You Found This Blog Too Late

Photo by Vicky Sim on Unsplash

What do you do if you have found this blog after you have submitted your application materials, or after you did an interview, or after you scheduled your clinical year?  You read some of the advice and realize, “Uh oh, I didn’t do that.”  Well, now what?  Fortunately, all is not lost.

First, realize that the information on this blog is just one person’s opinion.  I have a lot of experience, but different people look for different things.  If you read some piece of advice and think, “Dang, I didn’t do that, everyone will think I’m terrible!”  The truth is, they won’t.  There are many people in this world and they all prefer different characteristics in mentees, students, future colleagues, etc.  Don’t beat yourself up because you didn’t do something you read on here.  It’s very likely the people you are interacting with value things other than what I value.

Second, it’s in the past, so it’s beyond your circle of control.  If you’ve already scheduled your senior year and you won’t have essential specialties before the VIRMP applications are due, there isn’t a lot to be done about it.  Your schedule is set.  So don’t stress about it.  It is what it is, make the best of it.

Finally, take whatever advice you CAN apply now and start to do so!  If you feel you didn’t do well on an interview , work on improving for the next time.  If you messed up your schedule, try to do the best you can with what you have.  There are very few things you can do in your veterinary progression which are fatal flaws.  Almost anything can be dealt with.  Find the advice which can work for you, adapt it for yourself, and apply it for next time.

Veterinary Locums Work

Image of a plane flying overhead.
Image by Leszek Stępień from Pixabay

The White Coat Investor blog recently published an article about locum tenens work in human medicine, and it made me realize there are some notable differences from veterinary locum work.  Many people may not know about locum opportunities, and it’s a benefit of academia I’ve mentioned before.  For those who are interested in academia, or even those in private practice who want to spend time teaching, this is an introduction to veterinary locum tenens.

Locum tenens literally means “place holding” and is a short-term work commitment.  Many locums are short- 2-4 weeks- while others are long enough to cover maternity leave- 6-9 months.  Let’s break down how to find locum jobs, what the process is like, and advantages and disadvantages.

Finding Locum Jobs

Most locum jobs will be found in academia, although private practices will also sometimes employ locums, particularly when they’re also searching for a full-time and hard-to-get specialist.  Finding locum positions depends on the discipline.  In anesthesia, an email gets sent out to ACVA-L, to which most anesthesiologists are subscribed.  Other disciplines without a universal listserv may use more specialized listservs (e.g. Society of Veterinary Soft Tissue Surgery), post on Linkedin, post on social media, or put the listing up on the specialty’s job board website.

Personal connections are also a valuable source for locums.  About half of the time I do a locum, it’s because I get an email from someone I know who needs a locum for a specific time frame.  Many institutions which have an open position posted for a new faculty member will be amenable to locums- you just have to email the contact listed on the full-time position posting or reach out to the department head and ask if they are interested in you providing locum coverage.  Some universities may list locum positions on their employment site, although this is uncommon.  As far as I know, there are no third-party companies facilitating locums like there are in human medicine.

Locums Process

At least in anesthesia, once an email goes out to ACVA-L, you only have maybe a day or two to reply before the locum position has been booked up, in my experience.  So you have to be ready to jump on an opportunity that comes up.  Usually, institutions are looking for a locum for specific dates.  If it lines up with your availability (you’re off clinics and don’t have major teaching/research responsibilities), you email the contact person and indicate your willingness to help.  Sometimes, the details of the locum will be provided up front (e.g. pay, what expenses the institution pays vs. what you pay), but many times you have to ask in the email.  Most locums pay between $5-10k/week, and some of them cover your expenses (travel, lodging) while others do not.

Here’s a really important note: some employers will pay you as a W-2 and some will pay you as a 1099.  If you have to pay for your own expenses, and they pay you as a W-2, you CANNOT write off those expenses on your taxes!  I have no idea how institutions justify paying you as a W-2 employee (since you’re obviously a casual contractor, which is what 1099 is designed for), but I paid about $1k more in taxes one year than I had to because of that classification.  Ask before you agree: does the institution pay for your expenses and, if not, are you paid as W-2 or 1099?  At this point in my career, I’ve stopped taking any job which pays me as a W-2 and doesn’t take care of expenses.

Once you have agreed to do the job, some places will send you a contract.  They will walk you through the licensing process. Getting a license in another state can be a significant pain.  You have to get a letter from EVERY state you’ve EVER had a license in to indicate you didn’t do anything bad in that jurisdiction.  The AAVSB can facilitate this- for a fee, of course.  I’ve found it easiest to just pay the AAVSB fee rather than go through the hassle, but if you only have one or two state licenses, it may not be too bad for you to DIY.

If the institution is going to take care of your expenses, they may book lodging for you or you may book it and get reimbursed.  Sometimes, they have a lodging budget so you could book a nicer place and just pay for the difference yourself.  Usually, you will book your own flights.  If you have to pay for a license, you’ll usually get reimbursed.  If there are visa issues (e.g. locum in Canada), the institution’s lawyers will generate the paperwork and get everything set for you.  You may have to pay the fees at the time of the visa (obtained when clearing customs), but they will reimburse you.

If the institution doesn’t take care of your expenses, you have to pay for it all out of pocket and, hopefully, they give you a higher pay to compensate for everything.  I usually budget $1500/week for expenses, although this is highly location- and individual-dependent.  If you don’t mind AirBnBing a room in someone’s house, your expenses will be much lower compared to staying in a hotel.

When you show up on Monday before 8am, you should have a contact person to call who will escort you where you need to go.  Most locums start at 8am on Monday with orientation and paperwork and pharmacy access, then you start clinic responsibilities some time mid-morning.   If you’ve locumed there before, they may skip those steps and you can go right to the clinic area and get started.

Some locums require you to do primary emergency duty, some require you to be back-up to their residents/staff, and some have no emergency requirements.  Most will require 7-days-a-week coverage of clinic responsibilities, just like your “usual” job.  That is, if you have patients to discharge on Sat or Sun, you have to take care of them.  Some will require you to be on call until 8am the Monday after your week, making it impossible to do a locum week and then do a clinic week back home.  You may be able to finagle things- such as starting the locum on Sat or Sun before your official start date so you can leave on the Sun at the end of the time- if you have worked there before and know the people.

Some locums will give you the specialized communication devices the hospital uses (e.g. Vocera) or a dedicated cell phone for use during your time there.  They’ll provide you with access cards and maybe a name tag.  Some will provide scrubs, but I always bring my own anyway because they usually don’t have many sets in my size.  Otherwise, you should bring your own lab coat, stethoscope, and similar paraphernalia you use in your regular day-to-day clinic work.  Don’t forget to return everything they gave you before you leave on the last day!

You will have set up direct deposit with the institution at some point.  When the pay period after your locum rolls around, presto, the money gets deposited into your account.  If it was a W-2 locum, they will have taken out taxes.  If it was a 1099 locum, you’ll have to pay taxes when you file next year, assuming you have a regular full-time W-2 job.  If all you do is 1099 jobs, you’ll need to file estimated quarterly taxes. 

Advantages

  1. No committee work, politics, classroom teaching, equipment issues, or anything else not related to clinical teaching and patient care.  If all you want to do is be on clinic duty, teach house officers and students, and then leave the job without worrying about everything else normally associated with academia, locum jobs are perfect.
  2. Good pay rate.  If you do 50 weeks of locum work a year, you could earn in the $250k-$500k range.  On a practical level, that’s unlikely given the sporadic nature of locum offerings and coordinating the schedule.  
  3. Working vacation.  Whenever I do a locum, my wife comes along for at least part of the time, and we have a nice little trip.  We obviously can’t go on a hike 4 hours away from the hospital, or take a river cruise, but we can have a grand fun time nonetheless.  We love doing locums in Saskatoon– it’s now one of our favorite places to visit in the summer!
  4. Different types of practice.  I learned to place coccygeal arterial catheters when I spent time at CSU.  I learned how to do TAP blocks at UMN.  Remifentanil is cheaper than fentanyl in Canada, so I use it for large dogs when I’m there and get more experience with it. It’s fun to see how everyone practices differently and try out some drugs and approaches you don’t regularly have access to.
  5. Appreciative admin and coworkers.  Usually, you are solving a problem when you do a locum job that everyone appreciates.  Without you, the full-time people would have had to work more, or a service would have to close, or students wouldn’t get to be on the rotation.  My experience is that people are happy to see you.

Disadvantages

  1. No benefits.  You don’t get a laptop or an office or healthcare or any of a myriad of other benefits associated with full time academic employment.  If you have a regular job, this isn’t a problem.  But, if you’re only doing locums, you have to consider those other expenses in your budget.
  2. Away from home.  If you have pets at home, they will need to be cared for.  If you have children and you can’t bring them with you, or any other responsibility that requires you to be home, it’s hard to do locums.  If everyone comes with you, it can be a grand adventure.
  3. Questionable continuity of care.  You may pick up patients you don’t know about and you may work on patients which you then have to transfer.  I think this is pretty similar to most academic jobs where people rotate being on and off clinics but, at home, you can at least chat with the other specialists since they’re around.
  4. Minimal acclaim.  You won’t earn any teaching awards, or “clinician of the year” awards, or getting approval from your department chair, or similar external validation.  You do the job, you get paid.  That’s it.

One of the many benefits of an academic position is that we get consulting time when we can pursue locum opportunities without having to take annual leave.  At one institution, I had 20 days a year I could do consulting.  At another, I had one week a semester.  This is time you can spend generating extra revenue on top of your already perfectly sufficient academic salary.  You can supercharge your savings, or progress to financial independence, doing locum work.  It’s also a nice potential bridge to early retirement.  I could do 3-4 months of locum work a year to pay for all our expenses, and delay having to dip into my retirement savings.  Even doing 1-2 months would be a significant benefit in terms of income in a partial retirement.  If you haven’t tried it, I definitely recommend it!

Be OK Saying “no”

A couple of weekends ago, I presented a CE talk.  It was a one-hour talk which I’ve done before.  I enjoyed giving the talk- the attendees laughed in all the right places and I felt like I dispensed some good advice and information.  The talk was preceded by a four hour drive, and followed by a four hour drive.  All told it was ~9.5 hours out of my day- it took up my entire Sunday.  I didn’t get paid for it.  As I was driving down, I thought, “What in the world am I doing?”  I wasn’t OK saying “no”.

A common problem in veterinary medicine is that generally we are giving people.  We want to help.  We want to contribute.  We are all leaders, and the best leaders lead from the front- taking on tasks, solving problems, and making things better.  As a result, a lot of veterinarians end up taking on a lot of responsibilities.  Early career faculty members are especially bombarded with doing things, but even those who get to Associate or full Professor rank often have significant miscellaneous responsibilities.

We chair committees.  We’re on patient review boards.  We do CE for our staff.  We write communication materials and blogs for our clients.  We have hospital director or section chief duties.  We lead interviews.  There’s a whole bunch of Stuff that happens which we take responsibility for, even though it’s largely beyond the scope of responsibilities for our job.  I think it’s because we want to help and we have a hard time saying “no”.

I think saying “no” is hard because we don’t want to let others down.  When someone comes and asks us to help do something, maybe we feel flattered.  “Hey, they asked ME to help!  That means they must think well of me!  I should return that positive regard with a positive answer!”  Maybe we feel we need to have a reason to say “no”, that the default answer should be “yes” unless there’s a “good” reason.  Sometimes we may even feel busy and burdened already and yet say “yes” regardless.

Nearly every email that comes into my inbox I read and think, “Can/should I do that?”  Judge the undergrad poster presentations.  Take on an intern mentee.  Fill out a survey.  Give a CE talk.  Take a locum gig for a few weeks.  Provide feedback to the COE on accreditation standards.  Serve on this regional veterinary symposium subcommittee.  Do an external evaluation for someone’s promotion & tenure.  The asks are nearly endless.

And, until the past year or so, almost all of these I said “yes” to.  They sounded interesting, or I wanted to help, or I felt bad for the organizer because I thought they wouldn’t get many volunteers.  This had several significant effects on my career and life.  One, I had a lot of neat opportunities and interactions and learned a lot of different things.  Two, I kept very busy, with very little downtime.  Three, I sometimes did things that built up my CV and supported my career.  Four, I got a reputation for being someone who is willing to help and take on tasks.

Note that not all of these consequences are bad.  In fact, a lot of them are good.  Perhaps the most important to consider is #2, staying busy.  As a general rule, I’d prefer being more active than more idle.  In contrast, my best friend is unhappy if he has to work more than 20 hours in a week.  So this is something that will differ by person and is worth reflecting on.  I’ve also discovered that it can change.  Early in my career, if I wasn’t in my office most of Saturday and part of Sunday, I don’t know what I would have done with my time.  Nowadays, I like having time for walks or reading or other brain-downtime activities.  So, I have learned to start to say “no” more often.

Now I am being far more selective about the things to which I say “yes”.  I don’t have hard-and-fast rules (those would probably help this process a lot), but now when I look at an email I generally think, “This isn’t my responsibility.  Someone else can do this.”  I don’t think the world will collapse without my participation, but it’s hard telling myself that. Additionally, at this point in my career, I don’t NEED to bolster my education, CV, or reputation. In the example from the beginning of this post, I could have referred the CE opportunity to a junior faculty member who would benefit much more from giving the talk. As we advance in our career, we can say “no” in order to let the newer generation of vets say “yes”.  

It’s OK to say “yes”.  It’s ALSO OK to say “no”.  If you ALWAYS say “no”, I think you may miss out on some cool opportunities.  If you ALWAYS say “yes”, I think you may get burned out.  So, it’s a balance.  But most veterinarians have a harder time saying “no”.  So I encourage you to reflect on that and give yourself permission to say “no”.

Four Year Anniversary!

Well, the blog is going well even though, honestly, I haven’t been doing as much as I would like to do with it.  It looks like we’re reaching more people, which is fantastic.  I’ve had some positive emails from people who have gotten faculty positions and house officer positions who found the blog valuable.

I’m still mostly reaching pre-vet students through the Facebook APVMA group.  There’s no centralized house officer group to reach out to, unfortunately.

I have lots of ideas and think there’s still more advice to give.  I would love to write several “Complete Guide” posts which summarize everything for people applying to vet school, internships, residencies, and faculty positions.  I only got 14 posts in this year, which is definitely not enough to keep traffic continuing to flow.  I thought I was posting less because I wasn’t flying as much, and I originally wrote the blog when flying.  But I’ve done several long trips lately and still nothing.  

I’m not sure why.  Maybe it feels a bit more like work than fun, and I feel all my best advice is already out there.  Here’s to hoping this next year brings some fresh inspiration and enthusiasm to this endeavor!

Thank you all for reading and if any of you would like to contribute a Guest Post, please let me know!

Why Are We Here?

I was watching an interview with my favorite role-playing game GM, Brennan Lee Mulligan, and something he said made me literally sit up in my chair.  I thought, “This.  This is why I teach students.”  And if students understood it, life would be so much easier for themselves and for me.  First, though, a quick story.

I was teaching ECGs in the cardiovascular system course this semester, and got to 2nd degree AV block.  One of the students asked, “I’ve heard about different types of 2nd degree AV block.  Can you talk about those?”  My answer: “Good question!  However, that is clinically insignificant.  I recommend you focus on being able to identify the arrhythmia and determine if it’s a problem.”  My answer was informed by years of working with general practice veterinarians who often worried when their patient developed a 2nd degree AV block, even though everything else was fine.  Here’s the deal: if you can’t even determine if a 2nd degree AV block isn’t a problem, you don’t need to waste space in your brain worrying about Type I vs Type II.

What was Mulligan’s advice?  Here it is:

“I’m not here to raise your top, I’m here to lift up the bottom. …  Your worst show is pretty good.”

I spend a lot of time thinking about competence, medical error, and patient safety culture, so this exchange spoke deeply to me.  I’m happy when a student does a procedure quickly and expertly.  I’m pleased when the residents make a tough diagnosis.  But I am MUCH more interested in making sure that BAD things don’t happen regularly.  Bringing up the bottom.  When you’re tired, frustrated, irritated, and distracted, I still want you to be able to be a reasonably competent doctor.

This is just an extension of Aim for Zero.  It’s fine to want to be an amazing clinician, but I am MUCH more impressed by students who are consistently competent.  Their lows are still pretty good.  During their worst case, they at least know what to do and TRY to do it.  Medical error is the third leading cause of death in the US.  Anything we can do to raise up the bottom improves patient care and patient outcome.  Focus on bringing up the bottom, not trying to raise the top.

Writing a Cover Letter for a Letter of Recommendation

Once you’ve identified mentors to write you a letter of recommendation (LOR), the next step is to reach out to them to ask that they write said letter.  In that process, you might want to write a cover letter which provides them with some information to help them write the LOR.

Why write a cover letter?  The cover letter provides some information to the individual writing your LOR.  In some instances- such as if you’re having a specialty faculty member write an LOR for an internship or residency- this is unnecessary.  The writer knows the deal, knows the positions, and hopefully knows you.  In other instances- such as if the writer isn’t a veterinarian or you’re applying for a unique position- it can be very helpful.  The writer needs direction about what, exactly, to say.  When in doubt, ask your mentors if they think a cover letter COULD be useful.

What to include in a cover letter?  It doesn’t need to be long.  In fact, the shorter, the better; one page should be your maximum.  I would start with thanking the letter writer for being willing to write you a LOR.  Next, introduce the position to which you are applying and why you are applying.  Give a description of the position or a link to the position description.  Next, indicate what you believe would be most valuable for the letter writer to include.  For example, “If you can speak to my reliability and independent work, that would be particularly valuable.”  Finally, conclude with more appreciation and any deadlines which are relevant.

I think a cover letter could be valuable for any applicant for any position before, and including, vet school.  For internships, residencies, and faculty positions, you shouldn’t need one.  Keep it simple, to the point, informative, and appreciative and you help your letter writers provide exactly what you need for your applications.

Examples of Good Letters of Intent

I’ve spent a lot of time writing about personal statements.  There are general rules, which I’ve written about here and here.  Also, there are important and simple grammar rules to pay attention to, like these and these.  I’ve provided some examples of poor letters of intent, so now it’s time to look at some good examples.

These were all applicants for our internship program, and I obtained their permission and have removed identifying information.  Go and read each one, and then I will provide my analysis of why I like it.  As always, evaluators are highly variable, so don’t take my perspective as the gospel truth- just one perspective.

First Example

The first paragraph is simple and solid.  It expresses appreciation- of which I am a huge fan- and makes it clear who they are and for what they are applying.  I get the impression that this person is interested in oncology, but isn’t totally fanatic about it, the latter of which can be off-putting.

The second paragraph has some narrative elements in it, and I love that they acknowledge the bad part of their interest (oncology is sad) while explaining why they don’t think that’s the most important aspect of it.  I love that they talk about supporting clients, connecting with them, and helping them.

The third paragraph is a delight to me.  They show that they know what specialty medicine is and also what they can bring.  They don’t do so in a boastful way.  I also like that they’re specific.  They don’t say “I’m a good leader”; they say “oral communication”.  They share some of their experiences and what they’ve gotten from those.

The fourth paragraph talks about celebrating good things.  It’s a very positive message.  They share that they have a variety of perspectives from living different places, which is tremendously valuable to be a self-actualized human being.  They acknowledge they have learned a lot and have more to learn and grow.

Overall, I find the message is very positive, earnest, and insightful.  I feel like I know this candidate a little bit.

Second Example

The first paragraph clearly shows what they want in a program and what they feel their positive characteristics are.  They mention a specific interest, but don’t obsess over it.

The second paragraph is all about communication.  It doesn’t use “communication” as a buzzword.  They clearly articulate what their experience is and how that affected them.

The part of the third paragraph I like the most is “safe and inclusive learning environment”.  But, again, it’s supported by their experiences.  I believe that this writer understands what that means, rather than just, “yeah, yeah, this is something we’re supposed to say.”  I believe their experiences WILL help them make a positive learning experience for those around them.

The fourth paragraph is similar- they give experiences they have had, how they learned from those, and how they grew.  Great stuff.

The final paragraph has me convinced that they have a growth mindset and are humble.  They want to learn more and are willing to listen.  They acknowledge the difficulties an internship entails, so they have some idea of what they’re getting into.

Third Example

Once again, the opening paragraph is descriptive, clear, shows their professional interests, but isn’t overly aggressive.

The rest of the letter uses examples from their experience to highlight their own skills and professional ambitions.

The final paragraph emphasizes their interest in learning, which makes me think they have a growth mindset.  Appreciation expressed when closing the letter is also nice.

Conclusions

1) Be genuine, authentic, and earnest.

2) Use examples from your experience to highlight your skills and how you have grown.

3) Demonstrate that you have a growth mindset and are enthusiastic.

4) Be positive.

5) Don’t go overboard or try to be too much.  As always, aim for zero.

Two Types of Imposter Syndrome

Photo by Chris Yang on Unsplash

Imposter Syndrome is the feeling that you are in a certain position but don’t deserve to be.  Someone made a mistake somewhere- you’re not as good as people think you are.  You feel inadequate as a consequence of this belief.  Even though there’s external evidence of your success (e.g. getting a job, getting good annual reviews, getting good student evaluations, getting a publication), you believe that you are incompetent.  You also feel like you don’t belong where you are.

There are a variety of imposter syndrome quizzes online and, whenever I take them, I score fairly highly.  But when I think about it, I don’t FEEL bad.  I don’t feel like I shouldn’t be where I am.  I’m doing _exactly_ what I think I’m good at- being an academic!  I feel accomplished and happy in my professional position.  I contrast this with some of my academic friends, who have told me they don’t feel secure in their position and that they don’t “deserve” to be there.  What’s going on here?

In looking at imposter syndrome quizzes, there are a lot of questions that I believe relate to humility.  “I hesitate to brag about my accomplishments” and “I don’t like drawing attention to my successes.”  I think humility is a very important quality, particularly for people who are going to be effective in a team and be effective leaders.  I try to embrace these aspects of humility, so that’s how I perceive it, rather than an imposter syndrome characteristic. Note that humility is different from false modesty. False modesty, or pretending you’re not as competent as you are, is a form of dishonesty. It’s important to show confidence and competence as a DVM to your clients so they feel comfortable with your recommendations. 

There are other questions like “I believe the success I’ve had is a fluke” and “Even when I do well, I don’t think I really deserve it.”  I believe these questions are addressing the question of privilege.  EVERYONE who’s been successful has been a fluke!  Luck has a tremendous impact on success.  And I’m a tall white man raised in an upper middle class socioeconomic status household with two loving parents in the richest country in history.  I have every advantage imaginable- of COURSE I don’t “deserve” success.  It’s an accumulation of genetics, my upbringing, and how society treats me. I definitely worked hard (see below), but there are people out there who worked much harder than I did but may not have been able to achieve the same results due to being in a less advantageous situation.

Then there are questions I absolutely don’t identify with, like “ Success doesn’t come easy for me; I have to work at it” and “I worry about feeling overwhelming shame if my incompetence is ever revealed.”  Success HAS been easy for me.  I have realized in recent years that my ability to work long hours and enjoy doing so is yet another privilege because for some people working hard is HARD.  And I don’t feel incompetent, so I don’t worry about anything being discovered there.

I don’t know, maybe I do have imposter syndrome.  But I don’t FEEL like I do.  I feel like I am humble, appreciative of all the things in my life which have led to my success, and recognize the important part luck plays in our success.  That seems to meet a lot of the criteria for imposter syndrome, but I genuinely believe those questions miss the mark for me.  Maybe I’m in denial.

Grade Inflation Is Bad

I believe that grade inflation hurts everyone- admissions committees, faculty, and parents.  But, most importantly, it hurts students.  To understand why, we have to examine the purpose of grades and what grade inflation is.

Why Grades?

There are two types of assessments.  Formative assessments are designed to provide feedback to the student so they know what they need to learn/improve on.  Summative assessments are designed to measure the student’s performance against a certain benchmark to determine if they can do (or know) a certain thing.  A grade is primarily a summative assessment.  Although a student who earns a C on an assignment may intuit that there is something that was missing, it doesn’t provide them much specific feedback, so it doesn’t really help the student improve.  So the grade is illustrating if the student’s performance is adequate or not.

We need both summative assessments and grades in order to determine if students learn the material and, most importantly for your professional progression, to be able to compare student academic performance with other students.  It is assumed that a student with an A grade is more academically competent than a student with a B grade.  This does not mean the A grade student is smarter, worked harder, or knows the material better!  Any academic worth their salt knows that assessments are imperfect and really only measure one thing: how well the student could perform on one particular assessment.  However, there is some decent evidence that GPA correlates with successful completion of veterinary school, and performance on certain standardized exams also predicts future success.

So, we need grades to compare students, so we can select the ones most likely to be successful.  One of the worst things for any vet school is to have a student be dismissed because of poor academic performance.  Ideally, that student shouldn’t have been admitted in favor of another student who could successfully complete the program.  This required the admissions committee to know who is likely to be successful, and grades are an important (but certainly not the ONLY, and probably not THE MOST important) way to determine that.  What happens if every applicant has gotten all As and has a 4.0 GPA?

Grade Inflation

Students want to earn higher grades, because it is an external validation of their abilities (which every human likes) and because it makes them more competitive for future position applications.  So, if they don’t get the grade they believe they deserve, they grumble.  To their parents, to the faculty, to administration.  In the face of that grumbling, faculty members have two choices.  Stand firm, continue to assign the grades they believe the students earn, and continue to get student evaluations which are poor ONLY BECAUSE OF THE GRADES BEING GIVEN.  Or, give in to the grumbling and give students higher grades, often resulting in “easy As”.  

The students are happy- they get to have the grade they think they deserve.  Parents are happy- their beautiful snowflake IS a wonderful student!  Administrators are happy because students and parents aren’t grumbling to them.  The faculty member collects decent student evaluations, but perhaps there is some nagging feeling that they aren’t actually being an educator, just a rubber stamper. Problem solved.  Or is it?

Grade Inflation is a Problem

Believe it or not, humans like to be challenged.  According to self-determination theory, three things motivate humans: autonomy (the ability to do what we want; freedom), competence (getting better at skills; mastery), and relatedness (interaction with others; socialization).  Let’s look at the competence piece.

Why do people learn to play musical instruments?  There are surely a variety of reasons, but I doubt one of them is “because it’s easy.”  Why do people play competitive sports?  Nearly no human pursuit which requires a degree of skill is pursued because it’s easy.  Why would a student pursue an academic course that’s easy?  What sense of satisfaction would that student have?  If every course is an easy A, does the student feel accomplished for earning that 4.0 GPA?  Maybe some students do.  Maybe they want the easy path.  But every year I get student evaluations along the lines of, “This course was hard, but I learned a lot, and I appreciate it wasn’t just a walk in the park.”  Some students, at least, recognize the value of hard work and earning their grade.

There are some vet schools where the #1-10 ranked students in a class all have a 4.0 GPA.  How does that help internship programs which use GPA as a selection criteria?  Are they really ALL equally good at academics?  How come this happens year after year at the same vet school, but doesn’t happen at other schools?  This is an example of systemic grade inflation.  The faculty have caved over the course of years and decades to the whims of the students, and now the GPA has lost any utility in distinguishing student ability.

Grade inflation removes a genuine challenge for students, makes the point of grading obsolete, and undermines the whole academic system.

Objections

What about pass-fail courses?  Do students brush those off because they don’t get a grade?  Well, it depends.  Are the other courses they are taking that semester graded?  If yes, then they will ABSOLUTELY brush off the pass-fail course so they can focus on the graded courses.  What about if the whole institution is pass-fail?  Now you’re starting to move into the realm of competency-based veterinary education (CBVE), which is a terrific direction to go in.  In CBVE, the main question is CAN THE STUDENT DO THE THING?  It’s a yes-no variable, just like pass-fail.  This gets away from grades and towards the question of competency, which I think is a good idea.

What about courses which are TOO hard?  We all know courses where the average on the first exam is 50%.  I think this is up to the instructor to set clear expectations.  I typically tell students that a B grade is an average performance, a C grade is below average, an A grade is dramatically above average, and a D or F indicates they did not learn the material.  The problem is, most applicants to vet school are above average.  Compared with undergraduate students.  Once they get to vet school, the average resets.  Now an average vet student is expected to earn a B (according to my rubric).  But, guess what, those students aren’t accustomed to feeling average and are accustomed to getting As and so rail against getting a B or, god forbid, a C.  Is my class “too hard” or are their expectations of their performance not aligned with what I describe as my expectations?  If every student in my class earns an A, fantastic, I believe they have earned it.  That is statistically unlikely, but not impossible.  I don’t think grading on a curve is appropriate.  Set the expectation so the students know, then they perform to that expectation.

“I think the work I did was worth an A!”  I hear this all the time.  Often there are complaints that the exam questions were too hard, or weren’t related to the material, or there was too much to study, etc. etc.  Here’s the unfortunate truth.  As I mentioned earlier, grades do not evaluate how much work you do, how smart you are, or how well you learn the material.  They ONLY evaluate how well you do on the assessments.  Some students are “good test takers” so will perform better than students who are not good test takers.  There’s nothing to be done about it.  We can’t do an fMRI of everyone to see the neural connections being made when they are contemplating a problem.  Assessments measure what they measure, which is the student’s ability to answer the question the instructor created.  This is one reason we use OTHER metrics to evaluate applicants.  The GPA is imperfect.  It doesn’t perfectly predict a student’s future performance, it maybe only predicts ~20% of it.  The rest is not captured by grades. My wife has a theory that some students who routinely get As on exams have memorized the material but don’t necessarily retain it long-term, whereas students who make Cs may have really learned 70% of the material and will retain it for longer, because the portion they did learn they learned well. 

What To Do

To students: accept that your grade may not reflect your actual ability.  I did terribly in the preclinical courses in vet school.  I was on the cusp of the bottom 25% of my class rank.  But when I got to clinics, I could answer questions most of my classmates could not because I learned what was clinically relevant rather than the ridiculous minutiae which comprises most vet school exams.  I stayed in the clinic later than most of my classmates, volunteered to take their call shifts, and otherwise worked hard and got fantastic letters of recommendation for my internship.  I rinsed and repeated through my internship and residency.  You can be successful without amazing grades.  Focus on actually LEARNING the material rather than memorize and dump.  And you really can’t do anything about how the professor grades.  Focus on your circle of control and let it go.

To faculty members: stay strong and create clear expectations.  Maintain high standards- the students actually DO want to be pushed to learn.  Explain to them on day one that you are fighting grade inflation and expect them to have to WORK if they want an A in your class.  Make sure you are on their side and not opposing them.  Be prepared for the students to grumble.  Believe that, nonetheless, you are making the world a better place.

To parents: let your children be independent, self-actualized human beings and stop trying to live their lives for them.  Maintain interest and inquiry and encourage them and be supportive, but don’t go to bat for them.  They are adults, they need to learn how to handle life without you holding their hand. Some of the most confident adults I know learned early on that, as long as they did their best, they didn’t need to worry about their grades. They learned not to rely on external validation for their sense of self.

To administrators: realize that some faculty members probably need some coaching in setting and maintaining clear expectations (that is, some of them may WANT to fail a majority of the class and need guidance on that).  If a course is difficult, but the students perform well grades-wise nonetheless, be sympathetic to the students and validate their feelings without necessarily validating their beliefs that the course is unfair.  Be supportive of faculty who are trying to do the best thing for the students, and provide guidance if the faculty aren’t sure what the “best thing” is.  Particularly be supportive of efforts to combat grade inflation.  Maintain high standards, set clear expectations.

I can’t remember what inspired me to add this topic to my list of blog ideas, but I obviously feel passionately about it.  I do get frustrated by students who seem to focus only on the grade rather than learning the material.  In an ideal world, if they learned the material, their grade would reflect that.  I suppose I could do a 2-hour intensive oral exam with every student…  that would probably solve the problems with the assessment not accurately measuring their knowledge.  But I doubt most students would consent to that, and I don’t have the time to do that for 130 students. 

Grade inflation is a systemic problem, like racism. It can’t be solved with a single individual, or a single institution. This isn’t an ideal world, and never will be.  So we need to acknowledge the problems with grade inflation and work to prevent it.  Otherwise, one day, an A won’t mean anything at all.

Why We Declined Vet School Applicants Last Year

I participated in the interview and selection process for a vet school this year, and we had another amazing pool of applicants.  Nonetheless, the three faculty conducting the interviews generally agreed to place some applicants on the “do not offer” list.  This is not out of any malice- we just needed a way to reduce the pool to a manageable number, because there were so many amazing applicants.  

On a fundamental level, the admissions committee wants to make sure that students succeed and graduate.  The worst outcome for us is to have a student who fails or drops out of school.  The student has spent a ton of money by that point, the institution has invested tremendous resources, and another applicant who could have been successful was passed over.  So that is the admissions committee’s primary goal: find applicants who will get through vet school.  We have several secondary goals, like making sure the student body (and hence profession) is diverse in skills and backgrounds, but those goals can’t be met if the first goal isn’t met.

I went through and reviewed the themes of the applicants we chose not to extend an offer to, and am sharing those insights so you might know why you didn’t get an offer or so you can strengthen your own application.  I lumped them into five categories: experience, interview, academics, extra-curriculars, and references.

Experience

Everyone knows you need a certain number of experience hours to be competitive for vet school.  Most schools have a minimum number to be considered for an interview, and then an average number for those actually admitted.  Evaluators differ, but I like to see that an applicant knows what they’re getting into.  What if they get in and then hate it?  Working as a tech at a single practice for three years may or may not hit that goal.  I personally like to see a diversity of experience- spending time at several different practices, even just shadowing, would provide the applicant different perspectives from different veterinarians.  Also, I prefer to see current experience.  Having worked in a vet clinic eight years ago isn’t as meaningful- the profession has changed since then, and will change over the four years they are in school.  Recent, diverse experience (preferably including a variety of species) is what I look for.

Interview

Depending on the institution, the interview may be non-existent, a minor piece, or a major piece of your application.  The things we noticed during interviews which detracted from the application included speaking too much, not having thoughtful answers, not being enthusiastic, acting immature, lacking perspective, and being disheveled.  You’ll notice all of these are highly subjective.  I often found myself thinking, “This person ‘presents’ to me as immature, but their letters all indicate they are very mature.  What do I do with this information?”  All I can say on this point is to get some practice interviewing, research how to do a good interview, and do your best.  Don’t worry about it TOO much, though. Different evaluators look for different things, and you can’t be all things to all people.

Academics

Vet school is academically challenging, so we are looking for _evidence_ that the applicant can handle it.  If the applicant never took a regular-to-heavy course load (e.g. over 14 credit hours), if they had consistently poor grades, if they had a series of W over several semesters, and if they otherwise don’t have evidence that they have academic resilience and grit, we worried about their application.  In vet school, students routinely take 18-22 credits.  If the applicant has only ever taken 12 credits AND didn’t have something very time-consuming outside of school (full-time job, being in the orchestra, being on a college sports team), what evidence do we have that they can handle that 18-22 credit load?  If they have consistently poor grades, will they earn a D or an F, causing them to leave the program?  If they had one W, or a semester with several Ws and a reasonable explanation as to why, no worries.  But if they had several W over several years without a rationale, that makes us worry.  There’s no withdrawing in vet school- if you don’t do ALL the required classes, you don’t go on through the program.

Extra-Curriculars

This might just be me, but if you’re a straight A student with tons of hours of veterinary/animal experience but NOTHING ELSE- no hobbies, no leadership, no research, no pursuits of any kind other than school- I’m not sure I want to work with you or that you’ll be a good vet.  You’ll probably be a good student, so I don’t worry too much about this applicant making it through the program.  The problem is, there are dozens of other applicants who are straight A students, have tons of hours, and were ALSO captain of the dance team.  As a veterinarian, I believe you are a leader.  You can learn to be a leader during vet school, but if you have SOME kind of experience beforehand, I think that makes you a better applicant. You have probably heard a lot about the importance of work-life balance in general, and especially in the veterinary profession. If your whole life so far has been focused on the singular goal of getting into vet school, I worry about your ability to establish a good work-life balance in vet school and as a vet. Extra-curricular activities demonstrate that you can find things outside of work or school that you enjoy and can help you maintain that balance.

References

Nearly all of the references were glowing, “This is the best person I have ever worked with in 20 years”.  It’s hard to make much distinction when all of the letters say that.  So, even one bad letter is really obvious.  Also, if the letters are primarily not from veterinarians, or not from supervisors or professors, I wonder a little bit.  Does the applicant really know what they’re getting into?  As I’ve mentioned before, don’t send letters from family friends, even if that family friend is ALSO the veterinarian who has employed you since you were a 15-year-old kennel worker.

Looking back through the list of applicants we definitely DID offer a position for, I see a lot of these taken as notes.  That is, we ADMITTED many applicants whom I made a note, “not much veterinary experience”, “tends to go on a bit”, “only worked at one clinic”, “not a lot of extracurriculars”, “no large animal experience”, “academics questionable”, “references not great”, “not a heavy course load during school”, “doesn’t present as very mature”, “not insightful answers to questions”.  All of that is to say that you don’t have to hit ALL of these to be a good candidate.  But if you lack something from the above in your application, you should make sure that all of the rest of your application is amazing.