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Veterinary students’ understanding of a career in practice
  1. J. L. Tomlin, BSc, BVetMed, CertSAS, DipECVS, MRCVS1,
  2. D. C. Brodbelt, MA, VetMB, PhD, DVA, DipECVAA, FHEA, MRCVS1 and
  3. S. A. May, MA, VetMB, PhD, DVR, DEO, DipECVS, FHEA, FRCVS1
  1. 1Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA
  1. E-mail for correspondence: jtomlin{at}rvc.ac.uk

Abstract

Lack of a clear perception of the realities of a career in veterinary medicine could adversely affect young graduates’ satisfaction with the profession and their long-term commitment to it. Veterinary students’ understanding of a career in practice were explored. Traditionalentry first-year and final-year students, as well as entry-level ‘Gateway’ (widening participation) students, were invited to complete a questionnaire exploring their pre-university experiences and their understandings of a career in general practice. Broadly speaking, the undergraduate students taking part in the survey (the majority of whom were entry-level students) had a realistic view of average weekly working hours, out-of-hours duties and the development of their remuneration packages over the course of their careers. The main attractions of the profession were working with animals and the perception of a rewarding job. The main concerns were making mistakes and balancing work and home life. The vast majority of students wanted to pursue a career in general practice, and other career opportunities did not appear to be well understood, particularly by entry-level students.

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Veterinary work is perceived as stressful by more than 80 per cent of UK veterinary surgeons (Robinson and Hooker 2006), and veterinary surgeons report lower psychological wellbeing than workers in most other occupations (Johnson and others 2005). Employment issues and problems within a veterinary practice account for the largest number of calls to Vet Helpline, followed by depression (Halliwell and Hoskin 2005). Depression can manifest in subtle ways, such as increased irritability and decreased concentration, decision-making ability and memory (Firth-Cozens 1987). It is also among the known risk factors for suicidal ideation (Goldney and others 2000). Veterinary surgeons are reported to have the highest suicide rate of all professions – more than three times the proportional mortality ratio of the general population (Kelly and Bunting 1998) – and there is continuing interest in the reasons behind the high suicide rates within the international veterinary community (Miller and Beaumont 1994, Gardner and Hini 2006, Bartram and Baldwin 2008, Jones-Fairnie and others 2008).

Veterinary schools in general have a low attrition rate (Higher Education Statistics Agency [HESA] 2008), and the majority of graduates go straight into practice (Robinson and Hooker 2006). The decision to admit a student to a veterinary undergraduate course is therefore almost equivalent to granting a licence to practise (Confer and Lorenz 1999). In such a high-stress vocational occupation, it is important that the decision to become a veterinary surgeon is not taken lightly, and yet many prospective veterinary surgeons make the decision at a young age (Heath and others 2006, Fraser and others 2008), driven primarily by an interest in working with animals (Tomlin and others 2010). It has been reported that unrealistic academic or career expectations can foster an unbalanced lifestyle that may in turn lead to physical and emotional exhaustion, depression and addiction (Wolf 1994), and this article therefore evaluates whether veterinary students have a realistic or naive picture of a practice career.

Materials and methods

Traditional-entry first-year and final-year students as well as Gateway students (on a pre-BVetMed widening participation course) (Payne 2007) were invited to complete a questionnaire survey between September and December 2007. The questionnaire was designed around the study aims by the first author and then tested on a group of veterinary and non-veterinary colleagues at the Royal Veterinary College (RVC). (A copy of the questionnaire is available from the corresponding author on request.) The questionnaire explored the attractions of and concerns about the job of a practising vet, pre-university veterinary experience, career expectations and students’ knowledge of recent remuneration figures, hours of work and on-call duties. Students were asked to indicate their choices from predetermined tables and also encouraged to respond with free text. A paper questionnaire was completed by first-year students at the end of a lecture. Gateway students received the paper questionnaire via the internal mail system at the RVC, and final-year students completed an on-line questionnaire, by e-mail invitation via Survey Monkey (www.surveymonkey.com).

The study was regarded as ethically low risk, as defined by Carney and others (2004). Approval for the study was given by the RVC’s ethics committee.

Statistical analysis

Data were analysed using commercial statistical software (SPSS v 16.0). Quantitative data were assessed graphically for normality. Mean and standard deviation were reported for parametric data, and median and interquartile range were reported for non-parametric data. Student’s unpaired t test and one-way analysis of variance were used for parametric data, and the Mann-Whitney U test and Kruskal-Wallis test were applied to non-parametric data as appropriate (Kirkwood 1988). Post hoc comparisons were undertaken with Student’s unpaired t test and the Mann-Whitney U test for parametric and nonparametric data, respectively (Altman 1997). Categorical data were assessed with the chi-squared test and Fisher’s exact test (Kirkwood 1988). Significance was set at P=0.05. Qualitative analysis of the few written comments and additional text was performed by coding and thematic analysis (Boyatzis 1998), grouping similar items together and summarising their meaning.

Results

A total of 289 students responded to the questionnaire, and the overall response rate was 289 of 424 students (68.2 per cent); 200 students were in their first year, 63 were in the final year and 26 were on the Gateway course.

Student characteristics

Demographic data were identical to the previous study (Tomlin and others 2010). The age of respondents ranged from 18 to 28 years. The majority of respondents (232 [80.3 per cent]) were female. There were no significant gender differences among the three cohorts of respondents, although there was a trend towards more Gateway students being male (P=0.059).

Students’ veterinary work experience before admission

The median and interquartile range for days spent ‘seeing practice’ in each discipline before admission for all respondents are shown in Table 1.

There were no significant differences among the three student cohorts when the number of students seeing practice in each discipline was analysed or when the median time spent in each discipline was evaluated. There was, however, a non-significant trend towards first-year students having more research or laboratory experience before coming to university than the other two groups (P=0.055). Male students spent significantly longer seeing farm animal practice (P=0.004) than female students; otherwise, no significant differences were observed between the sexes.

Fifty-seven students (19.7 per cent) indicated that they had undertaken regular work experience over a long period. The following comments are illustrative:

  • ‘I worked at a small animal veterinary surgery every Thursday for one year and seven months’

  • ‘Every Saturday at a small animal practice for two years’

  • ‘Every Wednesday evening at a small animal practice for 3.5 years and every other Wednesday afternoon at a farm for six months’

  • ‘Mixed practice – every Thursday for a year and one month solid in the summer of 2004’

  • ‘Worked in a small/large animal practice for five years every Saturday’

When they were asked to list paid employment before admission, 46 students (15.9 per cent) had undertaken paid employment at a veterinary clinic. No significant differences were observed between cohorts or the sexes.

Range of jobs accessible with a veterinary degree

Students were asked to list all the available job options for a veterinary graduate that they were aware of. The responses were coded into major groups and the main results (where more than 10 students listed the job) are reported in Table 2.

In addition, five students listed pathology/pathologist as a career opportunity, and four students listed overseas work without specifying the discipline. Two students listed racehorse trainer as a job opportunity, and several further suggestions were made: behaviourist, biologist, chiropractor, finance and law, locum work, mobile vet surgeon, not sure – no careers advice, shipping company, television documentaries, television vet, vet journalist, vet forensics (all one suggestion).

Cohort differences

Gateway students were more likely than first-year students (P=0.005) and final-year students (P<0.001) to place ‘Zoo/exotic/wildlife/conservation’ on their list of career opportunities, and first-year students in turn were more likely than final-year students (P=0.003) to do so. More final-year students listed ‘Academic/lecturer/university’ and ‘Industry/pharmaceutical/pet products/sales representative etc’ as an employment opportunity than both Gateway (P=0.009 and P=0.028, respectively) and first-year students (P<0.001 and P<0.001, respectively). Finally, final-year students were significantly less likely to list ‘Research worker’ as a potential career opportunity for a veterinary graduate than first-year students (P=0.003), but there was no difference between final-year and Gateway students (P=0.339) or between first-year and Gateway students (P=0.364).

Gender differences

No significant gender differences were detected in relation to employment opportunities recorded.

Anticipated type of work

Students were asked whether they wanted to work as a vet in general practice when they graduated. Table 3 lists the responses to this question.

The majority of students (267 [92.4 per cent]) wanted to work in general practice on graduation. Of those who said no, one final-year student wanted to work in a university referral practice immediately on graduation, and two first-year students expressed a desire to work in research. All 26 Gateway respondents (100 per cent) wanted to be a vet in practice, but 19 first-year respondents (9.5 per cent) were unsure about becoming a general practitioner at the current time. Male students were more likely to indicate ‘Unsure’ or ‘No’ than female students (P=0.009), and first-year students were more likely to indicate ‘Unsure’ or ‘No’ than final-year students (P=0.033).

Students were asked to indicate which type of practice they wanted to work in on graduation. The results are listed in Table 4.

Mixed practice was the most popular student choice. Many in the ‘Other’ category chose wildlife/exotic combined with equine, farm or mixed practice. There were no significant differences among cohorts, and no differences were found between the sexes, with the exception that more women (27 per cent) indicated wanting to work in equine practice either exclusively or in combination with other species than men (14 per cent) (P=0.045).

Likelihood of getting the desired type of job

Students were asked to indicate on a five-point Likert scale the likelihood that they would get the job they wanted at graduation (0 Very unlikely, 1 Unlikely, 2 Don’t know, 3 Likely, 4 Very likely). Approximately one-third of first-year students (35 per cent) and Gateway students (32 per cent) did not know how likely they were to get the job they wanted at graduation. Final-year students were less undecided, with only 22 per cent indicating that they did not know. However, the final-year students were more inclined to use the ‘Very unlikely’ or ‘Unlikely’ categories than first-year or Gateway students (P<0.001). There were no significant differences between Gateway and first-year students (P=0.446) or between Gateway and final-year students (P=0.440), and no significant differences were detected between the sexes (P=0.144).

There were no significant differences when the type of job respondents wanted to do was compared with their sense of how likely they were to get that type of job (P=0.568), but there was a very slight trend towards those wanting equine work to be more positive about the likelihood of getting that type of work.

Wages

Students recorded, to the nearest £1000, the average 2006 remuneration package they anticipated for three different levels of veterinary practice experience: new graduates, five-year qualified and 20-year qualified practitioners (Table 5).

Significant differences in wages were reported between the sexes for both five-year qualified practitioners (P=0.012) and 20-year qualified practitioners, with male students indicating greater wages at 20 years after graduation in particular. No significant cohort differences were detected for any of the categories, and no significant differences were observed for new graduate wages between the sexes (P=0.101).

Hours of work and on-call expectations

Students were asked to indicate the average weekly working hours and weekly on-call time (Table 6) that they expected a vet in practice to undertake.

Significant cohort differences were detected for average weekly working hours (P<0.001). Final-year students’ estimates of working hours were significantly higher than those of both first-year students (P<0.001) and Gateway students (P<0.001), and first-year students in turn gave significantly higher estimates of working hours than Gateway students (P=0.010). No significant differences in estimates of weekly working hours were detected between the sexes (P=0.258).

Year cohorts also anticipated different on-call hours (P<0.001). Final-year students estimated significantly longer hours than both first-year students (P<0.001) and Gateway students (P<0.001), but there were no significant differences between first-year and Gateway students (P=0.779). No significant differences were detected between the sexes (P=0.145).

Attractions of the job of a practising vet

When respondents were asked to indicate the three main attractions of the job of a practising vet, ‘Working with animals’ was the most popular overall response (see Table 7).

Individual cohort responses were variable: ‘Working with animals’ was the most popular attraction for first-year students, but ‘Varied job’ and ‘Rewarding job’ were the most popular attractions for final-year and Gateway students, respectively.

When the single most attractive options recorded by students were compared, there were significant cohort differences (P<0.001). Finalyear students were significantly different from both first-year students (P<0.001) and Gateway students (P=0.002), but no differences were detected between first-year and Gateway students (P=0.240). First-year and Gateway students selected ‘Rewarding Job’ or ‘Working with animals’ most often, and final-year students were more likely to select other options. There were no significant differences between the sexes (P=0.421).

Concerns about the job of a vet in practice

When asked to indicate their single largest concern about the job of a practising vet, ‘Making mistakes’ was the primary concern for the majority of students (see Table 8).

When the top three concerns were evaluated, women were more likely than men to indicate ‘Lack of self-confidence’ as a concern (P=0.024), but no cohort differences were detected (P=0.588).

When the single largest concerns were evaluated, no differences were detected between cohorts (P=0.514) or the sexes (P=0.095).

Discussion

Like those of the previous study (Tomlin and others 2010), the results of the present study need to be interpreted with caution for two main reasons. The first is that the poor response from final-year students (35 per cent) makes the accuracy of the responses lower than for the other cohorts. However, major bias was unlikely, as the poor response rate was probably a reflection of the fact that a proportion of final-year students were off site (undertaking extramural studies) during the data collection period. The second reason is that up to 10 per cent of the first-year students were former Gateway students and it was unfortunately not possible to distinguish them from the traditional-entry first-year students. Some dilution of the differences between Gateway and traditional-entry first-year students has therefore occurred. Although the differences detected remain valid, other, more subtle differences between these two cohorts may not have been detected due to this study limitation.

Broadly speaking, the undergraduates who took part in this survey (the majority of whom were entry-level students) had a reasonable understanding of the basic working conditions of a veterinarian in general practice.

Estimates of weekly working hours and on-call time were reasonably accurate, although the impact of those duties did not appear to be fully appreciated. Professionals indicated on-call duties as an area of discontentment (Robinson and Hooker 2006), and 59 per cent of new graduates report being on-call as stressful (Routly and others 2002), yet students did not rank this concern highly.

Thirty-two per cent of veterinary professionals indicated that pay and benefits should be improved (Robinson and Hooker 2006), yet veterinary students did not appear to be concerned about wages and had realistic expectations of the level of remuneration the profession offers. Poor remuneration is one of the main reasons for leaving veterinary practice and the profession (Heath 2007a), although high income has been shown to be more important to older vets than younger vets (Brown and Silverman 1999). Male students were more inclined to overestimate increases in remuneration with experience, but as female veterinarians earn less than men, even when factors such as practice ownership, years of experience and type of practice are accounted for (Volk and others 2005), male expectations may in fact be accurate. Heath (2002) suggested that low income may contribute to the low number of men entering the profession, and Ilgen and others (2003) recommended that accurate indications be given of the variance in earning potential across the profession to attract applicants with a variety of career goals.

The range of work experience before admission was wide and not confined to small animal practice. Despite potential difficulties with accessibility and health and safety regulations, students gained experience in large animal, equine and mixed practice. Forty-five respondents (15.6 per cent) had laboratory or research experience, with a trend towards higher first-year participation. Two first-year students also expressed an early desire to work in research. A small percentage (9.5 per cent) of first-year students indicated they were unsure about practising as a vet following graduation. Although the numbers are low, these findings could optimistically indicate future improvement in the number of veterinary-qualified researchers (Nolan and Palmarini 2007).

Final-year students were generally more aware of the employment opportunities available to a veterinary graduate than entry-level students. General practice and research work were listed by the majority of students (95.8 per cent and 83.4 per cent, respectively), but other potential job opportunities were less well recognised, despite the fact that 89 per cent of the respondents had only recently applied to study veterinary medicine. These findings highlight a real need to educate careers advisers, and the public in general, about the many job opportunities a veterinary degree facilitates. This initiative could widen participation, by encouraging students who might not necessarily want to pursue a career as a practising vet, and reduce stress and anxiety levels by giving graduates the confidence that their veterinary degree is flexible and that a change of career after graduation is entirely possible. As men were less sure about going into practice after graduation than women, this initiative could also help increase the number of male applicants.

The majority of students (92.4 per cent) indicated a desire to work in general practice on graduation. These results are similar to the findings of Fitzpatrick and Mellor (2003) and Robinson and Hooker (2006). Mixed practice was the most popular job type, with 41 per cent of students indicating a preference for working in mixed practice on graduation. This finding is corroborated by Robinson and others (2004), who report that the majority of new graduates opt for mixed practice (in the hope of acquiring a variety of experience before choosing a preferred area of work) but that many end up in small animal practice, which seems to offer better support, career prospects and financial reward and less daunting on-call duties. Career expectations have been shown to change during the undergraduate course (Murray and others 2005), and career predictions made by students at the time of entry to the veterinary course may bear no significant relationship to their eventual destination (Heath 2002). Even so, a number of students may be disappointed that they are unable to secure a position in their preferred area of veterinary practice, and this could lead to an early dissatisfaction with the profession.

There were strong similarities between the main attractions of the job for students in the present survey and the ‘best things about practice’ as determined by veterinary professionals (Robinson and Hooker 2006), which suggests a good understanding among students of the job of a vet in practice. It is interesting to note how similar both lists are to the factors considered fundamental to happiness in the workplace (Warr 2007).

Students are also clearly aware that the veterinary profession does not have a good track record for work-life balance. DVM Newsmagazine surveys in the USA show that both men and women want to work fewer hours (Verdon 2004), and 66 per cent of veterinarians in an Australian study agreed with the statement ‘It is hard for me to balance my personal life with my career’ (Heath 2007b). Formal instruction on work-life balance at the undergraduate level has been reported (Harvey and others 2001), and some practices have adopted the Investors in People work-life balance model with great success (Investors in People Shuttleworth Veterinary Group 2004), but this is obviously an area that the veterinary profession as a whole needs to tackle.

Other student concerns were different from those of veterinary professionals. ‘Making mistakes’, ‘Being responsible for clinical decisions’ and ‘Remembering the facts’ were listed as major concerns by entry-level and exit-level students, indicating that the undergraduate course had done nothing to alleviate them. Making professional mistakes can have a considerable emotional impact on new graduates in terms of loss of confidence, stress and thoughts of leaving the profession (Mellanby and Herrtage 2004). Royal College of Veterinary Surgeons initiatives such as the Professional Development Phase may provide some support to new graduates in their transition to practitioner, but, as suggested in the medical literature, it is also vital that undergraduates be taught effectively how to reflect on, respond to and learn from any errors they make or observe during their course of study (Martinez and Lo 2008).

There is some evidence from the medical field that variables such as ‘Confidence in own knowledge’ and ‘Fear of encountering demanding situations’ have a significant influence on a student’s identification with the role of a doctor, particularly among female students (Gude and others 2005), and the authors suggest that the successful adoption of the doctor’s role is linked to a student’s general ability to handle interpersonal relations. Communication skills are a vital component of interpersonal interactions (Shaw 2006); good communication skills can improve staff relations, decrease conflict and increase motivation, promoting a working environment conducive to best practice (Stobbs 1999), satisfying clients (Stutts 1997) and avoiding complaints to regulatory bodies (Russell 1994). Every effort must therefore be made to ensure that communication skills are effectively taught during the veterinary undergraduate curriculum (Routly and others 2002, Latham and Morris 2007, Mossop and Gray 2008).

It would have been interesting to investigate the reasons for the apparent lack of self-confidence in this group of academically able students, particularly as lack of self-confidence appears to be a stressful part of veterinary practice (Routly and others 2002). Women were more likely to indicate this as a concern than men, a finding corroborated by Gilling and Parkinson (2009), who report that most of the graduates in their study who expressed high levels of self-doubt were female. Men were shown to exhibit higher self-esteem and avoidance of emotion-focused coping strategies than women (Lawrence and others 2006), even though women attained higher academic success. Distorted perceptions of competence and incompetence among medical students have also been reported (Albanese and others 2006), with high performers underestimating their performance and vice versa. Any similar mismatch between self-confidence or self-esteem and clinical competence in veterinary students needs to be identified and addressed before graduation to minimise the stress experienced by new graduates.

Further studies are required to explain the high levels of stress in the profession. It appears that a mismatch of expectations, at least at the superficial level, is not a contributing factor, and the present study generally corroborates the findings of the Royal College of Veterinary Surgeons that the majority of students who apply have good knowledge of the profession and realistic expectations (Robinson and others 2007).

It has been reported that learning styles and study habits can predict a doctor’s approach to work (McManus and others 2004), with high perceived workload and poor support determined as much by the doctors themselves as by specific working conditions. Studies of the learning styles and personality traits of veterinary undergraduates may help determine whether it is the job itself (Mir 2009) or the type of person undertaking the job that more significantly influences wellbeing within the profession. It has also been suggested that the profession should put more energy into adequately training future generations of veterinarians to cope with the high demands of the workplace by introducing self-care classes and personal development classes into the curriculum (Kinsella 2008).

References

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Footnotes

  • Provenance: not commissioned; externally peer reviewed

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