Veterinary schools focus on preparing graduates earlier, better


Some schools are upgrading their curricula to teach technical skills from day one and make soft skills mandatory. Is it enough to bridge the gap between ivory tower and the practice trenches?

How do today's veterinary schools squeeze in EVERYTHING DVMs will need when they graduate? ( many new veterinarians, the real education begins after graduation. 

There's so much knowledge and so many clinical skills to be crammed into four years of veterinary school, it's no wonder that some new graduates are left to learn the bulk of the professional and personal skills they need in practice outside of the classroom. 

Veterinary programs have been paying attention, though, and many schools are starting to adjust curricula to meet their students' changing needs. From financial literacy to soft skills to telemedicine, here's how some veterinary schools are updating their programs for a changing profession. 

University of Florida certifies veterinary business sense 

Veterinarians' discomfort with the business side of veterinary medicine has highlighted the need for more training in this area across the profession. At the University of Florida College of Veterinary Medicine in Gainesville, Florida, clinical assistant professor Martha Mallicote, DVM, works on helping students develop business skills in veterinary school. Although the school has long offered certificate programs at the club level, the graduating class of 2013 was the first to participate in a new veterinary certificate offered by the school with more rigorous education in both business and personal finance.

Martha Mallicote, DVMDr. Mallicote believes it's important to expand these offerings to veterinary students, who struggle to manage their school debt and business operations later on as practice owners.

“There's a little bit of fear,” she says. “It's very funny to me how veterinarians and scientists love data, but you put a dollar sign in front of it and they're like ‘no way.'”

The program is optional, Dr. Mallicote adds, but about a third of veterinary students are now earning the certificate before graduation. The program consists of six courses worth 10 credit hours offered throughout students' third and fourth years.

Show me the money! 

In addition to imparting business and personal finance savvy, some universities are also looking for ways to help their graduates manage their enormous levels of veterinary student debt-or keep from racking it up so high in the first place.

One example is the University of Florida, which is now awarding $20 million in veterinary scholarships annually-and the amount is growing. “A large portion of it is in bequests and it's going to take time to start seeing the impact on the debt load for individual students,” says Patricia Wlasuk, development director for scholarship support.

In November, a dvm360 Leadership Challenge will do a deep dive on student debt, examining how today's debt compares with decades past and what graduates, schools, associations and employers are doing to help. 

It's too early to say how much the program is impacting practice ownership, because many of the first graduates with the certificate are just four to five years out in practice, but the college is starting to collect quantitative data. 

Feedback from certificate graduates does indicate that the coursework helped them interview for first jobs or negotiate salaries.

“It seems to make them more marketable. There are a lot of practice owners looking for people to buy into their practice,” Dr. Mallicote says. “Knowing that you're hiring a graduate who's really interested in buying into a practice makes them more desirable.” 

James W. Lloyd, DVM, PhDThese initiatives are applauded by University of Florida veterinary school dean James W. Lloyd, DVM, PhD. “At our college of veterinary medicine, we really emphasize day-one competencies-not just clinical skills, but also communication, emotional intelligence, management, the ability to work in teams and leadership,” Dr. Lloyd says. “We teach clinical skills through emergency and critical care, primary care and dentistry in our hospital as well as through practice-based clerkships and shelter medicine, which take place in non-academic settings.”



Lincoln Memorial starts technical skills training early 

Faster clinical finesse

Here are three paths Lincoln Memorial University professors take to integrate clinical skills earlier in the veterinary school curriculum. Their team explains:

> Surgical ligation is taught starting in first semester, when students learn and practice the skill on models in the clinical skills laboratory. Surgical hand ties are taught, practiced and assessed in first semester, followed by instrument ties, including Miller's knots and transfixing ligatures in second semester. In third semester, students are taught and assessed on clamping, ligating and excising a structure. Each laboratory session involves an explanation of the skill and how and when it's used, a demonstration of the skill, student practice of the skill on a model with faculty oversight and feedback, and an individual assessment and specific feedback on how to improve skills. Students are assessed in objective structured clinical examinations during those first three semesters.

In fourth semester, students use their skill in ligation performing an ovariohysterectomy on a model. Each student is required to demonstrate competence during an end-of-semester practical exam that requires them to spay their model in front of a clinician. This exam is done aseptically in the surgical suite.

In fifth and sixth semesters, students perform spays and neuters on live animals as part of the college's Shelter Outreach in the Appalachia Region (SOAR) program. Students are evaluated on their case management, anesthesia and surgical skills, medical records, animal care and interactions with team members.

> Animal handling and restraint is taught, practiced and assessed beginning in first semester. This includes low-stress handling of companion animals and safe, effective handling of large animals, including horses, cows and sheep. Lab sessions contain background info, demonstrations, hands-on practice time, assessment and instructor feedback. Animal handling and restraint continues to be practiced and refined during students' physical examination labs each semester and is assessed in exams.

> Communication skills are taught starting first semester when students are introduced to the core communication skills and Calgary-Cambridge consultation model in lecture. The students then practice in labs of peers led by a faculty coach. The peers and coach work together to provide feedback and support.?The student also practices using a simulated client who's trained to assess using a rubric as well as providing specific feedback. The simulated encounters are videotaped to allow the student to self-assess as well. In each subsequent semester, students continue to practice communication skills for a wide range of topics and situations, including angry clients, difficult team members, routine preventive healthcare, medical mistakes, obesity, quality of life and more. Workshops are interspersed throughout the semesters and include topics on end-of-life care, the healthcare team, stress resilience, compassion fatigue and other professional topics. Each workshop has a communication opportunity for the students to practice their skills and receive feedback from each other.

At Lincoln Memorial University College of Veterinary Medicine in Harrogate, Tennessee, faculty are teaching and evaluating technical skills throughout the veterinary program rather than waiting until clinical rotations begin.

“Knowledge is key to becoming a good practitioner, but it's not the only thing you would need,” says Julie Williamson, DVM, MS, AFAMEE, the school's director of small animal clinical skills. “The best practitioners are the ones who not only have clinical knowledge, but clinical skills and professional skills, and who can work more closely with the veterinary care team. … We teach clinical skills in a way that allows our students to develop skills sequentially.”

To accomplish this, the school weaves these skills into early lecture-based courses, where students are presented with opportunities to get hands-on experience. They get a firsthand look at concepts they learn in lecture through skills labs and demonstrations that will provide a skill base for their later clinical rotations, she says. (See “Faster clinical finesse” at right.)

“We have [an] expectation for students to demonstrate competencies before they ever begin their clinical year,” Dr. Williamson says. “We're working to try and fill that gap.”

The school also is expanding how it teaches communication and professional skills so that by graduation students are better able to communicate their plan of care and recommendations to pet owners. 

Texas A&M focuses on technical skills as well as not-so-soft soft skills 

While individual programs are adapting to meet changing student needs across the country, some schools are taking the route of a full curriculum review. Texas A&M University's College of Veterinary Medicine and Biomedical Sciences in College Station, Texas, recently conducted a major curriculum analysis that started in 2014 and was completed with cooperation from both short- and long-term graduates, employers and faculty members. 

The final result was an action report that included suggestions for closing gaps in the school's curriculum, says Karen Cornell, DVM, PhD, DACVS, the university's associate dean for professional programs, with changes rolled out to first-year veterinary students at the start of this academic year.

Julie Williamson, DVM, MS, AFAMEE The report suggested more focus on preparing students in problem-solving, critical thinking and critical reasoning. It also indicated a need for increased mastery of communication and other professional skills, like financial literacy, she says.

“We also know that wellness is an important issue in our profession, including work-life balance,” Dr. Cornell says. “That's something we took very seriously and addressed significantly in our curriculum.”

What changed? The school added a series of professional and clinical skills courses for the first three years of the veterinary program with three streams-clinical hands-on skills, critical thinking and professional skills. 

The hands-on clinical skills portion provides additional training and focus on technical proficiencies for ultrasound and physical exam, for example.

For critical thinking, the school is using a published model adapted for veterinary medicine that helps students use a process of reasoning to think through cases-instead of passively absorbing information, she says.

In the third stream for professional skills, students learn how to better communicate with pet owners and colleagues. Students are challenged early on to enter a mock exam room and take histories on patients. They must collect and assess information from an actor posing as a pet owner to formulate a possible diagnosis and explain what's happening with the patient to the layperson.

The professional skills stream also includes the input of a certified financial planner on personal and professional finance. Topics covered include personal budgeting, credit scores, credit cards, student loans, personal wellness, interviewing skills, contract negotiation and cultural competency in dealing with diverse pet owner populations.

“People call these ‘soft skills,' which I think is crazy, because these are professional skills required of students to be successful as professional veterinarians,” Dr. Cornell says.

The school is also working on a plan to incorporate more training on telemedicine and telehealth. The plan is to develop a way to introduce and reinforce these concepts early in the program, then allow students to demonstrate skills by their fourth year. Dr. Cornell says veterinarians, like physicians, are increasingly being asked to deliver care where and how clients need it.

“I think one of the things we need to reinforce is that that we've moved from doctor-centered care to relationship-centered care,” Dr. Cornell says. “Working with a client means more than just providing direct orders.”

Rachael Zimlich is a freelance writer in Cleveland, Ohio, and a former reporter for dvm360 magazine.

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