To help students cope with the stresses of veterinary education and better prepare them for practice, the Washington State University College of Veterinary Medicine has hired a full-time counselor to work with students, and has woven courses on wellness, ethics, professionalism, relationships, and teamwork into the curriculum.
Dr. Richard DeBowes, the chair of the Department of Clinical Sciences, who has helped organize the program, said the effort is, in part, a response to studies that have shown that veterinarians are lacking in business acumen and the interpersonal skills necessary to be successful practitioners. It is also an effort to better meet the needs of a new generation of students who have a different set of competencies, values, strengths, and weaknesses than past generations, he said.
The 1999 report by Brakke Consulting Inc., commissioned by the AVMA to examine the economics of the profession, found that veterinarians with high self-esteem and less fear of negative evaluation earn more. But contrary to what might be expected, fourth-year veterinary students have lower self-esteem and more fear of negative evaluation than first-year students. The study identified the need to understand and reverse this trend to boost veterinary salaries.
The nature of professional medical education may be partially to blame. The negative impact that the high-stress environment of professional medical programs has on students in medical school has been well-documented (Shapiro SL, Shapiro DE, Schwartz GER. Stress Management in Medical Education: A Review of the Literature Acad Med 2000; 75:748-759). Studies also have documented high rates of substance abuse, interpersonal relationship problems, depression and anxiety, and suicide among medical students.
To combat those problems, most medical schools have hired on-site counselors to work with students, and a growing number of schools are adding programs aimed at boosting students' well-being, according to the American Medical Student Association.
Though there has been less research on the well-being of veterinary students, according to one counselor, many schools have hired on-site counselors to help students cope. Five years ago, Washington State hired a professional counselor to work with veterinary students.
Kathleen Ruby, PhD, the college's licensed professional counselor, serves as the foundation for the college's wellness programs. She has observed some of the problems veterinary students face. She has noted that veterinary students have higher levels of anxiety than the general population, and examined some of the reasons for this problem.
"(Veterinary students) come in here and the bell curve reasserts itself," Dr. Ruby said. "People who've always been at the high end of the bell curve are going to be redistributed along the curve. (This is) very distressing, and it creates adversity these students have never had to face before."
High-achieving students may also find it difficult to adjust to the highly regimented curriculum of veterinary school, where students have little control over their time and few choices.
"It creates a real powerlessness in students, where they have no sense of controlling their own destiny. ..." Dr. Ruby said. "It's kind of like we are taking a certain personality type that is very motivated, very driven, and putting them in an environment that is one of the most destructive to them becoming the kind of autonomous people we want them to become."
Traditionally, veterinary schools have ignored students' personal lives, and expected them to cope on their own, Dr. DeBowes said. But that philosophy doesn't work anymore, he said, and veterinary schools are looking for new ways to address overall wellness issues without lowering the bar academically.
As an on-site counselor, Dr. Ruby is available to help students with academic and personal problems, and has helped students dealing with deaths of family members, divorce, relationship stress, and emotional problems. This intervention helps reduce the disruption to students' education and health, Dr. Ruby said. Also, since the counseling office has become a more accepted part of the campus, students are seeking help earlier.
The shift in philosophy also is requiring faculty to take on a new role as coaches.
"That's different than the old style of teaching," Dr. DeBowes said.
At Washington State, this new approach begins with getting new students and faculty acquainted during a weeklong camp at the beginning of the school year. Students, faculty, and administrators are bused to a convention center in the Idaho wilderness where they participate in icebreakers, team-building activities, and discussions about the profession and the demands of veterinary medical training.
"It's been a major component for setting the tone," Dr. Ruby said.
The school has integrated ethics, professionalism, and wellness courses into the curriculum, employing a model used at some medical schools. During the first year, the focus is on helping students adjust to the demands of veterinary education, including understanding the emotions they may experience, juggling school and relationships, and developing professional detachment when dealing with live animals and cadavers.
The second year focuses on group dynamics and teamwork. Students are put into teams to complete a weeklong project that simulates working through a difficult clinical case in a private practice setting. They talk about working with colleagues and understanding themselves and others.
During the third year, students work on reinforcing those skills and take a seminar that introduces them to the way clinics operate.
"It's helping them get ready ethically, emotionally, psychologically for the experiences they might be having in clinics," Dr. Ruby said. Overall, she has gotten a positive reaction from students and faculty.
"The faculty is cautiously optimistic about it. This constitutes a departure from the traditional approach to veterinary education, " Dr. DeBowes said. He explained that faculty members experienced a more traditional approach to veterinary training when they were veterinary students.
Dr. DeBowes said students have been responding to the program by being more collaborative about problem solving and letting faculty know when things aren't working for them. For example, students recently approached faculty to inquire whether it would be possible to get tests graded and returned more quickly, so they can use their tests as learning tools. He said the students recognized that grading more complicated examinations takes time, and they were adamant that they did not want their tests dumbed down to speed their grading and return.
Dr. DeBowes said the school plans to evaluate the success of the program over the long term by talking to faculty and students, employers of the graduates, and the graduates themselves to determine their satisfaction with the profession, and whether they choose to stay in the profession.