DESIGNING A TEMPLATE FOR GRADUATE EDUCATION IN THE 21ST CENTURY
Billy E. Hooper, DVM, PhD
A summary of this symposium in the time available cannot adequately recognize the many contributions and the mass of information to be processed. Therefore Dr. Wagner and the Symposium Committee suggested that we focus on 1) where we came from, 2) where we are now, and 3) our challenge for the future.
Provost Larry Faulkner captured our mission when he stated that we were brought together by the "stresses created by the growth of knowledge." He used two chemistry text-books to illustrate his point and we could use our two national symposia on graduate education to mirror that image. We began this discussion 25 years and eight symposia ago in March of 1969 at Texas in our "Symposium on Graduate Education in Veterinary Medicine." We touched on the subject as a part of the Sixth Symposium at Guelph in June, 1975. There our program was titled "Faculty: Where Will They Come From," and we explored alternatives to obtain faculty from other than formal post-DVM programs. While individual colleges and the Pew study addressed graduate education, our collective efforts have focused entirely on the professional curriculum through the last 4 symposia so it was time for us to again take a national look at graduate education.
Background for this Symposium
As we were finishing the 11th Symposium at Auburn in 1990 we had the Admissions Recruitment program planned for Chicago, the 12th Symposium planned for Iowa, and we asked the question "Where do we go from here?". The Association of American Veterinary Medical Colleges (AAVMC) asked Dr. Norman Hutton to chair a committee to conduct a survey of emerging and critical issues in veterinary medical education. His committee, through the survey, discussions and small meetings outlined four major topics with the top two being:
- Designing Graduate Education for the 21st Century, and
- Internationalization of Veterinary Medical Education.
AVMA and AAVMC decided to go with the highest priority topic and to hold this symposium at this time. Our next task was choosing a site and choosing leaders. It was agreed that a broader committee consisting of representatives from industry, government, and AVMA Council on Research as well as the mix of AAVMC and AVMA Council on Education was necessary. In fact, we anticipated Dr. Faulkner's concept of dealing with this subject in the "larger framework in which we serve and function."
Next we needed a really strong institution with strong leadership. After considering several, we chose Dr. Bill Wagner, Chair of the AVMA Council on Education and Associate Dean for Research and Graduate Education at the University of Illinois. Dean Ted Valli then committed his excellent faculty and staff to serve as the hosts of this Symposium.
Framework of the Symposium
The context of our discussions was nicely captured by Dr. Maudsley in Figure 2 in the first paper in our registration packet (1).
Figure 1. (Figure 2, Maudsley paper.) The content and context of graduate medical education (GME).
If we substitute "veterinary medical" for "medical" we display the relative emphasis given to the issues discussed in this symposium. We have been very concerned for the social purposes of our graduate education, somewhat concerned for the context in which that education takes place and only minimally concerned with the content of our educational programs.
A Twenty-five Year Perspective
What a difference 25 years make! For those who think we make no progress let us look at the difference between the 4th and the 13th Symposia.
Progress: At the Fourth we structured our program with 17 papers, one discussant and minimal audience participation. At the 13th we structured it with 14 panelists; major audience interaction.; a major study to gather facts and attitudes; six major workshop topics; many small groups; and reports to yourself on what you have done and what you will do. At the 4th we gathered to listen--here we came to accept responsibility. In introducing ourselves we said "I came to learn," but the action was "I came to teach--share experiences, examine alternatives, arrive at consensus, and propose solutions to problems." In the composition of our participants we represented a wider range of age, a better gender distribution, better minority representation, and a much broader array of interests in post-DVM programs. Here we considered the needs of our customers and had a strong sense of "strategic planning."
Similarities: Yet even as our educational approach changes, some core principles continue. We wished to define the product of our program and the second question in the first session was from Dr. Osburn who said we "need to know what customers want." In our first Quality Assurance Workshop session the group stated, "The number one problem on non-degree programs is lack of clearly stated measurable objectives and outcomes." In our Certificate Workshop the number one issue was "Identification of client and needs assessment with long-term objectives to make programs relevant to the workplace of graduates."
Common to both symposia was the need to plan our programs in such a way as to obtain the desired product. Dr. Coffman said, "We should look to a seamless system which links the professional undergraduate experience to a lifetime learning process." The first priority solution of two workshops was "Strategic Planning" with a strong emphasis on 1) Funding of Research and 2) Regionalization of Programs.
A most interesting observation at this meeting was that we paid minimal attention to traditional MS/PhD Programs and major attention to a complex of possible post-DVM programs that hardly existed 25 years ago. At the 4th Symposium we identified three types of programs. Dr. Lumb stated that 15 of 21 North American Veterinary Schools had an MS in clinical science and five had PhDs in clinical science in five disciplines. At that time Dr. Jones said there were 7 Boards and only 2 clinical specialties with Radiology and Surgery having provisional recognition. Here at the 13th we identified seven types of programs: 1) traditional MS; 2) traditional PhD; 3) post-doctoral in primary research; 4) internship; 5) stand-alone residency; 6) residency with strong research component--without a degree, with an MS and maybe a PhD and then either in parallel or sequential; and 7) a certificate program for speciality practice. We could have added two more. Dr. Coffman pointed out that we may need other specialities when he said we "need more veterinarians with an education degree to leverage technology and improve education." Also near the end of the program we were reminded that we had not included the combined DVM-Graduate Degree programs in our thinking. It would be fair to say that most of our attention here was concentrated on residency programs.
Complexity of Post-DVM Programs
As outlined above, our profession faces a proliferation of formal post-DVM programs that is making our task more difficult. The major changes are a rapid and progressive expansion of disciplines and specialties, rapid expansion of specialty boards, rapid subdivision of specialty boards and development of programs where there are no boards.
Within any one discipline we face multiple and often conflicting goals. During the educational/training program the faculty must blend the three traditional missions of service, research and teaching. We ask our matriculants to be students while we also attempt to train them in how to be a teacher, a researcher and how to deliver high quality service.
Lurking constantly in the background is the specter of inadequate funding. We must ask ourselves who is the primary beneficiary of these programs and then who should pay for them. Far too often we in academia attempt to anticipate a consumer need and prepare graduates for that need by using funds provided for some entirely different purpose. Or we attempt to meet our need and justify it by stating that we are preparing students for a future we have neither defined nor documented. Dr. Britt demonstrated that with veterinarians we are saddled with stipend costs which exceed those of more traditional graduate students. We find it extremely difficult to attract appropriate funding from the primary beneficiaries.
Role of Faculty and Administrators
Much of our effort at this symposium has been an exploration of our role as faculty and administrators. We have clearly accepted a primary responsibility for the planning of these programs and in the maintenance of quality control. We recognized that in quality control we function both as faculty/administrators and as members of certifying boards.
With a program defined and quality controls established, we then play a primary administrative role in recruiting students, finding and directing funding and in many cases serving as contractors for contributions from those outside of academia.
We found that we must share responsibility for programs and in delivery of program components. This sharing is especially critical in clinical residencies where service, teaching and research responsibilities may be spread across several academic departments.
Our participants also explored a relatively new concern and accepted responsibility for developing it. The question was "Who mentors, guides and directs individual students and new faculty members?." We explored this area both as an individual responsibility and as a departmental responsibility. Feedback from our graduates suggested that we have not done this very well and two of our workshops developed recommendations which will allow us to be more effective.
Two Major Themes
Throughout this symposium there appeared to be two major themes that commanded our attention and guided our debates. The first was that we are in a period of rapid change. The second was the need for agreement on definitions and/or the problem of diversity in program goals.
Change: Almost every speaker said, and every workshop confirmed, that we are all struggling to keep abreast of the rapid change in our technology and in our social needs. Dr. BeVier emphasized the threat when he said "A segment of pork production is moving away from veterinary medicine as `Industry moves with lightning speed and Universities much slower'." Dr. Harris posed it as an imperative in stating that we must "stop selling what we produce and start producing what the consumer will buy." Dr. August pointed out that "Clinical veterinary medicine has undergone remarkable transformation in the past 20 years." Dr. McGregor then emphasized that in dealing with this change we have a dichotomy between "what is desired and what can be achieved."
Diversity of Goals: Throughout the symposium we struggled with diverse goals and the conflict of trying to accomplish multiple goals within limited time frames. This point is made quite clear by examining Dr. Troutt's statement that we are to "produce a well-grounded clinical investigator" and Dr. Rawlings' statement that we are to "train a competent clinical specialist who can be certified by passing speciality board examination"" (emphasis added). Dr. Fregin supported the concept that we "train clinical specialists who become board certified" while Dr. Gillespie suggested we "prepare veterinary specialists for professional services needed in the private and public sectors."
A major question was "Can we prepare both a researcher and a highly proficient clinical specialist in a single residency program?." Dr. Coffman said, "No, this is a Damoclean sword of sorts, because of the danger that, instead of doing both very well, we wind up doing both poorly." In reference to the clinical component, Dr. Michelle LeBlanc of Florida said "To be good at it you have to do it a lot" and implied that in her experience it was not possible to do both well. Others suggested that the problem will be greater in the future because "the future is more specialization" and Dr. McGregor outlined Cornell's 8-year "Veterinary Clinical Scientist" program.
Clearly there are abundant examples of high-quality programs which attempt to achieve two goals in parallel programs, but the weight of opinion among participants in this symposium was that to try both is to bite off more than most students can chew. We were encouraged to try more interdepartmental cooperation and Dr. Coffman left us with the thought that "Teaching, service and research can and must be developed upon their complementarities rather than their contradictions."
Survey on Postgraduate Education
A primary product of this symposium will be the Economic and Postgraduate Education survey conducted and reported by Dr. Karl Wise and Dr. Jim Ross. Both the quality of the study design and the 52% response rate from 6,900 veterinarians make this a significant contribution. Of the respondents, 31% held an MS, 15% held a PhD, 7% had completed postdoctorals and 35% had completed an internship or residency. With this we now have good data on job market, income, career satisfaction and perceptions about post-DVM education. This study will become a primary data base for recruitment activities and projections of future job markets.
Basically our graduates are satisfied with hours and income, but they still have changed jobs at least 2.6 times and over 25% have four or more changes and some as many as 30 job changes.
These graduates fill a wide range of jobs with extensive responsibility for supervision of others. This suggests that we may need to place more attention on development of interpersonal and management skills.
Our graduates believe that there are a reasonable number of jobs available and 73% think the future is stable or expanding. They see molecular biology as the most obvious emerging field with preventive medicine/food safety/public health as second.
They are telling us that in our recruiting we need to focus on intellectual challenge and improve financial incentives. To make training more productive and enjoyable, we need to improve mentoring and training in grantsmanship.
All of us will look forward to the published survey and the opportunity to examine it for detailed insights on the management of our graduate programs.
Topic Papers and Workshop Reports
Our workshops dealt with three basic questions, one resource issue and two specific program concepts. The participants spent 39 hours in group discussions, workshop leaders spent several hours condensing the discussions to central themes and recommendations and we have just spent 3 hours hearing their reports. Several of us visited workshops and found that there was extensive personal participation, spirited discussions, and strong cooperation in building consensus. Workshop leaders were especially effective in drawing all participants into the discussion and the scribes were great at capturing the key points.
Recruitment and Funding: Dr. Glickman reported 13 major forces changing graduate education and 7 general responses to these forces. In the recruitment arena, Dr. Simmons compared the "ideal" basis for graduate education to the general "student" reasons and found them to be quite different. He suggested a number of ways to be more competitive in recruitment. Dr. Bennett presented an excellent overview of how the U.S. Public Health Service views the changing patterns of graduate education and Dr. Coulter told us how USDA is working to provide both direction and funding for graduate programs.
In the workshop on recruitment, they identified the strengths and weakness of our current activities and suggested we need more continuous strategic planning. They advised us that we need to expand our networks, work harder on early admissions programs, and deal with the problems of retention. This group concluded that the graduate education community needs to do more to increase visibility to both veterinarians and veterinary students and that in so doing, we should enhance the image of a veterinarian as a strong member of the biomedical research community.
The funding workshop shared with us an excellent survey of 10 institutions by Dr. Britt. He reported that $8,600 is the minimum first-year stipend for an individual holding a BS degree and working on an MS. The maximum stipend was $24,000 for a DVM in the third year of a PhD degree program. The mean for a DVM was $7-8,000 more each year than for a BS degree holder in a similar position. The people in this workshop emphasized the need for more strategic planning, expansion of research and educational areas, training people in grantsmanship skills, setting priorities on time use, working in interdisciplinary groups and the importance of "seed money" to selectively promote specific programs.
Faculty Development and Mentoring: Dr. August affirmed some of the results of the survey and pointed out that many of our graduate students are poorly prepared to enter the academy and, as new faculty members, feel intellectually isolated, are susceptible to stress, and are often passive in seeking help. He described the approach being taken by his department to overcome these problems. Dr. Edmondson emphasized the need for a more inclusive view of "scholar." She suggested exploring frontiers of knowledge, integration of ideas and connecting thought to action in order to inspire students. Both Dr. August and Dr. Edmondson suggested we go beyond student evaluation and emphasized the importance of documentation of mentoring from the first day. In responding to a question, she helped us understand the importance of matching student mentoring needs with faculty ability to deliver and reminded us of the fact that we do not need to provide all mentoring just within our own department. Dr. Prieur gave us a definition of mentoring as the "process by which more experienced and knowledgeable individuals assist less experienced individuals become more proficient in their activities." He also presented 5 critical components of mentoring. Dr. Prieur made a most important contribution with the concept "Do not focus on tenure or boards as the goal--if you do the person tends to become unproductive after that goal is reached." Dr. Harris pointed out the reality of the market place is that a "consumer-driven society has created some confusion and loss of focus among certain faculty--faculty resent being asked `who their customer is'." He emphasized the importance of team building relationships and need for trust. In one workshop, Dr. Banks stated the importance of examining how society views us and recommended we each read 2 books--Prof Scam and Infidels in The Temple.
Dr. Phemister and Dr. Bailey led the 2 very popular workshops on this subject. Collectively they supported the concept of "achievement of excellence in scholarly endeavors" as the end-point of faculty development. In outlining 7 reasons why faculty development and mentoring are important they selected "wise use of human resources" as the number one reason. For faculty development, these workshops described a continuous cycle of "rebirth" as being an important concept. They then placed mentoring at the centerpiece of faculty development and gave us the concept of "R Cubed" for monitoring the process. Their "R Cubed" stood for Review-Refine-Reward.
Quality Assurance: The concept of quality assurance was a strong theme in all workshops. However this specific workshop focused their attention and dealt with the most contentious issue of the symposium.
In examining the nondegree programs, they focused on importance of stating expectations in measurable objectives. They also included the importance of mentoring and balancing the program requirements for the student. This area generated a great deal of debate on the problems of funding and emphasized the question of who pays--who should pay. In nondegree programs the participants suggested a balance of institutional and certifying board responsibility for both program and student evaluation.
Within graduate programs leading to a degree the workshop suggested that program structure and quality control are the primary responsibility of the department and university.
These workshop participants discouraged parallel programs which combined a residency and graduate degree. They pointed out the frequent conflicts in the objectives of the 2 programs, the length of time, and cost to achieve multiple goals and the changing job market which must now be considered as a major objective of residency training.
Regionalization of Training and Research Programs: The people in this workshop sounded as though they might have written the Pew Report in their emphasis on need for strategic planning. At the beginning of their first session the group redefined their charge to consider "interinstitutional" programs rather than the more narrow "regionalization" idea. They concentrated attention on distribution of available resources and the need to build on strengths of institutions. The participants recognized the problems of institutional control in shared programs, but pointed to several model programs and the benefits to all participants. This group identified 8 emerging opportunity areas tied to important societal needs. These were 1) food safety/environmental toxicology; 2) environment/wildlife; 3) risk/outcome assessment; 4) emerging diseases; 5) shifts in companion animal populations; 6) epidemiology; 7) animal behavior and welfare; and 8) systems for quality life and productivity.
Resident versus Degree -- Parallel or Sequential: Several speakers and 2 workshops addressed this subject. In the formal presentations, Dr. Gillespie spoke to the need for different models as well as increasing cost and limitations of job opportunities in some areas. Dr. Rawlings described Georgia's move to an elective MS/residency program, raised the flexibility issue and described the changing job market for graduates. Dr. Troutt described a successful joint MS/residency, viewed a joint purpose as complementary and addressed standards. Dr. Troutt said the "market place is going to invariably set the standard for what is produced" and called attention to escalating costs of graduate education. Dr. Fregin emphasized that we must develop a vision for when we "grow up," but also said that "now is the future which we must be concerned with." Dr. Fregin emphasized importance of scientists in practice as well as in institutions and called attention to the need for cooperation in joint purpose programs.
The workshop identified 4 specific endpoints for employment of graduates. They accepted need for balance in program components and also accepted conflict of competing goals. Marketplace opportunities were viewed as the primary limiting factor in present training programs. The group concluded that the most important measure of quality is "evidence of graduates' sustained productivity and leadership." They then examined the question of cost-effectiveness and expressed strong concern that faculty who teach in these programs do not receive appropriate credit for residency training. This group also emphasized the need to consider placing students in educational settings outside the primary institution and encouraged interinstitutional cooperation in developing training programs.
Certificate Programs: While no formal papers were presented on this subject, the workshop group was very effective in defining this new and emerging program area of post-DVM education. They explored a variety of formats for this educational process and identified 7 areas or programs currently online or under development. They emphasized importance of marketplace demand-pull in driving the development of these programs. Program planning was viewed as being more critical here than in more traditional graduate programs because each is an effort to meet a new need through a new program format. As with the residency training workshop, these participants felt that funding and recognition of faculty who teach are important considerations.
Miscellaneous Insights: In addition to all that took place in the formal meetings and workshops, other education was taking place. A few overheard discussions were 2 deans agonizing over funding vs. need; Dr. Dunlop's table debating the impact of biotechnology; and 2 faculty arguing the need for statistical training in residency programs. We shall also remember Dr. Coffman's admonition that "we should not rush to change since the universities last underwent major change in 1253" and the image generated by Dr. Schwartz and Dr. Bartels in "radiologists quit at 5:00 and surgeons work till the job is done." Perspective was also offered in Dr. Wagner's quote from Dr. Coulter that "as the chief said to the rainmaker `timing is everything'." We also enjoyed the concept of political correctness where "I don't care" is replaced by "low priority" and "deadwood" has been replaced by "driftwood." We had fun while we were educating ourselves.
In considering an analogy to summarize this meeting, I thought of the movie "A River Runs Through It." A major theme of that movie is that a river divides but also provides continuity. In the same way, graduate education divides the DVM program from many careers, but it is also the graduate program which provides the continuity which ties professional education and career together. In such an analogy we may view graduate education as creating or being the bridge connecting need to product. The 2,700 faculty of our veterinary colleges (5% of the profession) are both the bridge builders and the maintenance crew. What must we consider?
Examine the Banks: We must look at the 2 banks and examine what is being brought to the river as well as what is needed on the other side. On the supply side we look at the entering student and consider such things as education and diversity of age, gender and race, but most importantly we look at what the student needs and wants. On the consumer or demand side we ask them what they want and what they will pay for. If we produce anything that they don't want, we will simply block the road to more desirable products, overload the bridge for no productive purpose, and waste our limited resources.
Consider the Structure: We must examine the width of the river or the amount of information and skill level that is needed. On a county road or in a certificate program, thirty feet of steel beams or six months may well be adequate. Two miles across the bay or three years to a degree may well require consideration of approaches, piers and cable suspension to carry the weight that is needed. On the other hand, if we are considering the 8-year program proposed by Cornell, we may think of it as 18 miles across the Chesapeake and we need approaches, causeways, bridges and islands along the way.
We must also consider the materials we have to work with. Who will provide the financing and what return do our investors want on their capital? What will be our labor force? And what technology do we have to work with? All are critical questions if we are to finance our program and deliver to our students an adequate instructional program.
Lastly, we must consider the management of our bridge building project. Can we get the necessary cooperation from our subcontractors be they another institution or a private practitioner? How will we motivate our workers through what kinds of rewards and recognition? And how will we exercise the quality control that is needed?
Contingency Planning: We must also consider the risk factors of unforeseen and unexpected problems such as an earthquake during or after construction. What if demand increases and we need a 6-lane divided bridge when we built only two lanes? Or what if we build it for heavy trucks and railcars and discover that only cars will use it? Over or under investing may have equally disastrous results.
Warnings: As we build this bridge of graduate education we must also remind ourselves of one of the most frequent bridge warning signs. That is "Bridge ices over before roadway." Storms may make our programs more perilous than is perceived by those on either side and we must exercise caution in both design and conduct. At the same time we must remind ourselves of another major theme of "A River Runs Through It." That is the message that if a person does not wish to be helped, then you cannot help them, no matter how hard you try. We, here, tend to be those most apt to seek help and most apt to take it when available, but we must be concerned for our colleagues who need help to become better teachers, mentors, colleagues and thoughtful program participants. We must each be prepared to bring these colleagues to the point where they will assist us in listening to those who are our raw material and those who consume our product. Only to the degree that we listen well to those on both banks will we prosper.
All of us thank Dean Valli, The Illinois Faculty and the great staff which did all the hard work to make this both a productive and enjoyable symposium. A special thank-you to the workshop leaders who were up until 11:00 last evening. And most importantly, to Dr. Bill Wagner for his leadership over the past two years, we offer our applause.
There remains before us a major challenge. That is the need for Leadership. In the second paper given to you in your registration packet Dr. Jordan J. Cohen states that "The resource requirements for change are extensive: At the top of the list is LEADERSHIP." (2)
We began this summary with a snapshot of how much graduate education has changed in the last 25 years. Surely we all appreciate that it will change as much or more in the next 25 years. Our Template for the 21st century can only help us get to that point some 5 1/2 years from now. Nothing we do can be cast in stone. Strategic planning, flexibility, and continuous adjustment to consumer needs must be the hallmarks of our activity. That will require the very best leadership possible.
The 175 people here are the leaders. You represent 15 faculty colleagues, you represent 200 veterinarians, and you represent more than a million consumers of our product. You have defined the problem. You have outlined the proposed solutions. Now ask yourself "If I am not now the most knowledgeable and concerned person in my institution, then who is?." You cannot depend on your colleague reading the proceedings of this 13th Symposium--it will help them and you, but it cannot substitute for your presence.
Your answer must be that you are best prepared to deal with these issues; frame the difficult and complex questions; lead the discussions; help find the answers; and work to put the solutions in place. And if you do not do it, "who will?."
So the Symposium Planning Committee, the speakers and the workshop leaders now give you the title "Graduate Education Leader." They have given you and you have given yourself "A Template for Graduate Education in the 21st Century." In trusting you with that template all of us collectively place upon each of you individually a heavy responsibility for the future of graduate education. And we wish you great success as you move your colleagues into the 21st Century on the Template which you received at this Symposium.
Maudsley RF: Current environment for reform of graduate medical education: content and context. The Ecology of Graduate Medical Education, American Board of Medical Specialties, 1993, pp 7-19.
Cohen JJ: Change process in medical settings. The Ecology of Graduate Medical Education, American Board of Medical Specialties, 1993, pp 63-72