Informal schemes for veterinary students to undertake placements in the “real-world” settings of the clinical practice and government service branches of the veterinary profession are long-standing components of veterinary education. However, recent years have seen an unprecedented emphasis on such placements as a formal, critical, and integral part of veterinary curricula. The main themes that have come together to bring real-world placements to the forefront of curricula are the recognition that there are significant areas of veterinary practice that cannot readily be taught within the confines of an academic institution; the need to provide students with a greater scale or scope of clinical opportunities than are available through a university hospital; and constraints on universities’ ability to provide a full spectrum of clinical experience to students.

There has also been a significant change in the pedagogical environment of medical (and hence veterinary) education over the past two or three decades that has helped to drive clinical teaching toward real-world settings. There has been a substantial shift from didactic instruction and apprenticeship models of clinical instruction toward student-centered, constructivist modes of delivery, and the systematizing of clinical instruction around the competencies required of the newly graduated veterinarian. Furthermore, the competencies that the practicing veterinary profession expects of its new graduates are no longer confined to the areas of declarative knowledge and technical skills, but are also increasingly in the affective domains of communication, professionalism, and interpersonal skills. The profession, in fact, expects that graduates will be able to perform the clinical and technical tasks that will enable them to be effective as revenue earners (e.g., Jaarsma et al., 2008). To meet these new expectations, veterinary schools have had to invest in teaching methods that place greater emphasis on these skills, and, as part of that investment, have had to develop means by which they can be taught in the context of students’ real-world aspiration to be clinical practitioners.

Concurrent with these developments has been the opening of a number of new veterinary schools. For the established schools, their veterinary teaching hospitals (VTH) have had a long history of existence and, hence, also have a well-defined place in the veterinary community for their referral services and their needs for case material for clinical teaching. For new schools, setting up clinical teaching facilities has been challenging, as they do not have that history in the veterinary community. Even where there has been a long period of advocacy for a new school, that school, once founded, has to struggle for its “place in the sun” of a share of the local primary or referral caseload. Sometimes the need can be met by the purchase of an existing practice, sometimes there might be a gap in the provision of local/regional veterinary services, and sometimes neither of these options is readily apparent. This is not only the situation for new schools: existing schools may not be able to sustain some components of the teaching practice. Food animals commonly fall into this category: locations that may have provided a broad agricultural hinterland when the school was founded are now covered with urban development, and the rural practice has disappeared (Klee, 2008). Moreover, the effectiveness of clinical learning is also affected by the nature of the clinical practices that universities operate, inasmuch as universities need a cadre of clinical specialists to maintain their impetus in clinical excellence and research. Specialists, who may be operating at the level of secondary or tertiary referral, are not necessarily enthralled by teaching students simple medical or surgical procedures, so tension can ensue between the need for clinical specialisms and the achievement of Day One Competencies.

The net result of all of these trends has been a dramatic evolution of the use of external real-world settings, from the informal arrangements of “seeing practice” into key, core, planned, contractually defined components of the modern veterinary curriculum. Consequently, most veterinary schools have moved some or all of their clinical teaching to some form of distributed teaching model. Development of the distributed model, and the means by which it could be accredited as a means of providing clinical education, was not without controversy (Nelson, 2012), but the outcome of that period of discussion has been a robust model for curriculum delivery beyond the bounds of the veterinary teaching hospital.

Harden, Sowden, and Dunn (1984), in their seminal review of educational strategies in medical curricula, argued for community-based medicine as a critical curriculum component to supply the needs of practitioners who would subsequently provide primary accession medical services to the community. They noted that the hospital-based approach of medicine “has fostered an ‘ivory tower’ approach to medicine in which students during their training have little contact, if any, with the community which they are being trained to serve” (p. 291), and that “in hospital-based curricula it is in the process of becoming a doctor that the trend towards specialization has been initiated, intensified and maintained” (pp. 291–292). The large number of veterinary students who take internships as their first postgraduation employment who made that choice during their clinical training (Barbur et al., 2011) and the remarkable growth in veterinary specialty practice (Albers, 2008) may be symptomatic of the same process occurring in veterinary education.

One of the unique features of veterinary degrees that derive from the British (Royal College of Veterinary Surgeons, RCVS) model of veterinary education is the requirement for students to gain real-world experience of working with animals, particularly livestock, during the vacations of the junior years of their studies (Box 13.3).

In order to “have a realistic and appropriate perspective of the responsibilities of the veterinary profession” (University of California, Davis, 2015), prospective students are usually required to have completed a significant amount of veterinary experience before admission. After admission, regardless of whether a veterinary medical degree program adopts the traditional “preclinical, paraclinical, clinical” model or whether it has a more integrated structure, familiarization and enculturation with clinical practice are a key transition though which students have to progress. Johnson (2015) reviewed the programs of extramural study (EMS) placements in UK veterinary curricula, with the view that early clinical placements were primarily of value in learning the culture of veterinary clinical practice and observing the management of cases.

This process is commonly started at the transition from the junior to the senior years of the program – often at the start of the final year. However, current thinking is that clinical activities need to be incorporated into the program at a very much earlier level, ideally as early as possible. In fact, this is the process that many veterinary schools operate. Early-years clinical experience is important, as it provides context and reality for preclinical studies and, even if brief, such placements are well received. For example, D’Amore et al. (2011) describe a one-week placement of first-year medical students in rural Australia as being enjoyable, but also as a vehicle for students to understand the clinical and technical learning that they would need to achieve to be successful in clinical practice. Kaye et al. (2010) had a similar experience of placement of first-year medical students in rural Uganda: “many of the students … were in favor of this being part of their medical training. Some of the reasons given … were that it enables students to understand the medical conditions in rural areas, to see a variety of medical conditions (some of which are not seen in the teaching hospital), and to learn about the management of the health care system.” In veterinary education, Stone et al. (2012) argued for exposure to companion animal primary care throughout the curriculum as a means of providing interest in primary practice per se and of creating context for concurrent studies. Interestingly, they “originally thought that the first-year students could serve as animal handlers, second-year students as receptionists, third-year students as veterinary technicians, and fourth-year students as clinicians. This proved to be fallacious thinking” (p. 212); rather, they found that “junior” students benefitted most when fully incorporated into the “inter-professional team.” Likewise, initiatives in the United States and Canada have aimed at stimulating the interest of first- and second-year doctor of veterinary medicine (DVM) students in food animal medicine by getting them involved in real-world problems at the farm, practice, or rural industry level (e.g., Iowa State University: Karrier et al., 2008; Michigan State University: Howard, Lloyd, and Grooms, 2009).

On the other hand, starting clinical practice can be stressful. One way to address this issue is the use of simulators to familiarize students with the clinical material and interpersonal interactions that they will encounter – a process that has been beneficial in nursing and midwifery (McNamara, 2015; Cummins et al., 2015). Likewise, nursing education has emphasized the importance of clear goals and expectations around early-year clinical placements (Andrew et al., 2009). Veterinary curricula similarly need to have clear expectations of students’ achievements in early clinical placements (Bell et al., 2010). For example, James Cook University, Queensland, Australia (2015a) has a series of preclinical courses in veterinary professional practice, which structure learning experiences across the early years of the program to create understanding of, and familiarity with, veterinary clinical practice as a precursor to the main block of clinical studies in the final year. Learning outcomes for the early stages of these placements are largely in the affective domain of communication, workplace ethics, and teamwork, with later placements having a greater emphasis on “clinical” skills such as client communication, history taking, record keeping, and clinical examination.