Dr. Amy Durham, Professor and Assistant Dean at the University of Pennsylvania, joins Dr. Andy Roark on the Cone of Shame podcast to discuss PennVet’s new active learning and learner centered curriculum. Together they dive into the driving factors behind this decision and what it’s meant to students, faculty and the veterinary industry.
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LINKS
PennVet Article on Curriculum: https://www.vet.upenn.edu/about/news-room/bellwether/bellwether-magazine/bellwether-spring-2023/educating-a-21st-century-veterinarian
AAHA Article on Curriculum: Penn Vet transitions from discipline-based to fully integrated curriculum (aaha.org)
Today’s Veterinary Business Article: https://todaysveterinarybusiness.com/penn-vet-curriculum-121823/?oly_enc_id=5467B7086134E1Y
Competency-Based Veterinary Education: https://www.aavmc.org/programs/cbve/
Uncharted Veterinary Conference: https://unchartedvet.com/uvc-april-2024/
Uncharted on the Road: https://unchartedvet.com/on-the-road/
Charming the Angry Client Course: https://drandyroark.com/charming-the-angry-client/
Dr. Andy Roark Swag: https://drandyroark.com/store/
ABOUT OUR GUEST
Dr. Amy Durham is a Professor of Anatomic Pathology and Assistant Dean for Education at the University of Pennsylvania School of Veterinary Medicine. She went to Penn for vet school (class of 2005), did a residency in anatomic pathology at Penn, and then have stayed as a faculty member in the Department of Pathobiology. She became the assistant Dean for Education a couple of years ago, and is currently completing an MSEd in medical education.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome, everybody, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I got a great one. I am here with Dr. Amy Durham, Assistant Dean for Education at Penn’s Veterinary School, and we are talking about the curriculum transformation that they are currently going through. I am a, I’m an education nerd for those who don’t know.
I am married to a college professor who has a love of pedagogy, which is the science of teaching. My conference, Uncharted Veterinary Conference is an active learning, learner centered conference. It is all about hands-on learning and education. I just, I really dig this stuff. I really think that there are ways that we can dig in to train skills as well as knowledge.
And so I was really geeked out when I started reading about what Penn was doing. There’s a number of other vet schools that are rolling out similar curriculums. And I am just, I’m really happy and fascinated. I think the way that we educate doctors for a lot of schools has become outdated. It’s just– It doesn’t make sense in the modern world, the way that we educate and I am so happy to see people shifting what they were doing, being honest about where we are and the resources that people have and training in a way that’s going to make doctors successful and comfortable and competent as fast as possible. I just, I love this mentality. So anyway, I get in with Amy. We talk about what Penn is doing, why they’re doing it this way. I asked them about the transition and what that experience is like where it goes and just really start to dig into what they’re trying to accomplish. So I very much enjoyed this conversation.
Amy’s wonderful. I hope you guys will enjoy it. Let’s get into this episode.
Kelsey Beth Carpenter: (singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Amy Durham. Thanks for being here.
Dr. Amy Durham: Thanks for having me, Dr. Roark. It’s great to see you.
Dr. Andy Roark: It is great to see you. It’s my pleasure. For those who don’t know you, you are an anatomic pathologist by training. You are also wearing the hat of assistant dean for education at University of Penn’s College of Veterinary Medicine, and I became aware of you because I started seeing articles about the fully integrated curriculum that Penn’s vet school is transitioning to. And I wanted to know more about it because I’m a bit of an education nerd. And so that’s why I reached out to you. So thanks for making time.
Dr. Amy Durham: Absolutely.
Dr. Andy Roark: I started seeing this just a couple of months ago and sort of the announcement was Penn vet is transitioning to a fully integrated curriculum.
Can you go ahead and just, mile high layout? What does that mean? What does this general transformation look like?
Dr. Amy Durham: Yeah.
Okay. So I’m going to start to do this from the mile high version. So essentially we redesigned our entire four year curriculum and we had a couple of principles in mind when we did this, that one of them was this backward design principle. So what are the, you know, knowledge, skills, and values that we want the day one veterinarian to have when they graduate?
And then we just sort of went backwards from there and designed the curriculum. The other goal we really wanted to do is have the core curriculum, so that preclinical curriculum to be two years so that we get our students into the clinics in their third and fourth years. And so, yeah, so that’s how we sort of started out with those principles and a small, what we called curriculum redesign team was born in 2018 and we started to work.
Pretty early on, we knew we wanted to do this backward design, we knew we wanted to use competency based veterinary education as a guiding principle and we knew we wanted to have more learner centered versus teacher centered educational experiences. So these are context rich, application based experiences and integrated as you mentioned curriculum. And so the way we integrated was we how’s best to describe this? So essentially the first year is the animal and health. And so the, ologies that we do or the disciplines that we integrate together are things like anatomy and histology and physiology.
And those are integrated into what some people call systems based, but we, you know, we sort of do it like a block system. Or process based and so in any given process or system, the students are exposed to the anatomy, the histology and the physiology kind of concurrently or in an integrated way.
And they’re also sort of linked into context. And so we’ll start to introduce disease in the first year, but only as by example. And then in the second year, the same, it’s a mirror image of our first year, but now we’re focused on the animal in disease. And so, things like the diagnosis and treatment of diseases.
And so those would be courses in the traditional curricula, those courses would be things like pathology. We had something called medicine and surgery and the different sort of microbiology, parasitology, those types of things. And so those are really how it’s structured at a very high level.
Dr. Andy Roark: Okay. Talk to me a little bit about learner centered education versus teacher centered education. So you use those terms, but specifically what is, what do they look like?
Dr. Amy Durham: So, in the, sort of traditional sense of the teacher centered, you can see me standing up in a big classroom, Right?
I’ve got I’m on a podium. Students are sort of in the stadium in front of me, and there’s the screen, and I’m delivering a PowerPoint presentation and delivering content. And so we still have to do that.
To a certain extent, we can’t completely. We have not completely gone away from that. But what we’ve tried to do is integrate sort of more learner centered activities. So try to do more small group activities, more lab based activities. Even when we are lecturing per se, like, we want to, we do things where we stop and we quiz or poll students, we bring them in and sort of make it, make them sort of the center of the learning experience, not the professor standing in the front of the classroom.
Dr. Andy Roark: That totally makes sense. Can you tell me a little bit, I want to get into backward design, because I love this approach to creating doctors. This makes so much sense to me. I just beat my employees over the head with the phrase, what does done look like? What does success look like?
And I know they are saying, sick of hearing me say that because I say it, you know, daily. What does done look like? What does success look like here? And it’s because I just so deeply believe in this sort of backward design or what are we trying to produce? Can you lay down a little bit either the specifics or the general process that took you to deciding what a done, complete competent doctor looks like?
Because I think that’s really a point of debate for a lot of us.
Dr. Amy Durham: Yeah. I mean, we really used the CBVE this competency based veteran education that the AVMC has, and you can go onto their website and see. And we use their in concept, use their domains and competencies underneath those they have what we would call illustrative sub competencies, and then you can take it a step further to integrate something called entrustable professional activities. So those are the things that you can watch them do. And then if they can do that, you can entrust them to do them independently. And that means they’re competent and ready to go into practice. And so we really relied on the hard work of this group that are continuing to meet, like, you know, in iterations.
As are again, like I said, is one of our guiding principles. And then we but, of course, we also had to rely on our professors. I mean, every university has its unique personality, and it’s built on their history and the people that make up that place. And so we relied on our professors to do an exercise of really evaluating what they teach in the legacy curriculum and really looking at it and saying, Is this core?
Do I need– is this core knowledge? You know, And that’s a hard exercise because, you know, we’re content experts. Like I could lecture for days on the thing that I love, right.
But it’s probably not what it’s probably not the level of detail that our students need to have in sort of this core, preclinical curriculum and the same thing is true as we get into the second, the third and fourth years in their clinic years.
So it’s a hard exercise and honestly it’s not done. We, I mean this is, it’s a process that just sort of needs to keep going and be reevaluated routinely to say are we producing what we feel are those day one ready veterinarians and importantly, have we given them, and this is another principle that we used of understanding, do they know how to access information, right? So that they’re lifelong learners because you’re never done, right? Like, I’m back in school now myself. Like, you’re just never done. And so, you know, we create, we created this curriculum sort of based on the just in time principle, not the just in case. So don’t just go ahead and memorize a bunch of things just in case you need it.
At some point, know how to access and critically evaluate the information to sort of practice this evidence based medicine so that you, when you need it, when you’re in clinics and you know, oh gosh, I need to go get this information and you know how to get that information and apply it just in time for that patient.
Dr. Andy Roark: Hey guys, did you know that I have another podcast? I am the host of the Uncharted Veterinary Podcast with my dear friend, practice management goddess, Stephanie Goss. We have been answering questions for years. We started a year before Cone of Shame. I started doing the Uncharted Vet Podcast with Stephanie.
We take questions from our mailbag. We have listeners who write to us and they tell us about what’s going on in their practice and we try to answer their questions and they are all about. Communication, leadership, management, things like that. It’s about working with clients. It’s about working with staff.
It’s about working with your boss. It is about all of those sorts of things. We have everything from, trying to establish some trust in your team when you’re a brand new baby doctor, fresh out of vet school to, managing an employee with mental health issues to, how to. How to give notice without, without the guilt.
If you are in a place, you just can’t be there anymore. We’ve got all that stuff. We’ve got hiring, firing, working together, working with clients, reviewing your systems, getting your practice to run smoothly and efficiently, and how to manage your time. All that stuff is there. Check it out. I said 250 episodes.
You can see what everyone is about, from the title because it’s what, it’s basically the question that we’re being asked. But anyway, it is a very popular podcast. I hope that you’ll check it out and enjoy it and love it. I just love making it. So anyway, I just want to tell you it’s there guys. Let’s get back into this episode.
Andy Roark: This type of just in time education, as opposed to just in case, I really think that this is where education, not just in our field, but across, like, higher learning is going. We live in the age of artificial intelligence, like the computing power that we can bring to bear. We have more power in our pocket, in our cell phone, than veterinarians a hundred years ago had in a whole library.
They did not own the knowledge that we can pull up in 30 seconds online. And so at some point that has to fundamentally change how we educate because at some point if we’re just hammering facts into someone’s head that they could access in 20 seconds online, are we really training them as opposed to training them how to interpret information and recognize what is important and make decisions and make priority. So I really like this emphasis on just in time over. Just in case. Do you agree that there is sort of a societal shift in education in this direction? I mean, do you think that fundamentally with the technology we have this is where our skill based learning is going?
Dr. Amy Durham: You know, I don’t think we have a choice, right? I mean, I think, so I have a 14 year old son, and the way he learns is just not how I learned it. The way our students, our current students who are in their, typically in their 20s, the way they learn and access information is not how I learned and accessed information when I was going through school.
And so I think we have to meet our learners where they’re at and recognize that the amount of information that is out there, I think there’s something like the stat is the doubling time of biomedical information is just, it’s measured in like, you know, months and years versus decades at this point.
So there’s simply just no way that you can put all that information in your head. Like it’s just not, it’s just not possible. And so, yeah.
I think you’re absolutely right in higher education in general. But I would even say, you know, just education across the board, teaching people how to critically think, critically evaluate how to sort of have what we’ve called, like, productive skepticism for about what you read especially important for doctors is how to tolerate ambiguity so all of these things, this is how we are trying to embed into this new curriculum, these sort of values.
Dr. Andy Roark: Penn has a phenomenal reputation, and I know that because all of my friends who went to Penn tell me that they have one.
Dr. Amy Durham: Oh, gosh.
Dr. Andy Roark: but they, I know, but no, but they do, Penn, has a phenomenal reputation. When you talk about assessing the success of graduates to continue to kind of update and tinker with the curriculum going forward, what does that assessment look like in your mind?
How do you know when you have produced a successful graduate or not?
Dr. Amy Durham: That’s a great question. And so we, and you’ve always, we’ve always had to do this. All schools have always had to do a sort of a program assessment and outcomes assessment. It’s part of our accreditation process. And when you build a new curriculum, especially one that is very new, is this one, you want to make sure that.
You haven’t lost something in the translation and so we’ll do our continual, the things that we’ve always done for our curricular assessment and our outcomes assessment. So things like as basic as looking at NAVLE scores, right? Like that’s a metric, but also we do exit interviews with our vet students.
We interview employers around the area that hire our students to sort of see where they’re at. We go back to our students a couple of years later after they graduate and ask them a series of questions. But in this new curriculum, we’re introducing some other elements to our assessment, which is that we have always asked students, you know, for evaluations for the coursework and the professors.
But this time around, we’re also adding in surveys of our professors. So what did they think of the new classes? Because their opinions are really important. And we’ve also created focus groups. So 1st and 2nd year vet students sit in on like five or six student, you know, per focus group and they just give them lunch.
And we talk. And I mean, we I’m not in the room because I would sort of buy us a conversation. But they sort of talk to our administrative folks and have the conversation about what’s working and what’s not. And that information has really helped us sort of in real time make edits to this unfolding new curriculum.
So yeah, there’s a lot of ways to do this, and I think there’s no, there’s no one right recipe. And I think different schools probably have different ways of doing it. But in general, we have to continually evaluate. and one of the ways we want to do that too is by doing research, like asking, you know, research questions on the new curriculum and, publishing that data so that other schools can learn from it too.
Dr. Andy Roark: Talk to me about how other schools are changing because as you know, I was interested, I said because of its storied history, Penn really stood out to me when I started looking at who was integrating and changing up their curriculum. But there are, especially with the newer schools that are opening up, there’s a lot of them, especially ones that do some of their clinical training offsite and things like that.
These are newer models that we’ve seen for a while now, but a lot of them are leaning into very different models of education. Can you speak, and I know your specific interest is in Penn, and you’re sort of head down working on that, but do you see a trend in upgrading a move towards sort of a fully integrated curriculum across other vet schools?
Is this something that you think is moving very rapidly? is it kind of very piecemeal? What are your thoughts about education of veterinarians across the United States and Canada at large?
Dr. Amy Durham: You know, I don’t want to speak too much for other schools, but I can tell you just, you know, and working with other people from across the United States. And I would say that many, if not most, veterinary schools are, have undergone or are undergoing or plan to undergo some degree of curricular redesign at this stage.
So, you know, in general, I think change in academia is kind of like steering a cruise ship, like it usually takes a really long time. So I think maybe we’re seeing kind of a trend where this is accelerating and probably for the same reasons that we’ve talked about where we see, we have a different student population, we know more about adult learning theory, we know how to, sort of engage our learners better.
And so I think Penn is not, you know, Penn’s– The new curriculum is unique to Penn and what I’ve just described, but the idea of curricular change is certainly widespread throughout veterinary education.
Dr. Andy Roark: You mentioned sort of this transition. This is not a flip the switch. All right guys, on Monday when the students show up, we’re going to be doing it differently. What, how long does a transition like this take? What does that look? Is it rolled out in pieces? Surely it’s not summer break and we’re coming back with a whole new style.
What is that?
Dr. Amy Durham: It requires a lot of patience from our faculty and our students. So and I have to say everybody has been on board and been just amazing. But Yeah.
So essentially it’s got launched. The new curriculum got launched in 2022. And so as we stand here right now, we’ve got two classes in the new curriculum and we’ve got two classes in the legacy curriculum.
And so it’s, there’s times where I was teaching in the old curriculum and then I would turn around and then teach in the new curriculum. And I’m certainly not unique. A lot of our professors have had to do that. And so it’s. It’s been an all hands on deck and total buy in, and our faculty really embraced it and have done an amazing job and are currently, you know, working really hard to continue that transition.
Dr. Andy Roark: How do you square the experience of having the legacy students? You’ve got two classes of legacy students, and you’ve got two that you’re doing this new thing. And I’m sure the feelings are mixed. I’m a change junkie. I like to try new things. I like to push and evolve and, I don’t know. I just, I really, enjoy that sort of evolution things.
And so I think whenever I start rolling out a new thing, I am very excited for the people who are doing that, and I think I feel a little bit sorry for the people who are doing the old thing. Do you have thoughts like that, where you, because you see these, the legacy students, do you have thoughts of, Oh boy, I can’t, I’m so glad we’re transitioning to this? Are there things that you miss in the legacy way, where you say, It sure was a lot easier when we had, you know, in the Legacy way. I wonder if we’ll go back to that. What, how do you square having those two different experiences going on at the same time?
Dr. Amy Durham: Yeah, I mean, it’s real, it’s real. for the students that are in the legacy curriculum, I say to myself, I was a part of the legacy curriculum and I turned out just fine, right? or at least I hope I did. So, you know, I think they are getting a stellar education and they are going to graduate as stellar veterinarians.
And I think And both and I am excited for our new curricular students because it’s but they also they’re faced with some challenges too right? This is there’s hiccups in the rollout and they’ve got to roll with it. And they have been great and provided really important feedback, but also just, given us the grace to mess up and try to fix it. And so I think Yeah. I think, I mean, I love change too, but not everybody does. And so it’s taken, you know, we’ve had to sort of meet in the middle and sort of come together and I think it’s going well, but Yeah.
For sure there’s, this is not just, you know, like you said, flip a switch and everything’s done.
Dr. Andy Roark: Yeah. Well, this is, this has sort of been your baby along with the team I know you work with. And you’ve put so much into this. When you think about this transition, what is most important to you? I mean, what are, what do you feel that you desperately want to get right here? Like, what would make this a success, in your eyes?
Dr. Amy Durham: Oh, what does done look like? Right? There’s so many ways I could answer that question. I think–
Dr. Andy Roark: I just mean for you personally, yeah. I mean, you, as a person who has invested so much themselves, like, it’s, not, I just not even about the, curriculum overall, but, you, Amy, like, what do you want to get out of this?
Dr. Amy Durham: so. One of the things that I love, I’m a pathologist, which means like I sort of feel like I straddle between clinical medicine and sort of biomedical sciences. And one of the things that I’ve really loved about this new curriculum is how we’ve, you know, in the clinics, in practice, you talk about interprofessional clinic teams, right?
You’re sort of the doctor and the clinic staff. We’ve sort of modeled that kind of by accident with our interdisciplinary teaching teams. So not interprofessional, but interdisciplinary. So when we have these block courses, we have our basic scientists pair up with our clinicians to create this curriculum, and one of the things that I have been so, that I’ve loved to sit back and watch happen is sort of, even though we’ve all worked with each other in some way or another for you decades, in some cases, there’s this deeper level of respect that we have for what we all bring to the table in educating our, veterinary students that I’ve really enjoyed watching happen.
And then I also feel like in a way we’ve sort of modeled that idea that you can sort of have these teams come in and work really well together, even if they come from different disciplines or different skill sets. And so that’s sort of one of those, I don’t know, almost like it’s an emerging theme that’s come out of this curricular redesign process that I’ve really enjoyed.
Dr. Andy Roark: That’s awesome. Dr. Amy Durham, thank you so much for being here. If people have questions for you, if there are other institutions that are looking at transitioning their curriculum how can people reach out? How can they get in touch with you?
Dr. Amy Durham: I, you? can find me on, you can email me. I’m on the website. Please just email me. I’d love to answer any questions.
Dr. Andy Roark: That sounds amazing. Thanks so much for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.
And that’s it guys. That’s what I got for you. Thanks so much for being here. Thanks to Dr. Amy Durham for making time to talk about what Penn is doing. Big big love for those guys and encouragement for them and the journey that they’re on. And I’m just, I’m so glad that they’re putting the effort in.
I think it’s going to be great for our profession. I think it’s gonna be great for Penn grads. And just, anyway, I’m all optimism about this type of transition in our profession. I think it’s great to be in vet medicine. I love it. I love a lot about where we’re going And this just makes me super happy guys.
Take care of yourselves. I’ll see you later on.
