“Learning is not the product of teaching. Learning is the product of the activity of learners.”
John Holt
In his more than 25 years of general practice, Dr. Mike Dyer has seen the many challenges new veterinary graduates face. He and his partners employ approximately 20 veterinarians in 9 practices in the tristate area encompassing southeastern Ohio, eastern Kentucky, and western West Virginia. Typically, he says, it takes about 2 years for a new graduate to become fully prepared for practice. “It's like we've had to complete their clinical training once we hired them,” says Dr. Dyer, whose Appalachia-based practices require veterinarians who “have the grit to try things.”
Surveys of recent graduates and their employers bear out Dr. Dyer's observations and highlight the need for a revised educational model that better prepares veterinary graduates for the realities of private practice; a model that will produce more-competent and more-confident veterinarians who are ready to practice on their first day in the profession and can command salaries commensurate with their proficiency. More recently, veterinary organizations and employers have begun to realize their roles in helping new graduates transition into the workplace. However, new graduates must first possess the critical skills on which to build. The goal of any educational model is to produce capable veterinarians ready to do their best with the resources at hand for practices like Dr. Dyer's. Many of his clients have limited financial resources and are unwilling or unable to drive several hours to a specialty referral hospital, such as an academic veterinary medical center, for more costly, technologically advanced veterinary care. Yet, it is in such an academic center that most veterinary students spend much of their final year of training, observing and applying the knowledge they acquired during their preclinical years (Figure 1).
Illustration of the clinical training environment for veterinary students. Traditional clinical training models are based primarily to the right of the spectrum. The Ohio State University Preparing for Excellence in Veterinary General Practice program seeks to distribute clinical training opportunities more evenly across the spectrum, thereby increasing opportunities for training in primary care.
Citation: Journal of the American Veterinary Medical Association 259, 5; 10.2460/javma.259.5.463
There is obvious value in having veterinary students spend time observing specialists manage the types of cases typically referred to academic veterinary medical centers. Still, hands-on experience is crucial for success in private practice, and in our experience, most new graduates are comfortable only with those procedures and treatments in which they actively participated during their clinical training and are not comfortable taking primary responsibility for procedures and treatments they learned only through observation. Additionally, new graduates often are not comfortable modifying treatment protocols they have been taught. However, because veterinary medical education programs have only a limited amount of time to teach veterinary students, the knowledge and skills students acquire during their college training represent only a sample of all that is needed to be successful in private practice.
The traditional model of veterinary education in the United States and Canada tends to limit the spectrum of treatment options new graduates feel comfortable offering clients, potentially decreasing the care they can provide. “When you're 3 hours from a specialist or the client has limited resources and a dog has a broken leg, it's gut-wrenching to tell a family, ‘We can't do anything for you,'” says Dr. Dyer. “No one should have to euthanize their pet because it can't be provided some level of care.”
The challenge, as outlined by Stull et al,1 is that “given the highly sophisticated nature of procedures commonly taught and observed in veterinary colleges, veterinarians (most notably recent graduates) may be unaware of, and lack the knowledge and skills to offer, a wide spectrum of care options for a given condition and therefore may be unable to communicate to clients the relative effectiveness and costs of options along this spectrum.” This challenge has been documented many times, and veterinary students and employers alike have called for enhanced opportunities for hands-on learning to better prepare graduates to handle the demands of private practice from day one. Specifically, employers and recent graduates have suggested the need for additional training in business management,2 communication skills,3 and other nontechnical competencies,4 and new graduates have expressed a desire for more experience with general practice5 and point-of-care diagnostic testing6 as well as additional training in procedures such as dentistry7 and ophthalmoscopy8 and imaging techniques such as ultrasonography. They also desire training in strategies for addressing the veterinary needs of underserved communities,9 such as navigating conversations about financial concerns and presenting a variety of treatment options to clients. Veterinary employers seek to hire graduates who have a wider range of skills on day one.10 The Ohio State University veterinary students and new graduates have been vocal about the need for more experience with hands-on skills training earlier in their schooling and for mentoring opportunities during veterinary school and after graduation. In the past, this training has received less emphasis in our curriculum than would be ideal.
As a result of these concerns, The Ohio State University College of Veterinary Medicine has started to shift its approach to preparing veterinary students for careers in general practice by building a program based on the concept of spectrum of care. This new approach aims to produce competent and confident veterinarians who can meet the needs of and provide satisfactory outcomes for animals and their owners under a wide range of circumstances and conditions. In short, this new approach aims to produce new graduates who, with the help and support of mentors like Dr. Dyer, have the necessary background and skills to immediately enter veterinary practice.
What Is Spectrum of Care?
Spectrum of care aims to address the growing problem of affordability of veterinary care by providing a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limitations, thereby successfully serving an economically diverse clientele. Ideally, veterinarians should be able to provide several evidence-based options for care that encompass a wide variety of diagnostic and treatment approaches for patients and their owners.
Spectrum of care is not solely defined by affordability. As indicated by Stull et al,1 the spectrum of care options for any given patient will be influenced by many factors, “including the knowledge and skills of the veterinarian; the current scientific evidence regarding the safety and efficacy of available treatments, recommendations, or best-practice guidelines; practice-specific goals, culture, and available resources; and the owner's goals, values, and resources.”
Spectrum of care is not synonymous with access to care, although incorporation of a spectrum of care approach will help address issues of accessibility. Also, spectrum of care should not be viewed in a binary manner (eg, better vs worse care or substandard vs gold standard care; Figure 2). The question is not whether one embraces a spectrum of care approach (yes vs no), but rather how broadly across the spectrum of care one's approach extends.
Illustration of the spectrum of care concept. Spectrum of care involves providing a range of diagnostic and treatment options (top) and should not be viewed in a binary manner (bottom).
Citation: Journal of the American Veterinary Medical Association 259, 5; 10.2460/javma.259.5.463
Consider the common clinical scenario of a dog whose owner reports that the dog has been vomiting. Vomiting in dogs can be a sign of many underlying conditions, ranging from self-limiting disorders such as dietary indiscretion to life-threatening ones such as acute pancreatitis, intestinal obstruction, and neoplasia. When a middle-aged dog that has been vomiting for several days is presented to a tertiary care facility, the typical diagnostic and treatment approach would consist of baseline clinicopathologic testing, including a CBC, serum biochemical profile, urinalysis, and measurement of pancreatic-specific lipase immuno-reactivity; abdominal ultrasonography; and 24 hours of IV fluid therapy in the intensive care unit, all of which would result in substantial cost for the owner. If this is the only approach veterinary students experience during their clinical training, they may not feel comfortable, following graduation, offering different management options that take into account the owner's ability to pay for services and willingness to provide a different level of care.
Spectrum of care training, on the other hand, prepares veterinary students to offer a variety of management options while also giving them the knowledge needed to discuss with owners the degree of diagnostic certainty, likelihood of a favorable or unfavorable outcome, possible need for additional testing or treatment, and costs associated with each option. An alternative approach, for example, would be to check the dog's Hct and total protein concentration to evaluate hydration status, submit a blood sample for biochemical testing to rule out diabetic ketoacidosis and uremia, and administer fluids SC. If the owner declines this approach, another option could be to administer fluids SC and send the dog home with instructions for the owner to give the dog nothing to eat except ice chips for the first 24 hours and to offer small amounts of water and a homemade, low-fat diet of boiled chicken and rice over the next 24 hours if vomiting subsides, but to return for additional diagnostic testing if vomiting continues.
Veterinary students at The Ohio State University traditionally have received much of their clinical training by observing complex medical and surgical cases evaluated and treated in the Veterinary Medical Center by specialists who have access to sophisticated and costly diagnostic tests, imaging modalities, and treatment procedures. Although this traditional educational model contributes significantly to students' knowledge of how to manage cases, this clinical approach can be dramatically different from the experience of new graduates in general practice. New graduates frequently have difficulty making the transition to a setting in which the financial limitations of a more diverse clientele necessitate selectivity in the choice of tests and treatments. Furthermore, new graduates who have experienced case management primarily in a tertiary referral setting may not understand that other approaches are appropriate and acceptable in a general practice setting.
The traditional educational model also has limited our ability to instill confidence in veterinary students and address critical areas of clinical competency because of the limited opportunities for hands-on experience provided in a tertiary referral setting. Distributed veterinary education models have addressed some of the limitations of the referral training environment by providing students access to training in general practice settings during part or all of their final year. However, the distributed veterinary education model requires additional resources to provide oversight and ensure quality control of the education provided at the various practice sites, and veterinary students must manage the logistics and expenses of travel and living accommodations. Providing an on-site general practice rotation in a veterinary education program allows all students to participate in a cost-effective manner and ensures consistency of the clinical and academic experience. At The Ohio State University, this on-campus experience was historically limited to a single 2- to 4-week general practice rotation in the final year of the program, providing limited time for honing clinical skills and limited opportunity for case follow-up. Our small animal and equine general practices have been located within the Veterinary Medical Center, creating an environment convenient for specialists to contribute to patient management. However, this readily available, casual access to specialty consultation does not replicate the general practice environment and leaves students feeling such consultation is a necessary part of managing complicated cases.
Preparing for Excellence in Veterinary General Practice
The Preparing for Excellence in Veterinary General Practice program is a comprehensive curriculum that incorporates a continuum of clinical and didactic training focused on preparing students to be competent, confident, and practice-ready general practice veterinarians on day one after graduation. The program originated from a Stanton Foundation grant in 2015 and has been further defined and developed since that time. At the heart of the program is a spiral integrated design that allows for important spectrum of care concepts to be introduced early and then later explored in greater depth and breadth, while emphasizing application to general practice settings and increased student proficiency.
The Preparing for Excellence in Veterinary General Practice program allows spectrum of care concepts to be integrated throughout all phases of the veterinary program, from the first semester until the end of the fourth year, and shifts the focus of clinical training to teaching across the entire spectrum of veterinary health care options, from technologically advanced and higher-cost options to more practical ones consistent with veterinary care and cost expectations of a diverse population of clients. By emphasizing skills training, case-based critical thinking and problem solving, business and practice management (practice care), and explicit training in the principles of pet-centered care and the human-animal bond, the program's primary goal is to educate career-ready veterinarians who can provide high-quality affordable care while maintaining sustainable business practices.
The Preparing for Excellence in Veterinary General Practice program incorporates the Competency-Based Veterinary Education framework of the American Association of Veterinary Medical Colleges.11 The Competency-Based Veterinary Education framework is “designed to prepare graduates for professional careers by defining the abilities required to meet the needs of animals and the expectations of society”11 and is built around 9 domains of competence: clinical reasoning and decision making, individual animal care and management, animal population care and management, public health, communication, collaboration, professionalism and professional identity, financial and practice management, and scholarship. The components of the Preparing for Excellence in Veterinary General Practice program can be mapped to all of the specific competencies in the Competency-Based Veterinary Education framework as well as to the AVMA Council on Education's accreditation outcomes (Figure 3).
Illustration of how various elements of the spectrum of care (SOC) concepts included in The Ohio State University Preparing for Excellence in Veterinary General Practice program map to the domains of the Competency-Based Veterinary Education framework developed by the American Association of Veterinary Medical Colleges.
Citation: Journal of the American Veterinary Medical Association 259, 5; 10.2460/javma.259.5.463
Continuum of Clinical Training
A foundational component of the Preparing for Excellence in Veterinary General Practice program is the continuum of clinical training designed to provide instruction in essential hands-on skills throughout the 4-year veterinary degree program. This continuum includes several hands-on components that move veterinary students from “student as novice” along the path to “student as doctor” (Figure 4).
Illustration of how clinical training opportunities are aligned with didactic, classroom, and case-based learning at The Ohio State University College of Veterinary Medicine throughout the 4-year veterinary degree program to help move veterinary students along the continuum from “student as novice” to “student as doctor.”
Citation: Journal of the American Veterinary Medical Association 259, 5; 10.2460/javma.259.5.463
Veterinary Clinical and Professional Skills Center
From their first semester on campus and throughout the first 3 years of their program, students establish and build on the essential skills they will need as veterinarians through the college's Veterinary Clinical and Professional Skills Center. Students practice skills in a safe, low-risk environment, using models that range from simple, low-fidelity models to more sophisticated, high-fidelity, life-like models. They receive coaching and individualized feedback to gain the confidence they need to solve problems and succeed in new and different situations. During their clinical rotations, fourth-year students may identify a skill that needs refining, and they can return to the center and practice the skill in a safe environment with hands-on coaching. Local practitioners volunteer their time to help teach and conduct assessments in the program because they find joy and fulfillment in contributing to the clinical training of their future colleagues. Students are tested with hands-on, objective, structured clinical examinations, and a remediation program is in place. Students who make critical errors or do not demonstrate competence are provided feedback and given additional support, including retraining if necessary, before they are tested again. Students are monitored as they achieve competence and confidence in their abilities and as they continue to refine these essential competencies during their immersive clinical experiences in the final year.
Spectrum of Care Summer Externship Program
The Spectrum of Care Summer Externship program enables students between the first and second years of their program to learn under the guidance of general practitioners in busy small animal practices that serve a socioeconomically diverse clientele and model the spectrum of care philosophy. Admission to the program is highly competitive, and selection is based in part on expressed interest and previous involvement in community service. Students receive a stipend and compensation for travel and lodging. During the 10-week program, students learn how general practitioners serve their clientele and are taught important business and practice management skills. They spend 1 week shadowing their host veterinarian, 4 weeks in an intensive boot camp experience in the college that immerses them in the clinical and professional skills they will need to be an effective part of the veterinary care team, 4 weeks back in the practice for hands-on patient care, and a final week reflecting on, assessing, and documenting their experience. Drs. Matt and Tina Stonecypher host Spectrum of Care Summer Extern-ship Program students in their Xenia, Ohio, practice. According to Dr. Tina Stonecypher, “The students are experiencing what we did in our first month after graduation in general practice, only well before they go into practice.” When students resume their formal education during the fall semester of their second year, they report feeling more engaged and able to understand the importance of the new material they are learning because of their experience in this externship program.
Veterinary Medicine Outreach Program
Through partnerships with several nonprofit community organizations, fourth-year veterinary students learn spectrum of care principles while working with low-income, homebound, or homeless clients and clients in eldercare facilities whose pets are critically important to their emotional well-being. Students gain valuable experience maintaining the human-animal bond while practicing low-stress animal handling skills, technical skills, verbal and written communication skills, and team-based patient-centered care in a resource-limited environment. Students also learn practice management concepts such as inventory control, record-keeping, and budgeting. The program allows students the opportunity to hone their clinical skills and provide compassionate care for animals of underserved populations, while developing social awareness, building cultural competencies, and advancing their understanding of the importance of civic responsibility. Often, students comment that their fourth-year outreach medicine experience is one of the most valuable experiences of their final year.
Shelter medicine and surgery rotation
The shelter medicine and surgery rotation is a core 2-week clinical experience in the final year. At its conclusion, each student typically has completed ≥ 40 procedures as primary surgeon or anesthetist. With faculty oversight, students perform spay and neuter procedures on several species as well as dental extractions, mass removals, eyelid surgeries, hernia repairs, and other soft tissue surgical procedures often encountered in general practice. Students have the opportunity and freedom to make decisions while simultaneously having the support of clinical faculty with general practice experience who can provide immediate feedback and help students become more comfortable in their role as surgeon.
Spectrum of care career area of emphasis
Before beginning their fourth year, veterinary students select a career area of emphasis (CAE), which provides guidelines for course selection in the final year of the program in addition to a core set of required clinical rotations. The CAE options include companion animal, farm animal, equine, mixed animal, and individualized (for students with special interests such as pathology or zoo animal medicine). Now, students also have the option to select a new individualized spectrum of care CAE. Students who choose the spectrum of care CAE participate in an immersive general practice–centered training program. Students refine their surgical, dental, and diagnostic imaging skills during a 2-week intensive boot camp training period in the college before starting their clinical rotations. They then complete a 4-week general practice rotation in the Veterinary Medical Center's Community Practice Service (which moved to the new Frank Stanton Veterinary Spectrum of Care Clinic in June 2021) before rotating through 2 different spectrum of care–focused general practices for 4 weeks each. These rotations provide students experiential learning opportunities to apply their knowledge, hone their skills, and build confidence in their decision-making while working in a high-volume, resource-constrained environment. The veterinarians at these general practices serve as mentors and coaches, offering support and advice as students consider options for diagnosis and treatment and counsel clients. Students benefit by living in the communities they serve and experiencing life in rural areas of Ohio and surrounding states that often have a shortage of veterinarians and limited veterinary referral options.
Frank Stanton Veterinary Spectrum of Care Clinic
The new Frank Stanton Veterinary Spectrum of Care Clinic will provide students with valuable hands-on experience by practicing broadly across the spectrum of care as they treat pets presented by clients from diverse socioeconomic backgrounds. The clinic will provide a new physical location for teaching and learning small animal general practice. Most importantly, students will learn in a realistic general practice setting beginning in their first year and continuing throughout their veterinary education. During their first 3 years, students will learn business and marketing skills (practice care); practice customer service and communication; tailor and manage the client experience; shadow veterinary technicians to better understand how to effectively use their knowledge, skills, and attitudes; and learn many other aspects of successful clinical operations. In their fourth year, students will develop the confidence necessary to be ready to practice immediately after graduation by providing veterinary care as student doctors while being overseen by faculty coaches. The faculty coaches, located in adjacent observation rooms, will observe the student doctors interacting with clients and patients. Audiovisual technology will capture these interactions for subsequent review and communications training. A student doctor assigned as team leader will manage a group of his or her peers to practice leadership skills and promote smooth clinical operations. Student doctors will work closely with their coaches to learn the art of caring for clients and patients with a wide range of medical needs and the nuances of effective patient care, practice care, and client communication. The Frank Stanton Veterinary Spectrum of Care Clinic will be adjacent to but separate from the Veterinary Medical Center so students will not have immediate access to specialists. Instead, if the client chooses specialty care or the student doctor wants advice from a specialist, a referral or phone consultation will be arranged just as would be the case in general practice. This approach is very different from a hallway consultation or transfer of cases between services in the Veterinary Medical Center. We believe the Frank Stanton Veterinary Spectrum of Care clinic will provide the important components of a clinical training environment (Figure 5).
Illustration of factors that contribute to an ideal clinical training environment.
Citation: Journal of the American Veterinary Medical Association 259, 5; 10.2460/javma.259.5.463
Curriculum Redesign
A key component of the Preparing for Excellence in Veterinary General Practice program is the incorporation of a major curriculum redesign in the college of veterinary medicine. During this process, we used principles of outcomes-based education and backward design to ensure we teach and students learn and master core spectrum of care competencies that were developed in consultation with general practitioners and faculty members.
The spiral integrated curricular structure allows for essential threads to weave around a spectrum of care practice experience core that anchors the program. The threads run across all years of the program and include clinical skills (doing), communication skills (understanding), professional development (being), and critical thinking and case-based reasoning (connecting). Case materials and competencies from the Frank Stanton Veterinary Spectrum of Care Clinic will be used in teaching these threads whenever possible, and learning throughout the threads will be reinforced by early participation in practice experiences. The first-year theme will be normal, wellness, and prevention; the second-year theme will be abnormal, disease, and diagnosis; and the third-year theme will be treatment, advanced treatment, and planning. Students will be taught the elements of critical thinking, clinical reasoning, and problem solving as they work through authentic cases with the opportunity to apply what they have seen in the Frank Stanton Veterinary Spectrum of Care Clinic. As they work through each case, students will need to learn more about the impact of the client's socioeconomic situation, how to choose wisely when suggesting various tests and treatments, how to filter through the many tests available and interpret the results, and how to select the best treatment options given all of the factors germane to the case.
The Preparing for Excellence in Veterinary General Practice program aims to deliver new learning experiences that allow students to think as doctors from the start of their education. This approach aligns with our focus on graduating excellent veterinarians ready to more effectively provide primary care in general practice, preserve the human-animal bond, bring more value to their employers, and operate financially thriving private practices that better serve the needs of all patients and clients.
How Will We Define Success?
The college's vision for the Preparing for Excellence in Veterinary General Practice program addresses challenges that often stand in the way of graduates becoming successful in private practice. We will have achieved our goal when we consistently produce graduates like Dr. Marshall Aanestad.
After completing his first year of veterinary school at Ohio State, Aanestad was selected to participate in the Spectrum of Care Summer Externship program. The program immersed him in a successful general practice, where he learned alongside veterinarians at Dr. Mike Dyer's Proctorville Animal Clinic. “I was able to do 16 spays and neuters and also help out with specialized surgeries, including orthopedic surgeries,” says Aanestad. “The Proctorville Animal Clinic helps a lot of people who can't afford referrals to other places, so they are where the buck stops. And they're willing to do just about anything for their clients and patients.”
Now that Dr. Aanestad has opened his own general practice in Athens, Ohio, less than a year after graduation, he has developed an even greater appreciation for the importance of training students for excellence in general practice with an emphasis on learning to practice broadly across the spectrum of care. “I've been able to do a lot of things I never thought I would be doing in my first year,” says Dr. Aanestad, citing procedures such as cystotomy, peri-neal urethrostomy, limb amputation, enucleation, intestinal foreign body removal, ovariohysterectomy in a dog with pyometra, and diaphragmatic hernia repair in small animals as well as tube cystostomy and perineal urethrostomy in a goat. “Sometimes you have to pull up the most recent article or textbook and you just have to do it.”
He also practices broadly across the spectrum of care with nonsurgical patients. “I've had a few puppies that likely had parvovirus and the owners couldn't afford hospitalization or diagnostic testing,” he says. “I've spent a lot of time coaching owners on treatments they'll need to do at home.” Dr. Aanestad has the qualities that Dr. Dyer refers to as “the grit to try new things,” and his educational journey represents an early success of the Preparing for Excellence in Veterinary General Practice program.
Going Forward
Practice-ready veterinarians can be educated in many ways, and many colleges of veterinary medicine incorporate components of the Preparing for Excellence in Veterinary General Practice program. We believe our program, with the spectrum of care focus interwoven throughout all 4 years of the veterinary degree program and the immersion of students in clinical training experiences from the first semester through the end of their veterinary medical education, will bring value to new graduates and their employers. New graduates will be better prepared to provide a wide range of care options to patients and their owners while adding value to their employers' businesses earlier in their careers. We will continually assess the program's impact on the early career success of graduates. Student assessments, exit surveys of new graduates, employer surveys, and pre- and postimplementation surveys will provide valuable feedback to evaluate the program and make appropriate adjustments consistent with our Be The Model™ approach to our college's core missions.
According to Dr. Dyer, “students have the opportunity to graduate ready to run with minimal coaching because they've been able to put what they know in their heads into action with their hands. I have so much confidence in the Preparing for Excellence in Veterinary General Practice program because I've seen the results firsthand. This is much needed in our profession.”
We share our enthusiasm for these concepts in the spirit of contributing to the greater good of veterinary medical education and the veterinary profession. We look forward to disseminating the outcomes of our program and collaborating with others to enhance the way veterinary students are prepared for general practice. We believe this new educational model, grounded in the spectrum of care philosophy, provides a foundation that will benefit all graduates, regardless of their intended career path.
Acknowledgments
Funding for the Preparing for Excellence in Veterinary General Practice program was provided, in part, by the Stanton Foundation.
The authors thank Drs. Susan Borders, Mike Dyer, Brian Forsgren, David Haeussler, Brian Holub, Jennifer Jellison, Beth Kellogg, Robert
Knapp, Ira Niedweske, Todd Shockey, Matt Stonecypher, and Kimberly West for serving on the advisory board for the Preparing for Excellence in Veterinary General Practice program; and the faculty, staff, and students of The Ohio State University College of Veterinary Medicine for their time, effort and input in guiding the design, development and delivery of various programmatic elements.
References
- 1. ↑
Stull JW, Shelby JA, Bonnett BN, et al. Barriers and next steps to providing a spectrum of effective health care to companion animals. J Am Vet Med Assoc 2018;253:1386–1389.
- 2. ↑
Louisa Poon WY, Covington JP, Dempsey LS, et al. Evaluation of a primary-care setting at a veterinary teaching hospital by a student business group: implementing business training within the curriculum. J Vet Med Educ 2014;41:189–196.
- 3. ↑
Meehan MP, Menniti MF. Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's experiential learning theory. J Vet Med Educ 2014;41:371–383.
- 4. ↑
Cake MA, Bell MA, Williams JC, et al. Which professional (non-technical) competencies are most important to the success of graduate veterinarians? A best evidence medical education (BEME) systematic review: BEME guide no. 38. Med Teach 2016;38:550–563.
- 5. ↑
Dixon WHR, Kinnison T, May SA. Understanding the primary care paradigm: an experiential learning focus of the early veterinary graduate. Vet Rec 2017;181:480–484.
- 6. ↑
Roth IG, Meindl AG, Eckman SL, et al. Eliciting the student perspective on point-of-care diagnostic testing in association with a primary care rotation. J Vet Med Educ 2019;46:225–234.
- 7. ↑
Anderson JG, Goldstein G, Boudreaux K, et al. The state of veterinary dental education in North America, Canada, and the Caribbean: a descriptive study. J Vet Med Educ 2017;44:358–363.
- 8. ↑
Mowat FM, Royal KD, Westermeyer HD. Ophthalmoscopy skills in primary care: a cross-sectional practitioner survey. Vet Rec 2018;182:435.
- 9. ↑
Mattson K. Report outlines barriers to accessing veterinary care, possible solutions. J Am Vet Med Assoc 2019;254:448–449.
- 10. ↑
Kreisler RE, Stackhouse NL, Graves TK. Arizona veterinarians' perceptions and consensus regarding skills, knowledge, and attributes of day one veterinary graduates. J Vet Med Educ 2020;47:365–377.
- 11. ↑
Association of American Veterinary Medical Colleges. Competency-based veterinary education (CBVE). Available at: www.aavmc.org/programs/faculty-educators/cbve/. Accessed Dec 10, 2020.
