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Envisioning the Future of Veterinary Medical Education |
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ABSTRACT |
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The environment of veterinary medicine is one of profound change. The current number of veterinarians is inadequate to address the present and future needs of society. To remain relevant, academic veterinary medicine must prepare veterinarians for what may come in the future. In order to be recognized and remunerated for their knowledge, compassion, integrity, and judgment, veterinarians must first demonstrate their relevance to new societal trends.
The objective of the study reported here was to determine a future direction for academic veterinary medicine using Foresight technology. The tools employed were challenge questions and the development of eight future possible scenarios. The study supported the need for change. This report recommends an adaptive and responsive system of veterinary medical education, achieved by defining those areas of professional focus that would address all the anticipated needs of society. An area of professional focus signifies a pathway leading to a DVM degree. Colleges would choose to offer selected areas of professional focus most appropriate to their capabilities, according to a binational plan. Veterinary medicine is integral to the well-being of any future society. This is a pivotal moment for the veterinary profession and for veterinary medical education. Leadership, collaboration, and a shared vision will determine the destiny of the profession.
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Foreword |
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For its subsequent study, the AAVMC decided on a long-range planning project using a process called Foresight Analysis, a tool to look ahead over a 20- to 25-year time horizon. The objective was to determine a vision and future direction for academic veterinary medicine. The Norm Willis Group, a consulting team based in Ottawa, Ontario, was chosen to conduct the study. In addition to the team's expertise with Foresight technology, they had previously worked specifically with issues in veterinary medicine. Their leader, Dr. Norm Willis, is the former chief veterinarian of Canada and he has served as president of the OIE.
The Norm Willis Group's final report, published in this supplemental issue of the Journal of Veterinary Medical Education, is intended to provide a basis for strategic planning, by individual institutions and/or institutional consortia as well as by the AAVMC at the national and international levels, for curricular development in academic veterinary medicine to meet challenges that may be faced by the profession in the future.
The Foresight analysis process involved teams of professionals who began by asking challenging questions about the future. The initial team of professionals was selected by the AAVMC executive, and this group was re-enlisted to complete the process at a final synthesis meeting. The initial challenge questions led to the definition of multiple plausible future scenarios, which were analyzed at two subsequent workshops. The scenarios were selected not on the basis of whether or not they were likely to occur but, rather, on the basis of high uncertainty of occurrence and of high impact on the profession should they occur by 2025 or beyond. During discussions of the scenarios, the workshop participants originated a majority of the ideas and concepts for the following report. Participants were nominated by representatives of AAVMC member institutions and by AAVMC officers. They represented a broad range of expertise within the veterinary profession. Using the scenarios as tools, the workshop teams were challenged to assume that a given scenario had occurred and to answer a series of questions pertaining to its impact on a variety of issues relevant to the profession and, most importantly, to academic veterinary medicine. They then looked backward to consider what might have happened in our world to lead to that scenario. All ideas, concepts, suggestions, recommendations, and conclusions were carefully recorded during these discussions. The process was designed to unleash original thinking, to help the participants to escape from thinking about the future only as an extension of today's circumstances.
A final step, conducted by the synthesis team, involved distilling the ideas, concepts, suggestions, recommendations, and conclusions developed and recorded during the earlier workshop discussions of all scenarios to find mechanisms whereby academia might prepare tomorrow's veterinarians for any challenges the future may hold. The reader of this report is encouraged, therefore, not to look for solutions relevant to any specific problem in today's world, nor for solutions designed to meet any specific future scenario, but to understand that the objective of the study was to propose a responsive and flexible veterinary medical educational system that will prepare veterinarians for a myriad of opportunities and challenges in the next 20 to 25 years.
Funding for this project was provided by the AAVMC, Charles River Laboratories Foundation, and Merial Limited. The AAVMC expresses its appreciation to all the participants in this study.
REFERENCE
Keith W. Prasse, DVM, PhD, is Dean Emeritus of the University of Georgia College of Veterinary Medicine and a consultant to the AAVMC.
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1. Executive Summary |
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The current number of veterinarians in food-supply veterinary medicine, in biomedical research, in public health, in companion animal medicine, and in other anticipated needs is inadequate to address current and future societal needs and well-being.
How must academic veterinary medicine adapt in preparing veterinarians to respond to new needs of society? To remain relevant to shifting new societal needs, veterinary medical education must prepare veterinarians for what might come in the future, not just for what can be seen now.
The single characteristic that distinguishes veterinarians, in every role they play, is their unique relationship with animals, operating at the interface between society and animals.
Veterinary medicine is the only profession in the health and medical field that is trained in comparative medicine.
Concern for animals, their health and well-being, and their interface with people, inserts veterinarians as critical components of public health and as essential health care providers to society locally, nationally, and internationally.
For veterinarians to be recognized and remunerated for their knowledge, compassion, integrity, and judgment, they must first demonstrate relevance to new societal trends.
The veterinary roles that benefit society most are those that demand and capitalize on the unique knowledge and abilities developed through veterinary medical education.
THE IMAGE OF VETERINARIANS
The image of veterinarians in society is at the interface between animals and people.
The "Gentle Doctor" is a powerful and compelling image of veterinarians in the public psyche that should be expanded across all of the roles that veterinarians play in society.
The prime characteristics that veterinarians represent are:
A VISION FOR ACADEMIC VETERINARY MEDICINE
North American academic veterinary medicine is a global leader in the design and delivery of veterinary medical education systems.
It inspires and educates veterinarians to exemplary standards and values in an intellectually and emotionally rewarding career.
The profession is respected and valued by society for its leadership and dedication to the health and well-being of animals, people, and the environment.
A RESPONSIVE AND FLEXIBLE VETERINARY MEDICAL EDUCATIONAL SYSTEM
Fundamental changes in the education of veterinarians are required in order to create a system or process that is responsive to future needs. Basic issues that must be addressed include the following:
PROCESS
The objective of the study was to determine a future direction for academic veterinary medicine that would prepare veterinarians for the opportunities and possibilities that may emerge within the next 20 years.
The study analyzed multiple aspects of the veterinary profession, its relationship to components of society, and the veterinary medical educational process. The method used was Foresight technology, which seeks perspectives from the future rather than extending thinking from the present. It involved the expressed opinions of over 95 participants, together with those of eight members of the Norm Willis Group team.
Two distinct tools—challenge questions and scenario development—were used in the study. Eight challenge questions and eight scenarios were explored in four working meetings. The scenarios were:
PRINCIPLES CONSIDERED MOST IMPORTANT
KEY RECOMMENDATIONS
acceptance of the concept of an expanded veterinary medical educational program, leading to a DVM degree, through provision of areas of professional focus, perhaps identified as centers of emphasis, in North American colleges of veterinary medicine; acceptance of the fact that veterinary licensure will not cover all areas of professional focus, but rather will lead to public assurance of competency in a selected area of veterinary medicine.
EPILOGUE
Veterinary medicine has a proud and admirable history with many achievements in which it can take pride. It is integral to and has much that it can offer to the well-being of a future society.
This is however, a pivotal point in time for the veterinary profession and for veterinary medical education. A decision to broaden the scope and potential of veterinary medical education is fundamental for the profession to navigate this transition.
Stimulated by the exploration of the eight plausible future scenarios, a system of veterinary medical education was elucidated. This system, as proposed, is believed to be responsive and flexible enough to allow the academic community to adjust to any future challenge.
Leadership, collaboration, and a shared vision will determine the destiny of the profession.
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2. Project Definition |
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It was agreed that the study would employ a process of Foresight analysis, which would lead to the creation of a report suitable for developing a strategic vision for veterinary medicine and veterinary medical education. The report would also be used by the AAVMC or its member institutions to create academic strategic plans.
An AAVMC Foresight Project Definition Meeting was held in Ottawa, Ontario, to discuss the specifics of the study in greater detail. The attendees in this meeting were the Executive Committee, the executive director and project manager of the AAVMC, and the members of the Norm Willis Group team.
During the meeting, expectations for the study were enunciated in a series of 21 questions, which have been organized into categories and are presented in Appendix A. Further clarification was detailed for the profile of participants to be invited to the subsequent meetings of the study. As well, tentative dates and locations for the meetings to follow were suggested.
To ensure ongoing validation of both the process and the deliverables, the Core Team defined specific actions that would provide them with assurance for their expectations of the study.
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3. A Profession in Transition |
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HISTORICAL BACKGROUND
Over the centuries animals have provided people with food, energy, wealth, companionship, and prestige. The relationship is a very intimate one, which is both passive and active. Animals have played a most significant role in exploration and in conquests of territory. However, the veterinary art did not become institutionalized until the eighteenth century, when the first veterinary schools opened in Lyons and Alfort, France, in 1761 and 1764.1
The first veterinary school in England was the London Veterinary College, founded in 1791. This was followed by the Edinburgh Veterinary College (Royal Dick), founded in 1823.1
A graduate of the Edinburgh school established the oldest existing, accredited veterinary college in the United States and Canada, the Ontario Veterinary College, in Toronto in 1862, later relocated to Guelph, Ontario (1922).1, 2
In the United States, the first veterinary colleges were established in 1852 and 1854, in Philadelphia and New York respectively.3
Today there are 28 veterinary colleges in the United States and five in Canada.a
Professional veterinary associations and administrative boards were formed to verify competency in standards of service and codes of ethics, so that unqualified persons would not be allowed to dupe an ill-informed public.1, 2
EVOLUTION OF THE PROFESSION
Until the First World War, horses were a mark of pride and a symbol distinguishing gentry from peasants. In North America, by 1800, the arrival of large numbers of settlers was accompanied by a rapid increase in the livestock population. By 1860, the number of cattle, hogs, and horses in the United States far exceeded that of Prussia, Great Britain, and Ireland combined.1 Animals were essential to the settling of the continent and to the migration of people.
A major event for change in North America was the American Civil War, which created a need for persons qualified in the veterinary art, a demand for serviceable horses, and a high demand for beef and pork.1
After World War I, the influence of horses as a means of transportation declined and agricultural productivity expanded. As presaged by the sculpture "The Gentle Doctor" (Christian Peterson, 1937), the emphasis of the veterinary medical profession shifted once again by the 1950s toward companion animal medicine—an emphasis that remains today.b Recently, the globalization of food distribution and the market increase in livestock production have forced alternative approaches.
Therefore the emphasis of the veterinary medical profession has evolved from
WHY VETERINARY MEDICINE MUST CHANGE IN THE FUTURE: THE BROADER ENVIRONMENT
In a word, the environment is one of change.
The global society, and what surrounds and influences it, are in profound change. These changes will have very significant impacts on future veterinary medicine and veterinary medical education. There are major demographic, political, environmental, disease, technological, and economic influences, all forcing changes onto society. A few examples illustrate the point.
How will these changes alter the needs of society? How must academic veterinary medicine adapt to prepare veterinarians to respond to these new needs?
OTHER INDICATIONS OF THE NEED FOR CHANGE
It is unlikely that the current philosophy on how to protect animal health will be adequate in the future. There are vulnerabilities in the animal health framework. To safeguard the US economy, public health, and food supply, there must be recruitment and preparation of additional veterinarians into careers in public health, food systems, biomedical research, diagnostic laboratory investigation, pathology, epidemiology, ecosystem health, and food animal practice.5
The convergence of animal health and public health in the area of zoonotic and newly emerging diseases is a critical link to societal well-being.6
There is a need for more veterinarians to participate in or support biomedical research. To date, veterinary medical schools have shown a lack of commitment to prepare and train veterinary students for veterinary careers other than private clinical practice.7
The perspective on the role of animals in human society and in the ecosystem has changed. Research in veterinary science transcends species boundaries and is critical to the protection of public health. Such research is crucial to the advancement of our understanding of and our response to impending risks.8
This need for change is similarly recognized in other professions. For example, the engineering profession seeks to enrich and broaden engineering education so that those technically grounded graduates will be better prepared to work in a constantly changing global economy.9
IN SUMMARY
The need is eminently clear. The global societal environment is shifting. To remain relevant to the new needs of society, veterinary medical education must prepare new veterinarians for what might come in the future, not for what can be seen now.
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4. The Process and Methods |
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| Foresight allows preparation for diverse future challenges with adequate lead time. It does not predict or forecast the future, nor is it a strategic plan. Rather it anticipates and creates multiple, plausible futures that are possible and believable. These futures may be positive or negative, but in their diversity they bring into view issues and perspectives that may not have been initially considered.
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This study utilized two distinct tools, namely Challenge Questions and Scenario Development, to stimulate the thinking of invited participants (Appendix F) from a wide range of endeavors, as selected by the AAVMC. This thinking was elucidated in four separate working meetings.
In a Scoping Meeting, held in Atlanta, Georgia, sixteen participants began the process of framing the study. They defined the lenses or critical perspectives, the key drivers causing change, trends, and discontinuities that would be used as parameters to develop the Challenge Questions and the Scenarios. As well, they started the process to develop scenarios.
On the basis of these inputs, the Norm Willis Group Team developed eight sets of Challenge Questions and eight Scenarios to be explored in two workshops. The two workshops, held in Fort Collins, Colorado, and Knoxville, Tennessee, each answered four sets of Challenge Questions and explored four Scenarios. The Challenge Questions and the Scenarios were all considered from the perspective of the year 2025.
FORT COLLINS WORKSHOP CHALLENGE QUESTIONS
FORT COLLINS WORKSHOP SCENARIOS (SEE APPENDIX C)
1. Doomsday: The Pandemic Disaster of 2015–2025-
There is a major resurgence of zoonotic pandemics. Despite modern medicine, the impact of the new zoonotic diseases is reminiscent of the plague pandemics that devastated Europe centuries ago. Pets and animals are seen as the principal pool of disease and major transmission vectors and are destroyed indiscriminately.
The economy is in deep recession as governments at all levels place restrictions on travel, and actions are in crisis mode. Veterinarians are suspected of being too lenient and part of the problem. The quality of veterinary care drops and enrollment in veterinary schools also drops drastically.
2. The Great Animal Peace: Eradication of Zoonotic Health Threats- The risk of zoonotically based pandemics, such as avian influenza and BSE-related diseases, has virtually disappeared, similar to the war-free era of the Pax Romana. Modern veterinary epidemiology, vaccinations, risk-monitoring technologies, and risk-management procedures for diseases are prevalent and applied rigorously. Science and technology ensure that all animals are carefully monitored and any early onset of disease results in quick elimination. Animals, both large and small, are seen as valuable contributors to society's needs.
Veterinarians are seen to be largely responsible for this change, through visible public efforts, active promotion of citizen education, and major influence in public health programs.
3. Brave New World of Modified Species- Systematic mapping of the genome of animal species leads to massive genetic testing, modification and cloning of animals. Examples include: more disease-resistant strains for the food supply, novelty pets with designer features, and synthetic animal-cell-based protein foods. Additionally, individually genetically tailored designer therapeutics and drugs are created.
These developments raise major ethical challenges, such as organ farming and food safety. They also give rise to new threats, such as new diseases rising from xeno-transplantations.
4. Fragmented Profession- The veterinary profession evolves and eventually fragments into very different streams. Each stream requires different education levels, certification procedures, and business models. Different teaching institutions are created for the various streams.
The ethical guidelines and requirements are very different, creating an unprecedented divide.
KNOXVILLE WORKSHOP CHALLENGE QUESTIONS
KNOXVILLE WORKSHOP SCENARIOS (SEE APPENDIX C)
5. One Medicine, One Health-
Health care professionals acquire unified basic training, and public health services are subject to similar standards for humans and animals. Recurring threats of zoonotic diseases have created a move to standardize the basic training and preparedness of all health professionals. Public health agencies are staffed with specialists in human health as well as animal health. Veterinarians enjoy the same status and remuneration as physicians, and are subject to similar expectations and ethical standards. Science and technology are continually adapting these practices, as humans demand the best for themselves, their animals, and their food.
6. Global Warming, Eco-Crisis- Drastic changes in traditional weather patterns lead to changes in food production and dislocation of established food-producing regions. Personal health and security concerns are dominating public agendas, and regional conflicts over resources are creating major international tension. Isolationism and globalization are in continual tension as governments seek to control the negative spiraling of public confidence. There is a major stress on freshwater supplies that leads to a fundamental re-evaluating of the role of pets and the sustainability of food-producing animals. Increasing spread of new tropical diseases in previously temperate zones alarms public health authorities into a crisis mode. Veterinarians become more proactive, and take on a new role as eco-health stewards.
7. Norman Rockwell Veterinarian- The veterinarian, as captured by painter Norman Rockwell, offers a local, traditional, cottage-industry model of service. The emphasis is on personal service, and the focus is on small animals. Veterinary clinics are seen as part of the local business environment with strong community links. Technology is present, but is seen as low-key and non-invasive, primarily serving as an aid in the efficient delivery of very individual and customized service. Veterinarians stand apart from more technologically dependent professions on principle, providing personal care and service.
8. Globalized "Google Vets"- There have been major advances in technology, leading to widespread use of computer-linked sensors to carry out diagnostics, administer therapies, or carry out robotic tele-surgery from great distances. Clients, through a "Google vet service," have instant access to global remote diagnostics and tele-therapies from their home or farm computers. Traditional, locally based veterinary clinics are dramatically transformed to global offshore service providers. Veterinary education is now universally accessible and largely delivered through highly sophisticated distance learning technologies, with completely realistic, textured, 3-D holographic animal models. The dominant forces shaping the business and education models for veterinarians are global and virtual, with a large number of specialists offering tele-veterinarian services from offshore locations like India. There is intense global competition for franchises and services.
The full range of the Challenge Questions can be found in Appendix B, and narratives of the Scenarios are presented in Appendix C.
The Challenge Questions and Scenarios were addressed in the context of societal expectations and implications for the skills, competencies, and education of veterinarians. Finally, the participants undertook "backcasting" to determine the critical actions, decisions, and events that could have resulted in these scenarios.
Workshop 1 had 35 participants and Workshop 2 had 44 participants (see Appendix F).
In the final Synthesis Meeting, held in Sacramento, California, a group of 16 participants, 11 of whom had also attended the Scoping Meeting, analyzed the outputs of the two workshops. Under six themes, which reflected the grouping of the original 21 questions, they selected and summarized key actions, which were deemed most important for the veterinary colleges and the AAVMC to consider.
In developing the Final Report, the Norm Willis Group Team has taken into consideration the outputs, comments, and opinions of all four meetings.
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5. What We Heard: What May Lie Ahead for the Veterinary Medical Profession |
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5.1 EDUCATION
Philosophy-
It is essential that the veterinary profession respond to the future needs of society to remain relevant. In its present form, academic veterinary medicine cannot respond to all of the currently apparent societal needs, let alone the unknown but anticipated needs of the future. Clinical veterinary medicine is the predominant thrust of present day veterinary medical education and is the basis of the positive public image that veterinarians presently enjoy. Therefore, it is desirable that any modification of the philosophy of veterinary medical education build on, not detract from, this well-established and much valued reputation and contribution.
However to respond to both foreseeable and, as yet, undetermined future needs, a broad range of skills, knowledge, and attributes will be required, e.g., communication skills, leadership abilities, cultural competence, business skills, interpersonal skills, values, and ethics. It was suggested that the number of available, competent, licensed veterinarians be increased to address these needs, rather than be pulled from or compete with existing professional demands.
At present it is difficult for all colleges to deliver all the desired skills. Therefore colleges should consider developing areas of professional focus, perhaps identified as centers of emphasis.
Although there is a risk of perceiving colleges as first rate and second rate, the intent is to create institutions of focused expertise in selected areas for veterinary medical education, operating in communities of knowledge and competencies. These would create critical masses of expertise and efficiencies of financial, human, and physical resources. The range of training could be reflected in a national plan developed by the AAVMC, which would ensure that all options of veterinary endeavor in the future would be available for training at some colleges within the context of an integrated educational framework.
All colleges could collaborate on the total delivery of the national veterinary medical educational program, and students could choose to qualify for their DVM degree by attending multiple institutions.
On the basis of current demographic trends in society, there is a challenge for the colleges, faculty, and programs to reflect the diversity of ethnicity, culture, and total societal needs.
It is a reasonable expectation that students will be able to anticipate the length of education required to achieve their degree in the focused area of their choice, and that this will be commensurate with the projected remuneration after graduation.
Although students are encouraged to choose their desired career path and lifestyle, the profession as a whole has a responsibility to address the needs of society.
Structure- On the basis of a national plan, as developed by the AAVMC, colleges should choose to focus on certain areas of competency development that reflect their expertise and are most cost-effective for them. National standards could be developed to permit college accreditation, taking into account these areas of professional focus.
Following a specifically defined prerequisite program, which could be very important to achieve diversity and to obtain students already possessing the desired skills, there could be a two- or three-year core program, standardized across the continent. This would be followed by a one- or two-year program in an area of professional focus, which would lead to a DVM (professional focus) degree. If desired, a postgraduate program could follow, leading to additional advanced degrees e.g., PhD. The professional focused training could be provided in institutions that are different from those providing the core training.
Dual degrees could be obtained simultaneously under intensified full-year programs, such as DVM/MPH, DVM/PhD, DVM/MBA, DVM/biomedical engineering, or DVM/information and data analysis.
Licensure would be based on ensuring competency in the area or areas of professional focus.
To change a career path any time throughout a career would require retraining in the selected program area with a recognition of competency in that new professional focus.
Teaching hospitals may not be required in all colleges or all areas of professional focus, but would be essential for specific clinical areas of focus. Although some clinical experience could be obtained in private practice, the emphasis on education and the degree of advanced competency and experience in these teaching hospitals may be required for accreditation.
Modular training, which would be open source, portable, and non-linear, could expand access.
Research, including clinical research, should be an essential part of the functioning of each area of professional focus to advance knowledge and to be on the leading edge of that particular area.
Educational Delivery- Online, Web-based training could become an integral element of the educational process. However, hands-on experience is essential and fundamental to achieving a DVM degree. Virtual training could also be very important in providing lifelong education to maintain competence and to supplement a professional choice to change a career path. As well, distance education, both nationally and internationally, would allow best use of the unique competencies in the specific areas of professional focus.
Training could occur through cooperation amongst multiple institutions. Additionally, collaboration with other health professions, and with other disciplines and departments on campus, could expand options for educational delivery.
Consideration could be given to providing parallel training to paraprofessionals to permit better integration into health teams and corporate or community practices.
Curriculum- The pre-veterinary or DVM curriculum could consist of a nationally standardized core program of material, which would also include aspects fundamental to the profession as a whole, such as communications, leadership, public relations, values, ethics, problem-solving, dilemma management, conflict resolution, and the management of change. It would also be desirable to place emphasis on knowledge transfer and skills development.
In the segmented training program, as developed across the national plan, the curriculum could be broadened to provide options for such focused areas as:
Small animals Large animals Equine Further subdivisions of clinical practice The curriculum should be portable.
However, licensure for selected areas of professional focus and accreditation of colleges (taking areas of professional focus into account), are essential to permit such tailored curricula for the streams of emphasis.
Recruitment and Admissions- To effect a change, it would be necessary to make the full scope of veterinary medicine visible to society, especially to the applicant pool.
It would be beneficial to have a national recruitment strategy that seeks to achieve a greater diversity in applicants, approaching the diversity of society. Diversity can be accommodated in all its meanings (ethnicity, cultural, values, needs). The recruitment strategy could also stress diversity of interests, e.g., experience in public practice, leadership, community development, communications, business, and demographics. As well, recruitment could be started in secondary schools.
Health and other professions could also be mined to recruit students to particular areas of focus.
5.2 STATUS OF VETERINARIANS
Role in Society-
Veterinary medicine, as the only health profession with extensive training in comparative medicine, provides an essential role in public health, which should be emphasized. It requires refocusing the role of veterinarians in society to that of serving human health as well as animal health. This approach also involves broadening and increasing the roles for veterinarians in society by bridging the gaps among animals, humans, and the environment.
Considering veterinary medicine as a public health profession leads to a responsibility for ensuring a safe supply of food and water, as well as the associated responsibility for the protection and preservation of a sustainable ecosystem. Further, a vision could be fostered of "shared" responsibility for public safety on issues such as food safety, zoonotic diseases, xeno-transplantation, and microbiology.
An important approach is for veterinarians to assume a lead role in being credible, objective, and respected spokespersons on animal issues.
Throughout this course of change, it is important that the core values of the profession not be abandoned. The image of veterinarians as broad comparative practitioners is valuable to retain. However, if the profession fails to effect a change in the broader roles it plays in society, there is a serious threat that it could become a trade.
Leadership- Of critical importance to the status of veterinarians is their expression of leadership.
Veterinarians can serve as team leaders in many issues involving the animal/human interface. This would include assuming leadership as spokespersons on animal issues.
Examples of roles in which veterinarians could rightfully assume leadership include leadership of biomedical teams, leadership in the management of related crises, and leadership in the interdependence of eco-awareness, the food system, and animal/human health.
Veterinarians could be positioned to demonstrate leadership in contributing to public policy development and implementation in relevant areas, since greater leadership will lead to greater influence on public policy.
Additionally, veterinarians could exert leadership in the pivotal role of managing the inevitable changes that will flow out of the evolution of society's relationship with the animal population.
New Skills- In general, it will be necessary to take a multi-faceted global view of issues in the areas of science, economics, politics, and societal trends. Special emphasis should be placed on gaining new knowledge of contemporary public health issues. This could be addressed in specific areas of professional focus for comparative medicine, using examples such as the global monitoring program of the Centers for Disease Control and Prevention (CDC).
New skills to be addressed in the non-science areas include:
Areas to include for new science skills include ecosystems, comparative medicine, bio-informatics, genomics, proteomics, and the ability to coordinate expertise for end users at the interface between science and policy.
Admissions could consider requiring the development of some of these skills as prerequisites during the pre-veterinary training, or selecting students for admission who already have acquired and demonstrated some of these skills.
Role in Policy Making- Veterinarians need to be at the table for effective design of policy, regulation, and technology. Veterinary medicine needs to have a political voice, a plan, and a target to capitalize on opportunities to respond. Greater leadership will lead to greater influence on public policy.
Consequently, AAVMC could consider developing an enhanced policy role that would create a congressional and broader political awareness, and would prepare and promote veterinarians for senior political government positions. As well AAVMC, in parallel with other veterinary organizations, could advocate for the profession, particularly in education and preparation for specific policy roles.
An approach could be to encourage more joint DVM and legal degrees to enhance promotion of veterinarians and lobbying for policy development.
Veterinarians could be more prominent in public policy that concerns health care and disease prevention. To do so, they need to have more influence on the consideration of legislation in areas involving public health and the impact on the determinants of health. A possible role is for veterinary medicine to be at the interface between science and policy, assisting policy makers to "remain current" with scientific and technical advances.
Veterinarians may also have a public policy role in areas such as eco-health, as well as having a voice in the first line of defense against natural, accidental, or deliberate threats.
Public Perception of Veterinarians and Veterinary Medicine- There is a strong need to focus on and promote the value that veterinary medicine creates for society and animals, as well as the value of animals in society. Public trust will not be based solely on science, but will be strongly influenced by the credibility and balance that veterinarians can offer. It is important then to encourage the ability to communicate with people in person, and to interpret and place information in context to help their understanding.
AAVMC has a role to be the national voice for veterinary medicine as a human health profession, and to stress the importance of the human–animal relationship. If veterinary medicine is to be connected to human and public health, it is critical to be able to explain the relevance of veterinary medicine to human health. In balance, the profession must keep its core values but broaden the public perception and the profession's responses to change.
To improve their status, veterinarians must be more visible. The status will increase by connecting to and focusing on human health and public health issues. The development of a professional focus in public health will also lead to a greater profile. The profession needs a national strategy to educate the public, and especially its youth, about the broader role of veterinarians in society.
To be recognized and to have influence, it is critical that the profession speaks with one voice, to achieve unity and not fragment its impact. Veterinarians can present as leaders and expert spokespersons on areas of animal concerns, and as the first point of contact for issues pertaining to animal health and well-being.
Veterinarians may consider stepping beyond their traditional roles and into such areas as environment, social health, global health, and as "guardians" of the safety of new biomedical technology.
Veterinarians need to increase their role in community services, and to maintain and project an image of professionalism, caring, and giving. As well, it is important to the image of both the profession and individual veterinarians to mentor young people and future veterinarians.
5.3 ACCREDITATION AND LICENSURE
Accreditation of Colleges-
To accommodate the change and refocusing of curricula to allow students to select an area of professional focus, the accreditation must be flexible enough to recognize that all institutions may not offer the degree in all potential areas of professional focus.
Because a few areas of professional focus may require portions of the curriculum to be offered at more than one institution, accreditation standards will have to consider the pathway rather than a single institution.
The accreditations could recognize the convergence of human, animal, and ecological health, with AAVMC facilitating the development of standards for this convergence. As well, AAVMC could consider the development of quality control standards to allow this accreditation of the colleges. These standards could be continental in scope, and in the future may serve as models for implementation globally.
Licensure- Globalization and technology diffusion require standardization of competencies. For academic veterinary medicine and the colleges to respond to the broader needs of society, it is essential that they focus in selected professional areas. In doing so, the curricula will have to be tailored to emphasize the specific chosen areas. This will require changing the requirements for licensure to ensure competency in selected areas of professional focus as DVM (specified professional focus).
The verification of competence could be based on outcomes, and the standards used would be subject to rigorous peer review.
5.4 ALLIANCES AND PARTNERSHIPS
An aggressive pursuit of strategic partners will be absolutely essential for the future success of the AAVMC and the colleges.
Partnerships could be established
by forming collaborations with other disciplines and colleges on campus to form interdisciplinary links to business, law, education, science, medicine, and social sciences, by collaborating amongst the veterinary medical colleges on a national plan for veterinary medical education, by making greater use of adjunct faculty and inter-institutional appointments, by collaborating with the United States Department of Agriculture, the Department of Homeland Security, and departments of public health, environment, and natural resources, for research, funding, crisis management, and the security of the food supply, by AAVMC collaboration with the American Veterinary Medical Association (AVMA), Canadian Veterinary Medical Association (CVMA), and state and provincial associations of animal health and veterinary medicine to achieve unity by speaking with one voice for veterinary medicine, and for consensus on a national agenda for veterinary medical education, perhaps by forming an "Association of Associations," by promoting veterinary medicine as a human health profession, through collaboration with the CDC, the Association of Schools of Public Health, and with the Association of American Medical Colleges, by promoting, with the National Institutes of Health (NIH), the creation of an Institute of Comparative Medicine, and by bridging the concept of "One Medicine," by working with the food industry, the pharmaceutical industry, the Animal Health Institute, the agricultural production industry, and the human health insurance industry, by collaborating in the development of the skills and competencies required to meet their needs, to emphasize the breadth of scope of veterinary medicine, and to seek support and funding, by partnering in research to access and capitalize on the latest scientific developments, and to verify their safety and legitimacy, by cooperating in the development of technologists to complement the development of corporate or community practice teams, to achieve the most effective delivery of mission in the future, by collaborating with other public health contributors in addressing the daily health level of society versus episodic health care events, stressing the role that animals play in the health of society and the opportunity to mitigate impacts at the source, by partnering with organizations such as the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), and the World Health Organization of the United Nations (WHO), by preparing future veterinarians for deployment to address zoonotic disease prevention and control, for crisis management at the local, national, and international level, and for the eradication of animal diseases at source, by engaging internationally on the accreditation standards of education and ethics, by demonstrating leadership in veterinary medical education, by being the primary representative of comparative medicine. In addition to these suggested collaborations, the AAVMC and the colleges could reach out in a concerted fashion to such non-traditional areas as eco-health, social sciences, law, engineering, and change management.
One Medicine- The AVMA, CVMA, AAVMC, and the colleges could promote public acceptance of the role of veterinarians in improving and protecting the health of people, of animals, and of the environment. This will require first creating an awareness, then an integration into public health and human health, and then finally acceptance.
Through closer collaborations with public health and human health, particularly in communications and training, common integrated roles can be developed for the benefit, security, and prosperity of society. This would be guided by a concept of "One Medicine," which the AAVMC could drive, through the development of a national plan.
5.5 TECHNOLOGY
The absolute key for the future veterinary medical profession is adaptiveness and responsiveness. Technological advances in the future will be rapid and will exceed all expectations. Therefore, the need for the profession is to expect change and be ready to adapt and accommodate changing needs and opening opportunities. Academic veterinary medicine must prepare veterinarians for these events.
For Education- Academic veterinary medicine should take full advantage of new technology. As an integral part of the education process, technology can help colleges increase the number of students and generate revenue. Distance education from experts at centers of emphasis can occur both nationally and internationally. AAVMC may consider establishing a goal to have a virtual or global classroom in every college.
Virtual technology can be used to complement hands-on experience, and to customize educational programs for multiple purposes. Simulation can be used to supplement surgical and diagnostic programs. To take advantage of such technological opportunities, AAVMC could promote the use of a net-centric, open source, portable system of delivery for education.
For Use by the Profession- Tele-medicine will permit the availability of focused expertise at the colleges to smaller or remote practices, to smaller urban clinics, and to international sources of need.
Large corporate practices will be able to offer advanced technology for diagnostics and therapeutics, while handheld devices for diagnostics or instant information access will be important for rapidly addressing potential problems, for finding solutions, or for monitoring ecosystem health.
Tele-diagnostics and new diagnostic methods will also have an impact on surveillance and modeling.
Colleges must strengthen their abilities to evaluate, test, and deploy new diagnostic innovations. They must also enhance trend detection and analysis as well as disease control strategies. In addition, there is a role in scanning and interpreting new science and technology development, and in evaluating new skills and tools such as genomics and bio-information. This could be considered for an area of professional focus in colleges. At the very least, the standards for college accreditation should reflect these new technologies.
Another new opportunity for veterinary involvement could be in areas such as bio-farming, genetically modified animals, and agri-ceuticals. These new technologies will bring with them ethical questions in society for which veterinarians could play a critical interpretive role in framing the debate.
5.6 FUNDING, COSTS, AND REVENUE
Lobbying-
Lobbying is an important thrust to enhance the economic position of the profession and to recognize the critical contribution that animal health makes to societal productivity and economic competitiveness. AAVMC and the colleges can seek increased public and private funding by emphasizing the comparative medical aspects of the profession, the social and economic elements, as well as the community and public health benefits.
These efforts could be strengthened by having the AAVMC become more actively involved in economic policy, and by engaging more lobbyists. Also, the promotion of public funding for public good outcomes creates a new economic model.
Educational Funding- The availability of funding will directly affect the ability of the profession to address the shortage of veterinarians, and to meet new functional and specific area demands. AAMVC could develop a model for enhancing public and private funding, using a different language to engage different opportunities. Funding will be attracted through increased consumer and public confidence in the value of veterinarians.
AAVMC and the colleges could seek to develop alternative sources of funding through potential new revenue streams, such as opportunities to sell knowledge products and to exploit distance education. Agriculture will not necessarily be the driver. Another opportunity may be to seek directed funding for specific areas such as food animal veterinarians, and preparation for crisis management.
Tuition Fees- A changed public attitude toward veterinarians can lead to greater recruitment and financial support. The economic burden of a student's debt impedes progress by the profession. This is compounded by the low level of remuneration for graduate veterinarians. This remuneration is also influenced by the amount of disposable income in society, and by the status of animals in society. Hence a new model for tuition fees is required to increase access by students.
Another area of expanded government and corporate support is student placement and mentorship related to the public perception of risk in the ecological and food-security systems.
To increase student numbers, the issue of student debt should be addressed in an articulated plan.
Research Funding- AAVMC has two key roles in research funding:
A prime strategy for the AAVMC is to seek NIH funding for research and development, by stressing the role of veterinary medicine in public health, and by advocating the creation of a NIH Institute of Comparative Medicine.
Possible sources of funding are
5.7 SOCIETY
Role of Veterinarians-
What is emerging is a view of the role of veterinarians at the interface of animals, humans, and the environment, with a goal to protect and improve animal, human, and environmental health. The profession needs broader community engagement to determine the societal needs, and then to bridge the gap between its current roles and these societal needs. There is a need to emphasize that the veterinary medical role is for humans as well as for animals.
Veterinarians must step beyond their traditional roles and into social health and the environment so that the phrase "healthy animals—healthy food—healthy people" can take on a new meaning for the profession.
The human–animal bond is more important to an aging North American population. Veterinarians have a role as objective, caring, and ethical spokespersons on animal issues. Although this will mean working with humane societies and other cultures, the relationship of veterinarians as protectors of animal well-being is important.
In the medical field, veterinarians have a unique knowledge of the impacts of zoonotic disease, and they should lead in this area.
If terrorism and global conflict become more important to global society, there will be a need for veterinary skills, and veterinarians should prepare for and participate in crisis management.
Another role for veterinarians is ethical leadership in preparing for rapid environmental shifts.
Additionally veterinarians have an opportunity to capture a more visible role as leaders, change managers, educators of the public as well as students, and as respected and credible communicators.
Diversity Requirements- The North American society will become more diverse, and that change will be reflected in an increased need for diversity in the profession, embracing racial, ethnic, cultural, and discipline diversity. Society's attitudes to pets and animals will also become more diverse, and the profession must be prepared to address this issue. As well there is a need to protect biological diversity by preserving genetics and species in the face of disease occurrence. Therefore, it is important that cultural competencies are embedded throughout the veterinary curriculum.
Marketing and Public Relations- There is a critical need to explain the relevance of veterinary medicine to human health. The image must focus on the value that the profession creates for society, and the value of animals in society.
As well, there is a need to promote the role of veterinarians in the production of safe animal protein food in a way that preserves the health of the environment and also animal welfare.
There is a need for the profession to dialogue with society on its perceptions of veterinary medicine. The profession must be prepared to respond but at the same time preserve its core values and its scientific integrity.
To move forward will require a national strategy to educate youth and the public about the broader role of veterinarians in society. This can be supported by promoting and making available the achievements and successes of the profession's past history, while projecting its role for the future.
5.8 BUSINESS MODELS
Public Model-
There may be a growth into convergent team practices, which are linked to human health. If this is so, these practices are likely to be corporately managed as "health management organizations." In most communities, veterinarians could develop into "health care practitioners" who provide a public health and medical advisory role as well to the community. This growth into public health roles could lead to having this function built into a public service cost.
Urban Models- There is a trend in urban companion animal practice toward corporate practices with the possibility of developing the franchise model. This could be extended into global corporate organizations in which there would be some local control but with much better brand recognition.
However, remote technology and relationships with networks of specialty practices could also support a parallel growth of local community-oriented clinics.
There is a definite trend of orientation toward wellness practice, supported by insurance programs and technology advances such as bio-sensors.
Rural Models- The trend is toward corporate practices made up of multiple veterinarians, supported by teams of paraprofessionals and alternative technical advisors, to address food animal production. The elements of emphasis are toward bio-security, traceability, and on-farm food safety standards. As well, more veterinarians may be incorporated into vertically integrated production models.
Complementary to this movement could be a growth of niche practices that address the needs of large companion animals, exotic or non-traditional species, and organic or hobby farm operations. Distance technological linkages to networks of specialty expertise may also support these practices.
Corporate Model- In addition to corporate practices and food animal production, some corporations may develop on the basis of leading-edge genomics technology. Although capital intensive, these could develop into expert corporations providing such products as designer animals, pharmaceuticals, therapeutics, and xeno-transplantation.
General- The trend is expected to be toward larger practices with at least three veterinarians in order to realize the desired lifestyles.
All models point toward a more business-based orientation with a trend toward the outsourcing of practice management, and other competencies such as nutrition, husbandry, and engineering.
As well there may well be an increased use of paraprofessionals and supplementary support staff in all forms of practice.
There could be a shift to blending aspects of human health and wellness care into all practices of veterinary medicine.
5.9 VALUES AND ETHICS
Values-
In considering the social responsibilities of the veterinary profession, it is necessary to determine the expectations of society for the profession. The Veterinarian's Oath acknowledges society as the primary client of the profession, but this leads to dilemmas of societal expectations.
The new understandings of the links between animal and human health emphasize the public health responsibility, but there is a growing expectation that the primary client is the animal and its welfare.
This expectation creates a dynamic tension within the profession. But the issue is less about tension within the profession and more about the relevance of the profession to society. How the profession shapes society's expression of values and ethics in the future will define how the profession is seen in society.
Veterinarians must actively engage in these ethical debates, which are central to the paradox of the profession. The profession cannot rely on assumed values and ethics. However, strategically the profession is managing a dilemma—it is not solving a problem. The debate is at the interface of animal usage and humans.
The integrity and professionalism of veterinarians are universally recognized. However, as cultural diversity within the profession increases to match that of society, it will bring varied understandings of what personal integrity, trust, and other values mean. It is necessary that the profession negotiate, reinterpret, and reach consensus on what these fundamental and core values will be for the profession.
Ethics- The "social contract" professionals make with society is that they are given the benefits of professional autonomy in exchange for a commitment to high standards of conduct, which the profession itself enforces on its own members. The profession should reconsider its system of self-governance of ethics, or legal decisions will dominate.
Ethical responsibilities of the profession to society include:
It is necessary to teach the ethical implications of new technologies and to have proactive engagement in discussions of the ethics of technological development.
If the profession proceeds to a state of segm
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ABSTRACT
Foreword