Becoming a specialist is not easily achieved and the most common route is a one year veterinary internship, followed by a three year residency. Recognising the current shortage of veterinary specialists and offering a possible solution to perceived barriers to specialisation, the European Board of Veterinary Specialisation (EBVS) have introduced the option of a credit-based modular route to specialisation to offer more flexibility.
The standard pathway is for vets to undertake a year long internship of multi-disciplinary clinical training, followed by a three-year approved residency programme at a referral practice or university.
A residency programme consists of advanced training in a specialty in veterinary medicine under the supervision of a European Board of Veterinary Specialisation (EBVS) Diplomat. The residency leads to specialty certification in an EBVS-recognized veterinary specialty College.
In addition, to achieve RCVS Specialist status, an individual must have achieved a postgraduate qualification to at least diplomate level, and must additionally satisfy the RCVS that they make an active contribution to their speciality, have national and international acclaim and publish widely in their field.1
Barriers to specialisation
The pathway to becoming a specialist requires a heavy commitment which can have a significant effect on the life choices of candidates quite aside from a potentially heavy case-load, long working hours and challenging study requirements. The pay for some internships and residencies is strikingly lower than that of a vet working in practice, with the worst residencies coming in well below the average UK salary, meaning that financial factors are likely to feature highly in decision making. With vet students coming out of their studies with an average debt of £70,0003 and the current cost of living crisis, rising interest rates, and increasingly high cost of childcare in the UK4, there may be a stark financial choice between pursuing career aspirations and embarking on life decisions like buying a house or starting a family.
The potential need to relocate geographically to take up an internship and residency located within a college or referral practice, can be another limiting factor for candidates and a complication to established relationships and home lives.
Arguably, greater obstacles could be faced by women, who have a time-limited window for completing a family and still spend more time than men on domestic and caring responsibilities. According to RCVS figures, currently 48% of veterinary specialists in the UK are female compared with over 60% of UK vets.
Flexible solutions
The minimal length of a residency is three years, however it can take place on a part time basis so long as the total time is equivalent and it is completed within six years. In the case of maternity leave, illness or other exceptional circumstances, the college may agree for an extension of this time.
EBVS-recognised speciality colleges offer an ‘Alternate Residency’ option to individuals whose circumstances may prevent them taking up a standard residency. This is a residency that is tailor-made and approved for an individual, although it has identical requirements for resident activities, documentation and supervision and must still be completed within six years. A resident on an alternate training programme must spend the equivalent of at least 60% of 3 years working in the practice of their speciality, under direct supervision of a certified Diplomate of the College.2
Recognising that the current system is too rigid, and colleges cannot currently meet demand for specialists5, Mark Bowen, Director of Education at the EBVS says: “We know the workforce crisis extends into specialist practice. There are simply not the specialists needed to support the primary care practitioners. At the moment, many specialisms are struggling to train enough residents to keep up with the loss at the top of the profession. Flexible pathways to specialisation allow the specialist colleges to develop programs that deliver the same training, over a longer period and through more flexible routes. It still includes the rigour and supervision of other specialists, just in different ways.”
“Flexible pathways to specialisation allow the specialist colleges to develop programs that deliver the same training, over a longer period and through more flexible routes.”
Mark Bowen
In 2019 the EBVS carried out a survey on perceived barriers to specialisation in Europe to look for solutions, and as a result, in 2021 updated their policies6 to include a credit-based modular route to specialisation. This splits the overall curriculum into practical credits, made up of direct supervision in the clinic, with the potential for an element of remote supervision; and theoretical credits based on new learning through research and taught courses from CPD providers or colleges.
Flexibility comes from the ability to split practical and theoretical learning, as well as from the time over which credits can be accumulated, which can allow for career break periods of up to four years for parental leave or other work. There is no requirement to register at the outset, although only credits accumulated over the past eight years are admissible. Candidates can accumulate their credits and report back to the college when they have reached the required amount.
Is flexibility actually possible?
It is up to the individual speciality colleges to adopt flexible pathways in their own ways – they will determine the minimum duration of practical work and whether remote supervision can be used, and for theoretical credits, will define their content and methods of delivery, including whether prior accredited learning can be included. Currently, of the 27 European specialist colleges, the European College of Porcine Health Management (ECPHM) have chosen to offer a flexible, modular route to specialisation, and the European College of Veterinary Clinical Pathology (ECVCP), will offer the modular pathway upon individual request.
Others, including the European College of Bovine Health Management (ECBHM), are supportive of the concept, but are still working on developing the infrastructure for external certification of elements to be recognized as part of the training. Walter Grünberg, president of the ECBHM commented: “We see this modular route prospectively as a promising path for individuals who are unable to complete a standard or alternative residency program. The infrastructure for this is however still in the making and the details of this will have to be carved out in the future.”
“We see this modular route prospectively as a promising path for individuals who are unable to complete a standard or alternative residency program.”
Walter Grünberg
Some colleges are yet to decide, with the European College of Veterinary Sports Medicine and Rehab (ECVSMR) currently in discussions about the option. A working group for the European College of Veterinary Surgeons (ECVS) is looking into the subject. Bernard Bouvy, Executive Secretary of the ECVS, commented “The ECVS recognises that the path to specialisation in the field of veterinary surgery is intense and time-consuming and requires dedication and sacrifices from its residents for a period of minimum three years. For many individuals this falls into a time of their lives when they are also founding a family or are taking up specialist education after having started a family. Others may discover their passion after a few years on the job and develop a desire for further specialisation after having explored various aspects of what the profession has to offer.”
“The ECVS is currently exploring possible ways to allow the specialist training to become more compatible with different life situations while remaining adamant about the high-quality standards of our education.”
Increasing flexibility benefits the whole profession
Amongst the profession, the EBVS’ proposals for flexible pathways to specialisation have met with approval. Reacting on social media, Holger Volk, Professor of Small Animal Diseases and the Head of Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover commented: “I totally endorse this! Veterinary medicine has its golden era if we play it right. There is no question that the standards for a specialist need to be high, providing a clear framework. However, this should not be a barrier to a flexible pathway. Waiting [to adopt it] will harm the specialist status…”
Heather Bacon, Veterinary Clinical Senior Lecturer and Curriculum lead at the University of Lancashire School of Veterinary Medicine commented: “Inflexible pathways discriminate against caregivers (primarily women) and those with greater financial responsibilities or unable to support themselves on a traditional training income. Increasing flexibility whilst maintaining the same competency standards as a training ‘end-goal’ benefits the whole profession.”
Gayle Hallowell, Director of Veterinary Professional Development at IVC Evidensia also welcomes the proposal of a flexible, modular route. “The pathway isn’t easier, and is longer but more flexible which could allow vets to build a portfolio while staying at their current practice and doing rotations at times that suit. From a business perspective it can also be more cost effective for the referral practice than a standard residency.”
She acknowledges however that the pathway could be riskier: “The problem with combining the traditional programme with flexibility is that the resident still needs to see the amount and types of complex cases required, which could be difficult to fulfil. Additionally, their training may not always be equivalent in facilities and have the same access to journal clubs or other CPD options.”
“The specialist community won’t match the expectations of the veterinary profession if we don’t respond and change… this route would offer opportunities to talented individuals that are unable to follow a traditional route.”
Gayle Hallowell
Gayle concludes: “There is good reason for flexibility and individual colleges need to be open minded. The specialist community won’t match the expectations of the veterinary profession if we don’t respond and change. There is an ever-increasing need for specialists, and this route would offer opportunities to talented individuals that are unable to follow a traditional route.”
Flexible pathways will retain the rigour of training of a traditional residency, with the same examination requirements. They should not be seen as an easy route to specialisation and will require sustained commitment from individuals to complete all of the training requirements. Colleges will publish details as their programmes are developed and how individuals can accumulate credits. The theoretical components will require teaching to be accredited to diplomate level through accrediting bodies such as VetCEE, a pan European accreditor of CPD to ensure they meet the necessary standards of education.
This article was first published in February 2023.
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References:
1RCVS Specialist Status (n.d.) https://www.rcvs.org.uk/lifelong-learning/professional-accreditation/specialists-status/
2EBVS Specialist Education (n.d.) https://ebvs.eu/about/specialist-education
3 AVS/BVA Student Market Research Results 2020 https://www.bva.co.uk/media/3359/avsbva-research.pdf
4 Rising costs of childcare: which families are struggling most? (23 Aug 2022 https://www.economicsobservatory.com/rising-costs-of-childcare-which-families-are-struggling-most
5 RVCS Workforce Summit 2021 https://www.rcvs.org.uk/news-and-views/events/workforce-summit-2021/
6 Policies & Procedures of the European Board of Veterinary Specialisation Version 4 (Approved at and includes votes of the Nov 2021 GA) https://ebvs.eu/publications/public/policies-procedure-version-4-updated-2022