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JAVMA News Digest

The hidden curriculum

Every veterinarian knows there's much more to the job than being able to diagnose, treat, prescribe, and perform surgery. But how do veterinary students learn to be, well, veterinarians? A veterinary college's culture shapes the way students perceive the profession, their colleagues, and themselves as well as how they interact with clients and patients. And sometimes, the informal messages students pick up on don't match the institution's stated goals and teachings. Enter the hidden curriculum, an anomaly that was discussed during multiple presentations at the Association of American Veterinary Medical Colleges’ Annual Conference and Iverson Bell Symposium, March 10–12 in Washington, D.C.

There's the formal curriculum, with its lecture halls, syllabuses, and grading and evaluation methods. Then, there's the informal curriculum, which takes place outside the classroom among those who are teaching and trainees. In between them lies the hidden curriculum. It is, more or less, the collective messages that students unknowingly pick up from the faculty and administration. Put another way, it is the ideological and subliminal messages of both the formal and informal curricula that influence the culture of an institution (Acad Med 1998;73:403–407). It can take the form of policy development, resource allocation, activities, organizational or power structures, rituals and routines, or institutional slang and nomenclature.

Dr. Liz Mossop, associate professor of veterinary education at the University of Nottingham, has researched the hidden curriculum in veterinary programs, including her own (Med Educ 2013;47:134–143). She has found these programs tend to have a culture that normalizes disease and death, such as by euthanasia, as well as emphasizes competitiveness and hierarchy. Sometimes, a school's hidden curriculum even involves faculty teaching by humiliation.

Dr. Rosanne Taylor, dean of the University of Sydney Faculty of Veterinary Science, says the hidden curriculum is a major contributor to the formation of professional attitudes among veterinary students, particularly during clinical training as they learn the rules of the community of practice they are joining. Often, the hidden curriculum conflicts with what is learned during formal professionalism studies, creating a dilemma for students when the behaviors they see and believe they should emulate are at odds with their understanding of best practices. For example, students may be taught to communicate clearly and empathetically with clients but may see different behavior from clinicians in the teaching hospital.

Dr. Stephen May is deputy principal at the University of London Royal Veterinary College and co-author of a paper on the hidden curriculum, to be published this summer in the Journal of Veterinary Medical Education. At the AAVMC meeting, he asked the question: “Are we forgiving professional shortcomings in our role models because they are technically competent and bring in lots of money—even if they're awful to interact with, and that's not great for our students to be exposed to? What are we willing to do to develop a culture we want to be proud of?”

Dr. Taylor says the hidden curriculum often persists because of a reluctance by faculty, students, or administrators to give explicit, constructive, or timely feedback as well as fear of confrontation, a fear of challenges, or subjectivity.

The hidden curriculum's impact on subconscious learning goes well beyond professionalism. Dr. Taylor says the literature shows that the hidden curriculum causes a decrease in empathy (Med Educ 2004;38:934–941) and animal welfare commitment among veterinary students. Research has also shown the hidden curriculum can cause an increase in acceptance of unethical behaviors (Acad Med 1998;73:1195–1200) as well as tolerance of harassment, bullying, and discrimination (Acad Med 2006;81:648–654).

Influencing the hidden curriculum, the presenters said, requires the leadership and administration to set clear expectations, emphasize faculty development and training, acknowledge and explore the hidden curriculum, measure the culture, encourage student reflection and debriefing, mentor, and demonstrate culture by example through altruism, diversity, and service.

Condensed from May 15, 2017, JAVMA News

Bailey, Gill elected to AVMA Board

Drs. Michael Bailey and Ronald Gill were elected earlier this year to the AVMA Board of Directors representing districts II and VI, respectively.

Dr. Bailey is a veterinary radiologist and project manager for Idexx living in suburban Pittsburgh with his wife, Terri. He has served as Pennsylvania's alternate delegate in the AVMA House of Delegates since 2016 and is immediate past president of the Pennsylvania VMA. Additionally, he has been on the PVMA executive committee and board of trustees for eight years.

AVMA members in District II, comprising Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, and Virginia, elected Dr. Bailey to succeed Dr. Mark Helfat when his six-year term on the Board ends this July. Dr. Bailey becomes the first black veterinarian to serve as a district representative on the Dr. Michael Bailey AVMA Board.

District VI representative-elect Dr. Gill grew up on a small farm in southeastern Illinois, the same farm where he and his wife, Terry, now live.

Dr. Gill's participation in organized veterinary medicine began with the Southern Illinois VMA and later the Illinois State VMA, for which he spent a year as president. He has served on multiple AVMA entities, chairing both the Council on Veterinary Service and the Governance Performance Review

Committee. Dr. Gill was also Dr. Ronald Gill vice chair of the Council on Education. District VI is made up of Illinois, Indiana, and Wisconsin, and is currently represented on the AVMA Board by Dr. Chet Rawson, whose tenure on the board ends this July.

Condensed from March 1 and May 15, 2017, JAVMA News

A closer look at veterinary homeopathy

Homeopathy's place in veterinary medicine remains the subject of much debate. Depending on whom you ask, it is a gentler and more natural alternative to traditional medicine or an unproven and useless modality, at best.

According to the Merck Veterinary Manual, “controlled studies have demonstrated that homeopathic ‘provings'—sessions in which individuals record the symptoms caused by ingestion of the remedies—cannot distinguish between homeopathic dilutions and placebos. Indeed, no study has been able to distinguish homeopathic remedies from control solutions, by any method of analysis.”

Further, the National Institutes of Health has pointed out that although people sometimes assume that all homeopathic preparations are highly diluted and, therefore, unlikely to cause harm, some products labeled as homeopathic can contain substances not listed on the label or sufficient amounts of the active ingredients to cause adverse effects or drug interactions.

The Food and Drug Administration appears poised to issue new regulations for homeopathic drugs later this year. The agency currently does not evaluate the remedies for safety or efficacy. Whether that means the agency will tighten its regulations by subjecting homeopathic products to the same premarket approval process as other drugs, for example, isn't clear. And last November, the Federal Trade Commission declared that homeopathic products cannot include claims of efficacy without “competent and reliable scientific evidence.”

Also last year, a petition in the United Kingdom from an equine veterinarian has asked the Royal College of Veterinary Surgeons to prevent veterinarians from selling or recommending homeopathic products. The regulatory body is due to report back in the coming months.

Condensed from May 1, 2017, JAVMA News

Millennials now primary pet-owning demographic

The American Pet Products Association reports that millennials are now the primary pet-owning demographic, at 35 percent of U.S. pet owners to baby boomers’ 32 percent.

According to the APPA, U.S. pet ownership overall increased between 2014 and 2016, and spending in the U.S. pet industry—including spending on veterinary care—increased between 2015 and 2016.

The APPA biennial survey of pet owners found that 84.6 million U.S. households owned pets in 2016, up 6.1 percent from 2014. Millennials account for half of the owners of reptiles; small animals such as rabbits, guinea pigs, hamsters, ferrets, and gerbils; and saltwater fish.

The annual APPA report on pet spending found that overall spending in the U.S. pet industry increased 10.7 percent between 2015 and 2016 to $66.75 billion.

“While this shows a significant increase over last year, it is more reflective of an adjustment in data reporting than actual growth,” said Bob Vetere, APPA president and chief executive officer, in an announcement about the report. “Actual growth, when compared to previous reporting methods, is closer to 4 percent.”

Spending on veterinary care increased 3.4 percent to $15.95 billion in 2016. The APPA predicts a 4.2 percent increase in spending on veterinary care for 2017.

Spending on pet food increased 22.5 percent to $28.23 billion in 2016. The noticeable increase resulted primarily from the APPA accounting for new data from the Bureau of Labor Statistics, which indicated previous figures might have been too conservative.

Condensed from May 15, 2017, JAVMA News

Herd sizes, trade risk pig health

A million pigs cross state lines each week destined for other farms, where they are fed or bred, said Dr. Jeffrey J. Zimmerman. That does not include pigs sent to slaughter.

Outbreak responses need to start within hours of discovering infectious diseases. Dr. Zimmerman, a professor of diagnostic and production animal medicine at Iowa State University College of Veterinary Medicine, said growth in pig herd sizes over the past several decades also has reduced the ability to achieve herd immunity.

Dr. Zimmerman delivered his analysis during a late February lecture at the American Association of Swine Veterinarians’ annual meeting. The swine industry has endured deadly outbreaks including porcine epidemic diarrhea since 2013, watched as poultry producers fought an influenza outbreak during 2015, and has kept vigil for entry of foot-and-mouth disease and other diseases circulating in swine of trading partners.

Another presenter, Dr. Egan Brockhoff, a partner at Prairie Swine Health Services in Red Deer, Alberta, said porcine reproductive and respiratory syndrome and Seneca Valley virus infection could disrupt commerce. African swine fever would be devastating. And he questioned how swine veterinarians would respond if Nipah virus emerged in North American pigs.

He wants improved attitudes toward biosecurity on farms and improved communication among farms. He also envisions a North American information system for the swine industry and a swine industry biosecurity standard for the continent.

Other presenters described topics such as risk factors for disease spread, interventions need to reduce risk, and influences of herd size on continuous disease circulation.

Condensed from May 1, 2017, JAVMA News

Brachycephalic dogs more affected by many conditions

An analysis of Nationwide's pet insurance claims reveals that dogs of brachycephalic breeds—those having a broad, short skull—are more often affected than other dogs are by many common conditions, even after excluding conditions related to brachycephaly.

Nationwide released the Brachycephalic Breed Disease Prevalence Study on March 8 at the Western Veterinary Conference in Las Vegas. The analysis excluded conditions related to brachycephaly such as brachycephalic obstructive airway syndrome, entropion, and keratoconjunctivitis sicca and excluded conditions unrelated to anatomy, such as accidents and infectious diseases.

Brachycephalic dogs were more likely than other dogs to have certain ophthalmologic issues:

  • • Corneal ulcers, 6.34 percent of brachycephalic dogs, 1.4 percent of others.

  • • Ocular trauma, 2.15 percent of brachycephalic dogs, 0.92 percent of others.

  • • Conjunctivitis, 10.81 percent of brachycephalic dogs, 7.76 percent of others.

Brachycephalic dogs also were more likely than other dogs to have certain dermatologic issues, including the following:

  • • Malignant skin neoplasia, 0.46 percent of brachycephalic dogs, 0.25 percent of others.

  • • Fungal skin disease, 3.07 percent of brachycephalic dogs, 1.61 percent of others.

  • • Pyoderma, 18.93 percent of brachycephalic dogs, 14 percent of others.

  • • Otitis externa, 25.32 percent of brachycephalic dogs, 19.34 percent of others.

  • • Allergic dermatitis, 18.55 percent of brachycephalic dogs, 14.02 percent of others.

Among other conditions seen more frequently in brachycephalic dogs, pneumonia had a prevalence of 1.60 percent in brachycephalic dogs, compared with 0.77 percent in others. The prevalence of hyperthermia was 0.26 percent in brachycephalic dogs, compared with 0.11 percent in others.

The report is available at http://nationwidedvm.com/studies-and-research.

Condensed from May 1, 2017, JAVMA News

Legislators seek to end tax on veterinary student loan program

A bipartisan effort to repeal the tax on a Department of Agriculture program that pays off student loan debt for veterinarians working in underserved areas of the country was introduced in Congress this March.

The Veterinary Medicine Loan Repayment Program makes practice in underserved rural areas more financially feasible for recent graduates by providing up to $75,000 in loan repayments in exchange for at least three years of service in designated veterinary shortage areas.

The Internal Revenue Service takes 39 cents of every dollar Congress appropriates to the VMLRP, however. If Congress were to repeal the withholding tax as it did for the program's human medicine counterpart in 2004, the AVMA estimates roughly one additional veterinarian could participate for every three currently enrolled in the program.

On March 1, Republican Mike Crapo of Idaho and Democrat Debbie Stabenow of Michigan introduced S 487, the Veterinary Medicine Loan Repayment Program Enhancement Act, which would end the tax on the program. Companion legislation, HR 1268, was introduced in the House by Republican Adrian Smith of Nebraska and Democrat Ron Kind of Wisconsin the same day.

“This legislation will increase the number of veterinarians able to serve in the areas where they are needed most, which will help strengthen rural economies and protect the safety of our food supply,” Crapo said.

Learn more about the bill, read stories from program participants, and view infographics and other resources at http://jav.ma/studentloantax.

Condensed from May 1, 2017, JAVMA News

Resources on veterinary feed directives cover honeybees, aquaculture

The AVMA has produced new resources on veterinary feed directives, covering VFDs for honeybees and aquaculture.

According to the AVMA webpage “Honey Bees 101 for Veterinarians”: “In veterinary school you were taught how to diagnose and treat just about every animal species, but you probably had little education—if any—on honey bees. Until the federal government's Veterinary Feed Directive (VFD) final rule was issued, most veterinarians in the United States had little to no reason to be concerned about apiculture (beekeeping) and honey bee medicine.”

Honeybees have always been considered a food-producing animal, but there wasn't a requirement for veterinary oversight until the VFD rule implemented certain changes in federal policy regarding antimicrobials important in human medicine.

Members of the AVMA may access a 56-page document, “Honey Bees: A Guide for Veterinarians,” and three webinars on “Honey Bees, Antimicrobials and the Role of the Veterinarian.” A fourth webinar is in development.

The AVMA also has produced a webinar for members that discusses VFDs in aquaculture. The webinar “explains the requirements of the VFD rule, the aquatic veterinarian's role, and how to issue a VFD order when needed.”

The honeybee and aquaculture resources are available from the webpage on VFD basics at http://jav.ma/avmavfd.

From May 1, 2017, JAVMA News

AVMA releases report on veterinary markets

The AVMA has released the 2017 AVMA Report on Veterinary Markets, the first of four economic reports in the 2017 AVMA Economic Report Series.

The new report addresses key economic indicators relative to the markets for veterinary education, veterinarians, and veterinary services and reports on data related to the mental well-being of veterinarians. The report summarizes research presented at the annual AVMA Economic Summit in October 2016, discusses general U.S. economic conditions, and offers perspectives relative to the performance of U.S. veterinary practices.

Among the key findings in the report are the following:

  • • The total number of new veterinarians entering the profession in 2016 was 4,477.

  • • Mean debt acquired in veterinary college by 2016 graduates was $141,000.

  • • When compared with the national labor market, the market for veterinarians was slower to react to the recession, has a smaller variation in the supply-demand ratio, and is considerably more volatile month to month.

  • • A veterinarian's satisfaction with current employment and how well prepared a veterinarian felt for a career in veterinary medicine were associated with both gratification drawn from work and burnout in 2015 and 2016. The number of hours worked per week was also associated with burnout in both years.

  • • Following a trend seen in the robust market for veterinarians, veterinary practices’ revenue growth and earnings before interest, taxes, depreciation, and amortization have continued to show strong growth since 2013. The 2017 AVMA Report on

Veterinary Markets is available for free download by AVMA members at http://jav.ma/2017markets, and the report series is available for purchase by others at http://ebusiness.avma.org.

Condensed from May 15, 2017, JAVMA News

American College of Veterinary Microbiologists

The American College of Veterinary Microbiologists welcomed nine new diplomates and recognized one diplomate who is now certified in three specialties, following the certification examination it held Dec. 2–3, 2016, in Columbus, Ohio. The college also conferred honorary member status on Dr. Sharon Patton, Knoxville, Tennessee. The new diplomates are as follows:

Bacteriology/Mycology

* G. Kenitra Hammac, West Lafayette, Indiana Chien-Che Hung, Hong Kong Sarah Nicole Schmitt, Zurich Immunology

Felix N. Toka, Basseterre, St. Kitts and Nevis

Parasitology

Matthew Brewer, Ames, Iowa

Jon Jason Drake, College Station, Texas

Brian Herrin, Stillwater, Oklahoma

Virology

Dhammika H. Navarathna, Potomac, Maryland Aimee Noelle Reed, Gresham, Oregon Vinay Shivanna, Manhattan, Kansas

* Dr. Hammac was previously certified in virology and immunology.

From May 1, 2017, JAVMA News.

One Health Day returns in November

One Health Day, which debuted in 2016, will again be held Nov. 3. The One Health Commission, One Health Initiative team, and One Health Platform Foundation are calling on individuals and organizations to begin planning one-health education and awareness projects. Go to www.onehealthday.org.