It had only been a few days since I adopted Sadie who, with her soulful, inquisitive eyes, already had a piece of my heart. We were in the clinic at the local veterinary school for our post-adoption, post-spay wellness check and for some clarity on why Sadie had been intermittingly coughing up saliva infused little pools of blood. Sadie was a presumptively healthy one-year-old Australian Cattle Dog, and in my “I’ve-seen-enough-episodes-of-Gray’s Anatomy-to-know-this-is-not-good” mind, I was worried about what this might signal.
When the fourth-year veterinary student assigned to my case stepped into the room, I paced nervously and provided detailed responses to each intake question, showed photos of the blood Sadie coughed up and nervously asked, “Why is Sadie coughing up blood?” Without a reply, the student, who was only in the second week of her very first clinical rotation, squeezed and touched Sadie’s throat and listened to her heart and lungs one more time. I sat down, my leg bouncing anxiously up and down, tapping my hand on my bouncing leg.
As the students were instructed to do, she asked my permission to take Sadie to the larger exam room where she could do a more detailed exam under the supervision of her teachers. I consented and nervously asked one more time, “Why is Sadie coughing up blood?”
As the student left, with Sadie reluctantly in tow, she said, “Her trachea is not properly aligned.” And with that, she was gone, and I was left alone wondering, “What does that mean? How is it is even possible to have a misaligned trachea?” I absentmindedly stood in the room stroking my own throat, assessing the alignment of my own trachea, wondering if it was properly aligned.
The Veterinary Education Curriculum
The demands of a veterinary education program are intense. Students are expected to have in-depth knowledge of multiple species in the areas of anatomy, clinical pathology and diagnostic imaging, as well as competence in a wide range of surgical procedures ranging from the more common spays and neuters to more complicated procedures. And now, per a 2004 criterion added by the American Veterinary Medical Association’s (AVMA) Council on Education (COE), students are now also expected to demonstrate competency in interpersonal communication.
On top of curriculum stressors, veterinary students have to contend with managing debt, a heavy workload and impoverished relationships due to isolation. Given the breadth of the curriculum and external stressors, it is not surprising that veterinary medicine students report high levels of depression, anxiety and stress, surpassing the reported levels of human medical student counterparts.
Veterinary medicine programs select the most academically-elite and determined students, most of whom have academic backgrounds in applied sciences, animal science or agriculture, with very few coming from liberal arts or social science backgrounds. Yet now that the AVMA has made communication a core competency, students are faced with one more skill to master; one that for many is in and of itself a source of stress, anxiety and apprehension: communication.
Implications for Communication
Communication is not just about “talking good” and relaying information. Communication is about creating shared meaning, building and maintaining relationships, fostering trust and connecting with others. Experiencing elevated levels of stress or anxiety can disrupt the communication process and exacerbate feelings of communication apprehension, which can lead to impoverished interactions.
Communication apprehension is defined as “an individual’s level of fear or anxiety associated with either real or anticipated communication with another person or persons.1” As such, it is a stress response to real or anticipated conversations. It can prompt physiological responses such as increased heart rate, increased perspiration and increased breathing, all of which manifest as visible signs (e.g., face flushing, muscle tension) of our internal distress and emotional arousal.
Communication apprehension and its physiological behavioral markers can negatively affect one’s ability to communicate effectively, confidently and clearly with another person. When people experience elevated or clinical levels of stress or anxiety, the interpersonal communication process is disrupted; we are not able to fully attend to others because our focus is inward. This makes it difficult to focus on social cues and offer contextual appropriate responses.
In professions such as veterinary medicine with heavy interpersonal communication demands, coupled with the inclination to avoid or to limit time, communicating with another person is problematic. This is especially so when attention is split and the primary focus is on making sense of clinical signs and presentation of symptoms. People with high levels of communication apprehension are less likely to be successful in professions that require high levels of communication or interaction.
In medicine, positive outcomes are connected to communication. A doctor’s skill in effectively communicating with her/his clients is a critical component of the diagnostic process and treatment efforts. Therefore, effective communication with pet owners is necessary to satisfy clients, build relationships with clients, yield better clinical outcomes, enhance business and avoid malpractice.
A Natural Reaction
When the fourth-year student assigned to my case stepped into the exam room, she was breathing noticeably, smiling nervously and unsure of where to stand. Her facial muscles were tense as she began going through all the items on the intake form. She was recording my responses in between chewing on the top of her pen and tapping it nervously on the exam table. Her face flushing, respiration increasing, hands shaking, she reached for her stethoscope. Her body seemed to tense as she knelt on the floor to start Sadie’s physical exam. As she listened to Sadie’s heart and breathing, her eyes darted around the room. With hands still shaking, she stood on unsteady feet, shifting her weight from leg to leg, unsure of what to do or say next. Her eyes never fully met mine as she asked my permission to take Sadie to the larger exam area. This student was showing classic signs of stress and communication apprehension.
How could I expect her to pick up on my own nervousness when she was in an elevated state herself? I am certain she did not intend to cause me additional concern when she said Sadie’s trachea is misaligned, or that Sadie might have leukemia. She was so focused on mastering the clinical side of veterinary medicine that she failed to attend the interpersonal side of it.
This is not the reaction of an inept student. This a reasonable reaction to a stress- and anxiety-producing situation when someone is in an environment where the norm is experiencing elevated levels of stress and anxiety. After only three years of classroom instruction and labs, veterinary students spend their fourth year rotating through different services in their college’s veterinary hospital. Because of the breadth of the veterinary medicine curriculum, most of veterinary students’ training is focused on medical content rather than “soft skills” such as communication and positive self-care coping strategies.
Wellbeing in Veterinary Medicine
The effects of communication apprehension are not necessarily limited to the interaction itself. Communication apprehension could exacerbate an individual’s anxiety or stress, which in turn could influence wellbeing. The practice of mindfulness has garnered much attention in recent years and is considered an inherent human capacity.
Mindfulness training for health professionals and human medical students has been shown to relieve mental distress. Even brief online mindfulness trainings have shown benefits of decreasing stress among medical students. This brings us to the current breadth of the veterinary medicine curriculum. How can already overextended veterinary students add one more thing to their schedules?
As a communication scholar and a consumer of veterinary medicine services, I understand and support this 2004 criterion added by AVMA’s Council on Education. But I am also aware of the demands of the veterinary medicine curriculum and the negative downstream effects and costs to wellbeing. So, what can we do to better help veterinary students manage stress and anxiety, and subsequently enhance their interactions with veterinary clients?
Communication scholars can work with our colleagues in veterinary medicine to identify creative ways to integrate communication training into the veterinary medicine curriculum. Partnerships with student counseling services and trained colleagues with interest in self-care can also be pursued. There are opportunities for creative collaborations across each campus with a veterinary college. And these collaborations do not necessarily need to come at a cost of the medical training.
Medical schools in human medicine have been partnering with colleagues from the social sciences to inform curricular changes for more than 20 years. The positive effects of these collaborations are well documented. Veterinary schools do not need to shoulder the training of their students on their own. In a profession where the natural instinct is to step in and help, it is now time for communication scholars and colleagues with relevant social science backgrounds to step in and help our colleagues in veterinary medicine. Together, we can do better.
In Conclusion
Happily, Sadie’s trachea was not misaligned, nor did she have leukemia. It was determined that Sadie’s throat was mildly irritated from being intubated during her spay a few days earlier. Stress and anxiety can lead to communication apprehension, difficulty reading others’ social cues and not having enough available cognitive resources to shape contextually-appropriate responses. Stress and anxiety can also lead veterinary medical students (or any medical professional) to hear zebras instead of horses when they hear hooves. +
References:
1. McCroskey, J. C. (1977). Classroom consequences of communication apprehension. Communication Education, p. 78.
Additional Resources:
1. Phang, C. K., Mukhtar, F., Ibrahim, N., Keng, S. L., & Sidik, S. M. (2015). Effects of a brief mindfulness-based intervention program for stress management among medical students: The Mindful-Gym randomized controlled study. Advances in Health Sciences Education, 20(5), 1115-1134. https://doi:10.1007/s10459-015-9591-3
2. Shapiro, S. L., Schwartz, G. E., & Bonner, G. (1998). Effects of mindfulness-based stress reduction on medical and premedical students. Journal of Behavioral Medicine, 21(6), 581-599. https://doi:10.1023/A:1018700829825
3. Siqueira-Drake, A.A., Hafen Jr, M., Rush, B. R., & Reisbig, A. M. (2012). Predictors of anxiety and depression in veterinary medicine students: A four-year cohort examination. Journal of Veterinary Medical Education, 39(4), 322-330. https://doi:10.3138/jvme.0112-006R
4. Sweet, D. M., Gentile, D., & He, L. (2021). Communication Apprehension and Willingness to Communicate in Veterinary Medicine Students: Implications for Mindfulness and Communication Training. Health Communication, 1-9.
5. UCLA Mindful Awareness Research Center, Los Angeles. https://www.uclahealth.org/marc/
