Shelter medicine is a veterinary discipline of growing importance. Formally accepted as a clinical specialty in the US in 2014, the practice of shelter medicine worldwide is expanding. As a topic in veterinary pre-registration (undergraduate) education, it is frequently used as an opportunity to teach primary care skills, but increasingly recognized as a subject worthy of teaching in its own right. The aim of this study was to use a Delphi consensus methodology to identify learning outcomes relevant to shelter medicine education. Shelter medicine educators worldwide in a variety of settings, including universities, non-governmental organizations and shelters were invited to participate. Participants were initially invited to share shelter medicine teaching materials. These were synthesized and formatted into Learning Outcomes (LOs) based on Bloom’s taxonomy and organized into five subject-specific domains. Participants were then asked to develop and evaluate the identified LOs in two rounds of online surveys. Consensus was determined at > 80% of panelists selecting “agree” or “strongly agree” in response to the statement “please indicate whether you would advise that it should be included in a shelter medicine education program” for each LO. In the second survey, where re-wording of accepted LOs was suggested, preference was determined at > 50% agreement. Through this method, 102 agreed LOs have been identified and refined. These LOs, as well as those which did not reach consensus, are presented here. These are intended for use by shelter medicine educators worldwide, to enable and encourage the further development of this important veterinary discipline.

Fleas, mainly Ctenocephalides felis on both cats and dogs, are a very basic but continuing and common issue in veterinary practice. Fleas are important for their direct effects on infested pets, particularly when animals develop flea allergic dermatitis, and for their transmission of pathogens that can cause serious disease in cats and/or in humanssuch as Bartonella spp. Fleas also bite humans, and negatively affect the pet-human bond. This roundtable discussed flea biology, flea-borne diseases, efficacy of control measures available, and improving compliance and client engagement. Effective control of fleas requires an understanding of their biology, as this affects what strategies will and will not be effective: for example leaving a house empty will not control a flea infestation as the pupae can stay dormant for months. There is now a wide range of products that can be used to control fleas both on the pet and in the environment, including not only sprays but spot-on formulations, collars, oral tablets and injections. Used correctly, these are generally both safe and highly effective, with no signs of resistance developing, thankfully. However, owners often do not use products correctly, whether through inability to do so; lack of understanding of why correct use is important; or simple forgetfulness. A range of measures must be used to engage with clients, educate them and help them to remember to treat their pets against these pernicious parasites.

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Worldwide, pre-registration (undergraduate) teaching in shelter medicine shows considerable differences between veterinary faculties. A lack of consensus regarding key concepts of shelter medicine within veterinary curricula could explain these inconsistencies. However, it is increasingly recognized that more inclusion of shelter medicine within veterinary education is desirable. [7][8][9] The concept of constructive alignment 10 sets out parameters for curriculum development that focusses on linking the teaching methods and content to what the learners need to know and should be able to do. Integral to constructive alignment is the development of appropriate learning outcomes that students should be able to achieve at the end of a period of study. Furthermore, the method of study, student activities, learning materials, and assessment should be finely tuned to ensure students achieve their learning outcomes. Bloom's taxonomy of learning outcomes 11,12 considers student activity and achievement in three domains: cognitive (knowledge), affective (attitudes) and psychomotor (skills).The Delphi technique is a recognized method of harnessing expert opinion to reach consensus where absolute evidence is scant or lacking. 13 There is a simultaneous exploration of

• There is no clear evidence that a flank incision is more or less painful than a midline incision when spaying cats. However, the surgeon's preference and individual patient circumstances should be considered when choosing which approach to take. Clinical scenario Dr Perry brings her ive-month-old female domestic shorthair kitten, Kylie, in to be spayed. She has read on the internet that cats can be spayed using either a midline or a lank incision. She is very concerned about Kylie being in pain and asks you which is the least painful surgical option for Kylie. You wonder if one approach is less painful than the other.