Virtual rounds initiative started at UF provides veterinary students online clinical learning across university lines

Vice Rounds battlestation

Dr. Alex Fox-Alvarez leads online small group rounds with UF veterinary students on the surgery clinical clerkship who are now required to learn remotely. From his impromptu home workstation, he delivers an interactive clinical case rounds using real images, videos, and diagnostics to provide the closest thing to the real clinical experience as he can. (Photo courtesy of Dr. Alex Fox-Alvarez)

By Sarah Carey

Dr. Alex Fox-Alvarez, an assistant professor of small animal surgery at the UF College of Veterinary Medicine, has a reputation for taking innovative approaches to teaching.

So when COVID-19 safety measures implemented at UF meant fourth-year veterinary students were suddenly released from clinics on March 17 and faculty members needed to convert course content into an online format within one week, Fox-Alvarez turned a challenge into an opportunity for creative problem-solving.

“I wanted to make sure that my rounds included the elements of clinics that students would miss out on while away from the UF Small Animal Hospital,” Fox-Alvarez said.

The list was long: There would need to be client communication, taking a patient’s history, making a diagnostic plan and interpreting tests to determine the best next step in care. Skills typically learned by observation — including how to communicate findings to the client and develop plans for treatment and postoperative care, provide detailed surgical procedural explanations and even address ethical dilemmas — would need to be communicated by distance learning.

Fox-Alvarez reached for video, which he regularly used for surgical teaching during his residency training at UF and later as a faculty member. He scrambled to rework old surgery lectures into an online rounds format that would suffice to replicate the vast clinical experience for students over a relatively short period of time. When it soon became clear that students would remain away from clinics for longer than previously thought, his initial concept evolved into a platform that could deliver long-term online learning: Veterinary Isolated Clinical Education, or VICE, Rounds.

“I wanted to incorporate as many example case images and videos as possible so that students could have a more memorable experience with the case, which would hopefully help them understand the key points they would need to take away for use in practice,” he said. “I also wanted to make sure to include the experience of case rounds and discussing diseases and treatment options in a relaxed way in a small group with faculty.”

He created organized breaks in his initial rounds presentation to allow for discussion of key points immediately before they were illustrated in the slides, as well as worksheets for grading.

“These rounds are really fun to build and record, but doing a lecture well takes a lot of energy. It didn’t take long to realize what a monumental task creating a comprehensive online substitute for clinical education would be, especially in the face of the abrupt chaos falling upon all veterinary colleges at once,” he said.

“There was no way any one institution could do it alone, especially in a time frame fast enough to benefit the students now. Fortunately, Vet Med is a small, tightknit and passionate profession and I knew there would be colleagues elsewhere who would also be interested in making and volunteering their recorded rounds topics to benefit educators and students in our shared community.”

Fox-Alvarez then set up all of the logistics online to get the crowd-sourced VICE Rounds operational, and sent the initial call for volunteers to two surgery listservs where it spread and grew organically from there.

Volunteers contribute topic- and case-based rounds for on-demand streaming across teaching institutions, decreasing the pressure on each university to develop its own free-standing, off-site clinical curricula while managing urgent clinical needs, Fox-Alvarez said.

Currently, there have been 19 recorded rounds uploaded, with over 50 more topics in progress from veterinarians at 15 different participating universities, including one from Canada and five specialty private practices, including one from the United Kingdom. Within just two weeks of the first VICE Rounds, the initiative had garnered mentions in an American Veterinary Medical Association newsletter and on the Veterinary Information Network.

With the help of his wife, Stacey Fox-Alvarez, D.V.M., a third-year veterinary medical oncology resident, Fox-Alvarez continues to finetune the project, involving more colleagues from UF and other institutions, harnessing the collective energy and creativity to enhance content and students’ learning experiences in spite of the limitations in place.

Enough interest ensued that within a week, Fox-Alvarez had received additional recorded rounds from several other educators. From UF, rounds were contributed from his wife as well as from Penny Regier, D.V.M., an assistant professor of small animal surgery, and Alexander Thompson, D.V.M, an anesthesiology resident. Also contributing was Jacqueline Whittemore, D.V.M., Ph.D., an associate professor of medicine at the University of Tennessee’s College of Veterinary Medicine.

Whittemore, the first non-UF faculty member to volunteer to do a VICE rounds, said when she first read about the initiative, she was inspired to see people choosing to act in response to the pandemic, instead of to just their own circumstances. She worked deep into the night and wrapped up her first recording at 1 a.m.

“The biggest surprise for me has been all the feedback I have already received on it,” Whittemore said. “What has been more rewarding, however, is how much the catalog has grown between then and yesterday when I logged on to update the status for my newest rounds. It is a true testament to both the Fox-Alvarezes’ vision and the mettle of veterinary educators everywhere. We do, indeed, have some of the greatest jobs and colleagues on earth.”

Fox-Alvarez said he knew veterinary students everywhere in the clinical phase of their curriculum are probably disappointed that they are missing out on their clinical clerkships.

“So far, students have been very positive with feedback,” he said. “Although there is no substitute for experiential learning, VICE Rounds strive to emulate the clinical case experience using the unique resources and perspectives of veterinary educators from different specialties, universities and locations. I’m hopeful that this may serve as a lasting and reliable resource for students and veterinarians during an otherwise volatile time.”

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