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Veterinary Public Health in a Problem-Based Learning Curriculum at the Western University of Health Sciences

	ABSTRACT

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
As detailed in the Association of Schools of Public Health / Association of American Veterinary Medical Colleges 2007 Joint Symposium on Veterinary Public Health, veterinary public health (VPH) can no longer be viewed as a unique sub-specialty of veterinary medicine. Rather, its practice pervades nearly every aspect of the veterinary profession, regardless of whether the practitioner is engaged in small-animal, large-animal, research, corporate, or military practice. In congruence with the practice of VPH, the teaching of VPH should also pervade nearly every aspect of veterinary education. Accordingly, at Western University of Health Sciences, College of Veterinary Medicine (WU-CVM), public health is not simply taught as an individual course but, rather, is interwoven into almost every aspect of the curriculum, continually emphasizing the relevance of this discipline to the practice of veterinary medicine. This article outlines the teaching philosophy of WU-CVM, provides an overview of the curriculum, and describes the integral nature of public health throughout all four years of the educational program.

Key Words: public health • disease control • zoonotic medicine • structure of academic programs • veterinary programs and curriculum worldwide • curriculum structure • veterinary education

	INTRODUCTION

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
The practice of veterinary public health (VPH) is not limited to those whose job title is "Public Health Veterinarian." Veterinarians, whether in public or in private practice, play a vital role in safeguarding the health of the public. Involvement in public health is not a novel concept to the veterinary profession; in fact, the Veterinarian's Oath states that,

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.¹

There is growing recognition of the value of taking an integrated approach to public-health problems, as demonstrated by the movement behind the "One Medicine" concept.^2,3

The scope of VPH has expanded from "traditional" zoonoses such as rabies, psittacosis, and brucellosis to encompass many emerging pathogens, including West Nile virus, severe acute respiratory syndrome (SARS), and avian influenza. Anthrax spores distributed through the mail in 2001, which resulted in 22 cases of anthrax and five deaths, made bioterrorism a household word and increased public awareness of the potential for zoonotic disease agents to be used as bio-weapons.⁴ Zoonotic disease agents are overrepresented among recognized emerging infections and bioterrorism agents;^5–7 estimates indicate that zoonotic diseases represent 75% of emerging infections over the past decade.⁸ VPH also encompasses disaster preparedness, response, and recovery. Images of animals left behind following Hurricane Katrina and stories of people refusing to be evacuated without their pets remind the public of the importance of pets to both our mental and physical well-being.

To advance both education and research related to VPH, the Association of Schools of Public Health and the Association of American Veterinary Medical Colleges held a joint symposium in April 2007, titled Partnerships for Preparedness: Future Directions for Schools of Public Health and Colleges of Veterinary Medicine, that "focused on how schools of public health and colleges of veterinary medicine can collaborate to improve academic programs, public policy, workforce training and research."⁹ Throughout the symposium, presentations emphasized that the wide-reaching public-health applications of veterinary medicine in a rapidly changing world necessitate innovations in approaches to teaching VPH to future veterinarians. The traditional model of teaching public health as a stand-alone course is no longer sufficient, as this approach treats the field as a separate entity rather than conveying that it is integral to the very practice of veterinary medicine. Recent publications have emphasized the need for improved educational models in focused areas of public-health practice.^10–13 In 2004, Riddle et al. reported on current educational opportunities available in VPH, epidemiology, and preventive medicine in 27 North American veterinary colleges,¹⁴ including a listing of specific courses offered at schools and graduate opportunities for additional public-health training. However, examples of educational models in which varied aspects of VPH permeate the veterinary curriculum are not described in Riddle et al.'s article and have not been found in other literature.

At Western University of Health Sciences, College of Veterinary Medicine (WU-CVM), public health is integrated into nearly every aspect of the curriculum, starting in the first year of the program and continuing through clinical rotations. This article outlines the teaching philosophy of WU-CVM, provides a brief overview of the curriculum, and describes how public health is integrated throughout the WU-CVM educational program.

	TEACHING PHILOSOPHY

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
The teaching philosophy at WU-CVM is based on three founding principles: (1) student-centered lifelong learning, (2) reverence for life, and (3) clinical education through strategic partnerships. These principles are infused throughout the curriculum and serve as a template to create well-rounded, compassionate, and competent veterinarians who will excel in their chosen profession.

Student-centered lifelong learning flourishes in a learning environment that emphasizes being a well-informed consumer of all available resources, taking an evidence-based approach to the practice of medicine, and integrating ongoing learning efforts with previous knowledge. To this end, a problem-based learning (PBL) curriculum is used at WU-CVM to educate students in both the basic and the clinical sciences essential to the practice of veterinary medicine. Students self-direct the width and breadth of their learning efforts, with guidance from faculty members. The first two years of the curriculum are centered on carefully constructed clinical cases that prompt students to generate ideas and learning issues for self-directed study. When entering into their clinical courses and rotations in the last two years of curriculum, students continue in a PBL format while shadowing veterinarians in practice. At that time the paper-based cases encountered in the first two years of the curriculum are replaced by real patients, and students begin to generate their ideas and learning issues in a clinical setting.

WU-CVM is committed to educating future veterinarians, but not at the expense of harming the very animals we have taken an oath to protect. The hallmark of the "reverence for life" philosophy is the Willed Animals for Veterinary Education (WAVE) program. On the model of human medical education, all anatomical specimens used for veterinary training are donated by their owners for the sole purpose of education. These animals have died of natural causes or have been euthanized to relieve suffering due to disease; no animals euthanized for control of pet overpopulation are used in the WU-CVM program. No terminal surgical procedures are carried out within the curriculum. Similarly, students do not use animals to practice diagnostic or therapeutic techniques, such as venipuncture or biopsy, unless the animal is scheduled to have the procedures done for medical reasons. Two wellness clinics and a mobile veterinary practice at WU-CVM have been established to provide wellness and basic primary care for pets of WU faculty, staff, and students. At these clinics, students have ample opportunity to acquire clinical skills under faculty supervision without causing unnecessary pain or trauma to the patients. Students learn basic surgical skills while performing supervised surgical services for local animal shelters and mock surgeries on cadavers as part of their surgical training.

Finally, the clinical phases of our curriculum center on strong collaboration with practice partners, including various veterinary practices, specialty hospitals, and public and private institutions where veterinarians provide key services. This collaboration allows students to gain an understanding of the depth and breadth of the veterinary profession and exposes them to important aspects of veterinary medicine beyond clinical practice. Within clinical practice, students experience both private and corporate practice-management models involving different species and areas of specialty. In this educational model, students are engaged in learning veterinary medicine in the context in which they will practice it.

	CURRICULUM OVERVIEW

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
The general structure of the four-year curriculum is divided into Phases I, II, and III, corresponding to the years of differing curriculum delivery. The following overview describes the courses; Table 1 summarizes each course's contribution to the overall course load during Phases I and II.

Phase II (Year 3)
During the third year, students transition from the basic sciences to the clinical sciences. This phase consists of 16 two-week rotation-style courses at public, private, and corporate practice partner sites; a one-week on-campus course in practice management; and a formal presentation delivered to faculty and peers. A WU-CVM faculty member serves as course director for each Phase II course to maintain educational assessment standards. Practice partner sites, with the exception of livestock rotations, are located in southern California; all must meet stringent standards of veterinary practice established by WU-CVM. On-site clinical preceptors coordinate with course directors to provide supervision of students during their off-campus courses. Each practice partner has a minimum of three students enrolled concurrently at the site. The small-group atmosphere in each location continues to facilitate a problem-based, student-centered learning format while fostering greater independent learning in a supervised clinical setting. A list of Phase II courses is given in Table 1.

Phase III (Year 4)
The fourth-year curriculum at WU-CVM differs from that of most other veterinary colleges in that it is not based in a university teaching hospital. During their fourth year, students enroll in a minimum of 32 weeks of veterinary rotations at self-selected sites approved by WU-CVM. These rotations include two four-week core rotations in medicine and surgery (in the student's species of interest) and a minimum of six other four-week rotations for credit. All rotation sites must meet stringent standards for veterinary practice established by WU-CVM. Unlike Phase II course locations, Phase III rotation sites may be located anywhere in the world. Rotation advisors from WU-CVM follow students’ progress and monitor the quality of their learning experiences during the clinical rotations using e-mail and Web portfolio software. Designated faculty members who are board certified in surgery or internal medicine visit core rotations at least once during each student experience. Non-core rotations are subject to unannounced visits from faculty members to ensure compliance from both students and rotation sites.

	VPH IN THE WU-CVM CURRICULUM

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
Although there is a designated Veterinary Public Health course taken during Phase II, public-health learning issues are interwoven into most aspects of the veterinary curriculum. This section summarizes the public-health components in Phases I, II, and III.

Phase I
Veterinary Basic Sciences- During VBS PBL sessions, group discussion and guiding questions from trained faculty facilitators help students identify potential learning issues in the basic science disciplines that constitute the basis of the Phase I curriculum: anatomy, histology, behavior, epidemiology, genetics, immunology, microbiology, nutrition, parasitology, pathology, clinical pathology, pharmacology, physiology, pathophysiology, and toxicology. Basic clinical science disciplines and some other tangential topics vary between cases and may include practice management, communications, ethics, anesthesia, diagnostic imaging, production/husbandry, public health, internal medicine, and surgery.

An example of how public-health topics can be infused into a VBS case is "Ace," a case presented to incoming first-year students within weeks of matriculation. In this case, students take on the role of an emergency veterinarian whose canine patient presents with lacerations and puncture wounds. A second dog from the same owner is dead on arrival to the clinic. Under guidance from faculty facilitators, students identify basic science learning issues, including concepts of anatomical topography, skin histology, classification of cutaneous wounds, hemostasis, and normal microflora of oral cavity and skin. Progressive case disclosures include information from the injured dog's owner identifying a neighboring young German shepherd as the likely attacker and the presence of coyotes encroaching on the neighborhood. Student discussion evolves toward the veterinarian's role in reporting aggressive animals, dangerous-animal legislation, risks of rabies transmission from domestic and wild animals, and behavioral modification for aggressive animals. While no human injuries are reported in the case, students discuss the potential for attacks on human by aggressive animals. Additional examples of VBS cases featuring central public-health learning issues are highlighted in Table 2.

Phase II
Veterinary Public Health- The aim of the Veterinary Public Health course is to give our future veterinary health care professional the tools to recognize and address important VPH issues. Some of these issues include zoonotic and emerging diseases, outbreak investigation, disease surveillance, bioterrorism, and natural disasters. The course also promotes the establishment of productive relationships between practicing veterinarians and other health professionals at public-health agencies.

Student learning objectives in the Veterinary Public Health course are accomplished though a variety of course activities. For instance, students work in small groups on assigned case studies in a PBL format. These case studies are based on real-life scenarios and designed to highlight public-health learning issues. Some example case studies are provided in Table 3. Students work together to identify the learning issues in their case, research those learning issues, and then present their findings to the class. An additional component of this exercise is having students draft mock exam questions related to the case studies. This activity requires a thorough understanding of the material in order to write quality questions and motivates students to understand the case material well enough to have their own questions appear on the exam.

The Veterinary Public Health course culminates in a public-health presentation by students to a local school or community group. Students again work in small groups, each of which is responsible for selecting an audience-appropriate public-health topic to present. For example, one class put on a mini health fair at a local elementary school, which included a series of exhibits and demonstrations for the primary students (ages 5–9) addressing topics such as dog-bite prevention, proper hand washing, disaster preparedness, and safety around wild animals. Presentations by the 2008 graduating class included visits to three elementary schools, one high school, and a chapter of the Boys and Girls Club. Following their presentations, students are encouraged to leave educational handouts or brochures to reinforce the public-health messages. Veterinary students are often surprised at how challenging it is to master a topic well enough to easily convey it to a lay audience. This is a valuable lesson for students to take with them as they enter the workforce, where they will be interacting with clients and educating them about their pets’ health or working in public agencies to develop programs that can be implemented at the population level.¹⁵

In addition to the Veterinary Public Health course, the third-year curriculum includes several other courses that also devote a sizable proportion of their curriculum to important VPH learning issues. A brief description of these courses follows.

Food and Feed Safety- The primary aim of the Food and Feed Safety course is to provide students with basic knowledge about the role of veterinary medicine in producing safe foods of animal origin for human consumption and safe feeds for animal consumption. The course uses a modified PBL format to guide students to public-health-related learning issues involved in the food continuum, from pre-harvest through post-harvest production. Topics of discussion include microbial and chemical human health hazards in foods of animal origin; surveillance programs for food- and water-borne illness; common zoonotic conditions found in ante- and post-mortem inspection; tuberculosis, brucellosis, and trichinosis eradication programs for US livestock; and drug-resistant pathogens in foods. Students also visit selected slaughter plants and commercial animal-feed plants to learn firsthand about veterinary responsibilities in food safety and the role of Hazard Analysis Critical Control Points (HACCP) programs.

USDA Accreditation, Foreign Animal Diseases, and International Veterinary Medicine (USDA)- In the USDA course, students review the professional, legal, and ethical responsibilities of accredited veterinarians and develop an understanding of their role as global health care professionals. The course covers current control and eradication programs for zoonotic diseases in the United States, such as brucellosis, tuberculosis, and trichinosis (also included in the Food and Feed Safety course). Students also become familiar with zoonotic foreign animal diseases that are reportable in the United States, World Organisation for Animal Health (OIE) reportable diseases, and Centers for Disease Control and Prevention (CDC) Category A, B, and C Bioterrorism Agents/Diseases. A key learning resource is the online course Exotic and Emerging Diseases of Animals: Remembering the Zebras, available from Iowa State University and administered through the Veterinary Information Network (VIN).^a Students also interact with veterinarians from both the USDA APHIS and the California Department of Food and Agriculture to see the key role veterinarians play in responding to both accidental and intentional (i.e., bio-/agro-terrorist) introduction of foreign animal diseases. These interactions also give students an opportunity to see important career opportunities available in government and regulatory medicine.

Population Health and Production- The Population Health and Production course focuses on preventive medicine for animal populations. However, the epidemiological concepts of bio-security, disease dynamics in a population, outbreak investigation, disease monitoring and surveillance, and control and eradication programs are directly applicable to public health. During this course, students prepare a defensible proposal for a preventive medicine or herd health program in an animal population of their choice. These populations have included livestock herds, stables, kennels, catteries, animal shelters, pet stores, zoo exhibits, and wildlife populations. Most proposals include measures for preventing transfer of potentially zoonotic diseases from the animal populations to the people who interact with them.

Zoo Animal and Wildlife- Through participation in the daily activities of the veterinary staff at the Los Angeles Zoo, students in the Zoo Animal and Wildlife course acquire basic clinical, surgical, and management skills necessary for veterinarians working in a zoo setting. Emphasis is placed on management, transport, handling, restraint, capture, anesthesia, emergency and critical care, necropsy techniques, and appropriate specimen collection in zoo species. However, students are also expected to dedicate a portion of their time to student-centered learning activities relating quarantine protocols and bio-safety/bio-security issues in zoo or wildlife settings. Students also become familiar with federal and state regulations related to zoos and exotic-animal imports and identify public-health issues relating to the presence of zoonotic diseases in these populations.

Laboratory Animal Medicine and Research- The Laboratory Animal Medicine and Research course introduces students to the practice of laboratory-animal medicine. Concepts addressed include etiology, pathogenesis, diagnosis, treatment, and prevention of common diseases of laboratory animals. Additional topics include regulations governing care and use of research animals, animal facilities management, and handling and restraint of common laboratory species. Students also learn about the valuable roles of veterinarians in biomedical research and in furthering the practice of veterinary medicine through research. The concept of comparative medicine as the basis for human medical breakthroughs in disease prevention, diagnosis, and treatment resulting from animal research is emphasized. In addition, students gain an appreciation of occupational health and safety and of the zoonotic diseases common to laboratory animal settings.

Phase III: Fourth-Year Clinical Rotations
Of the 81 members of the WU-CVM charter class, which graduated in 2007, eight (10%) participated in a total of 12 fourth-year rotations in epidemiology, public health, or regulatory medicine. WU-CVM benefits from its close proximity and strong working ties with the Los Angeles County Veterinary Public Health and Rabies Control Program. Four members of the charter class completed rotations with LA County, where they participated in a research study of the gastrointestinal parasite burden among dogs visiting dog parks in the county. In addition, these students assisted with disease surveillance activities for West Nile virus, plague, exotic Newcastle disease, and avian influenza. Of the three students who participated in the Epidemiology Elective rotation with the CDC, one had the opportunity to participate in an outbreak investigation of Salmonella serotype Oranienburg in southeastern Arizona.

Table 4 summarizes the public-health, epidemiology, and regulatory-medicine rotations in which fourth-year students participated during the 2006/2007 academic year. Unfortunately, self-reported employment data received from 80% of these graduates indicate that no students are currently employed with primary duties as public-health veterinarians, although at least one graduate of the charter class is currently applying for admission to an MPH program. Follow-up surveys in future years will indicate whether any these graduates shift from careers in primary clinical practice to public-health practice.

	NEW DVM/MPH DUAL-DEGREE PROGRAM

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
Beginning in 2008, WU-CVM students will have the opportunity to enroll in a DVM/MPH dual-degree program. While completing the DVM educational requirements at WU-CVM, students can enroll in an MPH program administered through the University of Minnesota, School of Public Health. This 42-credit graduate program will allow students who enroll in both programs simultaneously to graduate with both DVM and MPH degrees after four years of professional education. In November 2007, when students were introduced to this new dual-degree opportunity, 58 students representing all four years of the curriculum indicated an interest in entering the MPH program.

	CONCLUSIONS

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 
The multidisciplinary and collaborative nature of the self-directed, student-centered curriculum at WU-CVM facilitates students’ exposure to veterinary public health early in their professional education. This curricular approach encourages critical thinking and lifelong learning, important skills for long-term professional satisfaction and success. Incorporating public-health concepts within the basic science curriculum is natural and intuitive. After all, the clinical sciences identified in our curriculum as belonging to public health are merely an application of basic science concepts such as behavior, epidemiology, microbiology, nutrition, parasitology, and toxicology. Faculty with strong experience and interest in VPH serve as role models and mentors for students. During clinical courses, the opportunity to interact with VPH professionals from public agencies gives students a valuable understanding of how government agencies function and of the advantages of a close working relationship with their local health department. The integrative nature of public-health learning throughout the clinical courses at WU-CVM demonstrates the importance of public health in all facets of the veterinary profession, not just for food-animal practice or for public-health officers. The introduction of a DVM/MPH dual degree program early in the curriculum will give entering students a practical way to explore and further their interest in this field. The approach adopted by WU-CVM not only instills the value of disease detection and reporting in future veterinarians in private practice but also encourages students to consider a challenging and rewarding alternative career path in veterinary public health.

	ACKNOWLEDGMENTS

 
The authors would like to thank Dr. Helen Engelke at the Western University, College of Veterinary Medicine, for her careful review of this manuscript.

	Footnotes

 
AUTHOR INFORMATION

Peggy L. Schmidt, DVM, MS, Dipl. ACVPM, is Director of Phase III Curriculum and Assistant Professor of Production Medicine and Epidemiology at the College of Veterinary Medicine, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766-1854 USA. E-mail: pschmidt{at}westernu.edu.

Rosalie T. Trevejo, DVM, MPVM, PhD, Dipl. ACVPM (Epidemiology), is Adjunct Professor of Veterinary Public Health and Epidemiology at the College of Veterinary Medicine, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766-1854 USA. E-mail: rttrevejo{at}yahoo.com.

Suzana Tkalcic, DVM, PhD, is Assistant Professor of Veterinary Pathology at the College of Veterinary Medicine, Western University of Health Sciences, 309 East Second Street, Pomona, CA 91766-1854 USA. E-mail: stkalcic{at}westernu.edu.

NOTE

^a "Remembering the Zebras" Web course available from <http://www.cfsph.iastate.edu/Products/webcourse.htm>.

	REFERENCES

TOP ABSTRACT INTRODUCTION TEACHING PHILOSOPHY CURRICULUM OVERVIEW VPH IN THE WU-CVM... NEW DVM/MPH DUAL-DEGREE PROGRAM CONCLUSIONS REFERENCES

 

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7. Institute of Medicine [IOM]. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: IOM, 1992.
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13. Moore DA. Veterinary school consortia as a means of promoting the food-supply veterinary medicine pipeline. J Vet Med Educ 33: 539–542, 2006.[Abstract/Free Full Text]
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16. National Association of State Public Health Veterinarians [NASPHV]. Compendium of Animal Rabies Prevention and Control <http://www.nasphv.org/Documents/RabiesCompendium.pdf>. NASPHV, 2007.
17. NASPHV. Compendium of Measures to Control Chlamydophila psittaci Infection Among Humans (Psittacosis) and Pet Birds (Avian Chlamydiosis). <http://www.nasphv.org/Documents/Psittacosis.pdf>. NASPHV, 2006.

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