DOCUMENT RESUME

ED 081 617 SE 016 654

AUTHOR Weiser, J. R., Ed..TITLE Learning Experiences, Proceedings of the Symposium on

Veterinary Medical Education (5th, June 18-21,1972)..

INSTITUTION American Veterinary Medical Association, Chicago,Ill.; Association of American Veterinary MedicalColleges, Ithaca, N.Y.; Georgia Univ., Athens:.Georgia Center for. Continuing Education.

SPONS AGENCY National Institutes of Health (DHEW), BethesdaMd..

REPORT NO NIH-72-4222PUB DATE Jun 72NOTE 150p.

EDRS PRICE MF-$0.65 HC-$6.58DESCRIPTORS *Conference bReports; *Education; Evaluation; Higher

Education; Multimedia InStruction; Science Education ;.*Symposia; *Teaching Methods; *Veterinary Medicine

IDENTIFIERS Minicourses

ABSTRACTThe primary purpose of the Symposium was to assist

the veterinary medical educator in becoming a more effective andefficient teacher. The main focus was placed on the educationalprocess and on newer ideas in education, with the expectation thatapplication could be made to the totality of veterinary medicaleducation. The Fifth Symposium was planned as a minicourse in design,presentation, and evaluation of learning experiences..The topics ofminicourses, multi-media instruction, and mastery learning wereemphasized. The meeting attempted to combine the features of asymposium (dining and free exchange), a conference (presentations byoutstanding authorities in the field of education, media, andevaluation), and a workshop,(individual participation andcontribution).,The major presentations are published in this volume,and appendices provide a statement of the participant objectives, alist of the program'contributors, and the results of a post-symposiumquestionn4ire.

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LEARNING EXPERIENCES

Proceedings

5th Symposium

on

Veterinary Medical Education

June 18- 21,1972

Edited by J. R. Welser

The symposium upon which this publication is based was conJucted pursuant to ContractNo. NI H 72-4222 with the U.S. Public Health Service, Department of Health, Education, and Welfare.

Sponsored by the American Veterinary Medical Association, Council on Education,in cooperationwith the Association of American Veterinary Medical Colleges, the University of Georgia College of VeterinaryMedicine and the Georgia Center for Continuing Education.

Dedicated

to

Robert Getty_, D.V.M., Ph.D.

Dr. Getty was a pioneer in Veterinary Medical Education, especially

in the application of media. He was a member of the. National

Coordinating Committee for the 5th Symposium until his untimely

death.

PREFACE

The Fifth Symposium on Veterinary MedicalEducation was built on the excellent base providedby the previous four symposia. The FirstSymposium, held at Michigan State University,provided an overview of veterinary medicaleducation. The Second, held at the University ofGeorgia, focused its attention primarily on clinicaleducation. The Third' Symposium, again held atMichigan State University, dealt withp re-veterinary programs; while the FourthSymposium, held at Texas A & M University,reviewed graduate education:" After havingconsidered the various components of oureducation program, it was appropriate that theFifth Symposium focus on the educational processand newer ideas in education with the expectationthat application could be made to the totality ofveterinary medical education.

The Fifth Symposium was sponsored by theAmerican. Veterinary Medical Association inconjunction with the 'Association of AmericanVeterinary Medical Colleges. It was initiated in1970 when the American Veterinary MedicalAssociat;on's House of Delegates authorized itsdevelopment. Partial funding was obtained fromthe National Institute of Health. The NationalCoordinating Committee consisted ofDoctors R. E. Brown, University of, Missiouri;J. Lieberman, Video Record Corporation;N. E. Hutton, Iowa -State University;W. M. Decker, A.V.M.A. Office representing theA.V.M.A.; and Doctors C. F. Reed, Michigan StateUniversity; J. J: Stockton, Purdue University; andJ. R. Weiser, University of Georgia, representingthe A.A.V.M.C. This committee developed theformat, specified the general topics and selectedthe site for the Fifth Symposium. Following theselection of the University of Georgia as thelocation, a local planning committee composed ofDoctors M. E. Adsit, L. M. Crawford, J. W. Harris,B. E Hooper, R. E. Lewis, J. T. Mercer,D. E. Tyler, and J. R. Welser, chairman, wasformed. The local committee further developed

and implemented the plans for the FifthSymposium. Invaluable assistance in carrying outthe Fifth Symposium was received from thefaculty, staff, and administration of the College ofVeterinary Medicine, University of Georgia.Without their help and encouragement, the FifthSymposium would not have become a reality.

For the pr..,oplo who planned the Fifth Symposium,the response was gratifying in spite of HurricaneAgnes and a pilots'- -strike. The registeredattendance of 325 was more than double the.number ever to attend a symposium on veterinarymedical education. In additiOn, the response of theparticipants in reading their pre-conferencematerials, attending the general sessions, andparticipating in the workshops made thesymposium a success.

The Fifth Symposium was planned as a minicoursein the design, presentation, and evaluation oflearning experiences. The topics of minicourses,multi-media instruction, and Mastery learning werefeatured. The meeting attempted to combine thefeatures of a symposium (dining and freeexchange); a conference (presentation byoutstanding authorities in \the field of education,media, and evaluation); and a workshop(individual participation and contribution). Basedon this, it was nicknamed "Tricom" by some.

The primary purpose of the Symposium was to\ assist the veterinary medical educator in becoming'a more effective and efficient teacher. Specific\objectives were included in the program, and uponpre- registration' the participants were sentpre-conference reading materials. The participantswere pre-tested on the readings utilizing TrainerTester cards donated by Van Valkenburgh,Nooger, and Neville. During the Symposium, eachparticipant filled a notebook with copies of theformal presentations, commercial literature,worksheets, and copies of the producedminicourses. A post-symposium test based on

prestated objectives was also administered to theparticipants utilizing the Trainer Tester-cards. Inaddition, the participants also filled outp re:Symposium and post-symposium opinionquestionnaires. A part of the post-symposiumquestionnaire has been included in the' Appendix.

The Symposium started with an overview of thechallenges that face veterinary medical educationin D r. Luther Terry's and W. W. Armistead'spresentations. D rs. Postlethwa it's, Brown's,Allen's, and ,Mager's . presentations definedminicourses, pointed out their application, andprovided the detailed instruction on how to makeup a minicourse and write performance objectives.Following these presentations, the participantsgathered in small work groups where they chose aminicourse topic and wrote performanceobjectives for their chosen topic. After appropriatecritique and feedback, the particpants attended apresentation on media selection by Dr. Millard andvisited media displays provided by Veterinarymedical educators from all of the colleges ofveterinary medicine. The participants were thenprovided a review of the field of instructionalevaluation along with futUre trends by Dr. Hedges.After presentations directed at different methodsof evaluations by Drs. Smith, Gardner, and Block,the participants met in their work groups tostructure a pre-test and post-test for theirminicourse.

The Wednesday morning session was devoted to adiscussion of future trends in education and theeducator's role in the affective domain. The

presentations centered around the subjects ofaccountability (Dr. Lessinger), career planning(Dr. Owens), and credits and degrees (Dr. Harris):Concluding the Symposium, T. H. Ham'spresentation of "Prospective and RetrospectiveViews of Medical Education" stimulated theparticipants and provided ideas for the future.

(';Thespin-off and follow-up to the Fifth"4 Symposium has indeed been gratifying, with

70 percent of the schools of-veterinary medicineholding post-symposium sessions" in the form ofprograms, discussion seminars, or circulatingpresentations along with summary statements.Three schools re-created the Fifth Symposium fortheir faculties. In these cases, faculty summarizedthe speeches that were delivered at the FifthSymposium, and individuals who attended servedas discussion leaders.

It is difficult to express appreciation ,to all whoworked and contributed so much to the FifthSymposium; however, without the support of thefaculty and the untiring work of the localcommittee, it would never have been as successful.Ultimately the credit goes to the participants whocame, were enthusiastic, and worked hard at theSymposium. Hopefully the effect of the FifthSymposium will not end with the publication ofthese proceedings.

J. R. WeiserEditor

Welcome RemarksR. B. Talbot

TABLE OF CONTENTS

New Horizons for Veterinary MedicineLuther L. Terry

Page

1

3

Discussion

R. B. Talbot 9

The Winds of ChangeW. W. Armistead 15

r.

Veterinary Medical Education and the UniversityDavid W. Mullins 21

Grand Rounds in Medical Education with Medical Students Up and Down the Centuries 'with aCrystal Ball

Thomas Hale Ham 25

Minicourses--What Are They?S. N. Postlethwait 37

Minicourses in Veterinary Medical EducationR. E. Brown 41

Minicourse PlanningA. R. Allen 43

The Key Performance Objectives -R. F. Mager 49

Media--Which One?William L. Millard 51

Tieing It Together: 'Trends in Educational Communications and TechnologyWilliam L. Millard 61

1'

Page

Testing and Evaluation for the SciencesWilliam D. Hedges 67

Professional AssessmentCognitive DomainJack E. Smith 75

Professional Assessment: Affective DomainH. Gardner

^

93

Toward the Setting of Mastery Performance Standards in Veterinary Medical EducationJames H. Block 99

The Affective Evaluation GameF. J. Frederick and Harrison Gardner 107

Some Rinctions of TestingH. Gardner and F. J. Frederick 111

Meesurement in the Affective DomainH. Gardner and F. J. Frederick 115

Academic Credit: Exposure or Attainment?J. W. Harris 123

Career PlanningW. A. Owens 131

Accountability in Higher Education: Policy Springboard for ReformLeon M. Lessinger 135

Open ForumC. F. Reed 141

Appendices 147

Appendix A Participant Objectives 149

Appendix B Program Participants 153

Appendix C Post Symposium Questionnaire 157

WELCOME REMARKS

FIFTH SYMPOSIUM ON VETERINARY MEDICAL EDUCATION

R. B. Talbot

Welcome:

It is certainly my pleasure to welcome all of you asparticipants in this Conference on VeterinaryMedical Education.

The theme of this conference is one I am vitallyinterested in and I want to congratulate you onchoosing to participate in it.

Let me for a moment then tell you as words ofwelcome a few things about the University and theCollege of Veterinary.Medicine.

'I. Georgia was the first state to charter a statesupported university. In 1784, the GeneralAssembly set aside 40,000 acres of land toendow a college and in 1785, the Universityof Georgia was incorporated by an act of theGeneral Assembly.

2. The University was actually established in1801, when a committee selected thepresent land site. The first class wasgraduated in 1804.

3. The curriculum of traditional classicalstudies was broadened in 1843, to includecourses in law and again in 1872, whenfederal funds became available foragriculture courses.

4. Today the University is composed of13 schools and colleges plus several auxiliarydivisions such as the Center for ContinuingEducation, in which we are meeting today.

5. In 1931, the General Assembly of the stateplaced all state supported institutions of

1

higher education, including the University,in one organization known as the UniversitySystem of Georgia. The System is governedby a single Board of Regents with oneexecutive officer, the Chancellor.

6. The University is a dynamic multifacitedinstitution today fulfilling instructional,research, and service responsibilities. Thereare approximately 18,000 full-time residentstudents enrolled and 1,900 facultymembers.

The present College of Veterinary Medicine wasorganized in 1946, although it was preceded at theUniversity by a degree program in VeterinaryMedicine from 1918 to 1933.

The College has experienced extensive growth anddevelopment since 1964. During this period, thefaculty has grown from 37 to 101 while theprofessional student enrollment has been heldfairly constant or around 250. Graduate studentenrollment, however, has increased from less than10 to more than 50 graduate students. The Collegeis composed today of seven departments plus twodiagnostic laboratories, one in Athens and one atTifton.

We are extremely proud of our faculty and studentbody at the College and invite you to spend asmuch time as possible with them during your stayhere.

It is my pleasure to again welcome you to thecampus. If I can be of any personal assistancewhile you are here, I hope you will not hesitate toask.

NEW HORIZONS FOR VETERINARY MEDICINE

Luther L. Terry, M.D.Vice President for Medical Affairs, University of Pennsylvania, Philadelphia

As I discuss the report of the Committee onVeterinary Medical Research and Education withyou, I am reminded of the story of two illiteratecountry boys neither of whom had learned to telltime. One day one of the boys showed up with abulge in the watch pocket of his trousers and alarge chain emerging from the pocket andextending into the side pocket. The second youngman on observing these facts and realizing that hisfriend was unable to tell time inquired, "Whathave you got on that chain in your pocket?" Towhich his friend responded, "It is a watch, want tosee it?" With that, he withdrew the watch from hispocket and displayed it prominently. The secondfellow responded, "Un-huh! What time is it?" Thefirst pushed the watch toward his friend and said,"There it is." The second boy peered at it for along moment and replied, "Damned if it ain't!"

In referring to our committee's report I am proneto push it et you and say simple, "There it is."However, for fear that you might respond like thesecond boy, I feel compelled to point out some ofthe background of the committee and remarkabout some of the contents of the report.

For many years, I have had a deep professionalinterest in veterinary medicine. This interest waskindled in part from my many years on the staffof the National Institutes of Health. During thisperiod the importance of laboratory animals inbiomedical research was indelibly impreSsed uponme and the applicability of animal models ofimportance to mankind was equally impressive.Furthermore, the importance of having specialistsin animal medicine as a part of the research teamwas equally evident.

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Then after I became Surgeon General, for the firsttime in the nation's history we were beginningitoconvince the Congress of the need for federalassistance in the education and training of ourhealth professionals. This culminated in 1963 withthe Congress first enacting the Health ProfessionsEducational Assistant Act. During the planning ofthis proposed legislation it was necessary for me,the members of my staff, and our consultants todefine quite clearly the various categories of thehealth professions in order that we might makevalid recommendations to the Congress. As oneanalyzed the situation it became quite clear thatveterinary medicine was an essential component ofour entire biomedical system from the standpointnot only of research, but also in the understandingof many human diseases and the prevention andmanagement of those diseases.

In 1965, when I left the Public Health Service andbecame Vice President for Medical Affairs at theUniversity of Pennsylvania, I discovered that Iinherited a degree of administrative responsibilityfor a School of Veterinary Medicine as well asSchool of Medicine, Dental. Medicine, Nursing, andAllied Medical Professions. It was at this time thatI first had the opportunity to observe closely theeducation and training of veterinarians and tolearn in great depth of the important biomedicalresearch being performed in our veterinary medicalschools. I can assure you that I was notdisappo!ited; I was elated to see the contributionsof veterinary medicine to human health andwelfare. I became a complete convert to theimportance of veterinary -medicine to humanhealth.

It was in the light of the above experience that Iwas delighted in 1969 when the officials of theNational Academy of Sciences--NationalResearch Council invited me to chair a committeeto study the subject and to makerecommendations for national guidance in thisregard. Furthermore, it was a great assurance tome when I. was requested to assist in the selectionof the members of the committee. We spentseveral weeks reviewing the background ofpotential members and in selecting persons whowere not only highly qualified, but who wouldtruly represent the various aspects of veterinarymedicine in the field of biomedical research andeducation. Frankly, I think that I am justified inbragging about the committee because I think weobtained the services of a group of outstandingpersons who were willing to dedicate a lot of theirpersonal time to the subject. Each member had afull-time responsibility to his home institution, buteach of them was willing to give of his personaltime, and many long weekends and holidays weredevoted to the study. I am grateful for thecontributions of each and every member of thecommittee.

In speaking of the background of this report Ishould not fail to mention that the Academy wasstimulated to establish this study from a requestsupported by a grant from the AmericanVeterinary Medical Association. You will note inthe report that other organizations, bothgovernment and private, also supported theproject. During the entire course of our studies, wereceived strong support from the AVMA, theAssociation of Veterinary Medical Schools, theDepartment of Agriculture, the Public HealthService, industry, and many other organizationsand individuals. The entire staff of the Academywas cooperative, but we owe special thanks to ourfull-time staff member, Dr. Samuel Abramson, aveterinarian, and to Dr. Russell Stevens, Secretaryof the Division of Biology and Agriculture, NAS.It is impossible to recognize all of our sources ofinformation and advice, but the committee isgrateful to each and all of them.

Now that New, Horizons for Veterinary Medicinehas been completed and published, I am concernedfor the first time. This concern reminds me of theage-old story of the apartment dweller who, when

4

preparing for bed, heard clearly his upstairsneighbor drop his first shoe on the floor and wasunable to sleep for the entire night while awaitingthe impact of the second shoe being dropped. Ourreport has been "dropped" and I am greatlyconcerned that I have heard little response aboutits contents. I sincerely hope that today thesecond shoe will be "dropped" and that we willhavd. a free and open discussion of the report.There must be persons here who have "good" and"bad" things to say about it. I am furtherappreciative that other members of our committeeare present to hear and to share with me in thiscritical discussion.

I would like to select certain generalrecommendations from the report and also tomention some of the more specific details:

1. Veterinary medical schools have historicallygrown-up in the atmosphere of land-grantcolleges and the result has been a muchcloser relationship to agriculture than tohuman medicine. Over the years veterinarymedicine has undergone a series oftransitions ranging from services almostentirely limited to diagnosis and treatmentof animal diseases during the early days, tothe more recent encouragement ofveterinarians in an array of medical servicesrelating to agricultural .enterprises and foodproduction, industry, companion animals,the public health, research and teaching. Inconsidering this evolution it is quite clearthat veterinary medicine should not releaseits ties to agriculture, but the profession isclearly. merging closer to huma "medieitfand this relationship should be strengthened.It is my opinion that a veterinary schoolwhich is geographically .near and/or has aworking relationship to a university medicalcenter is fortunate. Obviously, it is. notfeasible for most of our veterinary schoolslocated away from medical centers to bemoved. But it is possible for those schools toassociate themselves more directly withhuman medicine in their vicinity.Furthermore, the importance of this sharedrelationship between human and veterinarymedicine should be borne in mind by thosepersons who have a responsible role in the

location of new schools. It is a certainty, inmy mind, that those two interrelatedprofessions will need to work more closelyin the future.

2. Just as in human medicine, there is the needin veterinary medicine for major revision inour core curriculum and for up-dating manyof our teaching methods and techniques.Increasing specialization, in veterinarymedicine will necessitate some broadening ofthe core curriculum, but it also makes itmandatory that the veterinary student begiven an opportunity for special andintensive experience in a particular fieldwhile still in undergraduate professionalschool. Students entering professionalschools today are far better prepared thancomparable students of previous years and itis an opportunity, and challenge for oureducators of today'to take advantage of thisgreat asset. It is our responsibility to notforce them into the monotony of repeatingsubject matter but to use this additionaltime to introduce them to new learningexperiences and to give the student anopportunity for special attention to subjectsof special individual interest to him.

I shall not go into a discussion of many ofthe details of veterinary medical educationconsidered in the report. But I wish to callyour attention additionally to improvementin the use of teachin methodology tosupplement the time and ability of the goodteacher. Selfteaching devices have a realplace in professional education, not only tosupplement in-school learning, but to givethe trainee an experience which can bevaluable to his continuing educationthroughout life.

3. Veterinary medicine has lagged far behind itssister profession in the development of moreand better formal post-graduate programs toprepare its members for practice or research.I t is startling to realize that with1240 graduates of our veterinary schools in1970-71 there were less than 100 formalinternships available for their post-graduate

training. An even worse condition prevails inrelation to residency training leading toexceptional proficiency in the clinicalsciences. Since this type of training is lessformalized and standardized, it is difficult togive an exact estimate of the number ofresidency training spots available but in1969 there were only seven ::iteierina'rr---kschools offering residency training programs`and there were only 41 residents in trainingthat year.

Of course, it is recognized that not allpostgraduate training of veterinarians is informal intern or residence training programsand that these experiences are primarilydesigned for training to practice. There areadvanced degree programs leading to amasters or doctors degree in all but one ofour veterinary schools. During the 1.969 -70academic year, 312 veterinarians wereenrolled in Ph.D. programs and 321 were inmasters degree programs. In addition,veterinarians get advanced' degree training indepartments of veterinary science; medicalschools, and basic sciences departments ofuniversities. Non-degree training is availablein many government laboratories and atprivate research laboratories, but theseprograms are commonly informal in contentand are frequently tailored to the serviceneeds of the particular Organization.

To my mind, one of the most glaringdeficiencies in ,,our_ veterinary educationaland training activities is in the area ofpost-graduate training. We need more andbetter internships, residency, post-graduatedegree, non-degree, and specialty trainingprograms. This matter is so urgent that all ofour institutions with responsibilities in thisarea should address themselves to this greatneed. Furthermore, there should be acombined effort in this direction whichshould be led by the AAVMC and theAVMA. Uniformity and acceptablestandards should be of paramount interest.

4. Professionals generally are becomingincreasingly aware of the need to continue

their education beyond the period devotedto earning an academic degree. The rapidpace of scientific advance demands thata professional person pursue a program of"continuing education" if he is to beproficient in his profession. Since 1962 theAVMA has given leadership in stimulatingthe development of courses for this purposeand has .provided information on theavailability and content of specific programs.This is a step in the right direction but thereis much more to be done. There_should bemord collaboration and discussion ofresponsibility between the colleges ofveterinary medicine and the professionalassociations to facilitate the evaluation ofmore effective, expanded programs. Ourcomm ittee has suggested how theseobjectives might be obtained. _In addition,the committee has specifically recommendedthat the AVMA Council on Educationshould extend its efforts as follows:

"A program to structure appropriatecontinuing education courses shouldbe developed. Certain lectures anddemonstrations serve best, perhaps,without extensive involvement of anational association, but many coursescan be selected and organized forsequential treatment or directedtoward specific goals on a national,integrated, and coordinated basis.

"A system of evaluation of the qualityand effect of continuing educationprograms should be developed."

I commend this advice for yourconsideration and action.

5. One of the committee's very prominentconcerns was in relation to the training andutilization of paramedical,. personnel. As inhuman medicine, /there is a growingawareness of the deficiencies in this regardand an appreciation that this is one of thebest ways by which we may more rapidlyand effectively increase the availability ofquality veterinary medical services.

6

When one reviews the available informationon the subject, it is startling to learn of thevery low technical-to-professional staff ratioin our veterinary schools. And yet, here isthe greatest opportunity, not only to trainparamedical personnel, but also to "extendthe arms" of our teaching staff and train theyoung professional to use such personneleffectively. For example, it has been clearlyshown in dentistry that the most opportunetime to train a professional in the use ofauxiliaries is during his formal education,both undergraduate and immediatelythereafter. Furthermore, there are no areasrelated to veterinary medicine which aremore qualified to train paramedicalpersonnel than our professional schools. Aveterinary school's involvement in suchactivities need not be confined to itsimmediate premises but can be effectivelyextended by affiliated programs with privatepractice groups and other institutionsutilizing veterinary medical services.

The committee has pointed out a particulararea in which technicians could be usedmore effectively and thus permit theveterinarian more time for responsibilitieswhich are truly of a professionalnature--lay meat inspectors. It has pointedout that at least one state (New York)requires that lay meat inspectors have anassociate degree after two years of juniorcollege training in a food, meat, and dairytechnology program. The committee feltthat this effort deserved commendation, butalso recognized that the effectiveness of suchinspectors depended upon the quality of thetraining program plus the adequacy ofprofessional supervision thereafter. Juniorcolleges must have professional participationin such teaching if it is to be meaningful andeffective.,

General medical technologists can be trainedto work as a part of a veterinarian-led teamin much the same way as when serving as apart of a team in human medicine. Becausethe role of animal technicians is stillevolving, it was not felt that any fixed

curriculum or period of training can berecommended at this time. However,graduates of college-level programs should beencouraged to organize themselves so thatthey can develop a recognized certifying andaccrediting program and, ultimately,standardize course curricula with establishedminimal training requirements.

6. There are many other specificrecommendations of the committee, but inclosing I would like to call your attention toone other area to which considerableattention was devoted but with which it wasnot content with the information whichevolved. I am referring to the role ofcompanion animals in contributing tohuman health and welfare from theemotional standpoint. I am not referring toanything as utilitarian as a riding horse,hunting dog, or a seeing-eye dog.

There is a growing belief among psychiatristsand psychologists that companion animalsfulfill important emotional needs and hencecontribute significantly to human well-being.All of us have been impressed on repeatedoccasions by the importance of a pet to theelderly, the lonely, and to the mentally ill ormentally retarded person. The tragedy of theillness or death of such a pet can be literallydevastating to many such individuals. Yet,the role played by these animals has notbeen adequately studied. Consequently, wesometimes find ourselves in anuncomfortable position to respond when alegislator complains, "Why should publicfunds be used to help train a person who isto become a pet doctor?" I submit to youthat such an attitude is not justified, and weas a nation are devoting an increasingamount of professional veterinary resources

7

to the care of household pets--a trendwhich is likely to continue. I urge themembers of the veterinary and medicalprofessions to pay more attention to thissubject and to institute collaborative studieswhich will give us more objectiveinformation. Unless we can get more reliableinformation about the importance of pets tothe mental health of people and topsychotherapy, a serious threat will continueto hang over the heads of those of us whoare proponents of public assistance toveterinary research and education similar tothat of human medicine.

Pro bly the most controversial issue dealt with inour report is the number of veterinarians needed inthe future in various categories of practice, as wellas, the total needs for all types of practice. I amsure that some may disagree with our conclusions,but I would point out that the committee devoteda great deal of attention to this subject. Everyknown source which might be helpful wasconsulted. Furthermore, in Appendix H we havedescribed in detail how we arrived at thoseconclusions. I commend your attention to thissection for it is a matter of vital interest not onlyto veterinarians but to the entire nation.Unfortunately, our most optimistic predictionswill result in a significant deficiency in the numberof veterinarians by 1980. This shortage can bepartially atoned for by the development of moreeffective utilization of the existing personnel, butwe must continue to insist upon greater supportfor veterinary medical research and education atboth the state and national level.

All of us who served on the committee hOpe andtrust that our efforts will give leadership foradvancement in the entire field of veterinarymedicine.

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t)

DISCUSSION

The Committee of the National Academy of Sciences

"Report on Veterinary Medical Research and Education"

Panel

L. L. TerryW. H. Eyestone

Moderator

R. B. Talbot

Q. Was the effect of a decrease in thepopulation explosion on the projected needfor Veterinarians considered?

A. (D r. Eyestone): Yes, that point wasconsidered very seriously. The populationreduction projected for the next ten yearsmight reduce the need for professionalpersonnel. As Dr. Terry noted in his report,some professionals are being released fromthe lay-type activities in meat inspection bylay help. In a practice situation we couldprobably reduce the need for professionalpeople with lay help.

(Dr. Terry) Most of you are aware of thechange that is going on in human medicinetoday in terms of health manpowerpersonnel in the various categories. One ofthe very popular modes at the moment is thephysician assistant, a person less well-trainedthan a physician to assist in the delivery ofmedical care. Some of these programsencompass a few months training before the

person is put in the field under thesupervision of a physician to others whicharea a full four-year baccalaureate program.Frankly, human medicine is a confused messin this regard. Part of the confusion is due tothe realization that many things thatphysicians are doing could be performed bytrained technical supportive personnel. If weare going to get better distribution ofmedical care, we are going to have to utilize

.every aspect in trying to support thephysician and extend his expertise to covermore areas. I think the lame situation isfacing veterinary medicine today, though ithas not quite crystallized...or precipitated yet.This is one of the areas in which veterinarymedical schools need to give clearer andstronger leadership in order that the type ofpersonnel, their proper training, and theirutilization under professional supervision bedefined.

Q. On what basis was the additional need forVeterinarians projected since they vary from

* Chairman, Department of Pathology, School of Veterinary Medicine,- University of Missouri,Columbia, Missouri.

9

the projected need as published by theBureab of Health Manpower?

A. (Dr. Eyestone): The estimates from theHealth Manpower Act are extrapolations ofgrowth in the past, whereas the estimates inthis report were based more on professionalestimates of what might happen to certainsegments of the profession and adding it alltogether to come up with a number. Historyhas shown that the increase in the numbersof veterinarians and changes in thgir_activities does relate to population growtheven though their distribution does notrelate to centers of population. Veterinariansstill largely relate to the concentration offood animals in the country. Even thoughwe tend to follow population growth, thereare other factors to consider. We don'ttotally relate to population growth. Newareas are becoming involved,environments, etc. that Veterinarians arebecoming more and more involved andinterested in. There has been a reduction inthe need for veterinarians in the food animalarea by virtue of the mass productionmethods that are being used. This has beenduring a population growth era and fromwhat we've discovered does not lead to adrop in the need for veterinarians. Lack ofpopulation growth doesn't mean necessarilythat we've stopped growing. Contrary to thepublic opinion, we will still have a gradualincrease in the population. I believe thefigures which you see in this report arerelated to our expected population growth,not our growth due to other areas.

Q. Where do you feel lay help or.Veterinarytechnicians should be trained?

A. (Dr. Eyestone): Their training should berelated largely to the training in professionalschools where professional students wouldhave the opportunity to observe their useand training close at hand, where studentscan become accustomed to using auxiliaries.Also, this is the best place for this type oftraining. In the manpower law it states this

10

must be the place of their training in thecase of medicine.

(Dr. Terry): I have mentioned in myremarks that certainly not all of this trainingmust be, restricted to veterinary medicalschools. On the other hand, I do feel thatour veterinary medical schools are the ideallocus for continuing development and -improvement. In this regard, I think there isgreat incentive both to the trainer and to thetrainee if carried out properly. In referringto the primary and important load of theveterinary school in the training of technicalpeople, I didn't mean to infer at all that thisshould be the only point of training. In thefirst place, I think standards and programsfor training of these people should bedeveloped. In some veterinary schodls,faculty may be decreased by10 or 20 peltent if scuff work jobs were leftto technical help rather than to professionalpersons who shouldn't be doing themanyway. The same thing is true in privatepractice. Whether 5, 10, or 20 percent orwhatever it is, there is considerable segmentof work performed by a veterinarian, bothteachers in our school as well as practicingveterinarians in the field, which should notbe done by professional people. It is up to usto divise methods and programs for thetraining of people to do these jobs. Servingas a technician is a perfectly honorableprofession, but at the same time does notrequire the training that is required of aprofessional person such as a veterinarian. Iwould urge that much more be done in thisdirection and we cannot only improve theavailability of veterinary medical care but atthe same time we can do a lot better job ofmedical practice.

Many groups and individual veterinarianswill be training technicians for particularroles in their own office or practice area.This is to be expected. At the same time Iwould point out to you that manywell-trained technical people may be pickedup from the human medicalfield: radiological technicians and

Q.

A.

laboratory technicians and other people whoare trained in our hospital and medicalcenters and which-can be valuable additionsto veterinary practice and training.

What type of quality control is being placedon technical training schools?

(Dr. Eyestone): In some cases the stateveterinary association and the college aredoing some supervision over some of theactivities involved in the Associate of Artsdegree. Certainly the junior colleges', andother commercial training programs thathave sprung up have been having problems interms of agreement on what these peoplereally ought to have as training andsupervision of graduates. And they will haveproblems until we get to the point of statelicensure. I don't see how we can fullycontrol the situation. However, it seems tome that in the state boards of veterinarymedical examiners and in states where aveterinary college exists there should bereasonably close supervision over the kindsof curricula, teaching, and preparations foran associate of arts degree. Certainly thereare types of training that can be done nicelyin such a setting. But when one considers aveterinary technician, by definition,analogous to the physician assistant, thatkind of person really ought to be trained in aveterinary college clinical setting.

a I can cite seveTal, ex4mples where graduatetechnician training programs are- assumingprofessional duties. How can thisbe/prevented?

A. (Dr. Terry): fear, I literally fear, some ofthe technical and semi-professional peoplethat are being turned out by some of theseschools without acequate supervision,professional leadership, training, guidance,and instruction. To my mind the biomedicalarea must do everything it can to assist andstimulate the development of adequatetraining programs so that we will not have

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turned out an albatross to hang aroundsomeone's neck. I think we're probably infor some rough times in this regard, more soin the human medicine technical area than inveterinary medicine.

,Practically every community in this countrywants a community college. One of the bigfields in many of the community colleges isnot the liberal arts associate degree butsubprofessional technical training, especiallyin the biomedical area. I think all of us areconsiderably concerned about theavailability of quality teachers, guidance,and instruction for the people who are beingtrained in these areas. I think it's importantfor veterinary medicine to get its foot in thedoor so to speak, and to exert someleadership in helping to establish the nature,quality, and minimal requirements of thetraining of the subprofessional technicalpeople which will serve us and society.

Q. In a recent report of the Pan AmericanHealth Organization, it was recommendedthat the technical assistants to veterinariansbe called animal health assistants and theirtraining be carried out by colleges ofagriculture. Can you comment?

(Dr. Terry): I'm wondering if, as Linus inthe comic strip, veterinary medicine is losingits security blanket. In talking about thetraining of technical, paramedical, andsubprofessional personnel which are to beused by veterinary medicine: if theveterinarian is afraid to have his nameassociated with them and wants to call themanimal health care assistants rather thanveterinary assistants, and furthermore, if hedoesn't allow them to put a foot in hisschool, I fail to 166 the point! To me,clearly, the veterinary medical professionmust give leadership in this direction and Iwould hope that people here are in the bestposition to give that leadership. I'm alsoconcerned as to whether the veterinarymedical profession generally, and our

veterinary medical schools specifically, are

willing to step into this area and give somereal meaningful leadership.

(Dr. Eyestone): I think we gave a great dealof consideration to this point of view andattempted to be totally objective aboutmeasuring anything but effectiveness of thepersonnel involved. The only place to do thiskind of training was in, around or under thesupervision of colleges of veterinarymedicine; whether you call them veterinarytechnicians, or what have you. Although itseems to me these comments are more oftengenerated by the practitioners in our groupthan by those of us who are not in practice,people who had used well trained assistantsin their practices seemed to firmly agreeabout the issues that we have mentioned andthat these assistants should be trained byveterinary colleges. As Dean Tietzmentioned, perhaps this could be done atsome school in Denver, Colorado under thesupervision of the College of VeterinaryMedicine, with the students eventuallycoming to the clinic at the College ofVeterinary Medicine for final training beforebeing released to practitioners. As is stronglyreflected in the report, not only would thetechnicians who evolved from thisprogram be working in the properenvironment, but the senior students wouldlearn how to use them in their futurepractice.

Cl. Will the participant pay for continuingeducation, or can we look for public fundsto provide re-training and continuingeducation programs?

A. (Dr. Terry): Probably the best answer that Icould give would be based on our experiencein human medicine in continuing educationin medical schools and the role of publicfunds in relation to this. l do not feel wehave continuing education as well organizedin human medicine as we should have,although in recent years we have developedin terms of quality and areas covered.Generally speaking, public funds have been

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made available for continuing education inhuman medical areas only to institutions andnot to support the expenses of the personattending. In addition, the support to theinstitutions has not usually been enough toavoid them requiring tuition. There is ageneral tedency on the part of our legislatorsto feel that in contrast to a student who isgoing through school, a practitioner,whether he is working for an industrial firm,the Federal Government, or a privatepractice, is an earner. Therefore, he shouldpay at least in part, if not totally, for hisupkeep, refurbishment, and training in hischosen field of continuing education. Thus, Iimagine that some of our schools will begiven assitance in a limited form from publicfunds but, in general, I think that most ofthese programs will need to beconceptualized on the basis that participantswill pay a large part of the cost ofinstruction. Universities and otherinstitutions are obviously going tounderwrite some of the basic expenses, andprofessional organizations like the A.V.M.A.should also contribute. However, a large partof it will have to be carried by the individualprofessional who is getting the continuingeducation and, after all, it is tax deductible.

Cl. What is the role and importance ofcompanion animals in our society and do wehave data to support their importance?

A. (Dr. Terry): The committee was greatlydisappointed by the amount of reallyobjective information from any source onthe subject. At the same time everyone of usas individuals, whether we are proficientveterinarians, medical scientists, or otherprofessionals working in the area, areconvinced of the great importance ofcompanion animals, particularly pets in-relation 'to human health and welfare. Ithink we need much more study anddocumentation, of well conceived studiesthat are done by capable psychiatrists,psychologists, animal behaviorists, andveterinarians. These studies should be done

in a collaborative way, so that much moreevidence can be derived in this area. I thinkthat any physician who has taken care ofpatients such as the elderly, the lonely, thementally ill, or mentally retarded, cannotbut help having recognized the importanceanimals and pets play in the lives of thesepeople. But we just do not have enoughdocumented information. Time and timeagain I have been clobbered by somelegislator- who says, "Why should publicfunds be used to educate somebody who isgoing to become a rtet doctor?," which to

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my mind is a completely idntic statementand unappreciative of the importance of petsin relation to human life and welfare. Yetsomehow or another we have to obtain moreand better information on the subject inorder to overcome some of these prejudices.

(Dr. Talbot): Our time precludes any morequestions. I am sure Dr erry and Or. Eyestonewould be glad to answer any additionarinquirieson an individual basis. I would like to thankDrs. Terry and Eyestone for coming and adding somuch to our Symposium.

THE WINDS OF CHANGE

W. W. Armistead, D.V.M.Dean, College of Veterinary Medicine, Michigan State University, East Lansing

Introduction

Let me begin by explaining that the title, "TheWinds of Change," was assigned to me; I did notselect it. But I happily accepted it because itseemed so appropriate. When one thinks of a dean,one just naturally thinks of wind.

Seriously, the title is appropriate to the theme ofthe symposium and am honored to have beenasked to make this contribution to the program.As I understand it, my assignment is to interpretwhat changes are "in the wind" for veterinarymedical education. It is an important assignmentand one which I do not feel unusually qualified tocarry out. But i shall give it a try, with confidencethat what I overlook will be filled in by others atthis meeting.

That there are significant changes in the wind isindisputable. The real questions are (1) the natureof these changes and (2) their implications forveterinary medical education in the decade ahead.

In discussing these matters I shall try merely tohelp set the mood and stage for this symposium. Ifby chance I should have any impact beyond that, Ishall be surprised but grateful!

What Is in the Wind?

Veterinary medical education in the next decadewill be affected profoundly by many of the issuesimpinging upon higher education as a whole. Ofthese the most important probably is funding.Many of us in veterinary medical education havenot yet seen--or at least have not yet

15

accepted--the full implication of national trendsin financing higher education.

One thing is certain. We shall not see again for awhile a period of sustained growth such as weexperienced in the 1960's. There are severalreasons. The American public is showing increasingresistance to mounting taxes. The mushroomingdemands of social reform programs are producinggreater competition for the tax dollars at everylevel of government. And, what is. of greatpotential significance, the taxpaying public andtheir legislators are becoming increasinglydisenchanted with higher education in general.They appear to have been "turned off" by radicalstudent behavior, by even higher admissionstandards, by increasingly strident faculty salarydemands and, most recently, by the shortage ofjobs for new college graduates.

Also in the wind is a growing interest in innovationand experimentation in veterinary medicalcurriculums and teaching methods. Part of this isself-generated among progressive faculty members. ,

But much of it has been triggered by otherstimulants such as:

Austere state budgets which forceefficiencies.

Availability of federal funds throughprograms which put a premium on increasedenrollment.-

The pioneering example of certaininnovative human medical schools.

A growing body of literature on medicaleducation.

The rapid recent development of newtechnology for teaching and evaluation.

The changing character of the veterinarymedical profession.

Student demands for more flexibility,objectivity, and relevance in the curriculum.

What Are the Implications?

When all factors are considered it seems clear thatin the 1970's we in veterinary medical educationwill have to take a closer, more objective look atourselves. We shall have to become moreproductive, which is to say more effective andmore efficient.

New programs will have to be funded mostlythrough reallocation of resources rather than withadditional new funds. Program improvement willhave to be achieved mainly by increasingproductiVity rather than by adding people anddollars.

That is not all bad. Nor is it entirely illogical. Infact, it seems to me extraordinarily naive to expectthat those paying the bill (taxpayers) will happilysupport universities in the style to which they havebecome accustomed simply because we think theyshould. Economists agree that it is difficult, if notimpossible, to separate price from value. And it isthe one whO picks up the tab (taxpayer)--not thevendor (professor)- -who must feel that theproduct is worth the cost.

Of course it would be 'unfair and inaccurate toclaim that we are being victimized bycircumstances beyond our control. Much of ourcurrent dilemma is of our own making.

The fdderal government has responaed with fundsfor increased enrollment because we have insistedfOr years (apparently very convincingly) that thereis a great and growing shortage of veterinarians.

We appear to be losing the support of some ruraltaxpayers because we are not producing enoughveterinarians who are willing to enter farm practice

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and who can function effectively in today's highlybusinesslike livestock industry.

Urben clients (who alsci are taxpayers) arecomplaining about the lack of emergency serviceon cvenings and weekends.

Veterinary students are becoming increasinglycritical of their education partly, if not largely,because they feel that curriculum improvementhas lagged behind public need.

Legislators are becoming disenchanted withmedical education, including veterinary medicaleducation, because of what they interpret as itsexcessively high cost and low accountability.Whether their view is accurate or not, the facts arethat they believe it and We have done little tochange their belief.

The colleges also are being accused of graduatingveterinarians who are increasingly mercenary. Bothclients and older practitioners complain that newgraduates lack the commitment to service thattheir predecessors had; that they are moreinterested in salary, hours; and fringe benefits thanin taking care of patients. This of course is an oldallegation. Whether it is any more valid now thanin earlier years is open to question. But if it is true,there is great danger in its implications for thefuture of veterinary medical practice. Perhaps itwould be revealing to have a look at what hashappened in human medicine where thisdevelopment appears to be further advanced.

During the past two or three decades there hasbeen a striking change in the perception ofphysicians by their patients and, as a result, by thepublic at large. The image of the physician haschanged from that of friend and counselor to thatof scientific businessman. This change has beenpromoted by the growing impersonality of thedoctor-patient relationship. The family doctorseems to be disappearing. Very few physicians willmake house calls; even an illness developingsuddenly at home now is referred to the hospitalemergency room where it is treated by a harried,youthful, total stranger.

The remarkable growth of specialization also hascontributed powerfully to the change of public

attitude toward physicians. The specialist ofcourse is more competent. But because thespecialist's patient usually is referred, hence atemporary patient, and because of the specialist'sinterest in a narrow field of medicine, he is likelyto seem less genuinely concerned for the patient asa whole person.

ne serious consequence of the growingimpersonality of human medical practice is theenormous increase both in the number ofmalpractice suits and in the dollar values ofdamages awarded. Malpractice insurance rates forphysicians are skyrocketing. It seems that adisgruntled patient is more likely to sue a scientificbusinessman than a friend and counselor.

The lessons for veterinary medicine to be drawnfrom these developments in human medicineshould be fairly obvious. The problem may be oneto be grappled with primarily by organizedveterinary medicine. But the role and influence ofveterinary medical educators in shaping theattitudes of, and clarifying the moral issues for,future practitioners certainly cannot beoveremphasized.

Much of what We are doing in veterinary medicinewas borrowed from human medicine. Part of it hassuffered in the translation and some of it wasinappropriate to veterinary medicine in the firstplace. But, on the whole, the example of humanmedicine has served us well in our rapid transitionfrom a rustic art to a modern medical science.

Given the sophistication of veterinary medicinetoday, there certainly is no need for us to apehuman medicine. But it seems wise 'for us torecognize the obvious similarities of the twoprofessions and to try to profit from theknowledge that, historically, many trends inhuman medicine have preceded similar trends inveterinary medicine.

_.What Should We Do?

Even if I knew exactly what to do, it would beinappropriate to try to be too specific in apresentation such as this. But here, for whatever itmay be worth, is a partial list of trends--some

17

actual, some only wishful--which we probablyshould be supporting or promoting in veterinarymedical education. Most of these trends representnot the abandonment of one position in favor of-another but, rather, simply the shifting ofemp hasis.

From the "castle- with - moat" philosophy oncampus toward a more open, outward look toother parts of the university and to off-campusconstituencies.

From a scientific inferiority complex towardconfidence and par feelings about other medicalsciences and scientists.

From emphasis on reversing. disease toward moreattention to preserving health.

From traditional departmental alignments andcourse sequences toward more functionalcombinations and sequences.

From spasmodic, revolutionary curriculumrevision toward continuous evaluation andevolutionary change.

From simply adding to the curriculum (bylengthening or packing) toward shortening (byculling and condensing).

From emphasis on teaching toward emphasis onlearning.

From heavy dependence on the lecture towardmore programming.

From the empirical approach to education towardresearch-based teaching techniques, curriculumdeveloprrient,,and evaluation methods.

From the "generalist" approach to clinical trainingtoward options for accommodating differences instudent aptitudes, interests, and career objectives.

From ;traditional fact-testing of students towardevaluation of student performance.

From forcing the student into rote memorizationtoward development of student abilities indeduction and problem,solving.

From small enrollments toward larger enrollments.(All trends are not either desirable or undesirable.Some are merely inevitable, hence should be dealtwith constructively.)

From the chauvinistic, "what's-best-for-theprofession" philosophy toward a greater concernfor the wishes and needs of the consumer (client).

From a preoccupation with techniques towardmore awareness of principles.

Horn perceiving the O.V.M. curriculum as theonly preparation required for a career in veterinarymedicine toward acceptance of the necessity forcontinuous, lifelong education.

The transition of veterinary clinical education hasbeen particularly interesting. Throughout the firsthalf of his century the standards of veterinarymedical and surgical practice were set by privatepractitioners. In the 1950's the veterinary collegeclinics began a very rapid growth in competencewhich has placed them in positions of leadership.The reasons are obvious: increased dollar support,improved facilities, the development ofspecialization, and the growth of clinical research.

I n all this we should not discount the influence ofincreased student enrollment, which has justifiedlarger budgets and larger faculties, therebyproviding greater breadth and depth ofcompetence and more time for research and selfimprovement. While many are inclined to viewincreasing enrollments as exerting an undesirableinfluence on the quality of education, the reverseis more likely to be true.

Unfortunately, while the scientific stature ofveterinary medicine has been increasing at agratifying rate, improvement in veterinary medicaleducation has been disappointing. Most curriculumchange has been only cosmetic surgery--arearrangement of features to give the appearanceof youth. Underneath has remained the same,aging educational organism.

Of course nobody ever is completely happy withthe product of a curriculum committee--least ofall the most progressive members of the faculty.Committees operate on the principle of

18

compromise. Committee recommendationstherefore seldom represent a significant departurefrom the status quo because the most innovativesuggestions of individual members are bargainedaway in the process of committee debate. AsThomas Carlyle said, "Every new opinion, at itsstarting, is precisely in a minority of one." Ourcolleges of veterinary medicine would have muchmore interesting curriculums if we could devisesome means for providing safe condu(t of a newidea through the hostile wilderness of modernuniversity bureaucracy.'

As veterinarians we are relatively new at thebusiness of education. Most of us have a quitesuperficial knowledge of the literature ofeducational research and our educationalexperiments tend to be highly empirical.Furthermore, those of us who are most interestedin improving teaching and learning also are likelyto be the busiest with other tasks. As a result, itbecomes easier to think it up than to look it upand we tend to keep rediscovering the wheel. Stillwe are making progress and our ignorances andinefficiencies gradually are being overcome.

A number of blind spots persist in our view ofimproved veterinary medical education. Forexample, we have not taken advantage of one ofthe richest teaching resources in the wholesystem--the students themselves. It should bepossible to design the curriculum, schedule classes,and deploy personnel in such a way as to makemaximal use of this virtually untapped teachingresource.

We have learned already that an autotutorial carreldesigned for two students is more effective thantwo carrels designed for one student each. This isbecause of the reinforcing (teaching) influenceeach student has on the other. To carry thisfurther, upper level students should be able to helpteach lower level students, to the enormousbenefit of all concerned. Faculty time now spentin presenting introductory, elementary, ororientative material would become available forstudent counseling and evaluation. At least twoother benefits would accrue to students who areinvolved in teaching. The person who is requiredto teach is thereby stimulated to learn more

accurately. Moreover, through teaching onepractices communication. And poorcommunication is perhaps the greatest singledeficiency of professional individuals andorganizations.

There is another long-standing blind spot in ourvision of better veterinary medic& education. Irefer to our contradictory attitude towardagriculture. We tell our students that in largeanimal practice they must understand, support,and work closely with livestock producers. But wedo not often behave that way toward the animalscience departments on campus. We acknowledgethe importance of genetics, nutrition, andhusbandry to livestock health, yet we have onlyminimal interaction with those agriculturists oncampus who have the greatest expertise in thesesubjects. It is ironic that, with our new foundinterest in collaboration with human medicine, weare developing reciprocal agreements of a type wenever considered with agriculture. In view of thechanging character of animal agriculture, we needthe help of animal scientists in the training of ourstudents, in the design of our clinical researchprojects, and perhaps even in the continuingeducation of our clinical faculties.

Conclusion

When one considers what needs to be done inorder to bring our education& practices up to ouraspirations, the task seems overwhelming. To beginwith, we are not certain about what needs to bedone. Beyond that, implementing such changes aswe might agree upon is an awesome task.

As Machiavelli .pointed. out, ". . . there isnothing more difficult to carry out, nor moredoubtful of success, . . . than to initiate a neworder of things, for the reformer has enemies in allof those who profit by the old order, and onlylukewarm defenders in all of those who wouldprofit by the new."

Paradoxically, in these days when change hasbecome more fashionable, it has become at thesame time more difficult to bring about because ofthe enormous proliferation of committees,councils, and democratic procedural channels.

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The more conservative among us are likely todecry "change for change's sake" and to cautionagainst "extremes." But there is much ofGertrude Stein's contention that "a difference, tobe a difference, must make a difference." And toreally make a difference, changes must beextensive--extensive enough to alarmconservatives and to discomfort those who havesettled amiably into the status quo.

It seems to me that the danger of our "going toofar" in education& reform is !mote, indeed. Inthe first `place, the university IIireaucracy wouldnot permit it. A truly radical pi )posal would notlikely survive the nibblings and gnawings ofdemocratically selected committees and councils.And if by chance it were to make it through inrecognizable form, the delay would have been suchthat it no longer would seem radical by the time itemerged.

So my admonition is to promote intelligentchange, to innovate, to experiment, and to notworry about "going too far." If you are notconvinced that our democratic process will keepyou from going too far, perhaps you can findcomfort in the knowledge that no change has to bea life sentence. If it doesn't work it can be changedagain.

It should reassure you also to realize thatveterinary students are remarkably durable,adaptable, and enterprising. Having survivedscholastic screenings at the high school, university,and professional college levels, they are entirelycapable of surviving without permanent scarring anoccasional educational faux pas. Besides, we ineducation habitually credit ourselves with havingmore influence on students than we really have. Inthe final analysis, the individual student decideswhat he will learn. All that the best of us can do isto help him make the correct choices--and weare not always right.

I hope that my remarks will not be consideredanti-intellectual or anti-academic. I consider themto be exactly the opposite. It is the penchant forprobing new frontiers, for synthesizing newknowledge out of old, for testing hypotheses, thatcharacterizes the truly intellectUal scientist anddistinguishes him from the theoretical philospher.

Trying must be part of the intellectual process inany applied science such as veterinary medicaleducation. The theories of the Greek philosopher,Empedocles, although erroneous, were accepted astruths for 2,000 years because they were nottested.

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So I am optimistic about our chances for bringingabout significant reform in veterinary medicaleducation. And I am particularly excited about thepotential influence of this symposium on teachingand learning in our colleges of veterinary medicine.

ra.

O

VETERINARY MEDICAL EDUCATION AND THE UNIVERSITY

David W. Mullins, Ph.D.President, University of Arkansas, Fayetteville

You have asked me to address myself to thegeneral subject of "Veterinary Medical Educationand the University." Therefore, I shall share withyou some of my thoughts on the shifting trendsand changing directions in higher education andtheir possible implications for veterinary medicaleducation.

First, I shall comment briefly on the history andaccomplishments, the benefits and the needs ofveterinary medical education in the southernregion.

The Southern Regional Education Board'sprogram for assisting in providing regional servicesin veterinary medical education has grown andprospered for more than two decades. As youknow, this program is based on contracts throughSREB between states which have schools ofveterinary medicine and states which do not.During the first 21 years of the program--1949through 1970 -- nearly 8,000 spaces wereprovided by five existing schools for students fromother states.

The benefits from the program are obvious. Theschools themselves have received more than$11 million from the contracts. The program hasbeen a pacesetter in exemplifying the desirabilityand the fruitfulness of regional cooperation inproviding highly trained professional personnel.The program has provided veterinary medicaleducation for students who otherwise would nothave had such opportunity. The people of theSouth and the nation are the ultimatebeneficiaries. The program also has assisted schoolsof veterinary medicine in maintaining highadmission standards by giving them a wider choiceof applicants than one state could provide.

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While the program has developed rapidly andsuccessfully, the needs for veterinary medicalprograms and facilities have grown even morerapidly and thus, at this point in time, demandurgent attention.

In recent years, the size of pre-veterinary classeshas increased significantly. In almost every SREBstate, there are increasing numbers of wellqualified candidates seeking admission toveterinary schools under limited state quotas.Every contracting SREB state desires additionalspaces. Students are seeking enrollment inout-of-the-region schools because of the lack ofspaces in the South.

It is hazardous to predict the extent of futuredemands for professional and technical personnelin any field. However, there is no doubt that theneeds for all kinds of medical and para-medicalpersonnel will continue to increase at a rapid pace.The problem of expanding the size, scope andquality of our health education and deliverysystems is one of the crucial challenges of today. Itarises both from the growing demands and therapidly increasing costs of health education anddelivery. Veterinary medicine, with its impact onhuman, as well as animal health, is an integral andimportant part of the health delivery system.There also is an emerging and crucial role forveterir.ary medicine in ecology, marine and spacebiology, oceanography and other areas.

Therefore, in view of limited SREB spaces--theexpanding role of veterinary medicaleducation--and the projected needs of thefuture--it is obvious that the SREB programshould be augmented. To achieve this objective,the SREB special committee on veterinary

medicine, which I had the privilege of chairing,recommended to the board that three of the fiveexisting veterinary schools in the South beexpanded and that two new schools be established,including the one now under construction atLouisiana State University. These steps, thecommittee feels, would meet current demands. Inview of federal assistance in financing theexpansion and construction of these schools, thecommittee believes they should be committedfully to the concept of regional service.

While expansion certainly is one of the crucialneeds of veterinary medical education, it does notstand alone. Veterinary education, like otherprofessional programs, is subject to the changingconditions affecting higher education and societyin general.

Those of you who have had the opportunity ofreading the April 1 issue of your AssociationJournal were doubtless impressed byDr. George C. Poppensiek's article entitled, "The.Impact of University Reform on VeterinaryMedical Education." He makes the point that theacademic programs of schools of veterinarymedicine seem to have been less affected by thesocial and ethical revolutions of the 1960's thanhave those of the non-professional- schools.However, he concludes that veterinary students areno less impatient with the need for changes in theadequacy and relevancy of the instructionalprograms. He refers also to the needs for curricularrevision to reflect the changing needs, of thesociety the profession serves.

In my view, all higher education stands at acrossroads today.

During the past quarter of a century, universitiesand colleges have been concerned in larp measurewith expansion to care for the influx of studentsfollowing World War II and the Korean War. Theyalso have been involved in a vast expansion ofresearch and public service programs to cope withnational priorities resulting from the advent of theSpace Age.

Enrollment increases are due largely to thepopulation explosion and to the ever growingpercentage of high school graduates electing to

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attend college. The mushrooming of research andpublic service activities is correlated with thegeometric progression of science and technologyassociated with the Space Age.

Universities are still faced with the challenges ofresponding to multiplying demands for expandedprograms of education, research, and publicservice. However, other external, and internalpressures for improvement of higher educationarise today from changes in society. The people ofour nation, and indeed the world, are in theprocess of reassessing values, shifting emphases and

striking out in new directions. They are concernedabout the impact of new knowledge and newideas. They are seeking solutions to such urgentproblems as the need for international peace, racialunrest, desecration and pollution of ourenvironment. They are concerned about poverty inthe midst of affluence; and the scientific andtechnological upheaval that has altered thesubstance and quality of our lives. Philosophersand social scientists for years have been warning usthat we are not giving adequate attention to thesocial and economic problems of our times andthat technological developments have outrun ourpolitical and social processes. Thus, highereducation, it would seem, has no choice but togive attention to these changing conditions andshifting priorities.

In a commencement address at the University ofTennessee ,recently, SREB President Win Godwinhas spoken eloquently to this general question andI quote: "Higher education today faces newsocial, political and economic realities whichdemand academic reforms, not just moreacademics; efficiency, not just growth; more helpin applying knowledge to critical public problems,not just more research . . . We need moreflexibility in the teaching system, more points ofentrance, transfer and exit, and more opportunityfor work and experimental learning."

It is generally agreed that higher education mustbecome more introspective. During the period ofexplosive expansion, high education has not givenadequate attention to internal evaluation andrestructuring.

Therefore, it is time, in my opinion, for all who

have leadership responsibilities in higher educationto do some soul searching. Higher education mustbe more flexible and adaptable than in the past.Society demands it. Our programs must be subjectto continuous planning and painstaking review andevaluation in each major division of the universityand in each major discipline. The rigidity of thepast is incompatible with the dynamic demands ofthe present.

We have changed, and are changing, but not fastenough. In too many areas we continue to besatisfied with the status quo.

One of the major challenges we face is a growingcredibility gap on behalf of the publics we serve.Gone are the days when higher education wasinviolable--its programs unquestioned--and itsdecisions unchallenged. Today, questions are beingasked, programs are being subjected to scrutiny.Our decisions are being more closely examined.

Financial needs of universities have escalated; sohas the public demand for more economical andefficient use of available resources. One writer hasreferred to this development as "more forless . . . higher education's new priority."

In speaking to this subject, Allen Pifer, Presidentof the Carnegie Corporation, which long has takena constructive interest in higher education,declares that, quote, "This nation can no longerafford the luxury of an unplanned, wasteful,chaotic approach to higher education." In myview, this is an overstatement of the situation.Nevertheless, it does express a view held by aconsiderable segment of our publics.

Thus, another challenge which faces highereducation in the immediate future is how it will bestructured and financed. How will the variousstates structure and coordinate higher education,both public and private? How will it be financed?What share will the state provide? What share willbe provided from federal sources? And what sharewill the student bear? In my view, the trend ofplacing an ever-increasing burden upon the studentshould be reversed. Higher education should beprovided for qualified students at a price they canafford without unduly mortgaging their future.

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Another challenge must be the internalrestructuring of the curricula and programs of ouruniversities. All of our program areas--bothgeneral and professional--could profit fromcareful re-examination.

There are numerous and, indeed, revolutionaryproposals abroad in the land today. For example,Alexander M. Mood, Oirector of the Public PolicyResearch Organization at the University ofCalifornia, has advanced a much-discussed andrather extreme proposal under the title of"Universal Higher Education." Or. Mood believesthat students in the future will attend collegefull-time for only one year and that additionalhigher education will be a part-time activityextending over one's lifetime. He suggests thatevery youth attend college for one year whether ornot he or she has graduated from high.school. Hebelieves that the bulk of education beyond thefirst year should be accomplished at home throughthe use of learning consoles and video cassettes.

Other concepts are being advanced, together withexperiments to test their effectiveness.

The "British Open University" is receiving muchattention as a possible model for. some Americanexperiments in providing education at a lower costto the student and to the public. The "BritishOpen University" emphasizes a greater outreach ofuniversity programs off-campus, a change in degreestructures, and more continuing educationalopportunities.

"The university without wa "s" in this countryrepresents a similar approach to the British OpenUniversity concept. This model is being tried at anumber of colleges and universities.

Patterns of acceleration of degree programs alsoare being urged on grounds of economy andefficiency. Credit by examination is beingpracticed to an increasing extent by colleges anduniversities, thus permitting acceleration andrecognizing off-campus proficiency.

A large role in the future may be assumed byon-campus and off-campus electronic teachingdevices. This applies also to exploding library

technology through which on-campus andoff-campus access to knowledge will be the key toeconomy, efficiency and acceleration of thelearning process.

The Carnegie Commission under the leadership ofClark Kerr has taken a penetrating look at thewhole spectrum of higher education and has comeforth with some far-reaching recommendations.

Among other things, the Carnegie Commissionproposes "less time, more options." Thecommission suggests the shortening of the B.A.and M.D. programs to three years. The commissionbelieves that the time spent on the way to the B.A.degree can be shortened by one year immediatelywithout sacrificing educational quality. Thecommission believes that time spent on the Ph.D.and M.D. degrees can be reduced by an additionalone or two years. A , considerable number ofundergraduate programs and medical schoolprograms are experimenting with these procedures.

In the matter of more options, the commissionsuggests more opportunities in lieu of formalcollege work, more points of entrance and exit,stronger emphasis on continuing educationprograms, and opportunities to alternateemployment and stuuy, such as the "sandwich"programs in Great Britain.

The commission estimates that if all the reformsrecommended were implemented, operatingexpenditures for higher education could bereduced by 10 to 15 percent a year below levelsthat would otherwise prevail by 1980, or by$3 to $5 billion a year. In the opinion of thecommission, construction costs in the 1970'scould be reduced by one-third or a total for thedecade of some $5 billion.

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The Carnegie Commission's recommendations arereceiving wide and often favorable attention bygovernors, by legislators and the general public.

What does all of this mean for the highereducation community and for those charged withthe direct responsibility for professionaleducation, including veterinary medical education?

I am persuaded that leaders and policy makers inthe field of higher education should examine theCarnegie Commission's recommendations withcare, as well as other proposals and experimentsthat'are being advanced. Not to do so, would leavehigher education open to charges of smugness,inflexibility, and unwillingness to consider new,and what many feel are viable options and avenuesfor the future.

The SREB already has conducted a conference atAtlanta on June 11, 1972, on one aspect ofcurricular revisions, dealing specifically withapproaches to shortening undergraduate degreework. We can be assured that other regional andnational groups will examine various innovativeand experimental approaches to restructuring andreshaping higher education.

I would suggest that some carefully developedtechnique be created by each professionaldiscipline to explore these recommendations,proposals and innovations.

It therefore occurs to me that the sponsoringgroups of this symposium might appropriatelytake steps to explore approaches applicable to theveterinary. _medical education field. Perhaps a jointcommission or committee might be created andcharged with this responsibility. Such a proceduremight result in recommendations holding promisefor sound and accelerated progress in veterinarymedical education.

GRAND ROUNDS IN MEDICAL EDUCATION WITH MEDICAL

STUDENTS UP AND DOWN THE CENTURIES WITH A

CRYSTAL BALL

Thomas Hale Ham, M.D.Hanna-Payne Professor of Medicine and Director, Division of Research in Medical Education

Case Western Reserve University, Cleveland, Ohio

Reproduced with additions by permission of the Josiah Macy, Jr. Foundationfrom "The Changing Medical Curriculum." Report of a MacyConference: T. H. Ham, Grand Rounds with Medical Students: Through theCenturies With a Crystal Ball, pp. 183-191, 1972, Josiah Macy, Jr.Foundation, 277 Park Avenue, New York, New York 10017.

It is a privilege to report information on medicaleducation to this audience, based on an unsualhappening that occurred about one year ago. Adistinguished private foundtion, that shall benameless, offered me a small grant if I would testout their crystal ball with its two newattachments; one of them called theretrospectoscope and the other celled theprognosticator. The foundation wanted to validatethese instruments for their future use. Since Ineeded data myself in planning ahead, I acceptedthe mission provided I could make the plansmyself. This freedom was granted and I decided tomake grand rounds throughout a little more than acentury, talking directly to one medical student ineach of four different periods.

Personal interviews were carried out that broughtme first hand information from 1870, 1949, 1970,through the retrospectoscope, and, mostinteresting information from 1990, through theprognosticator. These were refreshing experiencesindeed because I found 'the integration of the dataallowed me to derive four postulates that appearessential for learning as well as a series ofprinciples for medical education and educators. Itis hoped that this information and conclusionsmay help as we plan ahead iri this period which has

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a few problems that are as yet unsolved. Becauseof limitations of time I shall not go into atechnical description of the instrumentation whichis based on the laser beam transmission ofaudiovisual communications, retrograde into thepast and projection into the future. Also, I canreport briefly that the data obtained by thismethod appears statistically significant within twostandard crystal balls.

1870. First I interviewed a student who wasabout to become a physician in 1870, a centuryago, in a small town in Ohio. He was just 21 yearsof age, was completing his three years of medicineand fully expected to be qualified in thesummertimeelirthe board of censors, allowing himto start his own practice. He was a fine lookingyoung man, had a small mustache, and a pleasingway of responding. He was a little surprised when Isaid I was calling from 1970, but he accepted this.At the age of 18 he had finished his schooling inOhio and had interviewed the doctor who was tobecome his preceptor. His preceptor was the onlyphysician in his community of about 1000 people.An' agreement was reached and, signed by thestudent and the student's parents stating that hewould serve as the apprentice to the physicianduring three years but would be allowed to go to a

medical school for two periods of 18 weeks eachin his second and third year, if all worked out. Itdid work out well because in the first year he hada chance to begin reading his preceptor's books onanatomy, botany, and materia medica andchildbirth. He dissected a sheep his first year. Itwas evident that childbirth, fevers, and accidentson the farms were important problems for thedoctor. The student was able to help considerablywith the care including the surgery, setting ofbones, making of pills and concoctions. By the endof a year and a half he knew many of the peoplein the community, knew the sick especially, andbegan to feel comfortable as he worked in theoffice and went with his preceptor in his carriage.

With reluctance concerning the value of theprogram, (his preceptor had never gone to a schoolof medicine) he was allowed, to go to a medicalschool in Ohio in the city of Cleveland where hehad .18 weeks of lectures lasting five days a week.There were six professors and he purchased aticket for fifty dollars from each of the professorsallowing him to attend. One free clinic onWednesday was attended by patients from all overthat part of Ohio. A good pathology museum,skeletons, and one or two cadavers were learningaids. He continued his work with his preceptor allsummer and returned once again to take the sameset of lectures in the third and last year of histraining. He found the lectures of some value butthe classes were quite large, being 75, so there wasnot much opportunity for discussion. He did notexamine any patients but he learned of newsciences that were coming. There was no doubt inhis mind that work with the physician in his townwas the exciting aspect of his training. He wasplanning to move to a still smaller communitywhen he was qualified so he could know all of thefamilies. His physician preceptor was a goodteacher and a respected person in the communityalthough he could do relatively little for many ofthe seriously ill patients who came to his office orwere attended in the home. There was no hospitalnear enough to use. Fevers carried away ten adultsand seven children in one winter month in 1870and abscesses were a major complication ofsurgery.

1946. I then asked to see a student in 1946 andfound that adjustment on the crystal ball was not

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too difficult. I interviewed a student who had hadfour years in a modern medical school and foundsome remarkable phenomena that were recognizedby him and his classmates. He said he had nocontact with, the community whatsoever and sawpractically. no patients during the first two yearsexcept at considerable distance or with a group ofother students. He found the departments wereexcellent indeed and were almost researchinstitutes unto themselves. There were goodopportunities to observe investigation which hadbrought great advances. These were thrilling.Somehow the faculty wanted to cover everythingbecause everything seemed so important. Theavailable material was excellent but he wasoverwhelmed by it all. He found that departmentswere such tight compartments that they did notknow what each other was teaching and they didnot seem to care. This seemed strange to mystudent who said he was buffeted from oneexamination to the other. He had a hard time todecide where to go into practice. Certainly hewould.choose an internship in a university setting.It was the only thing.

He found that grades and class standing madecompetition tough with his peers to get a topinternship. This made for discomfort with hisclassmates and the learning was done by thenumbers. But he said the clinical work wasexcellent and he felt better as he worked withchildren. He wants to do pediatrics. I wished himgood luck.

1970. It vies now possible to visit a student whowas enjoying himself in medical school in thesouthern part of the United States and I asked himhow come he was enjoying it. He said that theschool seemed to recognize his needs as a student,had given him a chance to learn on his own withguidance but with considerable freedom. In mostof the courses the faculty' had joined together toplan for the student with more than one disciplinetaking part, so that it seemed logical to relate theclinical problem and the basic science aspects frommultiple approaches on the same subject. Thisseemed obvious and permitted him to study on hisown from materials prepared by the faculty. Thefaculty had given heavy responsibility to him tolearn on his own and held him to it. He was doingmuch reading and preparation on his own and was

seeing patients at the beginning of the fir)st-yearwhich turned out to be a staggering challengebecause he felt so ignorant. However, he said therewas little contact with the community and thesepara