BE WELL: Changing the culture of a college of veterinary medicine using a comprehensive and integrated approach to promote health and well-being

Rustin M. Moore College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Brenda C. Buffington Office of the Chief Wellness Officer, The Ohio State University, Columbus, OH

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Susannah L. Abraham College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Katie Reid College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Mary Jo Burkhard College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Caroline El-Khoury College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Amanda M. Fark College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Jenn Gonya College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Jacqueline Hoying College of Nursing, The Ohio State University, Columbus, OH

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Ryan N. Jennings College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Sue E. Knoblaugh College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Matthew B. Miller College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Joelle Nielsen College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Emma K. Read College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Sharon Saia Employee Assistance Program, The Ohio State University, Columbus, OH

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Aaron M. Silveus College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Jonathan Yardley College of Veterinary Medicine, The Ohio State University, Columbus, OH

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Bernadette Mazurek Melnyk Office of the Chief Wellness Officer, The Ohio State University, Columbus, OH

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Viewpoint articles represent the opinions of the authors and do not represent AVMA endorsement of such statements.

Introduction

“Imperfections are not inadequacies; they are reminders that we’re all in this together.

We don’t have to do all of it alone. We were never meant to.”

–Brené Brown

In 2016, The Oiho State University (OSU) College of Veterinary Medicine (CVM) began a strategic planning process systematically evaluating 6 crucial domains: 1) institutional culture and sustainability of its people, 2) education and success of our students, 3) innovative and impactful research, 4) features of a highly successful referral veterinary medical center, 5) outreach and community engagement, and 6) overall operational excellence. The strategic plan that developed was rooted in 4 foundational principles: health and well-being; diversity, equity, inclusion, and belonging; effective partnerships; and resource stewardship; each principal is embedded in all parts of the plan (https://vet.osu.edu/about-college/strategic-plan). The ambition that emerged for the CVM from this process was “to be the model college of veterinary medicine in the world, impacting animal and human health through innovation, collaboration and excellence,” which is a continual journey rather than a destination.

Years of focus and hard work, compassion, and perfectionist traits are taking a toll on the veterinary profession through their effects on imposter syndrome, empathy and ethical fatigue, burnout, and mental health challenges such as depression, anxiety, and suicidal ideation.1,2 Colleges of veterinary medicine hold the key to a healthier and more balanced lifestyle for the next generation of veterinarians. In this article, we describe the programming we have implemented to address the health and well-being of faculty, staff, and students at OSU-CVM.

Based on a study3 of both graduate and professional students who were enrolled at The Ohio State University in 7 colleges (Dentistry, Medicine, Nursing, Optometry, Pharmacy, Social Work, and Veterinary Medicine) and participated in a wellness onboarding program, 17% of incoming students reported moderate to severe depressive symptoms, with 6% reporting suicidal ideation and 14% reporting moderate to severe anxiety. Factors predicting depression and anxiety included obtaining < 7 hours of sleep per night, worse general health, lower healthy lifestyle beliefs, lower healthy lifestyle behaviors, higher stress, and a perceived lack of control. Although not specifically reported in the publication, our analysis of the data indicated that veterinary students also had a higher prevalence of moderate to severe depression, moderate to severe anxiety, and suicidal ideation than did students in the other health sciences programs. In our CVM, poor health and well-being are considered serious threats to the satisfaction and success of our faculty, staff, students, and recent graduates.

In 2017, the CVM partnered with the university’s Office of Suicide Prevention to implement RUOK? Buckeyes,4 an anonymous interactive screening program designed specifically to identify those at risk of suicide and encourage them to seek help. Participants, including faculty, staff, veterinary students, graduate students, residents, and interns, were given access to an anonymous and confidential online stress and depression survey. Thirty-one of the 39 respondents were identified to be at high to very high risk for feelings of hopelessness; suicidal ideation (having a plan or attempting); clinically relevant depression; high levels of stress, anxiety, or worry; drug usage; or eating disorders. Although 39 out of just under 1,300 members of the CVM responded, this survey is designed to identify only those individuals currently at risk of suicide, which was approximately 3.0% of our CVM’s total population. Surveys were evaluated by a qualified university counselor, who provided personalized written assessments and encouraged the respondents to seek counseling using a portal that ensured anonymous communication.

The challenge for our CVM extends beyond students. In 2018, the CVM scored 54 out of 100 on the Health and Productivity Index, a methodology developed by IBM Watson Health that assigns a lifestyle risk profile index of between 0 and 100 to an aggregate employee population. Faculty and staff employees from our CVM scored on average 12 points lower than the composite score of all university employees, with high levels of stress and depression being the major contributors to our lower average score. Consequently, we believed we needed a health and wellness intervention to address health and well-being for our faculty, staff, and students.

Igniting Cultural Change

The CVM established a Health and Well-Being Task Force in the spring of 2018 that was charged with exploring development of a comprehensive and integrated program that would address health and well-being from the perspective of the 9 dimensions of wellness5 (Figure 1). Despite reports that 93% of medical schools have some sort of comprehensive wellness programming implemented for 1 of 3 main reasons, which include a national trend, student needs, and an accreditation requirement, there are few reports of veterinary schools creating the same.6

Figure 1
Figure 1

The Nine Dimensions of Wellness..

Citation: Journal of the American Veterinary Medical Association 260, 8; 10.2460/javma.21.07.0344

Our Task Force developed a request for proposals that would address the CVM’s specific needs for health and well-being components and meet desired outcomes. A lead member from the team that was selected was assigned as the on-site health and well-being coordinator at the CVM, a 50% appointment for the first 2 years and is currently providing 40% effort.

The comprehensive and integrated health and well-being initiative was named BE WELL, consistent with our BE THE MODEL mantra. Using BE WELL programming, the CVM is taking steps to institutionalize health and well-being and emphasize self-care by embedding it within our culture and strategic plan. More information on the initiatives and activities of our BE WELL health and well-being program is available (https://vet.osu.edu/about-college/wellbeing-initiative).

BE WELL Programming

The BE WELL programming emphasizes preventive measures, including key educational elements in the professional curriculum as well as other resources, services, and initiatives such as diversity, equity, inclusion and belonging; conflict resolution; and personal financial management guidance. The programming was developed to address the 9 dimensions of wellness.

Financial Dimension

Student loan debt negatively influences the financial satisfaction of veterinary students.7 JAVMA News reported that starting salaries for veterinarians have increased, and some CVMs have noted a decrease in the indebtedness of their graduates, yet other institutions have seen an increase in graduates’ educational debt up to 29%.8 The debt-to-income ratio for new graduates in the veterinary profession ranks among the highest among healthcare professions while the starting salaries rank as some of the lowest. Veterinary students at The Ohio State University carry a higher-than-average debt, with 2020 graduates averaging $200,613 in educational debt compared to the $169,742 national mean educational debt of veterinary graduates and with comparable findings in the debt-to-income ratio.9 Although the debt-to-income ratio has decreased in recent years, it is still above the 1.0:1.4 ratio that most financial professionals consider reasonable.10 High debt load can have a substantially adverse effect on the well-being of graduates in several ways, including poor financial health and delays in starting families, purchasing homes, or becoming practice owners.

To help students understand financial wellness, in addition to other elements of business and finance they receive throughout the curriculum, we developed the BE WELL $ Day. The program teaches students about core financial topics, including cash flow planning, student loan repayment, investing, retirement, debt management, estate planning, and tax planning, with goals of improving financial literacy and engendering a sense of control over one’s personal finances. This program is a required core component of the education of year 1 to 3 students.

The CVM also seeks to decrease the cost of veterinary education. We have kept tuition increases at ≤ 2% annually over the last 6 years and negotiated that nonresident students pay in-state tuition with only a nominal ($5.00) nonresident fee per semester after their first year, which helps decrease stress and anxiety of the uncertainty if they would be granted in-state residency. We have also prioritized and increased fundraising for scholarships, with our philanthropic scholarship distribution growing by approximately 600% over the last 7 years from approximately $371,000 in the 2014–2015 academic year to $2.55 million for the 2021–2022 academic year. This occurred with a concomitant increase in the number of transformational (≥ $15,000) scholarships awarded from 0 to 87 during the same period.

Emotional Dimension

The perceived stress scale (PSS) and the abbreviated PSS-4 scale (validated tools to measure the degree to which situations in one’s life are appraised as stressful) were used to assess the CVM students before and after the 2018–2019 academic year as part of our strategic plan. These stress assessment instruments indicated that our veterinary students tend to experience greater levels of stress than does the general public or students in human medical training. It also indicated that their level of stress increased substantially over the course of each academic year, identifying our CVM environment and DVM program as contributory factors. One could infer that our veterinary students are very resilient and can function well despite high levels of stress. However, just because they can function highly and be successful does not necessarily mean they are focusing adequately on their physical, mental, and social well-being.

While human medicine reports that administering self-assessments for mental health helps identify at-risk students, aids in connecting such students to support, and promotes help seeking behavior, fewer than one-third of all medical schools reported using burnout, depression, and anxiety assessment tools.6 More recently, it has been recommended to integrate brief validated mental health instruments into program evaluations to more objectively assess the effect of wellness programs on student wellbeing.6 We used PSS-14 and PSS-4 scores to establish measures of our students (Figure 2) at various times during their 4-year program compared with published values of these measures in the general population11 (all ages and genders), those ranging in age between 18 to 44, student employees, and most concerning compared with those who are disabled or too ill to work and second-year medical students.12 Although we were not able to separate out our data based upon gender, published data have shown that PSS-14 and PSS-4 values are significantly greater in females (PSS-14 = 20.2; PSS-4 = 3.1) compared with males (PSS-14 = 18.8; PSS-4 = 2.8) across all categories.11 Because approximately 80% of our veterinary students are female, it is possible that the high PSS-14 and PSS-4 levels observed in our students could have been impacted by the influence of gender, but these values are still greater than those of the other populations, indicating that stress levels in our students are impacted by other factors.

Figure 2
Figure 2

Perceived stress scale (PSS) scores for first- through fourth-year veterinary students in the 2018–2019 academic year (fall 2018 and spring 2019 semesters) using the PSS-14 (A) and PSS-4 (B) survey tools. Au18 = Autumn 2018. Sp19 = Spring 2019. VME = Veterinary Medical Education.

Citation: Journal of the American Veterinary Medical Association 260, 8; 10.2460/javma.21.07.0344

In the fall of 2018, the CVM’s Office of Counseling and Consultation set out with the goal to help break the stigma associated with seeking mental healthcare and counseling by requiring all first- and fourth-year veterinary students to schedule wellness check-ins with one of our two full-time on-site mental health professionals. These years were identified as pressure points within our veterinary program because students are transitioning into professional school in year 1 and into their clinical and patient care responsibilities in year 4. Wellness check-ins consist of short 15-minute appointments in which students connect with mental health professionals and learn more about the programming the CVM offers. A follow-up appointment for more in-depth counseling sessions can be scheduled on a voluntary basis. Because the second and third years have been cited by others as the most “challenging years” of a 4-year professional curriculum,13 we began offering check-ins with our assistant dean for student success to these students as well. The CVM also employs a part-time (6 h/wk) on-site psychiatrist to allow student access to necessary medication management. During the COVID-19 pandemic, students could schedule appointments with our counselors and/or psychiatrist either in-person or virtually.

From May 2019 through April 2021, the CVM’s Office of Counseling and Consultation provided over 2,000 individual appointments (not including wellness check-ins), with anxiety and stress being the most common student concerns. Students who used this service in fall 2020–spring 2021 academic year attended an average of 5.9 sessions. First- and second-year students used the services most often, followed by third- and fourth-year students, respectively. Utilization of services has increased each year, including virtual sessions during the COVID-19 pandemic. Between the 2019–2020 and 2020–2021 academic years, utilization increased by 11%. Graduate and professional students are also invited to take advantage of preventive programming provided by our mental health professionals, including workshops, yoga and mindfulness classes, lunch and learns, and peer-support and group-based interventions.

The CVM implemented the Honoring the Bond (www.vet.osu.edu/honoringthebond) program in 2001, which includes a licensed social worker who provides education and support for animal owners and pet parents who are clients of the Veterinary Medical Center as well as for our veterinary clinicians (faculty, residents, and interns), staff (technical and nontechnical) and students. Social workers in veterinary hospitals are active members of the veterinary healthcare team and their role is similar to that provided in a human hospital. In addition to helping relieve some of the time commitment of our veterinarians and to address the emotional needs of clients which can lead to stress and burnout of clinicians and others,14 our social worker serves as a vital part of our healthcare team so veterinarians and others can focus on the medical needs of patients.15

Social Dimension

Structural racism, sexism, homophobia, transphobia, xenophobia, and chronic discrimination against individuals with disabilities (ableism), including physical disabilities, mental or emotional disabilities, and cognitive differences (neurodiversity), can all cause emotional and mental harm. Long-term activation of the stress-response system (ie, increases in stress hormones such as cortisol) is known to be associated with increased risk of mental health conditions and other health problems.16 As we have worked to improve health and well-being in the CVM, we recognized the need to think more holistically about diversity, equity, inclusion, and belonging as well as culture, climate, and workload. More information about the initiatives and activities of our diversity, equity, inclusion, and belonging program is available (https://vet.osu.edu/about-college/commitment-diversity-equity-inclusion-and-belonging).

House System–style learning communities are popular in the UK and have been implemented at several medical and veterinary schools in the US.17,18 The CVM implemented its House System (https://vet.osu.edu/about-college/house-system) in summer 2020, which is designed to foster engagement and networking and provide a sense of connection among members of our CVM’s community. All faculty and staff who opt in along with all veterinary students are randomly sorted into 1 of 4 “houses.” Each house is identified with a name that corresponds to an animal mascot along with 2 values or virtues important to the CVM (Figure 3). In its first year, participants joined together in COVID-safe events that ended by hosting a House Cup Challenge, a week-long event that consisted of 7 points-earning challenges in which the first-place winner was celebrated by the CVM community. We are currently conducting a variety of in-person and virtual events to provide greater flexibility and opportunities for engagement.

Figure 3
Figure 3

The 4 houses in the CVM’s House System are identified with a name that corresponds to an animal mascot along with 2 values or virtues important to the CVM.

Citation: Journal of the American Veterinary Medical Association 260, 8; 10.2460/javma.21.07.0344

The CVM encourages veterinary students to supplement their formal education in areas of particular interest to them through involvement in student organizations and clubs. These not only serve as avenues for interaction, networking, and socializing but also provide a medium for academic discourse, personal growth, leadership development, intercultural understanding, community service, and lasting friendships.

The CVM’s Diversity, Equity, Inclusion, and Belonging Committee established the Community of Inclusion Affinity Groups, which are typically grassroots developed and led by students with faculty and/or staff advisors to provide opportunities for students, staff, faculty, and alumni to connect and engage with others who share similar identities and provide opportunities to socialize, build community, and help to nurture an inclusive environment.19 They foster shared identity among members of nondominant groups; create a support network of mentors, allies, and peers; help build cultural competency, fluency, and humility; and help recruit and retain members of minority groups and their allies by fostering a sense of belonging and a place where everyone, regardless of their background, attributes or lived experiences, can thrive.

Intellectual Dimension

Our Peer Tutoring Program, overseen by the director of the Office of Teaching and Learning (OTL), provides free aca­demic support to veterinary students in the first 2 years of the curriculum. The program uses a Multi-Tiered System of Supports (MTSS) framework, including Tier 1 group review sessions, Tier 2 individual tutoring 5 sessions, and Tier 3 individual consultations with the OTL director.

Peer tutors are selected annually and trained in concepts such as the growth mindset, science of human adult learning, and evidence-based educational practices. During the 2020–2021 academic year, peer tutors conducted 26 tier 1 class review sessions with average student attendance ranging from 20 to 150 students, provided 752 hours of tier 2 one-on-one tutoring sessions for 97 students, and created innovative solutions for verifying clinical skills training via Zoom because of the COVID-19 pandemic. Five students received tier 3 consultation.

Career Dimension

Individualized support is available through the CVM’s Office of Career Management and Professional Development, which assists students in their career path selection, employment preparation, professional identity development and branding, and professional skills development, including networking, interviewing, and negotiating. Annual utilization rates are consistently > 80%, and all first-year students are required to have a check-in meeting with the CVM’s Office of Career Management and Professional Development advisors. At the time of graduation, most students (up to 98%) have secured a position for their next career step, and most used the services during the process.

The professional development curriculum includes 6 semester-long courses that are part of our DVM program core curriculum, which covers personal and professional finance, career exploration, professional identity development, ethics, communications, teamwork, diversity, and inclusivity, as well as topics related specifically to personal well-being. Additionally, the office connects current students with alumni for the purposes of career exploration, networking, and mentoring. The CVM has developed and is nearly ready to implement an Alumni Village, a digital platform where students can explore alumni connections and reach out to alumni on a variety of topics.

Spiritual Dimension

Implementation of novel programming has helped to address the spiritual, emotional, and physical needs of individuals within the CVM. MINDSTRONG, also known as COPE in the literature,20 is an evidence-based, cognitive-behavioral skills–building program with the goal to provide consistent, evidence-based interventions that help individuals modify or develop lifestyle behaviors that improve overall mental health and physical well-being. Based upon preliminary data indicating the program’s positive effects on depression, anxiety and suicidal ideation in incoming first-year veterinary students as well as with other health science students, MINDSTRONG became mandatory for first-year students entering in the fall of 2020 (class of 2024) with programming delivered online via weekly virtual sessions over a 7-week period before students arrived on campus.21 This program also became mandatory for house officers (interns and residents) starting in summer 2020. Separate sessions are available for faculty and staff on a voluntary basis. Between autumn 2017 and summer 2020, 409 people in the CVM completed the MINDSTRONG program.

Faculty and staff also may access services through the university’s Employee Assistance Program (EAP), including mindfulness coaching, web-based articles and resources on a variety of topics, mental health counseling, “lunch and learn” programs, well-being webinars, financial counseling, and resilience training. To augment these services, the CVM also offered on-site counseling appointments through EAP to remove time barriers that often prevent faculty, staff, interns and residents from easily accessing university counseling services at off-site locations. Although utilization of the on-site EAP services was relatively low, it raised awareness of these services and utilization of counseling services off-site increased from 33 cases in 2017 to 63 cases in 2020.

YOU MATTER sessions offered an open and safe space for sharing about topics of concern in the CVM, such as suicide prevention, and were moderated by 2 counselors from EAP. Faculty and staff were invited to join separate sessions. These virtual sessions commenced with open-ended prompts such as, “What can you do for yourself this weekend for your self-care?” or “How do you build positive workplace relationships?” Thirty-four faculty members and 76 staff employees attended the meetings.

The CVM also hosted the Unburdened program,22,23 which uses an adaptation of the evidence-based Acceptance and Commitment Training program and focuses specifically on burden transfer to reactivity in difficult veterinary-client interactions. This program has shown promising effects in a pilot study.24 Unburdened is supported by the Clinical Scholars Program of the Robert Wood Johnson Foundation and directly targets those working with clients in veterinary medicine (https://www.unburdened.online). Approximately 30 participants met in a small group format for 1 hour each week for 3 consecutive weeks in a program provided by Dr. Mary Beth Spitznagel (https://www.unburdened.online/research).

As needed, the CVM provides “open spaces” so that faculty, staff, and students can process significant social justice events, tragedies, and natural disasters happening in our community, state, country and the world. Open Spaces employs a circle format and follows a structured process to allow respectful listening and dialogue. Attendance has varied based on topics but has ranged from 10 to > 50 participants. Student leaders in VOICE (Veterinarians as One Inclusive Community for Empowerment) and the CVM’s Community of Inclusion Affinity Groups received training and resources to help serve as circle moderators.

A Breaking Barriers series offered eight 1-hour sessions covering four topics (each repeated twice) over a 4-month period, which was facilitated using a circle format. The goal of these sessions was to discuss topics such as discrimination in the profession, pronoun use, allyship, and our LGBTQ+ community in order to help people in the CVM become allies and create a more inclusive environment where everyone feels welcome and can thrive.

Based on feedback from faculty, staff and students, the CVM is providing a “respite room” within our facilities to provide a conveniently accessible space to promote spiritual, mental, and emotional health and well-being through meditation, mindfulness, or “quiet time.”

Physical Dimension

The Health Athlete25 program, supported by the Office of the Chief Wellness Officer (CWO), consists of a 1- to 2-day workshop that covers nutrition, provides exercise recommendations, and emphasizes energy management through a comprehensive examination of personal goals and values in relation to spiritual purpose, as well as mental, emotional and physical development. Incoming house officers (interns and residents) were required to complete the Health Athlete program in summer 2020, and it is provided on a voluntary basis for faculty and staff. As of June 2021, 110 members of the CVM community had completed the Health Athlete training.

The Buckeye Wellness Innovators program, also an initiative under the Office of the CWO, allows faculty and staff at the university to share their passion for health and wellness with colleagues.26,27 Innovators promote university-wide wellness initiatives by communicating health and wellness activities to their colleagues. The CVM had 12 Buckeye Wellness Innovators from the 2018–2019 through 2020–2021 academic years who helped champion wellness initiatives.

Physical wellness initiatives have also included weekly fitness classes such as boot camp, yoga, tai chi, sunrise cycling, and group walking; Snack Switch Fridays is a popular event that allows faculty, staff, and students to swap out their unhealthy snack for a healthier choice. Training in how to prepare affordable healthy meals also has been provided, as have Friday snack carts in the Veterinary Medical Center and various fitness challenges.

The CVM is also providing on-site space in our facilities for an “activity room,” which all members of the CVM can conveniently access any time to promote their physical health and well-being through exercise.

Creative Dimension

The BE WELL Book Club, BE WELL Arts and Crafts Club, and our longstanding popular talent show also have also helped create opportunities for non–work-related CVM community engagements. Our veterinary students have opportunities to engage in Humanism in Medicine (https://medicine.osu.edu/student-resources/student-organizations/humanism-in-medicine), an initiative of the CVM that serves the entire health science community of the university by promoting a compassionate approach to all that we do in research, patient care, teaching, and learning, which includes an array of opportunities to participate in performing and creative arts across the 7 health science colleges.

Environmental Dimension

The CVM designed and posted signs (Figure 4) at the entrances of our buildings to remind everyone that they are responsible for the energy they bring to our facilities, including their words and behaviors. The CVM also launched a program whereby mental health crisis placards (Figure 5) were posted in all buildings and in strategic locations, including restrooms and restroom stalls, because people contemplating self-harm or suicide often seek a more private location. These placards as well as business cards with this same information, which were distributed to all students, staff, and faculty, are intended to help reinforce that everyone matters, they are not alone, and resources are available to help them navigate whatever issues they might be facing. At the time of publication, provision of the aforementioned “quiet room” and “activity room” within our facilities will provide conveniently accessible spaces to promote spiritual, mental, emotional, and physical health and well-being.

Figure 4
Figure 4

Signage placed throughout the CVM to remind everyone that they matter, their words and behaviors matter, and thus to take responsibility for the energy they bring into the environment.

Citation: Journal of the American Veterinary Medical Association 260, 8; 10.2460/javma.21.07.0344

Figure 5
Figure 5

Mental health crisis placards designed and placed throughout the CVM to remind everyone that they matter, they are not alone, and resources are readily available to help navigate whatever issues they might be facing.

Citation: Journal of the American Veterinary Medical Association 260, 8; 10.2460/javma.21.07.0344

Curricular Redesign

Simultaneously with development and implementation of the BE WELL programming, our veterinary curriculum has also been reviewed and redesigned. Curricular redesign represents an opportunity to address and positively impact health and well-being through a curricular subtext, sometimes referred to as a hidden curriculum, that goes beyond the factual medical and scientific material that students are taught. Only 13% of medical schools are reported to have implemented structural changes in the curriculum, such as changing grading or assessment and other programmatic elements to help reduce depression, anxiety, and other mental health stressors.6 We believe this is critical to the success of our BE WELL program.

In the fall of 2019, the Academic Standards Council rewrote the CVM’s academic charter to offer additional support for failing students, which provides the opportunity to improve their failed grade by successfully completing a defined remediation activity and reexamination. This approach has resulted in fewer dismissals and better assistance of students as physical and mental health challenges are identified in targeted discussions with support personnel. We have recently reworked a final-year assessment system to align with the American Association of Veterinary Medical Colleges’ competency-based veterinary education milestones.28 This outcomes-based paradigm has helped identify struggling students sooner if they do not progress through the program according to defined milestones and allows improved targeting for remediation.

Toward an Overall Culture of Wellness

Although not every person in the CVM or veterinary profession needs assistance or resources in all 9 dimensions of wellness, the following general recommendations provide guidance for success, satisfaction, and sustainability (https://swc.osu.edu/about-us/nine-dimensions-of-wellness): Career – make sure your job continues to be satisfying and fulfilling and, if not, don’t be afraid to try something new and different to find the enrichment you need; Creative – explore a range of interests whether it be Mother Nature’s beauty, arts, cultural experiences, literature, and more as a means to understand and appreciate the world around you; Emotional – consider seeking assistance to address areas of concern by speaking with a counselor, therapist, psychologist, psychiatrist, and/or a career or life coach; Environmental – reflect on the ecosystem with which you work and live and understand and appreciate your interconnectedness with nature and everything around you; Financial – develop a personal budget and adhere to it to ensure financial stability and to set and achieve realistic goals; Intellectual – engage in lifelong learning and feed your curiosity and learn something new every day; Physical – get sufficient sleep and exercise, eat a healthy and nutritious diet, and stay hydrated by drinking plenty of water; Social – develop and maintain a network of support with family, friends, and colleagues and find common ground with new people; and Spiritual – seek harmony and balance by exploring meaning and connection through depth of purpose, dialogue, and self-reflection and be thankful and express gratitude every day.

As our programs have been implemented, the question becomes: “How do we know we’re making a difference in the lives of the people in the college?” We continue to assess acquired data to guide our evidence-based approach. Our CVM score on the university’s Health and Productivity Index increased from 54 of 100 in 2018 to 60 of 100 in 2019. Each 5-point increase in the Health and Productivity Index is associated with approximately 3% lower medical costs, 0.4% less absenteeism and 0.7% fewer presenteeism (the lost productivity that occurs when employees show up but are not fully functioning in the workplace), days per employee. A growing body of evidence suggests that interactions with pets have positive health benefits on people, including physical, social, behavioral, emotional, mental, and psychological well-being.29 Consequently, the university Personal Health Assessment now includes questions about the value and importance of pets to employees’ personal well-being.

Our current students benefit from the CVM’s commitment to health and well-being. First- and second-year professional veterinary students, for example, are spending at least 10% less time in lecture halls and instead obtain substantially more hands-on experience in the Veterinary Clinical and Professional Skills Center, without spending additional hours on campus. Year 1 to 3 students began spending time in our new Frank Stanton Veterinary Spectrum of Care Clinic in fall 2021, and they will receive hands-on experience in a general practice setting that will foster competence and confidence. Fourth-year students have begun their core general practice rotations in the Frank Stanton Veterinary Spectrum of Care Clinic, where they are expected to “Be the Doctor” while faculty coaches observe their performance and guide their development using 1-way glass partitions and audiovisual monitors. Anecdotally, these structural changes in the curriculum and in teaching and learning are having a positive impact on our students’ well-being.

Moving Forward

The future success and sustainability of the veterinary profession depends upon the health and well-being of the entire veterinary community. Health and wellness efforts must be one of the guiding principles with necessary investments of resources and people’s time so all members of our CVM community and the broader veterinary profession can take full advantage of the available tools and resources. Doing so requires a shift in mindset and priorities as well as a sustained commitment to cultural change. Evidence-based programming that leverages the latest research and best practices is key to building a new culture that includes caring and belonging, which makes every member of the community feel valued, respected, and heard. It has been reported that effective comprehensive wellness programs in medical schools have 4 areas of needed intervention, including preventive, reactive, structural, and cultural,6 which reinforces what we have done with our approach in developing and implementing a comprehensive and integrated health and well-being program for our faculty, staff, and students.

With our BE WELL programming designed around the 9 dimensions of wellness, the CVM is laying the groundwork needed to enhance the health and well-being of our faculty, staff, and students, and it will be critical to maintain a focused effort to further develop and sustain such a program. Although our BE WELL program is just 1 example and is continually being reviewed and revised, we hope that sharing our experiences will help others in the veterinary community as they take steps to make health and well-being an integral part of the profession’s culture and climate.

Acknowledgments

The authors thank members of The Ohio State University CVM Health and Well-being Task Force/Committee; the College’s Buckeye Wellness Innovators; the Diversity, Equity, Inclusion and Belonging Committee and Council; others who have and continue to commit and contribute to enhancing this holistic approach to implementing and sustaining our comprehensive integrated health and well-being program; and Tim Vojt and Marc Hardman for their contributions to creating the illustrations and graphs.

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