If I understand the current teaching philosophy in veterinary medicine is that whether a person is going to be a GP or a specialist in anything they all take the same amount of schooling?   Correct me if I'm wrong on that one.

Seems to me why not have classes 4 years geared for GP of whatever the most common say 6 species are, then additional schooling/degrees for specializing in a particular area or less common species?

Personally I always thought vets were smarter than human dr's simply because of their ability to deal with multiple species.

My old human dr. was great, he was not only an osteopath, but also a surgeon (in his younger years), an obstitrition (sp?), got a pharmacutical degree so he could dispense meds from his office, and in later years got a veterinary degree so he could vet his own horses (never worked on anyone else's animals).  It was a sad day when he finally quit practicing and shortly later passed away.  He was a wise and great man.

cl June 13th, 2009 01:58:57 PM

In regards to your point 3:

I live near the Cornell Veterinary School, and that's where I take my cats for their routine care. They have something they call Community Practice Service, in which the fourth-year students take charge of seeing the patients (or well pets). They charge a bit less than they would to have a full-fledged vet doing the same things. I've always been quite pleased with the quality of care the students provide (for one thing, it's always clear that they've thoroughly read my cat's file beforehand); I know they're discussing matters with a vet behind the scenes, and that person always comes in and shakes my hand, but otherwise leaves it entirely up to the students to talk to me and go over recommendations. There are only a few drawbacks to this -- one is their tendancy to suggest high-tech diagnostics just because they're available, but I do know how to say no; more seriously, it means my cats are never seen by the same doctor twice in a row. I think when they're elderly and start to have complex health issues I'll want to have a regular vet who can monitor changes in their condition, but for now, I find the Community Practice Service to be an excellent thing.

T.T. June 13th, 2009 02:00:17 PM

I'm not sure it is still a minority of vet students going on to internships/residencies. In food animal, most of them do not. However, I feel like I constantly hear people talking about how to get into equine internships after they graduate. And all (or it feels like all) my small animal oriented friends are already talking about the match. Even the ones that said earlier they would not be interested in doing an internship. I seem to be the opposite of this - at first I was hell bent on internship and residency, and now all I want is a job. I have a multitude of reasons - wanting to pay off my loans, being older (although the older folks are gunning for internships as well), not wanting to be in a long distance relationship anymore, general burnout, desire to pick up my old hobbies again, and there's others. But I feel like not wanting an internship tells everyone else that I'm not very smart and lack ambition, and I should be putting my career ahead of "some boy". I feel like I constantly have to justify my decision, and it seems to shock everyone.

I'm not terribly concerned about my surgical skills - I feel like I've gotten a lot out of our terminal surgery course, upsetting as some may find that, and I'll be taking a rotation where I do nothing but spays and neuters. What I am concerned about is that I'd like to go into emergency practice and I'll graduate never having placed a chest tube, never having performed CPR, never having unblocked a cat, never having placed a central line. I've had a chance to work on my catheter skills during the anesthesia rotation, and I can intubate pretty well, but I feel like my clinical skills end there; the practice where I got my pre-vet "exposure" hours didn't allow me to do these things. I expect my first couple years out to be hell.

And of course, everyone's answer to this is "do an internship!" but I can't say I've seen interns trained in this sort of thing specifically; if anything, I see them shoved aside. Emergency skills are self-taught alone in the middle of the night. I don't see how it would be any less stress or a smoother transition.

Advice, Dr. Patty? :)

Julia June 13th, 2009 02:51:22 PM

It's definitely not a minority. At least 1/3rd to 1/2 of my class pursued more education post-DVM commencement.

As to the surgical skills - I found a way to hone mine in one quick year post-graduation: a private practice, 1/3rd emergency internship. In the past year, I have gone from being nervous in a spay to being able to perform GDV surgery, cystotomies, c-sections, splenectomies, nephrectomies, and everything in between with great confidence. My classmate and good friend did a private internship at a well-renowned hospital in Manhattan. She received NO surgical experience and recently did a neuter with heavy supervision. She was nervous the whole time.

My point? There are ways to get good surgical hands on knowledge before joining the private sector. The downfall? Being an intern, being paid 30,000 a year, and working, working, working, working. The trade-off? I feel like I can handle just about anything.

An intern June 13th, 2009 03:43:34 PM

Julia: I did a private practice internship that was 1/3-1/2 emergency work. There were no residents - I was overnights with 1 other doctor (as well as weekend days). In the past year, I have done EVERYTHING - including chest tubes, GDVs, c-sections - to the more routine elcampsia, HBC, lacerations, etc. I was never pushed out of the way, but I always had someone to help. When I did my first chest tube, the ER doc was nearby - but she didn't step in, and she only offered helpful advice.

There are internships out there that will prepare you for emergency work. I think trying to just jump in would be a very bad idea - for your mental health and the safety of your patients. I look back at what I knew a year ago, and I am so, so, so thankful that I did this. If I hadn't, and I had started doing ER medicine alone- my patients would have suffered.

I don't know where you live, but if you are interested in this internship - leave your email address, and I'll contact you.

An intern June 13th, 2009 03:47:56 PM

As a vet student going into my third year this fall, I feel obliged to comment. Physiology, BioChem and Molecular Bio WERE prerequisites for me to get into vet school. None the less, we went over them all over again during our first year. The (highly repected liberal arts) college I went to for undergrad didn't even offer some of the other classes I took in the first year, such as animal nutrition. We all came in with the pre-reqs, true, but our actual understanding of the material varied from PhDs in the subjects to 'oh yeah, maybe I took that class.' Then, the variation between what was actually taught in Physio at my undergrad versus someone else's made it seem like they weren't even the same class.  Maybe that's because mine was specifically an animal physio class, but the point is that we were nowhere near on the same page when it came to the basics, the foundation, that having a  class as a pre-req might make it seem. I'm not sure requiring a basis course would give a leg up for students so much as make the first semesters even more hellish as they tried to figure out what they were 'supposed' to already know and then make up for it.

I may be lucky, but my school does use a lot of case-based learning, even in the first year and it helps a lot. Not just clinical skills, but it helps us students see mentally how this is all supposed to fit together. Some nights those cases were the only thing keeping us sane because if there was a case, then we knew that all this knowledge was applicable somehow. Ditto for the practice in clinics. We've got a very strong community practice arm, though I think being in the middle of nowhere kind of makes our VTH the only clinic in town. I'm sure it must be more of a challenge for schools that are in urban areas... or even within an hour's drive of an urban area. We've also got an intro-to-clinics program that requires first-semester first-year students and everyone else to spend a certain amount of time in the clinic observing. It's a great bonus for us because we get to see things and then, by the time we're actually in clinics, we're comfortable enough there to actually make the most of any oppourtunities. Our communications and client interaction programs are among the best of the vet schools' or so I'm told, and that was in direct response to clinicians wanting new grads who could actually talk to clients. 

I honestly don't know what they could change. To me, the simplest (not easiest!) solution would be to make vet school cheaper. If my classmates and I weren't saddled with average $150K debt upon graduation, we could take lower 'newbie vet' salaries at clinics, be mentored and learn for a year and then maybe be ready to produce enough for employers to be happy. As it is, we can't afford to accept lower salaries because most of us will have $1250+ a month loan payments to make.

lindabcs June 13th, 2009 04:59:28 PM

intern - I'd be interested to know where you're at. letoutjulia at gmail dot com.

Julia June 13th, 2009 08:38:18 PM

It sounds like vet medicine needs some form of established post-grad education so that newly-minted DVMs get the same sort of training that human MDs (internship and residency) and science PhDs (postdoctoral research) get. Certainly MDs would never practice without at least one year of post-graduate training--and up to 7 more in the more specialized fields like cardio and neuro surg--and, in biomedical research, you can't get your own lab without completing a minimum of 3-5 years of postdoctoral training. It seems like vets should be held to similar standards. However, that will require established vets to develop intern/residency programs and commit to training younger vets. It also means a longer period of "indentured servitude" for new vets but, as a 4th-year postdoc who makes $35K/year (that's after 10 YEARS of post-college training), I have little sympathy for that argument.

Sarah June 13th, 2009 08:52:21 PM

As a current veterinary technician student, I have something I'd like to add.

My program is extremely challanging & worth every penny. We had a small class size starting out, and now that's even smaller. (23 students down to 15 now, I believe.)

Some of the students whom left or did not pass their courses where already working in private practice, some for years. It's a lot more difficult than I ever imagined-although my years of OTJ experience has helped me put these new. exciting, concepts of medicine into context I can relate too, some of my other classmates, whom have very little experience in the field, do not.  It's a crash course in mathematics, science, medicine & ethics. It's a two year degree, yes, but requires a year of prerequisutes to even qualify.And startign next year, I hear they are adding on additional semester for clincial rotations! (Nice!)

Some weeks, like now, I feel that so much information is being presented and the pressure is on to memorize it all...I feel as if I am no longer learning, so much as I am learning to simply "fast map" memorize and drop the info out on the next exam. It's upsetting that there are things I was so familiar with during my first semester that I have forgotten!!!(but thankfully, I do know where to look up the info!)

It would be nice to have a break, but my program is 18 months, straight through. No spring break. No 3 month summer break (3 weeks). Only challenge & trial & friendships & laughter & lots & lots of info!!!

I have found myself reading > 100 pages in a textbook at night, closing the book, and actually forgetting what it was I just read. Not the whole thing...but certain concepts. I take good notes (or at least I think I do!) & I make up bizarre little songs to remember things by...

I am actually entertaining the concept of veterinary school...but my love is animal behavior, so I am also strongly considering getting a Bachelors in Animal Behavior...where though?

More importantly, why do I want to continue torturing myself? The sleepless nights, the study groups, the endless cups of coffee...the stress...the frustration...the love of learning & medicine & animals & people....

Yup. I'm not anywhere near done yet!

Roxanne Sitarz

SCNAVTA President of MDC

Roxanne June 13th, 2009 08:58:39 PM

Good suggestions. I loved my Case Study classes in vet school, and I do think they helped me problem solve and understand the process of case workup in practice. I definitely think there needs to be more practical dentistry in school, as I knew NOTHING out of school (didn't take the elective). I never really considered doing an internship--like Julia, I just wanted to get to work. Thankfully, I picked a fantastic, well-managed AAHA-accredited hospital, and have been there (very happily) since graduation in 2004. I got most of my surgery experience doing spay/neuter rotations at shelters. I do not regret one bit NOT taking the terminal surgery course--I opted for the "alternative" course that just spayed/neutered humane society animals. Remember this--perhaps the most important part of any surgery is that the patient wakes up afterwards, and you need to learn how to keep that animal comfortable. I've been very happy with my choices (ie not doing an internship, going right into practice), but I think some of it is luck--ending up at a practice where I received good support and mentoring. 

JCB June 13th, 2009 10:55:00 PM

The major problem with delaying surgical training until after graduation is that in private practice, you would be practicing on someone's beloved pet, and the owner may not be aware that your skills are still largely undeveloped. For that reason, I think vet students should at least be able to do a competent bitch spay before graduating. The skills used in that surgery should carry over to other procedures.

As a fourth year vet student (in a five-year program), I do feel the pressure to stuff more, more, more knowledge into my brain. Our is a non-tracking program, and a lot of the large animal component includes animal production and husbandry, which is especially frustrating. I would prefer that there be more formal tracking and licensing by species - for instance, Companion Animal, Food Animal, Mixed Animal, Equine, Other (Lab, Poultry, Swine). I do not think that the economics of veterinary practice will support more years of compulsory schooling for every one. My school debt is US$200K, and I cannot start an internshhip or other training job at US$27-35K.

As for giving students the opportunity to learn more real-world cases, I think my school does it right. I will be spending about 1/2 of my clinical time at private practice clinics, and the other 1/2 at the teaching hospital. There are disadvantages to this approach, but I think they are largely outweighed by having the opportunity to see how a variety of clinicians work up everyday cases and to become adept in everyday procedures (cat bite abscesses, skin wounds, etc).

The other thing I like about my school is that discussion of the cost of each procedure or drug is usually included in lectures, so we know what the Gold Standard is, and then what various Plans B, C, and D we can offer if the client cannot afford the Gold Standard. I think this is especially important as more and more advanced care becomes available for pets.

cayugaduck June 13th, 2009 11:26:39 PM

I'm not a vet, but work closely with a shelter vet 1-2 days a week as a volunteer. One suggestion for those who desire more surgical experience  (and either don't want/can't afford a surgical residency) is to find a local shelter that does its own spays/neuters (rather than offer vouchers) and volunteer your services a few days a month. We  have a full time on-site vet, and also do a lot  of dentals on older animals, as well as wound repair, some simple orthopedic procedures, amputations, hernia repairs, as well as an occasional cherry eye, or enucleation. In addition, we are also the local animal control depository, and as such, get a lot of emergency work, as in HBC dogs and cats.

Last summer, we had a newly graduated vet who came in as a volunteer surgeon. She was entering a private practice owned by her father, and had, by her own admission, very limited surgical experience. I worked with her during the few months she was with us; initially, her technical skills were good, but she was very tentative and slow. (Our full-time vet can do a cat neuter in 5-10 minutes, and an uncomplicated dog spay in about 15 minutes). After a couple weeks, she had gotten much more confident, and was much faster, and her suturing skills had improved enormously. Toward the end of the summer, one of our shelter dogs developed a GDV, and she got to work on that as well, with our regular vet. (The dog survived, she fostered him, and ultimately adopted him--a living testament to her evolving surgical skills). She is now one of our substitute vets when our regular vet is on vacation.

Shellie June 14th, 2009 09:08:24 AM

Sorry for getting in here late and not commenting too much over the past couple of days--I'm out of town three time zones a day and it's tough to get to you outside my iPhone (not conducive to writing). Here's my impression of your comments (better late than never): 

I'm huge on internships and wish everyone could feel they could afford them. As someone who attended what was among the most expensive vet programs (at the time) and stayed in school two years beyond the veterinary program (accruing significantly more debt during that time), it doesn't seem too financially onerous to ask that vet students spend just one more year working for a very low salary while they acquire impressive skills. But that's clearly not what most vet students consider ideal--not yet anyway. I'm heartened to hear that it's changing. But that's not the case in my area. If 1/3 to 1/2 of the new grads that went into internships came back to practice here as generalists, veterinarians would not be complaining the way they are. Or perhaps that's just a testament to the bottom-half's "inadequacy."

The problem, as I see it, is that those of you willing to comment here, worry about your skills, pursue internships, and read blogs like this are not the norm. When I was in vet school it was obvious that only the best and the brightest opted for internships and advanced degrees beyond the standard veterinary curriculum. I believe that's still true, though the segment has expanded significantly (likely due to the larger footprint of the specialty medicine set, among other factors). However, that still leaves a sizable percentage out of the internship loop.

In fact, there may be a widening divide between the haves and the have-nots when it comes to post-vet school education. If so, how do we narrow it?

Dr. Patty Khuly June 14th, 2009 10:18:39 AM

I'm going into my third year of vet school--there are so many problems that really need to be addressed that I don't know where to begin.

There simply aren't enough hours in the day to learn all the material and master all of the technical skills we need to be proficient clinicians immediately after graduation--it's overwhelming. One of my classmates dates a medical student and he has far more free time than she does!

abc June 15th, 2009 02:37:29 AM

The one thing I'm thinking is -- how wide is the gap between the best and the brightest in vet school, and, say, the bottom 2/3 of the class? I'm really not seeing much of a difference between the A-, B-, and C-students at my school. And I'm not sure that the C-students will end up making worse vets than the A-students. After all, everyone had to have an A/A- average to get into the vet program to start with, so everyone is pretty motivated and conscientious (with a few outliers).

And I'm genuinely curious -- I know internship training turbocharges your knowledge base and comfort level with procedures in the first few years out of vet school. But do you feel that there is a significant difference between the competency of internship-trained vets and on-the-job-trained vets 10-15 years out (among vets in the same age cohort)? In what way?

Thanks.

cayugaduck June 15th, 2009 06:54:48 AM

Cayugaduck: It's a bell-shaped curve. Most students will be solid. But the bottom 1/4? I worry. Seriously. I can think of at least 10 students in my graduating class that should have been weeded out in year one. That's not ten bad vets. They're sweet and nice and will hep a lot of pets through what they've learned. But the critical thinking skills were never there to begin with. That's another story, though, quite apart from how vet students are trained. Vet schools also have to get better at dismissing the lower rung. I firmly believe that. 

As to internship-trained vets: I believe that it's not so much about the experience. It's more that this group self-selects for a certain kind of academic ambition. Yes, in my opinion they tend to make better vets. That is, they tend to aspire to higher standards. They'll question the popular use of certain drugs. they'll be more excited to attend conferences and continue to learn throughout their careers. But, again, it's not as much about the training as it is about the level of ambition. 

For the record, I did not complete an internship. At the time (14 years ago) an internship was almost exclusively for those interested in pursuing specialization. Though that's still true, the pool is wider now that more students are competing for specialty programs. And there's a bigger group of students interested in private practice internships by way of increasing their level of competence--again, it speaks to their aspirations to a higher level of care. Will many of those who don't pursue internships catch up or even surpass their internship-completing colleagues in proficiency and critical thinking? Of course. But that won't be the norm. Will many of those that didn't complete internships be better vets in many other ways? Absolutely. 

Dr. Patty Khuly June 15th, 2009 11:46:20 AM

Here is a suggestion for a "fourth prong." In many countries, students around age 14 yrs can enter "technical" high schools which prepare them for entry level work in a career as well as preparing them for later training. This gives them a leg up on their education, helps them to decide whether they really like a particular field and gives them something really meaningful as an alternative to riotous living and dissipation.  Such programs exist in nursing, early childhood education, mechanics (called "engineering"), HVAC etc.  Indeed we see the germ of this in many vocational and vo-ag high school programs in the US.  At the Saul Vo-Ag High School in Philadelphia, students take a full academic program including "heavy" math and science along with a meaningful specialty such as animal husbandry, lab animal, landscape horticulture, food marketing etc.  Rather than to "front load" the education of veterinarians with even more post-doctoral studies (when they are already burdened by high tuition loans, living costs, child care and compassion fatigue); why not see whether many students might be offered educational paths that begin in high school (or even before), give them marketable skills and credentials along the way, and facilitatate the percolation of theory into practical application

Dr. Steve Dubin June 16th, 2009 09:18:57 AM

Dr. K, you're describing (broadly) the changes that need made in all professional education but I'd back up a bit further.

1) Start tracking at a much earlier time.  Years ago, we decided it was "unfair" to track teens, that all should get the college prep education.  Not everyone will go to college and many know that early on.  Sounds like Saul Vo-Ag has gone with one of the solutions and that is to try to "do it all".  I don't see how it helps a student who is struggling just to get through high school to overload them with the traditional Ag/Tech tracking PLUS the college prep.  I prefer the students choose one or the other track; then community colleges bring students up to speed if they should decide to go on to college;

2) Undergrad education.  This also needs tracking.  Yes, a well rounded education is wonderful but the concept that students get this 4 years to piddle around and "find themselves" is more than dated and has proven disasterous for graduate schools who then have to re-teach what students were allowed to pass without learning.

3) Graduate schools need to require more pre-reqs and NOT re-teach.  Sorry students, if you didn't get it in undergrad, go back or catch up on your own time.

4) Case based learning for critical thinking. Oh, yeah!

5)  Grad programs need to be expanded by 1-3 years with the additional time being spent in internship; whether it's graduated time over the program, front loaded, or end loaded.  It needs to happen and in a way that the students aren't trying to pay back loans simultaneously.  Most of the professions got away from internships because students were being used as "slave" labor and it was seen as unfair; equally unfair is turning unprepared graduates loose on the world to wreck lives.

"employment contract expires at the end of the year"  If that's a serious problem, the solution is easy.  Make those contracts for 3-5 years.

Sorry if I sound unsympathetic to the students but I had an accounting degree with minors in English and business; better prep for law school than most and worked for an attorney for 2 years before law school.  Even so, I had to enroll in half time undergrad for a year after law school to keep my loans in deferment to accomplish my needed internship and a year wasn't really enough.  Suck it up grad students.  Get ready earlier and be prepared to be dirt poor for over a decade.

PJBoosinger June 17th, 2009 04:39:37 AM

Thanks, Dr. Khuly. Good food for thought.

cayugaduck June 17th, 2009 09:21:56 AM

I'm all for technical education. I'm big on steering kids into programs that serve their ultimate goals in life. It makes for more engaged students and a more highly skilled workforce at an earlier age. But when it comes to early technical tracking, here's where I say, "not in my back yard."

While I believe strongly in a technical education for those who struggle with the fundamentals of a high school and college curriculum, I don't believe it's best for most professionals. Accountants, lawyers, architects, bankers, dentists, physicians, veterinarians, etc. should receive a more well-rounded education. Steering them into high school technical programs not only does a disservice to their broader abilities but produces a short-sighted work force in fields where having a breadth of knowledge is essential (IMO) for the profession's integrity and society's benefit. 

Imagine a profession of veterinarians with little understanding on the impact of their policies and procedures on the wider issues in human public health, with no ability to effect public policy, with little capacity to bring creative concepts from outside their immediate profession to bear on how they practice. Just a few examples. For that reason, I say no thank you to the technical/vocational model for veterinarians--unless we build a new version (which is what you may have had in mind). 

But I do agree that earlier education needs to happen for veterinarians. Mentorship programs, on-the-job experience and more challenging high school and college curricula would do that. The problem is that not all schools are created equal and standardization is difficult, hence the disparity in student levels at the outset of our vet school programs. 

Dr. Patty Khuly June 17th, 2009 11:51:12 AM

On tracking, yes, anyone headed toward at least a bachelor's degree should get a more rounded education but that isn't the majority of students.  Less than 75% of high school students graduate from high school.  Of those HS grads, less than 70% enter college.  In other words, about half of those who start high school will at least start college.  I'm all for everyone sucking in as much education as humanly possible but I was raised in farm country where many who aren't the least bit interested in a rounded education focused on college prep are forced to take that type of education and the result is that they are so turned off they hate education generally.  Seems it would be better to allow these students to choose to be tech or ag tracked early rather than making them hate education.  In addition to being beneficial to them, it frees up the resources for those who want additional education.  The reality is that we're discussing a very small minority of the population.  Only 5.9% hold master's degrees and 3% have more than that.  It seems a tremendous waste of resources to prep all 100% for the needs of the 10%.

http://nces.ed.gov/pubs2009/2009082.pdf (And I suspect their stats are a wee bit inflated since, beyond high school, they focus on enrollment and percentage who graduate from what they intended to graduate from [and who readily admits they failed] http://nces.ed.gov/programs/coe/2009/section1/indicator10.asp)

http://www.census.gov/prod/2003pubs/c2kbr-24.pdf  Interesting that the Census bureau shows only 28.6% of the population as having graduated from high school :)

PJBoosinger June 17th, 2009 03:12:58 PM