So much has changed in we what we might call ‘structured veterinary education' since the inception of the first veterinary school in Lyon, France, a little over 250 years ago. One of the most defining events was the release of the Flexner Report. While this report focused squarely on medical education and was (and remains) not without controversy, many of the changes resulting from it served as a model for what would become modern veterinary medical education.
Part of this model is that education should be science based. As science evolves, so too do curricula. Curricula also ought to reflect the mission of the school, the needs of society and stakeholders served by the program. Not surprisingly, there are no two curricula that are exactly the same.
A relatively recent (and welcome) curricular evolution is the purposeful inclusion of courses designed to develop clinical and professional skills during the pre-clinical years. As a result, curricula today look very different than when I went to school. Pre-clinical training was then almost all didactic with the addition of some courses-specific laboratories (e.g., anatomy or bacteriology). I think it's fair enough to say that from my experience, when we began the process of developing the framework of the Texas Tech University School of Veterinary Medicine, I had very limited experience to go on. At the same time, however, practitioners were telling us, “Graduate students who can do things, who can communicate and who aren't afraid to try new things.” I was told in veterinary school you learned how to do things when you graduated!
So, we went exploring. And it was eye-opening.
Among the dozen or so programs we visited, we saw how some were upending stubborn didactic norms and incorporating comprehensive clinical and professional training from the get-go. This has now been formalized as Competency-Based Veterinary Education (CBVE) and is quickly being adapted across many curricula around the world. At the same time, one of the best pieces of advice our program received was “Make it your own.” In other words, do not plug and play a cookie-cutter program. Rather, create and adapt what you need so as to address the very reason for your existence in the world, to achieve your purpose, and to serve your stakeholders.
This was liberating, and it was where the serious fun began!
Part of CBVE is to purposefully start with the end in mind. What is it that employers of our future new graduates want relative to our purpose of service to rural and regional communities? Answers from practitioners all across Texas informed what we now call RaiderVet New Graduate Competencies (these are available on our website, www.vetschool.ttu.edu under Academics, and they follow the CVBE framework). Competencies cover both knowledge and skills. These RaiderVet New Graduate Competencies then inform each and every learning objective on course syllabi, all lecture learning objectives and the exam questions.
For us, this means far less time dedicated to didactic instruction (approximately 50%) and much more spent “doing” (approximately 50%). This begins the first week of the first year. It also necessitates that we both horizontally and vertically integrate our activities. Toward this end, we have specific courses we refer to as integrated courses. These courses take the principles that are being taught at the time in the foundational courses (e.g., anatomy, physiology, and microbiology) and horizontally integrate them within the context of a clinical outcome, practice experience or other aspects of the profession. Vertical integration talks to the semester-over-semester and year-over-year informed development of the curriculum. For example, physiology informs pharmacology, which in turn informs therapeutics (and vice versa). All of this takes an enormous amount of coordination, cooperation and communication.
Our Clinical and Professional Skills integrative course is a marque aspect of our program. This course occurs every semester for the first three years and spans at minimum one full day each week. It is one of several of our integrative courses. During the very first week of first semester, students are each assigned a handheld ultrasound that they carry throughout their four years with us (and take them home too). In the first year of the course, they learn how to hold and use surgical instruments, do fecal floats, become Beef Quality Assurance (BQA) certified, learn physical exams across multiple species, learn suture patterns and ligations, perform lameness exams on horses, do case-driven diagnostic pathology, perform phlebotomy across species, participate in case-driven radiology and so many other things.
We want the ultrasound device to become an extension of themselves. More than this, we want them to become proficient. For example, a requirement for students to get out of first year is that they have to locate and identify the spleen and kidney on a horse with the device.
In addition to developing these “doing” skills, they also start developing robust communications skills first semester and continue to develop these skills throughout their pre-clinical training. We are using what is called the Calgary-Cambridge model, which is built around best practices for communicating with clients. This includes things such as how most effectively to gather a history with open-ended questions, describe and plan with the client, break the information into chunks, check accuracy and shared understanding and other best practice.
To this end, we are fortunate to work with actors (i.e., standardized patients) from the Texas Tech University Health Sciences Center at Amarillo. They become standardized clients and work through specific scenarios with our students. Eight times a year these standardized client interactions are recorded, and the students subsequently self-evaluate their performance in addition to receiving feedback from the actors and our faculty.
The bottom line is that courses such as Clinical and Professional Skills are about building competency and confidence in that competence. It starts with basic competencies and lots of practice to build confidence in their abilities. Then we add complexity to the competence and so on and so on. Another way to put it is to practice until you get it right and then practice some more so you can't get it wrong.
All of this is to say that we – and the students – really enjoy this marque aspect of our program. What we are most excited is for others to work with our students and put their competencies to the test. We want to know where its working, and where we can improve.