Graduates fit for the 21st Century

In the early 2000s, in response to the internet age, educators around the world declared 'a paradigm shift' in societal expectations of graduates from purveyors of knowledge to professionals helping clients make sense of large amounts of information as this was customised to meet their individual needs. 

In veterinary medicine, this has led to continued specialisation from species to systems within species, in parallel with changes in medicine, and further development of the veterinary team with increased specialisation and professionalisation of veterinary nurses, as no individual can have an in-depth knowledge or comprehensive skill set that embraces every area of modern practice.

These developments are a particular challenge for the generalist - the veterinary surgeon who sees a full range of first-opinion cases, on behalf of their clients, and ’orchestrates‘ an animal’s or a flock’s care as specialist input from others is required.

Our profession gains its authority from being science-based, and science is the most powerful method we have for moving ever closer to truths about our material world.

However, our many successes in science can lead us to false conclusions: that science gives us certainty about the phenomena that we observe and, even worse, that science must have the answer to everything.

This means, when faced with a complex first-opinion problem, the new graduate, in particular, can feel overwhelmed by client expectations for a diagnosis and therapeutic plan, and assume that their struggle to provide these is due to their lack of knowledge and their personal failings as a professional.

A hundred years ago, the great physician and medical educator, Sir William Osler, pointed out that medicine is the “practice of an art which consists largely in balancing possibilities … a science of uncertainty and an art of probability”. 

More recently, Murdoch¹ has described the first-opinion caseload as embracing the “not sick”, the “not yet sick” and the “inexplicably sick”, alongside the “definitely sick”, with established disease, that when complicated gravitates towards specialist care.

For all of these, there is often uncertainty around outcomes of clinical management and, in addition, for the first three, uncertainty around the nature of the problem, given the limitations of diagnostic testing in this context and the economic constraints of general practice.

This means that it is important for new graduates to develop a full range of professional skills to complement their prodigious scientific knowledge. They need to be able to make sound judgements in the face of uncertainty, and communicate their conclusions effectively to animal carers, so that rational and defensible decisions can be made.

They need to be able to reflect on and judge decisions not just by outcomes, but by their quality in context, at the time they were made, and recognising the provisional nature of most diagnoses, confidently modify their advice as cases progress differently from the ways predicted and expected.

Mistakenly, specialisation is often viewed as an advancement from generalism. It is a way that some clinicians can restrict the degrees of uncertainty with which they deal and focus on caseloads with more predictable outcomes. They solve the complicated, and push forward the boundaries of therapy in established disease.

However, this should not cause us to lose sight of the fact that general practice is the most challenging of all clinical environments, despite it being the workplace in which most newly-qualified veterinary surgeons start to practise independently.

Established disease forms a subset of the problems that present, so it is important that their knowledge, skill set and experience is fully developed so that they are capable and confident in this challenging role, and can feel good about this most valuable of veterinary services to society. 

Huge progress in knowledge and technical skills has exposed the deficiencies in the non-technical skills so relevant to all sectors in which those with veterinary degrees work.  However, for the above reasons, this is particularly the case in general practice.

The RCVS Graduate Outcomes Consultation is about addressing this educational need, during the undergraduate and immediate postgraduate phases, to empower young veterinary surgeons, and help them to live with and take action in the face of complexity and uncertainty.

It is essential that we all contribute to ensuring that our successors successfully navigate the challenges of general practice and go on to successful and fulfilling careers.

¹Murdoch, J.C. (1997) Mackenzie's puzzle - the cornerstone of teaching and research in general practice. British Journal of General Practice 47, 656-658.

The Graduate Outcomes Consultation

Watch this video to hear the views of just some of the vets, vet nurses and vet students who have helped us to put together the #GradOutcomes consultation…about the importance of responding, and being part of #TheBigPicture!