Urgently rethinking the way we teach veterinary medicine

“It is no use saying ‘We are doing our best.' You have got to succeed in doing what is necessary.”

-Winston S. Churchill

Veterinary medicine and its system of education face a number of problems, and key leadership groups are struggling to find the collective resolve to do what is necessary. In a recent commentary, American Veterinary Medical Association (AVMA) President Dr. Ted Cohn stated, “Changes in veterinary education are necessary for the profession to meet society's ever-changing demands.” He called on veterinary organizations and colleges to have the “vision, courage, honesty, and determination” to recognize what is currently occurring in the profession and work together to “address our differences with civility and respect.”1

In this essay we attempt to do exactly that. We assert that academic veterinary medicine should be more imaginative, efficient, integrated and relevant. We believe the changes we propose could improve the profession's future.

First of all, the veterinary colleges need to develop greater self-awareness, considering not just their own needs but the needs of the entire profession and the society they serve. Despite numerous studies over the years calling for change, they have paid scant attention-rather, academic veterinary medicine seems to be overlooking the profession's problems rather than helping to solve them. Veterinary colleges must face the profession's problems consciously together, not just through self-interest.

Here are some ways they could do that.

Rethink expectations for faculty and students

Too many college faculty first enter the classroom without having been trained in the art and science of teaching. Students are still taught predominantly using centuries-old methods that make them passive recipients rather than active seekers of knowledge-the most common format is a professor standing in front of a group of students and talking. Lectures are a convenient way to convey large quantities of information but an imperfect way to learn, as students are led to believe that academic success depends on memorizing as many details as possible. This is detrimental to reflective and critical thinking.

Colleges are beginning to address the situation by converting lectures to seminars and workshops-the so-called “flipped” classroom in which students assume active leadership roles and faculty serve as coaches. This way, students also learn communication and negotiation skills. This is an exemplary model for training future professionals.

Some veterinary colleges have come together to create multi-institutional teaching academies. We should anticipate that this idea will become widely adopted, particularly if university funding continues to shrink. It is an excellent way for institutions to share resources and expertise for the benefit of the entire profession. Twenty-first-century computer-based technologies greatly facilitate this model, an exciting development for the near-future.

Colleges need to be especially prudent in the way they admit undergraduate students to their programs. A strong prior academic record is a good indicator of success in the veterinary curriculum, but it is not necessarily an accurate predictor of career success. To effectively assess students' life-skills, admission interviews need to be mandatory and include comprehensive evaluation of communication skills, interpersonal behavior, creativity and leadership potential. Merit should be given to applicants with a broad range of experiences, both academic and extramural, and formulated prerequisites should be minimal. Interview teams must be well-trained and should involve appropriately qualified veterinary practitioners and non-veterinarians, including human behaviorists. Successful student selection is critical to the profession's future.

Reconsider the traditional all-purpose eight-year curriculum

There is no reason why six-year, European-style veterinary education could not be successful in North America. One approach would be to admit students to a four-year veterinary program after two years of appropriate undergraduate education. The AVMA Council on Education (COE) has already granted full accreditation to 10 prestigious foreign universities with five- or six-year veterinary degree completion times. Students benefit from reduced tuition and out-of-pocket costs, smaller debt loads, and opportunities to earn income two years earlier. The time has come for “accelerated” veterinary education to be realized.

It is irrational to cling to the sentimental James Herriot image of every veterinarian ministering to all creatures great and small. Building on a common core of broad-based biomedical One Health education, the clinical curriculum should provide for in-depth elective concentrations (tracks) with strong practice themes, including public and corporate veterinary medicine. By linking the area of study to a student's career path, graduates will exercise better medicine than when they have too many diverse responsibilities.

Make veterinary education more relevant

Biomedical science is unquestionably the underpinning of clinical medicine; therefore, we must ensure that the content of the first half of the four-year curriculum is well-aligned with the needs of veterinary practice. Biomedical faculty's job is to help create competent future veterinarians, not biomedical scientists.

Some medical schools have introduced a “clinical immersion” approach, which teaches basic medical science through the solving of clinical problems-for example, one learns practical anatomy and physiology from a patient, not a book. Clinical immersion places internists, surgeons, pathologists and others on biomedical teaching teams, and it includes clinical presentations of body systems of individual animals and populations in a variety of animal species. This vertically integrated, problem-solving approach is a major advance in biomedical education.

Another way to make veterinary education more relevant is via distributed, community-based clinical experience. In an increasingly economically challenged and competitive world, university teaching hospitals are facing diminishing caseloads and are augmenting this with offsite training. Studying outside the academic campus is an excellent way for students to develop real-world, hands-on experience with a wide variety of animals, owners and communities. Also, it gives practicing veterinarians an integral role in education. Additionally, students learn interprofessional skills and protocols with technicians and nurses in private practice, and with PhD scientists, physicians and others in government and corporate settings.

The four newest veterinary colleges (three U.S. and one Canadian) have decided not to construct a teaching hospital on campus but to use community-based clinical training instead. Two such colleges are fully accredited by the COE, and two provisionally. Thus they are an established constituency. The current controversy in which some veterinary leaders are condemning the COE for accepting them is contradictory and counterproductive.

Distributed education requires excellent oversight, including careful selection of practice sites and practitioner-preceptors. Specific faculty members should be assigned to manage the program, and sufficient dedicated teaching time and resources must be made available. Preceptors and students alike need to adhere to well-defined educational goals and evaluation procedures. Where feasible, participating practitioners should be recognized and rewarded as salaried part-time faculty.

Leverage technology

Unquestionably, technology will continue to unite medical education. However, it is impossible to extrapolate with certainty the advances that will occur during students' careers; thus, the best way to prepare them is to include technological education and training prominently throughout the veterinary curriculum.

Soon, veterinary students may study anatomy on virtual dissecting tables and learn surgical techniques on virtual operating tables rather than on cadavers and patients. Embedded sensors may be used to gather, store and transmit data from the animal's body to a veterinarian's wearable device. And downloadable software no doubt will be available for every imaginable application in medicine and business. Eventually, advances in distance diagnostics (telemedicine) will effectively serve animal health needs in any location-potentially linking all areas of practice.

Veterinarians will also benefit from genomic technologies that define the molecular basis of diseases and their prevention and treatment. The immense computer power of the future, coupled with advanced informatics and 3D printers, will allow us to manufacture customized prosthetic devices and possibly even create new tissues and body parts.

Perhaps the biggest effect of technology on the veterinary curriculum may be the growth of online coursework. “Education without borders”-any place, any time-is an apt metaphor for 21st-century learning. In medical education, so-called blended learning (which integrates online and onsite teaching) will become more common as it combines the advantages of both. Veterinary students will increasingly enroll online in courses outside their home campus, which will provide education in areas where the college has limited expertise and expand their options for focused electives. Using simulation and interactive technology, students will be able to obtain virtual clinical experience online. If enough accredited online courses became available from multiple veterinary colleges internationally (a virtual world campus), a student would be able to earn his or her degree asynchronously or at an accelerated pace. It might even be possible to earn a veterinary degree largely online at greatly reduced cost. This notion has enormous political implications.

Although digital technology will inevitably play a dominant role in the future, we must never forget that the human-animal bond and doctor-patient-client relationships are the foundation of veterinary care.

Bolster business acumen

The term “financial literacy” has entered the vocabulary of higher education, although it is ill-defined and inconsistently applied. Ideally, every university student should understand and use sound financial principles, including knowing the costs of education and the earning potential in their chosen fields. Veterinary students in particular should receive customized training in personal finance, money management and small business insight, which can be achieved with robust courses throughout the curriculum. Why? For the same reasons they are taught medicine and surgery!

Veterinarians are the “products” of higher education, and ensuring the financial viability of that product must be a responsibility of the colleges. Training for clinical competency without imparting a keen understanding of the economic ramifications of that training is weak at best and disastrous at worst. Veterinary students are often the victims of their emotional expectations of a career in veterinary medicine, and this fiscally impaired vision can make them easy prey to financial institutions eager to lend them money. The enormous debt load carried by growing numbers of students is the principal factor keeping them from a satisfactory lifestyle, home ownership and practice ownership.

Online modules containing consistent, high-caliber finance and business information taught by well-qualified professionals should be a requirement in veterinary education. Complementary resources available through the AVMA and the Veterinary Business Management Association can augment the curriculum. Additionally, students should be required to study the various business models they encounter during their education, e.g. teaching hospitals, private practices, corporations and government organizations. Solid finance and business acuity is essential to the economic success of all veterinarians, irrespective of employment setting.

Want more ideas? Stay tuned for more proposed changes for veterinary education in part two of this commentary series.

Reference

1. Cohn TJ. In: Nolen RS. For Cohn, relevance of AVMA and profession is front and center. J Am Vet Med Assoc 2014;245:462-464.

Peter Eyre, DVM&S, BSc, BVMS, PhD

Professor-and-dean emeritus, Virginia-Maryland College of Veterinary Medicine

Blacksburg, Virginia

Robert C. Brown, DVM

Interact

Herndon, Virginia

Charles J. Wayner, DVM

Veterinary Vitality

Topeka, Kansas

Richard M. DeBowes, DVM, MS, DACVS

Inner Compass Leaders

Pullman, Washington

James F. Wilson, DVM, JD

Priority Veterinary Management Consultants

Yardley, Pennsylvania