“It is no use saying ‘We are doing our best.' You have got to succeed in doing what is necessary.”
—Winston S. Churchill
During the past quarter century, at least seven major national studies on the future of veterinary medicine and many more strategic planning exercises at the local (state association and college) level have been conducted. The latest effort is the North American Veterinary Medical Education Commission (NAVMEC), which the Association of American Veterinary Medical Colleges initiated in 2009. At the same time, the AVMA is launching a future critical issues scan designed to help the association update its 2008 strategic plan.
All these well-intended efforts have served to focus attention on the profession's shifting needs and challenges. Certainly, a number of piecemeal changes in veterinary education have happened over this time. With a few exceptions, however, it is hard to identify which of the recommendations from past reports were implemented and therefore difficult to determine how all the considerable time and effort actually improved the veterinary profession's capacity to address society's needs. There has never been a veterinary medicine renaissance.
Education, in all respects, is the undeniable foundation of the professions, and veterinary medicine is no exception. And, it is true and somewhat reassuring that veterinary education has evolved naturally over time to meet the changing needs of the profession and society. No doubt adaptations would continue no matter what. However, change on a scale necessary to address veterinary medicine's current systemic challenges cannot be left to chance. It must be properly planned, managed, and evaluated. The veterinary community seems to find it difficult to accept the obvious reality of unprecedented, externally driven pressures on the profession and suffers from constant anxiety about its future. This agony and perpetual self-study, which mainly consists of rediscovering well-known facts, cannot continue indefinitely without harmful effects.
Examination of past studies of the future of veterinary medicine reveals some obvious similarities. For example, few disagreed about the many strengths of the veterinary profession, although some different weaknesses and threats were identified. More importantly, a reasonable sense of optimism based on the identification of new directions and opportunities existed. Nevertheless, recently, concerns have grown that external changes are moving at an accelerated pace that probably exceeds the profession's ability to adapt and evolve in a timely fashion. Timing is a major factor; our conferences and strategic plans will be for naught if we act too late. Perhaps the most disappointing aspect of most future planning is the absence of robust, realistic expectations for implementation. Revisiting the past and analyzing the status quo is fairly easy, whereas identifying an agreeable way forward that could lead to tangible benefits is not. Our taking care of the future will have to transcend traditional educational programs and disciplines; the old, standard conservative remedies will not suffice. What we do must be transformative and sustainable; we have to be brave enough to do things not attempted before, try things others may have been afraid to. Why do we shy away from uncertainty, and why is it so difficult to initiate and sustain a large-scale paradigm shift?
The major barriers to change in the veterinary profession are few in number, although they are real and complex and have not changed substantially for many years. It could be anticipated that one of the first-mentioned causes (excuses!) for our collective inability to change is the financial problems that beset higher education. Undeniably, all veterinary schools are experiencing severe budgetary duress. However, a forward-looking restructuring of veterinary education is possible even given these economic realities. With proper resolve and care, one can be opportune, strategically creative, and fiscally responsible at the same time. Nevertheless, in certain instances, a college's budgetary woes may be so dire that such changes are nearly impossible. It will take a great deal of patience and time to overcome this level of difficulty.
An interesting, perhaps unexpected, paradox continues to be that college faculty members seldom provide strong leadership in comprehensive curriculum redesign and advancement. However, at the same time, most faculty members are genuine leaders in their fields, often renowned nationally and internationally for their expertise. They bring great prestige to academic institutions. Furthermore, faculty members eagerly embrace new developments in technology and pedagogy and teach at the cutting edge of their disciplines. But, when it comes to integrating and balancing the many components of medical education, personal interests may prevail at the expense of the necessary give and take. Veterinary faculty members work in a highly competitive environment where career advancement largely depends on individual reputation. The disciplines and specialties speak different languages, have different measures of success (research, teaching, and service), and compete among themselves for internal resources. Collaboration is not necessarily well rewarded; thus, it is small wonder that faculty members readily become self-sufficient. Also, too much credence is given to the old adage that the faculty owns the curriculum. University governance typically involves an organization of collegiate faculty, meaning that the content and management of degree programs are entrusted to a faculty committee, often chaired by one of its own. The roles of the dean and assistant deans in leading educational initiatives are often vague. Do they merely plead or negotiate with the curriculum committee, or can they coerce or even compel? Because of the pervasive culture of faculty authority in this regard, they may have the law on their side. Add to this the fact that most deans undergo periodic mandatory performance reviews, perhaps by some of the same faculty with whom they must entreat, and this awkward situation may become less than harmonious. Thus, it should not be surprising if some deans choose to equivocate rather than push for changes that could put their appointments in question. Self-preservation is a powerful instinct.
In a community of more than 100,000 veterinarians in the United States and Canada, we depend on a variety of representative professional bodies to convey the profession's collective voice and actions. These include the national associations (the AVMA and Canadian Veterinary Medical Association), state and provincial associations, accreditation and licensing authorities, specialty boards, government and corporate agencies, colleges, and universities. Historically, these organizations have not shared a unified vision, and when parties are polarized, it is easy for things to not get done. Consider also the persistent incredulity of veterinarians in general who cannot seem to bring themselves to believe in anything new unless they have actually experienced it. In any given population, only about 3% are true innovators and about 30% are early responders, which leaves two-thirds as late responders or opponents of change.
Given these bewildering complexities, what shall we do? Will the NAVMEC provide the right forum for success? The commission cannot just be about making changes to the structure and content of veterinary education. Its analyses and recommendations provide no guarantee that the profession will go in the right direction. Too often in previous studies, the planning exercise became an end in itself, seemingly more important than the activities it was meant to improve. The main goal of the NAVMEC should be to explore new ideas with big impacts—not just new educational techniques—and to build what is necessary rather than renovating what currently exists. Also, a robust, prioritized implementation plan will be essential to get the job done. It is encouraging that the commission includes representatives from all sectors of the profession and reassuring that its nine-member board of directors has been chosen to include, perhaps for the first time, equal representation from the three bodies responsible for ensuring the proper competencies of veterinary graduates: education, accreditation, and licensure. A genuine culture of responsibility, cooperation, and trust must emerge among these three representative groups, for within them, they have the necessary means to take action. But, unless their leaders agree, the changes to veterinary education that the NAVMEC proposes will not happen, and we will have made little progress. Do we now have the collective resolve to respond appropriately to this latest self-study?
All the blame for the profession's woes cannot be laid at the door of academic veterinary medicine alone, although it should be anticipated that the profession and the public will look to the colleges and schools to lead the search for answers. Therefore, every veterinary medical dean should endorse the NAVMEC agenda because of the colleges' and schools' fundamental roles in leading education. Admittedly, trying to cajole the deans with soothing new words of confidence may be met with some skepticism, especially given the individuality of each institution and the relative lack of implementation of previous strategic plans. Also, deans, like faculty, find themselves in competitive worlds that measure success by campus prestige and national rankings. It will take a considerable shift in the culture of the universities themselves to support and reward a college's and a dean's efforts involving partnerships, shared resources, and mutual successes, rather than individual prowess. However, without buy-in, and not just lip service, from the deans and a genuine commitment to collaborate, NAVMEC's voice will be faint.
The question of new curricular models has been under discussion for decades, with certainly much more debate to come. What shape could new models take, and what might be some guiding principles? Because of the differences among veterinary colleges and schools, no single curricular model will fit them all. Nevertheless, all institutions will somehow have to become less parochial among themselves and perhaps more cooperative with nonveterinary schools and departments within each university. There should be a flexible framework on which to build future programs in veterinary education collaboratively. The AVMA's Council on Education should welcome creativity, even experimentation, and not be apprehensive about new, perhaps radical, curricular models when accrediting colleges and schools. The licensing boards also should seriously consider differentiated areas of clinical licensure while continuing to maintain competency standards. Unless the culture and time-honored traditions of veterinary medicine shift substantially, little will change. We must shed our conservative image and be a forward-looking, entrepreneurial profession of the 21st century.
Veterinary education absolutely must continue to build on a solid foundation of basic science, biomedical sciences, and comparative medicine, as we have in the past. Certainly, NAVMEC should construct examples of model curricula, although most specific details cannot, in good faith, be prescribed because of the uniqueness of individual institutions and differences in regional resources. Particular changes in content can be worked out over time and are bound to vary considerably from place to place. Most existing conventional veterinary teaching hospitals are experiencing severe financial difficulties, in part because of the present economic downturn and the consequent general reduction in case numbers. Depending on geographic location, critical shortages of certain species, such as food animals, may occur. Indeed, from a business point of view, veterinary teaching hospitals could be considered in decline, even failing or nonviable. To some observers, veterinary medicine has become so large that no single college can any longer claim to provide sufficient support for all disciplines and species. The colleges must be allowed to respond constructively to this problem or, ironically, they may face challenges to their accreditation status because of their attempts to adhere rigidly to the status quo. The incongruity of this situation is alarming. A college could preferentially develop a limited number of programs in specified fields and invest in them as centers of excellence, while maintaining sufficient activities in other areas to preserve the much-cherished multispecies and multidisciplinary characteristics of veterinary medicine and satisfy minimal standards for accreditation purposes. Indeed, out of real necessity, some colleges are doing this surreptitiously in limited ways already. However, Council on Education accreditation-approved geographic fields of concentration would have to be cooperatively agreed to as part of a national plan. Specified schools could omit some species or disciplines altogether. Paradoxically, veterinary schools continue to graduate only generalists, whereas the world increasingly looks for those with special skills. An advanced tracking model, of course, necessitates some form of specified or limited licensure. This difficult conundrum must be faced head-on and not side-stepped as in the past.
Two recently established veterinary schools have found a truly innovative approach to clinical education. These institutions decided not to build a conventional veterinary teaching hospital, but to create a system of distributed clinical education through off-campus, affiliated general and specialty practices, and partnerships with other entities such as zoos, wildlife centers, and public and corporate agencies. This model includes the pedagogical training of affiliate veterinarians and requires that students obtain fundamental multispecies clinical skills prior to entering the clinical years of the curriculum. The traditional, fixed physical location for delivering veterinary education is becoming less important, and current needs suggest that education should take place how, when, and where it makes most sense. Certainly, this approach is new and creative, and it is heartening to note that the AVMA's Council on Education recently awarded full accreditation to one such school in the United States.
A century ago, the profession of engineering successfully addressed challenges similar to those the veterinary profession now faces by creating distinct professional tracks aligned with various specialties, while retaining multidisciplinary education in essential engineering principles, chemistry, physics, math, and computing during the early part of the curriculum. Also, engineering education has enthusiastically incorporated simulation and virtual-reality models, as have many human medical schools, whereas veterinary education has minimally adopted these technologies so far. Schools of engineering are by no means uniform in the number and variety of their specialty tracks. Indeed, they are proudly diverse and use off-campus education in numerous ways. A differentiated form of veterinary medical education and practice would fit the engineering model, with appropriate curricular adjustments and necessary changes in accreditation and licensure. During this time of open dialogue, veterinary medicine should seek inspiration from another such long-standing and highly successful profession. To continue pretending that every veterinary college and school must have full strength in all species and disciplines and that graduates must be identical at the time of graduation defies logic. Indeed, present-day graduates from the traditional schools are not equivalent in their coursework and clinical experiences. As in engineering, the future of our profession necessitates the development of high-quality tracks in veterinary education. Failure to implement this will lead down the road to embarrassing mediocrity that inevitably will result in lower societal status and effectiveness. Sufficient change in veterinary education and practice is hard to imagine without a new paradigm.
Other challenges exist as well. Veterinary education is still too focused on clinical practice, especially small animal clinical practice, which means that other areas, such as food production medicine, public and corporate practice, public health, environment and ecosystem health, biomedical research, and animal welfare, are de-emphasized. Veterinary medical education as a whole must continue its evolution from the traditional idea of coverage and so-called truths and right answers to concepts such as factual relevance, critical thinking, self-directed learning, and communication skills, among others. Facts do not keep, and furthermore, a fact-based curriculum is poor preparation for adaptation to future change. Finally, one of the gravest threats to the future of the profession is rapidly escalating tuition and total student debt. We are reluctant to admit that veterinary education is essentially already unaffordable and that no solution has been forthcoming, although the US federal government is considering repayable loans under the National Veterinary Medical Service Act. This program, supported by the AVMA, would offset part of veterinary graduates' educational debt in return for contractual work performed in some designated high-priority underserved situations. Another, more direct way of reducing students' costs would be to shorten their time to graduation, for example, from the typical 8 years to 6, by combining, intercalating, and overlapping baccalaureate degrees in general biomedical and health sciences with the DVM curriculum. Shared interprofessional education of this kind carries the added advantage of mixing students from several health-related fields, facilitating the opportunity for students with different career interests to learn from each other. Interprofessional communication would undoubtedly continue beyond graduation and would promote the sharing of expertise among different health professionals toward the societal goal of one medicine. Admittedly, in existing colleges and schools, sharing students, faculty, and curricula could have negative financial consequences. The model would be more feasible in a new school willing to try an unconventional approach and push the accreditation envelope. In any event, the idea of multiple, shared academic programs is likely to lead to a conservative reaction.
The search for good solutions requires lively debate, and we must not shy away from open controversy and even heated disagreement. The expectation that the NAVMEC will provide a roadmap is reasonable and achievable, although some details may be devilish. But the commission must not fall short, for time is surely running out and this could be our last realistic opportunity to craft a new, unified, workable plan for the future benefit of veterinary medical education, the veterinary profession, and the public good.
