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Path to a Clinician

"Engineering" a Veterinarian: Re-Evaluating the Path from Prerequisites to Competency

A recent educational survey research article was just published in the Journal of the American Veterinary Medical Association.  Opinion pieces on veterinary education aside, research articles of this nature are relatively rare for this journal, so its presence is notable in and of itself The article by Moore, Cohen and Brown dated November 1, 2018 surveyed Associate Deans for Academic Affairs at North American and Caribbean veterinary schools (n=21; 66% response rate). They asked them to rank list the first-year curricular courses that entering students struggled with the most, based upon the frequency of achievement of a C grade or less.  As a previous department head of a department responsible for faculty teaching such courses, this study was of great personal interest to me.  

 

The top-ranked "struggle" courses were (% of all responses in top 3 ranking)

Anatomy: 29

Anatomy and Physiology: 14

Physiology: 17

Histology and Developmental Anatomy, Immunology, Neurosciences and Biochemistry: each 7

Biochemistry: 5

 

Furthermore, the authors reviewed the required prerequisite courses reported in data provided to the American Association of Veterinary Medical Colleges by 32 North American and Caribbean veterinary schoolsOf the sciences, Biochemistry was required by 97%, Biology and Physics by 91%, Organic Chemistry by 88%, Mathematics or Statistics by 78%, Inorganic Chemistry by 81%, Genetics by 66%, Microbiology by 41%. Physiology was required only by 16%, Animal Nutrition by 12%, Cellular Biology by 6% and Anatomy by 1 school (3%).

 

Choosing the 6 courses that were required by >90% of the schools, the authors then conducted a survey of 771 practicing veterinarians asking them to assign a rank to the importance of these prerequisite courses.  I’ll report the collective % ranking a course in the top 3:

Biology: 98% 

Math or Statistics: 75%

Physics: 64%

Biochemistry: 51%

Organic Chemistry: 27%

Inorganic Chemistry: 10%

 

The same practitioners were asked to suggest and rank 7 courses that might be an alternative prerequisites (again, % for 1st-3rd ranking).  For ease of reading, where available, I list current percentages mentioned above

Anatomy: 84%   Current: 3%

Physiology: 78%; Current 16%

Cell Biology: 55%; Current: 6%

Communication: 37%; Current: not mentioned

Immunology: 23%; Current: not mentioned

Microbiology: 8%; Current: 41%

 

The authors concluded that students struggled most with anatomy, physiology and histology and that these courses were rarely included in required prerequisites.  It is not clear where the conclusions on histology arose, but let’s focus on anatomy and physiology. There is no question that these 2 topics consume a large percentage of the didactic and laboratory instruction in most first year curricula.  However, if the implication is that prior exposure, probably as an upper undergraduate biology electives, would relieve student stress, this might be too simplistic.  As most commonly taught, both of these topics are laden with factual content, and few undergraduate courses in these subjects reach the depth (or potential medical relevance) of those in an entire year of veterinary instruction. 

 

My observation has been that, regardless of the topic, it is the sheer volume of information that challenges students in a way they have often not experienced prior to veterinary school.  I fondly recall a seasoned faculty member teaching histology telling me that he felt that he should be given extra teaching credit for guiding first year students on “how to learn” in the context of the inevitably challenging veterinary curriculum. 

 

So, would eroding time devoted to other prerequisites such as organic chemistry or physics, as suggested by the authors,  necessarily help?  Maybe, but so might courses in medical terminology, or more refined prerequisite courses, which is the direction taken by medical schools as represented by changes in prerequisite pre-medical school science courses. While medical schools are paying more attention to sociology and psychology topics, they also are evaluating “what kind” of chemistry needs to be taught, and some have concluded that undergraduate pre-medical organic chemistry should be focused not on synthetic reactions, but more on chemical functional groups, and include the equivalent of a semester of biochemistry.   And the MCAT examination now explicitly evaluates critical thinking and problem-solving while expecting the candidate to utilize their base knowledge.

https://students-residents.aamc.org/choosing-medical-career/article/admission-requirements-medical-school/

 

As a clinical pharmacologist who also has taught physiology and the metabolism associated with endocrinology, I became acutely aware of what entering veterinary students understand from prior coursework.  So, even though 97% of veterinary schools require biochemistry, it has been my observation that what veterinary students need to understand, in addition to a solid understanding of molecular genetic principles, is metabolic biochemistry. Some undergraduate biochemistry courses lean more toward physical biochemistry, and students don’t see the relevance, and feel comfortable with forgetting. As an endocrinologist, I’d love for them to understand what a ketone body is, and where it comes from!As a pharmacologist, I’d be thrilled if they could be more familiar with the functional group organic chemistry so important to drug structure-activity relationships.

 

There are general didactic issues also, which have been previously addressed in this blog. For example, is the question mostly about whether students can handle large volumes of content, which, for many students means, memorize and forget? OR, should we be looking at their experiences (both pre-curricular and curricular) regarding finding and understanding such information in order to solve complex clinical problems?

 

Current initiatives within the veterinary educational scene should also be noted.  The AAVMC initiative to consider Competency-Based Veterinary Education, which, if implemented, would require careful evaluation of particularly the pre-clinical content behind these competencies. The Domains of Competence and Entrustable Professional Activities (EPAs) would be used to map out a curriculum.

CBVE Competence DomainsCBVE EPAs

 

All of these data and the CBVE initiative, and thoughts about years of student schooling and debt to train a veterinarian raise up again to me the idea I believe first proposed by a fellow pharmacologist and previous Dean Peter Eyre in the J Vet Med Ed in 2011.  https://doi.org/10.3138/jvme.38.4.328

 

Engineering Vet Education

 

Summarizing this adaptation of the engineering model to veterinary medicine in 3 general but overlapping phases:

 

  1. 4-year non-clinical core-elective program with majors related to biomedicine, e.g. toxicology and pharmacology, public health, pathobiology. Admission to the DVM program would be considered after the 3rd year. Others would complete a BS in biomedical sciences.
  2. 3- year core-elective species- or discipline-based (tracked) curriculum leading to a DVM degree in a chosen field of veterinary practice.
  3. The third component is the integration of themes of BS majors and DVM tracks with corresponding master's and PhD curricula, facilitating dual degree programs.

 

The idea of a 6-year training program for veterinarians is not far-fetched: most of the rest of the world has been using some version of this model of veterinary education for some time now.   The key is understanding the connections and proper sequence between content and skillsets…so as we address prerequisites and Day 1 clinical competencies, perhaps we should also revisit Peter’s idea?

 

Title Graphic Credits: Ralph M. Askren, DVM