Duty hours restriction for our surgical trainees: An ethical obligation or a bad idea?

To ensure patient safety and protect the well-being of interns and residents, the Accreditation Council for Graduate Medical Education (ACGME) issued guidelines in 2003 limiting the working hours of physician trainees. Although many supported the goals of the ACGME, institutions struggled to restructure their programs and hire staff required by this unfunded mandate. Numerous studies have analyzed the effects of duty hours restrictions on patient outcomes and physician training over the past 15 years. Most agree that duty hours restrictions improved well-being of house officers, but these improvements came at the expense of continuity, and patient hand-offs led to medical errors. Effects on resident training are program specific, with duty hours restrictions having the most deleterious effects on surgical disciplines. Because veterinary specialists assume a similar role in providing 24-hour patient care, interns and residents face work-related stress as a result of extended working hours, on-call duty, and an increasingly complex caseload. The North Carolina State Veterinary Hospital is staffed by approximately 100 house officers representing almost every veterinary specialty group. We surveyed departing house officers regarding their quality of life and training experience. Sixty-six percent of interns and residents reported that they do not have time to take care of personal needs, and 57%-62% felt neutral or dissatisfied with their mental and physical well-being. Most trainees believed that decreased duty hours would improve learning, but 42% believed that decreased caseload would be detrimental to training. Veterinary educators must consider post-DVM veterinary training guidelines that maintain patient care with a good learning environment for interns and residents.

Using a Modified Bookmark Procedure to Help Identify Reasonable Consequences for Academic Integrity Violations.

It is recommended that institutions develop academic conduct policies to help preserve academic integrity, enforce compliance, and aid in legal defensibility. These policies should also articulate reasonable consequences for persons found in violation. The problem, however, is that all academic misconduct offenses are not created equal, and determining reasonable consequences for these violations can be particularly challenging due to their subjective nature. Thus, the purpose of this study was to introduce a novel method for more objectively determining reasonable sanctions for several academic misconduct offenses of varying degrees of severity. We utilized a variation of the Bookmark procedure, a popular standard-setting technique used primarily by psychometricians in high-stakes testing environments, to investigate empirical survey data and develop policy recommendations. We encourage others to use this procedure, where appropriate, to identify appropriate cut scores and ranges to aid in policy development across a variety of contexts.

A theoretical framework for human and veterinary medical ethics education.

In their practice, physicians and veterinarians need to resort to an array of ethical competences. As a teaching topic, however, there is no accepted gold standard for human medical ethics, and veterinary medical ethics is not yet well established. This paper provides a reflection on the underlying aims of human and veterinary medical ethics education. Drawing from published literature on ethics education in the health professions a theoretical framework common to the teaching of human and veterinary medical ethics is proposed, based on three concepts: professional rules, moral virtues and ethical skills. The rules approach relies on the transmission of professional and social values by means of regulatory documents and depends intimately on the knowledge that students have of those documents. The virtues approach involves the inculcation of moral values and virtues that will stimulate students to develop desirable behaviours. The main focus of this approach to ethics is to develop students' attitudinal competences. Finally, the skills approach is focused on equipping the students with the necessary moral reasoning abilities to recognise and respect the plurality of ethical views that make part of contemporary society. This framework can inform future curriculum development in human and veterinary medical ethics as well as in other health care professions.

Corporate influence and conflicts of interest: assessment of veterinary medical curricular changes and student perceptions.

The ethics document of the Association of American Veterinary Medical Colleges provides guiding principles for veterinary schools to develop conflict of interest policies. These policies regulate faculty and student interactions with industry, potentially reducing the influence companies have on students' perceptions and future prescribing practices. This paper examines the implementation of a conflict of interest policy and related instructional activities at one veterinary college in the US. To inform policy and curricular development, survey data were collected regarding veterinary students' attitudes toward pharmaceutical marketing, including their perceptions of their own susceptibility to bias in therapeutic decisions. Responses from this group of students later served as control data for assessing the effectiveness of educational programs in the content area. A conflict of interest policy was then implemented and presented to subsequent classes of entering students. Classroom instruction and relevant readings were provided on ethics, ethical decision making, corporate influences, and the issue of corporate influence in medical student training. Within seven days of completing a learning program on conflict of interest issues, another cohort of veterinary students (the treatment group) were administered the same survey that had been administered to the control group. When compared with the control group who received no instruction, survey results for the treatment group showed moderate shifts in opinion, with more students questioning the practice of industry-sponsored events and use of corporate funds to reduce tuition. However, many veterinary students in the treatment group still reported they would not be personally influenced by corporate gifts.

Promoviendo un cambio curricular en la Facultad de Medicina Veterinaria y Zootecnia de la Universidad Peruana Cayetano Heredia con un perfil profesional definido desde el entorno de trabajo hacia la academia / Curricular change based on a professional profile defied from society needs

Objetivo: definir el perfil de referencia del futuro Médico Veterinario y Zootecnista para la reforma de los procesos de formación profesional. Metodología: La Facultad de Medicina Veterinaria y Zootecnia de la Universidad Peruana Cayetano Heredia trabajó con empresarios, empleadores, representantes de organismos nacionales, regionales e internacionales y egresados en la definición del perfil. Resultados y Conclusiones: El consenso apuntó a la formación de ciudadanos flexibles y capaces de aprender continuamente para reformular y reforzar sus fundamentos, competencias y criterios y así afrontar con éxito, liderazgo, emprendedorismo y una visión integral de su profesión, los cambios propios de una sociedad, cuyas necesidades e intereses evolucionan constantemente.

Aim: To define the reference a new professional profile to use it as the main driver for its curricular philosophy and structure reform. Methods: The School of Veterinary Medicine of UPCH approached and worked with its stakeholders to define the profile. They were entrepreneurs, employers, national, regional and international organizations representatives and alumni. Results and Conclusions: The consensus profile was defined as in a flexible-citizen formation with the capacity of continuous learning to successfully adapt their knowledge foundations, competencies and criteria to a very continuous and dynamic change in society needs and priorities. Leadership, entrepreneurship and integral vision of its professional role were also claimed as professional attributes for future success.

Veterinary science student preferences for the source of dog cadavers used in anatomy teaching.

Live animals and cadavers are integral to veterinary education. In the year of this survey (2008), and in at least the five preceding years, cadavers obtained by euthanasia of healthy pound dogs and ex-racing greyhounds were dissected by students, during their veterinary anatomy classes at the University of Queensland School of Veterinary Science. Students may have ethical concerns about this. An alternative approach was to use donated dog cadavers. These are owned pet dogs that have died of natural causes or have been euthanised for medical reasons, and have been donated by their owners for the purposes of veterinary education. Veterinary students at the School were surveyed in 2008, in order to determine their preferences for cadaver source. Data from 406 questionnaires were analysed. Third-year and fifth-year veterinary students were more likely than first-year students to prefer pound-dog/greyhound cadavers over donated cadavers for anatomy dissection (p ≤ 0.002). Between 32% and 45% of the students had no preference for either source of cadaver. These findings are consistent with the hypothesis that veterinary students become more accepting of the euthanasia of unwanted healthy animals for education as they progress through the veterinary programme, in contexts such as the current study. This could occur due to increased acceptance of the euthanasia of healthy animals generally, a decline in moral development, desensitisation, and/or the belief that healthy animal cadavers offer a superior learning experience.

Literature search strategies to comply with institutional animal care and use committee review requirements.

Under the US Animal Welfare Act, principal investigators who propose to use animals in their research must demonstrate that they have considered alternatives to potentially painful or distressful procedures when submitting applications to Institutional Animal Care and Use Committees (IACUCs). IACUCs requires that applicants conduct a current literature search to determine if alternatives are available to substitute the proposed animal use and, if the proposed study involves pain or distress, that more humane procedures, as they are described in the literature, be considered. This paper suggests literature search strategies that can be considered for use in order to comply with this IACUC requirement.

The current status of animal use and alternatives in Korean veterinary medical schools.

Two new Korean laws regulating animal welfare and the humane use of animals in science came into effect in 2008 and 2009. Both these laws impose ethical committee review prior to the performance of animal experiments in research, testing and education. This study briefly summarises the new Korean laws, and investigates the current status regarding the numbers of animals used, the alternatives to animals which are used, the curricula relating to the humane use of animals, and ethical review practices in Korean veterinary education. Approximately 4,845 animals, representing 20 different species, were used in veterinary medical education in Korea in 2007. Korea has begun to introduce formal courses on animal welfare for the humane treatment of animals used in experiments, and an ethical protocol review system prior to animal use in education. Korea is moving toward better animal welfare, by incorporating practices consistent with international standards. The information presented represents the first such data gathered in Korea, which should prove useful for monitoring the implementation of replacement, reduction, and refinement measures in animal use for education purposes.

A commentary on the animal welfare symposium, with possible actions.

The author analyzes the common themes addressed by speakers at the AVMA/AAVMC conference on animal welfare, adding a few comments of his own. These themes can be summarized in the basic statement that "the veterinary profession has a responsibility to its members and to the public to provide and ensure a good education in animal welfare science, ethics, and public policy and law." Veterinarians have a special role as animals' advocates for several reasons: they have the knowledge base and the required skills and commitment to fulfill this role; they have earned the confidence and respect of the constituents they serve; they are the professionals to whom policy makers logically turn for guidance on animal health and welfare issues. Therefore, the veterinary profession has an opportunity to reassert itself as the advocate not only for animals' physical health but also for their mental health and welfare. To be successful, however, the profession's leadership and members must engage without delay in advancing educational programs, research projects, and outreach to solidify authority in this key component of veterinary medicine.

Faculty ethics: ideal principles with practical applications.

Ethics in higher education is the subject of intense public attention, with considerable focus on faculty roles and responsibilities. Media reports and scholarly research have documented egregious misconduct that includes plagiarism, falsification of data, illicit teacher-student relationships, and grading bias. These accounts of wrongdoing often portray faculty ethicality as only a legal issue of obeying rules and regulations, especially in the teaching and research roles. My discussion challenges this narrow perspective and argues that characterizations of faculty ethicality should take into account broader expectations for professionalism such as collegiality, respect, and freedom of inquiry. First, I review the general principles of faculty ethics developed by the American Association of University Professors, as well as professional codes of ethics in specific professional fields. Second, I juxtapose the experiences of women and minority faculty members in relation to these general codes of ethics. This section examines three issues that particularly affect women and minority faculty experiences of ethicality: "chilly and alienating" academic climates, "cultural taxation" of minority identity, and the snare of conventional reward systems. Third, I suggest practical strategies to reconcile faculty practice with codes of ethics. My challenge is to the faculty as a community of practice to engage professional ethics as social and political events, not just legal and moral failures.

Fundamental training for individuals involved in the care and use of laboratory animals: a review and update of the 1991 NRC Core Training Module.

Public trust demands that individuals who do research, testing, or teaching with animals use humane, ethical, and scientifically sound methods. Furthermore, the Animal Welfare Act and the Public Health Service Policy require research institutions to provide basic training and to ensure that anyone who cares for and/or works with laboratory animals has the appropriate training or experience relevant to their job responsibilities. Institutions accredited by the Association for Assessment and Accreditation of Laboratory Animal Care International must also provide training programs and ensure the qualifications of personnel. The primary goal of this training is to provide individuals with basic knowledge and to reinforce attitudes and behaviors that help to ensure humane animal care and use. This article provides an overview of the core training module outline and content from the 1991 report of the Institute for Laboratory Animal Research, Education and Training in the Care and Use of Laboratory Animals: A Guide for Developing Institutional Programs, as well as pertinent updates for introducing personnel to information regarding the care and use of laboratory animals. Both mandatory and suggested training topics are reviewed, including relevant regulations and standards, ethical considerations, humane methods of animal experimentation and maintenance, and other pertinent topics. Although the fundamental training course content and delivery will vary depending on the nature and complexity of an institution's animal care and use program, this basic training provides the foundation for more in-depth training programs and supports humane and ethical animal care and use.

Veterinary education as leader: which alternatives?

This article suggests that veterinary medicine has a leadership role to play in our society on ethical matters involving non-human animals. The article contrasts two trends within veterinary medicine; the first trend is a continuation of the avowedly utilitarian attitude toward non-humans that has its roots in Western veterinary medicine's eighteenth-century origins, and the second is the implicit view in veterinary practice that animals matter in and of themselves. Using the idea of alternatives in research and teaching, the article suggests that, in the years to come, veterinary medicine's answers to the relationships of these two trends will shape not only the soul of veterinary medicine, veterinary education, and the veterinary profession but, just as importantly, the larger society and culture themselves. This text is based on the keynote address delivered at the AAVMC Education Symposium in Washington, DC, on March 9, 2006, under the title "Ethical Issues Impacting Animal Use in Veterinary Medical Teaching."