INSIGHTS FROM VETERINARY INTERPROFESSIONAL .INSIGHTS FROM VETERINARY INTERPROFESSIONAL INTERACTIONS:

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INSIGHTS FROM VETERINARY

INTERPROFESSIONAL INTERACTIONS:

IMPLICATIONS FOR INTERPROFESSIONAL

EDUCATION (IPE) IN THE VETERINARY CURRICULA

Tierney Kinnison

UCL Institute of Education

Thesis submitted for the degree of Doctor of Philosophy

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Declaration and Word Count

I hereby declare that, except where explicit attribution is made, the work presented

in this thesis is entirely my own.

Word count (exclusive of appendices and list of reference): 99,996 words

Signed:

Tierney Kinnison

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Abstract

Historically veterinary surgeons were trained, worked and developed in isolation.

However, due to increasingly complex care and public demand for quality but cost

effective treatment, veterinary practices have evolved into team based organisations

comprising of several occupations. Veterinary nurses are an important example and

have recently undergone professionalisation in the UK. Other specialised

occupations are developing in parallel including practice managers and

receptionists.

This research focused on veterinary interprofessional working and learning (IPW/L)

utilising an overarching case study design, incorporating social network analysis

(SNA) to map patterns of IPW/L and two embedded case studies to explore

interactions. The embedded case studies consisted of general observations,

shadowing selected individuals, interviews and artefact collection. Adaptations of

theoretical frameworks including Engestrms Cultural Historical Activity Theory and

knotworking, Hutchins distributed cognition and SNA concepts of boundary

crossing and homophily were utilised. Emergent themes from the data were

confirmed in an iterative process through triangulation.

Facilitators of veterinary IPW/L include trust and value, hierarchical organisation of

work, formal infrastructure and different perspectives. Key people were identified as

linking the team. Challenges to IPW/L include temporal and spatial nature of work,

hierarchical organisation and contrasting professional motivations (care vs cure).

Rich interactions are based on experience in contrast to solely professional status.

Outcomes of challenges include poor communication leading to errors and blame.

These findings have implications for interprofessional education alongside

implications for policy and practice if teamworking is to be improved in the interests

of animals and their owners.

This thesis represents the first instance of researching veterinary IPW/L in practice,

and by making use of novel methodologies and theories in this context, it has

identified both the importance of the team dynamic and factors contributing to

compromised patient care.

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Dedication

For the ever growing VetEd community,

and my wonderfully supportive family and friends

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Acknowledgements

The winding path to a PhD in veterinary education was the title of an article I wrote

with Sylvain Dernat for The Veterinary Record. Its certainly true. I am very

fortunate that since 2006, PhDs in veterinary education have been growing in

number. There is therefore a lovely community that is happy to share its

experiences and encourage others along their own path. I hope to be part of

bringing this community together for many years to come.

My fortune in timing extends to my thesis topic. Interprofessional working in

veterinary practices is constantly growing, and the ongoing changes in policy, make

this phenomenon an area worthy of study. It is an area with such potential, that I

first must thank my supervisors, Professor David Guile (Institute of Education,

University College London) and Professor Stephen May (Royal Veterinary College),

along with my upgrade examiners, for reeling me in & keeping the research realistic.

My supervisors have provided excellent complementary roles. I would like to thank

David for his direction and explanation of literature and frameworks that were so

new to me. I would like to thank Stephen for his continuous support, quick

responses, insights into the veterinary world, and most significantly, his belief in me

as an independent researcher.

I would also like to thank Stephen and my mum, Norma, for proofreading my thesis.

A huge thank you goes to the 11 practices who took part in the social network

analysis part of my study, and especially the two practices that went on to become

my case study sites. I am thankful to each and every partner/manager who gave me

the initial go ahead to visit their practice and allow their staff to take part. And

without each and every member, of all 11 teams, I would not have been able to

conduct this piece of research. My twelve focus individuals were unbelievably

accepting of my presence in their daily lives, and were so enthusiastic in welcoming

me into their world and sharing their thoughts. I cannot thank them, and every single

member of all 11 teams, enough.

I would like to acknowledge the Bloomsbury Colleges for funding my studentship.

Finally, my support team at home; friends and family, human and cat-shaped, thank

you so much for your support and interest in this rather substantial undertaking.

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Contents

Chapter One: Introduction and Context_

Introduction ............................................................................................................ 14

The Development of the Veterinary Profession ...................................................... 15

Veterinary Schools and Legislation ..................................................................... 15

Curricular Change .............................................................................................. 20

The Context of Other Professions ....................................................................... 23

Keeping up with the Professions......................................................................... 24

The Professionalisation of Veterinary Nurses ......................................................... 26

From an Occupation to a Profession .................................................................. 27

Veterinary Nursing Education and Curriculum .................................................... 32

The Relationship between Veterinary Surgeons and Veterinary Nurses ............. 34

Allied Professions or Occupations .......................................................................... 37

The Farriery Profession ...................................................................................... 38

Veterinary Surgeon Control ................................................................................ 38

Occupations in this Thesis .................................................................................. 39

Professions in Sociology ........................................................................................ 39

Chapter Two: Assessing Veterinary Surgeons and Nurses Professional

Status during the Rise of Interprofessional Working

Introduction ............................................................................................................ 40

Literature and the Classification of Veterinary Surgeons and Nurses ..................... 41

Definitions of a Profession .................................................................................. 41

Elements of Professionalism .............................................................................. 41

Pressures Leading to Interprofessional Working in the Veterinary Field ............. 51

Identified Challenges to Interprofessional Working/Learning .................................. 58

Separate Training ............................................................................................... 59

Contrasting Status .............................................................................................. 59

Understanding Roles and the Jostle for Jurisdiction ........................................... 60

Communication .................................................................................................. 63

Medical Systems Errors ...................................................................................... 63

Researching Interprofessional Working and Learning ............................................ 64

Chapter Three: A Brief Introduction to Methods

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Introduction ............................................................................................................ 66

Research Questions .............................................................................................. 66

Epistemology ......................................................................................................... 67

An Introduction to the Overarching Case Study Approach ..................................... 68

Case Studies ...................................................................................................... 69

Social Network Analysis (SNA) .......................................................................... 72