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Paper
Paper Stakeholder consultation on tracking in UK veterinary degrees: part 2 E. Crowther, K. Hughes, I. Handel, R. Whittington, M. Pryce, S.Warman, S. Rhind, S. Baillie There is ongoing debate in the profession as to whether veterinary students should focus on one (or a small number of) species during their undergraduate training (ie, track). This paper presents the qualitative data from surveys evaluating UK stakeholder opinion on introducing partial tracking (whereby students continue to qualify able to practise in all species) and full tracking (students qualify in a limited number of species with restricted registration). Surveys were distributed to practitioners, students and university staff; 1061 responses were completed. Thematic framework analysis was conducted on the free-text responses; responses were coded to a hierarchical framework developed inductively from the data. Six major themes were identified: choice, flexibility, competency and knowledge, stakeholder implications, specialisation and ‘what is a vet?’. The majority of the themes related to both full and partial tracking, usually being more pronounced in full tracking. The theme ‘choice’ is particularly important in light of the study’s quantitative findings on students’ awareness of the profession and their career aspirations (presented in a previous paper); should tracking be implemented, veterinary schools will need to take a proactive role in educating and assisting students while making career choices.
Introduction
This paper is the second from a study evaluating stakeholder opinion on tracking in UK veterinary curricula. The first paper presented the quantitative analysis and found widespread support from university staff, practitioners and veterinary students for the introduction of partial tracking (see Table 1) in the UK. The study identified that a move towards full tracking, with restricted registration of veterinary surgeons, was not supported. The concept of tracking in veterinary education is not new; the Universities of California Davis and Veterinary and Pharmaceutical Sciences in Brno, Czech Republic, introduced tracking in the mid1970s (Vecerek 2006, Klosterman and others 2009). In the UK, veterinary curricula include elective rotation(s) of variable duration. Some schools also have track rotations, but no curriculum contains the amount of elective study permissible within European regulations; 20 per cent of the curriculum, providing core competencies are met (European Association of Establishments for Veterinary Education Veterinary Record (2014) E. Crowther, BVSc, MRCVS, S. Warman, BSc, BVMS, DipECVIMca, DSAM, FHEA, MRCVS, S. Baillie, BVSc, CertCHP, PhD, MRCVS, School of Veterinary Sciences, Langford House, Langford, Bristol BS40 5DU, UK K. Hughes, BVM&S, BSc, MSc, MRCVS, I. Handel, BVSc, MSc, PhD, MRCVS, R. Whittington, BVSc, MRCVS, S. Rhind, BVMS, PhD, FRCPath, FHEA, MRCVS, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh,
doi: 10.1136/vr.102341 Easter Bush Veterinary Centre, Midlothian EH25 9RG, UK M. Pryce, BVetMed, MRCVS, Avonlodge Veterinary Group, 283 Wells Road, Bristol BS3 1PW, UK; E-mail for correspondence: [email protected] Provenance: not commissioned; externally peer reviewed Accepted April 16, 2014
and Federation of Veterinarians of Europe 2012). Many theoretical advantages and disadvantages to tracking have been discussed in the veterinary education literature; however, there is little evidence to document these; Klosterman and others (2009) remark on the similarities of tracked and untracked degrees on graduate careers. Potential advantages include (Karg 2000, Prescott and others 2002, Radostits 2003, Vecerek 2006, Haarhuis and others 2009, Chigerwe and others 2010) improved graduate competence, with concurrent improved competence of the profession better assessment of students matching faculty resources to more interested students; avoids teaching students irrelevant content space in the curriculum for detailed study in selected areas for smaller disciplines; a means of addressing the shortage of vets in less popular areas by controlling admissions increased satisfaction of career choice strengthened credibility of profession. Potential disadvantages include (Prescott and others 2002, Chigerwe and others 2010) limiting graduate options and necessitating retraining to change species required change in licensing disruption to admissions systems, including students learning to ‘beat’ admissions systems by feigning interest in less popular disciplines disruption to education, including different resource requirements and examinations for each discipline the need for mixed practitioners. The aim of this study was to evaluate opinion on full and partial tracking in veterinary degrees in order to inform the ongoing debate on this area. Due to a lack of UK literature on the topic, the authors July 26, 2014 | Veterinary Record
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Paper TABLE 1: Definitions relating to tracking Term
Our definition (as used in surveys)
Equivalent terms
Partial tracking
Students are trained across all species but are able to ‘track’ and/or undertake an elective in one or a limited number of species or disciplines. Students continue to undertake a multispecies final examination and still qualify to practise in all species. No longer teaching all areas of veterinary medicine during the undergraduate course. In ‘full tracking’, the students’ studies are directed to a ‘track’ of one or a limited number of species. Students would undertake a species-specific final examination, and qualify to practise in this area only. This would be a new concept in the UK and would require changes to Royal College of Veterinary Surgeons regulations
Differentiated curriculum (Vecerek 2006) Career streaming (Prescott and others 2002)
Full tracking
used a mixed methods approach to establish stakeholder opinion and to understand the reasoning behind such opinion. This paper presents the qualitative analysis of data from a survey distributed to UK university staff, practitioners and students. Many qualitative methods have been described; thematic framework analysis (a type of content analysis) was chosen as it allows the researcher to identify manageable categories or ‘themes’ from large datasets (Elo and Kyngäs 2008), while maintaining links to original verbatim comments from the participants. It has recently been used in animal welfare (Collins and others 2012), behaviour (Roshier and McBride 2013) and veterinary educational (Magnier and others 2011) research. This study was granted ethical approval from the University of Bristol Faculty of Medicine & Veterinary Science Committee for Ethics (reference FMV-111210).
Materials and methods
Surveys were distributed to three stakeholder groups; university staff, students and practising veterinary surgeons. University staff and students in the first, fourth and final years were sent an email containing a link to an online survey hosted by SurveyMonkey (www.surveymonkey.com). The practitioner survey is provided in online supplementary appendix 1 as an example. Practitioners were sent paper surveys with return envelopes to encourage participation. Several £25 voucher prizes were offered as incentives. All questionnaires contained demographic questions, closed answer questions on the respondents’ careers and Likert-style questions relating to opinion on partial and full tracking. The surveys also included free text questions regarding perceived advantages and disadvantages to partial and full tracking, with space at the end for any additional comments.
Data analysis
Responses where the demographic or Likert-style questions were incomplete were excluded. Descriptive statistics of demographic data were compared with Royal College of Veterinary Surgeons (RCVS) data for practitioners and students (Robertson-Smith and others 2010, Royal College of Veterinary Surgeons 2012). There were no available data to which the university staff sample could be compared.
Quantitative data analysis
Descriptive statistics were used to explore the opinions of the three groups, and univariate analysis was used to compare independent variables within each stakeholder group. Students’ knowledge of the professions’ employment profile was evaluated, and their career aspirations compared with the UK employment profile. The quantitative method is fully described in ‘part 1′ (Bright and others, 2014).
Qualitative data analysis
Thematic framework analysis involves an iterative process of coding and grouping into categories (or ‘themes’) related extracts from documents, surveys, interviews or focus groups. The themes can be determined using the raw data (an inductive approach) or, where it exists, from previous literature (a deductive approach). The themes are organised into a framework, to which additional data can be coded, and from which observations and conclusions can be drawn. An inductive approach was chosen, whereby themes and subthemes were identified from a subset of the data and used to create a coding framework. The remaining data were then coded to this framework. To create the coding framework, two authors independently coded 10 per cent of the free text. The two sets of codes were compared and were grouped according to emerging major themes. The sets Veterinary Record | July 26, 2014
Specialisation in veterinary education (Vecerek 2006) Career tracking (Prescott and others 2002)
of codes were then merged. Each major theme was discussed and codes condensed into a smaller number of subthemes within each major theme. This provided a hierarchical framework consisting of major themes containing subthemes, which in turn contained codes obtained directly from the data. The two authors then independently coded three responses from each stakeholder group to the developed framework. This coding was compared and discrepancies resolved by discussion, with adaptations made to the framework where deemed necessary. Finally, each subtheme was defined, using inclusion and exclusion criteria, and examples, where appropriate. The remaining responses were coded to this framework by the lead author. Where codes related to more than one theme, they were coded to all relevant themes in order to explore the relationships between ideas. Codes from themes emerging in the latter 90 per cent of responses were coded to new themes to avoid changing the meaning of existing themes and losing nuances in the data. Qualitative analysis was performed using NVivo 10.
Results
The sample included 203 university staff, 158 practitioners and 700 students after exclusions. In total, 7 (3.4 per cent) university staff, 4 (2.5 per cent) practitioners and 40 (5.7 per cent) of students refrained from answering any free text questions. Six major themes were identified using thematic framework analysis: choice, flexibility, competency and knowledge, stakeholder implications, specialisation and ‘what is a vet?’. These broad areas linked and overlapped, and for many of the subthemes, there were counterexamples within the data. Quotes from the data are presented within the results to illustrate key ideas, counterarguments or nuances (spelling mistakes have been corrected). Most subthemes related to both full and partial tracking, with the concept being more pronounced in relation to full tracking, for example, a reduction in career flexibility was perceived as worse in full tracking compared with partial tracking.
Choice
Choice over course material was perceived to be positive as it allows students to pursue an area of interest, improves the relevance of the course to future employment and gives an element of control to the learner. Negative implications included the possibility of a student, or graduate, changing their mind or regretting their choice. Issues regarding when a choice would have to be made were raised; all groups acknowledged that not all students know what they want to do from an early stage, and that making such a decision would be difficult given the consequences. At the undergraduate stage, despite undertaking significant work experience and EMS placements, it is difficult to choose which track to take and to be sure that it is the right track. University staff All groups recognised that students would choose their track for a variety of reasons, including interest, enhancing employment prospects or improving an area of weakness. It was suggested that tracking may disadvantage graduates applying for a job outwith their track. It was considered important to obtain a range of experiences before, during or after veterinary school before making a decision on career direction. To avoid influencing participants, potential track options were not mentioned in the survey questions, but many questions were raised by respondents; would there be a mixed track, would options vary by
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Paper university? Would there be discipline tracks, such as anaesthesia and imaging? If both options [partial track and full track] were available, people who didn’t fully track would be at a disadvantage to those who did, forcing people to full track. Student The ideal would be if you could have the choice of doing either full tracking or partial tracking depending on personal preference, how practical this would be to put in place I do not know! Student
Competency and knowledge
Respondents predicted that partial tracking would improve graduates’ day one knowledge and competency in the area of interest, providing an advantage when seeking employment in the tracked area: full tracking was seen to provide more competent graduates who may require less supervision in their first job. However, some thought the effect of partial tracking would be negligible, particularly if the training prioritised specialisation above first opinion practice. [Regarding partial tracking:] Communication is the key - no amount of ‘focussing’ is going to substitute for hands on experience. More time with clients would certainly help. More indepth detail may well not. Practitioner Concerns were raised that partial tracking could pose a risk to the non-tracked species, as due to reduced curriculum time and reduced student interest, graduates would be less competent in these species while still being able to practise with them. Conversely, some felt partial tracking would mistakenly reduce graduates’ confidence in the non-tracked species. An identified advantage of current veterinary education, and of partial tracking, was the ability to transfer skills and knowledge between species; to help problem solve in new situations and to increase opportunities for practising skills. Remembering the anatomy and physiology of the equine gut makes the rabbit much more understandable. Practitioner The breadth of veterinary degrees was deemed positive and viewed as particularly important to cross-species disciplines such as anaesthesia, imaging and pathology. However, some thought it was no longer feasible to be competent across all species. A lack of comparative knowledge and the ‘wider picture’ were predicted disadvantages of full tracking. Respondents valued a strong ‘all round’ foundation on which to base further training; some thought this was the role of the veterinary degree, while others thought this could be the preclinical stage. This foundation was thought to improve transferable skills, scientific thinking and ease subsequent career changes.
Flexibility
The ability to treat all species was seen as a major benefit when considering job or career changes, and even when working within the same practice; as presented in ‘part 1’, 26 per cent of practitioners reported making a significant change in career. Lack of such flexibility was viewed as a significant disadvantage to full tracking; reasons such as changing from large to small animal practice due to injury or family commitments were cited as concerns. Respondents mentioned that full tracking would necessitate considerable retraining, with associated time and expense, to change career; others highlighted that the current lack of formal retraining requirements is a concern that would continue with partial tracking. It was suggested that veterinary schools would need to provide additional modules for veterinary surgeons changing species. The effects of tracking on other career opportunities, such as working in research, government or working abroad, were also discussed. Respondents generally thought that partial tracking would not cause restrictions, but that full tracking would preclude these options. Some overseas students commented that they had chosen to study in the UK to avoid tracking, although as presented in part 1, country of origin did not relate to opinion on tracking.
One of the current main advantages of having a veterinary degree is the wide range of different job opportunities and [full tracking] would significantly narrow that. Student Participants thought tracking may affect ability to fit in with the job market; if graduates were unable to gain employment within their track, they may be unable to find work with different species. Similarly, if the professions’ employment profile changes in the future, the work force would not be able to meet demands. Several consequences of reduced flexibility were suggested, primarily in relation to full tracking. These included a higher attrition rate from veterinary courses if students could not change their track, the cost of retraining to change career, increased unemployment, more veterinary surgeons leaving the profession and worsening mental health.
Stakeholder implications Clients and animals
Respondents suggested tracked graduates may provide a better service to clients and their animals, and some commented that a higher service was now expected of veterinary surgeons. However, concerns were raised that with partial tracking, the standard of care for nontracked species would be worse, potentially causing welfare problems. This would be avoided by full tracking and restricted registration, which was seen to potentially improve care for minor species, provided a specialist was available. Small animal practices often see a number of exotic species and unless there is a practice member who has a particular interest, these patients often receive rather basic treatment at the hands of a non-specialist. Being unqualified to treat these patients [would] therefore ensure they were always seen by a specialist. Practitioner The major implication of full tracking for clients was that one vet could not treat all the species they owned, which would necessitate having more than one veterinary surgeon or practice, and possibly increasing the cost of veterinary care. Respondents noted that considerable education of the public would be necessary should full tracking be implemented. One proposed advantage of both tracking systems was the reduction in animals used to teach students who were not interested in that species, with consequent animal welfare benefits.
Practices and employers
The main concern for practices was how mixed practices would fare, although there were various perceptions about the importance of this issue; some felt that there is a trend even in mixed practices for veterinary surgeons to work with only a small number of species. Covering the out of hours rota was seen as a particular problem. It was also thought that new graduates value time in mixed practice before focusing on one species, which would not be possible with full tracking. Tracking could potentially affect student engagement while on extramural studies, providing a more rewarding experience for all if the placement was in the tracked species, and becoming a ‘box-ticking’ exercise if in the non-tracked species.
The profession as a whole
Many respondents feared that tracked degrees would fragment the profession, whereby veterinary surgeons in different areas had little in common. This was predicted to hinder the transfer of knowledge and skills between groups. We also need to make sure that we have a voice in public debate and come across as an integrated body of informed, dedicated professionals. I don’t think that “dividing” the students in this way before they have even graduated is a good way to promote this. University staff The considerable challenges of implementing full tracking were mentioned, for example, enforcing restricted registration and retraining. Additionally, the role of veterinary surgeons in treating all animals in an emergency would need to be revised. Respondents mentioned this obligation in relation to casualty animals, and to epidemic disease outbreaks. An outbreak of the scale of the 2001 Foot and Mouth Disease July 26, 2014 | Veterinary Record
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Paper crisis would be an even greater challenge to the profession if MsRCVS could not treat all species. Another concern raised by stakeholders was the potential of having a skewed graduate population that did not match the profession’s needs. It was expected that there would be an oversupply of small animal veterinary surgeons and an undersupply of large animal veterinary surgeons.
Implications for veterinary schools and education
One suggested advantage of tracking was the improved use of university resources and cases; these would not be wasted in teaching students who were unlikely to need the experience. Some thought tracking could allow a higher ratio of staff and cases to students, as not all the material would be taught to all students; the effect of this with partial tracking was thought to be minimal. Students may be more engaged with the curriculum as they would have actively chosen to participate in the areas they study. However, some respondents argued that it may be more difficult to justify resources for a smaller student body. Lower numbers in e.g. farm may cause problems for university funding and staffing. Practitioner Other perceived barriers to tracking included timetabling and the logistics of implementing tracked courses, including difficulties assessing students on different tracks, and an increased workload for staff. The difficulty of predicting or managing the number of students on each track, which could vary from year to year, was discussed. Universities would need to educate students on the job market and actively support students in making informed decisions regarding their track choice. The idea of a ‘quota’ of students on each track mapped to the prevailing job market was raised, which may affect admissions procedures. However, there were implications of students not being able to study on their track of choice. The role of a veterinary degree was discussed; whether it should primarily provide a broad scientific foundation or provide graduates that can integrate quickly into practice. I think more and more practices would prefer and will need more specialised graduates, fewer practices will be able to take new grads and train them when the veterinary schools could / should be producing the kind of graduates we need. Practitioner I believe that it is more important to teach veterinary students the fundamentals of science and scientific thinking. Practitioner It was recognised that tracking could reduce curriculum load although this may not be significant in partial tracking. Full tracking was thought to potentially enable a shortened course with reduced cost to students; alternative changes were suggested, such as a tracked year after the current five-year course, or a structured career progression. Whether any change is necessary was also questioned. Regarding partial tracking: It is not a big enough move. Omnicompetence is NOT possible. Practitioner What is the problem? If it is competency then the current framework is perfectly capable of producing competent vets. Practitioner
Specialisation
The researchers avoided the term ‘specialisation’ as this is a specific status defined by the RCVS, whereas tracking would provide a focus on a small number of species at the day one level. However, respondents appeared to use the term interchangeably. Some felt that specialisation should occur after graduation, whereas others thought that pre-graduation specialisation was more aligned with the profession. It was felt that full tracking would facilitate later specialisation in the same species, but may mean students felt less in need of further postgraduate training. The potential challenges associated with pursuing specialisation in a different area to the track were raised, as was specialising in cross-species disciplines. Veterinary Record | July 26, 2014
What is a vet?
Many comments related to the identity of veterinary surgeons in the UK, and the pride the profession has in its diversity. A fundamental characteristic of a veterinary surgeon was the ability to treat all species, particularly in an emergency situation; an obligation that many considered important. There was overwhelming support for a broad education and a basic knowledge across all species. Respondents felt the public expected this from the profession. Full tracking in particular was seen as a threat to the basic identity of a veterinary surgeon, although a few individuals felt that perpetuating the ‘myth’ of traditional, mixed practice was of no benefit. I believe anyone who calls themselves a veterinary surgeon should have a knowledge of all common animals. Practitioner Veterinarians and students take pride in the quote “Real doctors treat more than one species.” Student
Discussion
The aim of this study was to evaluate UK stakeholder opinion on tracking in veterinary curricula. Thematic framework analysis is a documented method of condensing large amounts of qualitative data into manageable categories (themes) and was used in this study to identify six major themes in over 1000 survey responses. Within qualitative methods, focus groups or interviews encourage in-depth discussion of the topics and comparison of participants’ opinions, while free text comments typically attract brief comments from respondents (Hanson and others 2011). However, conducting a survey as a mixed methods approach allowed the researchers to establish consensus using quantitative methods and to gain an insight into why such opinions were held using qualitative methods. Comments were typically brief and restricted to the participants’ initial opinion rather than a discussion of possible viewpoints; however, due to the large volume of data from a range of stakeholders, many nuances, counterarguments and details to each theme were identified, and the researchers believe that data saturation had been achieved for the questions posed. Without prompting, the participants identified the advantages and disadvantages of tracking previously discussed in the literature (Karg 2000, Prescott and others 2002, Radostits 2003, Vecerek 2006, Haarhuis and others 2009, Chigerwe and others 2010). For example, each group noted that tracking would improve the use of university resources; however, practitioners and university staff recognised that not all universities would be able to sustain resources across all tracks. This related to suggestions on how universities may need to collaborate to provide the required curriculum. Further investigation could establish the opinion of other stakeholder groups, for example, clients and industry, as previous work has shown that clients have different opinions to veterinary surgeons on the important attributes of veterinary surgeons (Mellanby and others 2011). Paper 1 demonstrated that the majority of respondents supported a move towards partial tracking, but were opposed to full tracking and restricted registration. Paper 1 also identified that students’ career aspirations were different in different year groups with final year students’ aspirations mapped to recent graduate employment figures (Robertson-Smith and others 2010). This is important in light of the theme ‘choice’ emerging from this qualitative data as it highlights the responsibility of universities in assisting students in making informed decisions on their choice of track, should tracking be implemented. It was suggested by respondents in this survey that support could be provided by educating students on employment prospects and ensuring students had sufficient exposure to different areas of the profession prior to making their choice. At the University of Utrecht, students have ‘profession-oriented weeks’ and tutorials prior to deciding their track choice at the end of the first trimester. This university also has an admissions programme to ensure sufficient students enter the food/ veterinary public health track (van Beukelen 2004). Interestingly the qualitative data reported here predicted an oversupply of small animal (particularly exotic) veterinary surgeons, with an undersupply of large animal veterinary surgeons, which is not supported by the data on students’ career aspirations.
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Paper Another major theme that emerged in this study was ‘flexibility’. This has previously been studied in relation to the career outcomes of tracked (University of California Davis) and non-tracked (Ohio State University (OSU)) graduates. Klosterman and others (2009) found that more graduates from the non-tracked degree (OSU) entered mixed practice, but regardless of degree type, a high number of those in mixed practice subsequently changed species. When those that had initially started in mixed practice were excluded, those from both degree types changed species with similar frequency (Klosterman and others 2009). This supports our respondents’ view that partial tracking would have less of an effect on career changes than full tracking. It was interesting to note the emergence of a more philosophical theme, ‘what is a vet?’. The profession appears to have a very strong identity, of which the ability to treat all common species is core. This also appears to be projected onto other stakeholders, for example, respondents thought that clients expect veterinary surgeons to have knowledge of many species. There is a feeling that clients expect a higher level of care than previously, and that within a few years of graduation, veterinary surgeons are currently often ‘tracked’ to a few species. We should acknowledge that the profession is not a static entity, and, as alluded to in survey responses, roles are changing, and will continue to change in the future. It is therefore crucial that we continue to discuss and debate the structure of veterinary education to ensure our graduates are best placed to succeed in their careers and that the profession as a whole can meet the demands of our changing world.
Acknowledgements
The authors gratefully acknowledge the participants who completed the survey. In particular, they would like to thank the contacts at UK veterinary schools for facilitating the dissemination of the survey within their universities.
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Stakeholder consultation on tracking in UK veterinary degrees: part 2 E. Crowther, K. Hughes, I. Handel, R. Whittington, M. Pryce, S. Warman, S. Rhind and S. Baillie Veterinary Record 2014 175: 87 originally published online May 12, 2014
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Paper
Paper Stakeholder consultation on tracking in UK veterinary degrees: part 2 E. Crowther, K. Hughes, I. Handel, R. Whittington, M. Pryce, S.Warman, S. Rhind, S. Baillie There is ongoing debate in the profession as to whether veterinary students should focus on one (or a small number of) species during their undergraduate training (ie, track). This paper presents the qualitative data from surveys evaluating UK stakeholder opinion on introducing partial tracking (whereby students continue to qualify able to practise in all species) and full tracking (students qualify in a limited number of species with restricted registration). Surveys were distributed to practitioners, students and university staff; 1061 responses were completed. Thematic framework analysis was conducted on the free-text responses; responses were coded to a hierarchical framework developed inductively from the data. Six major themes were identified: choice, flexibility, competency and knowledge, stakeholder implications, specialisation and ‘what is a vet?’. The majority of the themes related to both full and partial tracking, usually being more pronounced in full tracking. The theme ‘choice’ is particularly important in light of the study’s quantitative findings on students’ awareness of the profession and their career aspirations (presented in a previous paper); should tracking be implemented, veterinary schools will need to take a proactive role in educating and assisting students while making career choices.
Introduction
This paper is the second from a study evaluating stakeholder opinion on tracking in UK veterinary curricula. The first paper presented the quantitative analysis and found widespread support from university staff, practitioners and veterinary students for the introduction of partial tracking (see Table 1) in the UK. The study identified that a move towards full tracking, with restricted registration of veterinary surgeons, was not supported. The concept of tracking in veterinary education is not new; the Universities of California Davis and Veterinary and Pharmaceutical Sciences in Brno, Czech Republic, introduced tracking in the mid1970s (Vecerek 2006, Klosterman and others 2009). In the UK, veterinary curricula include elective rotation(s) of variable duration. Some schools also have track rotations, but no curriculum contains the amount of elective study permissible within European regulations; 20 per cent of the curriculum, providing core competencies are met (European Association of Establishments for Veterinary Education Veterinary Record (2014) E. Crowther, BVSc, MRCVS, S. Warman, BSc, BVMS, DipECVIMca, DSAM, FHEA, MRCVS, S. Baillie, BVSc, CertCHP, PhD, MRCVS, School of Veterinary Sciences, Langford House, Langford, Bristol BS40 5DU, UK K. Hughes, BVM&S, BSc, MSc, MRCVS, I. Handel, BVSc, MSc, PhD, MRCVS, R. Whittington, BVSc, MRCVS, S. Rhind, BVMS, PhD, FRCPath, FHEA, MRCVS, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh,
doi: 10.1136/vr.102341 Easter Bush Veterinary Centre, Midlothian EH25 9RG, UK M. Pryce, BVetMed, MRCVS, Avonlodge Veterinary Group, 283 Wells Road, Bristol BS3 1PW, UK; E-mail for correspondence: [email protected] Provenance: not commissioned; externally peer reviewed Accepted April 16, 2014
and Federation of Veterinarians of Europe 2012). Many theoretical advantages and disadvantages to tracking have been discussed in the veterinary education literature; however, there is little evidence to document these; Klosterman and others (2009) remark on the similarities of tracked and untracked degrees on graduate careers. Potential advantages include (Karg 2000, Prescott and others 2002, Radostits 2003, Vecerek 2006, Haarhuis and others 2009, Chigerwe and others 2010) improved graduate competence, with concurrent improved competence of the profession better assessment of students matching faculty resources to more interested students; avoids teaching students irrelevant content space in the curriculum for detailed study in selected areas for smaller disciplines; a means of addressing the shortage of vets in less popular areas by controlling admissions increased satisfaction of career choice strengthened credibility of profession. Potential disadvantages include (Prescott and others 2002, Chigerwe and others 2010) limiting graduate options and necessitating retraining to change species required change in licensing disruption to admissions systems, including students learning to ‘beat’ admissions systems by feigning interest in less popular disciplines disruption to education, including different resource requirements and examinations for each discipline the need for mixed practitioners. The aim of this study was to evaluate opinion on full and partial tracking in veterinary degrees in order to inform the ongoing debate on this area. Due to a lack of UK literature on the topic, the authors July 26, 2014 | Veterinary Record
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Paper TABLE 1: Definitions relating to tracking Term
Our definition (as used in surveys)
Equivalent terms
Partial tracking
Students are trained across all species but are able to ‘track’ and/or undertake an elective in one or a limited number of species or disciplines. Students continue to undertake a multispecies final examination and still qualify to practise in all species. No longer teaching all areas of veterinary medicine during the undergraduate course. In ‘full tracking’, the students’ studies are directed to a ‘track’ of one or a limited number of species. Students would undertake a species-specific final examination, and qualify to practise in this area only. This would be a new concept in the UK and would require changes to Royal College of Veterinary Surgeons regulations
Differentiated curriculum (Vecerek 2006) Career streaming (Prescott and others 2002)
Full tracking
used a mixed methods approach to establish stakeholder opinion and to understand the reasoning behind such opinion. This paper presents the qualitative analysis of data from a survey distributed to UK university staff, practitioners and students. Many qualitative methods have been described; thematic framework analysis (a type of content analysis) was chosen as it allows the researcher to identify manageable categories or ‘themes’ from large datasets (Elo and Kyngäs 2008), while maintaining links to original verbatim comments from the participants. It has recently been used in animal welfare (Collins and others 2012), behaviour (Roshier and McBride 2013) and veterinary educational (Magnier and others 2011) research. This study was granted ethical approval from the University of Bristol Faculty of Medicine & Veterinary Science Committee for Ethics (reference FMV-111210).
Materials and methods
Surveys were distributed to three stakeholder groups; university staff, students and practising veterinary surgeons. University staff and students in the first, fourth and final years were sent an email containing a link to an online survey hosted by SurveyMonkey (www.surveymonkey.com). The practitioner survey is provided in online supplementary appendix 1 as an example. Practitioners were sent paper surveys with return envelopes to encourage participation. Several £25 voucher prizes were offered as incentives. All questionnaires contained demographic questions, closed answer questions on the respondents’ careers and Likert-style questions relating to opinion on partial and full tracking. The surveys also included free text questions regarding perceived advantages and disadvantages to partial and full tracking, with space at the end for any additional comments.
Data analysis
Responses where the demographic or Likert-style questions were incomplete were excluded. Descriptive statistics of demographic data were compared with Royal College of Veterinary Surgeons (RCVS) data for practitioners and students (Robertson-Smith and others 2010, Royal College of Veterinary Surgeons 2012). There were no available data to which the university staff sample could be compared.
Quantitative data analysis
Descriptive statistics were used to explore the opinions of the three groups, and univariate analysis was used to compare independent variables within each stakeholder group. Students’ knowledge of the professions’ employment profile was evaluated, and their career aspirations compared with the UK employment profile. The quantitative method is fully described in ‘part 1′ (Bright and others, 2014).
Qualitative data analysis
Thematic framework analysis involves an iterative process of coding and grouping into categories (or ‘themes’) related extracts from documents, surveys, interviews or focus groups. The themes can be determined using the raw data (an inductive approach) or, where it exists, from previous literature (a deductive approach). The themes are organised into a framework, to which additional data can be coded, and from which observations and conclusions can be drawn. An inductive approach was chosen, whereby themes and subthemes were identified from a subset of the data and used to create a coding framework. The remaining data were then coded to this framework. To create the coding framework, two authors independently coded 10 per cent of the free text. The two sets of codes were compared and were grouped according to emerging major themes. The sets Veterinary Record | July 26, 2014
Specialisation in veterinary education (Vecerek 2006) Career tracking (Prescott and others 2002)
of codes were then merged. Each major theme was discussed and codes condensed into a smaller number of subthemes within each major theme. This provided a hierarchical framework consisting of major themes containing subthemes, which in turn contained codes obtained directly from the data. The two authors then independently coded three responses from each stakeholder group to the developed framework. This coding was compared and discrepancies resolved by discussion, with adaptations made to the framework where deemed necessary. Finally, each subtheme was defined, using inclusion and exclusion criteria, and examples, where appropriate. The remaining responses were coded to this framework by the lead author. Where codes related to more than one theme, they were coded to all relevant themes in order to explore the relationships between ideas. Codes from themes emerging in the latter 90 per cent of responses were coded to new themes to avoid changing the meaning of existing themes and losing nuances in the data. Qualitative analysis was performed using NVivo 10.
Results
The sample included 203 university staff, 158 practitioners and 700 students after exclusions. In total, 7 (3.4 per cent) university staff, 4 (2.5 per cent) practitioners and 40 (5.7 per cent) of students refrained from answering any free text questions. Six major themes were identified using thematic framework analysis: choice, flexibility, competency and knowledge, stakeholder implications, specialisation and ‘what is a vet?’. These broad areas linked and overlapped, and for many of the subthemes, there were counterexamples within the data. Quotes from the data are presented within the results to illustrate key ideas, counterarguments or nuances (spelling mistakes have been corrected). Most subthemes related to both full and partial tracking, with the concept being more pronounced in relation to full tracking, for example, a reduction in career flexibility was perceived as worse in full tracking compared with partial tracking.
Choice
Choice over course material was perceived to be positive as it allows students to pursue an area of interest, improves the relevance of the course to future employment and gives an element of control to the learner. Negative implications included the possibility of a student, or graduate, changing their mind or regretting their choice. Issues regarding when a choice would have to be made were raised; all groups acknowledged that not all students know what they want to do from an early stage, and that making such a decision would be difficult given the consequences. At the undergraduate stage, despite undertaking significant work experience and EMS placements, it is difficult to choose which track to take and to be sure that it is the right track. University staff All groups recognised that students would choose their track for a variety of reasons, including interest, enhancing employment prospects or improving an area of weakness. It was suggested that tracking may disadvantage graduates applying for a job outwith their track. It was considered important to obtain a range of experiences before, during or after veterinary school before making a decision on career direction. To avoid influencing participants, potential track options were not mentioned in the survey questions, but many questions were raised by respondents; would there be a mixed track, would options vary by
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Paper university? Would there be discipline tracks, such as anaesthesia and imaging? If both options [partial track and full track] were available, people who didn’t fully track would be at a disadvantage to those who did, forcing people to full track. Student The ideal would be if you could have the choice of doing either full tracking or partial tracking depending on personal preference, how practical this would be to put in place I do not know! Student
Competency and knowledge
Respondents predicted that partial tracking would improve graduates’ day one knowledge and competency in the area of interest, providing an advantage when seeking employment in the tracked area: full tracking was seen to provide more competent graduates who may require less supervision in their first job. However, some thought the effect of partial tracking would be negligible, particularly if the training prioritised specialisation above first opinion practice. [Regarding partial tracking:] Communication is the key - no amount of ‘focussing’ is going to substitute for hands on experience. More time with clients would certainly help. More indepth detail may well not. Practitioner Concerns were raised that partial tracking could pose a risk to the non-tracked species, as due to reduced curriculum time and reduced student interest, graduates would be less competent in these species while still being able to practise with them. Conversely, some felt partial tracking would mistakenly reduce graduates’ confidence in the non-tracked species. An identified advantage of current veterinary education, and of partial tracking, was the ability to transfer skills and knowledge between species; to help problem solve in new situations and to increase opportunities for practising skills. Remembering the anatomy and physiology of the equine gut makes the rabbit much more understandable. Practitioner The breadth of veterinary degrees was deemed positive and viewed as particularly important to cross-species disciplines such as anaesthesia, imaging and pathology. However, some thought it was no longer feasible to be competent across all species. A lack of comparative knowledge and the ‘wider picture’ were predicted disadvantages of full tracking. Respondents valued a strong ‘all round’ foundation on which to base further training; some thought this was the role of the veterinary degree, while others thought this could be the preclinical stage. This foundation was thought to improve transferable skills, scientific thinking and ease subsequent career changes.
Flexibility
The ability to treat all species was seen as a major benefit when considering job or career changes, and even when working within the same practice; as presented in ‘part 1’, 26 per cent of practitioners reported making a significant change in career. Lack of such flexibility was viewed as a significant disadvantage to full tracking; reasons such as changing from large to small animal practice due to injury or family commitments were cited as concerns. Respondents mentioned that full tracking would necessitate considerable retraining, with associated time and expense, to change career; others highlighted that the current lack of formal retraining requirements is a concern that would continue with partial tracking. It was suggested that veterinary schools would need to provide additional modules for veterinary surgeons changing species. The effects of tracking on other career opportunities, such as working in research, government or working abroad, were also discussed. Respondents generally thought that partial tracking would not cause restrictions, but that full tracking would preclude these options. Some overseas students commented that they had chosen to study in the UK to avoid tracking, although as presented in part 1, country of origin did not relate to opinion on tracking.
One of the current main advantages of having a veterinary degree is the wide range of different job opportunities and [full tracking] would significantly narrow that. Student Participants thought tracking may affect ability to fit in with the job market; if graduates were unable to gain employment within their track, they may be unable to find work with different species. Similarly, if the professions’ employment profile changes in the future, the work force would not be able to meet demands. Several consequences of reduced flexibility were suggested, primarily in relation to full tracking. These included a higher attrition rate from veterinary courses if students could not change their track, the cost of retraining to change career, increased unemployment, more veterinary surgeons leaving the profession and worsening mental health.
Stakeholder implications Clients and animals
Respondents suggested tracked graduates may provide a better service to clients and their animals, and some commented that a higher service was now expected of veterinary surgeons. However, concerns were raised that with partial tracking, the standard of care for nontracked species would be worse, potentially causing welfare problems. This would be avoided by full tracking and restricted registration, which was seen to potentially improve care for minor species, provided a specialist was available. Small animal practices often see a number of exotic species and unless there is a practice member who has a particular interest, these patients often receive rather basic treatment at the hands of a non-specialist. Being unqualified to treat these patients [would] therefore ensure they were always seen by a specialist. Practitioner The major implication of full tracking for clients was that one vet could not treat all the species they owned, which would necessitate having more than one veterinary surgeon or practice, and possibly increasing the cost of veterinary care. Respondents noted that considerable education of the public would be necessary should full tracking be implemented. One proposed advantage of both tracking systems was the reduction in animals used to teach students who were not interested in that species, with consequent animal welfare benefits.
Practices and employers
The main concern for practices was how mixed practices would fare, although there were various perceptions about the importance of this issue; some felt that there is a trend even in mixed practices for veterinary surgeons to work with only a small number of species. Covering the out of hours rota was seen as a particular problem. It was also thought that new graduates value time in mixed practice before focusing on one species, which would not be possible with full tracking. Tracking could potentially affect student engagement while on extramural studies, providing a more rewarding experience for all if the placement was in the tracked species, and becoming a ‘box-ticking’ exercise if in the non-tracked species.
The profession as a whole
Many respondents feared that tracked degrees would fragment the profession, whereby veterinary surgeons in different areas had little in common. This was predicted to hinder the transfer of knowledge and skills between groups. We also need to make sure that we have a voice in public debate and come across as an integrated body of informed, dedicated professionals. I don’t think that “dividing” the students in this way before they have even graduated is a good way to promote this. University staff The considerable challenges of implementing full tracking were mentioned, for example, enforcing restricted registration and retraining. Additionally, the role of veterinary surgeons in treating all animals in an emergency would need to be revised. Respondents mentioned this obligation in relation to casualty animals, and to epidemic disease outbreaks. An outbreak of the scale of the 2001 Foot and Mouth Disease July 26, 2014 | Veterinary Record
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Paper crisis would be an even greater challenge to the profession if MsRCVS could not treat all species. Another concern raised by stakeholders was the potential of having a skewed graduate population that did not match the profession’s needs. It was expected that there would be an oversupply of small animal veterinary surgeons and an undersupply of large animal veterinary surgeons.
Implications for veterinary schools and education
One suggested advantage of tracking was the improved use of university resources and cases; these would not be wasted in teaching students who were unlikely to need the experience. Some thought tracking could allow a higher ratio of staff and cases to students, as not all the material would be taught to all students; the effect of this with partial tracking was thought to be minimal. Students may be more engaged with the curriculum as they would have actively chosen to participate in the areas they study. However, some respondents argued that it may be more difficult to justify resources for a smaller student body. Lower numbers in e.g. farm may cause problems for university funding and staffing. Practitioner Other perceived barriers to tracking included timetabling and the logistics of implementing tracked courses, including difficulties assessing students on different tracks, and an increased workload for staff. The difficulty of predicting or managing the number of students on each track, which could vary from year to year, was discussed. Universities would need to educate students on the job market and actively support students in making informed decisions regarding their track choice. The idea of a ‘quota’ of students on each track mapped to the prevailing job market was raised, which may affect admissions procedures. However, there were implications of students not being able to study on their track of choice. The role of a veterinary degree was discussed; whether it should primarily provide a broad scientific foundation or provide graduates that can integrate quickly into practice. I think more and more practices would prefer and will need more specialised graduates, fewer practices will be able to take new grads and train them when the veterinary schools could / should be producing the kind of graduates we need. Practitioner I believe that it is more important to teach veterinary students the fundamentals of science and scientific thinking. Practitioner It was recognised that tracking could reduce curriculum load although this may not be significant in partial tracking. Full tracking was thought to potentially enable a shortened course with reduced cost to students; alternative changes were suggested, such as a tracked year after the current five-year course, or a structured career progression. Whether any change is necessary was also questioned. Regarding partial tracking: It is not a big enough move. Omnicompetence is NOT possible. Practitioner What is the problem? If it is competency then the current framework is perfectly capable of producing competent vets. Practitioner
Specialisation
The researchers avoided the term ‘specialisation’ as this is a specific status defined by the RCVS, whereas tracking would provide a focus on a small number of species at the day one level. However, respondents appeared to use the term interchangeably. Some felt that specialisation should occur after graduation, whereas others thought that pre-graduation specialisation was more aligned with the profession. It was felt that full tracking would facilitate later specialisation in the same species, but may mean students felt less in need of further postgraduate training. The potential challenges associated with pursuing specialisation in a different area to the track were raised, as was specialising in cross-species disciplines. Veterinary Record | July 26, 2014
What is a vet?
Many comments related to the identity of veterinary surgeons in the UK, and the pride the profession has in its diversity. A fundamental characteristic of a veterinary surgeon was the ability to treat all species, particularly in an emergency situation; an obligation that many considered important. There was overwhelming support for a broad education and a basic knowledge across all species. Respondents felt the public expected this from the profession. Full tracking in particular was seen as a threat to the basic identity of a veterinary surgeon, although a few individuals felt that perpetuating the ‘myth’ of traditional, mixed practice was of no benefit. I believe anyone who calls themselves a veterinary surgeon should have a knowledge of all common animals. Practitioner Veterinarians and students take pride in the quote “Real doctors treat more than one species.” Student
Discussion
The aim of this study was to evaluate UK stakeholder opinion on tracking in veterinary curricula. Thematic framework analysis is a documented method of condensing large amounts of qualitative data into manageable categories (themes) and was used in this study to identify six major themes in over 1000 survey responses. Within qualitative methods, focus groups or interviews encourage in-depth discussion of the topics and comparison of participants’ opinions, while free text comments typically attract brief comments from respondents (Hanson and others 2011). However, conducting a survey as a mixed methods approach allowed the researchers to establish consensus using quantitative methods and to gain an insight into why such opinions were held using qualitative methods. Comments were typically brief and restricted to the participants’ initial opinion rather than a discussion of possible viewpoints; however, due to the large volume of data from a range of stakeholders, many nuances, counterarguments and details to each theme were identified, and the researchers believe that data saturation had been achieved for the questions posed. Without prompting, the participants identified the advantages and disadvantages of tracking previously discussed in the literature (Karg 2000, Prescott and others 2002, Radostits 2003, Vecerek 2006, Haarhuis and others 2009, Chigerwe and others 2010). For example, each group noted that tracking would improve the use of university resources; however, practitioners and university staff recognised that not all universities would be able to sustain resources across all tracks. This related to suggestions on how universities may need to collaborate to provide the required curriculum. Further investigation could establish the opinion of other stakeholder groups, for example, clients and industry, as previous work has shown that clients have different opinions to veterinary surgeons on the important attributes of veterinary surgeons (Mellanby and others 2011). Paper 1 demonstrated that the majority of respondents supported a move towards partial tracking, but were opposed to full tracking and restricted registration. Paper 1 also identified that students’ career aspirations were different in different year groups with final year students’ aspirations mapped to recent graduate employment figures (Robertson-Smith and others 2010). This is important in light of the theme ‘choice’ emerging from this qualitative data as it highlights the responsibility of universities in assisting students in making informed decisions on their choice of track, should tracking be implemented. It was suggested by respondents in this survey that support could be provided by educating students on employment prospects and ensuring students had sufficient exposure to different areas of the profession prior to making their choice. At the University of Utrecht, students have ‘profession-oriented weeks’ and tutorials prior to deciding their track choice at the end of the first trimester. This university also has an admissions programme to ensure sufficient students enter the food/ veterinary public health track (van Beukelen 2004). Interestingly the qualitative data reported here predicted an oversupply of small animal (particularly exotic) veterinary surgeons, with an undersupply of large animal veterinary surgeons, which is not supported by the data on students’ career aspirations.
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Paper Another major theme that emerged in this study was ‘flexibility’. This has previously been studied in relation to the career outcomes of tracked (University of California Davis) and non-tracked (Ohio State University (OSU)) graduates. Klosterman and others (2009) found that more graduates from the non-tracked degree (OSU) entered mixed practice, but regardless of degree type, a high number of those in mixed practice subsequently changed species. When those that had initially started in mixed practice were excluded, those from both degree types changed species with similar frequency (Klosterman and others 2009). This supports our respondents’ view that partial tracking would have less of an effect on career changes than full tracking. It was interesting to note the emergence of a more philosophical theme, ‘what is a vet?’. The profession appears to have a very strong identity, of which the ability to treat all common species is core. This also appears to be projected onto other stakeholders, for example, respondents thought that clients expect veterinary surgeons to have knowledge of many species. There is a feeling that clients expect a higher level of care than previously, and that within a few years of graduation, veterinary surgeons are currently often ‘tracked’ to a few species. We should acknowledge that the profession is not a static entity, and, as alluded to in survey responses, roles are changing, and will continue to change in the future. It is therefore crucial that we continue to discuss and debate the structure of veterinary education to ensure our graduates are best placed to succeed in their careers and that the profession as a whole can meet the demands of our changing world.
Acknowledgements
The authors gratefully acknowledge the participants who completed the survey. In particular, they would like to thank the contacts at UK veterinary schools for facilitating the dissemination of the survey within their universities.
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Stakeholder consultation on tracking in UK veterinary degrees: part 2 E. Crowther, K. Hughes, I. Handel, R. Whittington, M. Pryce, S. Warman, S. Rhind and S. Baillie Veterinary Record 2014 175: 87 originally published online May 12, 2014
doi: 10.1136/vr.102341 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/175/4/87
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