Guidance on Critical Reasoning, Team Learning and Safety-focused practices in Veterinary Clinics

veterinary care is about more than clinical knowledge and technical skills it’s about thinking critically, learning from experience, and supporting the wellbeing of patients, clients, and the whole team this guidance uses current evidence and regulatory expectations to support veterinary teams in embedding safety focused practices such as near miss reporting, morbidity and mortality (m\&m) rounds, and schwartz rounds into everyday clinical work it aligns with the veterinary council of new zealand’s cpd framework and draws on insights from multiple professions and recent veterinary research why this matters for patients safer, higher quality care through shared learning and prevention of repeat mistakes for clients greater trust and transparency, knowing their animals are cared for by a reflective, learning focused team for the team a supportive, non blame culture that values everyone’s input and wellbeing, and that encourages competence and personal development the cpd requirement critical reasoning in practice the vet council's cpd framework requires veterinarians to plan, participate in, and reflect on learning activities that go beyond clinical knowledge and technical skills critical reasoning how you think, analyse, and make decisions is a core area of competence this includes reflecting on cases and outcomes (good and bad) participating in team discussions and reviews engaging in structured analysis of incidents and near misses near miss and adverse event reporting errors, sometimes called misadventures, are acts of omission (didn’t do) or commission (did do but shouldn’t have) that could or did lead to unintended outcomes near misses are incidents that could have caused harm but did not; adverse events result in actual harm reporting these events is essential for learning and prevention common veterinary errors include drug errors, communication failures, and treatment related incidents in a teaching hospital study, oversight, drug, iatrogenic, and staff related errors were most frequent barriers to reporting include fear of blame, lack of systems, and emotional distress a non punitive, confidential reporting culture is vital to encourage openness and improvement what reporting incidents that could have caused harm (near misses) or did cause harm (adverse events) why these are powerful opportunities for learning and prevention, not just for the person involved but for the whole team how use a confidential, non punitive system focus on what happened and why, not who is to blame share learnings with the team morbidity & mortality (m\&m) rounds m\&m rounds are structured, confidential forums to discuss complications, errors, and near misses they support root cause analysis, team learning, and emotional processing cases typically include deaths, 'never events'¹, safety incidents, and near misses discussions use tools like sbar² (situation background assessment recommendation (pang et al 2018)) and fishbone diagrams³ (also known as cause and effect, ishikawa, or fishikawa diagrams (pang et al 2018)) to identify contributing factors and generate recommendations regular m\&m rounds help build a culture of safety and continuous improvement what regular, structured team meetings to discuss complications, errors, and near misses why these rounds are a cornerstone of learning in medicine and are now recommended in veterinary practice they foster openness, collective problem solving, and continuous improvement how make them inclusive invite all clinical and support staff use structured analysis tools (like the sbar² tool) focus on learning and improvement, not blame schwartz rounds schwartz rounds provide a structured space for veterinary teams to discuss the emotional and ethical challenges of their work they focus on sharing experiences, supporting wellbeing, and fostering compassion these rounds help normalise emotions, reduce moral injury, and build team resilience they are inclusive, non blaming, and complement m\&m rounds by addressing the human impact of clinical work what facilitated forums for staff to discuss the emotional and ethical challenges of their work why veterinary work can be emotionally demanding schwartz rounds help teams process difficult experiences, support each other, and build resilience how hold regular sessions open to all staff focus on sharing experiences and supporting wellbeing, not clinical details making it work in your practice integrate these activities into your cpd plan and regular team routines, e g a weekly surgical or clinical care team meeting encourage open, honest participation from everyone record learning outcomes and changes made as a result review and update your approach regularly as part of your cpd cycle building a safety culture a safety culture includes openness, trust, learning, and system level thinking errors are often due to system factors, not individual failings leadership plays a key role in creating a non blame environment where staff feel safe to speak up approachable leaders, structured communication, and team based problem solving are essential supporting 'second victims', e g clinicians affected by errors, is part of a just culture cpd plans should cover all aspects of competence, including reasoning, communication, and wellbeing embedding these insights into cpd activities and team discussions strengthens clinical reasoning and improves patient safety references and links to further reading bmj 2000;320 759 reporting and preventing medical mishaps lessons from non medical near miss reporting systems https //doi org/10 1136/bmj 320 7237 759 cpd information for veterinarians march 2021 – veterinary council of new zealand continuing professional development giles g et al (2025) categorising reported errors and incidents from morbidity and mortality meetings (m\&ms) aust vet j, 103 267275 https //doi org/10 1111%2favj 13426 low r, wu aw (2022) veterinary healthcare needs to talk more about error jvim, 36 2199–2202 https //doi org/10 1111/jvim 16554 pang dsj, rousseau blass f, pang jm (2018) morbidity and mortality conferences a mini review and illustrated application in veterinary medicine front vet sci mar 6;5 43 https //doi org/10 3389/fvets 2018 00043 pmid 29560359; pmcid pmc5845710 qi boxset presentation for m\&m rounds in equine practice rcvs knowledge uk vet equine 2023 ethics in practice schwartz rounds and veterinary clinical ethics committees vinten, c e k (2020) clinical reasoning in veterinary practice veterinary evidence , 5 (2) https //doi org/10 18849/ve v5i2 283 definitions \[1] “never events” are serious, preventable incidents in healthcare that result in patient harm or death and should not occur if proper safety protocols are followed ² sbar is a structured communication tool that helps teams discuss cases clearly and consistently it stands for s ituation, b ackground, a ssessment, r ecommendation, see pang et al 2018 for more information ³a fishbone diagram is a visual tool used to explore the possible causes of an event by grouping them into categories like people, process, or equipment it helps teams identify contributing factors in a structured, non blaming way see pang et al 2018 for more information