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?