To educate without harm. To instill and support an appreciation and respect for life. To graduate veterinarians competent in clinical skills. These are some of the challenges we face as veterinary medical educators. Integrating new methods of learning in an established curriculum will require reallocation of monies, reapportionment of faculty, staff and student time, and securing of creative connections with new animal resources. Identifying and implementing these new methods will also require innovative and constructive thinking with realistic yet all-encompassing goals. A motivation to continually improve upon an existing program is key to success.

The goals of a clinical skills curriculum must be determined by the market into which the graduates will be entering. Surveys gathering input from veterinarians in the various fields can help guide the development (or redesign) of skills learning objectives. Additionally, consideration must be given to less tangible learning objectives that are easily satisfied in skills learning arenas (e.g., teamwork, time management, collaboration, respect for life, compassion, self-direction, etc.) Mastery of these skills learning objectives is paramount. Simple exposure to a skill is inadequate. The level of mastery will no doubt vary depending on the skill or attribute, but this requisite level of mastery must be pre-determined and then confirmed prior to advancement.

Learning skills requires time and repetition. A student's inherent abilities will dictate the amount of practice that student needs, and this will vary dramatically from student to student. A limited number of standardized experiences may not be optimal or even sufficient to accommodate this variance in student abilities and learning styles. The animal, both living and dead, is a very valuable learning tool (in a multitude of ways), and not to be treated with disrespect. A student must be adequately prepared, having mastered simple techniques with non-animal learning tools, prior to attempting more complex techniques using the animal learning tool. Additionally, it is wasteful of this valuable resource and time not to incorporate diverse expectations regarding, for example, proper instrument handling during gross anatomical dissection, or human-animal communication and handling alongside anesthesia induction.

It is taken for granted that we spend time studying to learn and retain facts and principles. This concept must be applied to learning and mastering clinical skills. Additionally, we must start with rudimentary techniques before progressing to complex skills with failure consequences. We must allow for repetition and gradual progress. We must provide a variety of experiences to accommodate different learning styles. We must clearly identify expectations and clinical applications/extrapolations for the various learning tools we provide. We must provide timely and specific feedback, including encouragement. And we must confirm requisite mastery prior to advancement to the next skill or level.

An example using the above concepts is the College of Veterinary Medicine at Western University of Health Sciences in Southern California. This new school will admit its first class of students in Fall 2003. The first two years of the curriculum will be spent largely in two "areas": the problem-based learning curriculum and the clinical skills curriculum. This curriculum is highly student-centered with a combination of scheduled and unrestricted/student-initiated experiences.

The third year of the curriculum will be spent in two-week rotations in twelve different areas: Practice Management; Small Animal Practice; Livestock Practice; Population Health & Production; Equine Practice; Humane Society/Shelter Medicine; Diagnostic Laboratory and Pathology; Laboratory Animal and Research; Zoo Animal & Wildlife; Veterinary & Environmental Public Health; Food & Feed Safety; and USDA Accreditation, Foreign Animal Diseases, & International Veterinary Medicine. These rotations will involve groups of three students in either clinical, apprentice-like experiences or campus-based, fieldtrip and individual project experiences.

The fourth year of the curriculum will be spent in four-week rotations determined by the student in conjunction with a curriculum committee. This individualized rotation schedule will be comprised of applied veterinary settings (private or corporate practice, diagnostic laboratories, governmental organizations, other veterinary schools and veterinary centers of excellence, etc.) in the United States or abroad.

In the clinical skills curriculum, students will receive, upon matriculation, lists of skills that must be mastered to a designated level prior to the end of the second year of the curriculum. These skills are connected to lists of learning tools that students may use to learn and develop the skills. "Learning tools" in this context is used very loosely; it is defined as inanimate and animate models, computer-based interactions, simulations, cadaver-based exercises, living animal experiences, etc.

All cadaver-based exercises will be supplied through a donation program involving animals who have died or been euthanized due to natural causes. This program will be modeled after willed body programs used in human medical education. These cadavers will be processed for use as preserved and "fresh" specimens. An additional benefit of using this source of animals is the learning that can occur about death and its emotional, financial and practical ramifications. Students will participate in memorial services and will interact with the guardians of the animals to a level that is appropriate (e.g., sympathy cards, cause-of-death findings, return of cremains, etc.)

The Anatomy and Surgery Center will house all cadaver-based exercises. This facility is designed to integrate basic anatomy with the clinical disciplines of surgery, medicine, medical imaging, pathology, physical therapy, etc. Faculty from these various disciplines will participate in student learning experiences in this facility.

The Psychomotor Proficiency Facility will be a dynamic, innovative learning center with extensive student accessibility (open 18-24 hours/day.) The colloquial name has become the Town PuMP relying on the historical connotation of the central, daily meeting place for a community. The goal will be to create an exciting, fun, interactive, comfortable, yet demanding and intellectually stimulating environment. In keeping with our goal of student-centered learning, the skills curriculum will be largely self-directed. Given that these skills are mandatory for farmed animals, small animals, equine and avian/exotics, there will be an academic infrastructure and established expectations within which students make choices on how they learn these required skills. The Town PuMP will provide the environment and the minimum standards for skills acquisition; students will work beyond these minimums to fulfill individual objectives. There will be variety of opportunities, and unlimited access to many resources. We will promote and support a motivated, self-directed learning environment.

A variety of skills will be honed in the first two years of the curriculum using living animal learning tools in the form of pet volunteers. These skills will be non-invasive or minimally invasive, including physical examination, blood sampling and handling, bandaging, etc. The animals will benefit (through prophylactic diagnostic tests such as physical exam or heartworm screening) or will be neutrally effected (except for receiving positive social interactions.) Similar large animal learning will occur using animals maintained in functioning agricultural units by the College of Agriculture, California State Polytechnic University, Pomona.

The service-learning concept will be used by WesternU-CVM to allow for more advanced living animal learning tools/experiences. Populations of animals that are relatively underrepresented with respect to medical care will participate in our Veterinary Ambulatory Community Service program and receive wellness/basic care on a scheduled basis using ambulatory veterinary facilities. Organizations and individuals responsible for these animals include small animal shelters, animal rescues (representing dogs, cats, horses, reptiles, farmed animals, birds, and rabbits), homebound seniors or hospice patients, homeless people, etc.

Students in the first two years will also rotate through the on-campus companion animal veterinary clinic. This clinic will provide wellness and basic care for contract clients and patients (e.g., students, staff and faculty pets under contract to visit the clinic four times per year.) Students will engage the patient-client-doctor relationship and manage the cases to the level to which they are capable under the direct supervision of faculty clinicians. Given the close proximity of the clinic to the Town PuMP and the Anatomy and Surgery Center, the student may refresh themselves on a skill in these non-clinical settings prior to application in the clinical setting should time allow while managing a case.

With these various facilities and experiences in the first two years, students may expect to become comfortable with equipment, familiar with anatomy, confident in their ability to perform technical skills, and able to teach themselves novel technical skills as they progress through their career. Many more learning objectives will be satisfied in this skills curriculum that go beyond clinical skills (i.e., interpersonal communication, clinical reasoning, time management, self-directed learning, practice management, etc.) With mastery of these lists of skills, students will be prepared to integrate these skills into their clinical activities in the third and fourth year of the curriculum. Because they will have become comfortable with these various skills, the clinical experience will not be focused on skills acquisition. Honing of these skills through their use in the management of cases will occur naturally (again in the simple to complex progression with appropriate supervision and guidance), and the other aspects of clinical medicine (problem solving, clinical reasoning, interpersonal/client communication, practice management, etc.) will receive the attention they deserve.

We are a creative species. We have made tremendous achievements in medicine, physics, engineering, and art. Educators can make as profound achievements in the educational arena as well. Why should a learning challenge be handled any differently than a disease challenge? Identify the problem, brainstorm various creative solutions, apply them, gather data, modify our actions and reassess the problem. This process must be ongoing - a constant evolution. We are at a stage where eliminating the harmful use of animals in education is not only achievable, but doing so will result in superior learning.