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Megan Branham, DVM

Teaching Executive Functioning Skills for Veterinary COHAT Procedure

Executive functioning skills are essential for success academically, professionally and

personally. These skills allow individuals “to direct, coordinate, and regulate [their] thoughts,

emotions, and behaviors in order to achieve [their] objectives” (Escolano-Pérez & Bestué, 2021,

p. 3). There are many executive functioning skills that are necessary in veterinary medicine,

however the three that are most important to the performance of a veterinary comprehensive oral

health assessment and treatment (COHAT) procedure are time management, organization, and

cognitive flexibility. A COHAT procedure is performed under anesthesia, therefore it is

imperative that all necessary equipment is readily available (organization) and that the procedure

is performed not only effectively, but also efficiently (time management) to ensure patient safety.

Anesthesia and the COHAT procedure come with unexpected circumstances all of which need to

be addressed quickly. It is important for a technician to be able to problem-solve and think on

their feet (cognitive flexibility) to ensure a safe procedure. Together these three executive

functioning skills allow for the COHAT procedure to be performed smoothly and with minimal

to no complications.

The first executive functioning skill needed, time management, is defined as “the

capacity to estimate how much time one has, how to allocate it, and how to stay within time

limits and deadlines” (Dawson, n.d. para. 13). When a veterinary patient is undergoing a

procedure, it is essential for veterinary professionals to work methodically and with purpose.

This is especially true for patients under anesthesia as a prolonged procedure time increases the

risk of complications. Students learning a COHAT procedure need to practice not only the

COHAT steps, but also the process of anesthesia induction, monitoring, and recovery.

Performing the COHAT steps on a cadaver animal will help students get a better understanding
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of how long each step takes to complete. The anesthesia aspects are covered in a different course.

In order to assist students with their time management as it relates to a COHAT procedure, a

group assignment can be performed prior to the cadaver lab (Symonds, 2021). Within this

activity, each group will be asked to move step by step through the setup, completion, and

recovery stages of an anesthetic COHAT. The group should estimate how much time each step

will require to complete. After a set time, the groups will come together to discuss how they

prioritized each aspect of the procedure. As a class, a timeline for a COHAT procedure will be

created and then followed in the cadaver lab. Another discussion will occur after the completion

of the cadaver lab to decide if any aspects of the timeline need to be altered. Through this

activity, students will discover how long parts of the COHAT take to complete and the

importance of performing certain aspects of the COHAT prior to others. For example, if

radiographs are taken after the scaling and polishing, the patient may be under anesthesia

needlessly while waiting for a treatment plan. The importance of time management cannot be

underestimated when concerning the completion of an anesthetized procedure and therefore it is

critical that students learn to use their time wisely.

Organization is the second important executive functioning skill required to safely

perform a COHAT procedure. Dawson (n.d.) defines organization as “the ability to create and

maintain systems to keep track of information or materials” (para. 7). A veterinary hospital can

be a lively place where it is common for multiple procedures to be happening at once.

Technicians are commonly multi-tasking and being pulled in numerous directions. The places

within the hospital where this does not work are within the operating or dental suites as patients

under anesthesia require a great deal of concentration and attentiveness. Therefore, it is

imperative that all equipment needed during an anesthetic procedure be organized and readily
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available for use. For a COHAT procedure, the dental suite needs to be setup in an orderly

manner so that anesthesia and the COHAT can proceed smoothly. All dental equipment should

be sterilized and easy to access. The anesthetic machine and monitoring equipment should be

prepared for the patient. The emergency medications need to be available. During a procedure is

not the time to search the hospital for a piece of equipment or a medication that is not in its

expected location. Just as with time management, organization is required to efficiently complete

the task at hand and limit the anesthetic time.

To show the importance of organization, as well as time management, a card game called

“Ace of Spades” (Harris, n.d., para.12) can be played with students. In this game two students

are asked to find the ace of spades card within a deck of cards. The first student to locate the card

wins. What the students come to realize is that one deck of cards is organized by suit, and one is

randomly shuffled. Inevitably the student with the organized deck of cards wins. While the

students may see the game as rigged, the lesson is that it is easier and faster to find things when

they are organized. This is true for a deck of cards and for a professional setting such as a

veterinary hospital. When considering the COHAT procedure specifically, organization can be

taught as well with an activity in which groups of student are given a short timeframe to list all

equipment that they will need to perform a COHAT on an anesthetized patient. The groups will

then compare lists to see how they are similar or different. Students may forget minor things

such as a periodontal probe or even major equipment such as a dental radiograph plate. For each

minor item left off the list, the group will receive one point; five points for major items. Each

point represents a minute of time wasted during the procedure and therefore teams should strive

for the least number of points. This aspect of the lesson will emphasize the importance of

organization, not only to performing the procedure successfully, but also to the time management
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of the patient’s care. Without an organized work environment, patients will be kept under

anesthesia longer leading to an increased risk of anesthetic complications and even death.

The last executive functioning skill that is critical to performing a COHAT procedure is

cognitive flexibility, which is defined as “the ability to revise plans in the face of obstacles,

setbacks, new information or mistakes" (Dawson, n.d., para. 4). While the other two executive

functioning skills are important to veterinary medicine in general and performing a COHAT in

specific, cognitive flexibility may be the most important. Technicians must have the ability to

“improvise, adapt, and overcome” (Dutton et al., 2020, p. 1). This is a common U.S. Marine

Corps phrase, sometimes known as Semper Gumby, that emphasizes the importance of flexibility

during challenging situations. Both anesthesia and dentistry do not always proceed in the most

fluid manner. Equipment malfunctions and patients do not always follow the textbook. Patients

may have abnormal anatomy or issues with anesthetic medications. A veterinary technician must

be able to face a problem head on and use critical thinking skills to solve it in a manner that

ensures appropriate patient care. To teach cognitive flexibility to students learning how to

perform an anesthetized COHAT procedure, an activity named “Plan A/ Plan B” (Cannon et al.,

2011, p. 118) can be used. Within this assignment, the instructor provides a potential

complication to students that decide among their group what their plan B will be now that plan A

has failed. The groups will then discuss their plans as a class. For example, plan A for a COHAT

would be that the dental radiograph machine works perfectly. Students must decide what their

plan B is if the machine stops working mid-COHAT. Another example could be anesthesia

related and students must decide on a plan B if their oxygen tank runs out during the procedure.

This activity allows students to creatively solve problems, which is a key part of cognitive

flexibility.
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While in school, students should not only learn the basics of their discipline but should

also work on improving their executive functioning skills. These skills must be practiced, and

educators can assist students in their endeavor at mastery by incorporating them into everyday

teaching (Diamond & Ling, 2016). This can be easily done with a little pre-planning and

multiple skills can be practiced at once, such as time management and organizational skills or

cognitive flexibility and perseverance. As these skills increase, students will also be increasing

the efficacy with which they learn as they will be able to manage their time, overcome obstacles,

and coordinate their thoughts. Diamond and Ling (2016) indicate that students with executive

dysfunction gain more from practicing executive functioning skills than other students.

Improving executive functioning skills have been shown to increase academic success, job

opportunities, and quality of life. This underscores the importance of including these skills in all

levels of education.
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References

Cannon, L., Kenworthy, L., Alexander, K.C., Werner, M.A., & Anthony, L.G. (2011). Unstuck

and on target!: An executive function curriculum to improve flexibility for children with

autism spectrum disorders. Paul H. Brookes Publishing.

Dawson, Peg (n.d.). Definition of terms. Smart but Scattered Kids.

https://www.smartbutscatteredkids.com/about/terms/

Diamond, A., & Ling, D. S. (2016). Conclusions about interventions, programs, and approaches

for improving executive functions that appear justified and those that, despite much hype,

do not. Developmental Cognitive Neuroscience, 18, 34–48.

https://doi.org/10.1016/j.dcn.2015.11.005

Dutton, R. P., Grissom, T. E., & Herbstreit, F. (2020). COVID-19 and Trauma Care: Improvise,

Adapt, and Overcome! Anesthesia & Analgesia, 131(2), 323–325.

https://doi.org/10.1213/ANE.0000000000004944

Escolano-Pérez, E., & Bestué, M. (2021). Academic achievement in Spanish secondary school

students: The inter-related role of executive functions, physical activity and gender.

International Journal of Environmental Research and Public Health, 18(4), 1-25.

https://doi.org/10.3390/ijerph18041816

Harris, T. (n.d.). Seventeen time management activities & exercises for increased group

productivity. The Exceptional Skills. https://www.theexceptionalskills.com/time-

management-activities/

Symonds, V. (2021, January 4). Seven time management training activities that will engage

learners. Symonds Research. https://symondsresearch.com/time-management-activities/