Ryane Englar

Interests

Teaching

clinical skills, professional skills, performing the comprehensive physical examination, medical record-keeping (SOAP notes) and other forms of documentation

Research

veterinary medical education, curricular design, pre-clinical curricular design, clinical communication, communication models, Calgary–Cambridge guide (CCG), relationship-centered care, critical thinking, self-reflection, self-awareness, cultural humility, awareness of others, diversity and inclusion (D&I)

Courses

Scholarly Contributions

Books

• Englar, R., & Dial, S. M. (2023). Low-Cost Veterinary Clinical Diagnostics. Wiley-Blackwell.
  More info

  Low-Cost Veterinary Clinical DiagnosticsA practical guide to maximizing the diagnostic value of in-house quick assessment tests (QATs)In Low-Cost Veterinary Clinical Diagnostics, the authors provide a hands-on resource designed to facilitate healthcare delivery across the spectrum of care.Historically, clinicians have been taught to apply the gold standard approach to the practice of medicine. However, recent advances in veterinary medical care and associated technologies have made practitioners question whether a one-size-fits-all approach is truly best. After all, when we perform diagnostic tests, are we testing out of the desire for completeness, to cover all bases for the good of the patient? Or are we testing because we are expected to?The reality is that gold standard care is not always advisable and not always possible. In clinical practice, veterinarians frequently encounter obstacles that limit their approaches to case management. Cost of care is a significant constraint that requires practitioners to rethink which diagnostic tests are essential.Not every patient requires a complete blood count (CBC), chemistry profile, urinalysis, and fecal analysis to obtain diagnostic value. This text suggests that the “best” approach to case management be determined by the situation, the context, the patient, and the client.While sophisticated panels of tests may remain the recommended approach to case management, Low-Cost Veterinary Clinical Diagnostics outlines entry-level, in-house diagnostic blood, urine, fecal, and body cavity fluid tests: how to perform them as well as the breadth and depth of patient-specific data that can be gleaned from quick assessment tests (QATs).
• Englar, R. (2021). Pet-Specific Care. Hoboken, New Jersey: Wiley-Blackwell.
  More info

  Pet-specific care refers to a practice philosophy that seeks to proactively provide veterinary care to animals throughout their lives, aiming to keep pets healthy and treat them effectively when disease occurs. Pet-Specific Care for the Veterinary Team offers a practical guide for putting the principles of pet-specific care into action. Using this approach, the veterinary team will identify risks to an individual animal, based on their particular circumstances, and respond to these risks with a program of prevention, early detection, and treatment to improve health outcomes in pets and the satisfaction of their owners. The book combines information on medicine and management, presenting specific guidelines for appropriate medical interventions and material on how to improve the financial health of a veterinary practice in the process. Comprehensive in scope, and with expert contributors from around the world, the book covers pet-specific care prospects, hereditary and non-hereditary considerations, customer service implications, hospital and hospital team roles, and practice management aspects of pet-specific care. It also reviews specific risk factors and explains how to use these factors to determine an action plan for veterinary care. This important book: Offers clinical guidance for accurately assessing risks for each patient Shows how to tailor veterinary care to address a patient’s specific risk factors Emphasizes prevention, early detection, and treatment Improves treatment outcomes and provides solutions to keep pets healthy and well Written for veterinarians, technicians and nurses, managers, and customer service representatives, Pet-Specific Care for the Veterinary Team offers a hands-on guide to taking a veterinary practice to the next level of care.
• Englar, R. (2021). The Veterinary Workbook of Small Animal Clinical Cases. U.K.: 5M Books.
  More info

  This workbook is intended to be a bridge between classroom learning and clinical training; to improve patient care and clinician confidence in practice. Common presentations in small animal practice are presented as real-world case studies while the reader is guided through work-up, critical thinking and problem solving to run the consultation efficiently. Key concepts of anatomy, physiology, radiology, clinical pathology, medicine and surgery are covered and readers are guided through history-taking and diagnostics to perform an effective consultation. Cases discussed include vaccinating the new kitten, castrating the new puppy, the puppy with diarrhoea, the blind cat, the head-shaking dog, the itchy dog. Categories of complaints covered include body weight, urinary problems, the digestive system, respiratory issues, eye problems, skin and soft tissue complaints, cardiovascular, reproductive, aural and neurological complaints. The aim is to present a problem-first approach and to encourage readers to think like clinicians rather than students by instilling a case-based problem solving approach.
• Englar, R. E., Craig, M., Lobprise, H. B., Ward, E., Downing, R., Kendall, K., McLeod, K. C., Becker, M., Haworth, D., Weinstein, P., Howell, A., & Ley, J. (2021). Pet‐Specific Considerations. doi:10.1002/9781119540687.ch6
• Englar, R. (2020). A Guide to Oral Communication in Veterinary Medicine. U.K.: 5M Publishing.
  More info

  Good communication skills provide better clinical outcomes and help avoid minor as well as major mistakes. Approximately 60-80% of negligence claims against vets are related to poor communication, with new graduates especially vulnerable. Communication skills are a growing part of the curriculum in veterinary schools, recognising how fundamental clear communication is to good practice. A Guide to Oral Communication in Veterinary Medicine covers why communication skills are important, the structure of typical communications and suggested approaches, veterinary specific communication pathways, and sample scripts between vet and client. Scenarios covered include everyday communication, dealing with challenging situations, different species, different settings, and communication within the veterinary team. The aim is to instill confidence and competence, build professionalism, and avoid problems. Most current teaching is based on a toolbox approach developed from the human medicine model. However, there is no set standard for teaching methodology, which is why this is primarily a book for students, but also includes a section for educators to provide guidance in this nascent subject.
• Englar, R. (2019). Common Clinical Presentations in Dogs and Cats. doi:10.1002/9781119414612
  More info

  Common Clinical Presentations in Dogs and Cats is a reliable resource and quick reference to essential information for diagnosing canine and feline patients, based on presenting complaints. The text takes a problem-oriented approach to recognizing common clinical conditions, and introduces diagnostic and treatment plans for companion animal practice. Equally useful for veterinary students and practicing clinicians, the book presents 78 chapters grouped by body system, for ease of access. Each chapter focuses on identifying the chief complaint, pinpointing possible diagnoses, and determining the clinical approach to patient care. The book is richly illustrated throughout with clinical photographs and line drawings that demonstrate the concepts presented. Common Clinical Presentations in Dogs and Cats is an essential resource that: Gives clinicians fast access to essential details for approaching common case presentations in dogs and cats and forming a correct diagnosis, Presents information by clinical signs, organized by body system, Takes a standardized chapter format for ease of use, Includes color photographs and line drawings to illustrate the conditions discussed Written for small animal general practitioners and veterinary students, Common Clinical Presentations in Dogs and Cats is a patient-side reference that can help practitioners gain the knowledge and confidence to correctly diagnose a wide range of clinical presentations.

Chapters

• Gibbons, P., Spangler, D., Miller, L., Hofmeister, E., Greenhill, L., Polisetti, S., Young, K., Wu, S., Huddleston, G., Englar, R., Simons, M., & Thomovsky, S. (2024). Roles of the Professional Program Instructor. In Educational Principles and Practice in Veterinary Medicine. doi:10.1002/9781119852865.ch6
  More info

  Teaching within a professional program goes well beyond delivering content specific to one's expertise. And in veterinary medicine in particular, which aims to prepare graduates to practice autonomously the day they earn their degree, professional program instructors must be prepared to take on a teaching load that is a heavy dose of content mixed with a lot of other skills. This chapter discusses a variety of important roles the professional program instructor plays, from the classroom to the lab, from the clinic to the community. Discussions of different approaches to instruction are included, as are specific topics related to curricular challenges and suggestions for continuing to evolve our veterinary education programs to meet the needs of our ever-changing society.
• Englar, R. (2023). Assessing Urine’s Physical Properties. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch12
  More info

  The physical properties of urine should be inspected when performing urinalysis on every sample. These characteristics are easily observed by both client and clinician alike and as such add no expense to case management, yet urine volume, color, clarity, and odor are often overlooked in favor of microscopic analysis. The veterinary team would do well to reconsider these features of urine because they provide unique insight about patient health and ongoing disease processes. Physical properties of urine also prompt pattern recognition. For example, observing turbid urine in canine or feline patients generates a list of the most common differentials, including pyuria, crystalluria, and bacteriuria. These clues guide decision-making as clinicians determine what is most likely ongoing in the affected patient and how best to achieve a definitive diagnosis.
• Englar, R. (2023). Assessing the Physical Properties of Fecal Matter. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch16
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  The physical properties of feces should be inspected when performing a fecal analysis on every sample. These characteristics are easily observed by both client and clinician alike and as such add no expense to case management, yet fecal color and consistency are often overlooked in favor of microscopic analysis. The veterinary team would do well to reconsider these fecal features because they provide unique insight about patient health and ongoing disease processes. Identification and characterization of the physical properties of feces also promotes pattern recognition. For example, whether a patient is exhibiting melena or hematochezia localizes the origin of disease. Melena is indicative of an upper bowel bleed. When blood from the small bowel is digested, it mixes with stool to form melena. By contrast, the fresh red streaks of blood that appear in cases of hematochezia signify a lower bowel bleed. These clues guide decision-making as clinicians determine what is most likely ongoing in the affected patient and how best to achieve a definitive diagnosis.
• Englar, R. (2023). Chemical Evaluation of Urine: Urine Dipstick Analysis. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch14
  More info

  Chapters 12 and 13 examined the physical properties of urine: volume, color, turbidity, odor, and urine specific gravity (USG). The diagnostic capacity of urine extends beyond these features. A complete analysis of urine must include the chemical parameters of pH, protein, glucose, ketones, occult blood (heme) and bilirubin. The presence or absence of these substances is vital data that can be captured through urine dipsticks, the test pads of which change color in the presence of the substance of interest. The relative quantity of substance present in the urine sample determines the degree of color change. Interpretations about patient health can then be made, thereby facilitating the diagnostic process in diseased states and/or case management. Clinicians can monitor through dipstick analysis how disease progresses and/or how the patient is responding to therapy.
• Englar, R. (2023). Consultation Room Communication Strategies that Facilitate Dialogue on the Diagnostic Approach to Patient Care. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch2
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  Today's veterinary client is an active participant in health-care decisions about their pet (1). This mirrors the trend in human health care in which the patient expects to provide input on the diagnostic and/or treatment plans. Delivery of health care is thus a partnership between the provider and client. Although veterinarians provide counsel, they are less experts-in-charge and more of guides-on-the-side. In this role, veterinarians deliver key information and resources that clients require to make informed decisions. The veterinarian must consider each client's needs, preferences, and expectations to decide upon the best approach to patient care. In this way, the veterinarian facilitates decision-making, rather than dictates it. To be successful, relationship-centered care requires effective communication that allows for more than one voice in the consultation room. Clients must lean on veterinarians to navigate patient care and veterinarians must lean on clients for buy-in and informed consent to proceed with care. This chapter outlines consultation room communication strategies that facilitate dialogue so that patient care can be both mutually agreeable and achieved.
• Englar, R. (2023). Direct Smears. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch17
  More info

  The preceding chapter (Chapter 16) examined the physical properties of feces that can be appreciated by applying sight and smell to diagnostic medicine: fecal color, consistency, and odor. This chapter will expand our understanding of fecal diagnostics by transitioning from macroscopic to microscopic assessment. We will concentrate on how to perform direct smears or wet mounts. This technique is a convenient and expedient in-house diagnostic tool that evaluates feces for motile organisms, including trophozoites, that may not survive the hypertonic solutions that are used in fecal flotation. For additional information of fecal flotation, please reference the next chapter, Chapter 18.
• Englar, R. (2023). The Gold Standard, Standards of Care, and Spectrum of Care: An Evolving Approach to Diagnostic Medicine. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch1
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  Making a diagnosis requires the clinician to function as a detective. The clinician must gather patient-specific data through history-taking and the physical exam. Key findings support the development of a diagnostic plan that can be presented to the client. As this plan takes shape and delivers additional data for interpretation, the clinician determines how best to medically and/or surgically intervene to provide optimal patient care. The definition of optimal care has changed over the years within the practice of all healthcare professions. Case management was historically dictated by the gold standard. Gold standard care required veterinarians to recommend all services available to maximize diagnostic accuracy. Unfortunately, case management is often restricted by cost of care, among other obstacles. Veterinarians are frequently required to adapt treatment protocols to client/patient needs and expectations. Rather than prescribing one gold standard or one standard of care, veterinarians must be prepared to offer a continuum of acceptable care options. This so-called spectrum of care incorporates the client's perspective into shared decision-making that is mutually agreeable.
• Englar, R. (2023). Urine Specific Gravity. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch13
  More info

  The preceding chapter (Chapter 12) examined the physical properties of urine that could be appreciated by applying the special senses of sight and smell to diagnostic medicine: urine color, turbidity, and odor. This chapter will expand our understanding of urine's physical properties by considering its density. Specifically, readers will learn how to compare the density of a urine sample to the density of water using the urine specific gravity (USG) test. This quick assessment test provides insight as to how well the kidneys can modify the concentration of urine by adjusting solute content. USG is paired with chemical and sediment analysis of urine to offer a complete portrait of the patient's hydration status and the capacity of their kidneys to regulate water balance through the excretion of waste.
• Englar, R., & Bessett, J. (2023). Fecal Flotation. In Low-Cost Veterinary Clinical Diagnostics. doi:10.1002/9781119714521.ch18
  More info

  The preceding chapter (Chapter 17) introduced direct smears or wet mounts as a convenient and expedient in-house diagnostic tool that evaluates feces for motile organisms, including trophozoites. This chapter will explore an additional means by which we can microscopically examine feces. We will learn how to perform both passive (gravitational) and centrifugal flotation to recover cysts, oocysts, and eggs of mature parasites that live inside the body and reproduce. This technique relies upon differential densities to separate macerated feces within hypertonic solutions of concentrated sugar or salts.
• Englar, R. (2021). Breed-Specific Variants in Laboratory Testing. In Pet-Specific Care. doi:10.1002/9781119540687.ch3
  More info

  Patients present with a wide range of ailments. Veterinarians rely upon patient data for clues that explain clinical presentations. Patient data are produced during the comprehensive physical exam and also through diagnostic testing. Reference intervals (RIs) facilitate interpretation of laboratory data because they capture what is considered “normal” for a given species. On complete blood count, Scottish deerhounds have lower than expected RIs for platelets and reticulocytes. Many, but not all, Cavalier King Charles spaniels have moderate thrombocytopenia with larger platelets than is typical. Patients with macro-thrombocytopenia are rarely symptomatic. Elliptocytosis is relatively uncommon in companion animals and is characterized by ovoid erythrocytes. This chapter presents breed-specific hematological and biochemical variations in cats. When the veterinary team keeps current on breed specific clinical pathology, patients are less likely to be misdiagnosed on the basis of values that stray from the norm.
• Englar, R. (2021). Environmental Considerations. In Pet-Specific Care. doi:10.1002/9781119540687.ch4
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  Patient health is intimately connected to the environment. Environmental considerations are particularly valuable during comprehensive history taking. Environmental considerations are essential for the veterinary healthcare team, on whom the burden of diagnosis falls. The ambient temperature and humidity may challenge our patient's ability to maintain homeostasis. Heatstroke is the result of pathological hyperthermia. Hypothermia is a common complication of general anesthesia but it also results from prolonged exposure to cold temperatures. Toxicological emergencies are common events in companion animal practice. Dermal exposure occurs more commonly in cats; oral exposure occurs more commonly in dogs. Several toxins cause neurotoxicity among companion animals, including heavy metals, such as lead. Pet-proofing the home is essential to keep pets safe because all ages, not just puppies and kittens, are at risk. Some environments foster disease including borreliosis, leptospirosis and systemic fungal infections.
• Englar, R. (2021). Environmental Enrichment. In Pet-Specific Care. doi:10.1002/9781119540687.ch4
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  Dogs and cats require environmental enrichment. Although their environmental needs change with life stage, dogs and cats benefit from the opportunity to exhibit species-specific behaviors. Indoor-only lifestyles increase lifespan, but potentially sacrifice physical and mental wellness. Having a working knowledge of cats as solitary hunters, with keen senses and flexible social systems, facilitates healthy human interactions with cats. Cats have five environmental needs: safety, carefully spaced resources, predatory play, predictable, positive, social interactions, and olfaction-friendly surroundings. Cats may develop aberrant behaviors and compulsive disorders, such as feline hyperesthesia syndrome or psychogenic alopecia. Indoor living offers protection from the elements, predators, and automobiles. Outdoor living offers the advantage of freedom to roam. Indoor, indoor/outdoor, and outdoor lifestyles are choices that our clients make for their pets, with guidance from the veterinary team. Environmental enrichment is essential to improve the quality of a pet's living space, regardless of its lifestyle.
• Englar, R. (2021). Pet-Specific Relevance of Reference Intervals. In Pet-Specific Care. doi:10.1002/9781119540687.ch4
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  Veterinary teams strive to maintain patient health, and identify and manage disease. History taking and physical examinations are important diagnostic tools but laboratory tests are often necessary for early detection of disease. Reference intervals have been established for diagnostic tests to guide decision making and patient-specific care. They are typically reported in terms of means and standard deviations. Reference intervals are provided for diagnostic tests to establish if a patient's result is normal, high, or low. Retesting is an important diagnostic consideration. Panel testing is when a group of diagnostic tests are performed on one or more samples to facilitate disease detection or patient monitoring. Because pet-specific variations in hematological and biochemical parameters exist, it is important to establish baselines early and revisit them regularly.
• Englar, R. (2021). Providing Care for Those Unable or Unwilling to Pay. In Pet-Specific Care. doi:10.1002/9781119540687.ch7
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  Veterinary healthcare providers are obligated by the Veterinarian's Oath to act as stewards of the animal kingdom. Cost of veterinary care is rising as scientific advancements increase the diagnostic and therapeutic tools available to healthcare providers. As diagnostic testing and treatment options expand, so too does the cost of care. Each test expands the arsenal of what healthcare providers can test for, and each test gives the clinician a better understanding of the patient's individual circumstances. In order for veterinary practices to survive, they must receive payment for services rendered. Options for financing care include the following: establishing wellness plans within individual veterinary practices, offering in-house payment plans, accepting third-party payments, and promoting PHI. Practices need to look beyond traditional methods of payment and implement financing strategies that assist clients with patient care expenses.

Journals/Publications

• Englar, R. E. (2024). Teaching Tip: Designing Three-Dimensional (3-D) Printed Struvite and Calcium Oxalate Crystals for Microscopic Examination. Journal of veterinary medical education, 51(6), 707-714.
  More info

  Accredited colleges of veterinary medicine are required by the American Veterinary Medical Association (AVMA) Council on Education (COE) to provide learners with hands-on diagnostic method training, including urinalysis. Although teaching hospitals and affiliated clinical partners offer opportunities to test and interpret urine, caseload is unpredictable. Textbook images and published case reports offer substitutes for experiential learning. However, these read-only modalities lack experiences for learners to evaluate slides microscopically for crystalluria. This teaching tip describes the development of three-dimensional (3-D) printed struvite and calcium oxalate models for skills training. Micro-precision 3-D printed models were designed using computer-aided design (CAD) software. Geometric representations in the Standard for the Exchange of Product Data (STEP) file format were exported for 3-D printing on 2 µm resolution platforms. Prints were manufactured from high temperature laminating (HTL) resin and affixed to glass slides. Although these 3-D prints are macroscopic rather than microscopic, their orientation on a fixed template side by side allows learners to differentiate between shapes, a skill that is key to urine sediment examination. These proof-of-concept prototypes will be integrated into the author's pre-clinical curriculum so that learners can gain experience identifying and differentiating between printed struvite, calcium oxalate monohydrate, and calcium oxalate dihydrate models as they would during routine inspection of urine. Formal feedback on the efficacy of these printed models will be solicited from learners and the instructional team. Future iterations will miniaturize the printed models to reflect their real-to-life microscopic dimensions more accurately.
• Jacobson, L., & Englar, R. (2024). Breaking down the barriers to accessible veterinary care. Journal of Feline Medicine and Surgery, 26(9). doi:10.1177/1098612X241283532
• Jacobson, L., & Englar, R. (2024). Breaking down the barriers to accessible veterinary care. Journal of feline medicine and surgery, 26(9), 1098612X241283532.
• Leith, G. S., Hallam, L., & Englar, R. E. (2024). Design and Implementation of a Safe Equine Radiation-Free Radiographic Simulator for Veterinary Skills Training in the Pre-clinical Curriculum. Journal of veterinary medical education, 51(5), 569-577.
  More info

  The ninth standard of accreditation as outlined by the American Veterinary Medical Association (AVMA) Council on Education (COE) mandates that all accredited colleges of veterinary medicine must provide instruction in medicine and surgery, including principles of practice, hands-on experiences with diagnostic methods, and interpretation of clinical findings. In equine practice, diagnostic imaging is used as a first-line diagnostic approach and is an integral part of pre-purchase and lameness examinations. Accuracy and consistency of radiographic interpretation relies heavily upon procedural techniques to acquire diagnostic images and overcome both motion artifacts and obliquity. Because the sizes and temperaments of equine patients potentiate hazardous working conditions for the veterinary team, learners might benefit from simulations that allow them to practice holding the x-ray generator and the imaging plate for diagnostic image acquisition in the absence of live horses. This teaching tip describes the development of a novel equine radiographic simulator for skills training in the veterinary curriculum. The model allows learners to handle imaging equipment safely and without radiation exposure as they develop proficiency positioning radiographic plates and placing directional markers. Learners can also test their understanding of radiographic positioning in reverse: if given a radiograph, they can be asked to describe how the x-ray generator was positioned to obtain the diagnostic image. Future iterations will investigate the simulator's efficacy with respect to learning outcomes when the model is paired with an assessment rubric as part of an objective standardized clinical examination.
• Leith, G., Hallam, L., & Englar, R. (2024). Design and Implementation of a Safe Equine Radiation-Free Radiographic Simulator for Veterinary Skills Training in the Pre-clinical Curriculum. Journal of Veterinary Medical Education, 51(5). doi:10.3138/jvme-2023-0080
  More info

  The ninth standard of accreditation as outlined by the American Veterinary Medical Association (AVMA) Council on Education (COE) mandates that all accredited colleges of veterinary medicine must provide instruction in medicine and surgery, including principles of practice, hands-on experiences with diagnostic methods, and interpretation of clinical findings. In equine practice, diagnostic imaging is used as a first-line diagnostic approach and is an integral part of pre-purchase and lameness examinations. Accuracy and consistency of radiographic interpretation relies heavily upon procedural techniques to acquire diagnostic images and overcome both motion artifacts and obliquity. Because the sizes and temperaments of equine patients potentiate hazardous working conditions for the veterinary team, learners might benefit from simulations that allow them to practice holding the x-ray generator and the imaging plate for diagnostic image acquisition in the absence of live horses. This teaching tip describes the development of a novel equine radiographic simulator for skills training in the veterinary curriculum. The model allows learners to handle imaging equipment safely and without radiation exposure as they develop proficiency positioning radiographic plates and placing directional markers. Learners can also test their understanding of radiographic positioning in reverse: if given a radiograph, they can be asked to describe how the x-ray generator was positioned to obtain the diagnostic image. Future iterations will investigate the simulator’s efficacy with respect to learning outcomes when the model is paired with an assessment rubric as part of an objective standardized clinical examination.
• Rebelo, N., Dias, M. J., Englar, R., Mateus, L., & Leal, R. O. (2024). Frequency of low-dose dexamethasone suppression test (LDDST) response patterns and their correlation with clinicopathologic signs in dogs suspected of having Cushing's syndrome: A retrospective study. Research in veterinary science, 175, 105318.
  More info

  A retrospective cross-sectional study was conducted to assess the frequency of low-dose dexamethasone suppression test (LDDST) patterns in canine patients that had clinicopathologic signs consistent with Cushing's syndrome (CS). Medical records for patients of interest (N = 128) were reviewed between January 2014 and December 2020 to analyse and classify LDDST results based upon the following patterns: lack of suppression, partial suppression, complete suppression, escape, or inverse. Complete suppression, lack of suppression, partial suppression, escape, and inverse patterns were identified in 39.1%, 31.2%, 14.1%, 10.1% and 5.5% of cases respectively. LDDST results were also evaluated with respect to clinical signs, serum alkaline phosphatase (ALP) activity, urine specific gravity (USG) and adrenal ultrasonographic findings. There was no association between LDDST patterns and clinical signs (p = 0.11), increased ALP (p = 0.32), USG (p = 0.33) or adrenal ultrasonographic findings (p = 0.19). In all dogs that demonstrated complete suppression or an inverse pattern, CS was excluded by the attending clinician. The diagnosis of CS was also excluded without further exploration in 23.1%, 7.5% and 5.6% of dogs that demonstrated an escape pattern, lack of suppression and partial suppression pattern, respectively. These results suggest that the clinical significance of LDDST patterns, particularly escape and inverse patterns, are misunderstood by some clinicians, leading them to prematurely exclude the diagnosis of CS.
• Rebelo, N., Dias, M., Englar, R., Mateus, L., & Leal, R. (2024). Frequency of low-dose dexamethasone suppression test (LDDST) response patterns and their correlation with clinicopathologic signs in dogs suspected of having Cushing's syndrome: A retrospective study. Research in Veterinary Science, 175. doi:10.1016/j.rvsc.2024.105318
  More info

  A retrospective cross-sectional study was conducted to assess the frequency of low-dose dexamethasone suppression test (LDDST) patterns in canine patients that had clinicopathologic signs consistent with Cushing's syndrome (CS). Medical records for patients of interest (N = 128) were reviewed between January 2014 and December 2020 to analyse and classify LDDST results based upon the following patterns: lack of suppression, partial suppression, complete suppression, escape, or inverse. Complete suppression, lack of suppression, partial suppression, escape, and inverse patterns were identified in 39.1%, 31.2%, 14.1%, 10.1% and 5.5% of cases respectively. LDDST results were also evaluated with respect to clinical signs, serum alkaline phosphatase (ALP) activity, urine specific gravity (USG) and adrenal ultrasonographic findings. There was no association between LDDST patterns and clinical signs (p = 0.11), increased ALP (p = 0.32), USG (p = 0.33) or adrenal ultrasonographic findings (p = 0.19). In all dogs that demonstrated complete suppression or an inverse pattern, CS was excluded by the attending clinician. The diagnosis of CS was also excluded without further exploration in 23.1%, 7.5% and 5.6% of dogs that demonstrated an escape pattern, lack of suppression and partial suppression pattern, respectively. These results suggest that the clinical significance of LDDST patterns, particularly escape and inverse patterns, are misunderstood by some clinicians, leading them to prematurely exclude the diagnosis of CS.
• Englar, R. (2023).

  Diagnosis, treatment and outcome of pheochromocytoma in a cat

  . Journal of Small Animal Practice, 64(6), 415-420. doi:10.1111/jsap.13601
• Englar, R. E. (2023).

  Teaching Tip: Designing Three-Dimensional (3-D) Printed Struvite and Calcium Oxalate Crystals for Microscopic Examination

  . Journal of Veterinary Medical Education, 50(2), 192-204. doi:10.3138/jvme-2023-0098
• Englar, R. E. (2023). Recasting the gold standard - part I of II: delineating healthcare options across a continuum of care. Journal of Feline Medicine and Surgery, 25(12).
• Englar, R. E. (2023). Recasting the gold standard - part II of II: communicating healthcare options along a continuum of care. Journal of feline medicine and surgery, 25(12), 1098612X231215639.
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  This is the second part of a two-part series on spectrum of care that encourages practitioners to tailor case management to the patient along a continuum of acceptable options. Part I defined the spectrum of care and broadened its approach beyond initial cost-of-care considerations. This second article introduces strategies for initiating conversations with clients about their needs, wants and expectations specific to healthcare options and case management decisions. It will explore how open inquiry, reflective listening, transparency and unconditional positive regard facilitate dialogue between providers and their clients as they collaborate on decision-making along a spectrum of care.
• Leith, G. S., Hallam, L., & Englar, R. E. (2023). Teaching Tip: Design and Implementation of a Safe Equine Radiation-Free Radiographic Simulator for Veterinary Skills Training in the Pre-clinical Curriculum. Journal of veterinary medical education.
• Molina, C. C., Dias, M. J., Domingues, T. D., Englar, R. E., & Leal, R. O. (2023). Clinical findings and prognostic factors for mortality in hospitalized dogs with leishmaniosis: aretrospective study. Comparative immunology, microbiology and infectious diseases, 101, 102041.
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  This retrospective study evaluated factors responsible for mortality of dogs hospitalized for Canine Leishmaniosis. Medical records of 31 dogs with leishmaniosis from a Portuguese Veterinary Teaching Hospital were examined between August 2018 and January 2022. Females (n = 18) and pure breed dogs (n = 27) were overrepresented, with higher frequency of Labrador Retriever (n = 4). Median age was 7 years (interquartile range=7). Most had historical findings of lethargy (n = 26) and the commonest clinicopathological abnormality was hypoalbuminemia (n = 26). Eleven dogs were classified as LeishVet stage II, 10 stage III and 10 stage IV. Fourteen dogs (45.2%) died or were euthanized, with azotemia, leukocytosis, stage IV, absence of diagnosis before hospitalization and lack of leishmaniosis specific treatment during hospitalization contributing to mortality. Absence of hypoalbuminemia and stages II/III increased survival. Mean hospitalization length prior to discharge was 5.41days ( ± 1.84) and diarrhea prolonged hospital stay.
• Molina, C. C., Dias, M. J., Domingues, T. D., Englar, R. E., Leal, R. O., & College, o. (2023). Clinical findings and prognostic factors for mortality in hospitalized dogs with leishmaniosis: a retrospective study. Comparative immunology, microbiology and infectious diseases.
• Prego, M. T., Dias, M. J., Mestrinho, L., Englar, R., Grinwis, G., Galac, S., & Leal, R. O. (2023). Diagnosis, treatment and outcome of pheochromocytoma in a cat. The Journal of small animal practice, 64(6), 415-420.
  More info

  Pheochromocytoma in cats is a rare clinical condition characterised by the development of a secretory endocrine tumour that arises from the adrenal medulla. An 8-year-old castrated male, domestic shorthair cat was referred for further investigation of a 4-month history of progressive weight loss with normal appetite, polyuria/polydipsia, generalised weakness, and severe hypertension. Sonography and computed tomography of the abdomen disclosed a mass arising from the left adrenal gland. The contralateral adrenal gland was normal in size and shape. Results from a low dose dexamethasone suppression test and measurements of plasma aldosterone concentration and plasma renin activity ruled out a cortisol-secreting tumour and aldosteronoma. The clinical presentation made a sex-steroid secreting tumour unlikely. Increased plasma metanephrine and normetanephrine concentrations prioritised the differential diagnosis of pheochromocytoma. The cat underwent adrenalectomy of the left gland and histopathological diagnosis with immunohistochemical markers confirmed the diagnosis.
• Soltero, E., Villalobos, C. D., Englar, R. E., & Graham Brett, T. (2023). Evaluating Communication Training at AVMA COE-Accredited Institutions and the Need to Consider Diversity within Simulated Client Pools. Journal of veterinary medical education, 50(2), 192-204.
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  The push for competency-based veterinary medical education by accrediting bodies has led to the inclusion of non-technical skills within curricula. Communication, self-awareness, and cultural humility are considered essential for post-graduate success. To facilitate skills development, veterinary educators have incorporated a variety of modalities including lecture, group discussions, virtual and peer-assisted learning, role play, video review of consultations, and simulated clients (SCs). The overarching goal is developing students into self-reflective practitioners through exposure to clinical scenarios that enhance and embody diversity. Decision making about case management is subject to stereotypes, bias, and assumptions. Racial and ethnic disparities reported in health care can adversely impact patient outcomes. This study was conducted to evaluate communication training and diversity among SC pools within veterinary colleges. A questionnaire was electronically disseminated to assistant/associate deans and/or directors of curriculum/education at 54 American Veterinary Medical Association Council on Education-accredited or provisionally accredited colleges of veterinary medicine. Twenty-one institutions are represented within the data set. Participating institutions summarized their communication curricula: 18 (85.71%) used SCs. Over 55% of these did not track SC demographic data or social identities; among institutions that did track, SCs were primarily monolingual English-speaking (77%), non-disabled (94.2%), white (90.4%), non-Hispanic/Latinx (98.6%) women (57%) over age 56 (64%). Sixteen institutions agreed with the statement "I do not feel that our SC pool is adequately diverse." Respondents shared that lack of time and capacity for recruitment were barriers to diversifying SC pools and proposed strategies to improve outreach.
• Englar, R. E., & Graham, B. T. (2022). Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care. Journal of veterinary medical education, 50(4), 399-412.
• Englar, R. E., Leal, R. O., Galac, S., Ferreira, R. L., Vicente, G., Fontes, A. P., Dias, M. J., & Oliveira, J. (2022). Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study. Veterinary Sciences. doi:10.3390/vetsci9080420
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  This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.
• Jesus, L., Arenas, C., Domínguez-Ruiz, M., Silvestrini, P., Englar, R. E., Roura, X., & Leal, R. O. (2022). Xanthinuria secondary to allopurinol treatment in dogs with leishmaniosis: Current perspectives of the Iberian veterinary community. Comparative immunology, microbiology and infectious diseases, 83, 101783.
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  Xanthinuria is a significant adverse effect in dogs on long-term allopurinol for treatment of leishmaniosis. The study aims to investigate how the Iberian veterinary community (IVC) identifies, manages, and proactively prevents xanthinuria secondary to allopurinol treatment. A cross-sectional study was conducted using an online survey, translated into two languages, and disseminated to the IVC via social networking forums. Respondents were asked to share their treatment regimens, adverse effects attributed to treatment, as well as preventive and reactive measures against xanthuria. Of two-hundred and thirty respondents, 99.6% prescribe allopurinol for canine leishmaniosis. Xanthinuria was estimated to happen in less than one out of every four dogs by 91.7% of the clinicians. Xanthinuria has been detected by 71.6% of respondents at least once. Three out of every four respondents inform owners about deleterious effects of allopurinol, and 28.4% consider implementing a change in diet in advance of treatment as a proactive measure. To monitor xanthinuria, urinalysis and diagnostic imaging are used by 71.2% and 31% of clinicians respectively. When xanthinuria is detected, 43.2% of the respondents discontinue allopurinol, 24% replace it by nucleotide-analogs, 14.9% reduce its dosage, and 3.1% split its dosage but increase administration frequency. Additional measures are taken by 72.1% of the respondents, 59.4% of whom prescribe a low-purine diet. The IVC recognizes xanthinuria as a fairly common secondary effect of long-term allopurinol treatment in dogs with leishmaniosis and recommends periodically monitoring and preventive measures.
• Oliveira, J., Dias, M. J., Fontes, A. P., Englar, R. E., Vicente, G., Ferreira, R. L., Galac, S., & Leal, R. O. (2022). Ultrasonographic Detected Adrenomegaly in Clinically Ill Cats: A Retrospective Study. Veterinary sciences, 9(8).
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  This retrospective study aimed to assess the prevalence of ultrasonographic detected adrenomegaly in clinically ill cats, evaluating the final established diagnosis, describe adrenal ultrasound findings and if the adrenomegaly was suspected or incidental. Abdominal ultrasonography reports of cats presenting to a veterinary teaching hospital between October 2018 and February 2021 were retrospectively reviewed. Cats showing adrenomegaly (one or both glands having a dorsoventral axis >4.8 mm) were selected and medical records respectively evaluated. Nine-hundred and eighty-three ultrasonographical reports were selected, of which, 68 (7%) disclosed adrenomegaly. European/Domestic Short-Hair (62/68; 91%) male (44/68; 65%) castrated (35/44; 80%) cats were overrepresented. Adrenomegaly was an incidental finding in 62/68 (91%) cats while in 6/68 (9%) it was identified in the context of investigating a potential adrenal disease. Concerning established diagnosis, chronic kidney disease was overrepresented (25/68; 37%), followed by endocrinopathies (20/68; 29%). Adrenomegaly was bilateral in 53% (36/68) of cases. In unilateral cases (32/68; 47%), it was more prevalent on the left side (23/32; 72%), with a normal-sized contralateral adrenal gland. Left adrenal demonstrated a larger size and a tendency to oval shape. This study assesses the prevalence of adrenomegaly in clinically ill cats, reinforcing it can be an incidental ultrasound finding.
• Baptista, R., Englar, R., São Braz, B., & Leal, R. O. (2021). Survey-Based Analysis of Current Trends for Prescribing Gastrointestinal Protectants among Small-Animal General Practitioners in Portugal. Veterinary sciences, 8(5).
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  In both human and veterinary healthcare, gastrointestinal protectants (GIPs) are considered a staple of clinical practice in that they are prescribed by general practitioners (GPs) and specialists alike. Concerning GIP use, overprescription of proton pump inhibitors (PPIs) has become a growing concern among human healthcare providers. This trend has also been documented within veterinary practice, prompting the American College of Veterinary Internal Medicine (ACVIM) to publish a consensus statement in 2018 concerning evidence-based indications for GIP use. This observational cross-sectional study evaluated self-reported prescribing protocols among Portuguese GPs to determine whether there is adherence to the consensus guidelines. Respondents were Portuguese GPs recruited by social media posts in veterinarian online forums. Data were collected from 124 respondents concerning their GIPs of choice and their rationales for prescribing them. Data were mined for prescription patterns and protocols. Among GIPs, PPIs were prescribed more often. Rationales for use included gastrointestinal ulceration and erosion (GUE), prophylactic management of nonerosive gastritis, pancreatitis, reflux esophagitis, and steroid-induced ulceration. Once-daily administration of PPIs was the most frequent dosing regime among respondents. Ninety-six percent of PPI prescribers advocated that the drug be administered either shortly before or at mealtime. Forty-nine percent of respondents supported long-term use of PPIs. Fifty-nine percent of respondents acknowledged discontinuing PPIs abruptly. This study supports that Portuguese GPs commonly prescribe GIPs in accordance with ACVIM recommendations to medically manage GUE. However, misuse of GIPs does occur, and they have been prescribed where their therapeutic value is debatable. Educational strategies should target GPs in an effort to reduce GIP misuse.
• Englar, R. (2021). Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey. Veterinary Sciences, 8(11), 271. doi:https://doi.org/10.3390/vetsci8110271
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  This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.
• Englar, R. E., Schettler, K. A., & Ostrom, S. A. (2021). Survey of communication challenges that impact relationships between veterinarians and dog or cat breeders and proposed solutions for retaining breeders as clients. Journal of the American Veterinary Medical Association, 258(4), 407-415.
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  To characterize communication challenges between veterinarians and dog or cat breeders and elicit their perspectives on how professional relationships between the two might be improved.
• Englar, R., Brett, T. G., Soltero, E. H., & Villalobos, C. (2021). Evaluating Diversity within the Standardized Client (SC) Pool at AVMA/COE Accredited Colleges of Veterinary Medicine. Journal of Veterinary Medical Education.
• Rebocho, R., Domínguez-Ruiz, M., Englar, R. E., Arenas, C., Pérez-Alenza, M. D., Corsini, A., Fracassi, F., Bennaim, M., & Leal, R. O. (2021). Use of Deoxycorticosterone Pivalate by Veterinarians: A Western European Survey. Veterinary sciences, 8(11).
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  This study aims to gather knowledge about the use of deoxycorticosterone pivalate (DOCP) by Western European Veterinarians (WEV) in dogs with typical hypoadrenocorticism. An observational cross-sectional study was conducted using an online survey, translated into four languages and disseminated to veterinary affiliates and mailing lists in six countries of Western Continental Europe. Respondents were tasked to share their therapeutic approach to hypoadrenocorticism, whether they preferred DOCP or fludrocortisone and the specific practical use of DOCP. One-hundred and eighty-four responses were included. Of these, 79.9% indicated that they preferred prescribing DOCP over fludrocortisone as a first-line treatment for mineralocorticoid supplementation. A total of 154 respondents had used DOCP at least once. Eighty percent of those who reported their initial dosage prescribed 2.2 mg/kg. After starting DOCP, 68.2% of the respondents assess electrolytes 10 and 25 days after administration following manufacturer instructions. In stable dogs, electrolytes are monitored quarterly, monthly, semi-annually, and annually by 44.2%, 34.4%, 16.9%, and 4.6% of respondents respectively. When treatment adjustment is required, 53% prefer to reduce dosage while 47% increase the interval between doses. Overall, DOCP is the preferred mineralocorticoid supplementation among WEV. Reported variability underlies the need to investigate the best strategies for DOCP use and therapeutic adjustments.
• Salah, E., Abouelfetouh, M. M., Englar, R. E., Ding, M., & Ding, Y. (2021). Cardiorespiratory Effects of Three Infusion Doses of Adenosine in Conscious Goats: A Preliminary Study. Veterinary sciences, 8(8).
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  Adenosine (AD) has been implicated in human healthcare as an endogenous signaling nucleotide in both physiologic and pathologic states. The effects of AD on cardiorespiratory parameters in ruminants has not yet been studied. The objective of this study was to evaluate the cardiac and respiratory changes that resulted from an intravenous AD infusion in goats. Six clinically healthy adult goats weighing 28 ± 2 kg were randomly assigned to one of four treatments in a crossover design with a seven day washout period. The goats received a 0.9 % saline solution (SAL treatment) and three AD treatments (AD 50, 100 and 200) intravenously at a dose rate of 50, 100 and 200 μg/kg/min. Cardiorespiratory and key cardiac parameters were measured before the treatment (baseline), during the infusion (dInf) and at 1, 3, 5 and 10 min after each infusion was discontinued. The AD 100 produced a significant increase in HR ( = 0.001) and the AD 200 resulted in significant rises in HR ( = 0.006) and RR ( = 0.001) compared with the baseline. This study concluded that the AD infusion could trigger an increase in HR and RR in a dose-dependent manner in healthy goats.
• Dias, M. J., Mouro, S., Englar, R. E., & Leal, R. O. (2020). Nasal foreign bodies identified by rhinoscopy in dogs: 42 cases. The Journal of small animal practice, 61(12), 752-756.
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  To evaluate signalment, clinical presentation, location and type of nasal foreign bodies identified by rhinoscopy in dogs.
• Englar, R. E. (2019). Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters. Journal of veterinary medical education, 46(2), 235-257.
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  The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.
• Englar, R. E. (2019). Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy. Journal of veterinary medical education, 46(4), 489-505.
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  Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.
• Jones, J. L., Rinehart, J., & Englar, R. E. (2019). The Effect of Simulation Training in Anesthesia on Student Operational Performance and Patient Safety. Journal of veterinary medical education, 46(2), 205-213.
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  A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students' perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students' initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.
• Englar, R. E. (2018). Using a Standardized Client Encounter in the Veterinary Curriculum to Practice Veterinarian-Employer Discussions about Animal Cruelty Reporting. Journal of veterinary medical education, 45(4), 464-479.
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  Animal cruelty is the antithesis of animal welfare. Because veterinarians take an oath to protect animal welfare, they are professionally obligated to report animal cruelty. Several US states have mandatory reporting laws for veterinarians, and both the American Veterinary Medical Association (AVMA) and the American Animal Hospital Association support reporting. Some state veterinary practice acts, such as Arizona's, also require reporting. Despite this, animal cruelty is not always emphasized in veterinary curricula. As a result, not all veterinary students and graduates feel comfortable recognizing signs of animal cruelty and may not be aware of the resources that are available to them when considering reporting. AVMA suggests that practices develop their own protocols for identifying signs that patients may have been victims of cruelty and consulting on cases with senior colleagues with regard to when to report. To enhance student comfort with these conversations, Midwestern University College of Veterinary Medicine developed a standardized client encounter titled "Grizabella's Final Fight." I hope that other colleges of veterinary medicine will adapt this teaching tool to allow students the opportunity to practice discussions surrounding animal cruelty reporting in the context of state-specific legislation that guides their code of professional conduct.
• Englar, R. E., Jones, J. L., Rinehart, J., Spiegel, J. J., Sidaway, B. K., & Rowles, J. (2018). Teaching Tip: Development of Veterinary Anesthesia Simulations for Pre-Clinical Training: Design, Implementation, and Evaluation Based on Student Perspectives. Journal of Veterinary Medical Education, 45(2), 232-240. doi:10.3138/jvme.1016-163r
• Englar, R. E., Show-Ridgway, A., Noah, D. L., Appelt, E., & Kosinski, R. (2018). Perceptions of the Veterinary Profession among Human Health Care Students before an Inter-Professional Education Course at Midwestern University. Journal of veterinary medical education, 45(3), 423-436.
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  Conflicts among health care professionals often stem from misperceptions about each profession's role in the health care industry. These divisive tendencies impede progress in multidisciplinary collaborations to improve human, animal, and environmental health. Inter-professional education (IPE) may repair rifts between health care professions by encouraging students to share their professional identities with colleagues in unrelated health care disciplines. An online survey was conducted at Midwestern University (MWU) to identify baseline perceptions about veterinary medicine among entry-level human health care students before their enrollment in an inter-professional course. Participation was anonymous and voluntary. The survey included Likert-type scales and free-text questions. Survey participants expressed their interest in and respect for the discipline of veterinary medicine, but indicated that their unfamiliarity with the profession hindered their ability to collaborate. Twenty percent of human health care students did not know the length of a Doctor of Veterinary Medicine (DVM) program and 27.6% were unaware that veterinarians could specialize. Although 83.2% of participants agreed that maintaining the human-animal bond is a central role of the veterinary profession, veterinary contributions to stem cell research, food and water safety, public health, environmental conservation, and the military were infrequently recognized. If IPE is to successfully pave the way for multidisciplinary collaboration, it needs to address these gaps in knowledge and broaden the definition of veterinary practice for future human health care providers.
• Show, A., & Englar, R. E. (2018). Evaluating Dog- and Cat-Owner Preferences for Calgary-Cambridge Communication Skills: Results of a Questionnaire.. Journal of veterinary medical education, 45(4), 534-543. doi:10.3138/jvme.0117-002r1
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  Veterinary client retention by companion animal practices is influenced by whether the client feels connected to the healthcare provider. Effective communication between the veterinarian and the client facilitates that connection. To prepare new graduates for success in clinical practice, many colleges of veterinary medicine are now incorporating communication into the curriculum to emphasize its importance in establishing and maintaining the veterinarian-client relationship. A 2016 focus group study by Englar et al. evaluated dog and cat owner communication preferences for Calgary-Cambridge Guide (CCG) communication skills and concluded that dog and cat owners may have different communication needs. This study was conducted to confirm whether species-based communication preferences exist among veterinary clients. A questionnaire was distributed online and on-site, within veterinary teaching hospitals and private practices. Based upon 215 submissions from dog owners and 166 from cat owners, the communication preferences of dog and cat owners overlap. Both dog and cat owners prioritize reflective listening as the most important foundational CCG communication skill, and both prioritize asking permission as the most important core CCG skill. However, dog owners valued open-ended questions more than cat owners, and cat owners valued empathy more than dog owners. Survey limitations were largely demographic: participants were predominantly female and between the ages of 18-40 years. Survey data may therefore not be representative of the perspective of males and/or those >40 years of age.
• Englar, R. (2017). A novel approach to simulation-based education for veterinary medical communication training over eight consecutive pre-clinical quarters. Journal of Veterinary Medical Education, 44(3). doi:10.3138/jvme.0716-118R1
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  Experiential learning through the use of standardized patients (SPs) is the primary way by which human medical schools teach clinical communication. The profession of veterinary medicine has followed suit in response to new graduates' and their employers' concerns that veterinary interpersonal skills are weak and unsatisfactory. As a result, standardized clients (SCs) are increasingly relied upon as invaluable teaching tools within veterinary curricula to advance relationship-centered care in the context of a clinical scenario. However, there is little to no uniformity in the approach that various colleges of veterinary medicine take when designing simulation-based education (SBE). A further complication is that programs with pre-conceived curricula must now make room for training in clinical communication. Curricular time constraints challenge veterinary colleges to individually decide how best to utilize SCs in what time is available. Because it is a new program, Midwestern University College of Veterinary Medicine (MWU CVM) has had the flexibility and the freedom to prioritize an innovative approach to SBE. The author discusses the SBE that is currently underway at MWU CVM, which incorporates 27 standardized client encounters over eight consecutive pre-clinical quarters. Prior to entering clinical rotations, MWU CVM students are exposed to a variety of simulation formats, species, clients, settings, presenting complaints, and communication tasks. These represent key learning opportunities for students to practice clinical communication, develop self-awareness, and strategize their approach to future clinical experiences.
• Englar, R., Williams, M., & Weingand, K. (2016). Applicability of the Calgary-Cambridge Guide to dog and cat owners for teaching veterinary clinical communications. Journal of Veterinary Medical Education, 43(2). doi:10.3138/jvme.0715-117R1
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  Effective communication in health care benefits patients. Medical and veterinary schools not only have a responsibility to teach communication skills, the American Veterinary Medical Association (AVMA) Council on Education (COE) requires that communication be taught in all accredited colleges of veterinary medicine. However, the best strategy for designing a communications curriculum is unclear. The Calgary-Cambridge Guide (CCG) is one of many models developed in human medicine as an evidence-based approach to structuring the clinical consultation through 71 communication skills. The model has been revised by Radford et al. (2006) for use in veterinary curricula; however, the best approach for veterinary educators to teach communication remains to be determined. This qualitative study investigated if one adaptation of the CCG currently taught at Midwestern University College of Veterinary Medicine (MWU CVM) fulfills client expectations of what constitutes clinically effective communication. Two focus groups (cat owners and dog owners) were conducted with a total of 13 participants to identify common themes in veterinary communication. Participants compared communication skills they valued to those taught by MWU CVM. The results indicated that while the CCG skills that MWU CVM adopted are applicable to cat and dog owners, they are not comprehensive. Participants expressed the need to expand the skillset to include compassionate transparency and unconditional positive regard. Participants also expressed different communication needs that were attributed to the species of companion animal owned.