Multiple veterinary stakeholders' perspectives on important professionalism attributes for career success in veterinary clinical practice : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Veterinary Science at Massey University, Manawatū, New Zealand

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Massey University
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There is an increasing body of literature on professionalism in the health sciences. Most research has, however, elicited the opinions of single groups of experts and tried to use these to generalise across the profession. The aim of the thesis was, therefore, to gain a broad understanding of professionalism by appraising the voices of many tiers of veterinary stakeholders involved in veterinary clinical practice. Through a mixed methods approach using card-sort analysis, online questionnaires, focus groups, critical incident reporting and analysis of client complaints, information was collected from first year and final year Massey University veterinary students, clinical veterinary practitioners and veterinary clients. An online questionnaire was also used to gather the final year veterinary students’ opinions on veterinary professionalism pedagogy. The iterative sampling method ensured that a wide range of perceptions were represented. These multiple perspectives, along with the existing knowledge contained within the literature on veterinary and medical professionalism, provide the basis upon which to develop a theoretical framework on professionalism in the veterinary context. The synthesis of data into a framework was undertaken primarily through a grounded theory approach. The research also provides support for the importance of including professionalism in veterinary curricula. Three overarching themes emerged from the analysis of the veterinary stakeholders’ opinions, namely: ‘committing to best practice’, ‘building the veterinarian-client relationship’ and ‘client expectations’. The framework of veterinary professionalism that has evolved from scrutiny of these themes revolves around the principles of ‘veterinary care’. Career success and satisfaction for practising clinical veterinarians hinges on three crucial domains of veterinary care: ‘patient-centred care’, ‘relationship-centred care’, and ‘self-care’. The focus of patient-centred care is the animal, while the foci of relationship-centred care are the client and veterinary colleagues. The self-care domain focuses on the practising veterinarian as a person. Professionalism, therefore, fundamentally revolves around veterinarians’ accountability to a social contract with patients, clients and colleagues as well as to themselves. Analysis of veterinary student opinions on the teaching of professionalism revealed constructive viewpoints and recommendations. Students recommended that the veterinary professionalism course be embedded across the whole primary veterinary teaching programme, including in the early years of study. It was further suggested that role-playing and reflective practice should be used throughout the programme to support the development of professionalism. The need to assess professionalism adequately and appropriately was also highlighted, as was the need to include rewards for displays of good professional behaviour. The potential for the hidden curriculum and negative clinical role models to undermine the teaching of professionalism was also addressed. Additionally, students recommended that the veterinary professionalism curriculum should prepare graduates for the job market by accommodating the requirements of veterinary employers. This research represents the first time that the opinions of multiple veterinary stakeholders on the attributes of professionalism important for career success have been solicited in one series of research studies. Furthermore, this study has used novel methodologies to determine the opinions of stakeholders. For the first time, a card-sort analysis has been used to solicit veterinary students’ opinions and the critical incident technique has been used to determine the perspectives of practising veterinarians. Analysing client complaints lodged with the Veterinary Council of New Zealand also represents an original method of determining those attributes of professionalism that will promote veterinary career success and satisfaction. By seeking the perspectives of multiple veterinary stakeholders, the body of knowledge about professionalism has been extended. Furthermore, the neoteric framework of veterinary professionalism, developed in the study, could help to form the basis for constructing a robust curriculum prescribing the teaching and assessment of veterinary professionalism. It may also be used by veterinarians as a guide in the practice of veterinary medicine and in their relationships with patients, clients, colleagues and society.
Veterinarians, Practice, Clinical competence, Veterinarians, Professional ethics, Veterinary medicine, Study and teaching, New Zealand