|Volume 21, Number 2||Fall, 1994|
This is an exciting time for veterinary medical educators across North America. The organizers of this symposium could not have picked a more appropriate title for this paper on curriculum. "A Changing Future" is a very accurate description of veterinary medical curricula today and I want to thank my colleagues in other colleges who have contributed to the content of this paper.
The last six years have been dynamic for those who educate the veterinarians of the future. While some significant changes were in the wind as early as 1985, most colleges of veterinary medicine were still carrying out the curricular changes developed in the late 60s and early 70s. A sense of both urgency and opportunity brought us together in 1987 at the Ninth Symposium on Veterinary Education. That same year brought us the Pew National Veterinary Education Program (PNVEP) challenge for strategic planning and some of the financial resources to work on our dreams.
As part of these efforts over the past six years, we have held four national educational symposia, and one to review a preliminary report of Future Directions for Veterinary Medicine, one recruitment workshop, three minority recruitment and retention workshops, one symposium on diversity, and one symposium on outcomes assessment. The AVMA has held two national symposia on food safety, one on biotechnology and one on public and corporate veterinary medicine. In addition, our efforts have been shared with the rest of the world in two World Veterinary Congresses and one Pan-American Federation of Faculties of Veterinary Science. Review and planning will continue next year, when we will address graduate and research education, and in three years, when we have an international veterinary medical educational program.
Also during this time, the AVMA has completely changed the accreditation essentials for the veterinary curriculum. The National Board Examination Committee has published entry level performance criteria for entry to veterinary practice, and our graduates are now evaluated by criteria-based, rather than norm-based, standards.
We are continuing to experience major technological changes in information storage, management, and retrieval. Accompanying the technological changes has been a major transformation in the way we think about how students learn and use information.
Compounding these social, professional, informational, and pedagogic changes has been the imposition of severe constraints in academic budgets, minimal growth of faculty numbers, and severe restrictions on resources needed to support innovative and experimental approaches.
This frame of reference is very important in understanding the current status of curriculum change. When I asked my colleagues to trace for me the stimulus for change, all of these factors were mentioned. They were convinced that it was the interaction of all these factors that had pushed or pulled them to where they are today.
A few summary conclusions about change in curriculum:
- Change is pervasive -- every college is doing something.
- Change is more evolutionary than revolutionary.
- Change is characterized by a few leaders, many followers and a few foot-draggers.
- Change is driven from the "outside" more than from "inside."
Driving Forces for Change in Curriculum
Most educators would readily accept the first three conclusions, but some will want to challenge the concept of "being driven from the outside." Therefore let me list a few of those outside pressures and you may judge for yourself.
1) Strategic Planning: In its finest form, it used a great deal of external input and the internal planning was an effort to meet those external needs and expectations. Almost everyone agrees that the PNVEP was the most important single stimulus for this activity.
2) Budgetary constraints: Few would argue that we have wished for the economic limitations under which we now labor. And all would agree that our legislators and our Regents expect us to do more with fewer resources.
3) Accountability: Most all of this is external to the college.
a. Licensing Examination -- Change in the cognitive blueprint, expansion of clinical simulations, definition of performance criteria and criteria-referenced passing points (rather than norm-referenced).
b. Outcomes Assessment -- Federal, State, University and accrediting groups demand that we demonstrate the results of our educational process rather than the process itself.
c. The Practicing Components of our Profession -- AVMA Public and Corporate Practice Symposium, Food Safety Symposia, standards developed by the Bovine Practitioners and American Animal Hospital Association's series of three national workshops on problem-based learning.
d. Students -- Litigation on use of animals in the curriculum and general pressures for more sophistication in the teaching/learning process.
4) Recruitment and admissions pressures: A wider range in age, life experiences, financial resources, life styles, and academic ability.
5) Social diversity issues.
6) Pedagogic principles and developments: Concerns for student "learning styles," concepts of group versus individual learning, personality and psychological profiles of both teachers and students, and concepts of managing versus memorizing information.
7) Involvement of veterinary medicine in the larger medical care and social issues: Pew Health Commission Task Force on Veterinary Medicine and recent publication (1) on strategies for veterinary medical education.
8) Our own faculty: Telling us how our primary consumer, the practicing professional, perceives their education. The December 1992 publication(2) by Dr. Elizabeth Stone, et.al., on 16 major areas of information use and the instruction provided in those areas.
9) Reward and recognition: The Merck Foundation Creativity awards at each college and the National Award. Smith Kline Beacham's addition of a National Distinguished Award on top of the long standing individual institutional Norden Teaching Awards.
It will come as no surprise that all of these factors have led and are leading to significant change. However, given the deliberate pace of academic veterinary medicine, it will also be no surprise that much of the change is still in the planning stages or is just now being implemented. We may also expect that symposia, such as this one, will increase the speed of change as it informs others of progress and increases our understanding of what is possible in our instructional programs.
We will attempt to group changes in curriculum into a few specific categories and identify colleges where some of the more significant progress is being made.
While not often identified specifically as curriculum, we must include instructional delivery systems because this is perhaps the most widespread of all instructional innovation today. Basically there are three major changes with considerable overlap in their application. They are being developed and applied throughout the preclinical curriculum.
1) "Active" as opposed to "passive" learning: Different institutions are using this concept in a wide range of ways. Perhaps the most common form is known as problem-based learning (PBL), and almost every institution has one or more courses being taught using this concept. Some institutions prefer the concept of "active learning" in which the student has a more complex involvement in the learning process. Others use the term "case-based" learning, where the student uses a specific clinical case for learning. Others use the term "interactive" learning, where the more traditional lecture setting is modified to provide more exchange between the teacher and the students. Regardless of terminology, the perception is that the more the student is active and involved in formulating questions, seeking answers, and finding solutions, the better they understand and retain the essential concepts. At least 14 colleges use a significant amount of PBL-type instruction. Mississippi is starting their freshmen class in a total PBL-based preclinical program, and Guelph is working on the concept of total PBL-based instruction.
2) Group or small group learning versus individual learning: The principle here is that fellow students can function as peer teachers. There is little evidence that students learn more scientific material in this setting, but almost all agree that students learn how to function as part of a team, that problem-solving skills are learned more readily in a group setting, and that the learning process is more fun.
3) Multimedia learning versus single source learning: The source of information for much of preclinical instruction has been the single instructor and limited text materials. During the 1970s, a great deal of instructional material was prepared as audiovisual presentations containing both pictures and sound tracks. While multimedia in the literal sense, it provided only a sequence of images or information in a pattern determined by the instructor. Today the word "multimedia" means a very broad range of visual materials, audio materials, simulations, algorithms, evaluations, feedback on learning patterns, and use of time, with all of this managed through a computer. But perhaps more importantly the word "multimedia" means immediate access to a tremendous body of information that allows the student to control the instructional process through posing questions as information is needed. Most colleges are developing some multimedia programs and seven indicated some significant effort. North Carolina has a new "master classroom," Michigan has a new computer laboratory, and Florida is incorporating this in the design of their new building. Guelph has one of the best developed systems. Guelph reports that a series of modules is in use and an authoring system is available, which is extremely user-friendly and readily accessible to all faculty.
In addressing specific course content of curriculum we should begin with the preveterinary experience. Surprisingly little has been done or is being planned in this area. Higher education leaders are beginning to talk of the K-100 learning pattern and the role that institutions of higher education play in that 95-year period of an individual's life. It appears, however, that the veterinary colleges are largely ignoring the K-16 period. Canadian colleges have for a number of years focused on the integration of high school, undergraduate college, and professional education. In the U.S., only Auburn has given serious attention to the preveterinary program, and then largely as a university move to strengthen the general education program. In the process of strengthening the undergraduate general education, the Auburn veterinary college has found it necessary to reduce some of the science requirements. They especially regret having to give up a preveterinary course in medical vocabulary. Articulation agreements between state institutions have forced some slight modification of preveterinary requirements at Georgia and Oklahoma, but these are generally limited to a small part of a specific discipline. The AVMA Council on Education, in its modification of the preveterinary requirements, stripped away all specific year and course requirements, and replaced it with the simple statement "Preceded by a broad preveterinary experience." Thus a tremendous opportunity is present if we can but think creatively about a 5-, 6-, or 7-year sequence, rather than focus exclusively on our traditional 4 years.
Within the preclinical portions of the professional curriculum several trends are clearly evident. The most prevalent is a change in instructional methodology described above. A major change is a reduction of core or required courses and an expansion of elective opportunities. Then there is a significant move to reduce this portion of the curriculum and to place students in the teaching hospital earlier in the four-year period.
The reduction in core and expansion of electives has received its greatest visibility at California, because of the detailed description published in JAVMA last November (3). There they moved from a 91% core and 9% elective program to 75% core and 25% electives in the 9 quarters of the preclinical curriculum. The entire fourth year is elective. Dr. Cardinet stated that a critical breakthrough was the acceptance of elective credit as being of equivalent value to core credit. Cornell has also received significant recognition of their new program through presentations by Dr. Donald Smith at national educational meetings. They chose to use the terms "foundation" instead of core, and "distribution" rather than elective, and describe their new curriculum as 70% foundation and 30% distribution courses. However, their total curricular component of 30% distribution courses is considerably less than California's total curricular elective component of 43%. Pennsylvania has had a strong elective program in the preclinical program for many years and they have chosen not to expand that elective program. Without describing changes as identification of core or elective, there are several other colleges making significant changes in preclinical curricular content. Florida describes this as having reviewed all content and cutting way back to basic principles. Mississippi states that beginning in 1984-86, they will cut all lectures by 33%. Guelph states that by using their multimedia resource base, they are cutting their course work in half. Colorado reduced lectures by 20%. Ohio is opening time in the second and third year for electives. Iowa has a very creative proposal called a "parallel curriculum" which would allow students to participate in a "production medicine" oriented program throughout the full four years.
A large number of colleges are using the reduced preclinical core as an opportunity to place students in the teaching hospital earlier in the program. For the most part, we are moving the clinical curriculum into the spring semester or quarter of the third year. Some like Ohio, Purdue, and Saskatoon continue some formal course work and expand the clinical rotation. Michigan and Auburn are starting full-day clinics in the second half of the third year. Others are going to full-day clinics and terminating formal preclinical instruction as early as the end of the second year. Mississippi provides a full two years of clinical instruction, but they start freshmen students in June so they maintain approximately five semesters of preclinical work. Florida's new curriculum will provide only two academic years of preclinical instruction. Colorado has moved some core clinical instruction into the second year. Michigan State's program is made more complex because of a shift from the quarter system to a semester system, but they will be treating 5 semesters as preclinical and 4 semesters as clinical instruction.
In addition to the significant reductions of preclinical core, we also want to recognize that because of case or problem-based instruction, a much greater emphasis is placed on clinical application of basic sciences to clinical medicine and surgery. Almost all colleges identify some efforts in this regard. Some set aside specific periods for clinical correlates or integration sessions, while others require specific case-based presentations. Colleges moving into multimedia-based instruction include this clinical orientation as an important aspect of each course. Cornell has one of the most innovative approaches. They go beyond just clinical orientation to a broader social and professional orientation, with a single course running over four years, which they call "Animals, Veterinarians, and Society."
In addition to clinical correlation, we also want to recognize a very broad-based effort to integrate the preclinical disciplines. These range from the cooperation of two or more instructors to teach a single system at the same time, to Cornell's very complex integration of multiple disciplines into single units such as those titled "The Animal Body" and "Function and Dysfunction."
Some new instructional concepts are also creeping into the preclinical curriculum. With the introduction of clinical cases, colleges are beginning to teach ethics earlier in the curriculum. A few courses in "critical thinking" are being introduced to assist students in working with problem-based learning systems. With group-learning exercises, some colleges have found it necessary to provide instruction on how people can best work and learn together. We also want to recognize the excellent work that Tufts has done in preparing materials titled "Animals in Society: A Curriculum," and the opportunities created for broadening our students' perceptions of their relationship to animals and mankind.
Changes in instructional methodology has been identified as the broadest-based curriculum change. Second in breadth and depth are changes in the clinical instruction portion of the curriculum.
We have already outlined the expansion of time devoted to clinical instruction. We need to emphasize that this expanded clinical instruction does not fit neatly into the context of the teaching hospital of the veterinary college. It might be better to drop the words "clinical instruction," and use the words "applied career oriented instruction," because the trend is to use less and less time in the core areas of the traditional teaching hospital. Instead a progressively larger portion of the clinical years is being devoted to elective programs which allow students to explore broader spectrums of professional opportunities. Most colleges require a quarter or semester equivalent of core multi-species clinical medicine and surgery and the tendency is to move this back into the third year of the curriculum. Others maintain only a core of the "service" components of the teaching hospital such as radiology, pharmacy, emergency medicine, and pathology and allow students to focus all live animal-based instruction on a limited number of animal species. Expanded electives allow students the opportunity to channel a major part of their clinical program toward nonclinical veterinary medicine. The concept of public and corporate practice, which is best developed at Maryland, is now widely accepted at other colleges. Almost everyone will allow students a significant time off-campus in other formal programs as well as career-related work-based learning experiences. Also within clinical medicine acceptance of the value of off-campus based externship or preceptorship instruction is accepted.
Within the clinical electives we suffer a real communication problem. A single word "tracking" has so many connotations that it is almost useless. It can mean a total focus on a single animal species, or it can mean the requirement to take a single clinical rotation that is linked to some other clinical component. The word has strong emotional overtones and is equated in some people's minds with "limited licensure." Because of these perceptions, there is a tendency to use the words "areas of concentration" or "expanded elective programs." In every case, people need to define their terms or there will be immediate misunderstanding.
The amount of elective in the clinical years varies considerably. California's 36 weeks is all elective in one of eight areas and a further 30% elective within an area. Minnesota's new senior year is 47% elective. Mississippi's two years of clinics will be fully 50%, while Florida's full two years will be 75 percent elective. Within the concept of "elective/concentration," California has the greatest number of "pathways" at eight. Most are using three species oriented, one mixed species and one public practice pathway for a total of five.
It is important to point out that very few colleges identify any change in the methodology of teaching clinical medicine and surgery. It is true that more computers and computer programs are used to manage information and medical records, and it is also true that there is more sophistication and specialization in clinical medicine and surgery. But, not since the introduction of the problem oriented medical record in the 1970s, has there been a significant change in how students are instructed in the teaching hospital. Students are still assigned individually, or in very small groups, to a specific section of the hospital and the client-owned animal remains the center point of all instruction.
Other Curricular Concepts
In surveying curricular changes, several other concepts were identified as important, but did not fit neatly into the outline presented above. These were:
- Inter-institutional networks are very important and expanding. Since these will be reviewed by Dr. Troutt in a following paper they will not be discussed here.
- The concept of combination DVM and Graduate degree programs is alive and well in most institutions, but only a small number of students are involved.
- The concept of alternative forms of surgical laboratories is still evolving, but nonsurvival surgery remains the norm.
- Ohio State has developed an interesting concept of a "capstone" quarter at the end of the professional curriculum.
- Outcomes assessment is the next major thrust, with Colorado being way out in front of the other colleges. North Carolina State has a good start, and a few colleges have committees working on the concept. Over 100 people attended an "Outcomes Assessment Workshop" at Tennessee last May, and the concept seems to be well developed in several of the other health professions. Guelph has discovered a major program in outcomes assessment by the Australian Veterinary Society and they believe this will be of great assistance to the North American veterinary colleges. The new AVMA Essentials will force the colleges to move quickly into outcomes assessment of their curriculum.
Some Lessons Learned
Faculty and administrators at colleges actively involved in curriculum change identified several principles which they believe may be useful to other colleges. These are:
- The best stimulus for change and the best change agent is the individual faculty member dedicated to improvement of instruction and the veterinary medical curriculum.
- Curriculum change can best be accomplished by getting consensus agreement on principles before beginning work on the details.
- Accepting a broad outline of curricular principles covering the entire program will allow a college to develop curriculum one year at a time and phase it in.
- Changes in any one part of the curriculum will stimulate change in other parts. Leaders suggest that a college start where there are interested and motivated faculty -- others will soon follow.
Curriculum committee chairmen and academic deans made several predictions which should be shared in this discussion of curriculum change. These are:
- Educational technology will become an ever-more powerful force in stimulating change. Many believe that we will move toward a national multimedia curriculum base.
- The expansion of electives and outcomes assessment will move us to a more "consumer driven" curriculum.
- Soon we will discover the opportunity to include the preveterinary years as a legitimate part of our curriculum and this will open a whole new world to us.
- We will open our eyes and face our responsibilities for multifaceted approaches to lifelong learning. The K-100 concept will grow, and we in veterinary education must consider no less that a K-60 concept in planning the role of the veterinary college in veterinary medical education.
Six years ago few of us could have visualized the rapid and extensive changes which are occurring. Much more change is on the drawing boards. We are in a continuum of a changing future. We have made some mistakes in the midst of many successes and we will make more. But we have learned from each one and, more importantly, we have learned that mistakes are easily overcome and they add significantly to our progress. Veterinary medical education today is an exciting and stimulating environment. We owe much to the Pew Charitable Trust for their assistance in bringing us to this point, where we embrace rather than fear the ongoing curriculum change in our veterinary medical colleges.
References and Endnotes
- Health Professions Education for the Future: Schools in Service to the Nation. Report of the Pew Health Professions Commission, pp 109-118, February, 1993.
- Stone EA, Shugars DA, Bader JD and O'Neil EH: Attitudes of veterinarians toward emerging competencies for health care practitioners. J Am Vet Med Assoc 201:1849-1853, 1993.
- Cardinet GH, Gourley IM, BonDurant RH, Cowgill LD, Stannard AA, McCapes RH, Smith BP and Rhode EA: Changing dimensions of veterinary medical education in pursuit of diversity and flexibility in service to society. J Am Vet Med Assoc 201:1530-1539, 1993.