Veterinary Education K M Edmondson, Cornell University, Ithaca, NY, USA ã 2010 Elsevier Ltd. All rights reserved. Glossary Theriogenology The branch of veterinary medicine concerned with the physiology and pathology of reproduction in animals, and with the clinical practice of obstetrics and gynecology. Xenotransplantation The transplantation of living cells, tissues, or organs from one species to another, such as from pigs to humans. to balance the need to train generalists with more specialized knowledge, and how to best prepare future professionals for an ever-changing world. As scientific knowledge increases, and the important roles veterinarians play in service to society become more visible, the expectations of new veterinary graduates also expand. The high costs associated with veterinary education, combined with significant student debt, heighten the challenges veterinary colleges face. This article presents the current status of veterinary education, discusses inherent themes that are common among veterinary colleges, and outlines future challenges. Introduction and Context Veterinary medicine is the medical profession at the interface between animals and people. Although a majority of veterinarians provide medical care for pets and food animals, professional activities of veterinarians also include preventing the transmission of zoonotic diseases from animals to humans, wildlife preservation and conservation, and public health. The broad, comparative training veterinarians receive in the biological sciences prepares them to care for a wide range of animal species, and uniquely positions them to serve as valuable team members in the promotion of human health and protection of the food supply. Within the global community, public awareness of the interrelatedness of animal and human health is increasing, as illustrated by emerging programs, such as the One Health Initiative, which recognize the synergy and potential benefits of promoting collaboration among physicians, veterinarians, and other scientific health professionals to develop global strategies to advance healthcare. Changing trends in pet ownership, the increasing value placed upon the bond between humans and animals, and the role of that bond in promoting human health, including mental health and well being, are also significant. Veterinary medicine as a profession is in a state of transition. Not only has a significant gender shift occurred, but there is a trend toward increased specialization as well. According to the American Veterinary Medical Association (AVMA), 75% of today s veterinary students are female (in contrast to 55% in 1988), and more than onethird of all veterinary graduates seek advanced training in a wide range of specialty areas (more than twice the number seeking additional training in 1988). Consequently, faculty at veterinary colleges must consider how Requirements, Accreditation, and Licensure In the United States, a typical veterinary curriculum is 4 years in length and leads to the degree of doctor of veterinary medicine, or DVM. In the United Kingdom, Europe, and Australasia, students enter veterinary college following secondary school. Programs of study are usually 5 years in length, and lead to the degree of bachelor of veterinary science (BVSc). Students in the United States and Canada have typically completed a baccalaureate degree prior to entering veterinary school. Some have completed advanced degrees. The academic requirements that applicants must fulfill are very similar to those required by schools of allopathic medicine or dentistry. In addition to substantial prerequisite coursework in the biological sciences and scores from standardized tests, prospective students are required to provide evidence of veterinary-related (and animal) experience, submit a statement of intent, and provide information related to their other activities and interests. The number of colleges of veterinary medicine is relatively small (28 in the United States and five in Canada), and the average number of students per class is just under 100. Veterinary curricula follow the traditional Flexner model of medical education, with emphasis on basic science disciplines in the first 2 years, followed by instruction in clinical disciplines in the second half of the curriculum, including a year of practical clinical training. The majority of preclinical instruction is didactic, with supporting laboratory exercises. Clinical instruction follows the apprenticeship model of education: usually within the context of a teaching hospital, students rotate through a series of clinical services, supervised by clinicians, and are directly involved in medical case management. Preclinical disciplines common to veterinary 71
72 Education of Professionals curricula include gross anatomy, histology, molecular genetics, physiology, pathology, microbiology, bacteriology, virology, parasitology, epidemiology, pharmacology, and embryology. Clinical disciplines include medicine and surgery, anesthesiology, imaging, population medicine, behavior, nutrition, and other specialty areas such as oncology, ophthalmology, neurology, cardiology, toxicology, dentistry, laboratory animal medicine, theriogenology, emergency and critical care medicine, and exotic animal medicine. Most schools in the US educate generalist veterinarians, but some allow students to focus on particular species. Veterinary students, therefore, are expected to master a significant amount of material that includes a strong foundation of basic science and clinical knowledge, clinical skills, and professional behaviors. Their knowledge and skills are assessed through a range of approaches that include traditional written examinations (with essay, short answer, or multiple-choice questions), oral and practical exams, demonstrations, and, occasionally, student presentations. As there is no requirement for additional training, new veterinary graduates can be licensed to practice medicine following graduation. Skills labs are incorporated into the educational program with the expectation that students will become competent in performing many standardized procedures prior to graduation. Those who wish to pursue additional training may choose internships and/or residency training in one of the disciplines listed above. Internships are usually 1 year in length. Residency training lasts 2 3 years, and qualifies the individual to sit for a Board Certification examination in that discipline. Since 1953, the Council on Education (COE) of the American Veterinary Medical Association has been the accrediting body for veterinary colleges in the United States and Canada. Although the COE makes all accreditation decisions, it is accountable through the AVMA to a governmental regulating body (the US Department of Education) and to a nongovernmental agency (the Commission for Higher Education Accreditation). In recent years, several veterinary colleges from other countries have sought and received accreditation from the AVMA. Currently, in addition to those in the United States and Canada, there are AVMA-accredited colleges of veterinary medicine in the United Kingdom, Australia and New Zealand, and in the Netherlands. To receive accreditation from the AVMA, each college must satisfy standards in 11 areas, and demonstrate the ability to provide students with the necessary resources for success within a highquality program that meets the designated standards. Once accredited, colleges receive full reviews every 7 years. Veterinary colleges in the United Kingdom are accredited by the Royal College of Veterinary Surgeons (RCVS), which conducts periodic visits every 7 10 years. Other countries have their own systems for accrediting veterinary colleges. Those that are members of the European Union (EU) have considered a move toward consistency or uniformity of their standards and curricula. The European Association of Establishments for Veterinary Education (EAEVE) and the Advisory Committee on Veterinary Training (ACVT) have developed a system for evaluating veterinary schools that applies to institutions within the EU. Beyond this, and based in part upon an effort to facilitate the globalization of animal disease control, a number of schools are supportive of recent initiatives to increase compatibility among veterinary education programs in different parts of the world. This is a complex undertaking, however, and is complicated by differences in organization, governance, financial structure, curricula, and overall costs. A license to practice veterinary medicine signifies that the holder is competent to treat all animal species. For graduates of AVMA-accredited institutions, the North American Veterinary Licensing Exam, NAVLE, is required for licensure in all of the licensing jurisdictions in North America. In addition, some states require a State Board Examination. To maintain certification, some states require practicing veterinarians to participate in continuing education activities, while others do not. Graduates of nonaccredited schools can seek licenses in the United States through two certification programs: the Educational Commission for Foreign Veterinary Graduates (ECFVG) which is operated by the AVMA, and the Program for the Assessment of Veterinary Education Equivalence (PAVE), which is operated by the American Association of Veterinary State Boards. Canada has its own certification requirements for graduates of international veterinary colleges, administered through the National Examining Board. New veterinary graduates are expected to function independently, and to possess a level of competence in a wide range of clinical domains. They are expected to demonstrate attributes such as ethical behavior, compassion, respect, honesty, and responsibility, as well as knowledge of animal disease and wellness, diagnosis, management and treatment, and business practice. They are also expected to reason deductively, exhibit problem-solving skills, communicate effectively with others, and perform core clinical procedures (including standard surgical procedures). Graduates should have a continual thirst for new knowledge, the ability to critically examine new knowledge, and the ability to recognize the limits of their knowledge and skill. Throughout their careers, veterinarians must adhere to a code of professional ethics. For veterinarians who belong to the AVMA, these are outlined in the Principles of Veterinary Medical Ethics. Local and state veterinary associations and licensing boards have additional rules governing professional conduct. The principles lay out expectations in the following categories: professional behavior; the relationship between the veterinarian, client, and patient; attending, consulting, and referring; influences on judgment; therapies; genetic defects; medical records; fees and remuneration; advertising; and euthanasia. The Veterinarian s Oath
Veterinary Education 73 comprises these elements, and includes additional language related to conservation of animal resources, promotion of public health, and the advancement of medical knowledge. In general, veterinarians are expected to relieve disease, suffering, or disability, minimize pain and fear, and to be honest, law abiding, and fair. Veterinarians should not engage in fraud, misrepresentation or deceit, and they should strive to enhance their image with respect to the public. They must be committed to improving their veterinary knowledge and skills, and be courteous, considerate, and compassionate. Impetus for Change in Veterinary Education In the past two decades, three major reports published within the veterinary profession contained recommendations for veterinary education. The earliest report, part of a national trend of curriculum reform efforts in medical education, was the Pew Report published in 1989 calling for sweeping changes for veterinary schools that redirected the emphasis on accumulating factual information toward a focus on how to find and use information, solve problems, and acquire essential skills and behaviors. It encouraged colleges of veterinary medicine to identify mechanisms for increasing students responsibility for their education, for strengthening curriculum content in the basic biological sciences, and for providing students with the opportunity for in-depth clinical instruction. To better meet the needs of the public with regard to food safety and public health, the Pew Report also called for the inclusion of additional curriculum content. It encouraged veterinary colleges to make research activities a higher priority, and to place more emphasis on post-dvm education programs. Colleges of veterinary medicine were also directed to decrease enrollments, and to focus their programs on a smaller number of specialty areas, creating centers of excellence. The Report projected changes in the organization of veterinary education, particularly as it related to clinical experiences, and predicted that veterinary practitioners would contribute more to educational programs, and to the direct instruction of veterinary students. In response, many veterinary colleges in the United States and Canada engaged in processes of curriculum review, and implemented a number of the Pew recommendations in the 1990s. Some schools experimented with and implemented different approaches to teaching. Following the lead of many medical schools, several veterinary colleges considered problem-based learning as an instructional approach. In an attempt to better integrate the basic science and clinical disciplines, to foster the development of clinical problem-solving skills, and to engage students in the learning process, many schools incorporated some aspects of this approach into existing courses, or made structural changes to their curriculum to include parallel or capstone problem-based courses. A small number of schools implemented entirely new curricula that used problem-based learning as the predominant instructional approach in the preclinical years. Still others restructured their curricula and incorporated other forms of small group learning. A common form of educational innovation among many schools was an increased reliance on various forms of computer-assisted instruction. Schools developed a wide range of educational resources during this period that supplemented or replaced material that had previously been taught didactically, and reduced the number of live animals there were used for teaching. Some schools developed tracking curricula that allowed students to focus on particular species or aspects of professional practice. Others changed approaches to clinical instruction to involve practitioners in innovative ways. Ten years after the Pew Report, the influential KPMG Study was published and focused primarily on the future job market for veterinarians and veterinary services. Contrary to the Pew Report, the KPMG Study projected a shortage of veterinarians in some areas, calling for colleges of veterinary medicine to expand curricular offerings relative to the professional knowledge, skills, and behaviors that contribute to economic success in veterinary practice. These included communication skills, technical skills, information related to business and practice management, critical thinking, and lifelong learning skills. While primarily focused on the veterinary profession and not on education (only one of the six critical issues identified in the report related to education), the implications of this report for veterinary colleges were clear, and it served as the impetus for additional curricular changes. In the time that has elapsed since the publication of the KPMG Study in 1999, a number of veterinary colleges in the United States, Canada, and around the world have taken significant steps to develop courses and curriculum materials focusing on client relationships and communication skills. In many instances, these initiatives have also led to a new consideration of clinical competency and outcomes assessment. The third and most recent major report to impact veterinary education is the Foresight Report, published in 2007. The goal of the report was to determine a vision for the future of academic veterinary medicine, and to provide a basis for strategic planning and curriculum development. The Report contained a series of recommendations that included acceptance of the ideas that veterinary licensure in the future would be limited to selected focus areas, that colleges of veterinary medicine should collaborate, and that they should identify areas of focus or program emphasis. These recommendations were based upon the notion that the needs of society were increasing, and that veterinary colleges could only respond
74 Education of Professionals to the changing needs of society through expansion. By encouraging colleges to work together, the recommendation to create centers of emphasis would allow veterinary medical education at large to respond, without requiring each college to expand its programs. With this, veterinary colleges were also asked to increase enrollments, so that the profession would be better able to respond to new demands and roles. In turn, accreditation standards would be modified, and limited to the requirements to teach a core program plus the areas of professional focus offered by an individual college. The Report also encouraged colleges to capitalize on emerging technology to provide distance education and web-based instruction, and to develop opportunities for virtual training through the use of simulators. These would be used to train students, and for continuing education programs for practicing veterinarians wishing to further develop their skills, or to retrain for other areas within the profession. The Report also directed veterinary colleges to address the problem of student debt, particularly in segments of the profession or regions of the country that have the greatest need for veterinary care. The Foresight Report generated lively discussion among veterinary educators, and the impact of its recommendations has not yet been fully realized. However, a key point in the Report focused on a national strategic plan for veterinary education that would be uniformly implemented, and it outlined possible models. Whether or not this is achievable in the coming decades remains to be seen. Themes in Veterinary Education Within the broad framework described above, a number of themes span veterinary education as a whole, and are also common to other professions. Perhaps the most familiar themes are the tension between breadth and depth, the need to integrate theoretical knowledge with practice, and finding ways to help students become comfortable with ambiguity in solving novel, ill-structured problems. All of these contribute to the development of professional expertise, and present challenges for teaching and learning. Many veterinary educators recognize the importance of integrating theory with practice, but few curricular alternatives have been offered for improving upon (or moving beyond) the apprenticeship model of educating. Educators have long incorporated various forms of real-world experience in their teaching to present new information, underscore the practical application of curricular material, and to enhance and extend student learning. For students at the university level, apprenticeships, field experiences, internships, and practicum experiences represent examples of the types of practical experiences many encounter as extensions (or even requirements) of their formal education. However, the Flexner model for medical education (formal theoretical training followed by a period of supervised practical application) dominates veterinary education, at the expense of alternatives that may be effective for achieving these goals. The research on meaningful learning supports a view of the development of expertise in veterinary medicine that helps students make meaningful and progressively elaborate connections between the knowledge they gain in a classroom and that acquired through field and clinical experience. The need to develop elaborate, valid propositional knowledge structures that provide a scaffold for subsequent knowledge gained through experience is consistent with research on learning in other domains, and with the Flexner model for medical education: acquisition of basic concepts, followed by practical application. While the characteristics of novices and experts (and their respective abilities) are now more clearly understood, models of medical expertise have lacked an account of the processes by which novices become experts. However, three factors are key: 1. the information to be learned must be appropriately structured, 2. the learning context must be clearly established, and 3. the learner needs to be actively engaged in the learning process. The structure of most veterinary curricula inhibits, rather than facilitates, meaningful learning and the integration of theoretical with practical knowledge. The disciplinary boundaries imposed in most traditional curricular structures encourage students to compartmentalize their learning, and most traditional examination formats focus on the retention of factual information rather than on more complex cognitive processes. This problem is exacerbated by exhaustive content coverage, and the need for veterinary curricula to address comparative aspects of many topics, such as important species differences. Increased specialization in the clinical domain has also led to the addition of significant amounts of content, which are now identified as core and required of all students. Topics such as oncology, dentistry, and emergency and critical care medicine are relatively new additions to the veterinary professional curriculum, and require time within course syllabi that are already very full. As mentioned previously, the number of veterinary graduates who are electing to pursue additional postgraduate training through internships and residencies is also increasing. A shift away from the education of generalist veterinarians toward a more specialized model could provide increased flexibility in curricular structure that would also bring important benefits to student learning. Another theme in veterinary education, which is common to medical educators, is the development and assessment of clinical competency. New accreditation
Veterinary Education 75 standards relating to the assessment of clinical competence have increased accountability for the acquisition of a broad range of skills, and in recent years, veterinary colleges have implemented initiatives to document the development of students technical skills. The focus on clinical competency (which in its extreme form might be interpreted as promoting the view of veterinarian as technician) is in tension with the view of the veterinarian as scientist, and raises questions within the colleges about the appropriate balance between theoretical and practical knowledge. To meet accreditation requirements and continue to deliver curricula of sufficient breadth and depth that are sustainable over time, colleges must find ways to incorporate the assessment of multiple attributes (knowledge, skills, and behaviors) within existing courses and frameworks. A common solution to a too-full curriculum is to shift the need for certain information or content downstream, by increasing program prerequisites. While this strategy can provide some relief in the short term, it could negatively impact admissions by increasing the requirements applicants are asked to fulfill. While the prerequisite courses required of applicants to veterinary colleges are not uniform, there are a number of requirements that are common. Large numbers of required courses, or variation among admissions requirements, can create undue impediments or obstacles for prospective students interested in preparing for a career in veterinary medicine. Moreover, for any profession seeking to attract the greatest number of applicants with diverse backgrounds, this is an important issue that must be considered. Similar to medical education, there is an emphasis on the need to ensure diversity within the student body and, ultimately, the profession. Certainly, in order for the profession to more closely resemble the society it serves, the number of underrepresented minorities who pursue a veterinary career must increase. Diversity is important not only in terms of an individual s ethnic or cultural diversity, but also in terms of her or his area of interest within the profession. The profession needs applicants who are also interested in research, in rural practice, in food supply veterinary medicine, and in public health. The gender shift that has occurred in the past 30 years also has implications for the profession, related to the declining number of male applicants. The decline of any group of applicants is troubling, and is at least partially attributed to the salary levels of new veterinary graduates and student indebtedness. Financial considerations create additional challenges for attracting a large, diverse, and talented group of prospective students. Another important theme in veterinary education is the use of animals in teaching. Animals are an essential component of veterinary education, but associated costs, availability of healthy animals and of cadavers, concerns for animal welfare, and the availability of technological alternatives, such as models and simulators, can impact the number and type of experiences offered. Even for noninvasive procedures, such as animal handling and restraint, the availability of animals for teaching can be an issue. In addition, as veterinary medical teaching hospitals provide increasing levels of tertiary care, students exposure to routine cases that are typical of primary care practice is becoming limited. Animal patients in veterinary teaching hospitals are seriously ill, and students are often relegated to the role of observer. Creative solutions, such as spay/neuter programs between animal shelters and veterinary colleges, can help address societal problems such as pet overpopulation, while improving a shelter animal s chances of being adopted and providing opportunities for students to develop important skills. However, programs such as this will not meet all needs, including the need for case material in certain subject areas. Many of the veterinary schools in the United Kingdom and Europe have made strides in the use of synthetic models, providing cost-effective opportunities for students to learn important skills. Other schools have forged partnerships with veterinary practitioners, who serve as adjunct faculty while educating veterinary students in private practices. Particularly for food animals, this model for clinical instruction has been used successfully in many parts of the world. As the US population become increasingly urbanized and veterinary colleges open referral clinics in metropolitan areas, this decentralized model of clinical instruction may become more common. Challenges for Veterinary Education Additional challenges to those noted above include the costs associated with clinical instruction and the economic future of the teaching hospital; demographic trends that project large numbers of faculty members will retire from veterinary colleges in the next two decades; the educational impact of increased enrollments in colleges of veterinary medicine to meet anticipated workforce needs; implications of limited licensure on educational programs, including continuing education; and ethical challenges resulting from new scientific advancements. Other developments that result from discoveries in cloning, synthetic animal-cell-based protein foods, organ farming, and xenotransplantation not only hold promise for improving human health and food safety, but also pose ethical challenges that veterinarians will need to help society address. The opportunity for veterinary educators to find creative and innovative approaches for meeting these challenges is large and growing, but will require bold initiatives and vision. Professional schools are responsible for responding to the needs of their stakeholders, but must also take the initiative to continually define and advance their professions. Veterinary colleges must be leaders in ensuring
76 Education of Professionals that the profession continues to serve society, promoting human and animal health, and in preparing flexible, skilled graduates who are capable of solving problems many of us cannot anticipate today. See also: Education for Medicine; Professions Health- Related. Further Reading Adams, C. L. and Kurtz, S. M. (2006). Building on existing models from human medical education to develop a communication curriculum in veterinary medicine. Journal of Veterinary Medical Education 33, 28 37. Blumberg, P. (2005). Why self-directed learning is not learned and practiced in veterinary education. Journal of Veterinary Medical Education 32, 290 295. Brown, J. P. and Silverman, J. D. (1999). The current and future market for veterinarians and veterinary medical services in the United States: Executive summary. Journal of the American Veterinary Medical Association 215, 161 183. Chieffo, C., Kelly, A. M., and Ferguson, J. (2008). Trends in gender, employment, salary, and debt of graduates of US veterinary medical schools and colleges. Journal of the American Veterinary Medical Association 233, 910 917. Edmondson, K. M. (2001). Applying what we know about learning to veterinary education. Journal of Veterinary Medical Education 28, 54 55. Farnsworth, C. C. (1997). Measuring the effects of problem-based learning on the development of veterinary students clinical expertise. Academic Medicine 72, 552 554. Fernandes, T. H. (2004). European veterinary education: A bridge to quality. Veterinary Journal 169, 210 215. Halliwell, R. E. W. (2004). Accreditation of veterinary schools in the United Kingdom and the European Union: The process, current issues and trends, and future concerns. Journal of Veterinary Medical Education 31, 105 110. Hubbell, J. A. E. (2008). Veterinary teaching hospitals: Current challenges and pathways for the future. Journal of Veterinary Medical Education 35, 62 65. Kogan, L. R., Butler, C. L., Lagoni, L. K., et al. (2004). Training in client relations and communication skills in veterinary medical curricula and usage after graduation. Journal of the American Veterinary Medical Association 224, 504 507. McGreevy, P. (2007). Firm but gentle: Learning to handle with care. Journal of Veterinary Medical Education 34, 539 541. Michell, A. R. (2004). European veterinary education: What does harmonization mean? Veterinary Journal 169, 157 158. Regehr, G. and Norman, G. R. (1996). Issues in cognitive psychology: Implications for professional education. Academic Medicine 71, 988 1001. Walsh, D. A., Osburn, B. I., and Christopher, M. M. (2001). Defining the attributes expected of graduating veterinary medical students. Journal of the American Veterinary Medical Association 219, 1358 1365. Willis, N. G., Monroe, F. A., Potworowski, J. A., et al. (2007). The Foresight Report. Journal of Veterinary Medical Education 34, 3 25. Relevant Websites http://www.aavsb.org American Association of Veterinary State Boards. http://www.avma.org American Veterinary Medical Association. http://www.aavmc.org Association of American Veterinary Medical Colleges. http://www.nbvme.org National Board of Veterinary Medical Examiners. http://canadianveterinarians.net National Examining Board (Canada). http://www.nbvme.org North American Veterinary Licensing Examination. http://www.onehealthinitiative.com One Health Initiative.