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 the immediate past president of the North American Veterinary Community.Read Articles Written by Bob Lester
The second most common comment I hear from employers regarding newly graduated veterinarians is that they aren’t practice ready. The first thing I hear is that we need more of them. It reminds me of the old joke, “The food here is terrible, and the portions are too small.”
Colleges of veterinary medicine espouse the merits of their programs in producing practice-ready graduates. In my experience, that’s true. I find new graduates to be idealistic, intelligent, compassionate team players eager to contribute and learn. However, some employers question the graduates’ readiness. They describe new grads as slow, unprepared to manage multiple cases and poor surgeons. They question the graduates’ entry-level clinical skills and their professional skills, such as communication, teamwork and leadership.
I’ve concluded that the success of the new veterinarian lies equally with these three primary stakeholders:
- Colleges of veterinary medicine, which educate veterinary students.
- The students, who ultimately own their learning.
- Employers, which are obligated to provide new graduates with the mentorship and structure necessary for launching successful careers.
It is not the colleges’ sole domain to produce a practice-ready graduate. In fact, no institution can graduate a successful new veterinarian in isolation. It might not take a village, but it does take the shared responsibility of the college, student and employer. None of them is likely to be successful alone.
What does practice ready mean? According to the AVMA Council on Education’s Standard 11 (outcomes assessment), “New graduates must have the basic scientific knowledge, skills, and values to provide entry-level health care, independently, at the time of graduation.” Graduates must obtain entry-level competencies in these nine areas:
- Comprehensive patient diagnoses.
- Treatment planning.
- Anesthesia and pain management.
- Basic surgery skills and case management.
- Basic medicine skills and case management.
- Emergency and intensive care case management.
- Understanding of health promotion, zoonoses and biosecurity.
- Ethical and professional conduct.
- Critical analysis of new information and research relevant to veterinary medicine.
That’s a tall order. Can any of us claim proficiency in all nine competencies? Were we entry-level ready at graduation?
New Educational Models
I’m encouraged by new veterinary schools’ curricula, like those at the University of Arizona, Texas Tech, Lincoln Memorial and Long Island. They’ve successfully challenged the status quo and built into the core curricula new models of education that include professional and clinical skills.
Veterinary students at those schools begin communication courses in month one, year one. They enter mock exam rooms populated by trained actors to gain competence and confidence in best communicating with clients. The communication simulations progress over the following terms to include scenarios involving delivering bad news, handling difficult clients and speaking with a diverse clientele.
Further professional skills courses include financial literacy exercises, leadership activities and practice management training. The education starts in the program’s first semester and builds throughout the pre-clinical years.
Likewise, the clinical skills curricula begin during the first semester and include extensive simulations and models that prepare students for Day One readiness. By having clinical and professional skills in the core curriculum, the schools better prepare their students.
Further, new schools are embracing a hybrid distributed clinical experience in which students rotate through carefully selected and trained real-world environments and see what is truly needed to be practice ready. The variety and number of cases they are exposed to far exceeds those seen in traditional referral veterinary teaching hospitals. Student involvement in real-world cases and with real clients exposes them to and better prepares them for entry-level care.
Of course, legacy schools understand the importance of professional and clinical skills coursework and have worked to include experiences (often outside of the core curriculum), after-hour offerings, guest presentations and club activities. Sadly, some legacy schools are struggling to maintain caseloads and keep veterinary teaching hospital faculty, limiting the number and variety of cases available to students. One AVMA-accredited veterinary school had to close its teaching hospital as a result.
Regardless of the school (legacy institution or new model), I see in our WellHaven Pet Health general practices that recent graduates approach or achieve the economic productivity of more-veteran colleagues within about six months. That success results from the graduates’ commitment to continuous learning, the training they received at their college and our practices’ commitment to provide a supportive environment, including a structured mentorship program.
You’ve read this far, so I’ll foist a couple of personal rants on you. Take ’em or leave ’em.
I am guilty of condemning veterinary schools for bragging about the number of graduates who go on to internships. In my experience, many of those grads pursuing internships were not looking for an advanced degree or board certification but were simply reluctant to enter the “real world” without one more year of training wheels. As a result, they felt neither confident nor competent upon graduation.
That’s right. Eight years of higher education, several hundred thousand dollars invested and they don’t feel ready? Hmmm, perhaps we all need to look in the mirror and ponder:
- Employers, are we stepping up to the obligation of mentorship?
- Graduates, you’re more ready than you think.
- Academia, what are students looking for in an internship that they didn’t get in the previous eight years?
Again, don’t get me wrong, there is a place for internships. But is 30% or more of a graduating class entering internships a good thing? I wonder. Will new veterinary schools that focus on clinical and professional skills, hands-on, real-world experiences, and exposure to more cases result in increased confidence and competence and Day One readiness? Will fewer of these graduates go on to internships? We’ll see.
Too often, students fear that their first job is critical in putting them on the path to a long and rewarding career. They fear that if their first job is not ideal, their career might derail. That’s absurd. Graduates can learn almost as much from a bad first job as from a good one. Of course, an excellent first job is far preferable, but a bad one is not a career limiter. New grads who find themselves in a poor situation can fulfill their obligations, give proper notice and find another job. There are lots of good jobs out there.
One Plus One Plus One Equals Practice Ready
All three stakeholders — academia, graduates and employers — are critical in producing practice-ready veterinarians. All three can do better. Academia can listen better to the needs of employers and graduates, as well as continue to innovate and improve educational models. Graduates can never forget their commitment to lifelong learning. Employers can take the responsibility of mentorship to heart.
Together, we will continue to produce confident, competent and practice-ready colleagues. The new graduates I know are ready. The future of our profession is bright.
In 2023, the AVMA Council on Education will conduct consultative site visits at two institutions proposing accredited schools of veterinary medicine. First up, in May, is Rowan University in New Jersey, followed in September by Utah State University.