Letters to the Editor

Reassessing admission requirements

Moore et al,1 in their study on courses required for admission to colleges of veterinary medicine, suggested that there might be some benefit for first-year veterinary students in replacing current prerequisite courses in organic chemistry and physics with courses in anatomy, physiology, and histology. Coincidentally, in a conversation with a college classmate—himself a physician—several months ago, we agreed that we felt at a bit of a disadvantage, compared with our veterinary and medical school classmates who had had prior exposure to anatomy, physiology, and histology before being immersed in those disciplines during our first year of professional school.

That said, I think it is troubling that the authors' justification for these changes was to reduce “the levels of stress and anxiety currently experienced by first-year veterinary students.” Education at every level is supposed to be challenging, and motivated students will always have a degree of stress and anxiety when trying to absorb massive amounts of material in a short time and master new concepts.

To my mind, the main problem is not so much the specific coursework first-year students face, but the fixed, 4-year period for a medical or veterinary degree. Part of the winnowing process has been to require undergraduate students to take rigorous science courses so that some may realize on their own that they may not have the mettle (not necessarily the intelligence or desire, but the discipline and focus) to handle a challenging professional curriculum and career.

Most everyone agrees that the actual knowledge of organic chemistry and physics is largely immaterial to being an effective physician or veterinarian. What is important is the process of grappling with difficult subjects that require intensive focus and a willingness to forego other distractions.

It certainly makes sense to suggest that aspirants for a career in human or veterinary medicine take elective courses in anatomy, physiology, and histology. But, as the authors noted, not every undergraduate institution can offer these courses. Furthermore, changing the prerequisite courses would only transfer the stress and anxiety to a different time, not eliminate it. I can attest to my own levels of stress and anxiety as a first-year veterinary student 40 years ago, but confidence as a professional requires that individuals face and overcome stressful and anxiety-provoking challenges. One day, these veterinary students will be facing life-and-death choices, managing tough clinical cases, and they need to be able to handle the stress and anxiety that automatically accompanies such situations.

Finally, I disagree with the contention that requiring chemistry courses as a prerequisite for admission to veterinary college puts underrepresented minority students at a disadvantage or discourages individuals who might excel as physicians or veterinarians from achieving that goal. There are many ways (eg, providing mentoring or other assistance) that underrepresented minority students can be encouraged before and during their undergraduate training to seek careers in veterinary or human medicine. Ultimately, colleges of veterinary and human medicine have a responsibility to ensure that their graduates have the knowledge and work ethic necessary to be trustworthy servants of the public. Those criteria are race and gender neutral.

James M. Fingeroth, dvm

Pittsford, NY

1. Moore JN, Cohen ND, Brown SA. Reassessing courses required for admission to colleges of veterinary medicine in North American and the Caribbean to decrease stress among first-year students. J Am Vet Med Assoc 2018;253:11331139.

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The authors respond:

We appreciate Dr. Fingeroth's interest in our paper.1 Although we agree with his assertion that prerequisite courses for admission to veterinary college should be rigorous, our concern is that the rigor must be in the right place. Many of today's veterinary students flourished in organic chemistry and physics, yet still arrive unprepared for their first year in the veterinary curriculum. Obviously, organic chemistry is not the right place. We propose that the rigor should be in courses that are relevant to what students will be studying, where many of them currently struggle, and in areas that most of the large number of practitioners polled in our study agreed would best prepare them to be competent practitioners. Rigorous undergraduate courses in anatomy and physiology fit each of these criteria.

We agree that the primary purpose of changing the prerequisites should not be simply to reduce stress; however, having students better prepared should positively impact our profession's current challenges with well-being, depression, and the high risk of suicide.2–4 Like Dr. Fingeroth, we were first-year veterinary students 40 years ago and recall the level of stress and anxiety we experienced learning anatomy, physiology, and histology for the first time. Although the material presented to us in those courses might be similar to what today's students are expected to master, their lack of prior exposure to this material is exacerbated by the volume and complexity of information in their other basic science courses. Starting around the same time we gained admittance to veterinary school, there was a dramatic expansion in the rate of generation of new scientific knowledge with applications to health care. We have had 40 years to absorb this new knowledge, but we ask current veterinary students to do so in a tenth of that time. As 3 examples out of thousands, innate immunity, cyclo-oxygenases, and the entire field of molecular biology either hadn't been discovered or were in their infancy when we were first-year students. Today's students have to learn this new knowledge alongside the basic anatomy and physiology concepts we learned, which have changed far less in that time span. Given both the explosion of information in these areas and the propensity for some faculty members to believe that veterinary students need to be exposed to every detail pertaining to these findings (a belief we do not share), it becomes even more important for incoming students to have a stronger basis in anatomy and physiology.

We agree with Dr. Fingeroth's point that the current 4-year period for earning a medical degree should be reconsidered. Given the fact that universities in other countries, including those that are AVMA accredited, produce well-educated graduates in a total of 6 years of postsecondary education whereas we typically require 8 years, it seems to us that the problem is more likely educational content and preprofessional school preparation than duration of training.

Finally, in our discussion, we referenced a study in which organic and inorganic chemistry were identified most often as the courses that discouraged students at Stanford and Berkeley from pursuing their goal of becoming physicians.5 This was true for all students, including underrepresented minority students. That study demonstrates another negative aspect of requiring students to take courses that have little relevance to human or veterinary medical practice.

James N. Moore, dvm, phd

Department of Large Animal Medicine

Scott A. Brown, vmd, phd

Department of Physiology and Pharmacology College of Veterinary Medicine, University of Georgia Athens, Ga

Noah D. Cohen, vmd, mph, phd

Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University College Station, Tex

  • 1. Moore JN, Cohen ND, Brown SA. Reassessing courses required for admission to colleges of veterinary medicine in North American and the Caribbean to decrease stress among first-year students. J Am Vet Med Assoc 2018;253:11331139.

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    • Search Google Scholar
    • Export Citation
  • 2. Stoewen DL. Suicide in veterinary medicine: let's talk about it. Can Vet J 2015;56:8992.

  • 3. Drake AS, Hafen M, Rush BR. Promoting well-being among veterinary medical students: protocol and preliminary findings. J Vet Med Educ 2014;41:294300.

  • 4. Whittington RE, Rhind S, Loads D, et al. Exploring the link between mindset and psychological well-being among veterinary students. J Vet Med Educ 2017;44:134140.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5. Barr DA, Matsui J, Wanat SF, et al. Chemistry courses as the turning point for premedical students. Adv Health Sci Educ Theory Pract 2010;15:4554.

Ownership of the profession

Corporate practice has become common in veterinary medicine for the same reasons that it has become common in so many other professions. The recent JAVMA News story on “The Corporatization of Veterinary Medicine”1 makes the following clear:

  • • The growth in practice value has made associate buyouts more difficult.

  • • The pace of change in technology can tax a small business's ability to keep up.

  • • Demographic changes within the profession have altered interest in practice ownership.

  • • Business management has become more challenging with increased regulatory complexity.

  • • Corporations can effectively leverage their size and skill set to promote profitability.

Private equity firms understand that the growing societal interest in pet ownership, increasing importance of the human-animal bond, and ongoing changes in the demographics of the United States mean that the future for veterinary practice is bright. Thus, it looks certain that the corporate footprint in the veterinary profession will only continue to grow in the near term. Corporate reach into the companion animal arena is accelerating and is now extending into mixed animal practices, while the corporatization of the specialty market is nearly complete.

As corporate roll-ups continue, it is unlikely that any of these practices will ever be in the hands of veterinarians again, severely limiting opportunities for veterinarians to participate in the financial future of the profession. As we work to maximize the value of the degree, growing corporate ownership represents a strong headwind to progress.

There is another way: doctor-corporate partnerships. Co-ownership allows veterinarians to exercise medical and ethical leadership while continuing to share in the financial performance of their practices as owners. Additionally, it allows for the generational transfer of ownership that drives wealth creation for millennial veterinarians.

Veterinary Practice Partners was founded in 2011 on the principle that practices with veterinary ownership can provide better patient care and financially outperform practices owned by third parties. Since then, Veterinary Practice Partners has partnered with 55 veterinarians (and 17 former associates) to bring the advantages of a corporation (eg, financial reporting, data analysis, human resources management, marketing, contracting, and operational support) to strengthen their individual practices.

Veterinary medicine is more than just a business, but running the business aspects of a practice takes skills most veterinarians were never taught in school. Doctor-corporate partnerships such as practice co-ownership can bring those skills to veterinarians while allowing them to fully participate in the financial rewards of this great profession.

Douglas G. Aspros, dvm

Pound Ridge, NY

Note: The author is Chief Veterinary Officer for Veterinary Practice Partners and a past president of the AVMA.

1. Nolen RS. The corporatization of veterinary medicine. J Am Vet Med Assoc 2018;253:13761379.

A call for readability guidelines in veterinary medicine

Health literacy refers to the set of skills people need to understand health information and be effective advocates for their own health.1,2 These skills include oral literacy, numeracy, and print literacy, with print literacy being particularly important because so much health-care information is written. Print literacy improves when health-care information is easy to read, and it is well established in human health care that easy-to-read texts and texts with good readability improve comprehension and promote positive health outcomes in patients.3 In fact, readability is so important that the American Medical Association, NIH, and US Department of Health and Human Services issued readability guidelines for medical information written for patient consumption. These guidelines recommend that all medical handouts, brochures, patient instructions, prescriptions, and similar materials be written at a sixth-grade reading level. This target reading level was selected on the basis of findings from the US Department of Education's National Adult Literacy Survey, which found that nearly half of American adults have low-level reading skills.4

We argue that health literacy is as important in veterinary health care as it is in human health care and contend that the readability guidelines issued by the American Medical Association, NIH, and US Department of Health and Human Services should be formally adopted by the veterinary profession. First, the literacy research from the US Department of Education is relevant for veterinary medicine because veterinary clients are a cross-section of the general public. Second, as veterinary medicine increasingly moves toward relationship-centered care, it becomes ever more essential that veterinarians communicate effectively with their clients and ensure client understanding to promote the best health-care outcomes for patients. Third, animal health information that contains unfamiliar anatomic terms, medical jargon, and complex descriptions of disease pathophysiology is likely to be above client literacy levels and can contribute to confusion, misunderstanding, frustration, and poorly informed decision-making.

The issues of health literacy and readability are beginning to be recognized in the veterinary profession. In 2 recent studies,5,6 we report on readability analyses of veterinary brochures written for small animal and equine clients. Findings from these studies indicate that most of the materials we analyzed were written above the sixth-grade reading level.

It is our hope that highlighting the issues of health literacy and readability will increase awareness among veterinarians and veterinary professionals. Freely available online software now makes it is easy to perform readability analyses of written materials intended for client consumption. Although further research is needed, we hypothesize that like human patients, veterinary clients with access to information that is easy to read will have better comprehension, be better partners in the veterinarian-client relationship, and see improved health-care outcomes for their animals. We strongly encourage the AVMA to consider issuing readability guidelines in support of this effort.

M. Katie Sheats, dvm, phd

April Kedrowicz, phd

Kenneth Royal, phd

Department of Clinical Sciences College of Veterinary Medicine North Carolina State University Raleigh, NC

  • 1. Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011;155:97107.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2. Baker DW. The meaning and the measure of health literacy. J Gen Intern Med 2006;21:878883.

  • 3. Lee PP. Why literacy matters. Links between reading ability and health. Arch Ophthalmol 1999;117:100103.

  • 4. Kutner M, Greenberg E, Jin Y, et al. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: US Department of Education National Center for Education Statistics, 2006.

    • Search Google Scholar
    • Export Citation
  • 5. Royal KD, Sheats MK, Kedrowicz AA. Readability evaluations of veterinary client handouts and implications for patient care [published online ahead of print Jun 1, 2018]. Topics Companion Anim Med 2018 doi: 10.1053.j.tcam.2018.03.005.

    • Search Google Scholar
    • Export Citation
  • 6. Sheats MK, Royal KD, Kedrowicz AA. Using readability software to enhance the health literacy of equine veterinary clients: an analysis of 17 AAEP “Newsletter and Website Articles” [published online ahead of print Nov 17, 2018]. Equine Vet J 2018 doi: 10.1111/evj.13042.

    • Search Google Scholar
    • Export Citation
  • 1. Moore JN, Cohen ND, Brown SA. Reassessing courses required for admission to colleges of veterinary medicine in North American and the Caribbean to decrease stress among first-year students. J Am Vet Med Assoc 2018;253:11331139.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 1. Moore JN, Cohen ND, Brown SA. Reassessing courses required for admission to colleges of veterinary medicine in North American and the Caribbean to decrease stress among first-year students. J Am Vet Med Assoc 2018;253:11331139.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2. Stoewen DL. Suicide in veterinary medicine: let's talk about it. Can Vet J 2015;56:8992.

  • 3. Drake AS, Hafen M, Rush BR. Promoting well-being among veterinary medical students: protocol and preliminary findings. J Vet Med Educ 2014;41:294300.

  • 4. Whittington RE, Rhind S, Loads D, et al. Exploring the link between mindset and psychological well-being among veterinary students. J Vet Med Educ 2017;44:134140.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5. Barr DA, Matsui J, Wanat SF, et al. Chemistry courses as the turning point for premedical students. Adv Health Sci Educ Theory Pract 2010;15:4554.

  • 1. Nolen RS. The corporatization of veterinary medicine. J Am Vet Med Assoc 2018;253:13761379.

  • 1. Berkman ND, Sheridan SL, Donahue KE, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011;155:97107.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2. Baker DW. The meaning and the measure of health literacy. J Gen Intern Med 2006;21:878883.

  • 3. Lee PP. Why literacy matters. Links between reading ability and health. Arch Ophthalmol 1999;117:100103.

  • 4. Kutner M, Greenberg E, Jin Y, et al. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: US Department of Education National Center for Education Statistics, 2006.

    • Search Google Scholar
    • Export Citation
  • 5. Royal KD, Sheats MK, Kedrowicz AA. Readability evaluations of veterinary client handouts and implications for patient care [published online ahead of print Jun 1, 2018]. Topics Companion Anim Med 2018 doi: 10.1053.j.tcam.2018.03.005.

    • Search Google Scholar
    • Export Citation
  • 6. Sheats MK, Royal KD, Kedrowicz AA. Using readability software to enhance the health literacy of equine veterinary clients: an analysis of 17 AAEP “Newsletter and Website Articles” [published online ahead of print Nov 17, 2018]. Equine Vet J 2018 doi: 10.1111/evj.13042.

    • Search Google Scholar
    • Export Citation

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