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“It's so much more satisfying knowing why you are doing something, rather than doing it because the books tell you”

23 April 2021, at 9:00am

Voltage gated sodium channels... pharmacokinetics of drug delivery... the difference between incidence and prevalence. Do we need to know all this stuff to be vets? So asked Tessa one of my first-year vets in a Zoom supervision yesterday – not her real name of course, we have to be assiduous in confidentiality these days, don't we?

Well, she certainly has a point doesn’t she. I mean you don't need to know the intricacies of the molecular mechanism of beta lactam inhibition of Gram-positive bacterial cell wall synthesis to give a dog a dose of a potentiated amoxycillin do you? Or perhaps we could put it a bit more bluntly and say that you don't need to know how an internal combustion engine works to drive a car! Maybe I should be a bit more climate change aware – let's use a more up to date example – thank goodness we don’t need to grasp how a solar cell works before having a set of them put on your roof to benefit both your bank balance and the earth and its warming climate as well. But if you are a mechanic in a garage, then knowing the inner workings of the engine is pretty much essential it would seem. And if you're a research physicist aiming to optimise the efficiency of solar cells – and boy we need that sort of expertise these days – then a profound understanding of photovoltaics is indispensable.

And that's what we are training these vet students for isn't it? To treat the animals that they are going to see with a deeper knowledge of the drugs they are using and the ways they act than just a rote learning of “drug X is used to treat disease Y”. But I know what you're going to say – for most of the cases you see that standard “X to treat Y” is all, truth be told, all you really do need.

I'm writing this on a Saturday morning in a veterinary practice where I'm waiting to see an emergency case of a cat with an ocular trauma. Just looking through the cases seen by the other vets here there's a vomiting dog, a cat with an abscess after an altercation with another cat, three boosters, a dog with bloody diarrhoea and an off-colour guinea pig to deal with. Do any of those need understanding of the basic sciences of gastrointestinal motility, bactericidal effects of neutrophils or the influence of adjuvants on vaccine efficacy? Maybe not. Perhaps my fresher student's question was entirely reasonable.

Or maybe understanding the microbiome of the guinea pig intestine is important in knowing not to give oral penicillin to that animal. Though having said that I’ve never understood why oral enrofloxacin seems fine though it must kill all those gut bacteria quite as much as does penicillin. So perhaps we don’t have to know exactly why one antibiotic works and another is dangerous to be safe in our antimicrobial dosing in such a species?

And yet, there's something deep within me saying that quite apart from anything else, it's so much more satisfying knowing why you are doing something, rather than doing it because the books tell you. But quite whether that warm feeling of understanding something is sufficiently worthwhile to warrant the hours of study required to pass those first-year multiple choice exams quizzing you about those sodium channels might be another thing entirely!

It really turns on whether we are training students to perform or educating them to think. I really hope that it’s the latter. If we just train them to do what they are told we really won’t progress much will we?

And with that in mind, let me tell you about another student, Adam (again a pseudonym!) now qualified and working in a wonderful mixed practice. He was quite one of the best students I think I have ever had – first class marks all the way through and a lovely individual as well. When I talked to one of the other teaching staff about how much more intelligent Adam already is than I will ever be, this rather supercilious lecturer replied that really, we lecturers should always be well ahead of our students. But that’s ridiculous – imagine what it must have been like to be Steve Hawking’s supervisor!

Thank goodness that some students outstrip us in intelligence – that way progress lies. Adam’s research project in his third year, that he carried on in his final year, was quite cutting-edge research that got him a paper in a reputable journal at the same time he was graduating. Amazing. And chatting to him on the phone a few days ago he tells me of the cases and clients he's been dealing with, but also that come the autumn he'll be off to start a PhD on vaccines for novel COVID variants. Learning that basic science detail in the early years of his veterinary degree enthused him to take his academic expertise further and further – hopefully to all our advantage!

Note what I said though about what a great person Adam was, able to chat with anyone from his peers and seniors to the cleaner sweeping through the corridor. And that's something that is to some degree innate I guess, but also that is imbibed though the years at vet school interacting with other students and staff and with clients as well. These days we examine students using OSCEs – objective structured clinical examinations (though I must admit I had to Google it to see what the acronym stands for!) – and I am involved with the communication evaluation. The student is asked to interact with an actor dealing with giving a diagnosis or dealing with a complaint. And while sitting through hours of these assessments is sometimes a bit taxing, it is wonderful to see students I've taught – some I've interviewed before they came to vet school five years previously – and realise how they have advanced to be just about ready to be let free into the real world. There are lots of stresses and strains in being involved in the academic world but seeing those first-year students blossom into brilliant vets makes up for it all!