In veterinary school we’re relentlessly dogged by biology, chemistry, anatomy, physiology, pathology, embryology and genetics. And that’s just the first one or two years. In the second and third years we’re exposed to seemingly endless coursework in ethics and nutrition and principles of medicine and surgery, among others. Then after all this butt-numbing classroom work, we’re typically granted just one last year to put it all together in a clinical setting.
That’s not exactly how it goes for all small animal curricula in every vet school, but it’s close. Some schools allow student to enter clinics early––after the middle of the third year for more hands-on learning. Some even extend clinics for two full years, in keeping with the modern drive to bring new grads up to speed for immediate workability in practice settings.
Along these lines, most schools now offer “tracking” (sort of a “major” in a certain group of species) so that students don’t get treated to too much extraneous stuff on sheep and goats (for example) when they’re planning on practicing on dogs and cats, exclusively.
So you understand, the veterinary curricula has traditionally been focused on creating well-rounded scientists, not on cranking out veterinarians-cum-technicians who happen to [maybe] know a thing or two about science and medicine. The idea is that veterinarians should be trained the same way physicians are (i.e., with an eye towards a complete arsenal of basic medical knowledge).
However, with the advent of molecular biology and other scientific breakthroughs, that “basic” knowledge base for a “well-educated” doc has expanded tremendously. More science has to get squeezed into the first two or three years.
That means that what was once a four to six hour day of classes has now morphed into an eight hour per day marathon of lectures and labs. Overwhelmed students take on more all nighters in their quest for cramming it all in. And it’s still not enough, not when actually being able to function in the real world of practice looms...in just another year or two.
It’s also true that the advancements in veterinary specialty medicine has altered the dynamics of the third and fourth year clinics. It means that third and fourth year vet students are taught by veterinarians increasingly dedicated to tinier and tinier arenas within veterinary medicine, a fact that can sometimes hamper efforts to educate students more broadly in the kind of general medicine most of them will practice.
The unique patient population of teaching hospitals also means students tend to be taught how to diagnose and treat in the abstract. Sure, they’ve always got real animals as a reference, but because teaching hospitals typically attract the most complex cases, real-life examples can be hard to come by.
Ultimately, the pushes and pulls of modern veterinary education means precious little time to learn how to actually handle what the youngest veterinarians among us will have to when they get their first real jobs. Add all that to the stress of the high cost of a veterinary education and you really have to marvel at what veterinary students are accomplishing in 2009:
They’re pushed to learn more by virtue of more advanced scientific knowledge. And now, they’re asked to cram all this basic science into two years while they become more clinically competent through “tracking” and by spending more time in clinics––despite the fact that a seriously specialized caseload gives them limited access to general practice examples.
I’m amazed at what’s asked of them. But not everyone sees it the same way. More on that tomorrow.
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The average veterinarian in my area (New Brunswick, Canada) has more knowledge than most General Practitioners I have had contact with. If it were legal I would go to my vet for my health issues! And I'm not joking as my Doctor is overworked and undercompensated. It's rush in rush out, with no useful dialogue. However our vet is always more than happy to spend an extra few minutes entertaining our pet hypochondria. I know that you have to pay out of pocket for your healthcare in the US but what is the quality of service you folks get?
Chuck June 12th, 2009 07:54:31 AM
Chuck, the quality of care we get when we have the means to pay for it, either out of pocket or insurance, is generally quite high. That's what our wing-nut politicians are yapping about when they utter phrases like "the best health care system in the WOOOORRRLLLLLDDDDD!!!!!"
The problem is access--such a large percentage of uninsured people, insurance plans with co-pays and limits that mean too many people can't afford to actually use their coverage, and doctors who have to argue with insurance company gate-keepers with high school educations about whether or not a particular procedure or a particular drug is really necessary. Also, the insurance payment schedules are set up to compensate specialists much more generously than GPs, so we have too many specialists and not enough GPs. And because the doctors or the office staff have to spend so much time on insurance company paperwork, they're even more crowded, slow, and stressed.
And if I'm reading what Dr. Khuly is writing correctly, the sheer increase in knowledge to be absorbed is pushing vets in the same direction, for different reasons: it's just really, really hard for a vet school student to learn what they need to know to be a GP rather than a specialist. Is that correct?
I'm sure the whole thing must be horribly compounded by the fact that human medical doctors only need t master this knowledge for one species, while even a vet who is going to do just small animal general practice, or just large animal practice, needs to have that same level of detailed knowledge of the medical needs of multiple species.
And I don't have the impression that vets are compensated anything like the way doctors are compensated, despite having to learn more in the same time--or even less time, because internships are standard in human medicine and unusual in veterinary medicine--and having to have been better qualified to begin with even to get in, because there are fewer seats available in proportion to the number of people competing for those seats.
There has got to be a better way, but I don't know what it is.
Lis June 12th, 2009 09:25:18 AM
I agree with this. There are simply too many competing topics to get it all in during vet school. I taught at CSU's vet school for 20 years and my subject matter (communication, euthanasia and grief support, the human-animal bond) is basic to the profession and to the success of a practice, yet we had to fight for every tidbit. We ended up creating a very comprehensive curriculum, including a week-long clinical rotation, but we were the exception, not the norm. The bottom line is that most veterinary teaching hospitals emphasize the subject matter of the docs they have on faculty. If you are an ambitious, aggressive person, you can literally build an empire within the school. The general practitioners a la community practice just don't find themselves in academia, thus they basics aren't taught.
Laurel Lagoni June 12th, 2009 12:30:33 PM
I had the misfortune of having to visit Ohio State's vet clinic again recently and can vouch that they do get routine visits for immunizations and check-ups too. I've always wanted to ask if those are staff or friends and family of staff because I know getting in the door is otherwise next to impossible without a referral.
The students who have worked on my cases have always been wonderful. They learn to take a good history and deal with the owners and their pets. That's what it's all about, right? The students are the ones whom I've found to be most sympathetic to my decision making process of creating the best quality of life possible for my animal.
I did a clinical in a teaching hospital for my profession and figure that dealing with complicated, multiple conditions will be a good foundation for dealing with things that are more ordinary.
Deanna June 12th, 2009 12:35:25 PM
It is my understanding that Ohio State (and probably other schools) have emergency services (that's why I went there - from Cleveland when one of my greys was suddenly paralysed, although there was a call ahead to let them know we were coming to see Dr. Couto and his team). We got there later in the evening and there were people coming in with HBCs, and other emergencies. Students were there working and learning at all hours. Some of the routine visits that do are for rescue groups, and include ortho work along with exams, vaccs., etc.
KateH June 12th, 2009 01:53:25 PM
I am very happy to be a wide-ranging generalist. After nine years of part time practice, I'm glad to be able to address health problems in creatures ranging in size from hamsters to dairy cows and horses (even though I don't work with the larger species anymore, I at least know what the issues are and how to treat them). Specialisation isn't for everyone, though I am glad the specialists are out there to help us generalists out (and vice versa, I hope).
Something that really would help vet students out would be some kind of a summer program (such as nurses have) that provides paid employment and on-the-job training in various fields. Of course, the financial arrangements would have to be worked out somehow, but it seems to me to be one of the only ways to maintain scientific and practical integrity for the veterinary profession.
brebis noire June 12th, 2009 04:21:10 PM
I am not sure that knowing a lot about scientific subjects always makes a student a well-rounded scientist. I learned far more about the scientific method and critical thinking skills as an undergrad than I did in veterinary school. The pressure to get good grades for the application for veterinary school teaches people how to memorize information for exams, not how to analyse information critically. This trend often continues into veterinary school, with many students honing their ability to remember large amounts of information for exams to a fine edge. Unfortunately that is a skill that does not have much relevance in practice. Fortunately most of us do learn to integrate the knowlege and become competent veterinarians.
Unfortunately the lack of understanding of science as a method rather than just a large body of knowledge and weak critical thinking skills have led to the "integration" of unproven and even disproven techniques, otherwise known as Complementary and Alternative medicine.
For more information and analysis of the infiltration of medicine, both human and veterinary by unscientific or even antiscientific interests, I reccomend taking a look at Science-Based Medicine blog; http://sciencebasedmedicine.org/.
SkeptiVet June 12th, 2009 11:38:24 PM
While I know that my teaching hospital has a different patient population than I'll see in general practice, I've been impressed at how focused our clinicians are on teaching us what we'll need to know as GPs. So, on my ER/Critical Care rotation, I got to place catheters, perform a thoracocentesis, and be the student on with a case of anticoagulant rodenticide toxicity, but didn't learn a lot about the case of the dog on the ventilator or follow up with the back dog who needed a hemilaminectomy because those are for the residents to deal with. On my cytology rotation, they made us comfortable with being able to diagnose mast cell tumors and Heinz body anemia, but also taught us when it's best to send a slide off to a pathologist for evaluation."Our goal is not to make you into pathologists in two weeks!"
Also, no matter which rotation I'm on, the majority of the time I'm just taking histories, doing physical exams, and SOAP SOAP SOAPing... all of which will be important skills whether I'm a GP or specialist.
Megan June 13th, 2009 10:24:40 AM
Professional educations were designed a hundred years ago and need serious rethinking and revision; tracking of education got a bad reputation in the 70's but, IMO, is a virtual necessity these days.
"If it were legal I would go to my vet for my health issues! And I'm not joking as my Doctor is overworked and undercompensated." Chuck, I'm with you. With one exception on the vet side and one on the MD side, I'd much rather see the worst of the vets I've known than the "best" of the MD's I've seen. I wouldn't want to be anywhere else in the world for critical trauma care than a US hospital but, for all else, the system is failing us miserably. I hear consistent complaining about being overworked and undercompensated but what I see are doctors who don't know how to handle their personal financial affairs well, let alone their business ones; nor do they have time management skills to speak of. I live in a community largely comprised of med students who have the delusion that they'll be able to retire wealthy after 15 years (max) in practice. Professionals in the US are nicely compensated but it is unrealistic to think one is going to retire at the same age as the last generation (or the one before that) when we're all living much longer; more so if one thinks they will get to do so on social security, as so many here expect these days.
We need major educational (and societal epectation) reforms and they need to start loooooonnnnnnggggg before graduate school!
PJBoosinger June 17th, 2009 04:00:09 AM
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