Distributive model of clinical education is a necessary part of the evolution of our professional education.
Certain bold innovations in veterinary education have created unnecessary controversy between the academic community and the general veterinary profession-particularly regarding accreditation by the American Veterinary Medical Association Council on Education1,2-but also among the colleges themselves.
Some veterinarians proclaim that the profession's future can only be built on veterinary educational structures from the past rather than honestly weighing the results and effectiveness of new models.3 Dr. Robert Marshak adamantly condemns distributed education,3 even though all veterinary colleges (including the two institutions with which he is closely associated) have successfully employed community-based clinical education for many years.
A decade ago, Dartmouth Medical School published a study that compared medical students' clinical skills development at a variety of distributed sites with skills learned at its own teaching hospital.4 A class of 156 senior medical students was randomly assigned to two equal-size cohorts and randomly rotated through three clinical education settings: Dartmouth's medical teaching hospital, college-affiliated off-campus clinics, and independent primary care community (family) practices. Four basic clinical skills were evaluated: communication, history taking, physical examination, and patient (human) education.
Researchers found no measurable differences in students' clinical skills among the three practice settings and no variations associated with the different body systems examined. Evidently, a campus-based, university-owned and -staffed teaching hospital may not be the perfect educational “gold standard” that Dr. Marshak advocates.1,3 Indeed, a fixed physical location should no longer be considered necessary to meet high educational standards in science, technology, engineering or medicine. Given the wealth of excellent private veterinary practices, corporate organizations and public agencies-together with state-of-the-art digital and other technologies-education that is well-managed can take place where it makes most sense, including (of course) college laboratories and teaching hospitals if those are the best choices.
Without doubt, the veterinary profession is facing several major issues that will be very difficult to resolve. Securing a prosperous future will require flexible thinking and much more professional harmony and trust than we have so far been able to achieve.5 We must respond appropriately to society's needs and expectations, as society will not adapt itself to our hapless behavior. Whatever we do-or fail to do-there will be real consequences that we'll all share equally, for better or for worse, whichever “side” we are on.
All progress depends on change. Even some of history's most sacred myths were forced to align with new scientific observations. Had it not been for a few condemned sixteenth- and seventeenth-century heretics, the earth might still be flat with the sun still rotating around it!
In our ever-changing world, we must be wary of authoritarianism that fosters notions of intellectual superiority and threatens imaginative thinking and the pursuit of new ventures. As with biogenetic diversity, intellectual diversity and opportunism are essential for advancement. We should keep an open mind about what works. There can be little doubt that community-based (distributed) clinical veterinary education will endure-as it should.
1. Marshak RR. Veterinary school accreditation: on a slippery slope? J Am Vet Med Assoc 2011;239:1183-1187.
2. Nelson PD. Veterinary college accreditation: setting the record straight. J Am Vet Med Assoc 2012;240:810-814.
3. Marshak RR. The rise of anti-intellectualism in veterinary education. dvm360 magazine 2015;46(9):30-34
4. 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.
5. Eyre P, Cohn TJ. Thinking and working together for the common good. J Am Vet Med Assoc 2015;247:591.
Dr. Peter Eyre is professor and dean emeritus at the Virginia-Maryland College of Veterinary Medicine in Blacksburg, Virginia.