kinesics, proxemics, paralanguage and autonomic shifts. Kinesics includes facial expressions, level of body tension, touch and movement, whereas proxemics is related to the shaping of space between the client, animal and veterinarian. Paralanguage involves voice-related components such as pitch, tone and volume. Autonomic shifts are an unpredictable variable as they are governed by the autonomic nervous system [ 40 ].

Delivering difficult news is considered as the most important aspect of communication for many veterinarians [ 14 ]. The strong relationship between clients and their pets makes it challenging for many clients to accept any difficult news as they view their pets as their family members [ 11 ]. When delivering difficult news, veterinarians are required to attend to the client’s emotional needs using communication strategies to minimise their negative experiences or risk of trauma [ 44 , 45 ]. Delivering difficult news can be especially challenging when the veterinarians have to communicate with vulnerable groups [ 44 ]. Modified communication strategies can be used to fulfil the expectations of the vulnerable groups, such as children and the elderly. For children, using specific ways of delivering bad news is important to reduce trauma at the developmental stage. When their pets are ill or could die, it is better to first communicate with their parents about ways to share the bad news with their children, and following an honest, simple and kind approach is recommended [ 44 ]. Likewise, when attending to the elderly, communication should focus on their connection with the pet. According to Bateman, communication skills are crucial for dealing with the situation without causing additional problems [ 45 ]. When the veterinarians can skilfully present bad news, they need not behave defensively during a difficult conversation, which allows time for their clients to accept and understand the information. It is also important to assess the preferences of the clients before delivering the difficult news. There are existing frameworks in human medicine that provide a step-by-step guide on how to break bad news, such as the COMFORT (Communication, Orientation, Mindfulness, Family, Ongoing, Reiterative messages, and Team) model and SPIKES (Setting, Perception, Invitation, Knowledge, Empathetic Response, Summary) protocol. However, research into developing a specific model for delivering difficult news in veterinary medicine has been limited. Veterinarians also face tremendous pressure while delivering bad news, which has been reported as one of the common factors of occupational stress in the veterinary career [ 30 ]. Thus, it is important to teach useful communication skills in the veterinary curriculum that can help veterinary students deliver bad news and avoid any stress due to miscommunication during the veterinary clinical practice. There are different approaches to minimise the stress caused to both the veterinarians and clients when delivering/receiving bad news [ 35 ]. As the loss of a companion animal can be traumatic and occasionally very difficult to accept for many people, veterinarians can invite clients to visit with a family member or friend as he/she could provide the necessary support to the clients when they receive the bad news [ 7 , 34 ]. There are many ways to express empathy. For example, a verbal condolence can provide emotional support, in addition to other approaches such as a sympathy card, informational support (i.e. grief management hotlines, brochures and booklets) and supporting non-verbal communication (e.g. hand on shoulder and back or hug) [ 21 ]. The level of support offered by the veterinarians can eventually help develop a trustful and sustainable relationship between the clients and their veterinarian [ 21 ]. Further, when explaining the diagnosis, information should be provided to the clients in a series of chunks. The veterinarians can provide signposting before delivering the message directly in explaining a diagnosis to a client [ 21 ]. Another approach is to keep the message simple and ensure that the clients understand the conditions completely [ 21 ]. Once a range of possible treatments options are provided and their potential risks are explained, clients can take an active role in making an informed decision that addresses their expectations [ 7 ]. Another factor to consider while delivering bad news is the setting. For example, a private room without distractions, and the availability of private exits, have frequently been suggested in several studies for creating a peaceful and calm atmosphere [ 21 ]. Considering animal welfare based on the diagnosis, euthanasia can be the most suitable option when the pet’s quality of life is seriously impaired [ 7 ]. Clients can be better informed about the worst scenario when they realise the seriousness of the situation. Although euthanasia is a hard decision to accept, clients with a close relationship with their veterinarian are more likely to accept it as an alternative while minimising guilt and additional financial burden [ 21 ].

Clients’ understanding and treatment adherence are the direct emotional rewards derived by building a trustful client–veterinarian relationship. The first consultation is critical for the veterinarians to make a positive professional impression on their clients, which can ultimately affect a client’s decision of returning or switching to another clinic. Furthermore, veterinarians can use special interactional strategies such as baby-talk for building the interpersonal relationship [ 29 , 31 ]. Without mutual trust, clients will eventually move to another veterinarian. To build a sustainable relationship, veterinarians can adopt suitable behaviours to present a reliable and competent image to their clients. For example, they can present their clinical diagnosis in a professional manner by explaining the diagnosis concisely and clearly and offer possible treatment options in a simple and comprehensible manner. Veterinarians should be patient and confident and show interest in the treatment and welfare of the animals, which can allow the development of a better client–veterinarian relationship [ 34 ]. The use of language should be kept relatively simple by avoiding jargon to ensure that the clients understand the information [ 7 , 21 ]. This is especially important in cases related to euthanasia. A soft tone of voice is also suggested to keep the atmosphere peaceful [ 21 ].

In the farm animal production context, the client–veterinarian communication is different because the major focus is on the health of the animal group rather than individual well-being. Veterinarians generally focus on the big picture in cases of farm animals. If the veterinarians do not use suitable communication strategies, the clients may misunderstand information on life-threatening conditions, which may lead to a large-scale zoonosis crisis [ 19 ]. Another possible reason for such outcomes is that farmers and veterinarians tend to focus on different concerns [ 36 ]. Famers generally struggle with financial constraints as they are running a business and tend to focus on minimising costs and short-term repercussions [ 50 ]. Moreover, when there are suspected cases of diseased animals, farmers can withhold from reporting to the veterinarian [ 19 ]. However, from a veterinarians’ perspective, the public health and wellbeing are a priority. In this case, disagreements can occur and the relationship between the two parties can be threatened. The unwillingness to adhere to recommendations can reflect distrust in the client–veterinarian relationship. Finally, to manage emerging zoonotic diseases, veterinarians should promptly provide necessary knowledge and communicate about emergency measures. When farmers understand the severity and risks of the possible zoonotic outbreak, they are more likely to follow professional advice. In addition, the veterinarians can allow the farmers to acquire an evidence-based understanding of the situation and corresponding actions [ 16 ]. It is also important for the veterinarians to explore the farmers’ motivation and understand their values and goals, which can be achieved by involving the farmers in the treatment plans and developing feasible solutions to enhance the client–veterinarian relationship [ 16 ].

Cross-disciplinary communication in a veterinarian professional team

In addition to the importance of the client–veterinarian communication, the veterinary profession necessitates teamwork. Occasionally, communication problems can occur between the veterinarians and other clinic staff. Ineffective communication is a major cause of critical incidents, which may result in animal harm and death and is the most common cause of complaints. For example, the lack of communication between the receptionist and veterinary surgeon has been reported as a major cause of communication errors [ 5 ]. Most surgeons value autonomy, but individualism and autonomy are not suitable or beneficial behavioural approaches within a group of professionals [ 5 ]. In most cases, there is limited time for communication, and team communication is problematic and lacks structure, resulting in possible miscommunication and clinical errors.

Communication issues within the veterinary team have been emphasised in the study by Ruby and DeBowes [ 48 ]. These researchers found that team communication in veterinary practice is challenging. Although training on team communication is included in the veterinary curriculum to prepare the students to become professional team players, several key elements are missing. To develop an effective team, one needs to decide consciously, display transparent governance, set clear expectations of the teammates, and avoid making assumptions. It is also important to motivate the rest of the team to be responsible for adapting to the agreed standards and implement them in daily clinical practice. The team leader can share important values to shape the team identity while maintaining a supportive and positive working climate.

Another important requirement is the ability of the team to develop conflict-resolving strategies, such as setting regular meetings to let all members participate in reaction and response to each other, and providing feedback that promotes self-reflection.

Training on veterinary communication skills

The importance of communication skills has been emphasised in all included studies. In the study by McDermott et al. [ 13 ], 98% of respondents believed that communication skills are equally important to or more important than practical clinical skills. Training on communication skills in the veterinary curriculum is very limited [ 13 , 37 ]. The existing veterinary curriculum does not fully address the needs in this aspect of practical skills. In one study, less than 50% of the participating veterinarians had received communication skills training in veterinary schools, 65% believed that the veterinary school did not fully prepare them to face communication issues in their career, and 50% had to attend post-graduate communication training workshops [ 13 ]. The continuous professional education currently available mainly includes simulated consultations and online training, offering less time investment while attending to money and applicability considerations.

Some veterinarians believe that learning communication skills from real-life cases throughout the veterinary career is more effective and applicable [ 13 ]. The communication skills that most veterinarians develop vastly depend on their everyday experiences. Although self-development through real-life experiences is critical for developing a unique yet suitable approach to communication, students should receive professional guidance for developing specific competence to communicate effectively in their early career [ 7 ].

There has been an upsurge in studies emphasising communication education. Organisations such as the Veterinary Defence Society have been sponsoring communication skill training courses for undergraduate veterinary students in the UK and Ireland for several years [ 7 ]. Generally, communication courses are spread throughout the whole curriculum to allow learning when students are on clinical rotation [ 49 ]. On average, only 15 h of discussion time are allocated for end-of-life topics in the intensively scheduled veterinary school curriculum [ 19 ].

Studies have also examined the contexts and scenarios that veterinary students are recommended to face during their communication skill education. According to Von Fragstein et al.’s consensus statement on medical school communication, which aimed to help medical schools provide an appropriate mix of communication learning experiences for students, students were recommended to engage with scenarios such as end-of-life communication, navigating cultural and social areas of sensitivity, dealing with communication impairment, and communicating about emotional topics. Studies have explored different teaching approaches or interventions for delivering veterinary communication skills, including lecture-based teaching, role play interactions, small-group discussions and real-life application [ 10 ]. Furthermore, studies have emphasised the importance of ethical considerations, especially in the topics of end-of-life conversation or euthanasia. Specific communication protocols have also been established for training in delivery of bad news. For example, the COMFORT (communication, orientation and opportunity, mindfulness, family, opening, relating and team) model is also applicable in veterinary medicine and training sessions as it considers different aspects of social support [ 21 ]. The model addresses cost-related issues and euthanasia, which are not found in human medicine practices [ 20 ]. This consultation model emphasises the importance of a client-centred approach. Veterinarians are recommended to encourage participation, negotiation and knowledge sharing instead of one-directional information provision [ 11 ]. This approach can create a welcoming setting and thus give a positive experience to the clients.

In general, lecture-based discussion about euthanasia occurs in the early years of veterinary school [ 50 ]. Kolb’s experiential learning theory is already a part of the veterinary curriculum, and one study showed that evaluation of real-life recorded consultations can be a reflective way of communication education [ 54 , 62 ]. In addition, simulations can enhance the students’ ability to develop empathy by increasing their ability to understand the clients’ feelings and emotions [ 49 ]. Two studies have reported the advantage of the shadowing approach, stating that the coaching process allows self-development by observation [ 11 , 16 ]. The unique benefit of this learning approach is that every student can have his/her own unique experiences.

In addition to the traditional teaching approaches, several innovative approaches to delivering communication using technology can be applied. For example, web-based learning is expected to become a major learning approach in veterinary medicine [ 2 ] and is already a valid and reliable communication teaching method in human medicine. Although no study has yet reported the same benefits of web-based learning in veterinary medicine, this approach is expected to have the same potential in veterinary communication education. Use of virtual patients is considered as an effective way to assess students’ communication skills in human medicine and as a potential communication assessment tool in veterinary medicine [ 2 ].

Although most studies have suggested changes in communication skills training, some limitations still remain in group training. For example, group training might compromise individual needs [ 55 ]. Hence, the idea of tailor-made training has been introduced, but it was not concluded to be a practical strategy in large group training [ 55 ]. One study suggested that when graduated students start practicing veterinary medicine, providing more continuous professional training (CPT) can reduce the communication skill gaps between senior veterinarians who graduated before 2000 and current veterinarians [ 13 ]. However, there is a lack of studies focusing on CPT for farm animal veterinarians [ 36 ], suggesting a lack of emphasis on communication skills of large-animal veterinarians.

This integrated review of the role of communication in veterinary clinical practice highlights the significance of client–veterinarian communication and the lack of communication training in the veterinary curriculum. Most of the included studies that have investigated the nature of veterinarians’ communication with their clients have emphasised that it not only affects the relationship between clients and the veterinarians but also the health of the animals. The review showed that the interaction between the clients and the veterinarians could be challenging as various types of dilemmas occur during different stages, such as insufficient consultation time, challenges in delivering difficult news, misconception and misunderstanding, and poor treatment adherence, echoing the findings of a review conducted by Cornell and Kopcha [ 63 ]. Despite the importance of maintaining effective communication and sufficient information exchange for different stakeholders throughout the diagnosis and treatment of animals, there is a lack of appropriate measures to tackle issues in these matters. The review supports the findings of [ 15 , 18 ], and shows that systematic communication education is absent in the existing veterinary curriculum. Although studies such as McDermott’s [ 13 ] and Jackson’s [ 7 ] have explored the possible future approaches, it is obvious that the current curriculum is not yet well developed and adequate, likely resulting in communication challenges for veterinarians in their practice. Consistent with a previous study that stated that interprofessional working is under-theorised and under-researched [ 5 ], this review highlights the lack of studies in the context of communication between veterinary professionals. Similar to the setting of human medicine, the approach and content of communication between the doctors or veterinarians and the nurses and receptionists may have a huge impact on the clients’ impression of the veterinarians and their perception of their pets’ healthcare. This is a finding that is similar to the results of a study conducted by Coe et al. [ 64 ]. However, not many studies have focused on this aspect of communication between the professionals or that between the farmers and veterinarians. Notably, a large body of evidence is available on the aspects of communication between the veterinarians and the clients and the associated challenges; however, more systematic research is needed to obtain a more comprehensive understanding of the communication between the veterinarians and other stakeholders, such as receptionists and clinical staff members.

This review has a few limitations. Although the findings were derived from heterogeneously designed studies, only studies published in English were included. As a result, the geographic focus of this research was also mainly on Western countries. Studies published in local languages that may reflect more detailed aspects of interpersonal veterinary communication affected by cultural factors were not included. Thus, the findings may be biased in terms of the overall social aspects. A systematic approach comparing diverse studies to understand the cultural differences between Eastern and Western countries would be meaningful. Thus, more in-depth studies examining how different cultures adopt distinct approaches to veterinary communication and influence the surrounding environment are warranted.

This review identified a gap in the communication skills of veterinarian professionals as well as a communication gap between different veterinarian professionals and the outcomes of effective client–veterinarian communication. For animals, effective communication between their owners and the veterinarians will allow better medical care in terms of drug route, dose and frequency and annual health check; better home routine care such as diet, exercise and wound care; and, consequently, an increase in their overall quality of life. Adequate and clear communication during veterinary consultations would allow clients to acquire the correct information about pet care and facilitate the history taking of pets by veterinarians, which could increase the clients’ satisfaction with the clinic experience and reduce stress [ 36 ]. Finally, from the perspective of veterinarians, effective communication can allow them to properly care for and treat the pets and avoid stress, foster a positive working environment, and enhance the effectiveness and efficiency of teamwork. The reviewed studies confirmed the importance of and the roles of communication in veterinary medicine and the need for a more comprehensive curriculum for teaching veterinary communication skills. This review highlights the requirement of more research to explore the culturally influenced communication approaches that veterinarians in non-English speaking countries adopt so as to develop more effective communication models than those commonly used in veterinary practices in Western countries.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Critical appraisal skills programme

Communication, orientation and opportunity, mindfulness, family, opening, relating and team

Continuous professional training

Preferred reporting items for systematic reviews and meta-analyses

Weight of evidence

Abood SK. Effectively communicating with your clients. Top Companion Anim Med. 2008;23(3):143–7.

Article   PubMed   Google Scholar  

Artemiou E, Adams CL, Hecker KG, Vallevand A, Violato C, Coe JB. Standardised clients as assessors in a veterinary communication OSCE: a reliability and validity study. Vet Rec. 2014;175(20):509.

Article   CAS   PubMed   Google Scholar  

Mendez DH, Büttner P, Kelly J, Nowak M. Difficulties experienced by veterinarians when communicating about emerging zoonotic risks with animal owners: the case of Hendra virus. BMC Vet Res. 2017;13(1):1–12.

Google Scholar  

Adams CL, Frankel RM. It May be a Dog's life but the relationship with her owners is also key to her health and well being: communication in veterinary medicine. Vet Clin North Am Small Anim Pract. 2007;37(1):1–17.

Kinnison T, Guile D, May SA. Errors in veterinary practice: preliminary lessons for building better veterinary teams. Vet Rec. 2015;177(19):492.

Schultz K. Pet owner study: communication key driver to improved animal care. North Olmstead. 2007;38(1):11–2.

Jackson C, Gray C. Breaking bad news. Practice. 2004;26(2):103.

Article   Google Scholar  

Shaw JR, Lagoni L. End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making. Vet Clin North Am Small Anim Pract. 2007;37(1):95–108.

Kurtz S. Teaching and learning communication in veterinary medicine. J Vet Med Educ. 2006;33(1):11–9.

Mossop L, Gray C, Blaxter A, Gardiner A, MAcEachern K, Watson P, Whittlestone K, Robbé I. Communication skills training: what the vet schools are doing. Vet Rec. 2015;176:114–7.

Shaw J, Barley G, Hill A, Larson S, Roter D. Communication skills education onsite in a veterinary practice. Patient Educ Couns. 2010;80(3):337–44.

Kogan LR, Oxley JA, Hellyer P, Schoenfeld-Tacher R. United Kingdom veterinarians' perceptions of clients' internet use and the perceived impact on the client–vet relationship. Front Vet Scie. 2017;4:180.

McDermott M, Tischler V, Cobb M, Robbé I, Dean R. Veterinarian-client communication skills: current state, relevance, and opportunities for improvement. J Vet Med Educ. 2015;42(4):305–14.

Morrisey JK, Voiland B. Difficult interactions with veterinary clients: working in the challenge zone. Vet Clin North Am Small Anim Pract. 2007;37(1):65–77.

Haldane S, Hinchcliff K, Mansell P, Baik C. Expectations of graduate communication skills in professional veterinary practice. J Vet Med Educ. 2017;44(2):268–79.

Bard AM, Main DC, Haase AM, Whay HR, Roe EJ, Reyher KK. The future of veterinary communication: partnership or persuasion? A qualitative investigation of veterinary communication in the pursuit of client behaviour change. PLoS One. 2017;12(3):1–17.

Article   CAS   Google Scholar  

Siess S, Marziliano A, Sarma EA, Sikorski LE, Moyer A. Why psychology matters in veterinary medicine. Top Companion Anim Med. 2015;30(2):43–7.

Pilgram MD. Communicating social support to grieving clients: the veterinarians' view. Death Stud. 2010;34(8):699–714.

Dickinson GE, Roof PD, Roof KW. A survey of veterinarians in the US: euthanasia and other end-of-life issues. Anthrozoos. 2011;24(2):167–74.

Hamood WJ, Chur-Hansen A, McArthur ML. A qualitative study to explore communication skills in veterinary medical education. Int J Med Educ. 2014;5:193–8.

Article   PubMed   PubMed Central   Google Scholar  

Nickels BM, Feeley TH. Breaking bad news in veterinary medicine. Health Commun. 2018;33(9):1105–13.

LaVallee E, Mueller MK, McCobb E. A systematic review of the literature addressing veterinary care for underserved communities. J Appl Anim Welf Sci. 2017;20(4):381–94.

Moher D, Liberati A, Tetzlaff J, Altman G, TP Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement 2009: 264–269.

Critical Appraisal Skills Programme (CASP). Critical appraisal skills programme tools for qualitative research. http://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf . Accessed Sept 2018.

Critical Appraisal Skills Programme (CASP). Critical appraisal skills programme tools for a trial. http://docs.wixstatic.com/ugd/dded87_4239299b39f647ca9961f30510f52920.pdf . Accessed Sept 2018.

Critical Appraisal Skills Programme (CASP). Critical Appraisal Skills Programme Tools for a case control study. [ http://docs.wixstatic.com/ugd/dded87_afbfc99848f64537a53826e1f5b30b5c.pdf ]. Accessed Sept 2018.

Critical Appraisal Skills Programme (CASP). Critical Appraisal Skills Programme Tools for a cohort study. [ http://docs.wixstatic.com/ugd/dded87_5ad0ece77a3f4fc9bcd3665a7d1fa91f.pdf ]. Accessed Sept 2018.

Pun JK, Chan EA, Wang S, Slade D. Health professional-patient communication practices in East Asia: an integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and mainland China. Patient Educ Couns. 2018;101(7):1193–206.

Robert F. Speaking to and for animals in a veterinary clinic: a practice for managing interpersonal interaction. Res Lang Soc Interact. 2004;37(4):421–46.

Ballantyne KC, Buller K. Experiences of veterinarians in clinical behavior practice: a mixed-methods study. J Vet Behav Clin Appl Res. 2015;10(5):376–83.

British Veterinary Association. Vet reprimanded for communication failures and making disparaging remarks. Vet Rec. 2016;179(17):426.

British Veterinary Association. Walk like a vet, think like an owner. Vet Rec. 2016;179(21):533–4.

Vijfhuizen M, Bok H, Matthew SM, Piccolo LD, McArthur M. Analysing how negative emotions emerge and are addressed in veterinary consultations, using the Verona coding definitions of emotional sequences (VR-CoDES). Patient Educ Couns. 2017;100(4):682–9.

Rujoiu O, Rujoju V. Animal companion loss and the veterinarian-client relationship—exploratory study. Rev Psihologie. 2016;62(3):211–26.

Ptacek JT, Leonard K, TL MK. “I've got some bad news…”: Veterinarians' recollections of communicating bad news to clients. J Appl Soc Psychol. 2004;34(2):366–90.

Moore DA, Sischo WM, Kurtz S, Siler JD, Pereira RV, Warnick LD, Davis MA. Improving dairy organizational communication from the veterinarian's perspective: results of a continuing veterinary medical education pilot program. J Vet Med Educ. 2016;43(1):33–40.

Rösch T, Schaper E, Tipold A, Fischer MR, Dilly M, Ehlers JP. Clinical skills of veterinary students – a cross-sectional study of the self-concept and exposure to skills training in Hannover, Germany. BMC Vet Res. 2014;10:969.

McArthur ML, Fitzgerald JR. Companion animal veterinarians' use of clinical communication skills. Aust Vet J. 2013;91(9):374–80.

Smith M, King C, Davis M, Dickson A, Park J, Smith F, Currie K, Flowers P. Pet owner and vet interactions: exploring the drivers of AMR. Antimicrob Resist Infect Control. 2018;7:46.

Carson CA. Nonverbal communication in veterinary practice. 2007;37(3):49–63.

Morgan CA, McDonald M. Ethical dilemmas in veterinary medicine. Vet Clin North Am Small Anim Pract. 2007;37(1):165–79.

O'Connell D, Bonvicini KA. Addressing disappointment in veterinary practice. Vet Clin North Am Small Anim Pract. 2007;37(1):135–49.

Klingborg DJ, Klingborg J. Talking with veterinary clients about money. Vet Clin North Am Small Anim Pract. 2007;37(1):79–93.

Brandt JC, Grabill CM. Communicating with special populations: children and older adults. Vet Clin North Am Small Anim Pract. 2007;37(1):181–98.

Bateman SW. Communication in the veterinary emergency setting. Vet Clin North Am Small Anim Pract. 2007;37(1):109–21.

Anbiah V, Vijayalakshmi R. Role of social media as communication channel for veterinary extension workers. J Ext Educ. 2017;29(2):5875–9.

Cohen SP. Compassion fatigue and the veterinary health team. Vet Clin North Am Small Anim Pract. 2007;37(1):123–34 2007.

Ruby KL, DeBowes RM. The veterinary health care team: going from good to great. Vet Clin North Am Small Anim Pract. 2007;37(1):19–35.

Kennedy M. Teaching communication skills to medical students: unexpected attitudes and outcomes. Teach High Educ. 2001;6(1):119–23.

Dickinson GE, Roof PD, Roof KW. End-of-life issues in United States veterinary medicine schools. Soc Anim J Hum Anim Stud. 2010;18(2):152–62.

Barron D, Khosa D, Jones-Bitton A. Experiential learning in primary care: impact on veterinary students' communication confidence. J Experiential Educ. 2017;40(4):349–65.

Cipolla M, Bonizzi L, Zecconi A. From “one health” to “one communication”: the contribution of communication in veterinary medicine to public health. Vet Sci. 2015;2(3):135–49.

Artemiou E, Adams CL, Toews L, Violato C, Coe JB. Informing web-based communication curricula in veterinary education: a systematic review of web-based methods used for teaching and assessing clinical communication in medical education. J Vet Med Educn. 2014;41(1):44–54.

Meehan MP, Menniti MF. Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's experiential learning theory. J Vet Med Educ. 2014;41(4):371–83.

McDermott MP, Cobb MA, Tischler VA, Robbé IJ, Dean RS. Evaluating veterinary practitioner perceptions of communication skills and training. Vet Rec. 2017;180(12):305–10.

Adams CL, Kurtz SM. Skills for communicating in veterinary medicine. Parsippany; 2017. https://www.amazon.com/Skills-Communicating-Veterinary-Medicine-Cindy/dp/0997767901 .

Caulfield J. How to do thematic analysis. [ https://www.scribbr.com/methodology/thematic-analysis/ ] Accessed January 2020.

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.

Mcgovern P, Nance ML. Imaging the injured child. In: Pediatric trauma: pathophysiology, diagnosis, and treatment. Boca Raton, US: CRC Press; 2017. p. 99–108.

Chapter   Google Scholar  

Challinor D. Letter from the Desk of David Challinor, February 7, 1990: Death of zoo animals and impact on keepers. [ https://repository.si.edu/bitstream/handle/10088/1782/Challinor_07_02_1990.pdf?sequence=1&isAllowed=y ]. Accessed July 2020.

Sutherland AM. Communication between the doctor and the cancer patient. CA Cancer J Clin. 1958;8(4):119–21.

Kolb D, Boyatzis R, Mainemelis C. Experiential learning theory: previous research and new directions. In: Perspectives on thinking, learning, and cognitive styles. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2014. p. 227–47.

Cornell K, Kopcha M. Client-veterinarian communication: skills for client centered dialogue and shared decision making. The veterinary clinics of North America. Small Anim Pract. 2007;37:37–47.

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.

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

Department of English, City University of Hong Kong, 83, Tat Chee Avenue, Kowloon, Hong Kong

Jack K. H. PUN

You can also search for this author in PubMed   Google Scholar

Contributions

JP participated to the study design, planning, performed the internet search, conducted the data analysis and prepared the final manuscript. The author (s) read and approved the final manuscript.

Corresponding author

Correspondence to Jack K. H. PUN .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The author declares that he has no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

PUN, J.K.H. An integrated review of the role of communication in veterinary clinical practice. BMC Vet Res 16 , 394 (2020). https://doi.org/10.1186/s12917-020-02558-2

Download citation

Received : 26 September 2019

Accepted : 07 September 2020

Published : 19 October 2020

DOI : https://doi.org/10.1186/s12917-020-02558-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Veterinary medicine
• Clinical communication
• English-speaking countries
• Clinical veterinary education

BMC Veterinary Research

ISSN: 1746-6148

• General enquiries: [email protected]