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
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 is president of the North American Veterinary Community and serves on the boards of Pet Peace of Mind, WellHaven Pet Health and the Lincoln Memorial veterinary college.Read Articles Written by Bob Lester
Published nearly a year ago, our article “What Vet School Could Look Like” — read it at bit.ly/VetSchool — speculated on the veterinary learner of tomorrow. While at the time we were encouraged by the early green shoots of change in veterinary higher education, our expectations were low, frankly, given the glacial rate of change in academia. Colleges of veterinary medicine contribute enormously to society, but at the same time they are outdated, expensive and resistant to change. This is true across higher education. Well, guess what? All it took was a pandemic to dramatically accelerate change in our beloved academic institutions.
To be fair, coping with COVID-19 is especially difficult for many veterinary colleges. Their functions are multiple and include education, research, hospital operations and multispecies health care delivery. Even more complex is a bizarre, unsustainable and unpredictable revenue model relying on state funding, grants, tuition, alumni support and endowments. Veterinary higher education is overdue for a major overhaul, one now forced upon it by a virus.
The good news? The global emergency has necessitated new thinking in support of learning, namely the wide-scale deployment of technology. The move to a virtual, more cost-effective teaching environment has taken an enormous leap forward. With no time for committee formation, task force creation or commissioned studies, years of deliberation were reduced to days or weeks. Traditional in-person classroom learning will return but at a much-reduced scale. The move to anytime, anywhere learning is well and truly launched.
How will the COVID-19 pandemic impact veterinary higher education? In a dozen different ways. Let’s explore.
1. Technology in Support of Learning
Technology will redefine how veterinary education is administered, configured and consumed. In 2019, U.S.-based venture capitalists invested $1.7 billion in the educational technology market, while global venture investment in EdTech reached $7 billion during the same period. COVID-19 has further motivated investments, further capacitating technological innovations and implementation. This means lots of dollars invested in remaking education.
Also, consider this:
- Long-term solutions center around online learning, remote learning, remote team training, peer-to-peer learning and assessment, lifelong learning, gamification, immersive technology, artificial intelligence and machine learning, robotics, and blockchain technologies.
- Virtual events, virtual mentors, virtual office hours — things previously unheard of — have been successfully implemented at many workplaces and a few universities. All in a very short time frame.
- We will see more redirection of resources. University dollars will go to technology upgrades, quality online content and programs designed to ensure student success in a remote environment. Some of these will be developed in-house, while others will be purchased off the shelf. Opportunities for collaboration between universities, within universities and with private entities are ripe for harvest.
- The pandemic caught many universities off guard in that they did not have an online presence, plan or content. Most patched their way through the spring semester by having their professors set up Zoom classes from kitchens, living rooms or home offices. This experience caused smart administrators to begin to think more about asynchronous online education, co-creation of content, the licensing of content and new faculty models. This will (eventually) help drive down the price of operating a college.
- Ask yourself this: What can be accomplished online using today’s technology and what must be delivered in person? The majority of materials in today’s veterinary curriculum can be delivered remotely. As technology changes, more topics and learning experiences will be delivered online. Over time, content and technology will advance and improve the student experience. This will give students the option to live where they want for the majority of their veterinary education journey.
2. Hybrid Distributed Models of Clinical Education
In this type of clinical education, academia partners with real-world clinical collaborators to provide an immersive, cost-effective, high-caseload, hands-on experience to best educate our future veterinarian colleagues. All share the goal of teaching and learning commonly seen conditions uncommonly well and better preparing graduates for entry-level success. Under this model, students and their teachers no longer are constrained by the limitations of a tertiary care teaching hospital, which, by design, focuses on uncommon and complex tertiary care delivery, often at the expense of primary care education.
COVID displaced fourth-year students from university teaching hospitals. Why? For two main reasons:
- The hospitals either closed or drastically reduced their scope of service.
- Most teaching hospitals were built years ago and were not designed to accommodate the growth in student numbers. The spaces become squeezed, making adherence to social spacing and safety requirements nearly impossible.
Enter the distributive model. Lincoln Memorial University, which we are well familiar with, has more than 900 core and elective clinical affiliates who, amid the pandemic, had to vary their delivery of veterinary services and figure out safe ways to serve clients and patients, all while remaining super busy and eagerly hosting senior students. At a time when the very fabric of clinical learning in the traditional teaching hospital was compromised, private practitioners stepped up to prepare students for clinical success.
Demand continues to grow for the distributive model. We can all help one another. The new generation of veterinary schools across the globe is nearly all of the distributive type — Calgary, Lincoln Memorial, Arizona, Long Island, Texas Tech, Western, Surrey, Nottingham, Harper and Keele. More are in the pipeline.
3. Prioritization of Skills and Competencies
Credit hours will become irrelevant. Sacrilegious? Yes, until COVID hit. Truth be told, outside of veterinary medicine exists a movement to prioritize skills and competencies over educational degrees. Take, for example, Udemy, edX and Lambda, where learners can enroll at little to no cost, from anywhere, to obtain valuable market-relevant skills. The movement is toward a learner-centered model that de-emphasizes equating competencies with grades and instead focuses on abilities and achievement as salient learning outcomes.
Fortunately, the Association of American Veterinary Medical Colleges recognizes the trend and has developed the CBVE (competency-based veterinary education) framework. Deconstructed, the 32 competencies will enable veterinary education to step away from traditional didactic methods, traditional exams and brick-and-mortar-bound activities. These ultimately will enable the learner to log their competencies into their digital learning record asynchronously and at their own pace.
Competencies are the currency of the future workforce and will be captured on a secure digital learning ledger (blockchain) that never closes. This allows learners to perpetually build their educational record, transfer it seamlessly, and train and retrain to meet the needs of our ever-changing society. That’s the future.
Blockchain is not bitcoin. It’s a technology with hundreds of uses in other vertical industries. In our learning context, blockchain can provide a platform for learners to acquire “badges,” or demonstrate competence via examination or skill demonstration throughout their educational journey and career.
Blockchain technology solves the implementation of the competency-based model of medical education. It provides a trustworthy, digitized, decentralized ledger that creates a method for multiple entities to issue and accept credentials that are portable, verifiable, shareable, meaningful and discoverable. Under such an ecosystem approach, the co-branded content and credentialing will hold tangible value and buy-in for all parties, including students, academics, regulators and employers.
Blockchain is not a fad. Its growth is inevitable as technology catches up to today’s world. Blockchain will become a crucial part of education and tomorrow’s world.
Think of it this way: Learner DVMs-to-be move in and out of veterinary practices and academic institutions during the four years (or less) of their curricula. They accomplish their didactic work either remotely or semi-remotely via peer-to-peer learning and facilitated discussions. Professors move from the sage onstage to a convener of discussions. Students progress at their own pace and complete their studies in their desired time frame, emerging with relevant skills for today’s market.
5. Limited (Enhanced) Licensure
The time has come to drop the outdated James Herriot-driven curriculum and licensure. The approach of all things taught to all students no longer makes sense. Imagine how much better prepared new graduates would be if valuable educational time wasn’t diluted by acquiring never-used skills.
This works for two reasons:
- The learners of the future wish to consume and learn only the skills most relevant to their employment. Think about a focused dairy student who does not want to work with dogs and cats. All of education, not just veterinary medicine, is moving that way. Learners want to achieve smaller, skill-based bits and get them done quicker and cheaper. Licensing exams will change, either under our direction or through an outside entity.
- The same learner, if she chooses, can add to her complement of verified skills. For instance, say she’s now a DVM who wants to pivot from dairy practice to companion animal. Well, that’s easy. She seamlessly enrolls to upskill in a dog and cat credentialing program. The new competencies go into her digital learning ledger and she takes the dog and cat enhanced license exam.
6. Learning Science
Learning used to be viewed as an art form. The artists (teachers) would decide how to sculpt their statues (students) using whatever method desired. Academic freedom at its finest, promoted by tenure. Yet, through scientific advances, learning is undoubtedly a science, not an art. We are rapidly learning how the brain processes, stores and interprets information. These discoveries are informing how we teach. Teaching with the outcome in mind. So, how will this change teaching?
- Adaptive learning. This means using machine learning, or artificial intelligence, to respond in real time to the learner’s knowledge base and directing new questions or concepts until the learner masters the content. In short, AI systems are going to personalize learning.
- Biometric learning. Think of it as a simple camera on every device — smartphone, laptop, tablet. The camera reads facial expressions and movements to determine whether the learner is understanding content or becoming uncomfortable. Some of today’s off-the-shelf programs know with 60% accuracy when the learner has left the subject he is supposed to be learning and has switched to Facebook.
- Sensors, exosuits, virtual assistants, haptic devices. They are coming.
7. New Revenue Models
The well of state subsidies that traditionally supported institutions of higher education was running dry pre-COVID. Now, the pandemic economy is emptying the well.
Some public universities have offset decreased state funding by increasing their enrollment or by admitting additional out-of-state (higher tuition) students. This is getting harder as the number of veterinary schools and seats grows and as students stay closer to home. Also, not all legacy veterinary colleges and teaching hospitals can handle an increase in numbers even if the AVMA Council on Education (veterinary medicine’s U.S. accrediting body) gives the go-ahead.
So, what happens? Well, new sustainable models are emerging, the chief of which is the distributive type, which has lower capital startup costs for facilities, lower operating overhead, a reliance on private partnerships and a focus on producing entry-ready graduates in a more cost-effective manner.
Here’s what veterinary educators also can do:
- Leverage existing centers of excellence. Every veterinary college does not need a capital-intense research enterprise. These already exist within many medical schools and in pharma and industry. The experts inside these places need not be replicated. Why not partner with them and allow students who desire a research-intensive track to participate?
- Co-create and co-brand content. Colleges can share revenue generated by partnering up, pairing faculty members and creating shared content. The mechanism for this is available, and the desire should be there, too.
- Share facilities. Classroom real estate is about to be as valuable as Sears mall real estate. Classrooms are empty or unused much of the day and many times of the year. Distance learning will do to classrooms what Amazon did to Sears.
- Share lectures. Why hold 31 preclinical didactic lectures 31 times with 31 professors? Talk about redundancy. Pick the best teacher and hold one virtual course to be shared by all students at all institutions. Students will consume from only the very best teachers when and where they want. The quality of instruction will rise and the cost will fall.
8. Cut, Snip, Shred
COVID forced colleges to cut material out of their curricula (applause). The chaos led educators to move content online. Professors finally said, “Do the students really need to know this?” and, perhaps, “Do I really have the time and energy to transfer all of this into a digital format?” We predict the trend will continue. Grounded with the CBVE competencies — we mentioned them earlier — this will lead to a new focus on delivering baseline, relevant content to students.
9. From Inputs to Outputs
Historically, accreditation-driven education has been, for the most part, driven by inputs. For example, in order for a veterinary program to be accredited, regulating bodies use checklists as they document the size of facilities, count the number of faculty and staff, confirm the presence of in-house student support programs, tour libraries, and ask about research projects — the list goes on.
Educational models outside of veterinary medicine are focusing on outputs. That is, did the graduates get good-paying jobs, did they actually learn, did they demonstrate mastery of the competencies and skills necessary to obtain the degree, and were they ready for entry-level careers? These new models don’t care about inputs; they look for learning outcomes.
This change is coming to veterinary medicine with or without us. Outcomes-based veterinary education ensures that students know and do what is needed. Let’s face it, the learners of tomorrow want their education to be cheaper, faster, at their own pace and focused on the end goal.
One might argue this can’t happen in veterinary medicine due to licensure and regulatory requirements. The taxi commissions told Uber the same thing.
10. Redefining Admissions
The winners in veterinary education will lower the barriers to admission. Think fewer steps, fewer requirements, fewer prerequisites, better webpages, more digital engagement, and the ability to enroll and be accepted within minutes. Tear down all the walls.
Colleges of veterinary medicine are discarding GRE scores as a criterion for admission. The scores have not been shown to correlate with student success. GRE scores often limit applicants of lower socioeconomic status.
COVID-19 immediately drove colleges to waive the GRE requirement, mainly because social distancing barred applicants from taking the exam. Isn’t it amazing how admissions committee members change their minds in the face of zero student applicants? It’s a win for diversity and inclusion.
So much work needs to be done here. Guess what? More and more students wishing to enter veterinary medicine will have attended community colleges and will not have worked hundreds of volunteer hours cleaning kennels, a path historically looked down upon by admissions committees.
Other benefits of this new approach to admissions include:
- In-person, on-campus applicant interviews will become optional, if not obsolete.
- The way in which a student engages the admissions process will become digitized. (Think TikTok, Snapchat and WhatsApp.) Email and computers are old ways of communicating.
- Students will demand robust and interactive admissions programs. Technology will allow for personalization by geography and areas of interest.
11. Asynchronous Learning
A quarter, a semester, a year, a four-year degree. Why have professional degrees like the DVM/VMD been time-bound and set at four years?
If I can learn at a faster pace, opt out of something I know, take off a semester or curate exactly what I want to learn, then why shouldn’t I? It’s already happening in undergraduate programs.
This is what the learner of tomorrow wants and what society requires.
So, what are prospective veterinary students saying? From the undergraduate side, as of this writing, some are deferring enrollment or enrolling closer to home. Students are concerned about the lack of a social experience in a physically distanced university.
Interestingly, the McKinsey consulting firm reported in May 2020 that if universities shifted to an online fall, 32% of students would look for schools offering better online resources. In addition, “The vast majority of students (83%) expect a tuition discount in the event of a remote fall semester,” “29% would look for lower cost of attendance” and “25% would look for better job-placement resources.”
So, what’s the point? First, landing students has become more and more competitive. Second, if veterinary medicine wants to continue to attract talent, and diverse talent, we better figure out a way to address three items of concern: cost, technology and geography.
A New Day Has Dawned
2020 marks the beginning of a new day in veterinary higher education, ironically one catalyzed by a virus the veterinary world has known for decades. The future of learning depends on a wide array of stakeholders — university administrators, students, licensing bodies, accreditors, faculty and staff, employers, consumers, practitioners, and public and private collaborators.
Change is uncomfortable, but it’s time for all of us to get used to being uncomfortable. Disruption is underway throughout higher education. Not all institutions will survive the virus. Darwin will be hard at work as we evolve to a better, sustainable, reasonably priced, new model of veterinary education.
Get ready for a blended, hybrid, student-centered, technology-rich future. Together we can build on the success of the old model, eliminate the outmoded, and build a new and better college of veterinary medicine.
LEARNING DURING A PANDEMIC
Oklahoma State University’s College of Veterinary Medicine enrolled 106 first-year students this fall. Though the public dedication of the Roger J. Panciera Education Center was postponed because of COVID-19 safety concerns, the brand-new building is being put to use. The building’s three identical classrooms allow for flexible education. “COVID has dictated that the tables and chairs stay just as they are so that students are socially distanced,” college spokesperson Derinda Blakeney said. “Otherwise, everything is on wheels and easily movable to go from auditorium style to small groups to whatever style fits the instructor and class objectives.” Above, Dr. Lyndi Gilliam, an equine internal medicine specialist, introduces herself to her veterinary students inside one of the classrooms.