Creative Disruption columnist Dr. Bob Lester is the chief medical officer at WellHaven Pet Health, a former practice owner and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves on the boards of Pet Peace of Mind, WellHaven Pet Health and the Lincoln Memorial veterinary college. He is president-elect of the North American Veterinary Community.Read Articles Written by Bob Lester
Jason W. Johnson
DVM, MS, DACT
Dr. Jason W. Johnson is vice president and global chief medical officer at Idexx Laboratories and the former dean of the Lincoln Memorial University College of Veterinary Medicine. He is widely recognized in the veterinary industry as a visionary innovator, collaborator, expert communicator and team builder, and change agent. He serves on the North American Veterinary Community’s board of directors.Read Articles Written by Jason W. Johnson
The cries from longtime practitioners and from the lectern at last summer’s AVMA House of Delegates meeting cast light on a startling accusation: New and recent veterinary school graduates lack practice readiness. The fingers are being pointed at academia and the students themselves. But, we ask, is that fair?
We believe that U.S. veterinary schools have never graduated smarter, better-prepared students. Veterinary academicians are among the most passionate and caring individuals in our profession. Their professional life is dedicated to readying the next generation for a successful veterinary career. We’re further encouraged by today’s bright, innovative, purpose-driven students.
If a finger must be pointed, it should be aimed at all of us — academics, students and employers. We can all do better.
What’s important to remember is the mission of veterinary academia: to produce entry-level veterinarians, not just entry-level practitioners. That’s a broad mandate given all that veterinarians do. Preparing our future colleagues for all this great profession has to offer isn’t easy. The volume of material, the skills required, the multiple species — it can be overwhelming. Newly minted veterinarians were never expected to know as much as they do today, and the expectations are rising.
Here’s something to consider: Medical knowledge is expanding exponentially. The doubling time was estimated at 50 years in 1950, accelerating to seven years by 1980, 3½ years by 2010 and a projected 73 days by 2020, according to the National Center for Biotechnology Information. Institutions of higher learning, especially veterinary schools, seek to incorporate as much of this new knowledge as possible into the curriculum. It’s packed — some would say overstuffed — with what the market often perceives as the wrong things.
Don’t forget that entry-level readiness is an issue in all workplaces. Is the newly minted surgical MD resident completely prepared for complex surgical procedures? Is the newly qualified apprentice plumber prepared to deal with all plumbing issues? Is the newlywed ready for marriage? Debates over practice readiness are not unique to our profession.
Meet the Stakeholders
At least three parties are critical to the success of the new veterinary college graduate.
1. The Student or Recent Graduate
Ultimately, students and recent graduates own their learning. We’re reminded of the Galileo quote “You cannot teach a man anything; you can only help him find it within himself.” It’s up to the learners to figure things out. They must be ready to stretch themselves, be uncomfortable and occasionally fail. Those who thrive will be those who stretch, adapt and find their way in this ever-changing world.
Today’s Generation Z students are brilliant, idealistic and multitaskers. They are digital natives and team players. They are sincere in their desire to make a difference and give back to the profession we all love. They view work-life balance differently than do the boomers who preceded them. Simply put, they and their millennial counterparts put life above work. Frankly, we think they’ve got it right. New grads will need to answer this question: “What value do I bring to my new practice?”
2. The Employer
A new graduate’s employer has an obligation to mentor and coach new colleagues. Orientation, onboarding, coaching, cheerleading and ongoing feedback are critical in helping new graduates to be successful. The old sink-or-swim model sucked years ago and sucks today. As employers, we must help new colleagues in their first few months and years of practice. After all, is it reasonable to expect a new graduate of any profession to arrive at the workplace fully formed and immediately productive? On-the-job training is a critical part of all learning journeys.
Good news: Millennials and Gen Zers welcome feedback, so be prepared to share it. Now more than ever, the employer should commit to continuous learning and development. This added support will correlate with improved productivity, engagement and retention.
Employers have historically been shut out of the academic world. That is changing fast. Companies are now invited into the learning process to co-create content, host students and offer upskilling. Our connected world is making this a reality. Employers will need to step up and step into the learning process to co-create relevant content, provide subject matter experts and host immersive workplace experiences for students.
We see this play out in the veterinary space with the growth of the distributive education model. Those wishing for better prepared new graduates are stepping in to help make a difference by offering veterinary workplace-based education and learning opportunities.
Academicians are brilliant and committed to student success. However, their ability to flex their learning structure is limited by the system in which they work. Veterinary academia is primarily rooted in a tertiary care referral model of clinical education, a model that has been dramatically disrupted in all other fields of health care education.
Human medical schools began moving away from an exclusive tertiary care model decades ago. Tertiary care referral training hospitals are wonderful places for animals suffering from complex diseases. They’re also great for specialty doctors to hone their craft and for interns and residents, but these hospitals arguably are not the best place for fourth-year veterinary students.
Do you recall your clinical-year training? We remember standing behind interns who were standing behind residents who were standing behind a boarded clinician performing an amazing specialty procedure never to be seen outside the ivy-covered walls. Here, cost was not an object.
Primary care is not emphasized in academia and is sometimes denigrated in tertiary care training hospitals. Last century, the only place to be exposed to great tertiary care — the best equipment and a handful of specialists — was in a university veterinary teaching hospital. That’s no longer the case. We’ve had an explosion of fabulous referral hospitals and specialists in every corner of the country.
An academic model relying almost exclusively on tertiary care referral clinical training poses many unintended consequences. These include lower case volumes, less repetition of real-world client interactions, clunky and inefficient systems, little exposure to primary care, and the message (intended or otherwise) that complex cases suitable for a progressive primary care practice are best handled at a tertiary care institution. The tertiary care approach is, in part, causing the scope of general practice to shrink. Graduates who lack confidence in entry-level practice can point to tertiary care training.
A word about internships. They are great for graduates who want to pursue advanced training, but many new graduates choose internships because they don’t feel prepared to enter practice. Unprepared after eight long, hard, expensive years of higher education. That’s not OK. Did the student not take advantage of their remarkable educational opportunities? Did academia let them down? Or are employers’ and society’s expectations of a new graduate unrealistic?
Look on the Bright Side
Now for the good news. More and more veterinary schools are moving to a hybrid distributive model of clinical education, a model in which the best of real-world, hands-on, primary care education is combined with tertiary care training. High-quality public and private practices and institutions, both for profit and not for profit, partner with schools in a best-of-both-worlds approach to clinical education.
Animal shelters, laboratories, industry, tech startups, pharma, government organizations and primary care practices are opening their arms wide as academia and its brick-and-mortar facilities slowly release students from a kung-fu-like grip. A mutual embrace is blossoming.
In the hybrid distributive model, the best of the tertiary care model is combined with real-world clinical training. This allows ample time for immersion in primary care and other specialty lanes of veterinary medicine, customized to individual student interests. The resulting increase in cases seen and hands-on experience in day-to-day primary care results in more competent, confident and practice-ready graduates. Commonly seen conditions are taught uncommonly well.
These community-based or distributive models allow for a deep and mutually beneficial partnership between academia and private practice. Both partner to best prepare the next generation of veterinarians. Additionally, this is a far more cost-effective model of teaching. Tertiary care referral hospitals are expensive to operate and, in some instances, add to student indebtedness.
More cause for good news comes from the academic world. Schools are beginning to teach the competencies we all know correlate with success outside the ivy-covered halls. The Association of American Veterinary Medical Colleges released a roadmap called Competency-Based Veterinary Education. Among the competencies for new graduates are communication, teamwork, leadership, basic practice management and entry-level clinical skills, just to mention a few.
In several of the newer veterinary schools, like Lincoln Memorial University, students participate in dozens of simulated exam room interactions involving trained actors. This learning prepares students for success in real-world exam rooms. The students take clinical skills labs beginning in the first semester, giving them hands-on experience with the basics necessary for entry-level work. They are required to demonstrate hands-on proficiency in high-stakes exams — no more hiding in the back row for four years. Students now complete mandatory practice management courses covering productivity, compensation and financial acumen. Students also participate in leadership courses, teamwork exercises and conflict scenarios. Kudos!
The Future Is Bright
Today’s new veterinary school graduates are brilliant, idealistic, collaborative and caring colleagues on whose shoulders our profession’s future rests. They’ve been prepared by the best and brightest our profession has to offer. The future of our profession is bright.
Vet med will look different tomorrow. Academics, employers, colleagues and graduates are responsible for building that future. Like the proverb says, “It takes a village to raise a child.”
Can we better prepare our new colleagues? Yes. Think about new teaching modalities, competency-based credentialing, open ledgers, distributive models, enhanced licensure, income sharing, new technology, distance learning, public-private partnerships, artificial intelligence. All should be on the table.
How do we get there? How can we work together to better prepare our colleagues of tomorrow more cost-effectively? It’s no easy task. It’s time to get creative and disrupt.