Integrating social accountability in veterinary medical education at the Ontario Veterinary College

From its inception over 160 y ago, The Ontario Veterinary College (OVC) has demonstrated a strong sense of service to its community. Consider OVC’s motto, Opus Veterinum Civibus: The Craft of the Veterinarian is for the Good of the Nation. This simple but powerful call to duty has guided OVC on its journey, supporting the evolving relationship between humans and animals, advancing veterinary medicine, and tackling our most pressing health and food security issues.

Today, we acknowledge the many individual and societal benefits accrued from the human-animal relationship; the health and well-being of humans and animals are inextricably linked (1). However, we find ourselves in an environment characterized by glaring social inequity — many Canadians struggle to access basic healthcare for themselves and the animals under their care (2). Increasingly, voices question the mission of the modern veterinary college and, indeed, the veterinary profession (3). Are we serving the nation as we should, or are we serving only that part of the nation favored with wealth and privilege?

Several questions arise from this line of reflection:

• As leading veterinary colleges, can we contribute to a more just society; and if so, how do we define our role?

• What actions should we take, knowing that veterinary care is out of reach for many animal populations due to economic, sociocultural, and geographic barriers, within and outside of our country?

• Can veterinary colleges better serve all Canadians and global citizens and the animals under their care (including domestic, feral, and free-living wildlife populations)?

• Should not the membership of our profession better reflect the cultural and intellectual diversity of the communities that require our services? Is our profession accessible and welcoming to all people and perspectives?

• What are the sources of moral injury (4) that drive so many frontline veterinary personnel to doubt their choice of profession? Could it be, in part, our daily struggle to address our perceived obligations to society?

As gatekeepers of our profession, it is time for veterinary schools to reflect deeply on their place in society. For most of history, veterinary schools have held as their mission to advance veterinary medical care and knowledge to the obvious benefit of animals, humans, and (more recently) the planet. However, in doing so, we risk losing focus on our founding obligation to address broader fundamental needs — the basic health and welfare needs of all animal populations.

At OVC, we are revisiting our mission by looking through the lens of “social accountability,” a concept borrowed from human medicine (5) and pioneered by Canadian medical schools (6).

Veterinary schools that commit to social accountability do the following:

• Fearlessly examine moral issues, including the concept of health equity for animals and humans, thus responding to the unique healthcare needs of underserved, vulnerable, and systemically marginalized populations.

• Challenge the status quo. Educate and discover, informed by science, but integrating existing and new knowledge of the social determinants of human and animal health.

• Partner with communities, support programs, recruit students, and adapt curricula to prepare graduates to respond to the spectrum of primary veterinary care needs of all the communities they serve.

• Take learning off campus, out of shelters, and into the communities where the need is great; exemplify a collaborative, team-based, culturally safe, relationship-centered approach to care delivery (7) under a range of conditions, focusing on health versus disease.

Veterinary schools that commit to social accountability acknowledge the veterinary team’s crucial role in the broader veterinary and human healthcare ecosystem. They help broaden the discussion among students, veterinarians, regulators, and the public on the evolving definition of “standard of care” (8), breaking down legacy models of healthcare delivery. These schools demonstrate how to partner on an equal footing with communities, enlisting the experience and expertise of relevant health, welfare, and social service entities, forming interdisciplinary teams to define needs and deliver services. Students participating in these teams engage in sustainable, equitable, and culture- and context-appropriate models of veterinary healthcare delivery using a One Health approach (9).

In the past, such curricular and experiential opportunities have often been relegated to elective or extracurricular volunteer experiences — nice to have, but not required. But increasingly, the profession, and by extension, veterinary programs, are accepting their obligation to formally address issues of health equity in primary care, thereby doing their part to ensure animals everywhere receive the care they are due (10).

In effect, we are experiencing a social movement to reframe the goals of our profession.

The daily ethical challenges encountered by healthcare teams as they struggle to provide the care animals need, when they need it, where they need it, are an important source of moral injury contributing to endemic disenchantment with the profession (11). We are belatedly accepting that socially accountable care is what veterinarians must do — it is central to our purpose — and its associated specific competencies deserve a place within core veterinary education.

The OVC has set in motion several intersecting initiatives to support this vison of social accountability in veterinary education. The goal is to model sustainable and equitable healthcare delivery with a preventive care focus.

We ensure our Doctor of Veterinary Medicine (DVM) students leave OVC with an understanding of their place in the broader healthcare ecosystem, with the experience and skills (both technical and cultural) to confidently support the provision of full-spectrum care (12) in the communities where they choose to work. Through these and other initiatives, OVC is consulting widely with the goal of integrating the principles of social accountability into its curricular and research programming. These commitments are anchored in OVC’s Healthy Futures Strategic Plan (13).

COMMUNITY HEALTHCARE PARTNERSHIP

The Kim and Stu Lang Community Healthcare Partnership Program (CHPP) was founded in late 2019 by the largest philanthropic gift in OVC’s history. Envisaged by Dr. Shane Bateman, its goals are to identify, understand, and help remove barriers that impede access to healthcare for animals (14). The core CHPP team now includes Dr. Lynn Henderson (Veterinary Director), Dr. Lauren Van Patter (CHPP Professor), and Meghan Longley (Clinical Services Manager). This program envisions a future where vulnerable humans and animals in Canada enjoy better health, stronger social supports, and integration into their communities.

Under the leadership of Dr. Joanne Hewson, curricular realignment and enhancement associated with CHPP provides learning opportunities for OVC students, allowing them to graduate with the technical and cultural competencies required to support and lead programs that expand access to animal healthcare for underserved populations. This program builds on a strong integrated clinical skills and primary care curriculum. It leverages educational partnerships with communities and health and welfare organizations throughout Ontario, and with Indigenous communities. Working alongside these external partners, as equals, students become familiar with approaches and business models that support a sustainable spectrum of care for underserved populations.

ACCESS-TO-CARE BUSINESS MODELS

Even highly marginalized communities contribute resources to the care of their animals. Innovators in access to care have implemented a range of sustainable business models to support their services. New research by Dr. Shane Bateman, funded by the Stanton Foundation, will describe the various business models currently in use, with a focus on models that can be successfully applied in the primary care business setting.

In the absence of publicly funded systems, other supports are often needed. The call for greater health equity resonates with many individuals and organizations, and they are often willing to support such programs. Philanthropy is one of several important sources of funding to improve access to care. At OVC, Remy’s Fund is a fund established by Kim and Stu Lang and sustained by revenues from many donors. Remy’s Fund supports the provision of veterinary primary care for animals referred through CHPP. As we deconstruct the legacy model based on a single standard of care and replace it with the principles of spectrum of care, even modest funding sources can be highly impactful in improving the lives of animals that traditionally have had no access to care.

VETERINARY WORKFORCE: IMPLICATIONS FOR ACCESS TO CARE

Canada is experiencing an unprecedented veterinary workforce shortage (15). The increased demand for services (at every point in the spectrum of care) has put unsustainable pressure on veterinary healthcare teams, leading to further loss of capacity. Until recently, underserved regions of Canada have typically been sparsely populated rural areas requiring the services of more food-animal or mixed-animal veterinarians. This is no longer the case. Now, rural, urban, food-animal, equine, companion-animal, primary, emergency, and specialist practices are all experiencing unsustainable understaffing of doctors and technicians. This crisis is especially acute in smaller urban, northern, and more remote communities, and in emergency and urgent care. This has led to a reduction in access to veterinary healthcare, including routine and emergency services for companion animals. As one might expect, marginalized populations are most vulnerable; many people in small communities do not have the capacity to obtain services from outside their region (16).

The OVC is engaged in several provincial and national initiatives to help solve this access-to-care crisis; these include growing our capacity to train veterinarians and veterinary technicians, improving pathways for qualification of foreign-trained veterinarians, supporting programs that encourage veterinarians to work in underserved regions of the province (most especially rural, remote, and Northern communities) (17), expanding the scope of practice for technicians, examining ways to improve the efficiency and sustainability of veterinary healthcare delivery, and enhancing the integration of digital technology into practice.

Dr. Jason Coe and his team from OVC have initiated a research program in association with the American Association of Veterinary Medical Colleges (AAVMC) that will provide competencies for DVM and RVT trainees to define and support high-functioning teams, including the expansion and better integration of skill sets for staff, technicians, and veterinarians across the spectrum of care.

Private-sector partners share OVC’s interest in the future of the profession and have provided support for faculty to conduct research that will guide the profession toward more sustainable and accessible models of care; this includes the IDEXX Chair in Emerging Technologies and Preventive Care (Dr. Theresa Bernardo), the VCA Canada Chair in Relationship-Centred Veterinary Medicine (Dr. Jason Coe), and the Kim & Stu Lang Professor in Community Medicine (Dr. Lauren Van Patter).

RECRUITMENT FOR DIVERSITY

We acknowledge the many systemic barriers that face members of underrepresented groups pursuing an education in veterinary medicine; we have made a renewed commitment to build working and learning environments that reflect inclusion and equity as guiding principles. Spurred by a call for greater diversity in our profession and acknowledging our college’s privileged role as a gatekeeper for the profession, OVC has embarked on a plan to enhance equity, diversity, and inclusion in our college and, by extension, the profession.

Principles of social accountability will increasingly be applied to recruitment and admissions processes so our graduates will better reflect the evolving cultural diversity of the communities we serve. Our recruitment and admissions policies are directly relevant to our aspirations for health equity: access to veterinary healthcare for diverse and underserved populations is enhanced if offered in proximity to those communities by persons who are linked to those communities (18). Expanded partnerships with vulnerable communities in Ontario, through CHPP and via the new Collaborative DVM Program with Lakehead University, will provide opportunities to build trust and understanding, making it easier to encourage and support members of those communities who lack sufficient opportunity and social capital to consider careers in veterinary healthcare.

GLOBAL AND PLANETARY HEALTH

Most recent DVM graduates in Canada engage in primary care of domestic species. Efforts to integrate the principles of social accountability rightly focus on the typical clinical setting. However, the concept of health equity pertains to all species, geographies, and sociocultural contexts. Veterinarians have a unique role to play on the global stage. We must support and advocate for veterinarians’ roles in teams who work to solve our current and future planetary health emergencies (19). Indeed, ecosystem and global health are central academic and research priorities at OVC. This commitment is exemplified by the establishment of the One Health Institute, along with several new academic offerings: a new undergraduate degree in One Health that can serve as a prerequisite for entry to the DVM program, a DVM-Masters of Public Health (MPH) combined program, and a suite of One Health and international development collaborative graduate programs. Learnings within the DVM program are highly transferrable; the knowledge, skills, and attitudes associated with engendering a sense of social accountability in the clinical sphere will serve graduates equally well should they find themselves drawn to more globally focused One Health/One Welfare initiatives.

We are at an exciting point in the evolution of veterinary medical education, part of a movement to reorient education and research toward issues of social justice and global health. Veterinary schools such as OVC accept their pivotal role and are doing their part to build a more diverse, resilient, inclusive, and effective veterinary workforce that is equipped with a renewed sense of purpose.

The profession of the future will be more diverse and inclusive; it will embrace the opportunity to apply the principles of One Health/One Welfare. Veterinarians will possess the capacity to help address issues of health inequity in their communities, locally and globally, both animal and human, employing sustainable models of care. This will result in better health outcomes for all, honoring our commitment to serve the nation in its most inclusive sense.