Commentary response: Distributive teaching model has doneand will donothing for veterinary medicines high standards

Dr. Peter Eyre is a passionate advocate of change in veterinary medical education. Indeed, he has been remarkably successful in affecting change by promoting and participating in the establishment of veterinary schools with a distributive model of clinical education. In his recent commentary, "Veterinary education and intellectual freedom," he argues that such schools, existing without a contemporary research enterprise or teaching hospital, represent a bold innovation and are comparable in quality to schools with teaching hospitals and core-elective curriculums that use clinical, research and public health electives to enrich and broaden a student's educational experience.

To support his view Dr. Eyre cites a 2005 Dartmouth Medical School (DMS) observational, non-randomized study1 in which the clinical skills of second-year medical students did not differ overall by preceptor's settings (teaching hospital, clinics and community practices). Dr. Eyre calls for similar studies in veterinary medicine but fails to recognize that a similar study would be impossible to implement in evaluating a distributed community-based veterinary clinical education program.

In the Dartmouth study students were divided into small groups and each given a standardized cardiopulmonary and standardized endocrine case available in all three settings. Each case was introduced and described in an introductory session followed by group exercises prior to preceptor assignments. All encounters were videotaped and standardized patient care instruments were designed and tested jointly by a course director and clinical skills evaluator.

To appreciate how Dr. Eyre's commentary misleads the reader, it should be noted that DMS is an elite medical school with a superb basic science faculty and a full-service teaching hospital (The Mary Hitchcock Memorial Hospital) where all students spend time in an environment where teaching, research and patient care are integrated. Also, Dr. Eyre does not mention that the kind of exercises described in the DMS study are designed specifically to prepare medical students for their intense clinical clerkship years, mainly in teaching hospitals. Nor does he take into account that, unlike veterinary school graduates, medical graduates wishing to practice are required to enter internship and residency programs in hospital settings.

I believe, as Dr. Eyre does, that veterinary medical education must change with the times and society's needs and expectations, present and future, but hardly in the direction that he advocates. I daresay that when the day comes that the Council on Education (COE), the accrediting agency for schools of veterinary medicine, begins to enforce its own published standards, no school, save one (Calgary), that uses a distributed model will be in a position to retain its accreditation. At present, for example, none except Calgary are in compliance with research standard 10-a “must comply” standard. Nor, in my opinion, do they meet COE standards for physical facilities, faculty size and quality, representation of essential disciplines, curriculum, clinical resources, and physical facilities and equipment.

In Dr. Eyre's model I wonder who will create new knowledge, technologies and procedures? Who will discover and cure new diseases? Who will educate the veterinarian-scientists required to sustain our discovery-based profession? Who will offer referral diagnostic services and quality continuing education? Who will expose students to the opportunities and thrill of research and discovery? Who will develop and introduce new clinical specialties? Who will be qualified to contribute to the profession's One Health initiative? Who will train students to address the urgent global issues of poverty, hunger, food safety and security, and environmental degradation, problems associated with the intensive livestock and poultry agricultural practices needed to feed an exploding, mostly urban, human population?

I would suggest that the traditional teaching hospital model, in its many guises, has been and continues to be far more flexible, successful and productive than Dr. Eyre concedes. Indeed, the revolutionary changes, largely modeled on medical education that began in the aftermath of World War II, rapidly transformed a near-moribund educational establishment into a galaxy of science-based, research- oriented schools that continue to lead worldwide in the education and practice of veterinary medicine.2 I would ask Dr. Eyre to imagine where the profession would find itself today if his distributive model had been dominant during those past sixty-plus years.

References

1. Carney PA, Ogrinc G, Harwood BG et al. The influence of teaching setting on medical students' clinical skills development: is the academic medical center the “gold standard”? Acad Med 2005;80:1153-1158.

2. Marshak RR. Veterinary school accreditation: on a slippery slope? Jour Amer Vet Med Assoc 2011;239:1183-1187.

Robert Marshak is professor emeritus of medicine and dean emeritus of the University of Pennsylvania School of Veterinary Medicine.