Teaching of professional skills in US colleges and schools of veterinary medicine in 2019 and comparisons with 1999 and 2009

Donna L. Harris From the College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824

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 DVM, MBA, MS
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James W. Lloyd Animal Health Economics LLC, Sears, MI 49679.

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 DVM, PhD

Abstract

OBJECTIVE

To quantify the extent that professional skills topics were presented to veterinary students at US colleges and schools of veterinary medicine (ie, veterinary schools) in 2019 and compare findings with similar data collected in 1999 and 2009.

SAMPLE

All 30 US veterinary schools in 2019.

PROCEDURES

An electronic questionnaire was sent to the associate deans for academic affairs of all 30 veterinary schools in the United States during fall of 2019. Results were compared with published results of a similar survey performed in 1999 and 2009.

RESULTS

A 100% (30/30) response rate was achieved for 2019. A total of 173 courses on professional skills topics were reported, of which 115 (66%) were required. The most common topic was communication (79/136 [58%] courses). Overall, courses were most frequently delivered in the first 3 years of the curriculum (129/158 [82%]), with required courses most common in years 1 and 2 (79/112 [71%]). Most courses (116/150 [77%]) were assigned 1 or 2 credit hours. These results represented continuation of a substantial increase in the teaching of professional skills, compared with findings for 1999 and 2009.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested a growing commitment to the teaching of professional skills on the part of US veterinary schools and the willingness to change on the basis of the current perceived needs of their graduates. The observed increases align nicely with the emerging framework for competency-based veterinary education and its substantial focus on assessing competency in professional skills as an important outcome of veterinary medical education.

Abstract

OBJECTIVE

To quantify the extent that professional skills topics were presented to veterinary students at US colleges and schools of veterinary medicine (ie, veterinary schools) in 2019 and compare findings with similar data collected in 1999 and 2009.

SAMPLE

All 30 US veterinary schools in 2019.

PROCEDURES

An electronic questionnaire was sent to the associate deans for academic affairs of all 30 veterinary schools in the United States during fall of 2019. Results were compared with published results of a similar survey performed in 1999 and 2009.

RESULTS

A 100% (30/30) response rate was achieved for 2019. A total of 173 courses on professional skills topics were reported, of which 115 (66%) were required. The most common topic was communication (79/136 [58%] courses). Overall, courses were most frequently delivered in the first 3 years of the curriculum (129/158 [82%]), with required courses most common in years 1 and 2 (79/112 [71%]). Most courses (116/150 [77%]) were assigned 1 or 2 credit hours. These results represented continuation of a substantial increase in the teaching of professional skills, compared with findings for 1999 and 2009.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested a growing commitment to the teaching of professional skills on the part of US veterinary schools and the willingness to change on the basis of the current perceived needs of their graduates. The observed increases align nicely with the emerging framework for competency-based veterinary education and its substantial focus on assessing competency in professional skills as an important outcome of veterinary medical education.

Introduction

The 1999 publication of a report1 on the current and future market for veterinarians and veterinary medical services in the United States (ie, the KPMG study) launched a broad-based national discussion about the then-current and future state of the veterinary medical profession. One of the key areas of concern was the contention that veterinarians may have lacked some of the SKAs necessary for economic success, particularly in the areas of business management and communication.

Before the KPMG study, skills other than clinical skills were often considered under the broad category of practice management. After the KPMG study, the National Commission on Veterinary Economic Issues expanded this category of SKAs to include all the core competencies needed for success in veterinary medicine,24 such as management and communication. The veterinary profession currently refers to these competencies as professional skills and has expanded the scope to include personal finance and well-being.5

Studies6,7 subsequent to the KPMG study further emphasized the importance of professional skills as a prelude to success in the veterinary profession. To obtain a broader understanding of the incorporation of these SKAs in veterinary medical education, a study8 was conducted in 1999 to determine the extent to which they were being taught in colleges and schools of veterinary medicine (ie, veterinary schools) in the United States and Canada.

In the years immediately following the 1999 study, a concerted effort was made within academic veterinary medicine to explore and share the best teaching methods for improving the SKAs of veterinary medical graduates.918 A follow-up study19 was subsequently conducted in 2009 to determine whether these efforts had changed the emphasis on professional skills in veterinary school curricula. Results of the study indicated that veterinary schools had added considerable opportunities for students to learn professional skills, particularly business topics and communication.

In 2011, the NAVMEC published a report defining the core desired competencies for all veterinary graduates.20 These competencies included multispecies knowledge plus clinical competency in 1 or more species or disciplines; one-health knowledge; effective communication skills; effective team members in interdisciplinary, multiprofessional, and multi-cultural environments; effective management (self, team, and system); commitment to lifelong learning, scholarship, and the value of research; leadership; understanding of diversity and multicultural awareness; and ability to adapt to a changing environment. Overall, core competencies emphasized the need for veterinary school graduates to develop the professional skills as well as the established clinical skills to be both professionally and economically successful as a veterinarian.

In 2015, the AAVMC convened a competency-based working group that researched and published in 2018 a CBVE framework.5 This framework outlines 9 domains considered fundamental for veterinary education, 4 of which focus on professional skills:

  • Clinical reasoning and decision-making.

  • Individual animal care and management.

  • Animal populations care and management.

  • Public health.

  • Communication.

  • Collaboration.

  • Professionalism and professional identity.

  • Financial and practice management.

  • Scholarship.

The purpose of the study reported here was to identify and describe courses covering the professional skills topic areas that were offered by US veterinary schools in 2019. Where applicable, we also compared those results with 1999 and 2009 results to provide a foundation from which to assess the response of US veterinary schools to the recommendations of the KPMG, NAVMEC, and CBVE framework. We believed such data would also be useful to veterinary school administrators and faculty as a reference as they evaluate their own professional skills curricula.

Materials and Methods

The study was designed as a cross-sectional survey. In fall of 2019, an electronic questionnaire seeking information about learning opportunities in professional skills was emailed to the associate deans for academic affairs (through the AAVMC email group) at all 30 veterinary schools in the United States. Policy of the AAVMC dictates that all surveys of member institutions be approved and distributed through the AAVMC and not administered directly by investigators. Recipients were instructed to complete the questionnaire themselves or to have the moderators of the appropriate courses supply information regarding specific course content. Each academic dean determined which courses to include in the survey response. Each college or school of veterinary medicine was considered a single respondent. Institutions that failed to respond to the survey were contacted by email and telephone.

For comparative reasons, the questionnaire was the same as used in 1999 and 2009. In these previous studies,8,19 the questions were found to effectively capture the teaching of professional skills as assessed on the basis of feedback received directly from the survey participants, and questions were found to be well understood and straightforward. In this regard, the previous studies served as an effective means for establishing the face validity of the questions. In addition, wherever possible, individual responses in the present study were validated through review of data published on the veterinary schools' websites. Whenever concerns arose regarding data quality, participants were contacted directly to achieve resolution. To enhance clarity and decrease the likelihood of misinterpretation, only numeric results from 2009 and 2019 were directly compared in tables because of the slightly different design of the 1999 study, which also included Canadian veterinary schools. Data were analyzed with the aid of a spreadsheet program.a

Results

Responses were obtained from all 30 US veterinary schools in 2019, although not all respondents completed each question. In 1999 and 2009, 31 Canadian and US veterinary schools and 28 US veterinary schools, respectively, were represented. Respondents for 6 veterinary schools in 2019 noted that their schools were undergoing curriculum reviews to become more competency based in alignment with the CBVE framework. The 30 respondents reported on a total of 173 courses related to the professional skills topics. All 30 (100%) respondents reported that their school offered at least 1 course on professional skills topics, 26 (87%) reported at least 3 courses, and 17 (57%) reported at least 5 courses (Table 1).

Table 1

Number (%) of US veterinary schools that offered courses on professional skills topics in 2009 and 2019.

No. of courses on professional skills 2009 (n = 28 schools) 2019 (n = 30 schools)
≥ 1 24 (86) 30 (100)
≥ 3 20 (71) 26 (87)
≥ 5 8 (29) 17 (57)

Of the 173 skills on professional skills topics, 115 (66%) were required courses and 58 (34%) were elective. Information on curriculum placement was provided for 158 (91%) courses (Table 2). The highest percentage (46/158 [29%]) of courses on professional skills topics were offered during the first year of the curriculum in 2019, whereas 16 (10%) courses were offered in multiple years. Information on curriculum placement of the 112 required courses on professional skills topics indicated that, again, the greatest proportion (42/112 [38%]) were taught in the first year. Of the 46 elective courses on professional skills topics in 2019, 3 (7%) were offered during the first year, 5 (11%) were offered during the second year, 13 (28%) were offered in the third year, 9 (20%) were offered in the fourth year, and 16 (35%) were offered in multiple years.

Table 2

Distribution of courses on professional skills topics by year of veterinary school curriculum in 2009 and 2019.

Year No. (%) of all courses on professional skills No. (%) of required courses on professional skills
2009 (n = 110) 2019 (n = 158) 2009 (n = 67) 2019 (n = 112)
1 29 (26) 46 (29) 23 (34) 43 (38)
2 17 (15) 41 (26) 14 (21) 36 (32)
3 37 (34) 42 (27) 24 (36) 29 (26)
4 8 (7) 13 (8) 2 (3) 4 (4)
Multiple years 19 (17) 16 (10) 4 (6) 0 (0)

Data on course credits were provided for 150 of 173 (87%) courses on professional skills topics in 2019 (Table 3). Although credit values ranged from 0 to 4 in 2019, with 3 (2%) courses offering a variable number of credits, the mean value was 1.5 credits and the median value was 1.0 credits. Most (116/150 [77%]) courses in 2019 were worth either 1 or 2 credits.

Table 3

Distribution of credit hours assigned to courses on professional skills topics in 2009 and 2019.

No. of credits No. (%) of all courses on professional skills No. (%) of required courses on professional skills
2009 (n = 110) 2019 (n = 150) 2009 (n = 67) 2019 (n = 107)
0 5 (5) 4 (3) 5 (7) 2 (2)
0.5 2 (2) 3 (2) 0 (0) 2 (2)
1 55 (50) 90 (60) 38 (57) 73 (68)
1.5 0 (0) 5 (3) 0 (0) 5 (5)
2 23 (2l) 26 (17) l4 (2l) 13 (12)
2.5 0 (0) 2 (l) 0 (0) 2 (2)
3 17 (14) 15 (10) 5 (7) 7 (7)
4 0 (0) 2 (l) 0 (0) 2 (2)
5 3 (3) 0 (0) 3 (4) 0 (0)
Other 5 (5) 3 (2) 2 (3) 1 (1)

Data on grading method were provided for 154 of 173 (89%) courses on professional skills topics in 2019. Of these 154 courses, 88 (57%) were graded on a numeric or letter grade basis, and 66 (43%) were graded as pass or fail. Of the 110 required courses on professional skills topics with available data in 2019, 59 (54%) were graded on a numeric or letter grade basis, and 51 (46%) were graded as pass or fail. Of the 44 reported elective courses on professional skills topics in 2019, 29 (66%) were graded on a numeric or letter grade basis, and 15 (34%) were graded as pass or fail.

Data regarding the number of years each course on professional skills had been offered was provided for 63 of 173 (36%) courses in 2019. Twenty-four of these 63 (37%) courses had been offered for ≤ 5 years, 5 (8%) had been offered for 6 to 10 years, 12 (19%) had been offered for 11 to 15 years, and 22 (35%) had been offered for > 15 years.

When asked who delivered the course content, respondents provided data for 104 of 173 (60%) courses in 2019. Most (82/104 [79%]) of these courses used at least 1 guest speaker. When used, guest speakers provided a mean of 70% of the course content. Of the 82 courses with guest speakers, 63 (77%) used speakers who held academic degrees in business or a related discipline.

Professional skills topics most commonly covered in 2019 included communication, law, and financial management (Table 4), with communication comprising at least a portion of the course content for 79 (58%) of the 136 courses for which content levels were provided by topic. Of these 79 courses, 65 (82%) were required and 14 (18%) were elective. When presented in any course, communication comprised, on average, 45% of the content, with 31 (48%) courses having ≥ 50% communication content.

Table 4

Number (%) of all courses, required courses, and elective courses on professional skills in which various topics were presented in 2009 and 2019.

Topic 2009 2009
All (n = 110) Required (n = 67) Elective (n = 43) All (n = 136) Required (n = 97) Elective (n = 39)
Personal time management 21 (19) 15 (22) 6 (14) 15 (11) 14 (14) 1 (3)
Personal budgeting 32 (29) 24 (36) 8 (19) 27 (20) 22 (23) 5 (13)
Student debt management NC NC NC 30 (22) 24 (25) 6 (15)
Ethics 25 (23) 24 (36) 2 (5) 30 (22) 27 (28) 3 (8)
Communication 53 (48) 33 (49) 20 (47) 79 (58) 65 (67) 14 (36)
Law 31 (28) 25 (37) 6 (14) 45 (33) 34 (35) 11 (28)
Leadership 19 (17) 10 (15) 9 (21) 12 (9) 7 (7) 5 (13)
Team building 12 (11) 8 (12) 4 (9) 7 (5) 5 (5) 2 (5)
Resumes and cover letters 20 (18) 16 (24) 4 (9) 23 (17) 19 (20) 4 (10)
Job seeking 22 (20) 15 (22) 7 (16) 23 (17) 18 (19) 5 (13)
Negotiating skills 19 (17) 14 (21) 5 (12) 13 (10) 11 (11) 2 (5)
Employment contracts 17 (15) 12 (18) 5 (12) 32 (24) 28 (29) 4 (10)
Personnel management 23 (21) 14 (21) 9 (21) 29 (21) 12 (12) 17 (44)
Marketing 24 (22) 15 (22) 9 (21) 36 (26) 15 (15) 21 (54)
Financial management 37 (34) 24 (36) 13 (30) 43 (32) 19 (20) 24 (62)
Strategic management 10 (9) 4 (6) 6 (14) 26 (19) 11 (11) 15 (38)

NC = Not collected.

Aspects of law were presented in 45 of 136 (33%) courses, with 34 (76%) of those courses being required and 11 (24%) being elective (Table 4). Law comprised a mean of 24% of the content in courses in which it was offered as a topic. Financial management was presented in 43 of 136 (32%) courses, with 19 (44%) of those courses being required and 24 (56%) being elective. Financial management comprised a mean of 28% of the content when it was included in a course. Personal budgeting, debt management, or both were covered in 42 of 136 (31%) courses. Thirty-four of the 42 (81%) courses with this content were required. Of the 42 courses covering these topics, 17 (40%) were presented in the third year, first year (13 [31%]), second year (7 [17%]), and fourth year (2 [5%]) and 3 (7%) in multiple years.

Respondents were given the opportunity to report other topics presented in their veterinary school's curriculum if not specifically requested in the questionnaire. Other reported topics included wellness (taught in 25 schools), personal finance (21 schools), career choices (19 schools), and diversity (13 schools). Additionally, personal finance and wellness were listed as topics presented during first-year orientation for 7 and 3 veterinary schools, respectively.

Discussion

Results of the 1999 KPMG study1 suggested that the future economic vitality of the veterinary profession would hinge on the degree to which veterinarians were able to acquire proficiency in business management and other nontechnical skills. This sentiment was subsequently echoed by NAVMEC in 2011,20 among others. Results of the present study indicated that colleges and schools of veterinary medicine have continued to address the importance of professional skills training in the veterinary medical curriculum. The number of courses containing professional skills topics increased from 47 in 1999 (across 31 US and Canadian veterinary schools8) to 110 in 2009 (across 28 US schools)19 and then 173 in 2019 (across 30 US schools). In 1999, 94% of veterinary schools had at least 1 practice management course, but only 36% had > 1 course.8 The number of schools with at least 3 courses increased from 10% in 19998 to 71% in 200919 and 87% in 2019. The number of schools with ≥ 5 courses increased from 0 in 19998 to 29% in 200919 and 57% in 2019. Of these courses, 24 were required in 1999 across 31 veterinary schools,8 67 were required in 2009 across 28 schools,19 and 115 were required in 2019 across 30 schools. Not only did the number of veterinary schools offering any content in professional skills training increase since 1999, but all schools offered more opportunities for students to learn in a variety of areas in 2019.

In 2009, courses on professional skills topics were more likely placed in the first and third year of the curriculum (required or elective) than in other curriculum years.19 In 2019, these courses were more evenly distributed over years 1 through 3, with more courses being required rather than elective, suggesting that veterinary schools are placing more value on students spending time acquiring professional skills. To further support this suggestion, the number of required 1-credit courses on professional skills topics increased from 38 in 200919 to 73 in 2019.

The relative use of guest speakers to deliver course content decreased since 1999, when 96% of courses used guest speakers.8 In 200919 and 2019, 87% and 79% of courses on professional skills topics, respectively, used guest speakers. This indicated that veterinary schools are investing in faculty to deliver professional skills content. Because data on the age of professional skills courses were provided for only 36% of courses, we suspect that course age might not have been common knowledge of the faculty or administrators who completed the survey.

Communication training continued to be the most common topic covered of all the professional skills and has grown substantially from 2009 to 2019. In 2009, 53 of 110 (48%) courses on professional skills topics covered communication, of which 33 (62%) were required courses.19 In 2019, communication training was provided in 79 of 136 (58%) courses, of which 65 (82%) were required courses. Clearly programs see value and place importance on communication training.

In light of the student debt issue currently facing the profession, the specific topic of student debt management was evaluated in 2019, in addition to the topic of personal budgeting, which was included in both 2009 and 2019. Between 2009 and 2019, a slight decrease was observed in the number of courses that covered personal budgeting, from 32 (29% of all courses on professional skills topics)19 to 27 (20%). However, a total of 42 (31%) courses covered personal budgeting, debt management, or both in 2019, and in several curricula personal finance was reported to be covered as an additional topic in courses or orientation; consequently, budgeting still appears to have been offered on a frequent basis.

Some of the reported increase in courses covering professional skills topics may have been attributable to the increase in the number of topics considered to be important components of professional education, such as a more in-depth approach to personal finance, wellness, and diversity. These topics were not listed for any veterinary school in 2009 but were listed in the “other” category for several schools as in the curriculum or part of orientation in 2019.

Finally, to achieve the desired positive impact on lifelong professional and economic success, the NAVMEC suggested that competency in the professional skills will be required.20 With recognition that teaching does not guarantee learning (ie, teaching is necessary but not sufficient), we are encouraged to see that the CBVE framework is quite heavily populated with professional skills topics and that veterinary school curricula are changing to align accordingly. This is a positive step toward the recommended development of appropriate outcome assessments for professional skills that accompanied the 2009 study.19 Having such outcomes measured will, in turn, facilitate rigorous evaluation of teaching methods and delivery models to determine which approaches are most effective in professional skills development and enhancing career success. Indeed, interest in these skills has apparently continued to grow, as evidenced by the recent emergence of faculty groups such as VetCAN and the Wellness Initiative, both formed under the AAVMC umbrella.21 Members of these groups will, no doubt, provide ongoing leadership for continued evolution in teaching of professional skills in US veterinary schools.

We view the results of the present study as encouraging because they demonstrated that US veterinary schools are continuing to evolve and incorporate professional skills into the curriculum. The veterinary profession and society are continually changing, as concerns such as mental health and well-being, career choices other than clinical practice, and personal finance knowledge join previous concerns such as student debt, lack of diversity, and business acumen. Our findings suggested that, as new areas of importance are identified in the veterinary medical profession, veterinary schools are incorporating those topics into the curriculum. As the importance of professional skills for academic and career success gains more attention, much work needs to be done to evaluate the most effective teaching and assessment methods. As veterinary schools move toward a more competency-based curriculum using the CBVE framework, competency assessments will need to be developed for the professional skills.

Acknowledgments

Funded by Care Credit.

The authors declare that there were no conflicts of interest.

Footnotes

a.

Excel 2020, version 16.4, Microsoft Corp, Redmond, Wash.

Abbreviations

AAVMC

American Association of Veterinary Medical Colleges

CBVE

Competency-based veterinary education

NAVMEC

North American Veterinary Medical Education Consortium

SKAs

Skills, knowledge, aptitudes, and attitudes

References

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Contributor Notes

Address correspondence to Dr. Harris (harrisko@msu.edu).
  • 1.

    Brown JP, Silverman JD. The current and future market for veterinarians and veterinary medical services in the United States. J Am Vet Med Assoc 1999;215:161183.

    • Search Google Scholar
    • Export Citation
  • 2.

    Lewis RE, Klausner JS. Nontechnical competencies underlying career success as a veterinarian. J Am Vet Med Assoc 2003;222:16901696.

  • 3.

    Klausner JS. NCVEI Update. Determining success competencies. J Am Vet Med Assoc 2001;219:15271528.

  • 4.

    Lloyd JW, King LJ, Klausner JS, et al. National workshop on core competencies for success in the veterinary profession. J Vet Med Educ 2003;30:280284.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Molgaard LK, Hodgson JL, Bok HGJ, et al. Competency-based veterinary education: CBVE framework. Part 1. Washington, DC: Association of American Veterinary Medical Colleges, 2018.

    • Search Google Scholar
    • Export Citation
  • 6.

    Volk JO, Felsted KE, Cummings RF, et al. Executive summary of the AVMA-Pfizer business practices study. J Am Vet Med Assoc 2005;226:212218.

  • 7.

    Cron WL, Slocum JV Jr, Goodnight DB, et al. Executive summary of the Brakke management and behavior study. J Am Vet Med Assoc 2000;217:332338.

  • 8.

    Lloyd JW, Covert BR. Veterinary practice management education in the Association of American Veterinary Medical Colleges member colleges during 1999. J Am Vet Med Assoc 2001;219:176179.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Ilgen DR, Lloyd JW, Morgeson FP, et al. Veterinary medicine careers: present practices and future needs as seen by veterinarians and college students—final report. East Lansing, Mich: College of Veterinary Medicine, Michigan State University, 2003;155.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ilgen DR, Lloyd JW, Morgeson FP, et al. Personal characteristics, knowledge of the veterinary profession, and influences on career choice among students in the veterinary school applicant pool. J Am Vet Med Assoc 2003;223:15871594.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Mase CA, Lloyd JW, King LJ. Initial study results on future needs for leadership in veterinary medicine. J Am Vet Med Assoc 2003;222:15161517.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Lloyd JW, Chaddock HM, Hoblet KH, et al. Enhancing nontechnical skills, knowledge, aptitudes, and attitudes through veterinary leadership development programs. J Am Vet Med Assoc 2007;230:14811485.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Lloyd JW, King LJ, Mase CA, et al. Future needs and recommendations for leadership in veterinary medicine. J Am Vet Med Assoc 2005;226:10601067.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Lloyd JW. NCVEI Update. Developing a curriculum to improve the skills, knowledge, aptitudes, and attitudes of veterinary students. J Am Vet Med Assoc 2002;220:976977.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Lloyd JW, Larsen ER. Veterinary practice management: teaching needs as viewed by consultants and teachers. East Lansing, Mich: College of Veterinary Medicine, Michigan State University, 2000.

    • Search Google Scholar
    • Export Citation
  • 16.

    Lloyd JW, Larsen ER. Veterinary practice management teaching needs as viewed by consultants and teachers. J Vet Med Educ 2001;28:1621.

  • 17.

    Lloyd JW, Walsh DA. Template for a recommended curriculum in “Veterinary professional development and career success.” J Vet Med Educ 2002;29:8493.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Lloyd JW, Bristol DG, Draper DD, et al. Models for teaching career development and practice management. J Vet Med Educ 2004;31:168174.

  • 19.

    Harris DL, Lloyd JW. Changes in teaching of nontechnical skills, knowledge, aptitudes and attitudes at US colleges and schools of veterinary medicine between 1999 and 2009. J Am Vet Med Assoc 2011;239:762766.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    NAVMEC. Roadmap for veterinary medical education in the 21st century: responsive, collaborative, flexible. Available at: www.aavmc.org/assets/data-new/files/NAVMEC/navmec_roadmapreport_web_single.pdf. Accessed Sep 17, 2020.

    • Search Google Scholar
    • Export Citation
  • 21.

    AAVMC. Focus—September 2020. Optimizing personal and organizational wellbeing. Available at: www.aavmc.org/news/focus-september-2020. Accessed Oct 25, 2020.

    • Search Google Scholar
    • Export Citation

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