'75
PROBE
developed and special interest groups have emerged from all facets of veterinary medicine. Administrators of our colleges of veterinary medicine have a tremendous challenge and obligation to see that the quality of individuals entering our profession is maintained. Some critics are charging that because applicants are selected on grades alone, the wellrounded professional veterinarian has alreadv been supplanted by the coolly detached scientist." We should continue to graduate from our institutions well-rounded veterinarians who are capable of choosing any one of many interesting aspects of our profession. Post-graduate specialization from a solid base will result in a better professional individual in whatever area is chosen.
easy to offer each elective only once as occurs at the OVA, CVMA and AVMA annual meetings. d) If students were to take different electives and would therefore not receive the same course should there be the same D.V.M. degree awarded at the end? Are we headed for a D.V.M. with an asterisk or perhaps a group of degrees suitable for each specialty? 7) The argument for specialization at the undergraduate level is that it is needed to allow the vast amount of scientific data available on a species to be offered to the student. However, are we becoming too intent on cramming more information into the student and not really looking at the all round professional individual? Dr. John Herrick (2) in an article on maintaining a standard of excellence in veterinary schools stated: "With Sputnik and a new scientific era, came specialization in all the professions. In the healing professions, the art, the bedside manner, the understanding and the compassion were too often forgotten. The patient was reduced to only a number, and the would-be professional individual became a highly-trained scientific technician. Despite all attempts to circumvent this trend, veterinary medicine, too, has been succumbing to the tenor of the times. Specialty boards have
REFERENCES
1. Funk and Wagnalls Standard Dictionary of the English Language. International Edition, New York: Funk and Wagnalls. 1973. 2. HERRICIC, JOHN B. On maintaining a standard of excellence. Vet. Med. small Anim. Clin. 69: 952-954. 1974. 3. RADOSTITS, 0. M. Specialization in large animal practice. Can. Vet. J. 15: 339-344. 1974.
SPECIALIZATION - WHEN, WHERE, HOW J. M. Walker* As VETERINARIANS we are faced with an identity problem. On the one hand, by the nature of our backgrounds and our training, we are interested in the medical and surgical problems of domestic animals which requires a broad education emphasizing basic principles of animal medicine while on the other hand and for various reasons, we are compelled more and more to narrow our field of interest and move closer and closer to the term specialist onto which the description veterinarian will be tacked. It is not my purpose to argue either for or against specialization; I leave that to Dr. O'Dea and Dr. Doig. However, from my posi'551 Riverdale Avenue, #15, Ottawa, Ontario KIS 1S3
tion as a small animal practitioner, I am well aware of the pressures that have a strong influence on the trend toward specialization. There is a natural instinct to advance in whatever one does - let's call it satisfying one's ego - and regardless of what one's profession is, advancement in today's world means specialization. That along with a growing public demand for a high level of diagnostic and surgical competence are important forces influencing a trend to specialization. There is no doubt that an ever increasing number of specially trained individuals in private practice will have a strong positive influence on the standards of veterinary medicine. Achieving higher standards will have a profound effect on the image of the veterinary profession as well as enabling the profession to better meet its obligations to the public it serves.
301
CANADIAN VETERINARY JOURNAL
To discuss specialization in veterinary medicine requires stipulation. It has a different meaning to the large animal practitioner than it does to the small animal practitioner. Large animal practice is faced with a growing demand for species specialization in dairy and beef cattle, equine and swine. Within these specialty groups he must be prepared to further concentrate his interest in reproduction, nutrition, management and disease prevention. Specialization to the small animal practitioner means concentration on a variety of disciplines - radiology, surgery, clinical medicine, cardiology, anaesthesiology, ophthalmology, etc., each of which better enables him to deal with the single animal. At the present time, perhaps because of demand, specialization at the discipline level is more advanced than at the group or species level with perhaps the exception of equine specialists. Because of this and because my interests are primarily at the discipline level in small animal practice-my remarks will be directed towards the future small animal specialist.
When to Specialize Advances in knowledge and technology over the past ten years have made specialized training a very attractive alternative to the new graduate. In most cases, the decision to seek some special expertise is made after the student has had some exposure to the clinical sciences and perhaps to one particular individual and his specialty. This is usually in the last two years of undergraduate study. Most veterinary colleges now offer rotating internship programs that have proven very popular and have given a tremendous boost to the profession. They do not offer any specialist training but do provide a very convenient and efficient transition stage between graduation and concentration on one particular discipline. Many students are now taking advantage of internship programs and move into these areas upon graduation. I have some mixed feelings about this route. There is no doubt that upon graduation some students definitely know that they want to specialize. At the same time, I am certain that many who apply for internship acceptance upon graduation do so because they are still very uncertain about what they want to do. I am a firm believer in experience and certainly the first two or three years of private practice provides a myriad of experiences. This is the period in which one sees one's deficiencies most clearly. It may be a desire to correct these deficiencies that stimulates an interest in a specialty area. Special interests are some-
thing one develops with time and experience, not something that one selects. Certainly there are some real disadvantages to leaving practice after two or three years to return to school, not the least of which is a considerable drop in standard of living. It is sometimes also difficult to get back into a study routine after being away from the books for sometime. And often the return to post graduate studies involves uprooting established community and family ties. Despite these disadvantages, I think that most of us who have returned from practice for post graduate training look on those initial years in practice as very worthwhile in providing a "feeling" for the profession. How to Specialize This is a difficult question to approach. There are many avenues available depending on what one's interest is, where one decides or is accepted to study and what one is preparing for upon completion of those studies. Certainly at this point in time, the available supply of highly trained specialists at veterinary colleges who are prepared or able to de-
velop formalized residency training programs is limited. In other words, the base for specialty training must be broadened considerably to meet the increased demand. Graduates of today are going to be in the vanguard of meeting this demand. We have to fill the teaching quotas before the requirements of private practice can be met. The development of specialists in human medicine involves a well defined program of training. Following a rotating internship program designed to give a broad base of experience, the medical graduate spends at least four and sometimes five years of residency in a particular discipline. This is followed by a series of written and oral exams before final certification. Specialization in veterinary medicine should follow this general scheme. It may be possible during residency training to devote a part of the time towards research and a post graduate degree. I see this as a necessity for those interested in a teaching or academic career but of no advantage if you plan to enter private practice. Board certification is now possible in a few disciplines, for example radiology, clinical pathology and surgery. At least two years of study under a board certified specialist is required prior to board examination. There is at present no Canadian board certification, however Canadians are certified as diplomates of American specialty colleges. The solution to this problem is long term, but it is a goal we must work towards.
302
PROBE
Where to Specialize Part of the process of gaining a particular expertise is the collection of a wide spectrum of ideas and facts, and building upon these to develop your own individual perspective. This is best accomplished through exposure to new environments, new people and ideas and new techniques. There is a limit to what you can glean from one source and often through continual exposure the student becomes a reflection of the teacher. I would encourage anyone considering post graduate training to undertake it at a college other than his alma mater. Go out there and learn different approaches and concepts, then perhaps you can infuse them into the system. I cannot advise you in specific terms as to where to specialize. For the most part each school has its strong and weak points and these reputations have a way of getting around. Often this is your only means of choosing where to study. Frequently one seeks to study under a particularly noted individual. Be careful of this approach. He may be too well known and in such demand that you rarely see him. Finally, I would like to mention the role of the specialist in small animal practice. Certainly as I have mentioned, there is a demand on the part of the public for a high level of diagnostic competence and specialists are necessary to provide someone to which the general practitioner can turn. The present structuring of
'75 most group practices is such that each member - whether a specialist or not - must be responsible for his share of the routine work load. In a busy practice this will limit considerably the time available to concentrate on one's specialty. In the final analysis, the most crucial factor as always is economics. The overwhelming majority of cases seen by busy small animal practitioners do not require any special training other than that provided by one's basic veterinary training and regular refresher courses. As I see it now, the future of the specialist in private practice is as a consultant or operating solely on a referral basis. This concept is already in practice in some areas of the United States. In summary, a greater degree of specialization in veterinary medicine is inevitable and, I feel, desirable. The student considering specialization must have a broad basic training on which to build. This should be attained either through two or three years of practice experience after graduation or an internship program. Following this, a residency patterned after that developed in human medicine and finally board certification. Research per se and post graduate degrees are of value only to those interested in teaching or research careers. Where one receives post graduate training is a subjective choice depending on one's imterests.
CONCOURS "SCHERING" POUR iTUDIANTS EN MiDECINE VETERINAIRE Les prix "Schering" sont offerts aux finissants 3. Les textes peuvent etre soumis en frangais de chacun des trois colleges veterinaires du ou en anglais. Canada. 4. Un "Comite de Selection" dans chaque Trois prix de $100 seront disponibles pour college sera responsable du choix des dix chaque college. meilleurs rapports de cas cliniques et les fera parvenir, avant le 1 mars 1976, a REGLEMENTS l'adresse suivante: 1. Rligibilite: Le concours ne s'adresse qu'aux President, Comite de Redaction finissants d'un college veterinaire du L'Association canadienne des veterinaires Canada. 360 avenue Bronson 2. Les prix seront attribues aux auteurs des Ottawa, Ontario KIR 6J3 meilleurs rapports de cas cliniques (de pour jugement final par le "Comite de Repr6f6rence: 300 a 1,000 mots), redig6s daction" de l'Association canadienne des sous forme convenable pour fin de publiv6terinaires. cation dans la "Revue vet6rinaire cana- 5. Les prix seront remis a l'occasion d'une dienne". Veuillez consulter les "Directives ceremonie officielle. aux auteurs" et les derniers numeros de la 6. La Revue se reserve le droit de publier, revue pour renseignements sur la forme et selon les regles habituelles de l'edition, la presentation. les articles primes. 303
PROBE
developed and special interest groups have emerged from all facets of veterinary medicine. Administrators of our colleges of veterinary medicine have a tremendous challenge and obligation to see that the quality of individuals entering our profession is maintained. Some critics are charging that because applicants are selected on grades alone, the wellrounded professional veterinarian has alreadv been supplanted by the coolly detached scientist." We should continue to graduate from our institutions well-rounded veterinarians who are capable of choosing any one of many interesting aspects of our profession. Post-graduate specialization from a solid base will result in a better professional individual in whatever area is chosen.
easy to offer each elective only once as occurs at the OVA, CVMA and AVMA annual meetings. d) If students were to take different electives and would therefore not receive the same course should there be the same D.V.M. degree awarded at the end? Are we headed for a D.V.M. with an asterisk or perhaps a group of degrees suitable for each specialty? 7) The argument for specialization at the undergraduate level is that it is needed to allow the vast amount of scientific data available on a species to be offered to the student. However, are we becoming too intent on cramming more information into the student and not really looking at the all round professional individual? Dr. John Herrick (2) in an article on maintaining a standard of excellence in veterinary schools stated: "With Sputnik and a new scientific era, came specialization in all the professions. In the healing professions, the art, the bedside manner, the understanding and the compassion were too often forgotten. The patient was reduced to only a number, and the would-be professional individual became a highly-trained scientific technician. Despite all attempts to circumvent this trend, veterinary medicine, too, has been succumbing to the tenor of the times. Specialty boards have
REFERENCES
1. Funk and Wagnalls Standard Dictionary of the English Language. International Edition, New York: Funk and Wagnalls. 1973. 2. HERRICIC, JOHN B. On maintaining a standard of excellence. Vet. Med. small Anim. Clin. 69: 952-954. 1974. 3. RADOSTITS, 0. M. Specialization in large animal practice. Can. Vet. J. 15: 339-344. 1974.
SPECIALIZATION - WHEN, WHERE, HOW J. M. Walker* As VETERINARIANS we are faced with an identity problem. On the one hand, by the nature of our backgrounds and our training, we are interested in the medical and surgical problems of domestic animals which requires a broad education emphasizing basic principles of animal medicine while on the other hand and for various reasons, we are compelled more and more to narrow our field of interest and move closer and closer to the term specialist onto which the description veterinarian will be tacked. It is not my purpose to argue either for or against specialization; I leave that to Dr. O'Dea and Dr. Doig. However, from my posi'551 Riverdale Avenue, #15, Ottawa, Ontario KIS 1S3
tion as a small animal practitioner, I am well aware of the pressures that have a strong influence on the trend toward specialization. There is a natural instinct to advance in whatever one does - let's call it satisfying one's ego - and regardless of what one's profession is, advancement in today's world means specialization. That along with a growing public demand for a high level of diagnostic and surgical competence are important forces influencing a trend to specialization. There is no doubt that an ever increasing number of specially trained individuals in private practice will have a strong positive influence on the standards of veterinary medicine. Achieving higher standards will have a profound effect on the image of the veterinary profession as well as enabling the profession to better meet its obligations to the public it serves.
301
CANADIAN VETERINARY JOURNAL
To discuss specialization in veterinary medicine requires stipulation. It has a different meaning to the large animal practitioner than it does to the small animal practitioner. Large animal practice is faced with a growing demand for species specialization in dairy and beef cattle, equine and swine. Within these specialty groups he must be prepared to further concentrate his interest in reproduction, nutrition, management and disease prevention. Specialization to the small animal practitioner means concentration on a variety of disciplines - radiology, surgery, clinical medicine, cardiology, anaesthesiology, ophthalmology, etc., each of which better enables him to deal with the single animal. At the present time, perhaps because of demand, specialization at the discipline level is more advanced than at the group or species level with perhaps the exception of equine specialists. Because of this and because my interests are primarily at the discipline level in small animal practice-my remarks will be directed towards the future small animal specialist.
When to Specialize Advances in knowledge and technology over the past ten years have made specialized training a very attractive alternative to the new graduate. In most cases, the decision to seek some special expertise is made after the student has had some exposure to the clinical sciences and perhaps to one particular individual and his specialty. This is usually in the last two years of undergraduate study. Most veterinary colleges now offer rotating internship programs that have proven very popular and have given a tremendous boost to the profession. They do not offer any specialist training but do provide a very convenient and efficient transition stage between graduation and concentration on one particular discipline. Many students are now taking advantage of internship programs and move into these areas upon graduation. I have some mixed feelings about this route. There is no doubt that upon graduation some students definitely know that they want to specialize. At the same time, I am certain that many who apply for internship acceptance upon graduation do so because they are still very uncertain about what they want to do. I am a firm believer in experience and certainly the first two or three years of private practice provides a myriad of experiences. This is the period in which one sees one's deficiencies most clearly. It may be a desire to correct these deficiencies that stimulates an interest in a specialty area. Special interests are some-
thing one develops with time and experience, not something that one selects. Certainly there are some real disadvantages to leaving practice after two or three years to return to school, not the least of which is a considerable drop in standard of living. It is sometimes also difficult to get back into a study routine after being away from the books for sometime. And often the return to post graduate studies involves uprooting established community and family ties. Despite these disadvantages, I think that most of us who have returned from practice for post graduate training look on those initial years in practice as very worthwhile in providing a "feeling" for the profession. How to Specialize This is a difficult question to approach. There are many avenues available depending on what one's interest is, where one decides or is accepted to study and what one is preparing for upon completion of those studies. Certainly at this point in time, the available supply of highly trained specialists at veterinary colleges who are prepared or able to de-
velop formalized residency training programs is limited. In other words, the base for specialty training must be broadened considerably to meet the increased demand. Graduates of today are going to be in the vanguard of meeting this demand. We have to fill the teaching quotas before the requirements of private practice can be met. The development of specialists in human medicine involves a well defined program of training. Following a rotating internship program designed to give a broad base of experience, the medical graduate spends at least four and sometimes five years of residency in a particular discipline. This is followed by a series of written and oral exams before final certification. Specialization in veterinary medicine should follow this general scheme. It may be possible during residency training to devote a part of the time towards research and a post graduate degree. I see this as a necessity for those interested in a teaching or academic career but of no advantage if you plan to enter private practice. Board certification is now possible in a few disciplines, for example radiology, clinical pathology and surgery. At least two years of study under a board certified specialist is required prior to board examination. There is at present no Canadian board certification, however Canadians are certified as diplomates of American specialty colleges. The solution to this problem is long term, but it is a goal we must work towards.
302
PROBE
Where to Specialize Part of the process of gaining a particular expertise is the collection of a wide spectrum of ideas and facts, and building upon these to develop your own individual perspective. This is best accomplished through exposure to new environments, new people and ideas and new techniques. There is a limit to what you can glean from one source and often through continual exposure the student becomes a reflection of the teacher. I would encourage anyone considering post graduate training to undertake it at a college other than his alma mater. Go out there and learn different approaches and concepts, then perhaps you can infuse them into the system. I cannot advise you in specific terms as to where to specialize. For the most part each school has its strong and weak points and these reputations have a way of getting around. Often this is your only means of choosing where to study. Frequently one seeks to study under a particularly noted individual. Be careful of this approach. He may be too well known and in such demand that you rarely see him. Finally, I would like to mention the role of the specialist in small animal practice. Certainly as I have mentioned, there is a demand on the part of the public for a high level of diagnostic competence and specialists are necessary to provide someone to which the general practitioner can turn. The present structuring of
'75 most group practices is such that each member - whether a specialist or not - must be responsible for his share of the routine work load. In a busy practice this will limit considerably the time available to concentrate on one's specialty. In the final analysis, the most crucial factor as always is economics. The overwhelming majority of cases seen by busy small animal practitioners do not require any special training other than that provided by one's basic veterinary training and regular refresher courses. As I see it now, the future of the specialist in private practice is as a consultant or operating solely on a referral basis. This concept is already in practice in some areas of the United States. In summary, a greater degree of specialization in veterinary medicine is inevitable and, I feel, desirable. The student considering specialization must have a broad basic training on which to build. This should be attained either through two or three years of practice experience after graduation or an internship program. Following this, a residency patterned after that developed in human medicine and finally board certification. Research per se and post graduate degrees are of value only to those interested in teaching or research careers. Where one receives post graduate training is a subjective choice depending on one's imterests.
CONCOURS "SCHERING" POUR iTUDIANTS EN MiDECINE VETERINAIRE Les prix "Schering" sont offerts aux finissants 3. Les textes peuvent etre soumis en frangais de chacun des trois colleges veterinaires du ou en anglais. Canada. 4. Un "Comite de Selection" dans chaque Trois prix de $100 seront disponibles pour college sera responsable du choix des dix chaque college. meilleurs rapports de cas cliniques et les fera parvenir, avant le 1 mars 1976, a REGLEMENTS l'adresse suivante: 1. Rligibilite: Le concours ne s'adresse qu'aux President, Comite de Redaction finissants d'un college veterinaire du L'Association canadienne des veterinaires Canada. 360 avenue Bronson 2. Les prix seront attribues aux auteurs des Ottawa, Ontario KIR 6J3 meilleurs rapports de cas cliniques (de pour jugement final par le "Comite de Repr6f6rence: 300 a 1,000 mots), redig6s daction" de l'Association canadienne des sous forme convenable pour fin de publiv6terinaires. cation dans la "Revue vet6rinaire cana- 5. Les prix seront remis a l'occasion d'une dienne". Veuillez consulter les "Directives ceremonie officielle. aux auteurs" et les derniers numeros de la 6. La Revue se reserve le droit de publier, revue pour renseignements sur la forme et selon les regles habituelles de l'edition, la presentation. les articles primes. 303
