Friday, July 1, 2011

How can vet school better prepare veterinarians?

This question was posed way back on a post I wrote about disillusionment with the veterinary field, and I've been meaning to get back around to it.

Here are my gripes with the veterinary curriculum as it stands:

1) Lack of tracking (at least, at my school). Everyone must take all classes - equine surgery, food animal medicine, exotics and wildlife.

2) Lack of applicable real world experience in the 3rd and 4th years.

3) Focus on extremely advanced diagnostics (MRI, CT scan) and treatments (linear accelerator, radiation therapy, ureteral stenting) instead of focus on "real-world" medicine and approaches.

4) Black and white, wrong and right answers. Shades of grey are not taught.

5) No classes on client communications, financial management, or anything to do with money.

So what are the answers to these problems?

First and foremost, I am a strong proponent of tracking. Everyone takes the same basic sciences for the first 2 years - anatomy, physiology, microbiology, clinical pathology, etc. After that, the classes become more specific. At that point, tracking should start - equine, food animal, small animal, and exotics/wildlife. Many but not all schools are starting to do this.

I cannot tell you how much I felt like 3 months of my 4th year were wasted in the barn. Everyone must rotate through 1 month of ambulatory services, 2 weeks of food animal production, 2 weeks of equine surgery, 2 weeks of overnights, and 2 weeks of equine medicine. That was 3 months that I could have been focusing on my chosen area - small animal medicine. Instead, I was a glorified technician, running around the barn on overnights, taking care of sick cows and sheep and pigs. Did it have its fun moments? Absolutely. Ambulatory was great fun, even in the dead of a Southern summer (July/August). It was still wasted time in which I could have been learning how to deal with the real world.

Secondly, there was no real world experience in 4th year. We were given 1 month to do externships. This may sound like a lot of time - but when compared with the other 14 months of rotations, it really isn't. My alma mater is trying to change this. They recently introduced a "Community Practice" to the vet school. This is staffed by students and a couple of the doctors at the school. It provides vaccines and spay/neuter services, which is excellent. It is one step towards making vet school more real world friendly.

Third, the focus on advanced diagnostics is too intense. It is great for us, as veterinarians, to know that CT scan is available, that radiation therapy can treat brain tumors and other disease. It's unlikely that most of us will have clients in this economy that will go that far for their pets. Classes and clinics should focus more on how to approach problems in a realistic and financially feasible way. Sure, it's great that my patients can have chemotherapy if they need it. Most people cannot afford $3000 to treat their pet for a benefit of 9-16 months.

This is hard for vet schools to do, admittedly. Most people coming to the vet school are there to spend any amount of money at whatever outcome. Thus, you spend a lot of time learning how to do echocardiograms, interpret CT/MRIs, and very little time learning how to administer steroids intelligently, and when to use antibiotics and when to avoid them. Part of this is unavoidable and goes back to the need for a community practice (which the school has done, admittedly).

Fourth - black and white answers. When I was in vet school, I was taught "steroids are absolutely wrong unless a definitive diagnosis is obtained." Now, steroids are massively overused and abused. I will admit that freely. Instead of teaching us to use them responsibly however, we were scared away from them altogether. Steroids are a useful tool, when used correctly. The veterinary field is full of useful tools - but they must be applied at the correct time and to the correct diagnosis (or suspected diagnosis).

At the vet school - we almost always got answers - through invasive and advanced diagnostics. In the real world, clients frequently tie our hands due to financial and personal limitations. Thus, we are left guessing at the best diagnosis and treating as best we can. Nowhere is that approach taught in veterinary school. In our case-based laboratories, we also always got an answer - usually after extensive full bloodwork, urinalysis, xrays, and a CT scan. This is not real or practical.

These laboratories should have focused more heavily on generating a problem and differential list, followed by empirical treatment based on suspected diagnosis. Then and only then should the answer have been revealed.

Lastly, we are taught no client communication skills. We are not prepared for the fact that we will act as a psychologist, financial advisor, therapist, priest, and every other niche at some point. When I first entered the real world, I had no idea how to talk to people about money. I had no idea how to ferret out what financial resources and expectations individual clients had. The first year was full of friction as I learned to deal with people, their financial and personal problems, and how to do the best I could with the least amount of resources.

This would be remedied by veterinary schools having client communication classes, simulated clients and patients, and more, more, more, more, MORE real world experience. Those 3 months I wasted in the barn could have been spent on externships at private practices - learning about the field that I was shortly to join.

These are just my thoughts. Does anyone have others?


BSDVM12 said...

Excellent post! As a current 4th-year vet student, I agree wholeheartedly.

And I guess that I have it pretty good at my vet school, judging by your post. We have tracking (small, general, or large) that applies to all of our 3rd year morning clinics and 4th year all-day clinics, as well as our 3rd year spring semester lecture courses. As a small animal tracker, it was fantastic to finish classes last fall knowing that was the last of the large animal lectures I'd ever have to sit through. I'm sure the large animal trackers felt the same. I've followed some discussions about the practicalities of creating separate tracks within the DVM degree itself, such that somebody interested solely in small animal could avoid all of the large animal course material and rotations and NAVLE questions. I'm not sure how such a program would take shape but I find it an intriguing idea.

I also feel lucky that my vet school has a well-established Community Practice service that sees all routine wellness appointments as well as any appt that comes in non-referred and not as an emergency -- meaning itching, skin lesions, lumps, limping, vomiting, diarrhea, coughing, fevers, ear infections, anorexia, etc. Senior students on Community Practice rotation act almost 100% as the doctor (the clinicians are there for backup but only the student interacts with the clients). I've since moved on to Internal Medicine and now Neurology rotations, and it's interesting to see how different the clientele for these services are -- clearly self-selected to be the clients who are willing and have the financial ability to do just about anything we suggest. Definitely not typical of real-world clients.

I do wish I would have more time for externships -- our small animal track has 36 weeks of required rotations at our own VTH, 4 weeks allowed for electives (each elective must be 2 weeks long and can be at the VTH or an externship), and 8 weeks for vacation (during which you can do additional externships if you want).

Finally, I'm glad my vet school has a client communication course. We take 40 hours of communications curriculum as juniors (including videotaped simulated client interactions) and are expected to videotape ourselves and write reflections/critiques as seniors as well. Nonetheless, I feel like even this great effort to help us develop and practice necessary communication skills will still leave me struggling to some degree when I hit the real world.

(We also have 80 hours of a Practice Management course as juniors, which also deals with personal finances, debt management, etc., but I have pretty mixed feelings on how that class was set up.)

So I guess it's nice to see that some vet schools are really trying to work on these things that will help students be better prepared for vet med outside of vet school. Thanks for giving me some perspective on the things that my vet school is trying to do well. I wish more schools would adopt these things!

C. Todd Dolen, DVM said...

I agree with your post. When in vet school I really hated that our school did not track. But now that I've been out 9 years, I find myself looking toward those other (non-small animal) career options when I struggle with burn out. I've actually considered things like food inspection and such and am a bit thankful for the exposure.

Excellent post.