JVME v21n2: PANEL ON RESIDENT vs. DEGREE PROGRAMS: PARALLEL OR SEQUENTIAL: GRADUATE EDUCATION IN A CLINICAL DEPARTMENT
| Volume 21, Number 2 | Fall, 1994 |
|---|
PANEL ON RESIDENT vs. DEGREE PROGRAMS: PARALLEL OR SEQUENTIAL
Jerry R. Gillespie, Chair
GRADUATE EDUCATION IN A CLINICAL DEPARTMENT
H. Fred Troutt, DVM, PhD
Introduction
The Department of Veterinary Clinical Medicine at the University of Illinois has both residency and Master of Science (MS) degree programs. The Department does not offer a PhD program. The residency and MS degree programs are linked in that unless a resident already has the MS degree, the resident must pursue an MS degree. The residency requirements are, for the most part, established by the respective specialty college of interest. Our graduate students function through a combined residency and master's program, essentially over a 3-year period. This program accommodates coursework and completion of a thesis. Our Departmental Graduate Committee (Dr. William Tranquilli, Chair) conducted an assessment of outcomes for our graduate students over the past 10 years.
Table 1. MS Degree/Residency Summary:1983-1993
MS Candidates Enrolled (Total) 116
Presently Enrolled 19
MS Degree Awarded as of l/94 84
Percent Completion as of 1/94 (84/97) 87%
Percent of MS Degrees Employed or in PhD Program 99
Residents Enrolled (Total) 90
Presently Enrolled 19
Number Board Certified (BC) 44
Number Presently Taking BC Examination 12
Percent BC or in Process of Completing Examination (56/71) 78%
Percent Board Certified Candidates Employed l00%The Committee noted: "Individuals completing either the MS degree and/or residency training program from the Veterinary Clinical Medicine Department are highly employable within academia, industry, or private veterinary specialty practice."
Overview
My view is that a clinical department is very much a research environment and graduate education for the clinician will hopefully prepare her or him to work in a research environment. The clinical case, including the farm, is the cornerstone of the clinical educational process; each case is a research project. I believe one of our fundamental concerns should be to make sure that we're producing a clinical investigator who can function investigationally and with some scientific independence within the venues of a number of institutions. Just as importantly, they must be able to communicate effectively as a scientist with colleagues in the preclinical sciences so that a viable team can approach research hypotheses. In order to have a pool of qualified faculty, we have a responsibility within a clinical department to produce a well- grounded clinical investigator. I'd be the first to admit that at times I get concerned over whether we really are doing that, but it's very difficult to refute the data that demonstrates that the people we produce are well placed after they leave us. Overall, the marketplace is going to set some sort of a standard for what is to be produced.
The general issue invariably involving a combined program is whether or not there is optimization of quality in either component. Periodically, concerns also are voiced that with the combined program we may be expecting too much from the student. In our program, the clinical appointment carries a 67% time allocation and sections arrange to provide research time for the graduate student. Hence, our efforts are not precisely parallel. Certainly, from the viewpoint of the candidate, the combined effort is challenging, requiring intellectual capabilities as well as time management skills. In our program we have not observed a general problem with quality, although intermittent problems do surface. Overall, we view the combined program as complementary. We hope that our residency disciplines are rigorous and our graduate efforts challenging, producing new information and instilling the scientific process within a suitable time frame. Certifying colleges, e.g., the American College of Veterinary Internal Medicine and the American College of Veterinary Surgeons, specify the resident must complete a research or clinical investigation. This can be accomplished by a route other than the degree route. But if the degree route is available, why not utilize it? In the overall order of things, at the MS level, I really believe that it doesn't matter whether we have sequential or parallel programs. (I, however, also doubt if in clinical education we should divorce, for too long, the clinician from the case.) What matters is the availability of necessary resources to make any effort work. This includes financial resources to support clinical instructional efforts, research, and capable faculty to lead and mentor effectively.
One of my assignments on the panel was to particularly address graduate education/residency programs as these relate to large animals. In our equine sections, I view the challenges and the opportunities as very similar to those associated with our companion animal/small animal sections and disciplines. For our food animal programs, however, the challenges and the opportunities become a bit more multifaceted, and perhaps, indirect. If the graduate student/resident is pursuing internal medicine, the avenues of clinical and graduate study must be broadened to include background in production medicine. This means broadening our instructional base, and also presents a challenge for the certifying process. For species specific production medicine, the clinical instructional process should be much more thoroughly defined with the graduate effort involving some permutation associated broadly with clinical epidemiology. These directions, too, present challenges for a certifying process.
Our efforts with species specific production medicine education are probably mostly implemented from a graduate education basis and not from a residency basis leading to certification of clinical proficiency. It will be of interest to see how the food animal species specific certification programs, now being implemented by the American Board of Veterinary Practitioners, are accepted; by both candidates and employers.
Challenges
Time and Intensity of Residency and Graduate Programs : We need to be aware that some of our MS thesis efforts are equivalent to some PhD dissertation efforts. I believe we must continue to examine our programs from a benefit/cost perspective with cost also assessed in units of time.
Adequacy of Research Funding : In general, funding to accommodate graduate research programs in a number of areas is a chronic problem. In our hospital operations, we are spending large sums of monies on very sophisticated diagnostic and therapeutic equipment and we need to make sure that equipment derives a research payback as well.
Funding for Graduate Student/Resident Salaries : Funding for graduate student and/or resident salaries can be difficult, and may be increasingly problematic in the future. We must look for funding sources and arrangements as alternatives to the traditional "state line" funding process. We have, as some of you do, programs with corporate sponsors. But now we are in serious negotiation with a private practice to fund two resident positions.
Availability of technical support to support faculty and their research students : We do not have sufficient technical assistance. Often, when we discuss veterinary medical education, we point out what the directions are and what the programs are in human medicine, and we seemingly try to emulate these. I don't know whether this is appropriate or not, but I do know they (in human medicine) have pounds of resources when we tend to commit grams.
The definition of species specific clinical programs : This must be accomplished for both graduate student and resident education in production medicine. Our food animal health maintenance deliverers must be equipped to cope with industry direction. We are concerned about lack of utilization of veterinarians in very large swine units. This should not be a surprise to us. The model was established in the poultry industry; large dairy units use veterinary services on a limited, if any, basis but in both industries this pattern is changing and we must work to accelerate that reduction. Additionally, there will be increasing emphasis on preharvest food safety, animal welfare and environment/animal interactions; these shifts must be accommodated educationally.
Future
My vision (cloudy as it may be) is that, in the future, residency education may shift to promote more of a private sector- public sector educational process, e.g., joint programs. We must be aware that we in academia do not have proprietary rights on clinical specialties. There is the argument that residency education will shift to specialty practices. My guess is that private practice will not have the time to mentor residents as they probably need to be mentored. We will continue to be significantly involved in residency education, but I also think we must recognize that we are producing specialists who are likely to be in direct competition for cases, thus influencing our referral posture and our capability of producing clinical specialists. Clear across the country our clinical programs are superb from a technical point of view. However, I also feel we may be increasing in an arrogance that doesn't allow the recognition of the value of our constituencies nor the essentiality of the routine. We can not forget our foundations.
I believe that all of us--our specialists who are on faculties, our administrators, some of whom are specialists--must come together to be more aware of, and to attempt to accommodate, the rising costs of specialty education. In addition, through such avenues as release time of faculty, travel funds for faculty and residents, and through the underwriting of programs for residents that are determined by a specialty college, we are really providing an infrastructure for the specialty colleges. We in academia thus have a sizeable financial burden that may not be able to be sustained in the future if the trend toward diminishing resources continues.
I would hope that we can work within clinical departments to develop the "laboratory" concept; directed by the clinician- scientist but incorporating nonclinician discipline-oriented scientists who function within the "laboratory." This amalgamation of personnel could serve as a rich resource for postgraduate education (some of which may not be degree oriented) and clinical research and possibly enhanced funding. It strikes me that the market for very specialized, tailor- made courses or certificate programs much like those that are held at Michigan State University, The Pennsylvania State University, University of Nebraska, University of Guelph, and University of Illinois will tend to increase in the future. There is conceivably a large body of clinicians who want a fairly precise educational focus in a specialty or subspecialty to acquire specific competencies and confidence in that respective area. I believe we must be sufficiently flexible to permit that development within a clinical department while at the same time maintaining degree- based programs.
Within our clinical educational process, we need to plan wisely for flexibility of a variety of programs, but not for absolutes of direction.