September 01, 2010

 

 Long road ahead to change veterinary education

 Yet implementation imperative to NAVMEC's success

 

August 18, 2010

 

 Woodrow Wilson once said, "It is easier to change the location of a cemetery than to change the school curriculum." The fact that this quote came up no less than three times at the third and final North American Veterinary Medical Education Consortium meeting reinforces the arduous task before the board and the Association of American Veterinary Medical Colleges.

The July 14-16 meeting at the Oquendo Center for Clinical Education in Las Vegas had the most ambitious agenda of the meetings to date. Nearly 200 participants were asked to synthesize information from the first two meetings; discuss the current state of accreditation, testing, and licensure and create recommendations for change; and, ultimately, come up with ways to implement recommendations that come from NAVMEC.

"We're going to create our own destiny for the profession. We have all aspects of veterinary medicine to help formulate those opinions and, hopefully, we can take those and move them forward," said Dr. Bennie I. Osburn, dean of the University of California-Davis School of Veterinary Medicine and chair of the NAVMEC board of directors.

Nature via nurture 

A major part of NAVMEC has been identifying core competencies, which include the essential nontechnical skills that veterinary students need to embody. At the most recent meeting, participants debated how and whether they can even be taught. 
 

Dr. Jennifer L. Hodgson, associate dean for professional programs at the Virginia-Maryland Regional College of Veterinary Medicine, said faculty need to be trained in assessing and teaching these skills, which can present a hurdle in and of itself.

That's because not only do many still believe these skills are intrinsic, they also might not be comfortable teaching these areas themselves, Dr. Hodgson said, making it less likely that they will adopt these subjects in their classes.

Core competencies can and should be taught, said Dr. J. David Haworth, director of Global Alliances at Pfizer Animal Health, but with realistic expectations. He gave the analogy that not every horse can run a quarter mile in under 30 seconds, but every horse can be taught to run a quarter mile. Similarly, veterinary schools and colleges need to establish a baseline of competencies and then guide students to exceed them.

To be successful in this "is a partnership between selecting the right people and teaching them further," Dr. Haworth said, pointing out that much of this involves requiring students to gain experience and having faculty reinforce good behaviors.

Training students in core competencies need not be limited to the classes within the curriculum, noted Dr. Kate Hodgson, a consultant in continuing professional development with the College of Veterinarians of Ontario. Students also develop core veterinary competencies through extracurricular activities.

During her presentation, Dr. Hodgson said the changing needs of society create a need to analyze and clarify the core competencies of the veterinary profession and define relevant outcomes across the continuum of the profession—from preveterinary studies through the continuing education choices made by veterinarians established in their careers.

"A competency-based outcome orientation enables the profession to meet the challenges of evolving roles of veterinarians in complex health care settings," Dr. Hodgson said.

Since 2002, the AVMA Council on Education's standards have included a requirement that veterinary schools have an outcomes assessment program in place. And in fact, the current standards address in some manner most of the core competencies outlined by NAVMEC.  

Follow the leader

What role accreditation as well as licensure and testing will have in forthcoming NAVMEC recommendations for potential changes in veterinary education was a source of much discussion. 
 

Some participants thought changes made in the COE accreditation standards as well as on state and national tests would help faculty and administrators achieve buy-in for NAVMEC recommendations.

Representatives from accreditation, licensure, and testing in veterinary
education discuss potential for change during a panel session.
 

However, during a panel discussion composed of representatives from those groups, most stated that while they won't hinder a transformation in veterinary education, they may not be the primary agents of change.

A former member of the American Association of Veterinary State Boards, Dr. John King, said, "The driver wouldn't be the (AASVB) but the legislators who decide to change the laws. To get consistency and agreement among all the states legislators, (that's tough). Yes, they can drive change, but I think to a large extent the profession, educators, and (NAVMEC) board will be the drivers."

Dr. David E. Granstrom, director of the AVMA Education and Research Division, added that accreditation is based on the standards, which are supposed to reflect societal needs. The AVMA Council on Education is obligated to listen to educators, practitioners, and the public because that feedback is ultimately what forms standards.

The standards of accreditation are designed to address societal needs while retaining sufficient flexibility to allow each college to meet its specific mission. The standards are the yardstick applied relative to that mission, he said. Nationally coordinated recommendations could lead change. Ultimately, the impact made through accreditation will depend on how accurately those recommendations reflect societal needs.

Dr. Linda L. Blythe, chair of the National Board of Veterinary Medical Examiners, took a similar stance to Dr. King's when she said, "Each (state) is an individual kingdom in its own. They take our advice, but they are independent."

She continued, "Remember, we make tests and we make tests at the request of state boards. I don't see the state licensing board as an impediment at all. We'll make what we're asked."  

Called into action

John Kotter, an expert on leadership and change and an emeritus professor at Harvard University, held a question-and-answer session about how organizations can effectively implement change. 
 

One audience member asked, "We're dealing with a loose affiliation of groups. Can you give us a perspective on how others created systemic change?"

Kotter replied that there is no single formula, but one way to do it, particularly if a group is large enough, is to develop a core group within the group who feel strongly about making changes "so that even with all the pressures on their time, they're willing to spend time with the core group and they provide some of the engine that gets things going, and then subgroups start to hook into them with meaningful roles. … The core group starts finding meaningful ways to get volunteers to hook on and in subgroups they can tackle more specific strategic challenges and barriers," he said.

Another audience member asked how veterinary schools can develop a vision for a profession that is made up of organizations that both compete for and collaborate with resources.

"Competition internally for funds is not anything new. The way you pull it all together is the same, no matter the setting. There's an appropriate time in the process where you get everyone to create and understand a vision that's broader than the pieces and that everyone can see the wisdom of," Kotter said. "The competition continues, but it's not a factor that drags you down, because everyone feels strongly about something that affects all of them. They see the whole can be larger than individual parts. But if people don't buy into it, then competition will overwhelm cooperation."

Arguably, the group with the greatest stake in overhauling veterinary medical education is the students themselves. According to Aaron G. Gibbons, Student AVMA president, they're ready and willing to make things happen now.

Dr. Jennifer L. Hodgson, associate dean for professional programs
at the Virginia-Maryland Regional College of Veterinary Medicine,
said faculty need to be trained in assessing and teaching
nontechnical skills such as communication.
 

He gave the example of the student chapter of the AVMA at Iowa State University, which presented Servant Leadership Awards this past spring to select faculty members who helped develop the students as individuals.

"To me, that is something that the faculty are going to recognize. The other faculty who don't receive the award might pick up that something isn't right," he said. "Students have a voice and power to influence or drive change, and they're willing to step up and do things. We're here to implement whatever we can, but we need help and direction to do it."  

A new direction

Though the direction and outcome from NAVMEC have yet to be determined, if it were up to Dr. Peter Eyre, the results from this consortium would be nothing like the past.

The professor and dean emeritus of the Virginia-Maryland Regional College of Veterinary Medicine pointed out that since 1961, there have been no fewer than 18 studies on the future of veterinary medical education.

"I'd like to ask you, what systemic change has occurred as a result of all these? There certainly have been some changes, but have we really had the kinds of systemic changes we need? Here we are. We've been studying ourselves for essentially 50 years. The AAVMC has been responsible for nearly half of those studies," Dr. Eyre said. "If we're not careful, the study becomes more important than the process it's trying to improve. And that's what's been in the past. We'll leave this room feeling good about the things we've done. Then what? NAVMEC may just be another encore if we're not careful and (don't) manage this thing adequately."

Dr. Eyre gave a few recommendations to avoid this outcome. For one, he said that the NAVMEC board of directors' main role should be to serve as a liaison that facilitates coordination among the veterinary schools; accrediting, licensing, and testing bodies; and other organizations.

"If we're not careful, the study becomes more important than the process it's trying to improve. And that's what's been in the past. We'll leave this room feeling good about the things we've done. Then what? NAVMEC may just be another encore if we're not careful and (don't) manage this thing adequately."   

—DR. PETER EYRE, PROFESSOR AND DEAN EMERITUS, VIRGINIA-MARYLAND REGIONAL COLLEGE OF VETERINARY MEDICINE

 

The AAVMC, he pointed out, should take responsibility for moving NAVMEC forward. Working with deans would be a key component of that.
 

"I recommend that the first step is to sell this to the deans—hardly any deans attended the three NAVMEC meetings. AAVMC should identify NAVMEC ambassadors who would visit each veterinary college or school and meet with the deans and faculties in order to describe the study and explain its recommendations," Dr. Eyre said.

Faculty must be persuaded that change is needed, and if this does not happen, nothing much is going to happen at the faculty level, he added. Merely convening an AAVMC roundtable of the deans at one of their regular meetings is unlikely to get the job done, he said.

For the longer term, Dr. Eyre suggested the AAVMC provide implementation resources, such as assisting deans in raising money or hiring a NAVMEC coordinator who can apply for grants or work for other funding for schools. Then, perhaps a fourth NAVMEC meeting could be held in winter 2011 to report back on progress made by the colleges. He also proposed an award that could go to the top college proposal considered most likely to generate "transformative, efficient, sustainable changes in veterinary medical education that address important professional needs."

"We can't sit around and send out a report and assume deans and faculty will like and incorporate (NAVMEC recommendations)," Dr. Eyre said.

NAVMEC project manager Dr. Mary Beth Leininger said at press time that an executive summary from the third NAVMEC meeting would be available in August at www.navmec.org. The NAVMEC board of directors will compile its recommendations and submit a final report to the AAVMC board of directors by the end of the year, and it will contain an implementation plan.