Friday, June 21, 2013

Bradley Viner discusses reflective veterinary practice

Bradley Viner is a UK based veterinarian and author of one of Success in Veterinary Practice: Maximising Clinical Outcomes and Personal Wellbeing. This is a helpful book for any veterinarian keen to continue to improve their practice. Dr Viner is a big proponent of measuring clinical outcomes and reflecting on all aspects of practice. Reflective practice, as Dr Viner so eloquently and persuasively argues, improves the care we can deliver to animals and clients and makes for a longer, more rewarding and successful (in terms of clinical outcomes) career. So I wanted to find out a bit more about Dr Viner and discuss reflective practice with him - as well as his weakness for Bernese mountain dogs.

Why did you become a veterinarian? Was there anyone (human or non-human) particularly influential in this regard?

Around the time that I stopped wanting to be a train driver at the age of six. I think a seminal event was seeing a dog that had been run over and feeling unable to do anything to help. Everyone told me I would grow out of it - but I never did.

I did have an excellent zoology teacher who was also my sixth form (last two years of high school) teacher. She was truly inspirational. When I met her again many years later I commented on how rewarding her career must have been, and she told me she had always wanted to be a doctor!

Tell us a bit about your career path - how did you get where you are now?

I never had any doubts about the fact that I wanted to go into small animal practice and be my own boss. I set up on my own after a year, and the practices just evolved from there. I made some good decisions, but also missed some excellent opportunities. About 12 years ago I joined a group of other GP vets that were working towards an MSc in Veterinary General Practice, all sharing the ethos that GP skills were undervalued and needed to be developed. That led on to my Doctorate, and I am still in close touch with many of that group. It gave me a somewhat unorthodox mix of practice and research melded together. My interest in veterinary education then led to my involvement with the RCVS, our governing body, to try and help shape its future from a practitioner perspective. 

In Success in Veterinary Practice you devote a chapter to reflective practice. What is reflective practice and why should your average vet take a reflective approach?

It's a simple concept - using Kolb's cycle of reflection upon experience to learn experientially. Most of us think we do that anyway, but the process often gets blocked, and doing it formally in writing can help greatly. Most practicing vets are still hung up on the idea that it is only clinical knowledge and skills that need developing, but reflective practice can help us to become much more effective in our workplace. 

When did you start reflective practice and what kind of impact has it had on the way you work?

Everyone does it to some extent but I was forced to formalise the process when I embarked on a degree founded upon work based learning. It has embedded within the way in which I work the concept of continual improvement which has not only changed the way I practice, but also the way in which I run my own organisation. 

How can reflective practice benefit the health of pets?

By improving our performance all round, including the "soft" skills that are more difficult to develop. In that way we can measurably improve our patient outcomes. 

There's a high burnout rate in this profession - why do you think this is?

I write about this quite extensively in my book. One has to accept that the model of someone graduating into a profession and staying within it for the whole of their lives has become much less common than it used to be in all walks of life. However, in the case of veterinary practice I believe it is often due to a mismatch between expectations and the reality of the routine of daily practice. The greatest skill is to be able to take pleasure in the ordinary. Even a routine vaccination consult can be rewarding if it is approached in a positive manner. 

How do you maintain your passion for this career? Has there ever been a moment when you questioned your career choice and how did you get through it?

I've never questioned my career choice because there is so much that can be done with a veterinary degree. I still enjoy consulting, but I also get a lot of pleasure from leading a successful organisation. We were only the second vet practice in the country to receive the Investors in People Gold Award earlier this year, which is all about developing our workforce. I also enjoy playing an active role in our governing body, the Royal College of Veterinary Surgeons, and some under- and post- graduate veterinary teaching. 

Veterinary students often visibly wince when I use the term "reflect" in classes...what advice would you give budding veterinarians?

Take a page out of the book of medical and nursing training, and get over it! The concept of reflective practice is well recognised as being a valuable tool, yet the veterinary profession still tends to scorn it. I think it may be something to do with the very action-oriented personalities that tend to enter the profession. Call it experiential learning if you like. 

You are very widely read. Any favourite books or websites on this or related topics?

My book contains recommended reading for each chapter as well as references. If I had to pick one book that has made more difference to my life and practice than any other, it would be The Mind and the Way:BuddhistReflections on Life, by Ajahn Sumedho. I can't claim to be a very good Buddhist, but I believe there is a great deal we can learn from their philosophy. Ajahn Sumedho is an American who became a buddhist monk, and so he is able to explain their concepts in a way that makes sense to a Western mind. For example, his discourse on walking meditation is a very good illustration of the value of rejoicing in the ordinary as I described earlier. 

Can you tell us about any animals you share your life with right now?
Bernese mountain dog (NB this is not Cleopatra, but I felt the need to include
a BMD in the post just to round it out. Objections? I didn't think so).
I own Cleopatra, my fourth Bernese Mountain Dog. They are a bit of a disaster from a strictly veterinary point of view, but they are such gorgeous and characterful dogs that I find it unavoidable to share my life with one. We also own Fluff, seventeen years old and the last survivor of what were five cats. He was always a bit of a loner, very antisocial, chased his brother away, and picked fights with all the others. Now that the others have all died he is in his element, and adores my wife. He is just waiting for me to pass away so that he can have her all to himself.