LMU models itself on the best

Veterinary college hopes to transform Appalachian region and beyond
Published on July 27, 2016
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The word “innovation” comes up a lot when faculty and staff talk about Lincoln Memorial University College of Veterinary Medicine.

The concept is best on display at the DeBusk Veterinary Teaching Center, just a 10-minute drive from the Harrogate, Tennessee, campus. The Small Animal Skills Clinic houses 18 dental machines and 24 surgery tables, not to mention separate equine and bovine teaching centers replete with rows of custom-built stocks. Every room is controlled by an iPad, and lectures can be live-streamed and recorded. Perhaps most noticeable is what isn’t there: patients and clients. Instead, there are inanimate teaching models, donated cattle and horses grazing in nearby pasture, and animals from local shelters.

Dr. John Dascanio, executive associate dean, said, too often, faculty are on clinic duty at veterinary colleges. He recalls running from the teaching hospital to a lecture and back while on faculty at another veterinary program. Other times, he’s seen faculty who solely perform research and don’t interact with students. And if they did teach, it was no more than 15 hours of lecture a year. At LMU, the faculty is primarily dedicated to teaching, and that’s intentional.

Lincoln Memorial, set to accept its third class of students when classes resumed Aug. 10, has had a few changes of plan along the way but now is poised to do big things for the profession and the Appalachian region. It started with Dr. Glen Hoffsis, founding dean of the veterinary college, who stepped down this past May. Dr. Jason Johnson, who took Dr. Hoffsis’ place, has also been integral to the program’s development (see article). Dr. Johnson says the biggest struggle and opportunity in launching the veterinary college was “getting it right.”

“You ask a lot of questions to everyone who is an expert. You look at who’s doing it best and then do it better,” he said.

Collaboration is key to research

LMU initially had planned to create a six-year program incorporating undergraduate education but scrapped the idea because “it was too much” for the AVMA Council on Education, Dr. Hoffsis said. The program already had enough to tackle with developing its hybrid distributive model of clinical education, which is still relatively new to the profession, he said.

“Developing a school is much harder than running one, something I didn’t initially anticipate,” he said.

That’s saying something, considering Dr. Hoffis served as dean for a combined 18 years at The Ohio State University and University of Florida veterinary colleges before joining the Lincoln Memorial faculty in 2014. Calling the COE’s research programs standard “an aggressive hurdle,” he said LMU decided the best way to meet it would be to use existing expertise. The veterinary college signed a cooperative agreement with the University of Kentucky to tap into its robust research offerings.

“Why replicate everything when you can collaborate?” Dr. Hoffsis said.

Drs. Hoffsis and Meisler
Dr. Glen Hoffsis (left), founding dean of the LMU veterinary college, and Dr. Sam Meisler, owner of five veterinary practices around Knoxville, Tennessee, discuss the veterinary college’s hybrid distributive model. Dr. Meisler is one of the participating mentors who will teach fourth-year students.

Kentucky has two centers of excellence—the Gluck Equine Research Center and the Veterinary Diagnostic Laboratory, which sees among the most large animal specimens in the country. A dozen LMU veterinary students performed research at Kentucky this summer.

That’s not to say LMU faculty don’t perform research. For example, Dr. Robert W. Henry, professor of veterinary anatomy, and Dr. Paul Nader, an LMU instructor of anatomy in zoo and wildlife medicine, are involved in an international project to preserve the intact heart of a blue whale through plastination. Both helped with the removal and preservation and will write an accompanying paper outlining the heart’s anatomy. Other areas of research by faculty include cancer, infectious diseases, lipidomics, leptospirosis, and tick-borne diseases and other parasitic diseases relevant to the Appalachians. Students are engaged in every project.

Serving the Appalachian region

Dr. Gary Vroegindewey, one-health director and assistant professor of one-health medicine, says he was attracted to LMU because of its innovative approach to education that follows many of the concepts developed through the North American Veterinary Medical Education Consortium report.

Dr. Williamson handles the LMUterus
Dr. Julie Williamson, Small Animal Skills Clinic director, handles the LMUterus, a low-fidelity uterus model with three ports that allow students to practice a variety of skin closure techniques. First-year students work on the first layer, and second-year students practice clamping, ligating, and suturing.

Students take one-health courses over five semesters, taught through an interdisciplinary approach by faculty from the veterinary college, DeBusk College of Osteopathic Medicine, and LMU Cumberland Mountain Research Center. Guest lecturers come from other universities, the state public health department, the EcoHealth Alliance, and government agencies. Students learn about relevant research, epidemiology, and biostatistics as well as population health with an emphasis on zoonotic disease.

“We are preparing our students to take a broader look at disease and health from a one-health perspective, including animal health, human health, and environmental health as well as the social, political, cultural, and economic background that influences one health,” Dr. Vroegindewey said.

Dr. Vroegindewey has been integral to another unique LMU institution: the Center for Animal Health in Appalachia. Its mission is to improve animal health and public health in the Appalachian region through conferences, workshops, and training programs to raise awareness and advance knowledge of the issues. Five CAHA research scholars were deployed this summer into rural practices to perform veterinary market studies, for example.

CAHA released its first State of Animal Health in Appalachia report during its inaugural conference, Oct. 14-15, 2015, at the DeBusk teaching center. According to the report, 7,178 veterinarians practice within the footprint of the Appalachian Regional Commission, providing care for an estimated 13.8 million small animals and 13.7 million large animals—with the latter worth about $42 billion. These veterinarians provide employment for an estimated eight people per practice, and their practices provide about $2.3 billion to the economy within the Appalachian footprint.

In the analysis, it first appeared that Appalachia was well-served by veterinarians. Nevertheless, 75 percent of the rural counties within the footprint have an apparent veterinary shortage, estimated to be a total shortage of 1,907 veterinarians.

Geography plays a huge part in health care delivery, Dean Johnson said. “That’s why the University of Tennessee (which also has a veterinary college) seems like it’s hundreds of miles away as opposed to 50.”

Up to 35 students, or about 30 percent of each veterinary class, come from the Appalachian footprint, which comprises 420 counties and 13 states.

“We put the focus on them. They’re more likely to come here and then stay and practice,” said Casey Bassett, PhD, associate dean of students for medical programs and associate professor of histology at the college.

Dr. Hoffsis, who is now tasked with working on fundraising and assisting with special projects, thinks the worst thing for the profession is to underserve areas because then others who aren’t as qualified will step in and take veterinarians’ place. That said, in his many years as a dean, Dr. Hoffsis has seen students change their minds and go into small animal medicine or practice in an urban area even though they had different intentions. That’s why he estimates that five to 10 students a year are likely to go into the Appalachian footprint and practice.

Making an impact

The way the curriculum is structured at LMU, first-year students start out taking basic courses such as histology and parasitology with medical students. In addition, as is the trend now, experiential learning begins in the first week of the first semester and builds throughout the preclinical courses. Students participate in structured, hands-on laboratory sessions to develop diagnostic skills and expertise in surgical and therapeutic procedures as well as skills in communication, teamwork, and leadership.

All skills are cumulative, and objective, structured clinical examinations are given to assess competence. Students who don’t perform a particular task proficiently come back a week later and demonstrate that they have mastered it. In these laboratories, there are six to eight students for every faculty member.

“The labs are designed so not everyone is crowded around a dog on intubation,” Dr. Johnson said.

LMU veterinary students
LMU veterinary students take one-health courses over five semesters. They learn about relevant research, epidemiology, and biostatistics as well as population health with an emphasis on zoonotic disease.

Usually the first-year students spend half the day in diagnostics or laboratories and then switch to the farm for the other half. By the end of their second year, students complete an entire model spay. Starting this fall, the third-year students will undergo a phase of comprehensive review and honing of their clinical and surgical skills so that by the following spring, they will be ready to spay and neuter shelter animals every Wednesday. Each student will be the primary surgeon for six or seven of the procedures. This collaborative spay-neuter program provides adoptable dogs to the region and beyond while allowing students to learn valuable skills performing the procedures.

For their clinical year, students may choose from 150 clinical affiliates offered by the veterinary college that are part of the “distributive hybrid” model. Participating mentors are adjunct members of the program. The sites are in “hubs” or cities where a veterinarian will coordinate them. Up to six students total tested out some of the sites this summer to “work out the bugs,” Dr. Dascanio said.

Starting anew

The first two classes are excited at the prospect of being part of—and even shaping—a new veterinary college. Kristi Mason, a third-year student, says the newness was “intriguing.” She didn’t get into her home veterinary college at North Carolina State University. Her mom told her about LMU after searching online, but she missed the deadline for the first class.

Dr. Nader shows a blue whale heart
Dr. Paul Nader, an LMU instructor of anatomy in zoo and wildlife medicine, shows a blue whale heart that has undergone plastination, a preservation process that removes water from the tissues and replaces it with a silicone polymer. He and Dr. Robert W. Henry, professor of veterinary anatomy, are experts in biological species preservation and are doing research in that field. Their creations also help students learn anatomy.

“Everyone on faculty is from various schools, so they know what worked and what didn’t. It’s a little concerning they’re not fully accredited yet, but after hearing about the program during regular updates from administration, I think we’ll be fine,” she said.

Jessica Trubey, originally from Michigan and also a third-year student, applied to Michigan State University’s veterinary college and to LMU. While it would have been cheaper at MSU, “I was almost relieved when I didn’t get in so I could go to LMU. You notice the energy on campus.”

She also likes the curriculum and what she’s learned so far. Trubey said, “That’s such a strange concept not to interact with animals your first or second year” as was the case not long ago at some veterinary colleges.

Matthew Heydenburg, a third-year student, says when something didn’t work for the first class, it was fixed in time for his class, a point the first class likes to remind the others of.

Already, the students seem to be making an impact beyond the veterinary college.

Veterinary students initially had problems finding pet-friendly housing because locals frequently keep their dogs outside. In response, LMU launched a pilot program allowing pets in two of its residence halls starting this July.

Off-campus housing is starting to turn pet friendly, too, students say. And a student group is looking to create a dog park.

Who knows what the landscape will look like in the coming years and how the veterinary students—and eventually graduates—will transform it.

Related JAVMA content:

Report: Appalachia’s rural counties have veterinary shortage (Dec. 15, 2015)

Center for Animal Health in Appalachia created (Jan. 15, 2015)

LMU appoints Hoffsis as dean (March 15, 2014)

Lincoln Memorial gets green light from AVMA council (Aug. 15, 2013)