More than 15 years ago, Kogan and McConnell1 suggested that veterinary students, like medical students, should be provided psychological services, primarily because the level of stress and the workload associated with the veterinary curriculum are extremely high. More recent evidence indicates that veterinary students experience high levels of stress, anxiety, and depression.2 In fact, in 1 study,3 a third of first-year veterinary students reported Center for Epidemiological Studies Depression Scale scores exceeding the clinical cutoff for depression, and profoundly affected students reported first-semester academic concerns and homesickness as inciting critical factors. Similarly, a recent survey4 of 3,888 veterinary students indicated that the 2 biggest stressors in veterinary school are the workload and pressure to excel. These problems are not unique to the veterinary profession, having been identified in dental and medical schools for decades.5,6
Given that these issues arise in the first year of the veterinary medical curriculum, we sought to identify those courses in which first-year veterinary students in North America and the Caribbean most often struggled academically; to review which courses are included in the prerequisites for admission to these colleges of veterinary medicine, as reported by the AAVMC; and to survey veterinarians regarding their opinions about existing and proposed alternative prerequisites for admission to veterinary medical colleges in North America and the Caribbean. The rationale for this study was to stimulate discussions among veterinary medical educators and veterinarians about altering the prerequisite science courses used as part of the admission process for colleges of veterinary medicine in North America and the Caribbean, with a goal of reducing the levels of stress and anxiety currently experienced by first-year veterinary students and promoting their well-being and professional success.
Materials and Methods
Identification of courses in which first-year students struggled academically
The associate deans for academic affairs (or equivalent) at colleges of veterinary medicine associated with 32 universities in North America and the Caribbeana were contacted by email to solicit their participation in an educational survey; colleges were selected on the basis of availability of email addresses for the associate deans at the time the survey was developed. On the basis of information derived from each school's website, each associate dean was provided a list of the first-year courses for their respective college and asked to indicate the first-year courses in which students most commonly earned a grade less than C or a grade that resulted in students being placed on academic probation. Respondents then were asked to rank these courses on the basis of the percentage of students who earned a grade less than C or a grade that resulted in students being placed on academic probation. Follow-up emails were sent twice, with an interval of 3 weeks between follow-up messages.
Survey responses were manually reviewed by the authors and tabulated. When necessary, the lead author (JNM) contacted a representative of the professional instruction program to clarify the content of named courses.
Prerequisite courses for admission to veterinary medical college
Courses required for admission to each of the colleges of veterinary medicine solicited to participate in the study were extracted from the AAVMC website7 and tabulated.
Veterinarian opinions regarding prerequisite courses
A web-based survey was developed by the authors to collect data regarding opinions of veterinarians about courses required for admission to veterinary medical college. The survey document was reviewed and approved by the Institutional Review Board of the University of Georgia (IRB #00004406). The survey website included an explanation of the study aims and objectives; respondents were required to provide an electronic signature indicating their consent to participate. The state veterinary medical associations of California, Georgia, New York, Ohio, and Texas were selected on the basis of broad geographic representation and asked to encourage their members to complete the online survey. In addition, administrators of the ABVP, ACVIM, ACVS, and AAEP were contacted and similarly asked to encourage their members to participate. These organizations were asked to send a single email message to their members soliciting their participation in the survey, with a link to the survey website embedded in the message.
The following data were collected from respondents to the online survey: gender (male or female); decade in which the respondent graduated from veterinary college; whether the respondent was certified by an AVMA-accredited specialty board and, if so, which college and when certified; number of years worked in private veterinary practice; and number of years worked in academic veterinary medicine.
Data from the AAVMC website indicated that 90% of surveyed colleges of veterinary medicine included the following 6 courses as prerequisites for admission to their veterinary doctoral programs: biology, inorganic chemistry, organic chemistry, biochemistry, mathematics or statistics, and physics. Respondents were asked to rank the relative importance of these courses for preparing students for the veterinary medical curriculum. Respondents also were asked to rank which of the following alternative courses might better help prepare students for the professional curriculum: anatomy, physiology, immunology, cell biology, microbiology, business or finance, and public speaking or communications.
Data analysis
Data were analyzed by means of descriptive and inferential methods. For descriptive purposes, data were tabulated. Proportions were compared between groups by means of a χ2 test; values of P < 0.05 were considered significant.
Results
Courses in which first-year students struggled academically
Of the 32 associate deans who were contacted, 21 (66%) provided responses about the courses in which first-year students struggled academically (ie, earned a grade less than C or a grade that resulted in students being placed on academic probation). Three of the 21 provided information on < 3 courses, with 1 respondent listing a single course and 2 respondents listing only 2 courses. Most (19/21 [90%]) schools ranked the courses as requested; for the 2 schools that did not rank the courses, a ranking was assigned by the authors solely on the basis of the order in which answers were provided. The most frequently represented courses were anatomy, physiology, histology, and combinations of these disciplines, representing 74% of the responses (Table 1).
Courses in which first-year veterinary medical students commonly struggled academically (ie, earned a grade less than C or a grade that resulted in students being placed on academic probation), as reported by associate deans of academic affairs (n = 21) at colleges of veterinary medicine in North America and the Caribbean.
| Ranking | ||||
|---|---|---|---|---|
| Course | First | Second | Third | All |
| Anatomy | 8 (38) | 5 (25) | 4 (24) | 17 (29) |
| Anatomy and physiology | 3 (14) | 3 (15) | 2 (12) | 8 (14) |
| Physiology | 2 (10) | 6 (30) | 2 (12) | 10 (17) |
| Histology and developmental anatomy | 1 (5) | 3 (15) | 0 (0) | 4 (7) |
| Immunology | 0 (0) | 0 (0) | 4 (24) | 4 (7) |
| Neurosciences and neuroanatomy | 0 (0) | 0 (0) | 4 (24) | 4 (7) |
| Biochemistry | 2 (10) | 1 (5) | 0 (0) | 3 (5) |
| Histology | 2 (10) | 1 (5) | 0 (0) | 3 (5) |
| Histology and physiology | 0 (0) | 0 (0) | 1 (6) | 1 (2) |
| Gastroenterology and metabolism | 0 (0) | 1 (5) | 0 (0) | 1 (2) |
| Molecular and cellular biology | 0 (0) | 0 (0) | 1 (6) | 1 (2) |
| Parasitology | 1 (5) | 0 (0) | 0 (0) | 1 (2) |
| Pharmacology | 1 (5) | 0 (0) | 0 (0) | 1 (2) |
| Pharmacology, nutrition, and toxicology | 1 (5) | 0 (0) | 0 (0) | 1 (2) |
| Total | 21 (100) | 20 (100) | 18 (100) | 59 (100) |
Data are given as number (%) of respondents who indicated that students commonly struggled academically in the course. Courses were ranked on the basis of percentage of students who earned a grade less than C or a grade that resulted in students being placed on academic probation.
Prerequisite courses for admission to veterinary medical college
For the 32 colleges solicited to participate in the study, the science courses most commonly required for admission to the college were biochemistry, biology, organic chemistry, physics, mathematics and statistics, and inorganic chemistry (Table 2). Anatomy was a requirement for admission for only 1 college, although it was recommended by 3 others, and physiology was required by 5 colleges and recommended by 3 others.
Courses required or recommended for admission to colleges of veterinary medicine in North America and the Caribbean (n = 32), as reported by the AAVMC.7
| Course | Required | Recommended | Total |
|---|---|---|---|
| Biochemistry | 31 (97) | 0 (0) | 31 (97) |
| Biology | 29 (91) | 0 (0) | 29 (91) |
| Physics | 29 (91) | 0 (0) | 29 (91) |
| English composition | 29 (91) | 0 (0) | 29 (91) |
| Organic chemistry | 28 (88) | 1 (3) | 29 (91) |
| Mathematics or statistics | 25 (78) | 1 (3) | 26 (81) |
| Inorganic chemistry | 26 (81) | 0 (0) | 26 (81) |
| Humanities and social sciences | 25 (78) | 0 (0) | 25 (78) |
| Genetics | 21 (66) | 0 (0) | 21 (66) |
| Microbiology | 13 (41) | 4 (12) | 17 (44) |
| Elective courses | 12 (38) | 1 (3) | 13 (41) |
| Speech or public speaking | 12 (38) | 1 (3) | 13 (41) |
| Physiology (systemic) | 5 (16) | 3 (9) | 8 (25) |
| Science elective courses | 5 (16) | 2 (6) | 7 (22) |
| Animal nutrition | 4 (12) | 1 (3) | 5 (16) |
| Advanced biological sciences | 3 (9) | 1 (3) | 4 (12) |
| Anatomy | 1 (3) | 3 (9) | 4 (12) |
| Cellular biology | 2 (6) | 1 (3) | 3 (9) |
| Advanced life sciences | 1 (3) | 1 (3) | 2 (6) |
| Animal science | 0 (0) | 1 (3) | 1 (3) |
| Ecology | 1 (3) | 0 (0) | 1 (3) |
Data represent number (%) of colleges that listed each course as a prerequisite for admission.
Veterinarian opinions regarding prerequisite courses
Of the 5 state veterinary associations that were contacted, 2 declined to participate and 3 sent out an electronic newsletter with a link to the survey. The 4 organizations that were contacted (ABVP, ACVIM, ACVS, and AAEP) all participated as requested.
A total of 771 veterinarians responded to the survey. Of these, 752 provided information regarding whether they were board certified; 392 (52%) were board certified by the ACVS, 168 (22%) were board certified by the ACVIM, 159 (21%) were not board certified, 20 (3%) were board certified by the ABVP, and 13 (2%) had some other specialty certification or skill. Among the 761 respondents who specified their gender, 395 (52%) were female and 366 (48%) were male. Decade of graduation was reported by 754 respondents, with 88 (12%) graduating in the 1970s, 173 (23%) graduating in the 1980s, 160 (21%) graduating in the 1990s, 260 (35%) graduating in the 2000s, and 73 (10%) graduating in the 2010s. For those respondents who had worked in practice (n = 733), duration of practice experience ranged from 1 to 40 years (median, 14 years). Similarly, for those respondents who worked in academia (n = 386), duration of time spent in academia ranged from 1 to 40 years (median, 8 years). Most respondents had graduated from colleges of veterinary medicine in the United States or Canada (n = 663 [88%]), followed by the United Kingdom or Europe (40 [5%]), Australia or New Zealand (27 [4%]), Mexico or South America (7 [1%]), and some other location (17 [2%]).
For the 6 courses most commonly listed as prerequisites for admission to veterinary doctoral programs, respondents ranked biology as most important in preparing students for the veterinary medical curriculum, whereas organic chemistry and inorganic chemistry were ranked as least important (Table 3). Mathematics or statistics, biochemistry, and physics were ranked as second, third, and fourth most important.
Rankings (by level of importance) assigned by practicing veterinarians (n = 771) to a survey on veterinary college admission requirements for 6 courses commonly required for admission to colleges of veterinary medicine in North America and the Caribbean.
| Ranking | ||||||
|---|---|---|---|---|---|---|
| Course | First | Second | Third | Fourth | Fifth | Sixth |
| Biology | 660 (86) | 62 (8) | 28 (4) | 12 (2) | 4 (< 1) | 5 (< 1) |
| Mathematics or statistics | 67 (9) | 333 (43) | 179 (23) | 122 (16) | 55 (7) | 15 (2) |
| Biochemistry | 18 (2) | 170 (22) | 210 (27) | 158 (20) | 135 (18) | 80 (10) |
| Physics | 94 (12) | 200 (26) | 197 (26) | 150 (19) | 122 (16) | 8 (1) |
| Organic chemistry | 8 (1) | 89 (12) | 107 (14) | 176 (23) | 209 (27) | 182 (24) |
| Inorganic chemistry | 10 (1) | 23 (3) | 47 (6) | 106 (14) | 218 (28) | 367 (48) |
Data represent number (%) of respondents who assigned each ranking to each course.
Rankings were identical for the ACVS diplomates, ACVIM diplomates, and veterinarians who were not board certified; because of their low number, ABVP diplomates were excluded from this analysis. Male and female respondents ranked all prerequisite courses similarly except for physics; the percentage of male respondents who ranked physics among the top 3 most important courses (162/366 [44%]) was significantly (P = 0.006) higher than the percentage of females who did (135/395 [34%]). There were minor differences in rankings by decade of graduation, with earlier graduates slightly more likely to rank physics higher than biochemistry and more recent graduates ranking organic chemistry higher than physics. It was not possible to statistically adjust for the individual effects of decade of graduation and gender because these 2 variables were strongly (P < 0.001) associated, with the percentage of male respondents decreasing as the decade of graduation increased. Percentages of male respondents by decade of graduation were 86% (76/88) for the 1970s, 53% (91/173) for the 1980s, 48% (76/160) for the 1990s, 37% (163/260) for the 2000s, and 30% (22/73) for the 2010s. Nevertheless, tabulation of data by decade and gender indicated that differences in rankings between genders appeared to be influenced by more recent graduates. Rankings of prerequisite courses did not vary by number of years in practice or with whether respondents had worked in academia.
The 2 alternative prerequisite courses for admission to a college of veterinary medicine that were ranked the most highly by respondents were anatomy and physiology (Table 4). There were small differences in the ranking of alternative courses by board-certification status. The percentage of respondents who ranked anatomy first differed significantly (P < 0.001) among ACVIM diplomates (82/168 [49%]), ACVS diplomates (127/392 [32%]), and respondents who were not board certified (42/159 [26%]). Nonetheless, each group ranked anatomy and physiology in the top 2 for alternative courses. Male and female respondents ranked these courses identically and identical to the ranking order of the total population. The ranking of the alternative prerequisite courses was the same for each decade of graduation except the 2010s, and the percentage of respondents ranking anatomy first did not differ significantly (P = 0.1342) among decades. Rankings were also identical for each of the 3 categories of duration of time in practice (0 to < 10 years [n = 249], 10 to < 20 years [228], and 20 to 40 years [276]). Veterinarians who had not worked in academia ranked anatomy and physiology the same, and the percentage of veterinarians who had worked in academia and ranked anatomy first (144/356 [39%]) was significantly (P = 0.025) higher than the percentage of those who had not worked in academia (121/386 [31%]).
Rankings (by level of importance) assigned by practicing veterinarians (n = 771) to a survey on veterinary college admission requirements for 7 courses that could be considered as alternative prerequisites for admission to colleges of veterinary medicine in North America and the Caribbean.
| Ranking | |||||||
|---|---|---|---|---|---|---|---|
| Course | First | Second | Third | Fourth | Fifth | Sixth | Seventh |
| Anatomy | 270 (35) | 292 (38) | 86 (11) | 56 (7) | 36 (5) | 27 (4) | 4 (< 1) |
| Physiology | 317 (41) | 179 (23) | 106 (14) | 69 (9) | 45 (6) | 32 (4) | 23 (3) |
| Cell biology | 58 (8) | 117 (15) | 244 (32) | 185 (24) | 105 (14) | 42 (5) | 20 (3) |
| Communication | 52 (7) | 90 (12) | 137 (18) | 120 (16) | 128 (17) | 73 (10) | 171 (22) |
| Business or finance | 3 (< 1) | 31 (4) | 89 (12) | 200 (26) | 248 (32) | 124 (16) | 76 (10) |
| Immunology | 60 (8) | 36 (5) | 74 (10) | 71 (9) | 99 (13) | 261 (34) | 170 (22) |
| Microbiology | 11 (1) | 26 (3) | 35 (4) | 70 (9) | 110 (14) | 212 (27) | 307 (40) |
Data represent number (%) of respondents who assigned each ranking to each course.
Discussion
The 4 principal findings of the present study were that first-year veterinary students commonly experienced academic difficulties in anatomy, physiology, and histology; these courses were rarely included as prerequisites for admission to veterinary college; veterinarians from a variety of backgrounds and experiences agreed that some of the current prerequisite courses were relatively less important than others; and these veterinarians highly rated courses in anatomy and physiology as alternative prerequisites. Given these findings, we suggest that veterinary colleges should consider replacing 1 or more prerequisite courses in organic chemistry and physics with an equal number of courses in anatomy, physiology, or histology. The goal would not be to reduce the rigor of students' undergraduate training, but to ensure students complete courses that will better prepare them for the first year of the veterinary curriculum. We believe that this will reduce the level of stress for first-year veterinary students and increase their self-confidence, well-being, and possibly academic performance. In addition, our suggestion is consistent with advice that the AVMA gives on its website for prospective veterinary students: “consider taking upper-level anatomy & physiology, zoology, microbiology, animal science/animal production, nutrition, and histology courses, to name a few. It's possible that taking these courses as an undergrad can make the comparable vet school classes much less stressful for you because you've already got a good foundation in that subject.”8
The finding that first-year veterinary students in North America struggle in anatomy, physiology, and histology was not surprising. The curricula of the surveyed colleges were similar, and only a small percentage of veterinary colleges included anatomy (1/32 [3%] required and 3/32 [9%] recommended) or physiology (5/32 [16%] required and 3/32 [9%] recommended) as prerequisite courses for admission, while none required histology. The same situation exists at most medical schools, and the potential impact of premedical courses in anatomy and histology on academic performance in the first year of the medical curriculum has been assessed in a few studies.9–11,b Depending on the outcomes assessed, the results of these studies have been mixed, with some indicating that premedical gross anatomy or histology coursework can improve academic performance in the corresponding medical school courses9,b and that taking a premedical gross anatomy course with prosected specimens or with 3-D anatomic virtual dissection software, anatomic models, and laboratory exercises was valuable.10 In contrast, a study11 of students in a college of osteopathic medicine failed to identify a significant difference in student performance in gross anatomy between students with premedical anatomy coursework and those without it. It is important to consider, however, that our focus was not on whether taking a particular course would significantly improve grades earned in a class. Rather, we were interested in pursuing approaches that might help reduce the stress and anxiety students encountered in anatomy, physiology, and histology classes and to help them succeed in their goal of becoming competent veterinarians.
Veterinarians who responded to our survey on admission requirements gave similar responses irrespective of their gender, decade of graduation, board-certification status, or academic experience. Collectively, they ranked 2 of the more commonly required prerequisite courses (organic chemistry and physics) as less important than biology, mathematics or statistics, and biochemistry. A common rationale for keeping organic chemistry and physics as prerequisite science courses is that they provide the rigor required to distinguish students ready to handle a professional curriculum from those who are not. Lovecchio and Dundes,12 for example, reported that 78% of students who dropped out of premedical training programs cited their grade in organic chemistry as the reason. The authors stated that “[i]t may be time to consider whether a single course (organic chemistry) should contribute to eliminating persons who might otherwise excel as physicians.” Similarly, well-qualified, underrepresented minority students admitted to highly selective public universities in the United States have reported that undergraduate chemistry courses caused them to abandon their hopes of becoming a physician.13 Given that veterinary medicine has a notable lack of diversity, particularly with regard to underrepresented minority students, we propose that it is time to reassess the role of organic chemistry courses as prerequisites for admission to veterinary medical education programs.
Veterinarians responding to our survey ranked anatomy and physiology most highly as alternative prerequisite courses. We concur with their opinion that including anatomy, physiology, or both will better prepare students for veterinary college. Being better prepared should enhance students' performance and increase their level of self-confidence in the curriculum. Undergraduate anatomy and physiology courses should provide the rigor currently attributed to organic chemistry and physics but have the distinct advantage of being relevant to the courses in which students struggle academically during the first year of the veterinary medical curriculum. Academic difficulties during the first year exacerbate stress and anxiety, which progressively worsen over the remaining years of veterinary school.2 Thus, reducing stress and anxiety during the first year would be expected to have benefits to students' mental health over the course of their training. A further benefit of students being better prepared in relevant disciplines is that they would consequently be more able to integrate material across disciplines early in the curriculum. Integrative processing of knowledge is an approach to veterinary medical education that resembles clinical decision-making. It should be noted that we are not advocating for more technical preprofessional training. We maintain that veterinarians should be exposed to the humanities and social sciences in their preveterinary education because these disciplines are personally and professionally enriching.
Our study had several limitations. We did not solicit the participation of all colleges of veterinary medicine in North America and the Caribbean, nor did we attempt to validate any of the responses from participating schools. Participating veterinarians in our survey were asked to rank 6 existing prerequisite science courses, whereas the AAVMC website lists 21 categories of prerequisites. We chose to limit the options to these 6 courses for 2 reasons. First, these courses were the science courses listed most commonly in the summary table of prerequisite courses on the AAVMC website. Second, we surmised that all the veterinarians surveyed would have taken these courses themselves as undergraduate students. We also asked participating veterinarians to rank only 7 alternative prerequisite courses, which were chosen on the basis of results of our survey of associate deans about the courses in which first-year students struggled academically. To those courses, we added communication and business skills as additional alternatives, recognizing their importance in the practice of veterinary medicine. Participants were given the opportunity to enter other options in a free-text format, but the number of submitted alternative courses was negligible.
Although nearly 800 veterinarians responded to our survey, our sample size could have been larger had we been able to provide more than a single contact, along with reminders to raise awareness of the study. Another limitation of our study was that we did not track the source of respondents. Although we were able to determine which respondents were diplomates of the ACVIM, ABVP, or ACVS, we could not determine how many respondents were members of the participating state veterinary associations or the AAEP. It was thus impossible for us to assess the extent to which selection bias by source (ie, which method of contact resulted in participation) might have impacted our results.
Nonresponse bias was also a potential limitation of the present study. The effect of nonresponse among associate deans of the veterinary colleges was likely small because the nonresponding colleges had prerequisites similar to those of the responding colleges and because responses from the participating institutions were generally consistent. The impact of nonresponse bias to our survey on veterinarians' opinions regarding prerequisite courses was likely higher, given that the membership of the ACVS, ACVIM, AAEP, and 3 state associations that participated is much larger than the 771 individuals who responded to the survey. The survey appeared to have been biased toward members of AVMA-recognized veterinary specialty organizations. Although results for survey respondents who were not board certified were similar to those of board-certified respondents, it is possible that the opinions of the survey respondents did not accurately reflect the opinions of the reference populations targeted by the survey.
We are hopeful that our findings will stimulate discussions about some of the problems currently being faced by veterinary medical students. In advancing our suggestion that veterinary colleges consider changing some of the courses required for admission, we recognize that some small undergraduate institutions may lack courses in anatomy and histology, particularly courses with associated laboratory sessions, and that changing prerequisite courses may put students from these institutions at a disadvantage. However, many of these institutions offer courses in physiology or combined courses in anatomy and physiology, and we believe that experience gained in such courses would be better than no prior exposure before encountering these subjects in the veterinary curriculum. There is a substantial amount of evidence that many first-year veterinary students are overwhelmed by the volume of information presented to them in the didactic portion of veterinary curricula, the concurrent pressure to excel, and their increasing educational debt. As a result, they experience problems with stress, anxiety, and depression.1,3,14–16 Although these problems are multifactorial in origin, we suggest that a key factor may be that students are inadequately prepared for foundational courses that are taught in the first year of the curriculum, especially anatomy, physiology, and histology. Although students admitted to the veterinary medical profession have proven that they can handle the rigors of undergraduate courses such as organic chemistry and physics, it is evident that those experiences do not prevent them from struggling academically in the first year of the veterinary curriculum. We believe that reducing stress early in their veterinary medical education is of immense importance to the wellness and success of our students and that changing the prerequisites for admission may be 1 way to do so.
Acknowledgments
Dr. Cohen was supported in part by the Link Equine Research Endowment at Texas A&M University.
ABBREVIATIONS
| AAEP | American Association of Equine Practitioners |
| AAVMC | Association of American Veterinary Medical Colleges |
| ABVP | American Board of Veterinary Practitioners |
| ACVIM | American College of Veterinary Internal Medicine |
| ACVS | American College of Veterinary Surgeons |
Footnotes
Associate deans for academic affairs (or equivalent) at colleges of veterinary medicine associated with the following 32 universities were contacted for inclusion in the study: Auburn University, University of Calgary, University of California-Davis, Colorado State University, Cornell University, University of Florida, University of Georgia, University of Guelph, University of Illinois, Iowa State University, Kansas State University, Lincoln Memorial University, Louisiana State University, Michigan State University, University of Minnesota, Mississippi State University, University of Missouri, North Carolina State University, The Ohio State University, Oklahoma State University, Oregon State University, University of Pennsylvania, Purdue University, Ross University, University of Saskatchewan, University of Tennessee, Texas A&M University, Tufts University, Virginia Tech, Western University, University of Wisconsin, and Washington State University.
Robertson EM, Thompson K, Notebaert A. Student perception of the value of previous anatomy coursework on medical gross anatomy (abstr). FASEB J 2017;31(suppl):732.6.
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