Dr. Ariana Hinckley-Boltax Co-Authors Research Study to Develop a Prioritized List of Clinical Presentations in Dogs, Cats, and Horses

The idea for the study came about when the Northeast Consortium of Veterinary Colleges first convened in 2017. Faculty, administrators, and researchers from Cummings School, Cornell University College of Veterinary Medicine, University of Pennsylvania School of Veterinary Medicine, North Carolina State University College of Veterinary Medicine, and Virginia-Maryland College of Veterinary Medicine formed the organization to address overarching issues in veterinary medicine that would be best tackled together, rather than as individual institutions. The Northeast Consortium’s first large-scale project was to create a validation assessment of clinical reasoning skills for veterinary students.

“It’s a black box in a way, the cognitive processes that experts take to come to conclusions. The study focuses on the output of clinical reasoning, clinical decisions, and actions. That output should be similar across students,” explains Hinckley-Boltax.

She joined the Northeast Consortium and the research study while earning her D.V.M. at Cornell University College of Veterinary Medicine. She was later offered a post-doctoral position in veterinary education at Cornell to lead the project. She concluded the study here at Cummings School. One arm of the project was to validate a blueprint for barrier exams to ensure that students are adequately prepared to treat patients.

“The list of clinical presentations originated from that project for high-stakes assessment design but can be used for much more,” says Hinckley-Boltax. “In order to provide an assessment of clinical reasoning that adequately assesses the wealth of information that students need to be adept at reasoning through, you need an assessment blueprint, a list of what an exam should cover based on the needs of the population it serves to ensure that it reflects what they will see in the field.”

The research team, hailing from all the veterinary institutions in the Northeast Consortium, developed a detailed survey, a list of more than 250 clinical presentations (such as coughing and vomiting) seen in all species, and surveyed 1,700 veterinarians nationwide. Each respondent reviewed 25 patient presentations, selected from the greater list based on a demographic survey of the species they treat most often.

“This list of clinical problems is essential for curriculum and assessment design because it informs educators on the most frequent and important problems that are seen out in the ‘real world’ of general practice,” says Hinckley-Boltax, who teaches core Clinical Skills courses to first- and second-year veterinary students at Cummings School.

She explains that students learn about different diagnoses and diseases, but also need to be ready to treat patients with undiagnosed issues, to evaluate the symptoms and use their clinical problem-solving and reasoning skills to arrive at that diagnosis.

“We focus on new graduates, day one ready, general practice competence,” she says. “The survey is about what clinicians see day to day, how frequently, and the relative importance of the new graduate to handle those problems independently. Graduates need mentoring and training, but the presentations they should be able to manage without assistance are critical for us to know.”

The surveyed veterinarians ranked clinical presentations by relative frequency and by relative importance. From the data gathered, the research team generated a prioritized list of clinical presentations based on those two factors individually and a combination of both. While the team collected data on all species in the survey, they had enough data to validate lists for dogs, cats, and horses.

The top 100 problems on that list are a starting point for blueprinting exams and designing curriculum. Hinckley-Boltax notes that the list is quite nuanced and elicits much to be considered. For example, ER conditions like seizures, respiratory distress, and blunt trauma don’t top the list in terms of frequency but are still critically important. Respiratory distress is ranked 56th overall—89th in frequency and first in relative importance. So, while students may not see a specific problem often, they need the skills to manage it when they do.

Hinckley-Boltax finds the results especially pertinent to third-year students in case-based reasoning courses that integrate what they have learned as first- and second-years to diagnose problems. “More and more institutions are ensuring that grads can step into primary care with competency and confidence. The data is important for the direction that the curriculum is headed and expectations of new graduates.”

In terms of findings, the survey revealed a gap in dental training for dogs, cats, and horses. Geriatric care, end of life care, and euthanasia also came up as critically important and in need of additional training.

“End-of-life care is less about diagnosing and more about maximizing quality of life and making the patient comfortable,” says Hinckley-Boltax. “We focus on treating and diagnosing but also need to arm students with the flexibility to provide a spectrum of care tailored to patients according to their individual context. The survey makes clear that we need to prepare graduates for contextualized care, not just treating disease, but treating patients where they’re at.”

Going forward, Hinckley-Boltax would like to develop a validated list for the other core species—cows, small ruminants, poultry, and pigs. While the majority of survey respondents were from the northeast, the problems identified are valid across state lines, Hinckley-Boltax explains, though the frequency of problems can depend on the region of the country. For instance, issues with cows from Texas typically pertain to beef cattle, while the northeast has more dairy cows. She feels a regional assessment would also be a useful follow-up study. While a solid portion of specialists responded to the survey, Hinkley-Boltax would additionally like to distribute the survey to more specialists to guide the development of higher-level training for interns and residents.

“I’m happy with the start—those three species cover a decent amount of curriculum,” she says.

Hinckley-Boltax has so far presented the survey results at the AAVMC (American Association of Veterinary Medical Colleges) Annual Conference and at the Veterinary Educators Symposium at Texas Tech University. Publication in the Journal of Veterinary Medical Education will broaden the reach of the findings further.

From a personal perspective, Hinckley-Boltax appreciated the opportunity to connect and work with colleagues across universities to help optimize the learning experience for students, an area of particular interest for her.