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The Future of Veterinary Medicine

Educational Session VI

Sunday, March 16, 2014, 8:00 a.m.–11:05 a.m.

8:00–8:15 a.m. Veterinary Medical Emergency Preparedness & Response: Responding to the Entire Family
Wesley Bissett, Texas A&M University
Debra Zoran, Texas A&M University

The Texas A&M College of Veterinary Medicine and Biomedical Sciences is providing the nation’s only required clinical rotation in emergency preparedness and response. This rotation, now in its second year is focused on providing students the skills and knowledge base to be personally and professionally prepared to weather a disaster situation and also to assist communities in preparing to mitigate and respond to animal issues resulting during emergencies and disasters. 

The information and experiences integrated into the Emergency Preparedness & Response rotation provide an educational opportunity that extends well beyond the confines of a disaster. Students must expand their horizons well beyond veterinary medicine and undergo a journey of self-discovery into the many attributes they will add to their profession and the communities they will join in the future.

8:15–8:30 a.m. Training Veterinarians in Disaster Management Using a One Health Approach
Carla Huston, Mississippi State University

Most veterinarians are not accustomed to working in the world of disaster management. However, veterinarians often find themselves thrown into the front lines of a natural or man-made disaster response. Successful disaster preparedness, response and recovery activities require a true One Health approach. Animal care, public health, preventive medicine, food safety, and environmental health are some areas in which veterinarians are well poised to assist following a large-scale disaster. This session will focus on challenges to providing disaster management training for veterinary students and veterinarians along with integrated approaches to providing such training utilizing a One Health approach.

8:30–8:45 a.m. Analyzing the Integration of One Health into Professional Training Programs: a Review of Existing Methods and Future Directions
Anna Fagre, Colorado State University

With the recognition of the One Health Initiative as a means of approaching transdisciplinary collaboration to address methods of surveillance and disease outbreak prevention and management, many institutions in the US and abroad have developed experiential learning strategies in hopes of exposing graduate and professional students to these networks. However, concerns have been raised that the lack of funding, faculty and student time constraints, and possibly even inertia due to the diverse usage of the term “One Health” threaten the future sustainability of many of these programs. To the best of our knowledge, no studies to date have reviewed and analyzed One Health programs implemented in graduate and professional training programs. This analysis will critically assess the impact of these programs by quantifying examples of past efforts, current undertakings, and potential areas of success for institutions wishing to implement or improve upon their own One Health curricula in the future using examples adopted from the literature as well as recent experiences of our university’s One Health Club.

8:45–9:30 a.m. RESPOND: Development of a Global Model for University-Based Engagement in One Health
Felicia Nutter, Tufts University
Katey Pelican, University of Minnesota
Dominic Travis, University of Minnesota
Saul Tzipori, Tufts University

Since 2009, with funding from USAID’s Emerging Pandemic Threats (EPT) Program, the RESPOND Project has been supporting the development of country-level One Health capacity in Africa and Southeast Asia. Tufts University and the University of Minnesota, in partnership with DAI, Training Resources Group and Ecology & Environment, are working with universities and governments to provide students, academicians and practitioners with competencies and tools that prepare them to work across disciplines with a broad range of stakeholders to improve the prevention, detection, and response to zoonotic diseases. RESPOND’s work is culminating in the support of two regional One Health university networks, One Health Central and East Africa (OHCEA), and Southeast Asia One Health University Network (SEAOHUN). Twenty-eight schools of veterinary medicine, public health, medicine, nursing and allied health are partnered with the University of Minnesota and Tufts University to strengthen faculty and curricula and jointly develop creative approaches to teaching and learning. Presentations will cover foundational aspects of RESPOND’s work, including legal framework and organizational development for the university networks, participatory development of One Health core competencies and curriculum maps, supporting faculty in learning about and teaching One Health, and changing how students learn and engaging them in One Health activities.

9:30–9:45 a.m. Disparity in Access to Health Care: Causes and Proposed Solutions for Low-Income Countries
Grace Thaxton, Auburn University

People in low-income or developing nations generally have less access to health services than those in wealthier countries. This disparity has been a major global issue for decades, yet little progress has been made to remedy it. The World Health Organization’s Alma Ata Declaration of 1978 stressed the urgency of increasing access to health care in poor communities and nations. The declaration stated that primary health care is the key to achieving “Health for All,” and thus should be a top priority of the global community. However, enduring solutions to the lack of access to health care have yet to be implemented successfully. Many studies attribute this failing to four factors: geographical location of services and consumers, availability, cost, and acceptability as defined by user willingness and cultural norms. The perceived quality of health care also plays a huge role in acceptability and utilization by consumers. These determinants are not considered individually when a consumer is deciding whether to seek healthcare, but are inseparably intertwined. Geographical distance often increases cost, and cultural norms may also influence ability to travel. Most interventions implemented fail to account for the interconnectedness of these factors, and therefore are unable to have a permanent, beneficial effect. Studies of health care delivery in the Bolivian Andes, Albania, Morocco, Tunisia, and Vietnam are reviewed and compared. In a review paper by Bigdeli et al., four ways to positively affect access to health care are examined: market forces, innovations in medical supply delivery, transparency and sharing of information, and donor agendas for funding. Ultimately, quality emerges as the determinant valued most by nearly all people worldwide, therefore successful interventions must focus on improving quality. While passing blanket legislation may be the easiest solution, the most effective remedy involves tailoring health systems to the local community’s needs and expectations.

9:45–10:05 a.m. Break

10:05–10:20 a.m. The Hidden Curriculum of Hospital-Based Teaching
Carrie Roder, Royal Veterinary College

Professionalism is a key part of the veterinary role and there has been much recent focus on the perceived decline of professionalism in graduate veterinary students. In an attempt to address this, formal professional studies are now a key feature in veterinary curricula across the UK. However, what is learnt in these lectures and seminars is at threat from the more pervasive messages delivered through the hidden curriculum of the clinical environment. 

Taking the Royal Veterinary College as a case study, a mixed methods approach was taken to understand the hidden curriculum of professionalism experienced by students during their final year clinical rotations. A longitudinal survey uncovered the students’ view of professionalism pre- and post-rotations, and hence any attitude change, while interviews, observations and further surveys were undertaken to understand the key messages of the hidden curriculum, the means by which they were delivered, and factors that affected the students’ susceptibility to these messages.

The primary mediators of the hidden curriculum were identified as the clinical service organization and the assessment process of the rotations, both of which emphasized the importance of technical skills over, and at the expense of, all other professional skills. Clinicians as role models and the students’ rotation group were identified as moderating these influences, either protecting the students or exposing them to the messages.

Developing a New Generation of Veterinary Educators and Professionals for the 21st Century
Ayona Silva-Fletcher, Royal Veterinary College

Educator development is, rightly, a continued focus of attention for institutions aiming to enhance the quality of their teaching. The best designed, integrated curriculum, in terms of content, sequencing of material, and its delivery, is undermined if those involved in facilitating student learning lack the required pedagogical knowledge and skills to be effective. The need for a One Health approach to manage human, animal, ecosystems and environmental health requires intersectoral and interdisciplinary approach to problem solving. Historically, many educator training courses for new lecturers have been generic, and have not taken seriously the implications of the differences in discipline-related concepts of knowledge and specific skills for education. How feasible is it to transform the veterinary educators with a science-based background to develop their teaching skills in interdisciplinary problem solving methodologies? Although there is an increased emphasis on transferable skills and literacies by governments and universities, evidence suggest that many skills and illiteracies are developed in a discipline-specific context and are not easily transferable. These differences are particularly noticeable between the science- and social science-based domains. Therefore, the dichotomy between the deeply rooted disciplinary-based training of the educators themselves must be addressed through educator training programs to foresee a change. Equally important is the training of the veterinary educators in the concepts of One Health to address the challenges to teaching and learning of the new generation of veterinary professionals. The focus of this session is to explore how the content and structure of a postgraduate veterinary education program has been developed to address the educational demand exerted by the One Health concept.

10:20–10:35 a.m. Application of CDC's Ten Essential Public Health Services among Veterinarians in HPAI Prevention and Control, Indonesia
Joann Lindenmayer, Tufts University
Iwan Willyanto, InL Veterinary Service

Highly pathogenic avian influenza (HPAI) emerged in Indonesia in 2003 and is now endemic among poultry populations. A coalition of stakeholders, including staff members of Ministries of Health and Agriculture, has been responsible for developing, implementing, and evaluating national plans to prevent and control HPAI. In 2008, we conducted a survey to examine the extent and depth of interactions between veterinary medical and human health care professionals during HPAI prevention and control activities. Joint participation of both groups as reported by veterinary medical professionals was assessed using the CDC’s Ten Essential Public Health Services (EPHS) Framework, modified to address HPAI. Respondents reported the highest number of interactions for joint attendance at meetings and helping communities organize to respond to HPAI-related health problems, and the lowest number of interactions for evaluating HPAI policies and programs, assuring quality of laboratory testing, personnel and procedures, and conducting HPAI-related research. The degree of interaction between human and animal care professionals was higher than anticipated. The emergence of HPAI has provided numerous opportunities to strengthen the joint participation of human and animal health professionals in carrying out the Ten Essential Public Health Services.

Tufts University One Health Twinning Program in the Democratic Republic of Congo: Lessons Learned
Diafuka Saila-Ngita, Tufts University

Tufts University implemented a twinning program involving faculty from various disciplines in the Democratic Republic of Congo (DRC) under the USAID Emerging Pandemic Threats program in 2012. DRC counterparts were the School of Public Health of Université de Kinshasa (UNIKIN) and the Faculty of Veterinary Medicine of Université de Lubumbashi (UNILU). The twinning program was multifaceted and conducted in a resource constrained environment. The purpose of the twinning program was to enhance multidisciplinary and multisectoral collaboration involving several disciplines: public health, nursing, medicine, veterinary medicine, and environment. Government veterinary and public health laboratories and disease surveillance units were also involved. The twining program also intended to improve the quality of education offered at DRC schools by facilitating interactions between DRC faculty and colleagues from Tufts University, the University of Minnesota, Africa and Vietnam. During these interactions, courses were taught, workshops, field trips to farms, slaughterhouses and laboratories were organized and reviews of curricula were held. Visiting faculty had background in epidemiology, infectious diseases, parasitology, histopathology, environmental health, health economics and research methods. The fact that faculty from UNILU Veterinary Medicine school are already involved with many other schools facilitated the implementation of the twinning program in Lubumbashi. Lectures, discussions and workshops organized during the twinning program were opportunities for knowledge improvement for participants from all disciplines. Field visits helped participants discover and assess other disciplines potential and capacity. Multidisciplinary collaboration is facilitated through joint learning and project opportunities, particularly when related to new concepts, topics, and issues at the interface of human, animal and ecosystem health. The authors conclude that when introducing One Health collaborative programs, it is important to capitalize on past multidisciplinary collaborative experiences. One Health collaboration has the potential of generating substantial savings through resource sharing and joint acquisition. 

10:35–10:50 a.m. Zoonotic Tuberculosis at the Human-Animal-Livestock Interface
Meghan Gibas, Colorado State University

Recently, the World Health Organization classified zoonotic tuberculosis (TB) as a “neglected zoonosis”. This is a serious concern, as areas where bovine TB caused by Mycobacterium bovis (M. bovis) is endemic overlap with countries suffering from the highest HIV/AIDS infection rates. Conditions in the developing world including living in direct contact with animals infected with M. bovis and the consumption of unpasteurized milk and dairy products, significantly increases the risk of this infection for humans. In Africa, a high prevalence of M. bovis infection in cattle and the Kafue lechwe antelopes has been reported; however, information on the proportion of human TB patients suffering from zoonotic TB is currently unknown. This is a public health concern as M. bovis is naturally resistant to pyrazinamide, a critical component to effective short course TB treatment, meaning that patients with undiagnosed M. bovis are being treated sub-optimally. Currently, we are conducting field projects in Kenya, Zambia, and Uganda to differentiate the specific species of Mycobacteria found among human TB patients in Africa. Furthermore, we are evaluating cultural and socioeconomic risk factors associated with the risk of zoonotic TB in these areas. The results of this study will provide an estimate of the prevalence of M. bovis infection in humans and information regarding risk factors associated with this zoonotic disease. Our interdisciplinary efforts will contribute to the development of the necessary foundation to create integrated preventative strategies and public health interventions to decrease the burden of zoonotic TB among human populations in rural areas of Africa.

10:50–11:05 a.m. One Border, One Health: A Novel Binational Approach to an Early Warning Infectious Disease Surveillance System
Helen Engelke, Western University of Health Sciences

Transboundary movements of humans, domestic animals, wildlife, vectors and vehicles are risk factors for the emergence of infectious diseases. As such, international collaboration is imperative in prevention and control. Over 100 health professionals from the border states of California and Baja California have come together to develop a model which would integrate human, animal and environmental health activities with a novel bi-national (Mexico/United States) approach. While collaboration between nations is critical, an argument also exists that those collaborative efforts should cross disciplines. Human, veterinary, and ecohealth professionals have not only become increasingly specialized they have also traditionally been institutionally separated often resulting in inefficiency, duplication of effort, and economically less sustainable programs. This team seeks to reconfigure those approaches to move away from species specific programs to more species neutral/pathogen specific programs creating an operationally successful One Health approach. The ultimate aim is not only to protect border communities but also to create an Early Warning System which would “shift surveillance to the left” and allow for actionable and timely interventions to limit emergence, mitigate spread, and enhance prevention and control, and hopefully thus decrease negative health, agricultural and economic outcomes. The groups initial three key areas of emphasis are in Surveillance, Training/Outreach, and Informatics/Data Sharing. 

Find a Veterinary School Near You! Monday, August 17, 2015

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AAVMC Executive Director Visits Australian and New Zealand Veterinary Colleges

read more Thursday, July 23, 2015

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