JVME v21n2: THE CLINICAL CASE AS THE CENTERPIECE OF GRADUATE EDUCATION -- LEARNING IN A CLINICAL CONTEXT

Volume 21, Number 2 Fall, 1994

KEYNOTE PANEL
VARIED PERSPECTIVES ON CURRENT ISSUES, PROBLEMS & CONCERNS
John R. Welser, DVM, PhD, Chair

THE CLINICAL CASE AS THE CENTERPIECE OF GRADUATE EDUCATION -- LEARNING IN A CLINICAL CONTEXT

Arthur I. Hurvitz, DVM, PhD

Introduction

The Animal Medical Center (AMC) was founded in 1910 as the New York Women's League for Animals. From that time until 1961, it functioned predominantly as an animal hospital. When it moved to its current biomedical complex located on the east side of New York City, the AMC underwent major reorganization to become a teaching, service, and research institution. The AMC provides round-the-clock veterinary care for nearly 70,000 patients annually--including dogs, cats, birds, reptiles, and other exotic animals. The Center trains approximately 60 interns, residents, and veterinary technicians annually. There are 85 veterinarians on staff with 26 specialty board diplomates. These are supported by over 200 administrative and technical personnel.

The 1993-1994 intern class consisted of 37 interns representing 18 veterinary schools. The 1994-1995 intern class consists of 35 interns representing 14 veterinary schools. Interns rotate as members of service teams through the Departments of Medicine and Surgery. There are 14 clinical services and each consists of senior staff members, residents, and interns, who work together on all the service's cases. Services act as integrated units which facilitates teaching and patient care. Interns also experience working with a variety of specialty services throughout their internship. The Department of Pathology is closely integrated with the clinical services, providing laboratory support seven days a week.

An important component of the internship program is comprehensive service rounds, which consist of a complete review of every patient, occurring twice daily. In addition, we offer "teaching" rounds at which patients are discussed in even greater depth. In the outpatient clinic, staff doctors are available for consultation on any case.

A formal lecture course complements rounds, ranging from weekly, one-hour lectures and conferences on surgery, medicine, neurology, neurosurgery, surgical pathology, and gross pathology, to weekly, three-hour, in-depth seminars on various topics presented by the AMC staff and authorities from other institutions. More than 300 lecture hours are given annually and informal seminars are held continuously. The advantages of learning in a clinical context are as follows:

  • Case-based teaching stimulates clinical reasoning, practice and communication skills, self- learning;
  • With the case as the vehicle for learning, learners are motivated to explore both on their own and through discussion with the group (service);
  • Human (psychosocial) and financial dimensions of practice are taught;
  • A strong motivation for learning is provided by perceived relevance of clinical veterinary problems;
  • Trainees are motivated to handle clinical cases competently;
  • Technical skills and procedures can be taught; and
  • Curiosity for self-teaching is instilled.

The disadvantages of learning in a clinical context are as follows:

  • Program is labor intensive.
    a) Diversified clinical staff is needed to represent various specialties
    b) Pathology services, paramedical, and support staff are required
  • Program is expensive.
  • It is difficult to evaluate trainee's performance.
  • Service heads must have skills in the art of questioning, listening, leading, discussing and interactive skills (facilitation) which differ from skills used in traditional formats (eg, lectures); service heads must keep medically current and be good managers.
  • Varied and adequate case load necessary for high quality program.
  • Training programs should exist in a full service veterinary hospital with pathology support services and a medical library.
  • Student should be independent and able to interact in a group setting.
  • No national standards exist for this type of program.