December 15, 2014

 

 The toll it takes to earn a veterinary degree

​Seeing students struggle, veterinary colleges boost wellness efforts

LaToiya Templeton had a rough transition into veterinary college, to put it mildly. Originally from the South Side of Chicago, she was one of only two black students in her class at The Ohio State University College of Veterinary Medicine. That’s out of 160 people. She admits it came as a shock moving to a place with little diversity—not only racially but also socioeconomically.

“Before vet school, I helped support my family back home. It’s not uncommon where I’m from that your parents barely graduated high school, or you have to send money to a sibling because they need it, or there are 15 people living in a house because they can’t afford rent,” Templeton said.



​The second AAVMC Health and Wellness Summit, held Oct. 8-9 at The Ohio State University campus, saw 72 people from 32 veterinary colleges listen to veterinary students as well as wellness and education experts talk about how to bolster support for struggling students.
 

Such personal upheaval came atop all the typical stresses veterinary students encounter. On top of that, she and her husband, Guy, welcomed a baby girl to their family the day before her third-year classes began this past August. Despite these obstacles, Templeton continues her studies in a year filled with laboratories, lectures, and surgeries. In fact, she says she’s thriving, thanks to the support she has received from the veterinary college. Professors have offered to podcast classes so she can watch from home, and administrators have made themselves available to talk about the difficulties of juggling so many responsibilities.

“Most professors assumed I wouldn’t do my third year because of the rigor and time commitment it requires. Third year is the last year students have prior to clinics and is a mixture of lecture-based learning and labs, practicing essential technical skills. Despite what people thought, (Dr. Linda Lord, associate dean for student affairs at OSU) said I had the option of continuing on, and so I took it,” Templeton said.

She said she couldn’t be doing it without the support of student affairs. “Every day is a challenge and a tribute to my desire for a better future. ... I’m grateful to see that outside of academics, they care and they want me to succeed,” she said.

Though Templeton’s experience may be atypical, her story illustrates how important it is that veterinary colleges support their students’ mental health and overall well-being.

But by their own admission, these institutions say that while their current health and wellness programs are doing some good, they have substantial room for improvement. That’s according to an August 2014 survey by the Association of American Veterinary Medical Colleges. The 23 veterinary colleges that participated acknowledged it is very important that they offer health and wellness programs to students. And yet, the consensus was that the current health and wellness offerings are less than adequate. In fact, the mean annual health and wellness budget at these colleges reportedly was between $25,000 and $50,000 (see accompanying graphs).

The topic of health and wellness in the veterinary profession has gained momentum in recent years as more information comes to light on the prevalence of substance abuse, mental health issues, and suicide among practitioners (see JAVMA, Nov. 15, 2013). Veterinary academia, in particular, has taken the issue to heart, as evidenced by the second AAVMC Health and Wellness Summit, held Oct. 8-9 at The Ohio State University campus in Columbus and sponsored by Zoetis. At the summit, 72 people from 32 veterinary colleges heard students as well as wellness and education experts talk about what’s working and what’s not when it comes to helping students, and why it matters.

“We can do better than what we are doing. ... We must do better for our students. We don’t have a choice,” said one of the speakers, Teresa A. Johnson, PhD, of Ohio State.

Set up for failure?

The limited data available make it clear veterinary students are suffering.

McArthur Hafen Jr., PhD, director of counseling services at Kansas State University College of Veterinary Medicine, surveyed three classes from 2008-2011 once a semester throughout their four years. This included having students fill out the Center for Epidemiologic Studies Depression Scale.

Dr. Hafen found that 32 percent of first-year students met the criteria for clinical depression (JVME 2008;35:102-109). In fact, each time the students were surveyed, a minimum of 28 percent had scores indicative of clinical depression.

“So every third student in a class is struggling at a clinical level. That’s a lot, and that’s a bit of a problem,” he said.

Dr. Hafen said the same study showed that the percentage of veterinary students scoring above the clinical depression cutoff score was higher than percentages reported for the general population (21.5 percent), all college students (23.7 percent), and human medical students (23 percent). 

A later study by Dr. Hafen indicated that veterinary students often experience psychological distress, with a combination of stress, anxiety, and depression symptoms throughout their four years. Depression scores peaked in the third year before falling in the fourth back to first-year levels. Anxiety scores followed a similar trend, remaining elevated throughout the entire program, but with the highest scores occurring in the second and third years. Dr. Hafen found clear predictors of depression and anxiety rates included homesickness, physical health, and unclear instructor expectations (JVME 2012;39:322-330).

Kara Brown, a fourth-year veterinary student at the University of Tennessee, said she struggled with depression in her first few years but was fortunate enough to realize she needed help and sought it out. That isn’t always the case, Brown said, because it’s not in veterinary students’ nature to seek help for fear of appearing weak or as though they shouldn’t be in veterinary school. They may also lack the ability to recognize depression in themselves, she said.

Staying healthy remains a challenge for Brown because of the lack of sleep, unhealthy eating habits, and constant stress.

“Sometimes it feels like the blind leading the blind—I’m depressed, you’re depressed. You’re with each other all the time, and if you’re all feeling the same thing, it’s not beneficial,” Brown said.

Jessie Scaglione, a third-year veterinary student at Ohio State, said she’s noticed a lot of her colleagues haven’t had time to develop emotional maturity.

As a result, Scaglione said, many students don’t have good life skills because they focus on getting straight A’s and on trying to be at the top of their class. Students don’t get enough sleep because they study so much, which is not healthy, and, she said, if the college says “‘This is what we want you to do to be a vet’ but does not take responsibility for supporting them emotionally, you will lose people.”

Terrence Doyle, a professor at Ferris State University in Michigan and an educational consultant, gave a talk on how stress, diet, exercise, and sleep profoundly affect the learning process.

Doyle pointed out that sleep deprivation inhibits learning and memory because it elevates stress hormone concentrations, causing the brain to stop producing new cells in the hippocampus.

“Memories are made during sleep. All of the work students do is sabotaged (when they are going on very little sleep) ecause the brain uses that downtime to take that important information they learned and move it to a more secure area of the brain (the neocortex) where memory has a chance to continue to be retrieved. Also, during sleep, the brain uses sleep spindles, which are bursts of brain waves that may be networking between key regions of the brain to clear a path to learning,” Doyle said.

Jennifer Brandt, PhD, a counselor with Ohio State’s veterinary college, says not only for students but also for interns, residents, and faculty, being well should not be considered a luxury.

“If I’m not bringing my best to work, I could hurt somebody. Taking care of oneself in terms of sleep, eating, and exercise is not a luxury, it is a survival tool to literally survive, and it’s also an issue of performing in a way that preserves life. Because if you haven’t taken care of your needs, animals could die,” she said.

The way forward

So where can veterinary colleges improve?

Even small changes have the potential to make big differences in students’ well-being, LaToiya Templeton said.

“If you look at the schedule and see two midterms are scheduled on a Monday ... moving one test to another day would go a long way with us. It’s not re-creating the world, like having a summer break before fourth year, but some things could be changed that didn’t seem important enough to someone (in administration) to make it happen.”

Dr. Johnson, coordinator for assessment and curriculum design at Ohio State, emphasized that health and wellness are intertwined with the curriculum and need to be thought about concurrently. 



Teresa A. Johnson, PhD, coordinator for assessment and curriculum design at Ohio State, said she’d like to see veterinary colleges normalize help seeking from students, provide greater social support, and partner with other campus mental health resources.
 

For example, a consequence of larger class enrollment at veterinary colleges is that lectures become the primary teaching strategy.

“Lecture isn’t conducive to learning, and learning then doesn’t align with necessary skills. It’s no wonder students stress out when going from lectures to clinics because they’re not prepared. Lectures also lessen student engagement and interaction, so you get student-faculty antagonism,” Dr. Johnson said.

Large class enrollment also lends itself to multiple-choice testing, which leads to frequent high-stakes testing for factual knowledge, giving students little room for failure. Because veterinary students are perfectionists, this eats at them, she said.

Dr. Johnson suggests institutions consider lowering the student-faculty ratio and increasing mentoring opportunities.

“We need butts in seats to pay for faculty and run our clinics—I get it. But we should be creating a better connection between our faculty and students,” Dr. Johnson said.

More specifically, she’d like to see a focus on creating a supportive learning environment that is interactive, lowers competition, and fosters mutual respect. This can be achieved by normalizing help seeking from students, providing greater social support, partnering with other campus mental health resources, and creating professional development for faculty.

Often, veterinary colleges think the answer is hiring a counselor, Dr. Johnson said, “but these counselors feel like they keep putting goldfish back in dirty water. You can’t just take out a teaspoon, you have to change most of the water, and I think it’s pretty clear we have some polluted water in our curricular situations.”

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