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Specialisation
J. vet. Anaesth. Vol. 21 (December 1994)
Editorial
Specialisation together with board certification to be equivalent to a PhD programme for clinical academic posts. Despite the fact that the expansion is now over there is still a steadily increasing number of board members in all specialist areas. In fact, just under 10 per cent of all A.V.M.A. members were board certified in 1990. It is estimated that some 30-50 per cent of clinical specialists are in general practice in North America. In the main these specialists are in group practices within the metropolitan areas although there is a trend towards the establishment of these groups in less densely populated areas. It is suggested that a three tier system of veterinary care could develop in North America. The first tier or general practitioner would provide the primary or preventative care. The second level of care would be provided by the clinical specialists in practice via a referral service. The third level of care would be provided by clinical specialists in the Veterinary Colleges in the form of research, prospective studies and expensive technology that has limited availability. However, this is likely to produce problems in relation to the very important provision of adequate and suitable clinical material for the teaching of veterinary students. It is also likely that subspecialitieswill emerge from the main areas of specialisation. The American College of Veterinary Anesthesiologists was established in 1975 and currently has somewhere in the region of 110 members. In the United Kingdom, the Association of Veterinary Anaesthetistswas formed in 1965.At the early discussions it was decided to explore the establishment of specialist qualification in the subject. However, the embryonic association was overtaken by events in the Royal College of Veterinary Surgeons, and it was mainly due to the efforts of one man, the late Professor Sir William Weipers that diplomas in veterinary anaesthesia and radiology were established with the first examinations in 1968. There has been a gradual evolution since that time and recently a number of Boards and specialitieshave been set up and/or reviewed. The original two part diploma examinations were replaced in the early 1980s by a two part certificate / diploma examination.The basic concept behind these changes were to establish a certificate qualification in a subject which was readily attainable from veterinary practice. The period of study for the Diploma in Veterinary Anaesthesia is considered to be best served by a two year period in a residency or similar posts in an approved centre such as a Veterinary School. It is, however, possible to produce a “personalised programme” which allows a flexible approach to the period of study but at least 200 days must be spent in an approved centre. It is somewhat unfortunate that the role of the Fellowship of the Royal College of Veterinary Surgeons has not been incorporated into the area of the certificateldiploma examinations. In the past few months it has been decided to discontinue the fellowship examination
Whilst it is a matter of fact that some hundreds of years after the formation of an organised veterinary profession the recently graduated veterinary surgeon is assumed to be omnicompetent, this cannot be considered to be the real situation. They need to develop their practical and clinical skills and to build on their mainly theoretical undergraduate training. In a substantial number of cases they may well undertake further training at a practical and theoretical level which may entitle them to be recognised as a specialist. However, despite this suggestion of omnicompetence it has always been the case that either by personal choice or by accident of geographical location and possibly by other factors that the veterinary surgeon has developed a specialist interest or some degree of specialisation. It is obvious that members of the profession who were practising in mainly urban areas would develop an interest and expertise in small animals and/or horses and those in rural areas would develop an interest in farm animal medicine and surgery. There was virtually no guidance as to how members of the profession should develop and build on these interests and skills and certainly no form of continuing professional development or refresher courses. There were, however, local veterinary societies in the United Kingdom which did discuss various scientific and clinical topics. It was probably not until the outbreak of the World War I1 that formal training courses were held for veterinary surgeons to develop further expertise. It was the stimulus of that war and need for the British nation to be self-sufficient in food production which led to the development of courses in bovine reproduction. Whilst these courses were successful they were certainly not developed further and matters remained static in the United Kingdom for a further 25 years. In the United States specialisation appears to have surfaced in a meaningful way in the early 1950s. The A.V.M.A. recognised two colleges in 1951 and these were the American Board of Veterinary Public Health and the American College of Veterinary Pathologists. The history and status of specialisation in the United States has been reviewed by Fessler et al. (1990). Recognition of Laboratory Animal Medicine was granted in 1957. The Advisory Board on Veterinary Specialities of the A.V.M.A. was set up in 1960. The original list of 3 colleges has now risen to 20 in 1994. The major growth area has been in the clinical specialities. The major motivating factor at that time was the career goal of obtaining employment in a faculty post at a Veterinary College. This was during the time of rapid expansion in both the staff of established veterinary schools and the development of new ones. The Veterinary Schools were wise enough to devise a policy in relation to board certification as an essential prerequirement for their clinical posts. This enlightened attitude was and still is in distinct contrast to virtually every other country in the world. They viewed residency training 57
J. vet. Anaesth. Vol. 21 (December 1994)
due to the many problems produced by a basically one-off examination, without a syllabus which was being overtaken by the relatively large number of certificates and diplomas. It would have been a fairly simple but logical step to establish specialists colleges within the Royal College of Veterinary Surgeons together with a fellowship qualificationi.e. FRCVS (Anaesthesia).At the present time the Royal College of Veterinary Surgeonsoffers Certificates in 17 different areas or subjects and diplomas in 16. There are, however a number of developments under consideration. In 1994 there were 651 certificate holders and 217 diplomates. Although there were equivalent numbers of people enrolled for the certificate examinations and 61 for the diploma examinations. This amounts to some 5%of the members on the Veterinary Register who hold a qualification which is considerably less than the North American figure of 70 per cent. There is obvious room for expansion. For some years the Royal College of Veterinary Surgeons did not establish a specialist list as it was considered that the 1966 Veterinary Surgeon Act precluded them from so doing. However, a list has now been set up in order to provide readily available information for both the public and the profession. Holders of the appropriate diploma but not certificate are eligible for entry to the list as are holders of other approved qualifications. Potential members must also have been active in the subject area for 5 years and spend 50 per cent of the professional time in the practice of their speciality.They must also be supported by statements from two independent referees. In 1978 the Council of Ministers of the European Community approved directives relating to veterinary science and the Advisory Committee on Veterinary Training (A.C.V.T.) was established. It had two principal tasks:
The subject of veterinary specialisationin the European Community was discussed by the A.C.V.T, in 1990 and 1991but the Commissionmade it very clear that it was not prepared to initiate legislation or to provide financial resources for such developments. Considerable time and effort was devoted to the definition of a specialist and the definition is: A specialist should be defined as a veterinarian who: has undergone in-depth training, at a postgraduate stage, in a discipline (or subject area, such as food technology) or in relation to a particular species of animal, which has led to a qualification of a specialist nature; has obtained formal recognition from the appropriate professional body or the competent authority that as a result of obtaining the said qualification, and meeting such requirements regarding appropriate experience as may be laid down, he/she has achieved specialist status; is therefore entitled to describe himself/herself as a specialist; and is likely to be regarded as having consultant status in the speciality. However, at the same time another area of the European Commission provided funding for the European Association of Veterinary Specialists. This included representatives of six subjects which were surgery, internal medicine, dermatology, ophthalmology and radiology. It was somewhat difficult to define the logic behind such a move particularly in relation to anaesthesia as it was already a well developed speciality. An Interim Board of Veterinary Specialists has been established but only the European Colleges of Surgeons have held examinations. Again at around the same time the European Association of Establishments for Veterinary Education (E.A.E.V.A.)addressed the subject of specialisation at the meeting held in Glasgow in 1991 and published a document entitled “Veterinary Specialisation in Europe”. They urged the European Commission to establish legislation on the subject of specialisation but to date this development has not been forthcoming. In view of all these developments the A.V.A. following a meeting in Utrecht in 1991 decided to drop the words “Great Britain and Ireland” from its title and seek a way forward to establish a European College of Veterinary Anaesthesia. Following a considerableamount of preparatory work by the successive Presidents, John Hird and then Polly Taylor a meeting was held in Giessen in March 1993 with representatives of virtually all Western European Countries and the A.V.A. Officers. A working group of Frank Gasthuys, Ron Jones, Urs Schatzman and A.V.A. President Polly Taylor was set up. This group liaised closely with the European Interim Board of Veterinary Specialisation and at the Halifax meeting in September 1993six “Grandfathers” were elected to choose the invited specialists. These were Professors Fritsch, Lagerweij and Jones (as the working party link) and Drs. Hall, Hansson and Weaver. The invited specialists are
(1) “To help to ensure a comparably high standard of veterinary training in the Community” and
(2) ”To communicate to the Commission and the Member States its opinions and recommendations including, when it considers it appropriate, suggestions for amendments to the articles relating to veterinary training”. There were a number of other statements in the minutes amongst which No 16 read ”The Council considers that the task of the Advisory Committee should, at the appropriate time, cover matters relating to specialist training”. It is well known that the A.C.V.T. mainly concerned itself with the undergraduate curriculum, the mutual recognition of qualifications and the development of directives. Additional work was provided by the expansion of the Community. In addition, despite limited resources, it set itself the target of organising a system of visitations to one Veterinary School in each of the members states. Whilst U.K. readers will be familiar with this system it did not exist in any other country. This target was achieved and plans were made for a comprehensive programme to visit virtually all of the Veterinary Schools before the year 2000. However the provision of resource has produced a major problem and at the present time the whole system would appear to be in jeopardy. 58
J. vet. Anaesth. Vol. 21 (December 1994)
tial feature of membership for the first few years at least. We wish our new venture every success.
Professor Schatzmann and Drs, Clarke, Gasthuys, Moens, Raptopolous, Taylor and Waterman. Their main task will be to consider all applications for “de facto” or foundation diplomates. This group met together with representatives of the “grandfathers” at Guelph in August. The European College of Veterinary Anaesthetists is now in embryonic On January lst form and is due to be depends On the effort and good1995. Its future will of all A.V.A. members. Hard work will be the essen-
Rs Jones REFERENCE Fessler JF, Burt JK & Brown RR (1990).Specialisation in veterinary medicine: Where we’ve beenand where we’re going.IournaloftheAmerican Veterinary Medical Association, 197,328-3
59
Editorial
Specialisation together with board certification to be equivalent to a PhD programme for clinical academic posts. Despite the fact that the expansion is now over there is still a steadily increasing number of board members in all specialist areas. In fact, just under 10 per cent of all A.V.M.A. members were board certified in 1990. It is estimated that some 30-50 per cent of clinical specialists are in general practice in North America. In the main these specialists are in group practices within the metropolitan areas although there is a trend towards the establishment of these groups in less densely populated areas. It is suggested that a three tier system of veterinary care could develop in North America. The first tier or general practitioner would provide the primary or preventative care. The second level of care would be provided by the clinical specialists in practice via a referral service. The third level of care would be provided by clinical specialists in the Veterinary Colleges in the form of research, prospective studies and expensive technology that has limited availability. However, this is likely to produce problems in relation to the very important provision of adequate and suitable clinical material for the teaching of veterinary students. It is also likely that subspecialitieswill emerge from the main areas of specialisation. The American College of Veterinary Anesthesiologists was established in 1975 and currently has somewhere in the region of 110 members. In the United Kingdom, the Association of Veterinary Anaesthetistswas formed in 1965.At the early discussions it was decided to explore the establishment of specialist qualification in the subject. However, the embryonic association was overtaken by events in the Royal College of Veterinary Surgeons, and it was mainly due to the efforts of one man, the late Professor Sir William Weipers that diplomas in veterinary anaesthesia and radiology were established with the first examinations in 1968. There has been a gradual evolution since that time and recently a number of Boards and specialitieshave been set up and/or reviewed. The original two part diploma examinations were replaced in the early 1980s by a two part certificate / diploma examination.The basic concept behind these changes were to establish a certificate qualification in a subject which was readily attainable from veterinary practice. The period of study for the Diploma in Veterinary Anaesthesia is considered to be best served by a two year period in a residency or similar posts in an approved centre such as a Veterinary School. It is, however, possible to produce a “personalised programme” which allows a flexible approach to the period of study but at least 200 days must be spent in an approved centre. It is somewhat unfortunate that the role of the Fellowship of the Royal College of Veterinary Surgeons has not been incorporated into the area of the certificateldiploma examinations. In the past few months it has been decided to discontinue the fellowship examination
Whilst it is a matter of fact that some hundreds of years after the formation of an organised veterinary profession the recently graduated veterinary surgeon is assumed to be omnicompetent, this cannot be considered to be the real situation. They need to develop their practical and clinical skills and to build on their mainly theoretical undergraduate training. In a substantial number of cases they may well undertake further training at a practical and theoretical level which may entitle them to be recognised as a specialist. However, despite this suggestion of omnicompetence it has always been the case that either by personal choice or by accident of geographical location and possibly by other factors that the veterinary surgeon has developed a specialist interest or some degree of specialisation. It is obvious that members of the profession who were practising in mainly urban areas would develop an interest and expertise in small animals and/or horses and those in rural areas would develop an interest in farm animal medicine and surgery. There was virtually no guidance as to how members of the profession should develop and build on these interests and skills and certainly no form of continuing professional development or refresher courses. There were, however, local veterinary societies in the United Kingdom which did discuss various scientific and clinical topics. It was probably not until the outbreak of the World War I1 that formal training courses were held for veterinary surgeons to develop further expertise. It was the stimulus of that war and need for the British nation to be self-sufficient in food production which led to the development of courses in bovine reproduction. Whilst these courses were successful they were certainly not developed further and matters remained static in the United Kingdom for a further 25 years. In the United States specialisation appears to have surfaced in a meaningful way in the early 1950s. The A.V.M.A. recognised two colleges in 1951 and these were the American Board of Veterinary Public Health and the American College of Veterinary Pathologists. The history and status of specialisation in the United States has been reviewed by Fessler et al. (1990). Recognition of Laboratory Animal Medicine was granted in 1957. The Advisory Board on Veterinary Specialities of the A.V.M.A. was set up in 1960. The original list of 3 colleges has now risen to 20 in 1994. The major growth area has been in the clinical specialities. The major motivating factor at that time was the career goal of obtaining employment in a faculty post at a Veterinary College. This was during the time of rapid expansion in both the staff of established veterinary schools and the development of new ones. The Veterinary Schools were wise enough to devise a policy in relation to board certification as an essential prerequirement for their clinical posts. This enlightened attitude was and still is in distinct contrast to virtually every other country in the world. They viewed residency training 57
J. vet. Anaesth. Vol. 21 (December 1994)
due to the many problems produced by a basically one-off examination, without a syllabus which was being overtaken by the relatively large number of certificates and diplomas. It would have been a fairly simple but logical step to establish specialists colleges within the Royal College of Veterinary Surgeons together with a fellowship qualificationi.e. FRCVS (Anaesthesia).At the present time the Royal College of Veterinary Surgeonsoffers Certificates in 17 different areas or subjects and diplomas in 16. There are, however a number of developments under consideration. In 1994 there were 651 certificate holders and 217 diplomates. Although there were equivalent numbers of people enrolled for the certificate examinations and 61 for the diploma examinations. This amounts to some 5%of the members on the Veterinary Register who hold a qualification which is considerably less than the North American figure of 70 per cent. There is obvious room for expansion. For some years the Royal College of Veterinary Surgeons did not establish a specialist list as it was considered that the 1966 Veterinary Surgeon Act precluded them from so doing. However, a list has now been set up in order to provide readily available information for both the public and the profession. Holders of the appropriate diploma but not certificate are eligible for entry to the list as are holders of other approved qualifications. Potential members must also have been active in the subject area for 5 years and spend 50 per cent of the professional time in the practice of their speciality.They must also be supported by statements from two independent referees. In 1978 the Council of Ministers of the European Community approved directives relating to veterinary science and the Advisory Committee on Veterinary Training (A.C.V.T.) was established. It had two principal tasks:
The subject of veterinary specialisationin the European Community was discussed by the A.C.V.T, in 1990 and 1991but the Commissionmade it very clear that it was not prepared to initiate legislation or to provide financial resources for such developments. Considerable time and effort was devoted to the definition of a specialist and the definition is: A specialist should be defined as a veterinarian who: has undergone in-depth training, at a postgraduate stage, in a discipline (or subject area, such as food technology) or in relation to a particular species of animal, which has led to a qualification of a specialist nature; has obtained formal recognition from the appropriate professional body or the competent authority that as a result of obtaining the said qualification, and meeting such requirements regarding appropriate experience as may be laid down, he/she has achieved specialist status; is therefore entitled to describe himself/herself as a specialist; and is likely to be regarded as having consultant status in the speciality. However, at the same time another area of the European Commission provided funding for the European Association of Veterinary Specialists. This included representatives of six subjects which were surgery, internal medicine, dermatology, ophthalmology and radiology. It was somewhat difficult to define the logic behind such a move particularly in relation to anaesthesia as it was already a well developed speciality. An Interim Board of Veterinary Specialists has been established but only the European Colleges of Surgeons have held examinations. Again at around the same time the European Association of Establishments for Veterinary Education (E.A.E.V.A.)addressed the subject of specialisation at the meeting held in Glasgow in 1991 and published a document entitled “Veterinary Specialisation in Europe”. They urged the European Commission to establish legislation on the subject of specialisation but to date this development has not been forthcoming. In view of all these developments the A.V.A. following a meeting in Utrecht in 1991 decided to drop the words “Great Britain and Ireland” from its title and seek a way forward to establish a European College of Veterinary Anaesthesia. Following a considerableamount of preparatory work by the successive Presidents, John Hird and then Polly Taylor a meeting was held in Giessen in March 1993 with representatives of virtually all Western European Countries and the A.V.A. Officers. A working group of Frank Gasthuys, Ron Jones, Urs Schatzman and A.V.A. President Polly Taylor was set up. This group liaised closely with the European Interim Board of Veterinary Specialisation and at the Halifax meeting in September 1993six “Grandfathers” were elected to choose the invited specialists. These were Professors Fritsch, Lagerweij and Jones (as the working party link) and Drs. Hall, Hansson and Weaver. The invited specialists are
(1) “To help to ensure a comparably high standard of veterinary training in the Community” and
(2) ”To communicate to the Commission and the Member States its opinions and recommendations including, when it considers it appropriate, suggestions for amendments to the articles relating to veterinary training”. There were a number of other statements in the minutes amongst which No 16 read ”The Council considers that the task of the Advisory Committee should, at the appropriate time, cover matters relating to specialist training”. It is well known that the A.C.V.T. mainly concerned itself with the undergraduate curriculum, the mutual recognition of qualifications and the development of directives. Additional work was provided by the expansion of the Community. In addition, despite limited resources, it set itself the target of organising a system of visitations to one Veterinary School in each of the members states. Whilst U.K. readers will be familiar with this system it did not exist in any other country. This target was achieved and plans were made for a comprehensive programme to visit virtually all of the Veterinary Schools before the year 2000. However the provision of resource has produced a major problem and at the present time the whole system would appear to be in jeopardy. 58
J. vet. Anaesth. Vol. 21 (December 1994)
tial feature of membership for the first few years at least. We wish our new venture every success.
Professor Schatzmann and Drs, Clarke, Gasthuys, Moens, Raptopolous, Taylor and Waterman. Their main task will be to consider all applications for “de facto” or foundation diplomates. This group met together with representatives of the “grandfathers” at Guelph in August. The European College of Veterinary Anaesthetists is now in embryonic On January lst form and is due to be depends On the effort and good1995. Its future will of all A.V.A. members. Hard work will be the essen-
Rs Jones REFERENCE Fessler JF, Burt JK & Brown RR (1990).Specialisation in veterinary medicine: Where we’ve beenand where we’re going.IournaloftheAmerican Veterinary Medical Association, 197,328-3
59