Veterinarians' Perceptions of Competence and Communication Skills in Bali, Indonesia

695 To cite this paper: Dharmawan NS, Wulanyani NMS, and Agustina KK (2025). Veterinarians' Perceptions of Competence and Communication Skills in Bali, Indonesia. World Vet. J., 15(3): 695-702. DOI: https://dx.doi.org/10.54203/scil.2025.wvj70 2025, Scienceline Publication World’s Veterinary Journal World Vet J, 15(3): 695-702. ISSN 2322-4568 Veterinarians' Perceptions of Competence and Communication Skills in Bali, Indonesia Nyoman Sadra Dharmawan1* , Ni Made Swasti Wulanyani2, and Kadek Karang Agustina3 1Veterinary Medicine Study Program, Faculty of Veterinary Medicine, Udayana University, Denpasar, Bali, 80234 Indonesia 2Psychology Study Program, Faculty of Medicine, Udayana University, Denpasar, Bali, 80234 Indonesia 3Department of Public Health, Faculty of Veterinary Medicine, Udayana University, Denpasar, Bali, 80234 Indonesia *Corresponding author's Email: [email protected] ABSTRACT Effective communication is a crucial aspect of veterinary medicine. Despite its importance, this subject has not been sufficiently studied in the specific context of Bali, Indonesia, resulting in a notable gap in the existing research literature. The present study addressed a significant gap in the literature by systematically examining how communication challenges, specifically client dissatisfaction, inadequate treatment compliance, and recurrent misunderstandings between veterinarians and pet owners, affect the quality of veterinary care. The current study explored how veterinary practitioners in Bali, Indonesia, perceive their professional skills and communication abilities. Data were collected through interviews, focus group discussions, open-ended questionnaires, and surveys, involving 218 practitioners in the study area. The participants included small animal practitioners (65%), livestock veterinarians (25%), and mixed-practice clinicians (10%), with experience ranging from recent graduates to senior professionals with over 20 years in the field. The current findings revealed that 86.2% of respondents considered communication skills as equally important as clinical knowledge in facilitating critical professional outcomes, including client trust, treatment compliance, and clinical effectiveness. Effective communication was recognized as crucial for fostering confidence, increasing job satisfaction, strengthening client relationships, and supporting important activities such as anamnesis and treatment discussions. However, practitioners encountered difficulties in discussing sensitive topics, including life-threatening diagnoses, euthanasia, and costly treatment options. Notably, 86.7% of participants indicated the necessity for post-employment communication training to maintain and advance their skills, highlighting the significance of ongoing professional development in Indonesia. The present study emphasized the critical role of communication in veterinary practice and highlighted the demand for targeted training programs to address existing gaps. Keywords: Client, Communication skill, Perception, Veterinarian ORIGINAL ARTICLE Received: June 26, 2025 Revised: July 27, 2025 Accepted: August 30, 2025 Published: September 30, 2025 INTRODUCTION Communication in veterinary medicine involves complex interactions among veterinarians, clients, animals, and colleagues. While perceptions of communication skills among veterinary practitioners might differ, their significance in daily practice is broadly recognized (Mabin and Taylor, 2023). Recently, communication has become increasingly recognized as a vital skill for veterinary professionals. This adjustment is reflected in the increasing focus on communication training in veterinary education, especially in developed countries (McDermott et al., 2017). Effective communication is essential not only in human healthcare professions but also as a fundamental skill in veterinary medicine (Gaida et al., 2018). Nevertheless, having only scientific and technical knowledge is not sufficient to succeed in this field. Veterinarians need to develop skills such as teamwork, entrepreneurship, cultural awareness, and effective communication with clients, staff, and colleagues (Gaida et al., 2021). Moreover, these skills are particularly important for veterinary academics, as they are crucial for handling interpersonal relationships and other professional responsibilities (Mabin and Taylor, 2023). Effective communication is essential for successful interactions among veterinary practitioners and their clients, as well as among practitioners themselves. However, a lack of proficient communication often leads to different challenges, including misunderstandings, unclear cost explanations, ineffective dialogue, insufficient client engagement, and ethical concerns (Hernandez et al., 2018). To effectively address these challenges, veterinary practitioners should prioritize improving their communication skills, including providing clear and transparent information to clients and making a dedicated effort to understand the diverse needs and expectations of their clients. Therefore, veterinary professionals can foster stronger client relationships and improve overall service delivery within the field by enhancing their communication skills, providing clear and transparent information, and striving to understand their clients' needs and expectations better (Pun, 2020). DOI: https://dx.doi.org/10.54203/scil.2025.wvj70 PII: S232245682500070-15 Dharmawan et al., 2025 696 From a psychological perspective, communication in veterinary practice can significantly impact practitioners’ mental and emotional well-being. Positive interactions, such as effectively explaining treatment plans or receiving client gratitude, can enhance job satisfaction and alleviate stress and burnout. Conversely, difficult conversations, such as delivering unfavorable and bad news, discussing euthanasia, or managing client conflicts, may contribute to anxiety, compassion fatigue, and emotional exhaustion (Pun, 2020). Given these psychological factors, it is essential to develop strong communication skills for both professional success and protecting veterinarians’ mental health in this challenging field (Steffey et al., 2023). Although communication is recognized as vital in veterinary practice, no published studies have examined veterinary practitioners' perceptions of their competence and communication skills in Indonesia, especially in Bali. The present study aimed to explore the perceptions of veterinary practitioners in Bali regarding their professional competencies and communication skills, focusing on their perspectives about the importance and role of communication in their interactions with clients. MATERIALS AND METHODS Ethical approval The present study employed solely interview methods with veterinary colleagues and focus group discussions (FGD). All participants have provided consent for the data they provided to be published. The present study did not involve the use of experimental animals, and all the procedures were conducted in compliance with the applicable ethical guidelines from the Ethical Commission of Udayana University, Indonesia. Study design The present study employed a mixed-methods approach involving 218 veterinary practitioners in Bali, Indonesia (Figure 1), conducted from May to August 2024. Data were collected through in-depth interviews, FGD, open-ended questionnaires, and attitudinal scale questionnaires. Qualitative analysis was utilized to examine responses from interviews, FGD, and open-ended questions, whereas quantitative methods were employed to assess data from the attitude scales. This questionnaire was created based on the study of McDermott (2018). Before implementation, a multidisciplinary panel of experts conducted an extensive validation of the questionnaire by specialists. The review panel included academic experts from Udayana University's Faculty of Veterinary Medicine, senior veterinary practitioners with at least 15 years of clinical experience, government officials from animal health regulatory agencies, industry representatives from veterinary employers, and executive board members of the Indonesian Veterinary Association, including its Bali branch. The experts conducted a comprehensive evaluation of the questionnaires and attitude scales, assessing them for content validity, specifically considering each item's relevance to the constructs being assessed. Additionally, the experts evaluated face validity related to clarity and contextual appropriateness for Balinese veterinary practice, cultural sensitivity, technical accuracy of clinical information, and practical applicability of tools. The pre-testing phase involved 30 veterinary practitioners to assess the instrument's feasibility under field conditions. Figure 1. The location of the study, Bali Island, Indonesia World Vet. J., 15(3): 697-704, 2025 697 Sample size According to the Indonesian Veterinary Medicine Association data, the total number of veterinarians in Indonesia as of June 2024 was 15,131, with approximately 900-1000 practicing in Bali province (IVMA, 2024). The inclusion criteria for participants in the present study consisted of practicing veterinarians employed in animal hospitals, clinics, or private practices across different locations in Bali. Using Slovin's formula with a 5% margin of error (Khalaf et al., 2019), the minimum required sample size was calculated to be 109 respondents to adequately represent the target population, including a proportional representation of Bali practitioners. To improve the validity and reliability of the current findings, the sample size was doubled, resulting in a total of 218 participants. This expanded sample size increased statistical power and provided a better representation of the target population of veterinary practitioners in Bali, Indonesia. n = N 1+Ne2 which n is the required sample size, N is the total population size, and e is the tolerable margin of error (5%). Data collection and analysis The validity of the veterinary communication skills scale (VCSS) in the present study was evaluated using content validity procedures. Content validity was established through expert evaluation to ensure the scale's items accurately represented essential veterinary communication skills. A panel of veterinary communication specialists reviewed each item for relevance, clarity, and comprehensiveness in measuring key competencies such as empathy, active listening, and client education. Items that did not align with communication competencies were improved or removed to enhance the scale's accuracy (Hecker et al., 2012). The content validity index was employed to evaluate the degree of agreement among experts regarding the scale. The current findings indicated that the results met or exceeded established acceptable thresholds, thereby confirming the strength of the measurement tool (Dalawi et al., 2023). This approach ensured that the VCSS effectively captures the critical aspects of veterinary communication, supporting its use as a valid assessment tool in both educational and clinical settings (Artemiou et al., 2014). The validity of the statements in the present study was assessed by expert evaluations, quantified with Aiken’s V index. A panel of subject-matter experts rated each statement for relevance, clarity, and appropriateness in measuring the intended constructs. Aiken’s V, a statistical metric for content validity, was used to assess expert agreement, with scores from 0 to 1; higher values signify greater agreement on an item's validity. Only statements meeting a predefined threshold (Typically V ≥ 0.70) were retained, ensuring the instrument's robustness. This method provided a rigorous and objective way to validate content, improving the credibility of the assessment tool (Timbi-Sisalima et al., 2024). To examine the underlying structure of the perception variables, the data were analyzed using exploratory factor analysis with Jeffreys's amazing statistics program, an open-source statistics software, which enables robust factor extraction and interpretation. Principal axis factoring with oblique rotation, including promax, was employed to identify latent constructs, allowing for correlations between factors when theoretically justified. The number of retained factors was determined using multiple criteria, including Kaiser’s eigenvalue-greater-than-one rule, parallel analysis, and scree plot inspection, providing a method grounded in data while remaining a theoretically relevant solution. Items with factor loadings below 0.40 or significant cross-loadings were removed to improve scale clarity and discriminant validity. This method provided empirical support for the dimensionality of the measured constructs while enhancing the scale’s psychometric qualities (Traymbak et al., 2022). Survey responses assessing the perceived importance of communication skills in clinical activities and practice factors were analyzed using a weighted Likert scale (1-5). Response frequencies for each category (1 means strongly disagree to 5 means strongly agree) were multiplied by their respective numerical values and summed to yield total weighted scores. Mean scores were calculated by dividing each variable’s total weighted score by the number of responses. Results were categorized as 1.00-1.80 (Very Low), 1.81-2.60 (Low), 2.61-3.40 (Neutral), 3.41-4.20 (High), and 4.21-5.00 (Very High; Joo et al., 2024). The current data were presented in both descriptive and qualitative formats to ensure comprehensive interpretation and clarity. This dual-method approach provided a deeper understanding of the results, as the numerical patterns were complemented by detailed narrative explanations. By combining both methods, the present study ensured that the results were statistically relevant within the specific context, thereby improving the overall validity and practical usefulness of the findings. RESULTS AND DISCUSSION A total of 218 veterinarians, whose ages ranged from 24 to 65 years, participated in the current study by completing a structured questionnaire. The participants included small animal practitioners (65%), livestock veterinarians (25%), and mixed-practice clinicians (10%), with experience spanning from recent graduates to senior professionals with over 20 years of experience in the field. The gender distribution of the participants in the present study revealed a slight majority Dharmawan et al., 2025 698 of males (51.8%) in comparison to females (48.2%). This distribution stands in contrast to the findings of McDermott et al. (2015), which reported a predominance of female respondents (57.3%) over males (42.7%) in their study conducted across the United States and the United Kingdom. This disparity may be indicative of underlying regional sociocultural norms, as well as differences in veterinary specialty selections, where large-animal practice has historically drawn a higher proportion of male practitioners (Morello et al., 2021). Additionally, varying expectations regarding work-life balance may contribute to these disparities. Noteworthy studies have demonstrated that female veterinarians encounter distinct challenges, including an elevated incidence of burnout and client bias, factors that could significantly affect their career sustainability within the specific context of Bali (Steffey et al., 2023). Communication training The findings regarding respondents' participation in communication training are detailed in Table 1. The distribution of participants who engaged in communication training within the context of the current study was notably balanced, with 109 respondents (Representing 50% of the total) indicating their involvement in such training. The current findings indicate that 50% of respondents received communication training during their veterinary education, with lecture-based instruction being the most common format (72.5% of trained participants). Following graduation, only 43.6% of practitioners pursued further training in communication skills. The present data revealed a significant decline in participation in communication training after the completion of formal education. A significant majority of respondents (86.7%, n = 189/218) from Bali expressed a keen interest in pursuing additional communication training opportunities. Among these practitioners, 70.4% (n = 133/189) showed a strong preference for consultation and simulation-based training formats, highlighting the critical demand for practical learning methodologies that remain unaddressed, emphasizing the significant local need for educational approaches. Table 1. Respondent data on communication training among veterinary practitioners in Bali, Indonesia, in 2024 Time period Participation Number (%) Type of Training A B C D During the study Yes 109 (50%) 14 (12.8%) 2 (1.8%) 79 (72.5%) 14 (12.8%) Not 109 (50%) After graduation Yes 95 (43.6%) 34 (35.8%) 36 (37.9%) 18 (18.9%) 7 (7.4%) Not 123 (56.4%) A: Consultation/Simulation, B: Online, C: Lecture, D: No response The current findings are consistent with McDermott et al. (2015), who emphasized the importance of enhancing communication training for practicing veterinarians, especially through more practical and accessible approaches such as simulation and online methods training. The present study revealed a significant gap between veterinarians' awareness and training in communication skills. Although the majority acknowledged the importance of communication competencies, only 41% had received formal instruction during veterinary school. Notably, among veterinary practitioners who engaged in post-graduation training, 61% reported a significant increase in their preparedness for client interactions. Effective communication skills are essential in veterinary practice, as they not only facilitate the understanding of client concerns but also contribute to the delivery of high-quality patient care. These communication skills may be equally, if not more, essential than clinical knowledge on their own (Kourkouta and Papathanasiou, 2014). Simulation-based and online training offer flexible solutions for busy veterinarians. Simulation allows practitioners to engage in realistic scenarios, refining their communication skills in a clinical context without risk to patients or clients (Englar, 2017). Online training provides accessibility and convenience, facilitating integration into challenging work schedules (Spruijt et al., 2023). Pun (2020) emphasized that many veterinary practitioners lack specialized training in communication and suggested that veterinary curricula should incorporate more comprehensive communication training. Communication training in veterinary schools has been demonstrated to equip graduates for professional challenges, boost their clinical outcomes, and foster better team collaboration (Mills, 2024). In developed countries such as the United States, the United Kingdom, Germany, and Canada, communication skills training is already a standard part of healthcare curricula (Gaida et al., 2021). In veterinary medicine, effective communication is a key skill that greatly impacts professional success (Bell et al., 2019). Effective communication is linked to higher pet owner satisfaction and improved veterinarian well-being. Developing strong relationships and showing empathy play crucial roles in enhancing owner compliance (Brown, 2018). For veterinarians, strong communication skills enhance job satisfaction and foster effective teamwork (Stackhouse et al., 2020). Mills (2024) noted that many veterinary colleges have integrated World Vet. J., 15(3): 697-704, 2025 699 communication skills training into their curricula, often incorporating client interaction simulations and advanced communication techniques. The strong preference for simulation-based training (70.4%) highlights its proven effectiveness in closing the knowing-doing gap in clinical communication (Spruijt et al., 2023). Unlike conventional lectures, simulations provide a safe environment for deliberate practice of high-stakes situations such as euthanasia discussions, offering repetitive exposure along with immediate feedback. This approach directly addressed the main challenges identified by Bali practitioners through different mechanisms (Table 1). First, role-playing exercises improve emotional readiness by lowering anxiety related to difficult conversations, while allowing for the integration of local client-practitioner dynamics. Additionally, the hands-on aspect of simulation promotes better skill retention than passive learning methods, leading to more lasting competency development. These advantages collectively explain why clinical simulation has become the preferred training method among respondents (Favier et al., 2021). Perception of communication skills The current findings revealed that the majority of respondents (86.2%) perceive communication skills as equally important as clinical knowledge, while 13.8% believe communication skills are even more important than clinical knowledge. The strong agreement among respondents on the importance of communication skills reflected the findings of McDermott et al. (2015), where 98% of surveyed veterinarians in the United States and the United Kingdom rated communication skills as at least equally important to clinical practice knowledge. Pun (2020) further supports the perspective by underscoring the significance of effective communication as a vital professional skill within the practice of veterinary medicine. Effective communication plays a pivotal role in strengthening veterinarian-client relationships, enhancing the efficacy of medical care, and facilitating a smoother transition for new graduates into clinical practice. Moreover, effective communication is integral to fostering professionalism and promoting collaborative teamwork within veterinary practice (Mills, 2024). In the present study, communication skills were rated as highly important, with very high scores, across multiple aspects, including confidence, job satisfaction, time management, income/profit, client relationships, and colleague relationships. Additionally, communication skills were deemed highly important in most of the clinical activities, such as obtaining medical histories, making diagnoses, explaining diagnoses and prognoses, discussing treatment plans, obtaining client consent, managing client expectations, optimizing client compliance, encouraging follow-up visits, and discussing treatment costs (Table 2). Mills (2024) highlighted that effective communication is essential for establishing and maintaining long-term relationships between veterinarians and clients. Veterinarians who dedicate time to understanding client concerns and expectations are more likely to build client loyalty and foster lasting relationships (Abood, 2007). Clients who perceive that their veterinarian actively listens to and values their contributions demonstrate a greater propensity to seek subsequent services. This phenomenon is vital for the sustainability and long-term viability of veterinary practices (Pun, 2020). The present findings are consistent with prior studies, which have explored the significance of communication skills, their impact on client satisfaction, the role of training and education, factors influencing communication proficiency, the effect of communication on clinical decision-making, and communication risks related to zoonoses (Arnecke et al., 2024). Communication challenges in veterinary practice Regarding the communication challenges faced by veterinary practitioners in Bali, Indonesia, the current findings are summarized in Table 3. The present findings indicated that discussions surrounding euthanasia constituted the most challenging communication topic, as evidenced by 102 respondents rating it as very difficult. This was followed by communications regarding life-threatening conditions (54 respondents), costly treatments (53 respondents), difficult diagnoses (53 respondents), and complex treatment protocols (44 respondents). In contrast, discussions concerning prolonged care were perceived as moderately complex, yielding an average score of 3.39. Multiple peer-reviewed studies have documented the professional challenges veterinarians face when conveying unfavorable news, explaining complex diagnoses, or guiding end-of-life care decisions (Artemiou et al., 2014; Hernandez et al., 2018; Gaida et al., 2021). According to Pun (2020), discussing euthanasia is often one of the most emotionally challenging parts of veterinary practice. Many veterinarians experience significant emotional stress when recommending or performing euthanasia, particularly when clients are hesitant to accept or fully understand the decision (Cooney and Kipperman, 2023). Veterinarians often have to balance the animal's welfare with the emotional needs and expectations of the owner (Quain et al., 2021). Another significant challenge is handling client expectations, particularly in cases where clients hold unrealistic expectations regarding treatment outcomes or the prognosis for critically ill animals (Christiansen et al., 2016). These professional challenges become particularly pronounced when practitioners are required to clarify the limitations of therapeutic interventions or to justify euthanasia as the most ethically defensible option (Pun, 2020). Dharmawan et al., 2025 700 Table 2. Veterinary practitioners' perceptions of communication skill importance across clinical activities and practice factors in Bali, Indonesia, in 2024 Variable Number of Responses Number of Responses × Score Average Category 1 2 3 4 5 Factors Confidence 0 0 9 22 187 1050 4.82 Very High Job satisfaction 0 0 9 47 162 1025 4.70 Very High Time management 0 0 13 58 147 1006 4.61 Very High Income/profit 0 0 18 53 147 1001 4.59 Very High Client relationships 0 0 6 17 194 1056 4.86 Very High Colleague relationships 0 1 5 25 187 1052 4.83 Very High Types of Activities Obtaining medical history 0 0 6 22 190 1056 4.84 Very High Diagnosing a condition 0 0 12 26 180 1040 4.77 Very High Explaining the diagnosis 0 0 4 11 203 1071 4.91 Very High Discussing prognosis 0 0 8 30 180 1044 4.79 Very High Discussing treatment 0 1 8 28 181 1041 4.78 Very High Obtaining client consent 0 0 4 25 189 1057 4.85 Very High Managing client expectations 0 0 6 25 187 1053 4.83 Very High Optimizing client compliance 0 0 8 41 169 1033 4.74 Very High Encouraging follow-up visits 0 0 7 35 176 1041 4.78 Very High Discussing treatment costs 0 0 10 39 169 1031 4.73 Very High 1: Very Low, 2: Low, 3: Moderate, 4: High, 5: Very High Table 3. Perceptions of practicing veterinarians in Bali regarding communication difficulties in clinical case discussions with clients, in 2024 Variable Number of Responses Number of Responses × Score Average Category 1 2 3 4 5 Conditions where diagnosis is difficult 9 24 82 49 53 764 3.53 Difficult Conditions where treatment is difficult 9 28 85 52 44 748 3.43 Difficult Life-threatening patient conditions 13 34 64 53 54 755 3.46 Difficult Conditions requiring Euthanasia 7 16 52 41 102 869 3.99 Difficult Conditions requiring expensive treatment 11 28 70 56 53 766 3.51 Difficult Conditions requiring prolonged treatment 17 33 69 47 52 738 3.39 Moderate 1: Very easy, 2: Easy, 3: Moderate, 4: Difficult, 5: Very difficult Implications for veterinary education Previous studies in veterinary communication have highlighted the importance of a structured approach to teaching effective communication skills within veterinary curricula (Pun, 2020; Mabin and Taylor, 2023). Haldane et al. (2017) found that both veterinary practitioners and students consider verbal communication and interpersonal skills to be the most essential competencies for aspiring professional veterinarians. In English-speaking countries, the CalgaryCambridge model has been widely adopted by veterinary institutions to develop students' communication skills, leading to improved client interactions (Bard et al., 2017). However, Agne et al. (2024) emphasize that despite the recognized importance of teaching communication-based clinical reasoning skills, current educational approaches for teaching these skills remain inadequate. Consequently, there is an urgent requirement for integrated communication skills training within veterinary education programs across higher education institutions globally. Study limitations While the present study contributed a valuable understanding of veterinary communication training in Bali, several limitations should be acknowledged. The self-reported nature of the data could lead to response bias, particularly regarding individuals' evaluations of their communication skills (Rosenman et al., 2011). Focusing on Bali as a regional example may restrict the relevance of these findings to other Indonesian provinces that have different cultural or practical traits (Muhtar et al., 2025). Regarding gender differences, the current findings of a slight male predominance (51.8%) contrast with Western studies (McDermott et al., 2015) and may reflect Bali's unique veterinary workforce dynamics. This warrants further investigation into cultural, educational, or professional factors influencing gender distribution in Indonesian veterinary medicine. The high preference for simulation-based training, indicated by 70.4% of respondents, can be attributed to its established efficacy in improving clinical communication skills through intentional practice in secure environments, as evidenced by the findings of Spruijt et al. (2023). This method, designed to evaluate communication issues in veterinary practice, provided instant feedback and allowed repeated practice of complex situations such as euthanasia discussions, directly targeting the specific challenges highlighted in the current results. World Vet. J., 15(3): 697-704, 2025 701 CONCLUSION The present study confirmed that communication skills are equally vital as clinical expertise in veterinary practice, with 86.2% of practitioners acknowledging their importance for both clinical outcomes and professional achievement. While 50% of individuals received training primarily delivered through lectures, a notable 86.7% expressed a strong desire for additional educational opportunities. Among these respondents, a significant preference for simulation-based learning was indicated, with 70.4% highlighting it as a particularly valuable mode of instruction. The primary challenges discussed include ethical concerns surrounding euthanasia, the high costs of medical treatments, and difficulties in achieving accurate diagnoses. Veterinary curricula should incorporate mandatory communication training through realistic methods and simulations. Findings should be interpreted within Bali's context, as the unusual gender distribution needs further exploration. Implementing these changes would enhance patient care, strengthen client relationships, and increase practitioner satisfaction. Future studies should incorporate standardized client evaluations to validate selfreported data and assess regional differences. Additionally, the impact of gender on communication styles and challenges in client interactions across Indonesia's different veterinary practices should be investigated. DECLARATIONS Acknowledgments The authors would like to thank the Indonesian Veterinary Medicine Association, Bali Branch, and the study respondents for their support. Authors’ contributions All authors were actively involved in every stage of the study and manuscript preparation process. Nyoman Sadra Dharmawan designed the theoretical framework and research concept, supervised data collection, and contributed to manuscript preparation. Ni Made Swasti Wulanyani contributed to the study methodology, data analysis and interpretation, and manuscript preparation. Kadek Karang Agustina participated in study design, organized focus group discussions, coordinated data collection, and assisted in manuscript preparation. All authors have reviewed and approved the final edition of the manuscript. Funding The present study was funded by Udayana University through the Institute for Research and Community Service under contract number B/255.106/UN14.4.A/PT.01.03/2024. Competing interests The authors have not declared any conflict of interest. Ethical considerations Ethical issues, including plagiarism, consent to publish, misconduct, data fabrication and/or falsification, double publication and/or submission, and redundancy, have been checked by all the authors. Availability of data and materials The data to support the present study's findings are available upon reasonable request to the corresponding author. REFERENCES Abood SK (2007). Increasing adherence in practice: Making your clients partners in care. Veterinary Clinics of North America: Small Animal Practice, 37(1): 151-164. DOI: https://www.doi.org/10.1016/j.cvsm.2006.09.011 Agne GF, Carr AMN, Kirkwood RN, and Petrovski KR (2024). Assisting the learning of clinical reasoning by veterinary medical learners with a case example. Veterinary Sciences, 11(9): 433. DOI: https://www.doi.org/10.3390/vetsci11090433 Arnecke AL, Schwarz S, Lübke-Becker A, Jensen KC, Herre C, and Bahramsoltani M (2024). Risk communication on zoonoses and antimicrobial resistancehow do exotic pet owners perceive the communication of their veterinarians?. Animals, 14(14): 2035. DOI: https://www.doi.org/10.3390/ani14142035 Artemiou E, Adams CL, Hecker KG, Vallevand A, Violato C, and Coe JB (2014). Standardised clients as assessors in a veterinary communication OSCE: A reliability and validity study. Veterinary Record, 175(20): 509. DOI: https://www.doi.org/10.1136/vr.102633 Bard AM, Main DCJ, Haase AM, Whay HR, Roe EJ, and Reyher KK (2017). The future of veterinary communication: Partnership or persuasion? A qualitative investigation of veterinary communication in the pursuit of client behaviour change. PloS One, 12(3): e0171380. DOI: https://www.doi.org/10.1371/journal.pone.0171380 Bell M, Cake M, and Mansfield C (2019). Success in career transitions in veterinary practice: perspectives of employers and their employees. VetRecord, 185(8): 232. DOI: https://www.doi.org/10.1136/vr.105133 Brown BR (2018). The dimensions of pet-owner loyalty and the relationship with communication, trust, commitment and perceived value. Veterinary Sciences, 5(4): 95. DOI: https://www.doi.org/10.3390/vetsci5040095 Christiansen SB, Kristensen AT, Lassen J, and Sandøe P (2016). Veterinarians’ role in clients’ decision-making regarding seriously ill companion animal patients. Acta Veterinaria Scandinavica, 58(1): 30. DOI: https://www.doi.org/10.1186/s13028-016-0211-x Dharmawan et al., 2025 702 Cooney K and Kipperman B (2023). Ethical and practical considerations associated with companion animal euthanasia. Animals, 13(3): 430. DOI: https://www.doi.org/10.3390/ani13030430 Dalawi I, Isa MR, Chen XW, Azhar ZI, and Aimran N (2023). Development of the Malay language of understanding, attitude, practice and health literacy questionnaire on COVID-19 (MUAPHQ C-19): Content validity and face validity analysis. BMC Public Health, 23(1): 1131. DOI: https://www.doi.org/10.1186/s12889-023-16044-5 Englar RE (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): 502-522. DOI: https://www.doi.org/10.3138/jvme.0716-118R1 Favier RP, ten Cate O, Duijn C, and Bok HGJ (2021). Bridging the gap between undergraduate veterinary training and veterinary practice with entrustable professional activities. Journal of Veterinary Medical Education, 48(2): 136-138. DOI: https://www.doi.org/10.3138/jvme.2019-0051 Gaida S, Dilly M, Tipold A, and Härtl A (2021). Motivation and experience matters: What veterinary mentors think about learning communication skills: A qualitative study. Journal of Veterinary Medical Education, 48(4): 441-450. DOI: https://www.doi.org/10.3138/jvme.2019-0068 Gaida S, Härtl A, Tipold A, and Dilly M (2018). Communication identity in veterinary medicine: A grounded theory approach. Veterinary Record Open, 5(1): e000310. DOI: https://www.doi.org/10.1136/vetreco-2018-000310 Haldane S, Hinchcliff K, Mansell P, and Baik C (2017). Expectations of graduate communication skills in professional veterinary practice. Journal of Veterinary Medical Education, 44(2): 268-279. DOI: https://www.doi.org/10.3138/jvme.1215-193R Hecker KG, Adams CL, and Coe JB (2012). Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: The importance of context. Journal of Veterinary Medical Education, 39(3): 304-310. DOI: https://www.doi.org/10.3138/jvme.0312.022R Hernandez E, Fawcett A, Brouwer E, Rau J, and Turner PV (2018). Speaking up: Veterinary ethical responsibilities and animal welfare issues in everyday practice. Animals, 8(1): 15. DOI: https://www.doi.org/10.3390/ani8010015 Indonesian veterinary medical association (IVMA) (2024). Indonesian veterinary medical association membership card data. Joo Y, Jang Y, Park CG, and Yang YL (2024). Development and validation of a patient-centered communication scale for nurses. BMC Nursing, 23(1): 550. DOI: https://www.doi.org/10.1186/s12912-024-02174-7 Khalaf AJ, Aljowder AI, Buhamaid MJ, Alansari MF, and Jassim GA (2019). Attitudes and barriers towards conducting research amongst primary care physicians in Bahrain: A cross-sectional study. BMC Family Practice, 20(1): 20. DOI: https://www.doi.org/10.1186/s12875-019-0911-1 Kourkouta L and Papathanasiou IV (2014). Communication in nursing practice. Materia Socio-Medica, 26(1): 65-67. DOI: https://www.doi.org/10.5455/msm.2014.26.65-67 Mabin IG and Taylor R (2023). Developing communication comVeterinary Medical Associationpetency in the veterinary curriculum. Animals, 13(23): 3668. DOI: https://www.doi.org/10.3390/ani13233668 McDermott MP (2018). Veterinary communication skills and training in the United Kingdom and the United States of America. Doctoral thesis, University of Nottingham, UK. McDermott MP, Cobb MA, Tischler VA, Robbé IJ, and Dean RS (2017). Evaluating veterinary practitioner perceptions of communication skills and training. The Veterinary Record, 180(12): 305. DOI: https://www.doi.org/10.1136/vr.103997 McDermott MP, Tischler VA, Cobb MA, Robbé IJ, and Dean RS (2015). Veterinarian–client communication skills: Current state, relevance, and opportunities for improvement. Journal of Veterinary Medical Education, 42(4): 305-314. DOI: https://www.doi.org/10.3138/jvme.0115-006R Mills PC (2024). Education and communication in veterinary clinical practice. Animals, 14(17): 2622. DOI: https://www.doi.org/10.3390/ani14172622 Morello SL, Genovese J, Pankowski A, Sweet EA, and Hetzel SJ (2021). Occupational segregation by gender in veterinary specialties: Who we are choosing, or who is choosing us. Veterinary Surgery, 50(6): 1191-1200. DOI: https://www.doi.org/10.1111/vsu.13676 Muhtar F, Nasir MA, Sudarsono, and Nordin H (2025). Interfaith educational collaboration enhances cultural adaptation in Lombok and Bali. Jurnal Pendidikan Agama Islam, 22(1): 22-42. DOI: https://www.doi.org/10.14421/jpai.v22i1.10627 Pun JKH (2020). An integrated review of the role of communication in veterinary clinical practice. BMC Veterinary Research, 16(1): 394. DOI: https://www.doi.org/10.1186/s12917-020-02558-2 Quain A, Ward MP, and Mullan S (2021). Ethical challenges posed by advanced veterinary care in companion animal veterinary practice. Animals, 11(11): 3010. DOI: https://www.doi.org/10.3390/ani11113010 Rosenman R, Tennekoon V, and Hill LG (2011). Measuring bias in self-reported data. International Journal of Behavioural and Healthcare Research, 2(4): 320-332. DOI: https://www.doi.org/10.1504/IJBHR.2011.043414 Spruijt A, Prins-Aardema CC, Carvalho-Filho MA, Jaarsma D, and Martin A (2023). Co-constructive veterinary simulation: A novel approach to enhancing clinical communication and reflection skills. Journal of Veterinary Medical Education, 50(2): 134-139. DOI: https://www.doi.org/10.3138/jvme-2021-0160 Stackhouse N, Chamberlain J, Bouwer A, and Mexas AM (2020). Development and validation of a novel measure for the direct assessment of empathy in veterinary students. Journal of Veterinary Medical Education, 47(4): 452-464. DOI: https://www.doi.org/10.3138/jvme.0818-096r Steffey MA, Griffon DJ, Risselada M, Buote NJ, Scharf VF, Zamprogno H, and Winter AL (2023). A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors. Frontiers in Veterinary Science, 10: 1184525. DOI: https://www.doi.org/10.3389/fvets.2023.1184525 Timbi-Sisalima C, Sánchez-Gordón M, Otón-Tortosa S, and Mendoza-González R (2024). Self-assessment guide to quality in accessible virtual education: An expert validation. Sustainability, 16(22): 10011. DOI: https://www.doi.org/10.3390/su162210011 Traymbak S, Sharma A, and Dutta M (2022). Reliability and construct validity assessment of Wong and Law emotional intelligence scale and satisfaction with life scale in the Indian Hospitality Industry. Annals of Neurosciences, 29(2-3): 121-128. DOI: https://www.doi.org/10.1177/09727531221100249 Publisher’s note: Scienceline Publication Ltd. remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/. © The Author(s) 2025