Thinking differently about clinical skills training: The bovine pregnancy diagnosis via transrectal palpation showcase

Annett Annandale

    Research output: ThesisDoctoral thesis 2 (Research NOT UU / Graduation UU)


    Thinking differently about clinical skills training: The bovine pregnancy diagnosis via transrectal palpation showcase Clinical hands-on training is an integral part of veterinary education. Skills acquisition opportunities are however limited by welfare and ethical concerns around the use of live animals for training purposes, large student cohort sizes and budget constraints, amongst others. The same holds true for bovine trans-rectal palpation (TRP) and pregnancy diagnosis (PD) training and is furthermore challenging since extensive exposure to TRP in live cows is required to ensure competency. At the same time, it is an important competency for veterinary graduates as bovine PD by TRP is one of the most frequently performed procedures in large animal practice and of economic importance. The main aim of this thesis was to investigate alternative and improved undergraduate veterinary training methods for bovine trans-rectal palpation (TRP) and pregnancy diagnosis (PD) skills. The second aspiration of this thesis was that thinking differently about clinical skills training for bovine TRP and PD as an example might lead to an alternative approach to traditional skills training in general that has the potential to overcome some of the training constraints at teaching institutions. This led to a number of studies describing and evaluating TRP and PD assessment methods, identifying predictors and factors affecting students’ TRP and PD accuracy, developing and implementing research-based innovative teaching ideas, including optimised simulator training, in-training assessment methods, additional training opportunities linked to or not directly linked to the TRP skill itself and the use of technology to improve skills training. The series of studies described in this thesis demonstrate how training innovations, such as the “mini Cow Palpation Box” and the “Bovine Pregnancy Diagnosis Improvement Exercise Programme” (, can be combined with traditional training to improve overall TRP and PD training and to optimise limited live animal exposure to practice these skills. The findings of this thesis can be implemented to respect and maintain high ethical standards for the use of teaching animals. The thesis leads to a description of practical implications for undergraduate bovine TRP and PD skills training methods which summarises the teaching strategies and interventions for bovine TRP and PD training. The practical recommendations described can be used to design or improve bovine TRP and PD training programmes at veterinary teaching institutions. Furthermore, this thesis describes a new concept to teach clinical hands-on skills (The “Predictor Micro-Skills Concept”) which is based on the TRP and PD skills training investigations done as part of this PhD thesis and which are considered to be applicable to many other clinical skills. Lastly, an approach to blending a fun student project and research while teaching is outlined.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • Utrecht University
    • Kremer, Wim, Primary supervisor
    • Bok, Harold, Co-supervisor
    • Holm, D.E., Co-supervisor, External person
    Award date6 Jul 2020
    Print ISBNs978-94-640-2361-9
    Electronic ISBNs978-94-640-2361-9
    Publication statusPublished - 6 Jul 2020


    • Veterinary Education
    • bovine pregnancy diagnosis
    • transrectal palpation
    • clinical skills


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