personal statement medical laboratory science

*Students graduating that began the second half of the program.

**Students who found employment (in the field or in a closely related field) and/or continued their education within one year of graduation.

***Students who passed within the first year of graduation

†Not a final result; rate calculation currently in progress

Who Is the Ideal Student for This Program?

Medical Laboratory Sciences (MLS) is a profession that combines the challenges of medicine, the basic sciences, and clinical sciences into a highly satisfying and valued career. Medical laboratory scientists function as detectives, investigating and determining the causes of disease. They utilize the latest biomedical instruments and molecular techniques to perform both routine and complex testing.

As vital members of the health care team, medical laboratory scientists (sometimes called medical technologists) find great satisfaction in making a direct impact on medical care. Today's medical laboratory science graduates work in diverse settings including hospital laboratories, physician offices, clinics, commercial and research laboratories, pharmaceutical and biotechnology firms, as well as government and public health facilities.

Learn more about Careers in Laboratory Sciences .

State Licensure Information

While the completion of this program will make graduates eligible to register for an ASCP Board of Certification Exam, this does not automatically guarantee a graduate will also meet their state’s requirements for state licensure (if applicable). Since each state may have different requirements for licensure, each student is encouraged to contact their state’s regulating agency and review these requirements prior to beginning any degree program. State’s requiring licensure may require extended duration of practicum experiences, additional academic courses (outside the student’s program of study), etc. These additional requirements may require you to take a course or courses outside of GW.

In particular, New York and California have additional requirements for state licensure.  Both NY and CA require extended times for practicum rotations. Please also be aware that the BSHS in MLS program may not meet the student lab requirements for NY state licensure.  We recommend that students who live in New York or California or plan to relocate to New York or California do research to determine the NY and CA licensure requirements.

Career Outlook

The U.S. Bureau of Labor Statistics projects that an increase in the aging population is expected to lead to a greater need to diagnose medical conditions, like cancer or type 2 diabetes, through laboratory procedures. Overall employment of medical laboratory technologists and technicians is expected to grow 11% from 2018 to 2028, faster than the average for all occupations, with a median salary of $52,330 per year. 1 According to Burning Glass, from May 2017 to May 2018, these high-demand, high-paying metro areas were seeking medical laboratory technicians with a bachelor’s degree:

• New York, N.Y., 1,417 job postings, $70,590 mean salary
• Boston, Mass., 562 job postings, $74,030 mean salary
• Washington, D.C., 525 job postings, $66,840 mean salary 2

Admission Requirements

To be accepted into this program, you must have:

• Completed application
• Minimum cumulative GPA of 2.7 and science GPA of 2.5. (For GAA applicants, a minimum cumulative GPA of 2.75 and science GPA of 2.5 are required)
• Personal statement
• One letter of recommendation (letter of recommendation is waived for GAA applicants)
• Applicants must have at least 45 credits from a regionally accredited college or university in specified courses

SEE ALL REQUIREMENTS

Tuition Details

The BSHS in Medical Laboratory Sciences program at GW consists of 60 credit hours. Please find the cost per credit hour and total estimated program costs  here .

Note: Tuition rates are subject to change and additional fees may vary by program.

GET TUITION DETAILS

Meet the Program Director

GW’s experienced faculty provide you with the rich, practical knowledge and support needed for you to succeed in the program and in your career.

Cliff Cymrot, DHSc, MHA, MLS(ASCP) CM , SH CM , MT(AAB), MT(AMT)

Dr. Cliff Cymrot is the current Program Director for Medical Laboratory Sciences (MLS) and has over 10 years of experience in combined teaching and clinical laboratory practice. In addition to his program director duties, Dr. Cymrot teaches a range of courses within the MLS program, both online and face-to-face, such as Hematology lecture and lab, Bacteriology lab, Immunohematology lab, Molecular Diagnostics, and Capstone.

Prior to his arrival at George Washington University (GW), Dr. Cymrot worked as a medical laboratory technician at a medium-sized, 200-bed hospital in upstate NY. In 2008, Dr. Cymrot worked for Advance Magazine for Laboratory Professionals providing storylines for the comic strip “Lab out Loud” that he worked on with his brother-in-law. He has also been a contributor for several chapters in the Textbook of Diagnostic Microbiology by Mahon, Lehman, and Manuselis, as well as having various research publications.

He is also a member of the DC chapter for the American Society for Clinical Laboratory Science (ASCLS), American Medical Technologists (AMT), and the American Association of Bioanalysts (AAB). He also holds certifications in ASCP, AMT, and AAB in Medical Laboratory Science, and Specialist in Hematology.

In 2010, he earned his B.S. in Medical Technology from the University of Cincinnati (UC). He was then promoted to medical laboratory scientist and soon after began working as an adjunct instructor for SUNY Orange teaching Microbiology for Health Professionals, Fundamentals of Anatomy and Physiology, and Certification Preparation. In 2014 he earned his a master’s degree in Health Administration from UC.

After graduation, he received an offer to facilitate an online graduate level course in health systems management at  UC. In 2015 he was offered a position at GW to teach all of the laboratory courses in the newly created BSHS in MLS blended/hybrid program. After three years he was offered the Program Director position for the undergraduate MLS program here at GW. In 2022 he then went on to complete his doctorate in health sciences at GW. In 2024 he was offered the Program Director position for the MSHS in Laboratory Medicine program here at GW. Dr. Cymrot is actively involved in the MLS profession and loves teaching, research, and promoting MLS.

Curriculum Details: Hybrid (Blended)

The hybrid Medical Laboratory Science (MLS) program requires 60 credits of GW coursework.

Program completion time is 2 years.

Note: These are examples of course sequencing. Summer IS included in our program. Students will work closely with their academic advisor regarding any edits that need to be made to the plan based on successful course completion or offerings.

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MLS 2007W - Writing in the Health Sciences (3 credits) - 8 weeks

Introduction to the health sciences literature Emphasis is on construction, evaluation and organization of written communication of health sciences information.

MLS 3001W - Professional Ethics for MLS (3 credits) - 8 weeks

Ethical and professional conduct of and dilemmas encountered by medical laboratory professionals. Restricted to students in the medical laboratory science programs. Includes a significant engagement in writing as a form of critical inquiry and scholarly expression to satisfy the WID requirement.

MLS 4141 - Immunology and Serology (3 credits) - 15 weeks

Principles of the immune system’s components, functions, interactions with microorganisms, and the clinical applications of immunologic assays to human health and disease.

MLS 4158 - Laboratory Management (3 credits) - 8 weeks

Introduction to critical concepts of lab management, including leadership theory, management principles, human resource management, financial management, quality management, and laboratory operations. Proctor fee.

MLS 4116 - Clinical Bacteriology I (3 credits) - 8 weeks

Principles of clinical microbiology with emphasis on pathogenic characteristics, isolation, and identification of bacteria related to human disease; theoretical approach to the current diagnostic techniques and identification systems used in clinical practice. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1111.

MLS 4117 - Clinical Bacteriology II (2 credits) - 8 weeks

The etiology of infectious diseases in different body sites with an emphasis on the epidemiology, pathogenic mechanisms, and laboratory identification of suspected etiologic agents; specimen collection and handling, diagnosis and treatment of medically significant bacteria. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1111.

MLS 4119 - Parasitology, Mycology, and Virology (2 credits) - 15 weeks

Principles and procedures involved in the diagnosis of parasitic, fungal, and viral infections; disease causation, specimen collection and handling, laboratory identification and treatment of medically significant fungi, parasites, and viruses. Proctor fee. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1112; or BISC 1116 and BISC 1126.

MLS 4216 - Clinical Bacteriology Lab (1 credit) - 15 weeks

Hands-on experience in current diagnostic techniques and identification systems used in clinical practice; principles, procedures, techniques and data interpretation for the isolation and identification of clinically significant bacteria. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1111. Corequisites: MLS 4116.

MLS 4219 - Parasitology, Mycology, and Virology Laboratory (1 credit)

Principles and procedures involved in the diagnosis of parasitic, fungal, and viral infections; disease causation, specimen collection and handling, laboratory identification and treatment of medically significant fungi, parasites and viruses. Laboratory fee. Corequisite MLS 4119. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1112; or BISC 1116 and BISC 1126.

MLS 4145 - Clinical Biochemistry I (3 credits) - 8 weeks

This course studies the methodologies employed in the chemical analysis of human blood and body fluids. This includes an examination of the fundamentals of measurement and the principles of instrumentation as they relate to the assay of each analyte studied. In addition, the laboratory results are correlated with the clinical significance and pathophysiology which may generate changes in the analyte. Throughout the course, the quality assurance measures required to ensure reliability and validity of the laboratory results are also emphasized. [add to end of description: Proctor fee.

MLS 4146 - Clinical Biochemistry II (3 credits) - 8 weeks

This second course in clinical biochemistry continues the study of the measurement and interpretation of chemical constituents in human blood and body fluids. The laboratory results of each analyte are correlated with the clinical significance and pathophysiology which may generate changes in the analyte. Throughout the course, the quality assurance measures required to ensure reliability and validity of the laboratory results are also emphasized.

MLS 4151 - Molecular Diagnostics (3 credits) - 15 weeks

Introduction to the molecular techniques used to diagnose human disease; technology, theory, and methodology of specific molecular protocols that can be used within a clinical laboratory setting to aid in disease diagnostics including those of genetic, oncogenic, and infections origin. Proctor fee.

MLS 4246 - Clinical Biochemistry Lab (1 credit) - 15 weeks

Practical laboratory course covering the principles and procedures of various diagnostic testing procedures performed in the clinical biochemistry laboratory; measurement and interpretation of chemical constituents in human blood and body fluids. Laboratory fee. Corequisite: MLS 4145. Prerequisites: CHEM 1111 and CHEM 1112.

MLS 4251 - Molecular Diagnostics Lab (1 credit) - 15 weeks

An introduction to the theory of and laboratory techniques in molecular biology with an emphasis on molecular and serological techniques, including DNA extraction and quantitation, restriction enzyme digestion, polymerase chain reaction, agarose gel electrophoresis, flow cytometry, and ELISA. Restricted to students in the medical laboratory science program.

MLS 4130 - Hematology I (3 credits) - 8 weeks

Study of the blood and blood-forming tissues with emphasis on hematologic techniques and cell identification; anemias and non-malignant leukocyte disorders. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1111.

MLS 4131 - Hematology II (3 credits) - 8 weeks

Study of the blood and blood-forming tissues with emphasis on white blood cell disorders; introduction to the hemostatic system and associated coagulation disorders. Restricted to students in the medical laboratory science program. Prerequisites: MLS 4130.

MLS 4150 - Immunohematology (3 credits) - 15 weeks

The major blood group systems that affect the practice of transfusion medicine and examines the processing and distribution of blood products supplied by transfusion services. Proctor fee.

MLS 4230 - Hematology Lab (1 credit) - 15 weeks

Diagnostic analyses used to evaluate disease states associated with human blood cells; quality assurance in the hematology lab and on the evaluation of stained blood smears and microscopic differentiation of blood cells. Restricted to students in the medical laboratory science program. Prerequisites: BISC 1111. Corequisites: MLS 4130.

MLS 4250 - Immunohematology Lab (1 credit) - 15 weeks

Performance of routine blood banking procedures, including blood group and Rh typing, antibody screens, antibody identification, cross matching, and elution and absorption techniques. Restricted to students in the medical laboratory science program.

MLS 4159 - Capstone Seminar (1 credit) - 15 weeks

Comprehensive review of medical laboratory science, which prepares students to sit for the board of certification examination. Integration of knowledge gained in didactic and practicum courses within the various laboratory disciplines, including hematology, microbiology, chemistry, and immunohematology. Proctor fee.

MLS 4160 - Blood Bank Practicum (4 credits) - 15 weeks

Clinical practicum in which students apply medical knowledge and clinical skills gained in MLS 4150. Prerequisites: MLS 4150.

MLS 4161 - Clinical Biochemistry Practicum (4 credits) - 15 weeks

Application of the medical knowledge and clinical skills gained in the didactic clinical biochemistry I and clinical biochemistry II courses. Proctor fee.

MLS 4162 - Hematology Practicum (2 credits) - 15 weeks

Analyses and laboratory testing of human blood specimens.

MLS 4164 - Clinical Microbiology Practicum (4 credits) - 15 weeks

Students apply medical knowledge and clinical skills gained in MLS 4123 (Clinical Microbiology I), MLS 4124 (Clinical Microbiology II), and MLS 4151 (Molecular Diagnostics). Proctor fee.

MLS 4165 - Urinalysis Practicum (1 credit) - 15 weeks

Active engagement in applying medical knowledge and clinical skills in the analysis of urine and body fluids.

MLS 4166 - Coagulation Practicum (1 credit) - 15 weeks

One-week required rotation for students in the Bachelor of Science in Health Science in Medical Laboratory Science (MLS), Post-baccalaureate MLS, or Post-baccalaureate in Hematology for MLS certificate programs. Focus on analyses and laboratory testing of human blood specimens.

Curriculum Details: 100% Online

Students with MLT certification enter into the 100% online program and will complete 38 credit hours of core courses, 14 – 29 credits of electives (determine by the number brought in at admission), and eight credits of clinical experience in their local area.

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MLS 2007W - Writing in the Health Sciences (3 credits) - 15 weeks

MLS 3000 - Clinical Lab Mathematics (3 credits) - 8 weeks

Basic mathematical techniques used in the clinical laboratory, including exponential and logarithms, measurement systems, solutions and concentrations, proportionality, graphing, statistics and quality control, and method evaluation; practical applications of data analysis. An equivalent college-level mathematics course or permission of the program director may be substituted for the prerequisite. Restricted to students in the medical laboratory science program. Prerequisite: HSCI 2117.

MLS 4136 - Clinical Experience I (2 credits) - 15 weeks

Supervised clinical experience in clinical chemistry. Proctor fee.

MLS 4137 - Clinical Experience II (2 credits) - 15 weeks

Supervised clinical experience in microbiology. Proctor fee.

MLS 4138 - Clinical Experience III (2 credits) - 15 weeks

Supervised clinical experience in hematology, coagulation and urinalysis. Proctor fee.

MLS 4139 - Clinical Experience IV (2 credits) - 15 weeks

Supervised clinical experience in transfusion medicine and serology. Proctor fee.

Elective (12 credits)

GW SMHS does not admit first-time college freshmen or provide general education courses; therefore, students are expected to enroll at another institution of higher education for at least one semester during an academic year following their high school graduation, and prior to transferring into GW.

To apply for the BSHS in Medical Laboratory Sciences (Hybrid or 100% Online) , you’ll need:

• Minimum cumulative GPA of 2.7 and science GPA of 2.5. (For GAA* applicants a cumulative GPA of 2.75 is required on the GW-GAA partner transcript. If additional transcripts exist, a cumulative GPA that includes all institutions must be a minimum of 2.7).
• Personal statement: Applicants must include a 250–500 word essay describing your reasons for undertaking study at GW, your academic objectives, career goals, and related qualifications including collegiate, professional, and community activities relevant to your program of interest. Include any substantial accomplishments not already mentioned on the application form.
• One letter of recommendation (letter of recommendation is waived for GAA applicants): Letter of recommendation should be from academic instructors who can strongly attest to your academic ability or individuals who served in a supervisory capacity for you, and who can strongly attest to your work ethic. The recommender cannot be from a family or friend. Recommender will submit a letter via the application portal on letterhead and has a signature and credentials/contact information.
• MLT certification or graduated from a NAACLS-accredited MLT program within the last 6 months (for fully online BSHS route only) 
• Applicants must have at least 45 credits from a regionally accredited college or university, which include the coursework specified below (All required courses must be completed with a C grade (C- grades and lower do not transfer) or better at a regionally accredited institution of higher learning):

Transfer credit may include dual enrollment coursework. It may also be considered from Advanced Placement (AP), International Baccalaureate Credit (IB) credit as well as the College Level Examination Program (CLEP exams). Please refer to GW Undergraduate Admissions for information on maximum credits, minimum scores, and GW course equivalents for AP and IB credits.

If you have an associate degree from a participating D.C., Maryland, Virginia community college, you may be eligible for guaranteed admission to this program. Review the list of participating institutions .

International Students

International students should check with individual programs regarding eligibility for visa sponsorship. Generally, online and hybrid programs are not eligible for student visa sponsorship from GW. This would include transfer students from any other institution with an existing visa.

Official transcripts from institutions outside the U.S. must be accompanied by an official transcript evaluation from an accredited independent evaluating agency. Please be sure you request a detailed evaluation that includes all course titles, credit hours, grades, U.S. degree equivalency, grade-point averages (GPA), and date of degree conferral. For a list of acceptable foreign credential evaluation services, please visit NACES .

Applicants who are not U.S. citizens are also required to submit official test scores for the Test of English as a Foreign Language (TOEFL) or Pearson’s Test of English (PTE) Academics or the academic International English Language Test System (IELTS). To be considered for admission, there are required scores that you will need to meet. Score requirements may differ by school and program so  check the admissions requirements for your program .

Supporting Documents and Official Transcript

Documents and Official Transcripts not submitted online should be mailed to:

Mail: George Washington University ATTN: Transcript Processing Center 1415 W 22 nd St. Suite 220 Oak Brook, IL 60523 

Alternatively, official electronic transcripts can be sent to: [email protected]

As you explore our programs at George Washington University, our dedicated staff is here to support you. If you have any questions or want to know more, click the "Request More Information" button below, or email   [email protected] .

Request More Information

Clinical Lab Sciences

There are many pieces to the clinical lab scientist training program application, including your gpa, personal statement, list of experiences, letters of recommendation, and biographical information. use the navigation below to explore each aspect of preparing for a clinical lab scientist training program..

• What is a Clinical Lab Scientist?

Clinical (or Medical) Laboratory Scientists work with pathologists, other physicians, and scientists who specialize in clinical chemistry, microbiology, or other biological sciences. Together, they detect, diagnose, and treat many patient diseases. As part of this health care team, Clinical Laboratory Scientists are responsible for performing tests and developing data on the patient's blood tissues and body fluids. They have the knowledge of the principles behind these tests, the ability to recognize physiological conditions affecting test results, and the ability to develop data that may be used by a physician in determining the presence, extent, and the cause of disease.

In addition to working in a clinical laboratory, jobs for clinical laboratory scientists are available in departments of public health, industrial labs, pharmaceutical companies, the armed forces, the National Institutes of Health (NIH), and the World Health Organization (WHO).

Clinical laboratory scientist licenses may be general (for all areas of the clinical lab), or limited to performing procedures in one particular area (clinical chemistry, clinical microbiology, immunohematology, and toxicology).

• Becoming a Clinical Lab Scientist

Before starting a training program, you obtain a Trainee License through the California Department of Public Health. This license permits you to train, not work, as a licensed Clinical Laboratory Scientist. 

To obtain a trainee license, you must have a bachelor's degree and must have completed the following coursework:

Visit the California Department of Public Health to apply for a trainee license. 

CLS Training Programs

Most training programs in California are run by universities (e.g. UCs, CSUs, Loma Linda) and take place in hospitals; some programs are run by the hospitals where training occurs, and others by private companies (e.g. Blood Source). 

Training programs are 12 months. 

CLS License

After completing a training program, candidates are eligible to take a national exam to be a certified Clinical Laboratory Scientist. 

• Clinical Lab Sciences Prerequisites

* Check your major requirements before choosing classes. * If you have already taken BIS 105, we encourage having the syllabus ready to share with schools. Applicants don’t necessarily need to take additional classes before they apply. Requirements vary by school. Please call HPA’s Express Advising for questions.​ Updated 2/2023.

See the  Clinical Lab Sciences Program Prerequisite Chart  for a sample list of CLS programs and their requirements.

Note: The above courses are only suggested, not absolute.  Although no particular undergraduate major is required, some schools prefer students majoring in one of the biological sciences or chemistry. As long as all prerequisites are met, any major may be chosen.

Prerequisites and minimum GPAs differ by program.

• Experiences

Each CLS program has a set of "Essential Functions" that are expected of their CLS students.  Applicants should have good laboratory technique, strong critical thinking skills, the ability to work under stressful conditions, and a professional attitude. Any experiences that you have had that can demonstrate these skills will make you a stronger applicant.

Laboratory experience is essential in building and demonstrating your laboratory skills and abilities and can be gained through working in a college laboratory, research laboratory, or volunteering in a hospital-based clinical laboratory.

• Applying to CLS Programs

Standardized Exam

The GRE is not required for CLS programs. 

Personal Statement

Explain your interest in a career in clinical lab sciences. 

Letters of Recommendation

Programs require three letters of recommendations from either professors or employers; many require two to be from instructors. Some schools also require letter writers to complete a form in which they should be able to address familiarity, the applicant’s strengths and weaknesses, the applicant’s ability to do independent work, and the applicant’s profile (e.g., reliability, emotional control, laboratory skills, etc.). 

Most programs require personal interviews prior to acceptance into clinical training. Some will contact you directly to schedule your interview, while other require that you request an interview. 

Choosing Programs

There are 227 accredited CLS programs in the nation as of October 2015. In California, there are thirteen CLS programs with ten nationally approved programs and 3 CA-only approved programs, including those at CSU Los Angeles, Physician’s Automated Lab, and Children’s Hospital Central California. 

Each program varies in terms of minimum GPA, prerequisites, class size, tuition/fees, etc. When selecting programs to apply to, be sure to take these factors into consideration as you may not need to pay any tuition for some, while others can be much more costly. Also, while programs typically last for only a year, there are a couple of programs that may last longer.

If you have any questions in regards to selecting programs, please come see an advisor at Health Professions Advising.

• Frequently Asked Questions
• More questions? Check out our FAQ page or schedule an appointment with an advisor!

CLS Programs in California.pdf

CLS_InfoPacket.pdf

Guide to Writing a Medical School Personal Statement

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Don't underestimate the importance of your personal statement in your medical school application . Your GPA and MCAT scores show that you are academically capable, but they do not tell the admissions committee what type of person you are. Who you are matters, and the personal statement is the place to tell your story.

Tips for a Winning Med School Personal Statement

• Make sure your personal statement is "personal." It needs to capture your personality and interests. What makes you uniquely you?
• Clearly and convincingly present your reasons for wanting to attend medical school.
• Don't summarize your activities, accomplishments, or coursework. Other parts of your application will convey that information.
• Use logical organization, flawless grammar, and an engaging style.

The medical school admissions process is holistic , and the admissions folks want to enroll students who are articulate, empathetic, and passionate about medicine. Your personal statement provides you an opportunity to make the case that you have what it takes to succeed in medical school and that you will contribute to the campus community in positive ways.

You will want to put significant thought and time into your personal statement since it will play a role in all of your medical school applications. Nearly all medical schools in the United States use the American Medical College Application Service (AMCAS) to manage their applications, much like hundreds of undergraduate institutions use the Common Application. With AMCAS, the prompt for the personal statement is pleasingly (and perhaps frustratingly) broad:

Use the space provided to explain why you want to go to medical school.

This simple prompt allows you to write about almost anything, but some topics will be much more effective than others.

Choosing Personal Statement Topics

A medical school personal statement is relatively short (less than 1/3 the length of this article), so you'll need to be selective when deciding what to include. As you identify your areas of focus, always keep the prompt in mind—your personal statement needs to explain why you want to go to medical school. If you find yourself straying from that goal, you'll want to refocus and get back on track.

Successful medical applicants typically include several of these topics in their personal statements:

• A meaningful academic experience. Did you take a specific class that truly fascinated you or convinced you that you want to pursue a career in medicine? Did you have a professor who you found inspiring? Explain how the academic experience affected you and how it relates to your current desire to go to medical school.
• A research or internship experience. If you had the opportunity to conduct research in a science laboratory or intern at a medical facility, this type of hands-on experience is an excellent choice for inclusion in your personal statement. What did you learn from the experience? How did your attitude towards medicine change when you worked side-by-side with medical professionals? Did you gain a mentor from the experience? If so, explain how that relationship affected you.
• A shadowing opportunity. A significant percentage of medical school applicants shadow a doctor during their undergraduate years. What did you learn about the real-world practice of being a doctor? If you were able to shadow more than one type of physician, compare those experiences? Does one type of medical practice appeal to you more than another? Why?
• Community service. Medicine is a service profession—a doctor's primary job duty is helping others. The strongest medical school applications show that the applicant has an active history of service. Have you volunteered at your local hospital or free clinic? Have you helped raise money or awareness for a health-related issue? Even service that has nothing to do with the health professions can be worth mentioning, for it speaks to your generous character. Show that you aren't in this profession for you, but for others including those who are often underserved and underrepresented.
• Your personal journey. Some students have a personal history that is integral to their desire to become a doctor. Did you grow up in a medical family? Did serious health concerns of family or friends raise your awareness of the work doctor's do or motivate you to want to solve a medical problem? Do you have an interesting background that would be an asset to the medical profession such as fluency in more than one language or an unusual range of cultural experiences?
• Your career goals. Presumably, if you are applying to medical school, you have a career goal in mind for after you earn your M.D. What do you hope to accomplish with your medical degree. What do you hope to contribute to the field of medicine?

Topics to Avoid in Your Personal Statement

While you have many choices about the type of content you can include in your personal statement, there are several topics that you would be wise to avoid.

• Avoid discussion of salary. Even if one factor that draws you to medicine is the potential to earn a lot of money, this information does not belong in your personal statement. You don't want to come across as materialistic, and the most successful medical students love medicine, not money.
• Avoid early childhood stories. A brief anecdote about childhood can be fine in a personal statement, but you don't want to write entire paragraphs about your visit to a hospital in second grade or how you played doctor with your dolls as a young child. The medical school wants to get to know the person you are now, not the person you were over a decade ago.
• Avoid presenting television as an inspiration. Sure, your interest in medicine may have begun with Grey's Anatomy , House , The Good Doctor or one of the dozens of other medical dramas on television, but these shows are fiction, and all fail to capture the realities of the medical profession. A personal statement that focuses on a television show can be a red flag, and the admissions committee may worry that you have some sanitized, exaggerated, or romanticized notion of what it means to be a doctor.
• Avoid talk of school rankings and prestige. Your choice of a medical school should be based on the education and experience you will get, not the school's U.S. News & World Report ranking. If you state that you are applying exclusively to the top-ranked medical schools or that you want to attend a prestigious school, you may come across as someone who is more concerned with surfaces than substance.

How to Structure Your Personal Statement

There is no single best way to structure your personal statement, and the admissions committee would get quite bored if every statement followed the exact same outline. That said, you do want to make sure each point you make in your statement flows logically from what precedes it. This sample structure will give you a good starting point for conceptualizing and crafting your own personal statement:

• Paragraph 1: Explain how you became interested in medicine. What are the roots of your interest, and what about the field appeals to you and why?
• Paragraph 2: Identify an academic experience that affirmed your interest in medicine. Don't simply summarize your transcript. Talk about a specific class or classroom experience that inspired you or helped you develop the skills that will help you succeed in medical school. Realize that a public speaking, writing, or student leadership class can be just as important as that cellular biology lab. Many types of skills are important for physicians.
• Paragraph 3: Discuss a non-academic experience that has affirmed your interest in medicine. Did you intern in a biology, chemistry or medical laboratory? Did you shadow a doctor? Did you volunteer at a local hospital or clinic? Explain the importance of this activity to you.
• Paragraph 4: Articulate what you will bring to the medical school. Your essay shouldn't be entirely about what you will get out of med school, but what you will contribute to the campus community. Do you have a background or experiences that will enrich the diversity of campus? Do you have leadership or collaborative skills that are a good match for the medical profession? Do you have a history of giving back through community service?
• Paragraph 5: Here you can look to the future. What are your career goals, and how will medical school help you achieve those goals.

Again, this is just a suggested outline. A personal statement may have four paragraphs, or it may have more than five. Some students have unique situations or experiences that aren't included in this outline, and you may find that a different method of organization works best for telling your story.

Finally, as you outline your personal statement, don't worry about being exhaustive and covering everything you have done. You'll have plenty of space elsewhere to list and describe all of your extracurricular and research experiences, and your transcript will give a good indication of your academic preparation. You don't have a lot of space, so identify a couple important experiences from your undergraduate years and a couple character traits you want to emphasize, and then weave that material into a focused narrative.

Tips for Personal Statement Success

Well-structured, carefully-selected content is certainly essential to a successful medical school personal statement, but you need to consider a few more factors as well.

• Watch for commonplace and cliché statements. If you claim that your primary motivation for becoming a doctor is that you "love helping others," you need to be more specific. Nurses, auto mechanics, teachers, and waiters also help others. Ideally your statement does reveal your giving personality, but make sure you stay focused on the specific type of service doctors provide.
• Pay careful attention to length guidelines. The AMCAS application allows 5,300 characters including spaces. This is roughly 1.5 pages or 500 words. Going under this length is fine, and a tight 400-word personal statement is far preferable to a 500-word statement filled with digressions, wordiness, and redundancy. If you aren't using the AMCAS form, your personal statement should never go over the stated length limit.
• Attend to grammar and punctuation. Your personal statement should be error-free. "Good enough" isn't good enough. If you struggle with grammar or don't know where commas belong , get help from your college's writing center or career center. If necessary, hire a professional editor.
• Use an engaging style. Good grammar and punctuation are necessary, but they won't bring your personal statement to life. You'll want to avoid common style problems such as wordiness, vague language, and passive voice. A strong statement pulls the reader in with its engaging narrative and impressive clarity.
• Be yourself. Keep the purpose of the personal statement in mind as you write: you are helping the admissions officers get to know you. Don't be afraid to let your personality come through in your statement, and make sure your language is natural to you. If you try too hard to impress your reader with a sophisticated vocabulary or jargon-filled description of your research experiences, your efforts are likely to backfire.
• Revise, revise, revise. The most successful medical applicants often spend weeks if not months writing and rewriting their personal statements. Be sure to get feedback from multiple knowledgeable people. Be meticulous, and revisit your statement many times. Almost no one writes a good statement in a single sitting.
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SOP - BSc (Hons) Biomedical Science

• Sample personal statement

05 August, 2022

Sop - bsc (hons) biomedical science share.

• 12 May, 2013

I am aspiring to study a BSc (Hons) Biomedical Science Programme at the University of Bedfordshire It will provide knowledge as well as graduate-level analytical and transferable skills to prepare for a wide range of careers or further study. My goal in studying biomedical science is to gain a deeper understanding of the human body. This course provides a solid foundation in laboratory science used to research, diagnose, and treat disease. The course will enable me to gain an in-depth understanding of how the human body works, and the molecular, cellular and organ-level processes that take place in the human body. Moreover, I believe that this course will help me demonstrate my academic and intellectual abilities.

I have seen the course modules, syllabus, and learning outcomes of the BSc (Hons) Biomedical Science programme at the University of Bedfordshire this course provides the education, skills, and training required to pursue a career as a professional. The course supports meaningful learning through a curriculum that provides intellectually challenging and practical relevant competencies for future careers in the biomedical sciences. Laboratory-based practical skills are an essential part of this course and will help in developing various practical strategies for a career in biomedical sciences including various biomedical industries and biomedical research. This course teaching method includes practical classes, tutorials, seminars, workshops, Project work, Team- working, IT-based teaching and learning, Case studies and problem-based learning, and guided study. Moreover, the course demonstrates a thorough foundation in theory and practice in human anatomy, physiology and reproductive science, molecular and clinical genetics, clinical immunology, medical microbiology, cellular pathology, clinical biochemistry, hematology, and transfusion science. The assessment methods used across this course include opportunities for Coursework, examinations, Literature review, Research dissertation, Problem-based learning activities, oral presentations, and laboratory practical work. Having the opportunity to study this course I am looking forward to improving my skills and knowledge. This course will help me gain an understanding of the biomedical science method and provide career opportunities through the techniques and skills used. After completing this course, I would like to join the reputed institutes of my country as a Biomedical Scientist or Clinical Research Associate to build my professional career. So, I believe this course will be suitable for my career planning and professional development objectives.

I completed my Secondary and Intermediate from the science groups respectively. While I studied in school and college, I was involved in various types of curriculum activities such as Attend Seminars and Workshops, Debating, Volunteering, Socializing, and Fund Rising. Since I am interested to expand my knowledge in biomedical science, I have come to the conclusion that I need a higher degree from abroad that will enrich my knowledge and skills. I think I should gain more knowledge in the field of Biomedical Science so I decided to continue my further studies with this course. I think I should gain more knowledge in the field of Biomedical Science so I decided to continue my further studies with this course. It will help me develop a broader and more balanced understanding of basic Biomedical Science. In addition, I am eager to gain complete knowledge and skills from this course. Moreover, this course applies the standard method for understanding and evaluating risks and for working safely and solving problems with practical skills in the laboratory. So, I believe this course will be the right choice for me as I am looking for a successful career in this course.

It was difficult for me to choose a specialization as an alternative to the courses available to me, but I finally decided to pursue a career in Biomedical Science. As a science student, studying these course modules would not be difficult for me. The modules include Microbiology and Biochemistry, Human Anatomy & Physiology, Cell Biology, Molecular Genetics, Skills in Biomedical Science, Chemistry, Skills in Science, Human Metabolism, Medical Physiology, Immunology, Medical Microbiology, Haematology & Transfusion Science, Genetics, Cellular Pathology, Biomedical Science Research Project, Applications of Microbiology, Clinical Biochemistry, Applications of Immunology, Human Genetics, Biology of Disease, and Molecular Biology. So, I hope my chosen course will make me better and further open doors for my profession.

There are several reasons I aspire to study in the UK because the UK is famous for profession. Because this country has had a great reputation for quality higher education since its inception. It is true that the UK is a well-known country and has huge popularity. The UK maintains a quality management system with high standards in all fields. In recent years, most reputed companies in Bangladesh are emphasizing hiring Bangladeshi graduates with degrees from abroad. Where the study environment in my country follows theoretical systems of education and no practical skills are gained. Academically the UK prepares students and provides soft skills that are useful for future careers. UK accommodation and living expenses, and tuition fees are also reasonable. The affordable tuition fees attracted me the most. Furthermore, an academic degree from the UK is recognized and appreciated by employers around the world. This is why I chose the UK as my preferred destination and goal. According to a recent study of international graduation results in 2019 by iGraduate by Universities UK International 82% of overseas graduates believe their UK degree is beneficial for financial investment, and a similar number of graduates said they were satisfied or very satisfied with their careers. Approximately 83% believe a UK degree helped them get a job. So, it will be a big achievement for me if I can study this course at the University of Bedfordshire .

The University of Bedfordshire is a specialty selection from the various options available to me as it is incredibly welcoming to international students. With more than 18,985 students, the university has a significant mature student body and provides outstanding higher education to people from more than 150 countries. University has invested heavily in their facilities to support students in order to create a physical and intellectual environment for learning. In addition, the University of Bedfordshire is dedicated to supporting international students to develop the skills, emotional intelligence, and creativity needed to thrive in a constantly changing world and the competitive job market. Universities have invested heavily in their facilities to support students in order to create a physical and intellectual environment for learning. Also, the university has a reputation for teaching, research, and business partnerships. Moreover, the university has a well-equipped campus. According to DLHE 2018, 91% of graduates are working and/or further studying within six months of graduation. So, if I get the chance to study this course at the University of Bedfordshire I will never look back and it will be a great achievement for me.

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Medicine Personal Statement Examples

Get some inspiration to start writing your Medicine Personal Statement with these successful examples from current Medical School students. We've got Medicine Personal Statements which were successful for universities including Imperial, UCL, King's, Bristol, Edinburgh and more.

Personal Statement Examples

• Read successful Personal Statements for Medicine
• Pay attention to the structure and the content
• Get inspiration to plan your Personal Statement

Personal Statement Example 1

Check out this Medicine Personal Statement which was successful for Imperial, UCL, QMUL and King's.

Personal Statement Example 2

This Personal Statement comes from a student who received Medicine offers from Bristol and Plymouth - and also got an interview at Cambridge.

Personal Statement Example 3

Have a look at this Medicine Personal Statement which was successful for Imperial, Edinburgh, Dundee and Newcastle.

Personal Statement Example 4

Take a look at this Medicine Personal Statement which was successful for King's, Newcastle, Bristol and Sheffield.

Personal Statement Example 5

Pick up tips from this Medicine Personal Statement which was successful for Imperial, Birmingham and Manchester.

Personal Statement Example 6

This Personal Statement comes from a student who got into Graduate Entry Medicine at King's - and also had interviews for Undergraduate Medicine at King's, QMUL and Exeter.

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An applicant’s personal statement is one of the most important pieces of your application materials. It is the school and admission’s committee first opportunity to hear from you about why you are passionate about your career choice.

Fall and Spring Personal Statement Writing Workshop

Held every fall and spring The Writing Center presents a workshop for how to craft a strong personal statement essay for your health professions applications.

• Why your personal statement is important & and what will make it great.
• What to write about and what to avoid.
• Explore writing reflectively toward ‘show’ and not just ‘tell.’
• Receive direct feedback on your essay

No matter where you are in the writing process, this workshop is designed to help you brainstorm or refine your essay.

Here are some other resources that will help you unlock your writing potential.

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Application Personal Statement

I'm planning to apply for the CLS program and am currently working on my personal statement. However, I'm really unclear what direction to take it in.

I've heard from many people that the personal statement should work more like a cover letter that explains your experiences, and that the CLS program does not generally care for sob stories. However, I have heard from a few people (with minimal experience and subpar grades, I might add) that they wrote a more humanities-based essay about their struggles and personal skills and still got accepted into the program.

Can anyone who got into the program share a general idea of what they wrote about? Or if anyone is a CLS director, can you share what you look for in an application essay? Thanks!

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Biomedical Sciences: Advice on the Personal Statement

You can also download this page as a pdf document .

Your personal statement is an important part of your application to Oxford. It allows you to tell us about your interests, achievements and ambitions in your own words. Although we do not formally score your statement we read it carefully and use the information it contains as part of our short-listing exercise. If you are invited for interview, the statement is likely to provide a focus for the questions that you are asked. It is therefore essential that your statement is an accurate, unembellished account of your activities. We may check the claims that you make on your statement: discovery of fabricated or exaggerated material – during the admissions exercise, or even later on during your time as a student – may bring into question your suitability to study on the course.

Present yourself in the best light: the same basic facts about yourself (in terms of education, interests, experience), when presented differently, can quite dramatically convey positive or negative messages about you to tutors.

For Biomedical Sciences, whilst your academic record and BMAT performance data will come into play when candidates are being short-listed for interview, time spent in drafting an effective personal statement should also help your overall chances of success. Every detail becomes even more important once you have reached the interviews and are being considered for a place.

DO NOT BE SHY IN DECLARING ANY MITIGATING CIRCUMSTANCES

These may help us to put your achievements or personality within a finer context. We actively look for reasons why you may have under-performed in examinations, or performed well against the odds. These may be factors associated with your schooling, health or domestic circumstances. If you are returning to study after a break, or switching vocation, it is even more important to highlight your reasons for choosing a course at Oxford, and for you to demonstrate your determination, resilience, ability and commitment.

DO NOT SIMPLY RECOUNT EVERYTHING YOU HAVE DONE

We’re looking for quality, not quantity! Remember that large numbers of candidates apply for our courses. Tell us in what ways you will stand out from the crowd. In choosing to talk about an activity, describe what you have drawn from the experience: has it changed you as a person? Did it surprise you?

WE WANT TO LEARN ABOUT YOU AS A PERSON, NOT JUST ABOUT YOUR ACADEMIC QUALIFICATIONS

If you have undertaken extra-curricular activities, or hold positions of responsibility at school, tell us why you sought these, and why they are important to you. You will not impress us by simply recounting that you took up a placement in Thailand, but we might be more appreciative if you tell us what you personally learnt from the experience, about your interaction with local people, and about shadowing the medical team working within your village.

Example: I have become involved with a city music and drama group, and work especially with the younger members. I find this exciting and more than occasionally challenging. Coaching for the group has given me experience in organising others, as well as teaching them. Watching group members learn and progress is thrilling, especially in the case of one of them who has ADHD. At first he was incapable of remaining still, silent or attentive for even a few minutes, but eventually became far more focused and calmer, making excellent progress in many areas.

DIRECTLY ADDRESS OUR SELECTION CRITERIA

• Motivation and capacity for sustained and intense work.

Example: My interest has always been in how the body works in the way it does, and why. This was triggered early on by my mother's cancer, and I felt compelled to find out all about this condition, and what could be done to help treat it. I am thirsty for new knowledge, and am fascinated by the interrelatedness of systems in the human body.

• A strong track record of academic achievement, and particular ability and potential in science and/or mathematics. An excellent record at GCSE (or equivalent).
• Intellectual curiosity and enthusiasm and readiness to cope with the academic demands of the course.

Example: I read beyond the syllabus topics covered at A-level extensively, and decided to research and write an extended essay discussing ethics and science, with particular emphasis on 'living wills'. I enjoyed the challenge and discipline of studying independently, and follow recent developments and debate in this area.

• Reasoning and problem solving ability: use of a logical and critical approach, and strong powers of analysis.
• Communication: Good command of the English language. Ability to express ideas clearly and effectively. Ability to listen.

Example 1: I have worked as a hotel waitress during the summer conference season, which allowed me to develop teamwork skills, and work under various time pressures. It also allowed me to interact with many different members of the public.

Example 2: I took part in my school's open day, and demonstrated experiments in the Chemistry lab. During the last year I have also participated in a reading scheme, helping younger pupils with learning difficulties.

• Ability to generate own ideas and proposals. Originality and creativity of thought, lateral thinking and hypothesis-generation.

YOU WILL NOT BE ALONE IN TRYING TO OPEN WITH AN ATTENTION-GRABBING INTRODUCTION...

If you try this, make sure it helps tutors to learn something about what motivates and enthuses you.

Example: My vast collection of books and videos on "How the Body Works" when I was 7 years old first triggered my interest in the functions of the body. Watching the little personified, cartoon blobs that represented red blood cells run around an animated yet functioning body fascinated me and I longed to find out more. As a result, when a friend received a letter explaining their little girl had just been diagnosed with X at just 14 months old, I was intrigued to find out what this was.

THE STATEMENT IS CALLED  PERSONAL  FOR A REASON

It should be written by you, not by your parents, siblings, or teachers. Do not plagiarise material that you find on the web as there is a great chance that such deception will be discovered.

DO NOT FEEL THAT THERE IS A PRECISE TEMPLATE TO FOLLOW THAT WILL SCORE YOU POINTS

We look for bright and independent thinkers, so try to be original!

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Biomedical Laboratory Sciences (BLS) is a challenging and rewarding health care profession that has great impact on patient care. Working in a variety of settings, laboratory scientists are essential members of the health care team who provide vital information about the status and function of the body and its systems. The data obtained by laboratory professionals is utilized in the diagnosis, treatment, and prevention of disease.

The continued success of the Department of Biomedical Laboratory Sciences is my highest priority and I am honored to serve as the chair of this important department.

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Betselot  Zelalem, BSHS ’20, chose to enroll in the Medical Laboratory Sciences Program at GW because it combined her interest in the molecular level of science and medicine.

“The MSHS program in clinical microbiology helped me advance to new career opportunities and increase my salary,” said Zara Tariq. “It has also given me the confidence to further my studies and driven me to continue learning in the health sciences.”

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Applying to the CLS Program

Courtney Santos “Applying to the Clinical Laboratory Science major was the best decision I have ever made.”  – Courtney Santos

The CLS program will prepare students for entry-level laboratory positions and a future in a constantly growing area of health care. Now is a great time to start a career in the clinical laboratory profession, because there is a nationwide shortage of clinical laboratory personnel. Our graduates have multiple job offers when they complete the program and go on to have rewarding careers in a wide variety of positions. We look forward to receiving applications and talking about the exciting field of clinical laboratory science.

Students typically enter the Clinical Laboratory Science program after completing general education requirements and prerequisite courses. Successful completion of the prerequisite courses listed under the major does not guarantee admission to the program. CLS students are selected on the basis of science and math prerequisite courses, grades, a written application, interviews, and letters of recommendation. Students who already have a baccalaureate degree and have the CLS prerequisite courses may apply for admission to the program and request a second baccalaureate degree from UNC-CH.

Because enrollment is limited, students are encouraged to begin the application process early in the fall preceding the year of enrollment. Completed applications received by the second Tuesday in January will receive first consideration for admissions. Completed applications received after that date will be considered if there are positions available in the program. Transfer students should note that the last day to apply to the CLS program through Undergraduate Admissions is February 15th. Transfer students are encouraged to apply as early as possible to allow ample time for transcript evaluation. Please also review our “ Information for Transfer Students ” page.

Please note: If you intend to work in a state that requires licensure of clinical laboratory personnel, you are advised to read the information on our Certification and Licensure page before completing your application for the CLS program.

Beginning the application:

• Transfer Students, Second Degree Students and UNC-CH graduates: Applicants must apply to UNC and to the CLS program through Undergraduate Admissions . Applicants should indicate that they are applying to the CLS program, and should also get the CLS-specific questions on their application.
• Current UNC-Chapel Hill Students only: Log in to the ConnectCarolina Student Center. In the “other academic” dropdown, select “Apply for Change of Major.” Once the request is completed and submitted, applicants will receive an email with instructions for completing the application. Download the  CLS Supplemental Form to upload with the application.

Within the online application, it will ask for information including:

• A list of current and planned courses. We need to know which courses applicants are currently taking and the courses they plan to take before entering the CLS program so we can make sure they will have the CLS pre-requisite courses and the courses needed to graduate from UNC-Chapel Hill.
• School and community activities.
• Work and volunteer experiences.
• Special recognition and honors.
• Recommendations . The email addresses of two recommenders will be required within the application for electronic submission and delivery. Applicants will receive an automated email containing instructions to complete a recommendation form and to submit the form via email. Recommendations should be completed by college professors or teaching assistants who are familiar with the applicant’s academic abilities.
• Essay.  Applicants will be asked to upload a one-to-two page typed statement describing their interest in CLS, their career goals, and how they think they can contribute to the CLS profession.

Please remember, as applicants complete the online application they should:

• Include a current email address on the application because we will rely mainly on email for communication with applicants.

Application Assistance:

If students have questions about the application process, they should email [email protected] . If there are any technical difficulties, please contact the UNC help desk at (919)962-HELP (919-962-4357).

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Biomedical sciences personal statement example 38.

The University of Oxford defines biomedical science as the “focus on how cells, organs and systems function in the human body” but to me, this is a very basic definition of something that means a lot to me. It is the chance to learn more about the subject that I am passionate about, the chance to be able to diagnose diseases in advance and prolong someone’s life, the chance to make a difference in the world. For as long as I can remember, I have always been surrounded by medical based subjects from first-hand experience while at the doctor to work experience and TV shows based around the subject. I am applying to the biomedical science courses as it is something I have a great interest and passion in.

By taking biology and chemistry at a higher level, I have expanded on my knowledge on the subjects but I am still not satisfied with just this knowledge and wish to learn more. Gaining a qualification in the biomedical spectrum would allow me to get a job as a biomedical scientist which is my main goal for the future. I feel like by gaining this qualification and being able to get a job, I will be able to do something that I love everyday while having the opportunity to learn new things every day. Spending my days in a hospital laboratory feels like the right career path suited to me as a person and my interests. My main aim in life would to be to gain this qualification after 4 years of studying hard and be able to work as a biomedical scientist in a hospital lab researching, diagnosing and treating diseases. This is a career option that very much excites and motivates me to be the best in my studies and further education. I am interested in all the subjects under biomedical science including clinical biochemistry, haematology, histopathology, cytopathology, medical microbiology and blood transfusion and would love to be able to have a deep enough understanding of them all so that I may find one that I am most suited to and continue with it in a full time lab environment.

I have taken part in several different work experience opportunities including working at a local primary school gaining people skills and working at a vet practice gaining lab, people and general world of work skills for a working environment. In summer 2015, I organised a work experience placement which I felt would help me gain a further understanding in the career of a biomedical scientist and so over a few month of emailing several people in the field I was able to arrange a week work experience placement in the holiday. This was extremely beneficial as I worked in all different fields and undertook several different jobs within these fields to gain first hand skills and knowledge I would not be able to get from the internet or a classroom.

I was lucky enough to be able to get a work experience opportunity in the biomedical sector at Aberdeen Royal Infirmary, where I had the chance to experience each individual segment of biomedical science they had to offer including pathology, microbiology and haematology which I found the most interesting. Alongside myself in the lab were current biomedical students as well as qualified ones. This was important for me as I could ask questions regarding their study and work, get answers and see different opinions on what it is like.

I have gained many qualities from volunteer work, school experiences, extra-curricular and hobbies that I believe are crucial to university life and in the world of work. I have been volunteering as a youth leader in a young choir called ACE. Empowerment of people to believe in themselves through a wide range of activates such as singing, dancing, outdoor activities and performing. Through this group I have developed a wide range of skills such as leadership and teamwork. An example of my skills gained in leadership can be seen when I took control and planned and carried out a performance at a local care home and organised donations for the home.

Teamwork can be regularly seen when working with young children, people the same age as me and older people in order to get a job done. Through ACE choir I have achieved my 500 hour Saltire volunteering award as a sign of my dedication and hard work over the years. I am currently working towards a new award and am at 700+ hours. During summer 2015, I spent 2 weeks volunteering as part of the staff team at the Aberdeen International Youth Festival as a member of the Events Team. During this time, I stayed in university dorms and mingled with many current students. Through this experience, I gained skills such as management, time keeping and team skills which I feel could help me if I were to get a place at university. I have undertaken many roles in my time at secondary school. I have achieved junior, half and full colours for my dedication to clubs over the years such as debating, choir and rock challenge.

In S5 I was given the title of a prefect and was again awarded it in S6. Throughout my time as a prefect I have gained time management, organisation and public speaking skills which I believe are very important not just at university but later in life when perusing a career. In 2014/2015 school year, I worked towards my leadership award. This was a challenging course that involved researching, planning and executing an activity off our own backs. I found this a lot of fun and learned a lot about myself and my skills and qualities through it. I also have the title of a school mentor and assistant librarian within the school. This has helped me with my interpersonal skills. I spend my time assisting people with their queries on different subjects, checking in and out books and promoting the library throughout the school. Being a mentor has really helped me mature as I have to out others feelings and needs before my own. As well as classes and revision classes, I am involved in many activities.

After being let down by my school, I organised for myself and several friends to complete our bronze Duke of Edinburgh award with an open award centre. It was a daunting process but we completed it with smiles on our faces. I then proceeded to silver and the gold with the award centre where I worked with people I had just met and created lifelong friends and memories. Being asthmatic, the expeditions were always a struggle for me but I pushed forward. This is a great example of the fact that if I put my mind towards something I will get it done. After finishing my Gold Duke of Edinburgh, I was invited back to become a Bronze level leader where I will help and encourage those who are involved.

My hobbies include music, science and Japanese culture and language. I am a self-taught ukulele player and love to sign and write music. I have not yet preformed with my ukulele but have plans to do so in the near future. I have performed by myself, as a duo and as part of a choir many times and love the thrill of performing for others and doing what I love. From this I have acquired a lot more confidence when preforming and further developed my time management skills while balancing my hobbies, revision, school work and having time for family and friends.

During my years at school I have always loved science and more importantly biology, because of this I have been enrolled in the OU course entitled Molecules, Medicines and Drugs: A Chemical Story. Through this course I am gaining a SCQF 7 grade (equivalent to an SQA graded advanced higher Scottish baccalaureate) I which I will receive at the end of the course after I sit my exam in February. This course involves standalone study which, alongside group work, is a key element of further education. The fact that this course is related to what I want to study in further education reflects my dedication to the subject as it is a lot of work. For many years I have been interested in Japanese language and culture.

Recently, I decided to take this interest more seriously and have begun to self-study Japanese language. Despite it being a hard subject to learn, I have not given up and continue to push through.

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ORIGINAL RESEARCH article

Dairy farmers’ considerations for antimicrobial treatment of clinical mastitis in british columbia and alberta, canada.

• 1 Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
• 2 Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
• 3 Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, United States
• 4 University of Bristol Veterinary School, Bristol, United Kingdom
• 5 Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada

Introduction: Clinical mastitis (CM) treatment decision-making is a multifaceted process that remains relatively understudied, despite CM being one of the most prevalent diseases on dairy farms worldwide, contributing greatly to the use of antimicrobials in the dairy industry. This study aimed to gain insights into decision-making mechanisms employed by dairy farmers in British Columbia and Alberta, Canada, when dealing with CM.

Methods: Interviews were held with 15 dairy farmers in the Canadian provinces of British Columbia and Alberta and analyzed using reflexive thematic analysis to develop both the decision-pathway and overarching themes influencing the CM decisions by farmers in this region.

Results and discussion: The analysis generated a decision-making process that begins with identification and classification of CM, guided by visual characteristics of milk and the udder, available milk production and quality data, presence of systemic signs, and additional diagnostics. Subsequently, CM cases are assessed based on the likelihood of cure, value of the cow, and herd goals to decide whether antimicrobial treatment is desired. Next, a treatment choice is made by evaluating severity and urgency of the case, availability of drugs and timing of the case. Finally, definition of treatment success and progression over time following the treatment decision guides the termination of treatment. Three overarching themes were generated that shape the decision-making process: ‘Personal attributes’, including personal approach and experiential knowledge; ‘Inter-actor dynamics’, such as shared decision-making and dynamics among producers, veterinarians, and milkers; and ‘Moving beyond protocols’, which highlights the dynamic nature of mastitis decision-making. These insights have the potential to inform the development of effective interventions to improve CM antimicrobial use that align with the reality of farming operations within Western Canada, and potentially beyond.

1 Introduction

Mastitis is an inflammation of the udder, marked by various physical and chemical changes in the milk and the udder tissue ( 1 ). Visual confirmation of changes to the milk classifies clinical mastitis (CM), with more moderate cases also showing inflammatory signs in the affected quarter(s), and severe cases including signs of systemic illness ( 2 ). While yeast, algae, external particles, and udder trauma can cause mastitis, CM is predominantly caused by bacterial pathogens. Therefore, intramammary antimicrobial administration is the recommended and widely adapted treatment for CM, often accompanied by systemic antimicrobials and pain medication in severe cases ( 3 ).

Mastitis is one of the most prevalent diseases on dairy farms world-wide ( 4 ), with an average CM incidence in Canada of 19 cases per 100 cow-year ( 5 ). With treatment rates averaging between 90 and 100% ( 6 – 8 ), CM treatments contribute greatly to the total amount of antimicrobials used on dairy farms. When coupled with dry cow therapy, intramammary antimicrobial use accounted for 66% of total antimicrobial use on Canadian dairy farms during 2019 and 2020 ( 9 ). While direct implications of mastitis to the farm owner primarily include economic losses stemming from preventative measures, culling, reduced milk yield and milk discard—estimated at CA$744 per CM case ( 5 )—implications of mastitis-related antimicrobial use extend to broader concerns surrounding antimicrobial resistance ( 10 ), which necessitates responsible use of antimicrobials on dairy farms. In addition, due to the frequent nature of mastitis, in many countries including Canada, farmers are allowed to administer antimicrobial intramammary treatments following protocols and antimicrobials prescribed by their herd veterinarian, adding depth to their role as farmer.

In the context of mastitis management, many Canadian dairy farmers have embraced practices aimed at improving udder health within their herd, such as proper milking procedures and vaccines, although the latter are still not widely adopted ( 5 , 11 ). The practice of analyzing CM milk samples to guide antimicrobial treatment decisions has existed for some time, their importance to reducing antimicrobial use further highlighted in recent efforts ( 12 ). However, the adoption of analyzing CM samples is less than optimal, as evidenced by a survey among Canadian farmers ( 8 ). To ensure effective adoption of such interventions and to enhance antimicrobial stewardship among dairy farmers, a comprehensive understanding of on-farm CM treatments decision behavior remains critical ( 12 , 13 ) and is often overlooked when implementing or suggesting interventions, leading to a lower-than-expected compliance ( 14 ).

The decision-making process for treating CM with antimicrobials is multifaceted and has a complex decision structure. Vaarst et al. ( 15 ) described in the early 2000s for Danish dairy farmers, that their decision-making included weighing various information sources including SCC, CM case history, lactation stage, reproduction status, value of the cow, availability of replacement heifers, bulk tank SCC, and availability of alternative treatments. Recent survey results highlighted the differences in priority of these decision-factors among Canadian farmers ( 8 ). Although these results suggest that these priorities shape the decision-making process of individual farmers, the quantitative study design did not allow for an exploration of underlying causes. This is particularly of interest as research into general antimicrobial use has underlined that intrinsic and extrinsic factors impact antimicrobial use decisions. These factors include attempts to increase the chance of cure by treating as quickly as possible, motivation to improve animal welfare, perceived efficacy of chosen treatments, and external referents such as other farmers and the herd veterinarian ( 16 – 18 ). Although it is unsure how these factors play a role in CM decision-making.

To address the lack of a comprehensive and nuanced understanding of CM-related antimicrobial treatment decisions among dairy farmers, given the modern landscape where numerous tools and techniques are available to the farmer to enhance udder health and refine antimicrobial treatment choices, this study used a qualitative approach to investigate the core of dairy farmers’ practices and decision-making mechanisms around CM treatment decisions. As opposed to quantitative research, qualitative research can facilitate in-depth exploration with farmers, thereby allowing participants to share their experiences, priorities and thought processes. Interviews also offer a personalized and contextual understanding. As such, the qualitative approach of this study will be able to capture insights in CM decision-making that quantitative methods might overlook.

2 Materials and methods

This study was reviewed and approved by the University of Calgary Conjoint Faculties Research Ethics Board (# REB21-0699). This report was written according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) framework ( 19 ).

2.1 Positionality statement

The lead author (EdJ) is female, 29 years old, and holds a PhD in Veterinary Medical Science from the University of Calgary. Her PhD research focused on mastitis-related antimicrobial use on dairy farms, a topic on which she and her colleagues have published several manuscripts. EDJ’s knowledge of the dairy industry came from research projects conducted in the Netherlands and Canada as part of her BSc and MSc degrees in Animal Sciences at Wageningen University in the Netherlands, and from her work in her PhD. EdJ comes from a family of dairy farmers, and though her grandparents were the last ones to own a farm, many relatives still work in the agri-business. EdJ lived in the Netherlands until the age of 24 years, and thus shares a cultural background with many of the participants as Dutch ancestry is common among Western Canadian dairy farmers. EdJ is a dairy product consumer and a left libertarian according to the economic/social political compass. Since EdJ’s research has been largely quantitative in nature, she familiarized herself with qualitative research methods and analysis through auditing courses, extensive reading, and collaboration with colleagues with experience using qualitative methods. All other authors work or study in dairy veterinary science and have a range of training in, and experience with, qualitative research methodologies.

2.2 Data collection

Data were collected through semi-structured interviews between June 2022 and August 2023. Participants in the Canadian provinces of Alberta and British Colombia were recruited through existing connections of the researchers and through extension events. As such, participants were aware of the study interests of the researchers. Potential participants were shortlisted based on their herd size, milking type, and location to ensure a variety in farm management practices.

A telephone script was used for recruitment by phone. During the recruitment, special attention was paid to scheduling the interview with those responsible for most CM treatment decisions. Consent was sought either on paper prior to the interview or orally, if the participant was unable to sign the paper consent form ahead of the interview. A short online questionnaire, using the software platform Qualtrics (Seattle, WA, United States), was sent ahead of the interview to acquire information regarding milking system, number of milking cows and production parameters for each farm ( https://data.mendeley.com/datasets/hv9h7k499b/1 ; 8 ).

Interviews were conducted using Zoom (Zoom Video Communications, San Jose, CA, United States) or in-person upon the producers request if the location of the farm was within 200 km of the University of Calgary. One interview was conducted by phone due to lack of an internet connection on the farm. In-person and phone interviews were voice-recorded using 2 recording devices (Philips VoiceTracer DVT2050). Zoom-interviews were video- and voice-recorded using both the recording device as well as the Zoom recording function. All interviews were conducted by EdJ, except for 5 interviews which were conducted by EdJ and IvdV together.

Interviews were guided by a semi-structured interview script and consisted of 3 parts ( https://data.mendeley.com/datasets/hv9h7k499b/1 ; 8 ). First, questions were asked to build rapport and gain an understanding of the farmer’s background and the farm itself, including personnel situation and the farm’s strengths and challenges. Throughout this text, ‘farmer’ refers to an individual who has financial ownership and investment in the farm. In the case of some participants, this person may also participate as a milker, train employees on recommended milking procedures, and, in collaboration with the herd veterinarian, may assist in the development and implementation of mastitis diagnosis and treatment protocols. This individual may also be responsible for relaying that information to other on-farm employees who will implement established protocols. All participants were in a position of decision-making autonomy either solely or in collaboration with another farm owner. Secondly, participants were asked to describe their most recent CM cases, using their own definition of CM. Follow-up questions covered case identification, information sources consulted, communication between farm personnel and veterinarians, treatments considered (both antimicrobial and non-antimicrobial, including anti-inflammatory), and treatment expectations. Various CM cases were discussed with each participant, until both the interviewer and the interviewed farmer were satisfied that the full range of scenarios on the farm had been discussed. Lastly, questions were asked regarding on-farm antimicrobial stewardship, which will be analyzed and published separately. The interview guide was not pretested, but the researchers revised and adapted the guide in an iterative fashion at several instances during the data collection process to further explore generated themes. The interviewers were free to rephrase questions and use probing questions throughout the interview.

Duration of interviews averaged 55 min ranging from 35 to 79 min. The interviews were transcribed verbatim with the help of the automated transcription program Otter.ai (Los Altos, CA, United States) and checked for accuracy. The first 5 interviews transcripts were checked by both IvdV and EdJ, the other 10 transcripts were checked by EdJ. Participants received an anonymous participant ID and are referred to in the paper as P#.

2.3 Analysis

The CM decision-making process can be classified as multifaceted and complex in nature ( 20 ), which warrants considering them within a broad context that goes beyond traditional hierarchical decision research ( 21 , 22 ). Reflexive thematic analysis was therefore chosen for this research, as its reflective approach allows for use of the critical realist paradigm compared to the constructivist paradigm of the classical decision research concept ( 23 – 25 ).

All interviews were analyzed by the principal researcher (EdJ). After familiarization with the data, segments of text that captured meaningful information related to the farmers’ CM treatment decisions were paraphrased into codes. The inductively generated codes were recorded in the online diagramming tool draw.io (JGraph Ltd) and collated to generate the different facets of CM treatment decisions, as well as to simultaneously generate themes that ‘overarch’ the core concepts of the CM treatment decision pathway. Codes and themes were refined and revised by re-reading transcripts and identifying quotes to provide context. This iterative process, in combination with extensive discussions between EdJ and A-MS regarding data interpretation, ensured rigorous and insightful representation of the data. After the analysis was finalized, all participants were offered the opportunity to validate the draft manuscript to ensure that their views were accurately captured ( 26 ).

An assessment of ‘information power’ was used to identify whether enough interviews were conducted to obtain a good understanding of farmer decision making regarding clinical mastitis treatment in Western Canada. Information power is preferred over ‘data saturation’ in reflexive thematic analysis ( 25 ), because it aligns with the understanding that meaning is generated through interpretation rather than being discovered, making the determination of sufficient data inherently subjective and context-dependent ( 27 ). Information power suggests that the more relevant information the sample holds for the actual study, the fewer participants are needed ( 28 ). Information power depends on the width of the study aims, sample density, the use of an established theory, or not, quality of dialog, and analysis strategy ( 28 ), and was assessed continuously throughout the iterative process of data collection and analysis to determine the sample size.

Fifteen interviews were conducted with 17 dairy farmers in the Canadian provinces of Alberta ( n  = 11) and British Columbia ( n  = 6). In total, 24 farmers were approached, of which 4 could not participate due a lack of time, 3 were unable to respond to scheduling requests, 1 did not feel the interest of the study aligned with their farm goals, and 1 was no longer in operation. Participants were either farm owners or herd managers, each actively involved in CM diagnosis, treatment decisions and udder health management. The farms were a mixture of those milking in a parlor (n = 8) and with automated milking systems (AMS) ( n  = 7). One farm produced grass-fed milk; the other 14 farms operated conventionally, meaning they were not required to adhere to specific production labels such as organic or grass fed. As organic dairy farms have to adhere to more strict regulations regarding AMU ( 29 ) which can affect decision-making mechanisms on treatment of CM, organic dairy farmers were excluded from this study. One farm was part of a Hutterite colony. Hutterites, a German speaking community, have a distinct communal structure and are accountable for a substantial portion of dairy production in Alberta ( 30 ). Almost all farms were staffed by a combination of family members and external employees, with the larger parlor farms employing additional individuals to aid with milking. Most interviews were conducted with 1 interviewee, whereas during 2 interviews 2 interviewees were present. In total, 15 farmers were male and 2 were female. Production characteristics of the dairy farms are described in Table 1 ; study sample averages are in accordance with provincial averages.

Table 1 . Milk production characteristics of the study farms ( n  = 15) associated with the participants interviewed ( n  = 17) between June 2022 and July 2023.

3.1 Clinical mastitis decision pathway

Upon thematic analysis of the transcripts, a decision pathway ( Figure 1 ) was developed that all farmers followed regarding their CM antimicrobial treatment decisions. This pathway included various considerations at each step. Identification and classification of CM cases formed the start of this pathway (which differed depending on milking system), followed by an evaluation of likelihood of cure, perceived value of the cow, and herd goals to arrive at a treatment approach. Next, treatment options were considered based on severity, drug availability, clinical signs, and timing of the case. The decision pathway ended with an assessment of treatment expectations and progression to determine treatment termination.

Figure 1 . Sequence of considerations for antimicrobial treatment of clinical mastitis cases and overarching themes, based on interviews ( n  = 15) with Canadian dairy farmers ( n  = 17) in Alberta and British Colombia between June 2022 and July 2023.

3.1.1 Identification and classification

All participants described direct visual confirmation of clinical signs to be most important in identifying CM, which includes presence of flakes, discoloration, and milk consistency, as well as hardness and temperature of the udder quarters. One farmer described this as: “Usually you see any abnormality like the color of the milk, or any kind of swelling of the quarter or chunks or watery milk or anything like that” (P4). These observations often took place during the fore-stripping process in the parlor.

Some farmers described their high proficiency to identify CM cases by relying on subtle indicators such as differences in udder shape. One farmer described: “You use a teat dip cup. You touch the udder with the top. So, you have another option that you think like hey, this is maybe not right” (P6).

Next, to visual identification in the parlor, participants also used milk production and milk quality data to shortlist cows with a high likelihood of CM, after which identified cows were subjected to visual examination. Specific indicators include changes in milk production, SCC data obtained from DHI records or AMS, conductivity, instances of milk filters clogging due to the presence of clots or cows milked with AMS who had incomplete milkings: “I look at my cell count list when I do DHI, and I’ll see if there’s anybody high that’s surprising” (P4), and “As soon as one cow has something that will stick on the milk filter, it is noticeable. So really, that’s the first line” (P13). Indicators were used alone or in combination. On farms with AMS, missed visits to the AMS were also viewed as an indicator for udder health problems: “I’d say my biggest ones are they are not going to the robot and they are down in milk” (P17).

The selection of the milk production and quality indicators was guided by data availability. However, these data were not prioritized and valued similarly by the interviewed farmers. For example, for one farmer low milk production was the starting point of CM identification: “When she comes into the parlor and there’s little milk yield, we’ll go back to the data” (P15). After having identified cows with a high likelihood of CM, the California Mastitis Test (CMT) was typically used to pin-point the inflamed quarter. A farmer detailed this process, explaining: “We’ll flag them in the parlor so that we see them. And then we’ll do a California Mastitis Test on them” (P16).

The third route to identify CM included an overall assessment of the cow’s wellbeing, including behavioral pain indicators such as kicking during milking, reduced activity levels, decreased rumination and other systemic inflammation signs such as fever. This was described by one producer as: “If we were to visually see that the cow is dropping in milk, or if she’s looking skinny—we also have the Heatime system [real-time monitoring through ear or neck tag; Heatime® Pro+, Allflex, Saint-Hyacinthe, QC, Canada], so the rumination and the activity. If we start seeing them going down that way, we would intervene” (P5).

More specifically, for severe CM cases, farmers described the presence of a hard quarter, watery milk, a severe decline in milk production, a sore udder, or behavioral pain indicators such as kicking: “She’s downhill for real. Milk clear, watery looking, and swollen udder, fever” (P16). A rapid onset of these clinical signs was also mentioned as an indicator for severity: “… speed of onset and severity of symptoms. If the whole quarter is packed right full of junk right away then I’m not gonna put out, I’ll treat her right away” (P4). Severe cases that included the combination of a hard quarter and watery milk were referred to by many farms as “ coliform” mastitis, or “ E. coli” despite the absence of diagnostic culturing to confirm causal pathogen: “And then we have coliform which comes out as orange [milk] and the udder is hard, rock hard” (P17).

Definition of chronic cases varied among the interviewed farmers, but commonly mentioned were cows with persistent high SCC and those with frequent recurrence of CM, as detailed by the farmers: “They have flakes, and they do not go away. Every milking, they come in and you strip them out and you’ll mint the udder and for weeks” (P1), and “… anything that regularly has a cell count over 250–300,000” (P4).

The interplay of these three identification pathways: (1) direct visual confirmation of clinical signs and milk characteristics, (2) cows with a high likelihood of CM based on specific indicators, and (3) overall assessment of the cow’s wellbeing was intricate and farm-specific and was further influenced by the milking set-up (AMS vs. parlor). For example, on AMS farms, identification through data often preceded visual checks. One of the interviewed farmers milking with an AMS explained: “I track our mastitis through conductivity per quarter via the robots, and from there we paddle test with CMT, and make our assessment from overall look of the cow, the look of the milk, the volume of the milk and how well the cow is eating” (P14). In contrast, on parlor farms, visual confirmation overall preceded analyzing data, as other farmers who milk in a parlor explained: “Then [after the milker calls with a case of mastitis] I pop onto the computer and check the history, whether she was down in previous milkings or not” (P1). All farmers underscored the significance of visual confirmation of clinical signs before treating a cow: “I would want to be seeing a drop in milk, I want to be seeing changing [milk] color, CMT paddle tests, all that before treatment goes into place” (P14).

Farmers also highlighted the significance of other subtle differences in identification of CM in AMS vs. parlor systems. AMS are less able to detect flakes in the milk, which can change the perception of CM by the farmer. As one farmer stated: “When we were pre-stripping in the parlor and she had pieces, we would treat them. But now you have got the robots. And you do not see all the pieces, and the cows are fine. So, it has been a gradual progression here. Mastitis is always going to be there, but it does not all have to be treated” (P10). However, it was also mentioned that AMS allow for more frequent SCC reports, making an interpretation of high SCC values possible within the context of an extended period: “Now that we are every day seeing their somatic cell score, and you realize that what we would have thought with DHI as a clinical case of this cow, that 2 million, in robots, she might be 2 million for a few days, and then she’s down to nothing” (P5).

Some farmers adopted an analytic approach by regular culture of milk samples through their DHI laboratory or veterinary clinic. Although some farmers cultured each CM case, it was more common among the interviewed farmers to only submit samples of specific cows or cases for culturing to confirm the presence of pathogens in the udder or determine the causal agent of an abnormal cluster of CM cases: “To see whether they actually had bugs in the quarters, or if it was just inflammation causing flakes to show up” (P1). Testing fresh cows was common, as described by one farmer: “We test all the fresh cows for Staph. at day six and day eight” (P12). This method allowed for the identification of intramammary infections at the start of the lactation. Seldomly were diagnostic tests used to evaluate treatment efficacy: “It’s when we see issues with the treatment, like if it’s not working being effective, then we’ll culture to see if there’s a new bug, or if we should be using a different antibiotic” (P14).

Identifying other potential causes of clinical signs was also an essential aspect of making treatment decisions. Noting these served as an additional tool to identify cases that might not benefit from antimicrobial treatment. This ranged from improper milking settings to the presence of malformed teat ends: “Some older cows will potentially have a bad teat end, or something that’s just not perfect. It does not seem like it’s dangerous to them. It’s not milk you want to drink or ship, but they will recover on their own” (P13).

3.1.2 Treatment approach

After CM cases were identified, a treatment approach was determined. Farmers described starting with an assessment of the potential efficacy of antimicrobial intervention as compared to non-antimicrobial approaches, followed by an evaluation of the value of the cow, herd goals and weighing of alternative treatment options. These aspects interacted with each other and were considered together to determine a treatment approach with or without antimicrobials.

To determine the likelihood of cure when administering antimicrobial treatment, the same indicators were often used as those used for identification and classification of CM cases. More specifically, where changes in milk production, SCC, and conductivity were used to identify CM cases, farm-specific thresholds were used by some to inform the likelihood of cure and presence of chronic infections: “like maybe a 50% drop in milk” (P1), and: “The vet considers a mastitis case anything over 400 [thousand]. To me, that’s not worth the headache or the treatment. Because give her some time, and she might drop back under 400 without treatment. Because somatic cell count numbers can be all over the place” (P8). If cases did not meet the threshold, antimicrobial treatment was often withheld.

The assessment of cure also included an evaluation of lactation stage. A more pro-active treatment approach was often taken with fresh cows experiencing CM, as the transition period is known to increase physiological stress. Farmers expressed worry about the occurrence of other health conditions, and progression to worse forms of mastitis in fresh cows if left untreated: “They’re under a big transition, so they just do not have any reserves. And I think that’s when it [mastitis] can go [get worse]. It can be more deadly. They just do not have the same fight, or the same immune response [as cows later in lactation]. Their body is worried about 100 other things” (P13).

For most cases, history of CM in the same quarter was evaluated, although thresholds and associated actions differed by farm. Where one farmer had a strict rule: “If it’s the third time, we never treat again” (P3), others also considered the timing of repeated cases: “I would say if they relapsed right away, we would have them on a beef truck. But if they relapse in a couple of weeks, we would retreat them” (P17). The reason for this threshold was explained as: “I usually find that the treatment does not work [in those instances]” (P17). Similarly, if cows were deemed ‘chronic’, it was likely that she will not receive treatment: “If she’s chronic, sometimes I do not treat her and [farm owner 2] will say ‘beef her’” (P17). By incorporating these different elements, farmers tailored their treatment strategies to individual CM cases.

For those farmers who used additional diagnostics by sending milk samples to a laboratory for bacteriological culture or cultured milk samples on farm, outcomes of these tests were almost never factored into decisions regarding the treatment approach. Instead, they informed general herd trends or allowed for identification of subclinical mastitis among fresh and chronic cows. However, farmers articulated a level of confidence gained from the test results: “This incubator did not change my protocol at all, because I should have treated her anyway. So, it was good. Yeah. But it is nice to know” (P1).

Non-severe CM treatment approaches were often tied closely to culling considerations. An assessment was made of the cow’s contribution to the herd’s overall value. As such, low producing cows, non-pregnant cows and cows with chronic mastitis were more likely to be put on the cull or do-not-breed lists instead of receiving treatment for non-severe CM. In contrast, pregnant or high-producing cows were less likely to be culled and were thus more likely to be considered for treatment: “If a cow was pregnant, and she has good genetics, and she’s at 200 days in milk, and she develops a chronic mastitis, we’ll just milk her and dump it in the ground for the rest of her lactation with the eye to either trying to clean up in the dry period, or the worst case scenario if we get one more calf out of her” (P3). Cows in their first lactation were also less likely to receive treatment and be culled instead: “If it’s a first lactation, forget it, she’s probably gone. We’re not going to mess around. First lactation heifers should have zero issues” (P17).

The farmer’s personal feelings toward specific cows also played a role. A cherished animal might receive more attentive care than her counterparts, potentially leading to antimicrobial treatment. One farmer explained: “If it’s secondary [case in lactation], and I really liked her [personally], then, you know, she has a good chance of being treated again” (P3).

Certain herd goals also came into play when selecting a treatment approach, including milk production incentives under the Canadian milk supply system and limitations imposed by provincial milk boards on the level of bulk tank SCC (BTSCC). In scenarios where mild CM cases did not adversely affect overall milk quality, farmers described opting to withhold antimicrobial treatment or stop treatment as soon as improvements were seen, to fulfill targets. One farmer described: “If I see enough improvement, then I do not continue for another [additional treatment] day because I do like to see milk in the tank” (P12), and another described: “Depending on how we are doing with our quota that month, they [cows positive for Staph. aureus ] either get shipped, or if we need to, we keep milking them for a while” (P12).

3.1.3 Treatment choice

After selecting a treatment approach, different treatment choices were considered by the interviewed farmers, depending on severity, drug availability, and other factors.

For severe CM cases, common practice among the farmers was to invoke an assertive and comprehensive treatment approach, which farmer P13 referred to as the ‘shotgun’ approach, where a combination of intramammary and systemic antimicrobials, alongside anti-inflammatories and pain medication were administered: “First, Cefa-Lak [cephapirin sodium] in the quarter. Then I will separate her out and if she has a fever of like, 102–103 [degrees Fahrenheit] and above, I’ll do Trimidox iv [trimethoprim-sulfadoxine]. And then, like, Banamine [flunixin meglumine] for pain” (P13). Such an aggressive therapeutic strategy was motivated by several critical factors: a sense of urgency to address the cow’s need promptly, to prevent further decline of the cow’s health, and to increase the cows’ survival chances, as underscored by the following statement: “before she goes septic, to get that IV antibiotics in her system. The main objective: save the cow” (P14). This also holds for CM cases that initially were classified as non-severe but showed a worsening of clinical signs in the following days.

For moderate and mild CM cases, intramammary antimicrobials were deemed sufficient by most of the interviewed farmers: “When a cow has mastitis, our main mode of treatment is Cefa-Lak [cephapirin sodium]” (P5), and cases were monitored for worsening of signs. Only a few farmers took a more aggressive approach for non-severe cases. For example, one farmer used a protocol where a 5-day course intramuscular antibiotic was provided for any case: “Everybody gets Metacam [meloxicam] because they usually come with a fever. Everybody gets intramammary. In that quarter, we use Cefa-Lak [cephapirin sodium]. And then everybody gets 5 days of Trimidox [trimethoprim-sulfadoxine] treatment” (P17).

Limited intramammary antimicrobial products were available to the interviewed farmers due to discontinuation of products and new regulations. For example, because of the discontinuation of the intramammary drug Special Formula 17,900 (a combination of penicillin G procaine, dihydrostreptomycin sulfate, novobiocin sodium, polymyxin B sulfate, hydrocortisone acetate, and hydrocortisone sodium succinate), alternatives were sought. One of the interviewed farmers described limited availability as the reason they used Cefa-Lak (cephapirin sodium), explaining: “It used to be 17,900; they do not make that anymore, right?” (P13). Another farmer co-administered a steroidal anti-inflammatory alongside intramammary antimicrobials: “In the Spectramast syringe [ceftiofur hydrochloride] we do add dexamethasone, just to get the inflammation out of the udder” (P1).

Participants were divided regarding co-administration of pain medication in cows with non-severe CM. Some farmers provided pain medication in the presence of certain clinical signs of non-severe CM cases: “If we see that their [cows with non-severe CM] quarter’s hard or they are looking a little sad, we will give them also a dose of Metacam [meloxicam]” (P5). Other farmers stated that they did not give pain medication to cows with non-severe CM: “A mild mastitis? Yeah, no, probably not. I would not give pain medication” (P7). These farmers conveyed the belief that non-severe CM does not appear to cause significant pain in cows, or that cows do not show and therefore experience pain in the same way as humans do. “They’re not painful, if they are still milking 50 to 70 percent of their expected milk volumes. They just have an infection, but it is not slowing them down; it is not disrupting their eating, it is not disrupting their production substantially” (P14). This perception influenced the decision-making process, resulting in a limited use of pain medication for non-severe CM cases.

In situations where cows developed CM nearing the weekend, farmers tended to adopt a more aggressive treatment approach, primarily driven by the constrained availability of veterinarians and limited options for culling during weekends. Farmers opted to mitigate the likelihood of further deterioration of the cows’ condition. This was illustrated by one interviewed farmer who said: “If it’s a Friday or a Thursday, I always treat them because we have to keep them for the weekend” (P17).

For non-severe CM cases that would not qualify for antimicrobial treatment according to protocols, udder mint cream was popular among some of the farmers, as well as essential oils (such as calendula). Cream and oils were also used for more severe cases in combination with antimicrobial treatments in attempts to offer relief to signs such as hard and swollen udders. Nevertheless, a sense of skepticism existed regarding the effectiveness of these alternatives, and their use often stemmed from the desire to take immediate action of non-severe CM cases without resorting to antimicrobials: “She would maybe have gotten better on her own. But maybe it feels good. You’re doing something” (P1). Only 2 farmers mentioned the use of oxytocin: “I’m under the belief that oxytocin will, right off the bat, potentially just let [the milk] down. I’m under the belief that if the cow can let it out, that’s, eh, less to fight” (P13).

3.1.4 Treatment termination

Following the chosen treatment, each farmer described a process where CM cases were monitored until a set outcome was reached. These outcomes were influenced by the severity of the CM case at time of identification.

When asked about assessing the cure of non-severe CM cases, the interviewed farmers provided a comprehensive list of clinical signs and production characteristics as determining factors. These included the absence of flakes in the milk, lower SCC, resolution of udder tenderness, and restoration of milk production to normal levels. For example, one farmer shared: “You hope to see a cow with low somatic cell and milk production back to expected [levels] or higher” (P14).

For severe CM cases, treatment expectations were more temperate and included indicators such as an increase in milk production, absence of clinical and systemic signs, and survival of the cow. More specifically, farmers expressed pessimism regarding the recovery of cows from severe CM cases if substantial inflammatory signs were present at time of diagnosis: “If she does not respond within a few days, the outcome is not very good. Then she will probably be dead within five days” (P7).

Similarly, for chronic cases, treatment expectations were also tempered: “Chronic cases that kind of get it [CM], and then it goes away. And then they have a high somatic cell count for a while. Some of those ones do not always respond to treatment” (P16). Multiple farmers discussed the option of drying off quarters after unsuccessful treatment. For instance, one farmer shared: “If they are chronic, and treated them or they will not respond to treatment, we have dried off quarters in the past […] And then we’ll have a three-quarter cow who still milks good. Cheaper to keep her that way” (P16).

Practices diverged when the endpoint of antimicrobial treatment was discussed. Some farmers did not adhere to label instructions, discontinuing antimicrobial treatment after 2–3 days: “If they are still clinical, we will not just keep treating them because we should; maybe it’s already cleared up” (P16). Conversely, some farmers extended antimicrobial courses up to 5–7 days until all clinical signs had completely subsided. Some switched drugs during this period, although this was typically accompanied by a consultation with the veterinarian: “If the search [for a cure] gets longer than 4 or 5 days, I’ll start talking with my vet” (P4). Regardless, there was consensus that visible improvement of non-severe cases was expected within 3–4 days and cure was expected within a week when treatment was successful: “If we see a response, then we’d call that a success. I would assume within a week or so” (P5).

3.2 Overarching themes

In addition to the decision-pathway, three themes were generated from the interviews that ‘overarched’ every aspect of the CM treatment decision-pathway which can be described as ‘Personal attributes’, ‘Inter-actor dynamics’, and ‘Moving beyond protocols’.

3.2.1 Personal attributes

3.2.1.1 personal approach.

The influence of differences in approach among owners, herd managers, and milkers on dairies (where multiple people share the decision making) appeared to hold significant importance. Contrasting perspectives of the owner and the farm manager were evident during several interviews. In one interview, the owner leaned toward a more relaxed approach, preferring to observe the situation before acting, while the farm manager advocated for a proactive stance, leading to a more liberal use of antimicrobials for treating CM cases: “I [full-time farm hand] tend to treat them quicker. I am more like ‘Oh, she had flakes tonight, I’ll start treating her’. I’m quicker [to treat] where he [farm owner] will just wait and see what happens for 12 or 24 h” (P12). On this farm, it also translated into differing durations of intramammary antibiotic treatments: “I think that I [full-time farm hand] treat them longer than [farm owner] would have done too” (P12).

3.2.1.2 Experiential knowledge

The evaluation of the factors in each step in the decision-making sequence ( Figure 1 ) was often attributed to experience by the interviewed farmers. This included generational knowledge, where certain products have been used to treat CM previously, including by older generations of farmers: “The way our dad taught us is just basically give three treatments. Give Cefa-Lak [cephapirin sodium], let us say, for example, at 5 pm, and then the next day at 5 pm as well, and the next day at 5 pm. That’s the protocol at this point” (P9). Another farmer’s perspective exemplified this generational continuity regarding abstaining from treating certain cases: “For 16 years, my dad always had the idea: ‘If they get E. coli , you just got to let them be and they either fight it and win or they do not” (P5).

Experiential knowledge of outcomes of previous decisions was also important. Sometimes this pertained to previous CM cases in the same cow: “So, if we did not use Metacam [meloxicam] in the first case, or if we used Spectramast [ceftiofur hydrochloride], now we’ll use something else” (P3), and: “That one older cow, that [CM] will sometimes come in waves. We do not treat her and that’s just kind of the way I do it” (P13). Experiential knowledge also encompassed treatment outcomes of other cows with similar CM cases: “Sometimes you just think, it did not work for the last cow, is it going to work for this cow?” (P6). Farmers also linked the historical efficacy of certain treatment choices and products to treatment decisions: “I have been doing this for a little while. You can safely assume that miscellaneous case that recurs every three weeks, it’s probably a chronic Staph.” (P3), and: “Our vets have in the past said a saline solution IV helps, but we have tried, and we just give them time and put them in a straw pack and see what they do” (P5).

3.2.2 Inter-actor dynamics

3.2.2.1 shared decision making.

On non-AMS farms, milkers played a crucial role in identifying CM cases. Almost all interviewed farmers shared the on-farm labor with family members or external staff. The interviewed farmers detailed a close relationship between the milking staff and the farm owners. Often, the situation was described where milkers identify CM, but herd managers and owners were consulted before making treatment decisions: “They’ll either call or text me when they see a problem cow” (P4). The manager or owner typically assumed the responsibility of maintaining records for treated cows and their respective mastitis history: “I’m sort of the person that decides and has a database of what cows might be chronic, why they might be treated or not treated if they have been treated multiple times” (P3). When multiple persons on a farm were involved in the CM treatment decision making, a discussion typically only took place when cases were more complex. “If there’s a question about it, then usually [co-owner] and myself will talk: ‘Okay this cow’s got mastitis’. We take a look at her: ‘Is she one we want to cull or is she one we want to treat?’ and make that decision then” (P16). Less complex cases that aligned with protocols typically did not require consultation with other decision makers before acting, explained by one farmer as: “Sometimes there is a little bit of a discussion involved but most of the time it is automatically done” (P15).

It became apparent from the interviews that if multiple decision-makers were present on a farm, their perception of cow value often differed, as well as their experience regarding the consequences of treatment decisions. This influenced treatment decision making. In one interview, these differences were highlighted: “Because he [farm owner 1] is not in here doing all the work. Right? Where she [farm owner 2] and I take turns, we have to treat these cows, find these cows and deal with these cows. And she [farm owner 2] is a lot more ‘out you go’ than he [farm owner 1] ever is” (P17). These varying stances underscore the dynamic interplay between various actors involved in treatment decisions.

3.2.2.2 Dynamics with veterinarians

Interviewed farmers described that veterinarians were consulted to discuss treatment protocols as well as evaluate previous CM cases, causative organisms, the general udder health status of the herd, and chronic cases: “While the decision [to treat] lays with us, he’s [the veterinarian] with herd health. We sit down and discuss some things.” (P8). Urgency was provided as a reason not to consult the veterinarian for the treatment of specific cases, as described by one farmer: “If you wait ‘til tomorrow ‘til the vet comes out, you have waited too long” (P13). Nonetheless, farmers underlined that their herd veterinarians were approachable and easy to reach: “If I have any questions, I’ll reach out to him, and he’ll respond within a couple of hours usually” (P4).

3.2.2.3 Dynamics with milkers

Farmers expressed challenges in ensuring employee adherence to protocols, especially when it came to monitoring cows with few clinical mastitis signs. Another challenge raised was that employees may not always feel entirely comfortable administering antimicrobial treatment: “It depends on who’s milking. If they are, if they know how to treat the cow or not” (P1). Employees sometimes also lack the knowledge to safely administer intramammary antimicrobials or to identify CM cases: “For the past few years, the staff I have aren’t capable. They’re very good milkers, but they just do not have that diagnostic experience and treatment” (P4). Issues with milkers were also encountered when choosing the appropriate treatment: “Although the milkers tend to want to treat [severe cases with] intramammary anyway, the treatment is generally Metacam [meloxicam]” (P3).

3.2.3 Moving beyond protocols

Throughout the interviews, farmers referred to on-farm protocols, which were often oral in nature although they remain a requirement for the mandatory Canadian national quality assurance program proAction. However, when delving deeper and probing into exceptions and exceptional circumstances where deviation from the protocol occurred, the more intricate decision-making process detailed in this manuscript emerged. For example, one interviewed farmer described their protocol with a one-liner: “Treating? Anything over a million” (P8); which was later revised, and a more nuanced picture was given that followed the various considerations depicted in Figure 1 . Similarly, for another farmer, when asked if there ever were situations to not treat cows, information about pregnancy and cull list emerged which was not included in their protocol: “If the cow’s a cull, she’s always going to be culled. And if she is only making 20 or 25 kg, we probably would not put the time or effort into that [to start treatment]” (P9). These examples illustrate that ‘exceptional’ situations occur often, and that, in practice, moving beyond the set protocol is more common than is often recognized.

4 Discussion

In this study, we examined CM treatment decision making on 15 Western Canadian dairy farms by describing the intricacy of identification and classification of CM, factors considered during antimicrobial treatment decision making as well as subsequent drug choices and considerations around treatment termination. Three overarching themes that influenced this decision-making process were generated: ‘Personal attributes’, ‘Inter-actor dynamics’, and ‘Moving beyond the protocol’.

The presented decision-making diagram aligns with conclusions drawn by Vaarst et al. ( 15 ), which covers decisions made based on clinical signs, individual cows, and the entire herd. Nonetheless, our study adds a new layer of information by specifically highlighting decision-making around treatment choice, which includes considerations of alternatives to antimicrobials and urgency of action, an aspect not studied by Vaarst et al. ( 15 ). Regardless, the overall similarity between the 2 studies underscores a consistency across 2 decades in Canada and Norway, where farmers are shown to consider the same aspects. Key aspects of the CM decision-making process as indicated in the current study have also been reported in other studies, such as the importance of case severity, SCC, suspected pathogen, and the comparison with other cases on the farm ( 31 , 32 ). These factors aid the farmer in minimizing uncertainty regarding treatment outcome, an important determinant driving on-farm antimicrobial use ( 17 ). Recent work also suggests a variability among farmers in terms of prioritization of these different decision factors ( 8 ). However, because the current study approach did not intend to quantify the relative importance of each decision factor, but rather to provide insight into the intricacies and complexities of the decision-making process, no claims can be made regarding variation in the relative importance of each of the factors among our participants.

Our study also describes the process of identifying and classifying CM, highlighting differences between farms with AMS and traditional milking parlors in prioritizing the use of various types of data. Although farms with both types of milking system used milk production and quality data in addition to visual evaluation of the udder to identify CM, AMS farmers generally had access to data from more sensors and more frequent data reports, a benefit also highlighted by Swedish ( 33 ) and Ontario farmers ( 16 ). These data allow for identifying inflammation without visual evaluation, which is often the starting point of the CM identification process on parlor farms. All AMS farmers in the study reported performing a visual assessment of the udder after evaluation of data reports suggested CM, which has also been reported by German farmers ( 34 ). It is important to note, however, that farms with AMS need to regularly review available data to prevent high false-positive rates and to minimize workload ( 35 ). This is especially important when built-in algorithms are used to predict the presence of CM, as sensitivity ranges around 60–80% ( 36 ). Differences in antibiotic treatment choices between parlor and AMS farms were not assessed in the current study, although research from the Netherlands suggests that AMS farms are more likely to treat with systemic antimicrobials compared to intramammary antimicrobials due to difficulties administering intramammary antimicrobials outside the milking parlor ( 37 ).

Other tools used by farmers to identify and characterize CM cases in this study included assessment of rumination and activity data. Decreased rumination is an established indicator of reduced feed intake, which has been associated with the presence of CM ( 38 ). Reduced lying time has also been described as one of the behaviors occurring during mastitis ( 39 , 40 ). Some farmers also employed additional diagnostics in the form of culturing CM milk samples. Most commonly, cultures were employed to identify intramammary infections among fresh cows, although some farmers cultured all CM cases, similar to what has been previously reported by U.S. producers ( 31 ). As such, most farmers initiated treatment without awareness of causative agent. Since certain non-severe cases (e.g., those caused by E. coli or CM cases where bacteria are not present in the udder) do not require antimicrobial treatment, culturing of confirmed CM cases is recommended before initiating antimicrobial treatment ( 12 ).

Non-severe CM cases that were selected for antimicrobial treatment often received only intramammary antimicrobials, with severe cases also receiving systemic antimicrobials, reflecting protocols suggested by research in the United States ( 41 ). Although protocols were established with herd veterinarians, veterinarians were rarely consulted for individual cases throughout the decision-making process. Administration of systemic antimicrobials is considered extra label in many countries, and their effectiveness for treating severe CM cases is debatable ( 12 ). However, although administration of systemic antimicrobials should only occur after veterinary approval (and preferably after diagnostic testing), the interviews indicated that this was not always the case. Although co-administering NSAIDs has been shown to improve bacteriological and clinical cure outcomes ( 42 , 43 ), few farmers reported using pain medication for non-severe CM cases, in contrast to frequent use by Danish farmers ( 32 ).

Extending CM treatments beyond label prescription was common practice, similar to what has been documented in Germany and the Netherlands ( 44 , 45 ). The predominant reason for extended treatment in our study was a continuation of clinical signs, which raises concerns about farmers inability to differentiate between intramammary infections versus just the presence of clinical signs. After a normal course of antimicrobial treatment, underlying infections are unlikely to persist for most cases with a bacteriological cause, although signs of inflammation might still be present ( 46 ). Although an assessment of a milk sample after treatment is the only way to confirm bacteriological clearance ( 47 ), this was not employed by any of the farmers in our study, likely due to time and financial constraints, although this was not covered in the interview. Regardless, awareness of the distinction between infection and inflammation among farmers is essential to prevent unnecessary antimicrobial use and risk of antimicrobial resistance ( 48 ).

Through the Canadian dairy industry’s national quality assurance program proAction, dairy farms are required to have standard operating protocols (SOPs) for common antimicrobial treatments. Although such SOPs are valued by farmers ( 31 , 49 ), farmers are also known to deviate from these protocols ( 50 ), similar to results described in this study. Delving deeper into the theme ‘Beyond the protocol’ allows us to make inferences regarding the ‘thinking systems’ used by interviewed farmers. According to dual process theories, cognitive operations can be categorized into 2 thinking systems: intuitive (‘System 1’) and reflective (‘System 2’) ( 51 ). The intuitive approach involves quick, automatic decisions, often relying on associations. In contrast, the reflective approach is more deliberate, carefully considering all alternatives before arriving at a decision. The quickness with which farmers summarized their protocols early in the interviews suggests they mainly used an intuitive cognitive system when handling CM cases that fit normal descriptions. However, in complex situations such as CM decision making, cognitive operations can move from reflective to intuitive, as skills and experience develop, in line with observations in our study ( 52 ). Only when asked to delve into details of CM treatment decisions, or when discussing cases where treatment expectations were not met, did the controlled, self-aware, reflective approach emerge. This implies that most farmers’ CM decisions are more likely to be automatic and associative, where past experiences and context are considered subconsciously ( 53 ).

Use of the intuitive cognitive approach for mild and moderate CM cases can introduce cognitive biases, including choices geared toward short-term gains ( 54 ). This may make antimicrobial treatments more appealing than improvements in udder health management. In contrast to the more mentally taxing reflective approach, intuitive cognitive processes place higher value on the first information that comes to mind (the ‘anchoring bias’) and tend to overestimate the likelihood of specific outcomes because they are plausible ( 54 ). These heuristic judgments are inherent biases to the intuitive cognitive process and can be mitigated through a deliberate effort to reason ( 52 ). However, they represent a challenge when trying to improve CM decision making on the farmer level. Veterinarians, in contrast to farmers, have received extensive training on the use of antimicrobials and their impacts, shaping their intuitive decision-making to include long-term gains. We suggest that interventions aimed at improving CM decision making among farmers should target methods of slowing down the decision-making process, to allow for new cognitive associations to be made which will help make more sustainable CM treatment decisions.

We can also extrapolate the interplay between intuitive and reflective thinking approaches to the theme ‘Personal attributes’, especially regarding the use of different types of experiential knowledge in the decision-making process. Often, farmers displayed assessing experiential knowledge when they drew associations between the current case explored in the interview and previous cases - an example of practices guiding intuitive decisions. When treatment outcome expectations were not met, however, farmers seemed to move to the reflective approach, drawing on other experiences (such as efficacy of medication on previous cases of the same cow) to aid in decision making. The role of experiential knowledge in antimicrobial treatment decision making has also been seen in U.K. and U.S. farmers ( 17 , 49 ). Rees et al. ( 17 ) also described experimental knowledge, which relies on the outcome of deliberate testing and trials of different treatments. Experimental knowledge, however, did not emerge from the interviews in this study; this might indicate that, although it plays a role in other on-farm antimicrobial decision-making processes, this type of decision making might not play an important role in CM decision specifically.

Another overarching theme generated was ‘Inter-actor dynamics’. While most CM treatment decisions were made by the herd manager, regular discussions among the operational team, co-owners, milkers, and veterinarians were common. These discussions revolved around operating protocols and herd goals. Participants described that ad hoc meetings between 2 or more actors took place to discuss cases requiring special attention. This behavior implies that actors believed that the group would reach better quality decisions together compared to solo, a characteristic of a synergetic group dynamic ( 55 ). In case of treatment decisions for CM cases that do not follow normal patterns, this assumption is likely correct, as each actor holds different pieces of information relevant to the decision making: the milker and the herd manager have daily contact with the affected cows, whereas the owner is more informed on the long-term herd goals, and the veterinarian has insight into the disease risk factors and etiology. A certain decision hierarchy, and thereby power imbalance, also seemed to be present, with owners and older generations having more decision power, a feature also recognized by Rees et al. ( 17 ) during interviews with U.K. farmers regarding general on-farm antimicrobial use. This decision hierarchy can lead to tensions, and can be a source of stress, an important aspect to recognize and mitigate when proposing the adoption of novel CM treatment protocols ( 17 ).

The role of the veterinarian in on-farm decision making is well-established and documented ( 45 ). More specifically, dynamics between veterinarians and dairy farmers have been described extensively (e.g., 56 , 57 ). However, the dynamics between the actors in these decision-making teams on dairy farms have not been described, and therefore, cannot be used to contextualize our findings. Studying group dynamics is complex ( 58 ), yet is common practice in healthcare settings ( 59 , 60 ), and studying team dynamics can help identify areas for improved antimicrobial stewardship, [(e.g., 61 )]. Other actors – other farmers and nutritionists previously mentioned by Swinkels et al. ( 45 ) – were not mentioned in our interviews. This could be attributed to their more indirect impact on treatment decisions, primarily influencing protocols rather than specific case decisions.

The lack of involvement of the veterinarian in case-by-case decision-making can be considered a consequence of the structure of current dairy practice in the region. As part of the shift toward progressive dairy medicine, emphasis has been placed on training producers and on-farm employees to recognize clinical signs of commonly occurring medical conditions, such as CM, and to follow an established protocol. Additionally, feasibility concerns have been described by producers and shed light on the lack of involvement of the veterinarian at this level ( 62 ). These include: the availability of the veterinarian to visit the farm for each CM case, the additional cost to the producer, and the geographic landscape of the region (i.e., farms are considered relatively far apart). While the expectation that the veterinarian participate in decision-making regarding each CM case may not be considered practical for producers and veterinarians in this context, direct involvement of the veterinarian in protocol development is important and was not thoroughly discussed by participants in the sample. The data collected through the interview process do not allow us to know that the veterinarian was not involved in the protocol development process. However, they do highlight the lack of involvement of the veterinarian in individual cases and demonstrate that the producer does not view the veterinarian as a first line resource for decision-making regarding CM cases.

The current legal framework in Canada ( 63 ) states that a prescription is needed to purchase antimicrobials, and antimicrobials are only to be prescribed within a current veterinarian-client-patient relationship ( 64 ). This relationship demands veterinarians having sufficient knowledge on which to base the assessment, diagnosis, and treatment of cases, and clients assuming responsibility to communicate the needs of the animal to the veterinarian. Therefore, based on the current legal framework, the veterinarian should be contacted in cases that do not allow the producer or on-farm employee to easily follow the protocol so that an individual assessment can be made. Based on information gleaned through this study, further assessment of veterinarian-producer relationships is warranted and may allow us to further unpack the lack of involvement of the veterinarian in decision-making surrounding CM.

In reflecting on the lead researchers’ perspectives and position, and its potential impact on the presented results, it is important to note that EdJ’s background in clinical mastitis was primarily theoretical, derived from scientific literature, rather than practical experience—as she is not a veterinarian. This lack of direct clinical experience facilitated an open and non-judgmental environment during the interviews, encouraging farmers to share their practices more freely. Regarding the information power of the final sample size, EdJ’s initial unfamiliarity with qualitative research required additional interviews to cover all topics; as the participating farmers were all involved in their CM treatment decisions and farmed on conventional farms, the narrow study aim was more easily addressed. The differences between farms with AMS and conventional milking systems did require additional interviews to sufficiently describe each situation’s intricacies.” The iterative fashion in which the results were generated by EdJ, including discussions with the rest of the research team, allowed for continuous reflection on the achievement of sufficient information power to answer the research question. In reflecting on the interview method used, the data obtained from Zoom interviews matched the quality and richness of in-person interviews; similar themes and concepts were brought forward. This similarity is consistent with research comparing the quality of Zoom with in-person interviews ( 65 ).

While our study has provided valuable insight into CM decision making, it is important to acknowledge several limitations that might impact the findings. Interviews rely on respondents’ ability to accurately recall details about their decision-making process, which can be challenging, considering most of the CM events discussed occurred in the past – sometimes multiple weeks or months ago. An ethnographic approach, where participant and direct observation are at the core of data collection, can help mitigate this issue and provide deeper insights into social dynamics. However, it is important to note that this method is time-consuming and resource intensive. In contrast to focus groups, interviews allow for more in-depth exploration of individual experiences. Although both interviews and focus groups may be susceptible to socially desirable responses from participants, the interviewer took specific measures to build rapport with farmers and maintain a nonjudgmental and curious stance throughout the interviews. Surveys could be employed in future research as they are a tool to capture quantifiable data and allow for describing trends among farmers with AMS and those milking with parlors. Similarly, surveys would allow for inferences regarding the use frequency of described practices and could quantify the reported treatment considerations among the broader dairy farmer population in Canada.

In conclusion, CM treatment decision-making is a multifaceted process, and can be classified into 4 steps: identification and classification, treatment approach, treatment choice, and treatment termination. At each of these steps, farmers considered many different factors leading to CM treatment decisions, including evaluation of milk production and quality data, visual characteristics, systemic signs, additional diagnostics, likelihood of cure, value of the cow, herd goals, urgency of treatment, available drugs, timing of the case, definition of success and progression over time. Three themes shaped these decisions: ‘Personal attributes’, including approach and experiential knowledge; ‘Inter-actor dynamics’, such as shared decision making and dynamics among producers, veterinarians, and milkers; and ‘Moving beyond protocols’, which highlights the dynamic nature of their decision making. While tools and techniques are available to assist farmers in improving udder health and refining antimicrobial choices, understanding the generated themes is key for designing effective interventions for CM that align with the reality of farming operations.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by the University of Calgary Conjoint Faculties Research Ethics Board (#REB21-0699). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

EdJ: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing. IvdV: Data curation, Formal analysis, Methodology, Writing – original draft. A-MS: Conceptualization, Formal analysis, Methodology, Writing – review & editing. JI: Conceptualization, Formal analysis, Methodology, Writing – review & editing. KR: Conceptualization, Formal analysis, Methodology, Writing – review & editing. DK: Formal analysis, Writing – review & editing. HB: Conceptualization, Methodology, Supervision, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Canada’s Natural Sciences and Engineering Research Council (NSERC) Industrial Research Chair Program granted to HB, with industry contributions from Alberta Milk (Edmonton, AB, Canada), Dairy Farmers of Canada (Ottawa, ON, Canada), Dairy Farmers of Manitoba (Winnipeg, MB, Canada), British Columbia Dairy Association (Burnaby, BC, Canada), WestGen Endowment Fund (Abbotsford, BC, Canada), Lactanet (Guelph, ON, Canada), SaskMilk (Regina, SK, Canada), and MSD Animal Health (Boxmeer, Netherlands). EdJ was supported by an NSERC CREATE in Milk Quality Program Scholarship.

Acknowledgments

We would like to thank the participating dairy farmers for sharing their knowledge and perspectives.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: clinical mastitis, decision-making, antimicrobial use, treatment choice, farmer attitudes

Citation: de Jong E, van der Velden I, Smid A-MC, Ida JA, Reyher KK, Kelton DF and Barkema HW (2024) Dairy farmers’ considerations for antimicrobial treatment of clinical mastitis in British Columbia and Alberta, Canada. Front. Vet. Sci . 11:1417958. doi: 10.3389/fvets.2024.1417958

Received: 15 April 2024; Accepted: 31 July 2024; Published: 08 August 2024.

Reviewed by:

Copyright © 2024 de Jong, van der Velden, Smid, Ida, Reyher, Kelton and Barkema. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Herman W. Barkema, [email protected]

† Deceased

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