Envisioning the Future of Veterinary MedicalEducation: The Association of American VeterinaryMedical Colleges Foresight Project, Final Report

Norman G. Willis g Fonda A. Monroe g J. Andre Potworowski g Gary Halbert g Brian R. Evans gJohn E. Smith g Kenneth J. Andrews g Lynelle Spring g Andrea Bradbrook

ABSTRACT

This report of the Association of American Veterinary Medical Colleges 2006 Foresight Project, developed under the

leadership of an AAVMC Steering Committee, drew on the experience, imagination, and energetic participation of more than

95 participants from across the United States and Canada.

The environment of veterinary medicine is one of profound change. The current number of veterinarians is inadequate to

address the present and future needs of society. To remain relevant, academic veterinary medicine must prepare veterinarians

for what may come in the future. In order to be recognized and remunerated for their knowledge, compassion, integrity, and

judgment, veterinarians must first demonstrate their relevance to new societal trends.

The objective of the study reported here was to determine a future direction for academic veterinary medicine using

Foresight technology. The tools employed were challenge questions and the development of eight future possible scenarios.

The study supported the need for change. This report recommends an adaptive and responsive system of veterinary medical

education, achieved by defining those areas of professional focus that would address all the anticipated needs of society.

An area of professional focus signifies a pathway leading to a DVM degree. Colleges would choose to offer selected areas of

professional focus most appropriate to their capabilities, according to a binational plan. Veterinary medicine is integral to the

well-being of any future society. This is a pivotal moment for the veterinary profession and for veterinary medical education.

Leadership, collaboration, and a shared vision will determine the destiny of the profession.

Foreword

In 2005, the Board of Directors of the Association of

American Veterinary Medical Colleges (AAVMC), under

the leadership of Dr. Lawrence E. Heider, Executive

Director, and then president Dean Bennie I. Osburn,

instigated a proposal to conduct a long-range planning

study for academic veterinary medicine. A previous study

undertaken between 1987 and 1991, known as Future

Directions for Veterinary Medicine, was conducted by the

Pew National Veterinary Education Program and sponsored

by the Pew Charitable Trusts.1 In addition to leadership

training and development of strategic planning principles

and skills for faculty and college administrators, that study

famously led to significant advances in veterinary medical

educationnotably, the greater application of tracking, or

areas of emphasis within curricula, to allow students an

opportunity to acquire greater knowledge and clinical skills

in their chosen areas of endeavor, as well as the adaptation

of technology and pedagogical processes to foster greater

problem-solving skills and self-learning capabilities amongstudents. Greater emphasis on research was encouraged.In addition, several inter-institutional programs wereestablished to offer better learning opportunities in certainfields. Several well-known programs, including a seven-school program for food-animal/production medicine ledby the University of Illinois, the Gulf States Consortium forAquatic Pathobiology, and the Center for Government andCorporate Veterinary Medical Practice at the VirginiaMaryland Regional College of Veterinary Medicine,continue today.

For its subsequent study, the AAVMC decided on a long-range planning project using a process called ForesightAnalysis, a tool to look ahead over a 20- to 25-year timehorizon. The objective was to determine a vision and futuredirection for academic veterinary medicine. The NormWillis Group, a consulting team based in Ottawa, Ontario,was chosen to conduct the study. In addition to the teams

JVME 34(1) 2007 AAVMC 1

expertise with Foresight technology, they had previouslyworked specifically with issues in veterinary medicine.Their leader, Dr. Norm Willis, is the former chiefveterinarian of Canada and he has served as presidentof the OIE.

The Norm Willis Groups final report, published in thissupplemental issue of the Journal of Veterinary MedicalEducation, is intended to provide a basis for strategicplanning, by individual institutions and/or institutionalconsortia as well as by the AAVMC at the national andinternational levels, for curricular development in academicveterinary medicine to meet challenges that may be faced bythe profession in the future.

The Foresight analysis process involved teams ofprofessionals who began by asking challenging questionsabout the future. The initial team of professionalswas selected by the AAVMC executive, and this groupwas re-enlisted to complete the process at a finalsynthesis meeting. The initial challenge questions ledto the definition of multiple plausible future scenarios,which were analyzed at two subsequent workshops. Thescenarios were selected not on the basis of whether ornot they were likely to occur but, rather, on the basis ofhigh uncertainty of occurrence and of high impact on theprofession should they occur by 2025 or beyond. Duringdiscussions of the scenarios, the workshop participantsoriginated a majority of the ideas and concepts for thefollowing report. Participants were nominated by represen-tatives of AAVMC member institutions and by AAVMCofficers. They represented a broad range of expertise withinthe veterinary profession. Using the scenarios as tools,the workshop teams were challenged to assume that a givenscenario had occurred and to answer a series of questionspertaining to its impact on a variety of issues relevantto the profession and, most importantly, to academicveterinary medicine. They then looked backward toconsider what might have happened in our world to

lead to that scenario. All ideas, concepts, suggestions,recommendations, and conclusions were carefully recordedduring these discussions. The process was designed tounleash original thinking, to help the participants to escapefrom thinking about the future only as an extension oftodays circumstances.

A final step, conducted by the synthesis team,involved distilling the ideas, concepts, suggestions, recom-mendations, and conclusions developed and recordedduring the earlier workshop discussions of all scenariosto find mechanisms whereby academia mightprepare tomorrows veterinarians for any challenges thefuture may hold. The reader of this report is encouraged,therefore, not to look for solutions relevant to anyspecific problem in todays world, nor for solutionsdesigned to meet any specific future scenario,but to understand that the objective of the study wasto propose a responsive and flexible veterinary medicaleducational system that will prepare veterinariansfor a myriad of opportunities and challenges in the next20 to 25 years.

Funding for this project was provided by the AAVMC,Charles River Laboratories Foundation, and Merial Limited.The AAVMC expresses its appreciation to all the partici-pants in this study.

REFERENCE1 Pritchard WR. Future Directions for Veterinary Medicine.Durham, NC: PEW National Veterinary Medical EducationProgram, Institute for Policy Sciences and Public Affairs,Duke University, 1988.

Keith W. Prasse, DVM, PhD, is Dean Emeritus of the University

of Georgia College of Veterinary Medicine and a consultant to

the AAVMC.

1. Executive Summary

A PROFESSION IN TRANSITIONThe environment of veterinary medicine is one of change.There are major demographic, political, environmental,disease, technological, and economic influences, all drivingchanges in society. These changes will have significantimpacts on future veterinary medicine and veterinarymedical education.

The current number of veterinarians in food-supply

veterinary medicine, in biomedical research, in public

health, in companion animal medicine, and in other

anticipated needs is inadequate to address current and

future societal needs and well-being.

How must academic veterinary medicine adapt inpreparing veterinarians to respond to new needs ofsociety? To remain relevant to shifting new societal needs,

veterinary medical education must prepare veterinariansfor what might come in the future, not just for what can beseen now.

The single characteristic that distinguishes veterinarians,in every role they play, is their unique relationship withanimals, operating at the interface between society andanimals.

Veterinary medicine is the only profession in thehealth and medical field that is trained in comparativemedicine.

Concern for animals, their health and well-being, andtheir interface with people, inserts veterinarians ascritical components of public health and as essentialhealth care providers to society locally, nationally, andinternationally.

2 JVME 34(1) 2007 AAVMC

For veterinarians to be recognized and remunerated fortheir knowledge, compassion, integrity, and judgment, theymust first demonstrate relevance to new societal trends.

The veterinary roles that benefit society most are those thatdemand and capitalize on the unique knowledge andabilities developed through veterinary medical education.

THE IMAGE OF VETERINARIANSThe image of veterinarians in society is at the interfacebetween animals and people.

The Gentle Doctor is a powerful and compelling imageof veterinarians in the public psyche that should be expandedacross all of the roles that veterinarians play in society.

The prime characteristics that veterinarians represent are:

1. compassion

2. expertise

3. humaneness

4. judgment

5. care

6. understanding

A VISION FOR ACADEMIC VETERINARY MEDICINENorth American academic veterinary medicine is a globalleader in the design and delivery of veterinary medicaleducation systems.

It inspires and educates veterinarians to exemplarystandards and values in an intellectually and emotionallyrewarding career.

The profession is respected and valued by society for itsleadership and dedication to the health and well-being ofanimals, people, and the environment.

A RESPONSIVE AND FLEXIBLE VETERINARY MEDICALEDUCATIONAL SYSTEMFundamental changes in the education of veterinariansare required in order to create a system or process thatis responsive to future needs. Basic issues that must beaddressed include the following:

. Without significantly increasing the length of theeducation, it is not possible for individual collegesto provide the requirements to meet all of theanticipated needs.

. The concept of change is for an adaptive andresponsive system of veterinary medical education,achieved by defining the areas of professional focus,which would address all of the anticipated needsof society. An area of professional focus signifiesa pathway leading to the DVM degree.

. Colleges will choose to offer selected areas ofprofessional focus most appropriate to their capabil-ities. A national plan will ensure that all defined areaswill be available on the continent in at least onecollege. Experts will also be centralized in appropriatecenters of emphasis to create leading-edge criticalmasses of expertise.

. The Association of American Veterinary MedicalColleges (AAVMC) and the individual institutionsmust plan on a collective basis rather than anindividual basis.

. Selection and admissions of students will be based onthe premise that the profession ensures a predeter-mined minimal number of seats in each area ofprofessional focus. For certain professional focusareas, the option will exist for a DVM degree to beearned by attending multiple colleges through anactive, national, cooperative program. Such programswill require inter-institutional agreements withrespect to residency, tuition and fees.

. Accreditation of colleges will be altered to allowfocused educational delivery in some areas but nodelivery in other areas.

. Licensing of a graduate veterinarian will recognizecompetency in a specific area or areas of professionalfocus.

PROCESSThe objective of the study was to determine a futuredirection for academic veterinary medicine that wouldprepare veterinarians for the opportunities and possibilitiesthat may emerge within the next 20 years.

The study analyzed multiple aspects of the veterinaryprofession, its relationship to components of society, and theveterinary medical educational process. The method usedwas Foresight technology, which seeks perspectives fromthe future rather than extending thinking from the present.It involved the expressed opinions of over 95 participants,together with those of eight members of the Norm WillisGroup team.

Two distinct toolschallenge questions and scenariodevelopmentwere used in the study. Eight challengequestions and eight scenarios were explored in four work-ing meetings. The scenarios were:

. The Pandemic Disaster of 20152025

. The Great Animal Peace

. Brave New World of Modified Species

. Fragmented Profession

. One Medicine, One Health

. Global Warming, Eco-Crisis

. Norman Rockwell Veterinarian

. Globalized Google Vets

PRINCIPLES CONSIDERED MOST IMPORTANT

1. Veterinary medicine must remain relevant to thechanging needs of society.

2. Veterinary medical education can respond to thesechanging needs only by expanding the areas ofeducation through creating areas of professionalfocus according to a national plan.

3. The number of graduating veterinarians must beincreased, not only to address population growth, but

JVME 34(1) 2007 AAVMC 3

to allow the profession to respond to new demandsand roles.

4. Academic veterinary medicine should reflect theexisting and anticipated diversity in society.

5. Veterinary medicine should seek greater collaborationand cooperation with human health in the publichealth area, with veterinarians playing a moredominant role in the management of zoonoticdisease, public health, and the impact on ecosystemhealth.

6. The public image and status of veterinarians can beenhanced only through a powerful and professionalmarketing and public relations campaign.

KEY RECOMMENDATIONS

1. The AAVMC must achieve consensus on two key points:

g acceptance of the concept of an expanded veter-inary medical educational program, leading to aDVM degree, through provision of areas ofprofessional focus, perhaps identified as centersof emphasis, in North American colleges ofveterinary medicine;

g acceptance of the fact that veterinary licensurewill not cover all areas of professional focus, butrather will lead to public assurance of competencyin a selected area of veterinary medicine.

2. The AAVMC should develop a national strategicplan for implementation of the concept that eachcollege will use as guidance to develop a specificstrategic plan.

3. The AAVMC and the colleges should develop a planto reduce student debt, at least in unfulfilled areas.

4. Colleges must develop opportunities for continuingeducation for veterinarians seeking to change careersand licensure in a new area of professional focus.

5. Colleges should capitalize on new technology toprovide distance education.

6. The AAVMC should pursue, with the NationalInstitutes of Health, the establishment of an Instituteof Comparative Medicine.

7. The licensing boards through the American Associationof Veterinary State Boards and the state or provincialveterinary associations should address the modifica-tion of licensing for graduate veterinarians to allowlicensing for a professional focus.

8. Accreditation of colleges of veterinary medicineshould be limited to the requirements to teach thecore program plus the areas of professional focusoffered at that college.

9. The AAVMC, the American Veterinary MedicalAssociation (AVMA), and the Canadian VeterinaryMedical Association (CVMA) should come to con-sensus on major issues for the profession to ensurethat there is a unified voice that speaks for theprofession to prevent conflicting messages to thepublic.

10. The AAVMC could consider monitoring ongoingchanges in society, in political systems, in theenvironment, and in disease, to assess any potentialimpacts on the future direction and education ofthe profession that may require the addition oralteration of areas of professional focus withinthe curriculum.

EPILOGUEVeterinary medicine has a proud and admirable historywith many achievements in which it can take pride. It isintegral to and has much that it can offer to the well-being ofa future society.

This is however, a pivotal point in time for the veterinaryprofession and for veterinary medical education. A decisionto broaden the scope and potential of veterinary medicaleducation is fundamental for the profession to navigate thistransition.

Stimulated by the exploration of the eight plausible futurescenarios, a system of veterinary medical education waselucidated. This system, as proposed, is believed to beresponsive and flexible enough to allow the academiccommunity to adjust to any future challenge.

Leadership, collaboration, and a shared vision will deter-mine the destiny of the profession.

2. Project Definition

On the first of February 2006, the Association ofAmerican Veterinary Medical Colleges and theNorm Willis Group signed a letter of agreementwhereby the Norm Willis Group would complete anin-depth study of the future of academic veterinarymedicine.

It was agreed that the study would employ a process ofForesight analysis, which would lead to the creation of areport suitable for developing a strategic vision for

veterinary medicine and veterinary medical education.The report would also be used by the AAVMC or itsmember institutions to create academic strategic plans.

An AAVMC Foresight Project Definition Meeting was heldin Ottawa, Ontario, to discuss the specifics of the study ingreater detail. The attendees in this meeting were theExecutive Committee, the executive director and projectmanager of the AAVMC, and the members of the NormWillis Group team.

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During the meeting, expectations for the study wereenunciated in a series of 21 questions, which have beenorganized into categories and are presented in Appendix A.Further clarification was detailed for the profile of partici-pants to be invited to the subsequent meetings of the study.As well, tentative dates and locations for the meetings tofollow were suggested.

To ensure ongoing validation of both the process and thedeliverables, the Core Team defined specific actions thatwould provide them with assurance for their expectations ofthe study.

3. A Profession in Transition

This section outlines the key pressures that are forcing achange in veterinary medical education if veterinarians areto remain relevant to and valued by society.

HISTORICAL BACKGROUNDOver the centuries animals have provided people withfood, energy, wealth, companionship, and prestige. Therelationship is a very intimate one, which is both passiveand active. Animals have played a most significantrole in exploration and in conquests of territory.However, the veterinary art did not become institutiona-lized until the eighteenth century, when the first veterinaryschools opened in Lyons and Alfort, France, in 1761 and1764.1

The first veterinary school in England was the LondonVeterinary College, founded in 1791. This was followed bythe Edinburgh Veterinary College (Royal Dick), founded in1823.1

A graduate of the Edinburgh school established theoldest existing, accredited veterinary college in the UnitedStates and Canada, the Ontario Veterinary College,in Toronto in 1862, later relocated to Guelph, Ontario(1922).1, 2

In the United States, the first veterinary colleges wereestablished in 1852 and 1854, in Philadelphia and New Yorkrespectively.3

Today there are 28 veterinary colleges in the United Statesand five in Canada.a

Professional veterinary associations and administrativeboards were formed to verify competency in standards ofservice and codes of ethics, so that unqualified personswould not be allowed to dupe an ill-informed public.1, 2

EVOLUTION OF THE PROFESSIONUntil the First World War, horses were a mark of pride and asymbol distinguishing gentry from peasants. In NorthAmerica, by 1800, the arrival of large numbers of settlerswas accompanied by a rapid increase in the livestockpopulation. By 1860, the number of cattle, hogs, andhorses in the United States far exceeded that of Prussia,Great Britain, and Ireland combined.1 Animals wereessential to the settling of the continent and to the migrationof people.

A major event for change in North America was theAmerican Civil War, which created a need for personsqualified in the veterinary art, a demand for serviceablehorses, and a high demand for beef and pork.1

After World War I, the influence of horses as ameans of transportation declined and agriculturalproductivity expanded. As presaged by the sculptureThe Gentle Doctor (Christian Peterson, 1937), the empha-sis of the veterinary medical profession shifted onceagain by the 1950s toward companion animal medicinean emphasis that remains today.b Recently, theglobalization of food distribution and the marketincrease in livestock production have forced alternativeapproaches.

Therefore the emphasis of the veterinary medicalprofession has evolved from

horses

livestock

companion animals

a possible new point of transition in the future.

WHY VETERINARY MEDICINE MUST CHANGE IN THEFUTURE: THE BROADER ENVIRONMENTIn a word, the environment is one of change.

The global society, and what surrounds and influences it,are in profound change. These changes will have verysignificant impacts on future veterinary medicine andveterinary medical education. There are major demo-graphic, political, environmental, disease, technological,and economic influences, all forcing changes onto society.A few examples illustrate the point.

. At 19:16 GMT, February 25, 2006, the global popula-tion passed 6.5 billion people (World PopulationClock of the U.S. Census Bureau).

. Worldwide, the amount of forest is shrinking by thesize of a soccer field every two seconds.

JVME 34(1) 2007 AAVMC 5

. The consumption of water is rising twice as fast aspopulation growth.

. In the past 25 years, 38 new pathogens haveemerged75% originated as animal diseases(Mark Woolhouse, University of Edinburgh).

. With an annual increase of 76 million people, theworld population is expected to reach 9.1 billion in2050.

. With immigration into North America accelerating,combined with a declining birth rate, the ethnicdiversity in society will continue to increase, withthe associated impact on values.

. In 2007, for the first time in history, urban peoplewill outnumber rural people.

. Political destabilization, inflamed by bio-terrorismand religious fanaticism, is expected to increase.

. Changes in the atmosphere are causing powerfulshifts in the environment (melting of the ice caps,rising sea levels) and in the climate (hurricanes,flooding).

. Global water shortages, especially in heavilypopulated areas, will soon approach critical levels.

. The emergence of new diseases is occurringabout every eight months and the threat ofnew zoonotic diseases is very real. Of themore than 1,400 pathogens causing humandisease, 800 have crossed the species barrierfrom animals.

. The speed of global travel and of disease transmissionare surpassing control measures. The rate of habitatchange leads to unprecedented disease exposures.

. Information technology has flattened the globe foraccess to information and service.4

. Consumer spending power in emerging economieswill go from $4 trillion to $9 trillion by 2015, but thegap between rich and poor is increasing.

How will these changes alter the needs of society? Howmust academic veterinary medicine adapt to prepareveterinarians to respond to these new needs?

OTHER INDICATIONS OF THE NEED FOR CHANGEIt is unlikely that the current philosophy on how to protectanimal health will be adequate in the future. There arevulnerabilities in the animal health framework. To safeguardthe US economy, public health, and food supply, there mustbe recruitment and preparation of additional veterinariansinto careers in public health, food systems, biomedicalresearch, diagnostic laboratory investigation, pathology,epidemiology, ecosystem health, and food animal practice.5

The convergence of animal health and public health in thearea of zoonotic and newly emerging diseases is a criticallink to societal well-being.6

There is a need for more veterinarians to participate in orsupport biomedical research. To date, veterinary medicalschools have shown a lack of commitment to prepare andtrain veterinary students for veterinary careers other thanprivate clinical practice.7

The perspective on the role of animals in human society andin the ecosystem has changed. Research in veterinaryscience transcends species boundaries and is critical to theprotection of public health. Such research is crucial to theadvancement of our understanding of and our response toimpending risks.8

This need for change is similarly recognized in otherprofessions. For example, the engineering profession seeksto enrich and broaden engineering education so that thosetechnically grounded graduates will be better prepared towork in a constantly changing global economy.9

IN SUMMARYThe need is eminently clear. The global societal environmentis shifting. To remain relevant to the new needs of society,veterinary medical education must prepare new veterinar-ians for what might come in the future, not for what can beseen now.

4. The Process and Methods

The method employed in this study was Foresightasystematic approach for anticipating the future. Foresightencourages participants to imagine possible futures over a10- to 25-year future horizon without it being an extension ofpresent thinking. It provides a means of liberating thinkingand conceptualizing consequences and leading triggers.

This study utilized two distinct tools, namely Challenge

Questions and Scenario Development, to stimulate the

thinking of invited participants (Appendix F) from a

wide range of endeavors, as selected by the AAVMC.

This thinking was elucidated in four separate working

meetings.

In a Scoping Meeting, held in Atlanta, Georgia, sixteen

participants began the process of framing the study. They

defined the lenses or critical perspectives, the key drivers

causing change, trends, and discontinuities that would be

used as parameters to develop the Challenge Questions and

the Scenarios. As well, they started the process to develop

scenarios.

Foresight allows preparation for diverse future challengeswith adequate lead time. It does not predict or forecast thefuture, nor is it a strategic plan. Rather it anticipates andcreates multiple, plausible futures that are possible andbelievable. These futures may be positive or negative, but intheir diversity they bring into view issues and perspectivesthat may not have been initially considered.

6 JVME 34(1) 2007 AAVMC

On the basis of these inputs, the Norm Willis Group Teamdeveloped eight sets of Challenge Questions and eightScenarios to be explored in two workshops. The two work-shops, held in Fort Collins, Colorado, and Knoxville, Tennessee,each answered four sets of Challenge Questions and exploredfour Scenarios. The Challenge Questions and the Scenarioswere all considered from the perspective of the year 2025.

FORT COLLINS WORKSHOP CHALLENGE QUESTIONS

1. Societal Expectations

2. Education Format and Delivery

3. Business Models

4. Ethics and Values

FORT COLLINS WORKSHOP SCENARIOS(SEE APPENDIX C)

1. Doomsday: The Pandemic Disaster of 20152025There is a major resurgence of zoonotic pandemics. Despitemodern medicine, the impact of the new zoonotic diseases isreminiscent of the plague pandemics that devastatedEurope centuries ago. Pets and animals are seen as theprincipal pool of disease and major transmission vectorsand are destroyed indiscriminately.

The economy is in deep recession as governments at alllevels place restrictions on travel, and actions are in crisismode. Veterinarians are suspected of being too lenient andpart of the problem. The quality of veterinary caredrops and enrollment in veterinary schools also dropsdrastically.

2. The Great Animal Peace: Eradication of ZoonoticHealth ThreatsThe risk of zoonotically based pandemics, such as avianinfluenza and BSE-related diseases, has virtually disap-peared, similar to the war-free era of the Pax Romana.Modern veterinary epidemiology, vaccinations, risk-monitoring technologies, and risk-management proceduresfor diseases are prevalent and applied rigorously. Scienceand technology ensure that all animals are carefullymonitored and any early onset of disease results in quickelimination. Animals, both large and small, are seen asvaluable contributors to societys needs.

Veterinarians are seen to be largely responsible for thischange, through visible public efforts, active promotion ofcitizen education, and major influence in public healthprograms.

3. Brave New World of Modified SpeciesSystematic mapping of the genome of animal species leadsto massive genetic testing, modification and cloning ofanimals. Examples include: more disease-resistant strainsfor the food supply, novelty pets with designer features, andsynthetic animal-cell-based protein foods. Additionally,individually genetically tailored designer therapeutics anddrugs are created.

These developments raise major ethical challenges,such as organ farming and food safety. They also giverise to new threats, such as new diseases rising fromxeno-transplantations.

4. Fragmented ProfessionThe veterinary profession evolves and eventually fragmentsinto very different streams. Each stream requires differenteducation levels, certification procedures, and businessmodels. Different teaching institutions are created for thevarious streams.

The ethical guidelines and requirements are very different,creating an unprecedented divide.

KNOXVILLE WORKSHOP CHALLENGE QUESTIONS

1. Science and Technology

2. Status of Veterinarians

3. Relationship with Public Health

4. Policy, Regulation, and Funding

KNOXVILLE WORKSHOP SCENARIOS(SEE APPENDIX C)

5. One Medicine, One HealthHealth care professionals acquire unified basic training, andpublic health services are subject to similar standards forhumans and animals. Recurring threats of zoonotic diseaseshave created a move to standardize the basic training andpreparedness of all health professionals. Public healthagencies are staffed with specialists in human health aswell as animal health. Veterinarians enjoy the same statusand remuneration as physicians, and are subject to similarexpectations and ethical standards. Science and technologyare continually adapting these practices, as humans demandthe best for themselves, their animals, and their food.

6. Global Warming, Eco-CrisisDrastic changes in traditional weather patterns lead tochanges in food production and dislocation of establishedfood-producing regions. Personal health and security con-cerns are dominating public agendas, and regional conflictsover resources are creating major international tension.Isolationism and globalization are in continual tension asgovernments seek to control the negative spiraling of publicconfidence. There is a major stress on freshwater suppliesthat leads to a fundamental re-evaluating of the role of petsand the sustainability of food-producing animals. Increasingspread of new tropical diseases in previously temperatezones alarms public health authorities into a crisis mode.Veterinarians become more proactive, and take on a newrole as eco-health stewards.

7. Norman Rockwell VeterinarianThe veterinarian, as captured by painter Norman Rockwell,offers a local, traditional, cottage-industry model of service.The emphasis is on personal service, and the focus is onsmall animals. Veterinary clinics are seen as part of the localbusiness environment with strong community links.Technology is present, but is seen as low-key and non-invasive, primarily serving as an aid in the efficient deliveryof very individual and customized service. Veterinariansstand apart from more technologically dependent profes-sions on principle, providing personal care and service.

JVME 34(1) 2007 AAVMC 7

8. Globalized Google VetsThere have been major advances in technology, leading towidespread use of computer-linked sensors to carry outdiagnostics, administer therapies, or carry out robotic tele-surgery from great distances. Clients, through a Google vetservice, have instant access to global remote diagnosticsand tele-therapies from their home or farm computers.Traditional, locally based veterinary clinics are dramaticallytransformed to global offshore service providers. Veterinaryeducation is now universally accessible and largelydelivered through highly sophisticated distance learningtechnologies, with completely realistic, textured, 3-D holo-graphic animal models. The dominant forces shaping thebusiness and education models for veterinarians are globaland virtual, with a large number of specialists offeringtele-veterinarian services from offshore locations likeIndia. There is intense global competition for franchisesand services.

The full range of the Challenge Questions can be found inAppendix B, and narratives of the Scenarios are presented inAppendix C.

The Challenge Questions and Scenarios were addressed inthe context of societal expectations and implications for theskills, competencies, and education of veterinarians. Finally,the participants undertook backcasting to determine thecritical actions, decisions, and events that could haveresulted in these scenarios.

Workshop 1 had 35 participants and Workshop 2 had 44participants (see Appendix F).

In the final Synthesis Meeting, held in Sacramento,California, a group of 16 participants, 11 of whom hadalso attended the Scoping Meeting, analyzed the outputsof the two workshops. Under six themes, which reflectedthe grouping of the original 21 questions, they selectedand summarized key actions, which were deemed mostimportant for the veterinary colleges and the AAVMC toconsider.

In developing the Final Report, the Norm Willis GroupTeam has taken into consideration the outputs, comments,and opinions of all four meetings.

5. What We Heard: What May Lie Ahead for theVeterinary Medical Profession

In this section we present a summary of what was saidduring the courses of discussion around the ChallengeQuestions and the Scenarios, and during independent,individual interviews.

5.1 EDUCATION

PhilosophyIt is essential that the veterinary profession respond to thefuture needs of society to remain relevant. In its presentform, academic veterinary medicine cannot respond to allof the currently apparent societal needs, let alone theunknown but anticipated needs of the future. Clinicalveterinary medicine is the predominant thrust of presentday veterinary medical education and is the basis of thepositive public image that veterinarians presently enjoy.Therefore, it is desirable that any modification of thephilosophy of veterinary medical education build on,not detract from, this well-established and much valuedreputation and contribution.

However to respond to both foreseeable and, as yet,undetermined future needs, a broad range of skills,knowledge, and attributes will be required, e.g., communi-cation skills, leadership abilities, cultural competence,business skills, interpersonal skills, values, and ethics.It was suggested that the number of available, competent,licensed veterinarians be increased to address these needs,rather than be pulled from or compete with existingprofessional demands.

At present it is difficult for all colleges to deliver all the

desired skills. Therefore colleges should consider develop-

ing areas of professional focus, perhaps identified as centers

of emphasis.

Although there is a risk of perceiving colleges as first

rate and second rate, the intent is to create institutions of

focused expertise in selected areas for veterinary medical

education, operating in communities of knowledge and

competencies. These would create critical masses of

expertise and efficiencies of financial, human, and physical

resources. The range of training could be reflected in

a national plan developed by the AAVMC, which

would ensure that all options of veterinary endeavor

in the future would be available for training at some

colleges within the context of an integrated educational

framework.

All colleges could collaborate on the total delivery of the

national veterinary medical educational program, and

students could choose to qualify for their DVM degree by

attending multiple institutions.

On the basis of current demographic trends in society,there is a challenge for the colleges, faculty, and programsto reflect the diversity of ethnicity, culture, and totalsocietal needs.

It is a reasonable expectation that students will be able toanticipate the length of education required to achieve theirdegree in the focused area of their choice, and that this will

8 JVME 34(1) 2007 AAVMC

be commensurate with the projected remuneration aftergraduation.

Although students are encouraged to choose their desiredcareer path and lifestyle, the profession as a whole hasa responsibility to address the needs of society.

StructureOn the basis of a national plan, as developed by theAAVMC, colleges should choose to focus on certain areas ofcompetency development that reflect their expertise andare most cost-effective for them. National standards couldbe developed to permit college accreditation, taking intoaccount these areas of professional focus.

Following a specifically defined prerequisite program,which could be very important to achieve diversity and toobtain students already possessing the desired skills, therecould be a two- or three-year core program, standardizedacross the continent. This would be followed by a one- ortwo-year program in an area of professional focus, whichwould lead to a DVM (professional focus) degree. If desired,a postgraduate program could follow, leading to additionaladvanced degrees e.g., PhD. The professional focusedtraining could be provided in institutions that are differentfrom those providing the core training.

Dual degrees could be obtained simultaneously underintensified full-year programs, such as DVM/MPH,DVM/PhD, DVM/MBA, DVM/biomedical engineering,or DVM/information and data analysis.

Licensure would be based on ensuring competency in thearea or areas of professional focus.

To change a career path any time throughout a careerwould require retraining in the selected program area witha recognition of competency in that new professional focus.

Teaching hospitals may not be required in all collegesor all areas of professional focus, but would be essentialfor specific clinical areas of focus. Although some clinicalexperience could be obtained in private practice, theemphasis on education and the degree of advancedcompetency and experience in these teaching hospitalsmay be required for accreditation.

Modular training, which would be open source, portable,and non-linear, could expand access.

Research, including clinical research, should be an essentialpart of the functioning of each area of professional focus toadvance knowledge and to be on the leading edge of thatparticular area.

Educational DeliveryOnline, Web-based training could become an integralelement of the educational process. However, hands-onexperience is essential and fundamental to achieving a DVMdegree. Virtual training could also be very important inproviding lifelong education to maintain competence andto supplement a professional choice to change a career path.As well, distance education, both nationally and inter-nationally, would allow best use of the unique competenciesin the specific areas of professional focus.

Training could occur through cooperation amongst multipleinstitutions. Additionally, collaboration with other health

professions, and with other disciplines and departments oncampus, could expand options for educational delivery.

Consideration could be given to providing parallel trainingto paraprofessionals to permit better integration into healthteams and corporate or community practices.

CurriculumThe pre-veterinary or DVM curriculum could consist ofa nationally standardized core program of material, whichwould also include aspects fundamental to the professionas a whole, such as communications, leadership, publicrelations, values, ethics, problem-solving, dilemma manage-ment, conflict resolution, and the management of change.It would also be desirable to place emphasis on knowledgetransfer and skills development.

In the segmented training program, as developed acrossthe national plan, the curriculum could be broadened toprovide options for such focused areas as:

1. Public health

2. Ecosystem health

3. Emergency management and crisis response

4. Businesscorporate model of practice

5. Food safety and security

6. Clinical medicine

g Small animals

g Large animals

g Equine

g Further subdivisions of clinical practice

The curriculum should be portable.

However, licensure for selected areas of professional focusand accreditation of colleges (taking areas of professionalfocus into account), are essential to permit such tailoredcurricula for the streams of emphasis.

Recruitment and AdmissionsTo effect a change, it would be necessary to make the fullscope of veterinary medicine visible to society, especially tothe applicant pool.

It would be beneficial to have a national recruitmentstrategy that seeks to achieve a greater diversity inapplicants, approaching the diversity of society. Diversitycan be accommodated in all its meanings (ethnicity, cultural,values, needs). The recruitment strategy could also stressdiversity of interests, e.g., experience in public practice,leadership, community development, communications,business, and demographics. As well, recruitment couldbe started in secondary schools.

Health and other professions could also be mined to recruitstudents to particular areas of focus.

5.2 STATUS OF VETERINARIANS

Role in SocietyVeterinary medicine, as the only health profession withextensive training in comparative medicine, provides anessential role in public health, which should be emphasized.

JVME 34(1) 2007 AAVMC 9

It requires refocusing the role of veterinarians in societyto that of serving human health as well as animal health.This approach also involves broadening and increasingthe roles for veterinarians in society by bridging the gapsamong animals, humans, and the environment.

Considering veterinary medicine as a public health profes-sion leads to a responsibility for ensuring a safe supply offood and water, as well as the associated responsibility forthe protection and preservation of a sustainable ecosystem.Further, a vision could be fostered of shared responsibilityfor public safety on issues such as food safety, zoonoticdiseases, xeno-transplantation, and microbiology.

An important approach is for veterinarians to assume a leadrole in being credible, objective, and respected spokes-persons on animal issues.

Throughout this course of change, it is important that thecore values of the profession not be abandoned. The imageof veterinarians as broad comparative practitioners isvaluable to retain. However, if the profession fails to effecta change in the broader roles it plays in society, there is aserious threat that it could become a trade.

LeadershipOf critical importance to the status of veterinarians is theirexpression of leadership.

Veterinarians can serve as team leaders in many issuesinvolving the animal/human interface. This would includeassuming leadership as spokespersons on animal issues.

Examples of roles in which veterinarians could rightfullyassume leadership include leadership of biomedical teams,leadership in the management of related crises, and leader-ship in the interdependence of eco-awareness, the foodsystem, and animal/human health.

Veterinarians could be positioned to demonstrate leadershipin contributing to public policy development and imple-mentation in relevant areas, since greater leadership willlead to greater influence on public policy.

Additionally, veterinarians could exert leadership in thepivotal role of managing the inevitable changes that willflow out of the evolution of societys relationship with theanimal population.

New SkillsIn general, it will be necessary to take a multi-faceted globalview of issues in the areas of science, economics, politics,and societal trends. Special emphasis should be placed ongaining new knowledge of contemporary public healthissues. This could be addressed in specific areas ofprofessional focus for comparative medicine, using exam-ples such as the global monitoring program of the Centersfor Disease Control and Prevention (CDC).

New skills to be addressed in the non-science areas include:

. Leadership

. Ethics

. Business management

. Law

. Crisis management

. Cultural competencies

. The ability to filter and transmit information inwritten form and verbally with people in person

Areas to include for new science skills include ecosystems,comparative medicine, bio-informatics, genomics, proteo-mics, and the ability to coordinate expertise for end users atthe interface between science and policy.

Admissions could consider requiring the development ofsome of these skills as prerequisites during the pre-veterinary training, or selecting students for admissionwho already have acquired and demonstrated some of theseskills.

Role in Policy MakingVeterinarians need to be at the table for effective design ofpolicy, regulation, and technology. Veterinary medicineneeds to have a political voice, a plan, and a target tocapitalize on opportunities to respond. Greater leadershipwill lead to greater influence on public policy.

Consequently, AAVMC could consider developing anenhanced policy role that would create a congressionaland broader political awareness, and would prepare andpromote veterinarians for senior political governmentpositions. As well AAVMC, in parallel with other veterinaryorganizations, could advocate for the profession, particu-larly in education and preparation for specific policy roles.

An approach could be to encourage more joint DVM andlegal degrees to enhance promotion of veterinarians andlobbying for policy development.

Veterinarians could be more prominent in public policy thatconcerns health care and disease prevention. To do so, theyneed to have more influence on the consideration oflegislation in areas involving public health and the impacton the determinants of health. A possible role is forveterinary medicine to be at the interface between scienceand policy, assisting policy makers to remain current withscientific and technical advances.

Veterinarians may also have a public policy role inareas such as eco-health, as well as having a voice in thefirst line of defense against natural, accidental, or deliberatethreats.

Public Perception of Veterinarians and Veterinary MedicineThere is a strong need to focus on and promote the valuethat veterinary medicine creates for society and animals, aswell as the value of animals in society. Public trust will notbe based solely on science, but will be strongly influencedby the credibility and balance that veterinarians can offer.It is important then to encourage the ability to communicatewith people in person, and to interpret and place informa-tion in context to help their understanding.

AAVMC has a role to be the national voice for veterinarymedicine as a human health profession, and to stress theimportance of the humananimal relationship. If veterinarymedicine is to be connected to human and public health,it is critical to be able to explain the relevance of veterinarymedicine to human health. In balance, the profession mustkeep its core values but broaden the public perception andthe professions responses to change.

10 JVME 34(1) 2007 AAVMC

To improve their status, veterinarians must be more visible.The status will increase by connecting to and focusing onhuman health and public health issues. The development ofa professional focus in public health will also lead to agreater profile. The profession needs a national strategy toeducate the public, and especially its youth, about thebroader role of veterinarians in society.

To be recognized and to have influence, it is critical that theprofession speaks with one voice, to achieve unity and notfragment its impact. Veterinarians can present as leadersand expert spokespersons on areas of animal concerns, andas the first point of contact for issues pertaining to animalhealth and well-being.

Veterinarians may consider stepping beyond their tradi-tional roles and into such areas as environment, socialhealth, global health, and as guardians of the safety ofnew biomedical technology.

Veterinarians need to increase their role in communityservices, and to maintain and project an image ofprofessionalism, caring, and giving. As well, it is importantto the image of both the profession and individualveterinarians to mentor young people and futureveterinarians.

5.3 ACCREDITATION AND LICENSURE

Accreditation of CollegesTo accommodate the change and refocusing of curricula toallow students to select an area of professional focus,the accreditation must be flexible enough to recognize thatall institutions may not offer the degree in all potential areasof professional focus.

Because a few areas of professional focus may requireportions of the curriculum to be offered at more than oneinstitution, accreditation standards will have to consider thepathway rather than a single institution.

The accreditations could recognize the convergence ofhuman, animal, and ecological health, with AAVMCfacilitating the development of standards for this conver-gence. As well, AAVMC could consider the development ofquality control standards to allow this accreditation ofthe colleges. These standards could be continental in scope,and in the future may serve as models for implementationglobally.

LicensureGlobalization and technology diffusion require standardiza-tion of competencies. For academic veterinary medicine andthe colleges to respond to the broader needs of society, it isessential that they focus in selected professional areas.In doing so, the curricula will have to be tailored toemphasize the specific chosen areas. This will requirechanging the requirements for licensure to ensure compe-tency in selected areas of professional focus as DVM(specified professional focus).

The verification of competence could be based on outcomes,and the standards used would be subject to rigorous peerreview.

5.4 ALLIANCES AND PARTNERSHIPSAn aggressive pursuit of strategic partners will beabsolutely essential for the future success of the AAVMCand the colleges.

Partnerships could be established

1. at an educational level,

g by forming collaborations with other disciplinesand colleges on campus to form interdisciplinarylinks to business, law, education, science, medicine,and social sciences,

g by collaborating amongst the veterinary medicalcolleges on a national plan for veterinary medicaleducation,

g by making greater use of adjunct faculty and inter-institutional appointments,

2. at a government level,

g by collaborating with the United StatesDepartment of Agriculture, the Department ofHomeland Security, and departments of publichealth, environment, and natural resources, forresearch, funding, crisis management, and thesecurity of the food supply,

3. at an internal professional level,

g by AAVMC collaboration with the AmericanVeterinary Medical Association (AVMA), CanadianVeterinary Medical Association (CVMA), and stateand provincial associations of animal health andveterinary medicine to achieve unity by speakingwith one voice for veterinary medicine, and forconsensus on a national agenda for veterinarymedical education, perhaps by forming anAssociation of Associations,

4. at a public health level,

g by promoting veterinary medicine as a humanhealth profession, through collaboration with theCDC, the Association of Schools of Public Health,and with the Association of American MedicalColleges,

g by promoting, with the National Institutes ofHealth (NIH), the creation of an Institute ofComparative Medicine, and by bridging theconcept of One Medicine,

5. at a corporate or private sector level,

g by working with the food industry, the pharma-ceutical industry, the Animal Health Institute, theagricultural production industry, and the humanhealth insurance industry,

g by collaborating in the development of theskills and competencies required to meet theirneeds, to emphasize the breadth of scope ofveterinary medicine, and to seek support andfunding,

6. at a technical level,

g by partnering in research to access and capitalizeon the latest scientific developments, and to verifytheir safety and legitimacy,

JVME 34(1) 2007 AAVMC 11

g by cooperating in the development of technologiststo complement the development of corporate orcommunity practice teams, to achieve the mosteffective delivery of mission in the future,

7. at a community level,

g by collaborating with other public health contrib-utors in addressing the daily health level of societyversus episodic health care events, stressing therole that animals play in the health of society andthe opportunity to mitigate impacts at the source,

8. at a global level,

g by partnering with organizations such as theWorld Organization for Animal Health (OIE), theFood and Agriculture Organization of the UnitedNations (FAO), and the World Health Organizationof the United Nations (WHO),

g by preparing future veterinarians for deploymentto address zoonotic disease prevention and control,for crisis management at the local, national, andinternational level, and for the eradication ofanimal diseases at source,

g by engaging internationally on the accreditationstandards of education and ethics,

g by demonstrating leadership in veterinary medicaleducation,

g by being the primary representative of compara-tive medicine.

In addition to these suggested collaborations, the AAVMCand the colleges could reach out in a concerted fashionto such non-traditional areas as eco-health, social sciences,law, engineering, and change management.

One MedicineThe AVMA, CVMA, AAVMC, and the colleges couldpromote public acceptance of the role of veterinarians inimproving and protecting the health of people, of animals,and of the environment. This will require first creating anawareness, then an integration into public health andhuman health, and then finally acceptance.

Through closer collaborations with public health andhuman health, particularly in communications and training,common integrated roles can be developed for the benefit,security, and prosperity of society. This would be guidedby a concept of One Medicine, which the AAVMC coulddrive, through the development of a national plan.

5.5 TECHNOLOGYThe absolute key for the future veterinary medical professionis adaptiveness and responsiveness. Technological advancesin the future will be rapid and will exceed all expectations.Therefore, the need for the profession is to expect change andbe ready to adapt and accommodate changing needs andopening opportunities. Academic veterinary medicine mustprepare veterinarians for these events.

For EducationAcademic veterinary medicine should take full advantage ofnew technology. As an integral part of the educationprocess, technology can help colleges increase the number

of students and generate revenue. Distance education fromexperts at centers of emphasis can occur both nationally andinternationally. AAVMC may consider establishing a goal tohave a virtual or global classroom in every college.

Virtual technology can be used to complement hands-onexperience, and to customize educational programs formultiple purposes. Simulation can be used to supplementsurgical and diagnostic programs. To take advantage of suchtechnological opportunities, AAVMC could promote theuse of a net-centric, open source, portable system of deliveryfor education.

For Use by the ProfessionTele-medicine will permit the availability of focusedexpertise at the colleges to smaller or remote practices, tosmaller urban clinics, and to international sources of need.

Large corporate practices will be able to offer advancedtechnology for diagnostics and therapeutics, while hand-held devices for diagnostics or instant information accesswill be important for rapidly addressing potential problems,for finding solutions, or for monitoring ecosystem health.

Tele-diagnostics and new diagnostic methods will also havean impact on surveillance and modeling.

Colleges must strengthen their abilities to evaluate, test, anddeploy new diagnostic innovations. They must also enhancetrend detection and analysis as well as disease controlstrategies. In addition, there is a role in scanning andinterpreting new science and technology development,and in evaluating new skills and tools such as genomics andbio-information. This could be considered for an area ofprofessional focus in colleges. At the very least, the standardsfor college accreditation should reflect these new technologies.

Another new opportunity for veterinary involvement couldbe in areas such as bio-farming, genetically modifiedanimals, and agri-ceuticals. These new technologies willbring with them ethical questions in society for whichveterinarians could play a critical interpretive role inframing the debate.

5.6 FUNDING, COSTS, AND REVENUE

LobbyingLobbying is an important thrust to enhance the economicposition of the profession and to recognize the criticalcontribution that animal health makes to societal produc-tivity and economic competitiveness. AAVMC and thecolleges can seek increased public and private funding byemphasizing the comparative medical aspects of theprofession, the social and economic elements, as well asthe community and public health benefits.

These efforts could be strengthened by having the AAVMCbecome more actively involved in economic policy, and byengaging more lobbyists. Also, the promotion of publicfunding for public good outcomes creates a new economicmodel.

Educational FundingThe availability of funding will directly affect the ability ofthe profession to address the shortage of veterinarians, and tomeet new functional and specific area demands. AAMVCcould develop a model for enhancing public and private

12 JVME 34(1) 2007 AAVMC

funding, using a different language to engage differentopportunities. Funding will be attracted through increasedconsumer and public confidence in the value of veterinarians.

AAVMC and the colleges could seek to develop alternativesources of funding through potential new revenue streams,such as opportunities to sell knowledge products and toexploit distance education. Agriculture will not necessarilybe the driver. Another opportunity may be to seek directedfunding for specific areas such as food animal veterinarians,and preparation for crisis management.

Tuition FeesA changed public attitude toward veterinarians can lead togreater recruitment and financial support. The economicburden of a students debt impedes progress by the profession.This is compounded by the low level of remuneration forgraduate veterinarians. This remuneration is also influencedby the amount of disposable income in society, and by thestatus of animals in society. Hence a new model for tuition feesis required to increase access by students.

Another area of expanded government and corporatesupport is student placement and mentorship related tothe public perception of risk in the ecological and food-security systems.

To increase student numbers, the issue of student debtshould be addressed in an articulated plan.

Research FundingAAVMC has two key roles in research funding:

. to identify new sources of research funding

. to maximize the development of infrastructure tosupport collaborative research.

A prime strategy for the AAVMC is to seek NIH funding forresearch and development, by stressing the role of veter-inary medicine in public health, and by advocating thecreation of a NIH Institute of Comparative Medicine.

Possible sources of funding are

. industry (e.g., pharmaceutical companies, devicemanufacturing, private insurance sector)

. state and federal governments (e.g., the NationalInstitute of Health, the US Department of HomelandSecurity, the US Department of Agriculture)

. contributions to the public good such as bio-terrorismor agro-terrorism, which may become areas of focusfor some colleges

. transdisciplinary, collaborative research approaches

. new areas of research in tele-medicine, remotemedicine and surgery, sensing, surveillance,epidemiology.

5.7 SOCIETY

Role of VeterinariansWhat is emerging is a view of the role of veterinarians at theinterface of animals, humans, and the environment, with agoal to protect and improve animal, human, and environ-mental health. The profession needs broader communityengagement to determine the societal needs, and then to

bridge the gap between its current roles and these societalneeds. There is a need to emphasize that the veterinarymedical role is for humans as well as for animals.

Veterinarians must step beyond their traditional roles andinto social health and the environment so that the phrasehealthy animalshealthy foodhealthy people can takeon a new meaning for the profession.

The humananimal bond is more important to an agingNorth American population. Veterinarians have a role asobjective, caring, and ethical spokespersons on animalissues. Although this will mean working with humanesocieties and other cultures, the relationship of veterinariansas protectors of animal well-being is important.

In the medical field, veterinarians have a unique knowledgeof the impacts of zoonotic disease, and they should lead inthis area.

If terrorism and global conflict become more important toglobal society, there will be a need for veterinary skills, andveterinarians should prepare for and participate in crisismanagement.

Another role for veterinarians is ethical leadership inpreparing for rapid environmental shifts.

Additionally veterinarians have an opportunity to capture amore visible role as leaders, change managers, educators ofthe public as well as students, and as respected and crediblecommunicators.

Diversity RequirementsThe North American society will become more diverse, andthat change will be reflected in an increased need fordiversity in the profession, embracing racial, ethnic,cultural, and discipline diversity. Societys attitudes to petsand animals will also become more diverse, and theprofession must be prepared to address this issue. As wellthere is a need to protect biological diversity by preservinggenetics and species in the face of disease occurrence.Therefore, it is important that cultural competencies areembedded throughout the veterinary curriculum.

Marketing and Public RelationsThere is a critical need to explain the relevance of veterinarymedicine to human health. The image must focus on thevalue that the profession creates for society, and the value ofanimals in society.

As well, there is a need to promote the role of veterinariansin the production of safe animal protein food in a way thatpreserves the health of the environment and also animalwelfare.

There is a need for the profession to dialogue with societyon its perceptions of veterinary medicine. The professionmust be prepared to respond but at the same time preserveits core values and its scientific integrity.

To move forward will require a national strategy to educateyouth and the public about the broader role of veterinariansin society. This can be supported by promoting and makingavailable the achievements and successes of the professionspast history, while projecting its role for the future.

JVME 34(1) 2007 AAVMC 13

5.8 BUSINESS MODELS

Public ModelThere may be a growth into convergent team practices,which are linked to human health. If this is so, thesepractices are likely to be corporately managed as healthmanagement organizations. In most communities, veter-inarians could develop into health care practitioners whoprovide a public health and medical advisory role as well tothe community. This growth into public health roles couldlead to having this function built into a public service cost.

Urban ModelsThere is a trend in urban companion animal practice towardcorporate practices with the possibility of developing thefranchise model. This could be extended into globalcorporate organizations in which there would be somelocal control but with much better brand recognition.

However, remote technology and relationships with net-works of specialty practices could also support a parallelgrowth of local community-oriented clinics.

There is a definite trend of orientation toward wellnesspractice, supported by insurance programs and technologyadvances such as bio-sensors.

Rural ModelsThe trend is toward corporate practices made up of multipleveterinarians, supported by teams of paraprofessionals andalternative technical advisors, to address food animalproduction. The elements of emphasis are toward bio-security, traceability, and on-farm food safety standards. Aswell, more veterinarians may be incorporated into verticallyintegrated production models.

Complementary to this movement could be a growth of nichepractices that address the needs of large companion animals,exotic or non-traditional species, and organic or hobby farmoperations. Distance technological linkages to networks ofspecialty expertise may also support these practices.

Corporate ModelIn addition to corporate practices and food animal produc-tion, some corporations may develop on the basis ofleading-edge genomics technology. Although capital inten-sive, these could develop into expert corporations providingsuch products as designer animals, pharmaceuticals, ther-apeutics, and xeno-transplantation.

GeneralThe trend is expected to be toward larger practices with atleast three veterinarians in order to realize the desiredlifestyles.

All models point toward a more business-based orientationwith a trend toward the outsourcing of practice manage-ment, and other competencies such as nutrition, husbandry,and engineering.

As well there may well be an increased use of paraprofes-sionals and supplementary support staff in all forms ofpractice.

There could be a shift to blending aspects of humanhealth and wellness care into all practices of veterinarymedicine.

5.9 VALUES AND ETHICS

ValuesIn considering the social responsibilities of the veterinaryprofession, it is necessary to determine the expectationsof society for the profession. The Veterinarians Oathacknowledges society as the primary client of theprofession, but this leads to dilemmas of societalexpectations.

. Is the primary obligation to the social benefits of usinganimals, or is it to the animals themselves?

. Is the primary obligation to animal welfare, or is it toeconomic benefits, or to public health?

. Is the primary client the human or the animal?

. Is the veterinarian working for the patient or theclient?

. Is the veterinarian responsible for the patient and theadvocate for the animal?

The new understandings of the links between animal andhuman health emphasize the public health responsibility,but there is a growing expectation that the primary client isthe animal and its welfare.

. Between small animal and large animal practices, themoral status of animals changes.

. Is the humananimal relationship one of guardian-ship or property?

This expectation creates a dynamic tension within theprofession. But the issue is less about tension within theprofession and more about the relevance of the professionto society. How the profession shapes societys expressionof values and ethics in the future will define how theprofession is seen in society.

Veterinarians must actively engage in these ethical debates,which are central to the paradox of the profession. Theprofession cannot rely on assumed values and ethics.However, strategically the profession is managing adilemmait is not solving a problem. The debate is at theinterface of animal usage and humans.

The integrity and professionalism of veterinarians areuniversally recognized. However, as cultural diversitywithin the profession increases to match that of society, itwill bring varied understandings of what personal integrity,trust, and other values mean. It is necessary that theprofession negotiate, reinterpret, and reach consensus onwhat these fundamental and core values will be for theprofession.

EthicsThe social contract professionals make with society isthat they are given the benefits of professional autonomyin exchange for a commitment to high standardsof conduct, which the profession itself enforces on itsown members. The profession should reconsider itssystem of self-governance of ethics, or legal decisions willdominate.

Ethical responsibilities of the profession to society include:

. participation in the public debate over the develop-ment and regulation of new technologies,

14 JVME 34(1) 2007 AAVMC

. education and communication to the publicabout disease threats and crises(who speaks authoritatively for theprofession?)

It is necessary to teach the ethical implications ofnew technologies and to have proactive engagementin discussions of the ethics of technological development.

If the profession proceeds to a state of segmentationand areas of professional focus, there is a potential forconflicts of position to arise. It will require an overarchingumbrella group to speak for the entire profession.

Since veterinary medicine is a global profession, it may wellrequire international engagement and agreement on stan-dards and ethics.

6. Discussion: Elaborated Principles and KeyRecommendations

6.1 VETERINARIANS, VETERINARY MEDICINE, ANDACADEMIC VETERINARY MEDICINE

What Makes Veterinarians UniqueThe single characteristic that distinguishes veterinar-ians is their unique relationship with animals. Thisrelationship exists at the interface between society andanimals.

Veterinary medicine is the only profession in thehealth and medical field with training in comparativemedicine of multiple species. Veterinarians use a compara-tive matrix as a way of solving problems. Concernfor animals, their health and well-being, and theirinterface with people, inserts veterinarians as criticalcomponents of public health. They are essential healthcare providers to society locally, nationally, andinternationally.

What Are the Roles that Veterinarians ShouldPlay in Society?Veterinary roles that benefit society most are thosethat demand and capitalize on the unique knowledgeand abilities developed through veterinary medicaleducation. In addition to practicing clinical veterinarymedicine, by defining roles in areas such as publichealth, eco-health, food supply and safety industry, crisismanagement, research, and business management,veterinarians and the veterinary medical profession willfulfill their obligation to the well-being of society andanimals.

Veterinarians are ideally suited to serve as translatorsof new science, and as interpreters of disease preven-tion and consequences on animal and human populations.

The comparative matrix education of veterinarians isparticularly suited to complex decision making.Veterinarians can handle multiple parameters in situationssuch as disaster and pandemic disease management.As an extension, veterinarians are particularly effective ascoordinators in multi-stakeholder events, both locally andnationally.

The values and ethical standards that are fundamentalto the profession must become clear and completelytransparent. The position of veterinarians and theprofession must be clearly and definitively representedin ethical questions that involve the well-being ofanimals. Veterinarians should represent the moralbalance of new technologies and practices that involveanimals.

Values and ethics are an integral element in the fabricof the profession, and influence the role it represents in

society. As a result, values and ethics should be an integralcomponent of education.

A Vision for Academic Veterinary MedicineNorth American academic veterinary medicine is a globalleader in the design and delivery of veterinary medicaleducation systems. It inspires and educates veterinarians toexemplary standards and values in an intellectually andemotionally rewarding career. The profession is respectedand valued by society for its leadership and dedication tothe health and well-being of animals, people, and theenvironment.

JVME 34(1) 2007 AAVMC 15

A Future Image of Veterinarians

. Veterinarians work in society at the interface betweenanimals and people.

. The Gentle Doctor is a powerful and compellingimage of veterinarians in the psyche of the majority ofthe public.

. This is an image that should be retained andexpanded and should be actively promoted.

. This emotional image touches people in a way thatan alternate, more accurate, but intellectual imagewould not.

. The expansion of the image should encompassthe multiple roles that veterinarians serve insociety.

This future image of the veterinarian is depicted inFigure 1.

6.2 PRINCIPLES CONSIDERED TO BE MOST IMPORTANTUsing Foresight technology, with its numerous exercisesand group discussions, the many talented participantsproduced a broad range of insights, conclusions, andrecommendations.

The objectives of this study were very focused and specific.Therefore, only the most compelling principles are pre-sented here, and have been developed from all of thepreliminary meetings.

1. Veterinary medicine must remain relevant to thechanging needs of society.

2. Veterinary medical education can respond to thesechanging needs only by expanding the areas ofeducation required to prepare the veterinariansof the future.

3. Veterinary medical colleges can achieve thisexpansion by identifying areas of professional focus,each leading to a DVM degree, and each perhapsidentified within institutions as centers of emphasis,according to a national plan.

4. In addition to meeting the demand createdby population growth, and increasingexpectations for traditional services, the numberof graduating veterinarians must be increasedto allow the profession to respond to newdemands and roles.

This increase could be facilitated by

. a publicity campaign to expand the image of theprofession

. a resolution of the perceived student debt loadversus graduate veterinarian remunerationimbalance

. changed admission criteria that match the needs ofthe expanded profession

. a more flexible and adaptable program

5. Academic veterinary medicine should reflect theexisting and anticipated diversity in society.

Figure 1: A future image of veterinarians

16 JVME 34(1) 2007 AAVMC

6. It is necessary that legislators and policy makersunderstand the extent of the value that veterinarymedicine brings to the health and well-being ofsociety and actively support the profession withappropriate legislation and increased funding.

7. There is an opportunity for veterinary medicineto capitalize on new technology for the deliveryof education and veterinary services (e.g.,analytical work, research, diagnostic sciences,and therapy).

8. Veterinary medicine should seek to achieve greatercollaboration and cooperation with human healthin the public health area, with veterinarians playinga more dominant role in the management of zoonoticdisease, public health, and the impact on eco-systemhealth.

9. The One Medicine concept is an exciting andlogical future goal. It is concluded that veterinaryand human health convergence must first beachieved before One Medicine can be realisticallypursued.

10. Strategic partnerships and alliances are essentialfor academic veterinary medicine to be successfulin the cooperative delivery of an expandededucational process and new areas of professionalfocus.

11. Modification of the national licensing system forgraduate veterinarians, and of the accreditationstandards for colleges of veterinary medicine, arefundamental to the acceptance and implementationof the required academic changes.

12. The public image of the veterinarian as theGentle Doctor should be retained, promoted, andexpanded in the current and new roles in society thatveterinarians can play.

13. The status of veterinarians can be enhanced by

. advocating for the well-being of animals

. achieving and demonstrating increasedcompetence

. becoming more visible to the public

. clearly defining the fundamental values andethical standards of the profession

. articulating the professions position on significantand controversial issues in society that involveanimals

14. The power and influence of the veterinaryprofession will be strengthened by achievingunity and speaking with one voice in mattersof fundamental principle.

15. The public image and status of veterinarians will bechanged only through a powerful and professionalmarketing and public relations campaign.

6.3 RECOMMENDATIONSThe participants in this study offered an extensiverange and number of thoughtful individual insights andrecommendations for change to the AAVMC. These have

been recorded in the preliminary reports and are alsocollated in Appendix D.

Here, we present a series of 45 recommendations for actions.These recommendations are based on the insights andconclusions reached during the course of the study.They are presented in categories deemed most pertinentfor the AAVMC.

Education

1. As a first priority, the AAVMC must achieveconsensus on two key points within academicveterinary medicine and the profession as a whole.The first is acceptance of the concept of an expandedveterinary medical educational program to beachieved through provision of areas of professionalfocus, perhaps identified as centers of emphasis inNorth American colleges of veterinary medicine. Thesecond is an acceptance that veterinary licensure willrecognize competence in selected areas of profes-sional focus, and will lead to public assurance ofcompetency in a selected area of veterinary medicine.

2. The AAVMC should develop a national strategic planfor implementation of the concept.

3. Each college should develop a specific strategic planto achieve fulfillment of the educational concept atthat location.

4. Within the national strategic plan, the AAVMC andthe colleges should create a design for the concept offocused veterinary medical education. An example isillustrated in Figure 2.

5. It is recommended that the AAVMC and the collegesreach a decision on the program design and thelength of the educational program for uniformimplementation in North America.

6. The national plan should define the areas of profes-sional focus required for both the traditional andanticipated future needs of society as well as theprerequisites needed for each focus area.

This plan will require the agreement and collaboration of allcolleges.

7. Each college can choose and establish its areas ofprofessional focus from those listed in the nationalplan.

8. The national plan should ensure that there is at leastone center of emphasis for each defined focus area.

9. The national plan could predetermine the minimalnumber of seats required to respond to each area ofprofessional focus.

10. The system for the granting of DVM degrees couldbe modified to allow the degree to be obtained byattending more than one college of veterinarymedicine in a national cooperative program.Such programs would require inter-institutionalagreements on residency, tuition, and fees.

11. The AAVMC and the colleges should promote theadvantage of pursuing dual degrees in intensifiedprograms.

JVME 34(1) 2007 AAVMC 17

Recruitment and Numbers

12. It is essential to the success of the concept presentedhere that the number of graduating veterinarians beincreased to maintain the number of practitionerscommensurate with societys needs, and also addressunder-serviced and new areas of practice.

13. The AAVMC and the colleges could pursueexpansion of recruitment through publicity of careeropportunities, increased awareness of the scopeof the profession, promotion of the image ofveterinarians, and appeal to the full rangeof diversity in society.

Admission

14. The criteria for admission could be modified to selectfor the broader range of skills required for futureveterinarians.

15. Efforts should be made to attract students from otherprofessional groups, who already have the desiredprerequisite skills.

16. Selection for admission must consider achievingdiversity in the profession, which would reflect thediversity in society. Achieving diversity within theprofession will lead to a broader understanding ofthe profession and wider use of veterinary medicalservices.

17. Students could be selected for admission intoareas of professional focus where they have apreference, up to the predetermined numberof seats in that area.

18. The AAVMC could monitor on an ongoing basisthe number of students nationwide in each focusedarea and could then predict response to anticipatedsocietal needs. This comparison could be used asjustification for proactive lobbying for support.

Student Debt and Remuneration

19. The AAVMC and the colleges should develop a planto reduce the student debt load, at least in unfulfilledareas.

20. The AAVMC could conduct a study of theremuneration of graduate veterinarians to evaluatewhether that remuneration is in balance with theinvestment in the education.

New Technology

21. Colleges should capitalize on new technology toprovide distance education and to utilize virtualsimulations in education. This will facilitate increas-ing the number of students in certain componentsof the educational program, and will supportcontinuing education.

22. Colleges should actively promote the integrationof technological advances into the delivery ofprofessional services for such areas as remote accessto expertise, research, diagnostics, therapeutics,bio-sensing, data collection and interpretation,and national and international cooperation.

Strategic Alliances and Partnerships

23. The AAVMC should form alliances with humanhealth organizations to promote cooperation in thepublic health field.

24. The colleges could form partnerships with othercolleges, departments, and disciplines on campus toexpand opportunities for educational programdelivery, and as well use cross appointments andadjunct faculty to deliver professionally focusedsubject matter and to increase teaching capacity.

25. The AAVMC and the colleges could form allianceswith humane societies and other animal welfareassociations to influence policy on the well-beingof animals.

26. The AAVMC and the colleges should promote closeralliances among veterinary associations to produce asa profession more concerted joint efforts on relevantpolicy and societal issues.

27. The AAVMC could initiate a relationship with suchinternational organizations as the WorldOrganization for Animal Health (OIE), the Food andAgriculture Organization (FAO), the World HealthOrganization (WHO), and the World VeterinaryAssociation (WVA), to influence the development ofglobal standards in veterinary education.

Animal HealthHuman Health Convergence

28. The AAVMC should aggressively pursue and pro-mote the collaboration and cooperation of animal and

Figure 2: Examples for possible veterinary medicalprogram designs

18 JVME 34(1) 2007 AAVMC

human health to more effectively and competentlyaddress the public health needs of society.

29. Although the blending of education for the medicalfields has tremendous appeal and potential for thefuture, it is recommended that the One Medicineconcept be actively pursued only when the conver-gence of animal health and human health has beensubstantially achieved. However, consideration couldbe given to initiating formal relationships withcolleges of human medicine.

30. The AAVMC should pursue with the NationalInstitutes of Health (NIH) the establishment of anInstitute of Comparative Medicine.

Image of Veterinarians

31. It is recommended that the degree Doctor ofVeterinary Medicine (DVM) be retained and notchanged because of its firmly established recognition.

32. The public image of veterinarians as the GentleDoctor should be retained, promoted, and expandedto capitalize on its broad appeal.

33. The AAVMC should promote this expanded image ofveterinarians and make clear to the public the rangeof roles that veterinarians play in society, and thevalue they bring to society.

Marketing and Public Relations

34. A key recommendation is that the AVMA/CVMA,along with the AAVMC, must aggressively marketthe image of veterinarians and seek to elevate theirstatus and influence in society. This would involve aprofessional marketing and public relations cam-paign to promote veterinarians roles in and con-tributions to society.

35. The marketing campaign should also promote theimage of veterinarians so the public can understandthe core values of veterinarians, what they do, andthe unique training they have in comparativemedicine, as well as their essential role as members ofsocietys health care team.

Lobbying

36. The AAVMC should intensify lobbying to state,provincial, and federal governments to secureincreased support through legislation, policy, andfunding for the new, enhanced, academic veterinarymedical program. Lobbying is a tool to broadenpolitical understanding of the scope of veterinarymedicine.

37. Within the limits of their 501-c-3 status, the AAVMCcould consider engaging more lobbyists to acquirethis support.

Funding

38. The AAVMC as well as the colleges should aggres-sively pursue increased funding from industry andfoundations to support the new concept of veterinaryeducation.

39. The AAVMC and the colleges could pursueincreased funding for research via collaborativeresearch projects in public health, from theDepartment of Homeland Security, and from phar-maceutical companies.

40. The AAVMC and the colleges could pursue increasedstudent funding through increased scholarships, andthrough the payment of tuition by governments,industry, and rural communities for students indeficient areas in exchange for service in those areasfor agreed periods of time after graduation. Theseinclude such areas as food supply veterinarians,preparation for crisis management, public health,public security, and eco-health.

Licensing and Accreditation

41. The licensing boards, through the AmericanAssociation of Veterinary State Boards and theprovincial veterinary associations, should address themodification of licensing for graduate veterinarians toallow licensing for an area or areas of professionalfocus.

42. The AAVMC should also ensure mo