The role of professional development to support wellbeing amongst Veterinarians
Large volumes of research surrounding issues facing veterinarians are available with most reflecting high suicidality, stress and burnout in the profession. An increasing body of work is the emergence of measures and positive effects pertaining to performance and wellbeing.
The impact of stressors in veterinarians such as long working hours, compassion fatigue, work-life imbalance, work-place communication/collegial issues and moral distress1 are all cited as significant contributing factors to diminishing welfare of veterinarians and veterinary nurses2 . Veterinarians with an aptitude for or access to strategies to manage or overcome work-related stress and enhance resilience has thus become an issue of increasing importance in veterinary education and research, in an effort to safe-guard retention and wellbeing across the profession.
The need for the provision of measures to build resilience and wellbeing is resounding, with the Royal College of Veterinary Surgeons (RCVS) investing in the Mind Matters Initiative – launched in 2015 to improve the mental health and wellbeing of those in the collective veterinary cohort, including students, veterinary nurses, veterinary surgeons and practice managers3. The importance and scale of issues facing the entire profession, combined with well documented approaches to their improvement, underpin a strong case for the development and offering of continuing professional development dedicated to the topic. While there are numerous studies examining mental health and wellbeing in veterinary medicine, there are only few studies devoted to evaluating programs aimed at enhancing wellbeing in the profession. Nevertheless, drawing on existing wellbeing programs which focus on the key areas of challenge and opportunity identified by the extant literature are likely of benefit.
It is well documented that veterinarians and associated professionals experience a high degree of stressors in the course of undertaking study and into their employment. Stress is defined as “an interaction between the person and their (work) environment and is the awareness of not being able to cope with the demands of one’s environment when this realisation is of concern to the person”, and, is related to a complex intermix of factors4. In a recent US survey of 3500 veterinarians, 1 in 20 reported suffering from psychological distress, with depression, burnout and anxiety most prevalent5. In addition to the issues consistently reported (disproportionate suicidality, staff turnover, burnout and increased mental health risks), stress can have serious consequences within the workplace (turnover, absenteeism) and for the individual (poor health outcomes).
It is commonly reported that veterinary professionals have a suicide rate up to four times higher than the national average, a statistic shared across borders6. According to the Australian Veterinary Association (AVA) the six principal issues facing veterinary professionals are: long working hours, poor managerial skills, heavy workload, poor work/life balance, difficult clients and performing euthanasia7. Serious problems arise from the combination of ‘what’ veterinary professionals do within the occupation and ‘where’ or the environment in which they work. As stressors are inherent to veterinary work it is of upmost importance that strategies to address the psychological wellbeing of veterinary professionals is crucial. Also of importance is stigma associated with mental ill-health generally and in the profession . In order to improve resilience and wellbeing and to help veterinarians utilise effective coping strategies, stigma needs to be addressed8.
Overall, there is more than adequate research justifying the need for a wide range of strategies to build or enhance career resilience and manage work related stress amongst veterinary professionals. Further, the prevalence of literature highlighting negative-framed stressors (stress, suicide, depression, and burnout) suggests the need to reframe the dialogue to one that embraces and refocuses on the positive effect of protective factors that build or enhance resilience amongst professionals9. McArthur et al define resilience as ‘a dynamic and multifaceted process in which individuals draw on personal and contextual resources, and use specific strategies to navigate challenges and to work toward adaptive outcomes’, finding that mindfulness and self-compassion are two key factors in fostering resilience10.
Utilisation of a resilience-focussed approach has been found to benefit others in emotionally demanding professions such as nursing, medicine, dentistry and teaching. To this end resilience, through the building or enhancement of protective factors and emotional intelligence, for veterinarians has the potential to foster traits and abilities that may be called on in times of adversity to maintain equilibrium and lessen the impact of, or susceptibility to, common stressors in the veterinary profession. McArthur et al in their study of veterinary students found that students with higher non-judgemental and non-reactive mindfulness along with self-compassion scored higher for levels of resilience. This suggests that providing the opportunity for individuals to measure for such traits may provide a foundation in which to bridge paucities and potentially develop career resilience. The provision of a tailored learning or professional development opportunities would support access to and development of capabilities surrounding resilience for veterinarians, and has the potential to be applied to professions facing similar issues more broadly. Other healthcare professions face similar challenges and likewise would benefit from tailored training in this field.
Continuing Professional Development involving career resilience/wellbeing that incorporates the evaluation and development of interpersonal skills incorporating personal resources such as effective communication, mindfulness and self-compassion and the development of adaptive and targeted coping strategies would be useful across the profession to combat the ongoing demands of providing compassionate care. Addressing early symptoms of stress has the potential to limit development of severity that may lead to burnout. It also has the potential to limit the impact of common stressors associated with the veterinary profession.
The literature suggests that students, graduates and female veterinarians would most benefit given their self-reported poor wellbeing in veterinary practice, however this needs to be considered in context. For example, young graduates are often on a steep learning curve (as with all new graduates). Therefore, new graduates are likely to benefit from supportive workplace structures designed to maximise development, both their clinical skills and their wellbeing. However, as noted by the Mind Matters program, these initiatives are best aimed at the entire profession. Targeted professional development could (should) also be extended to employers in a bid to reduce workplace stressors that undermine wellbeing overall. Training to help employers and supervisors enhance collegial communication such as the provision of effective, constructive and supportive feedback would be advantageous. Additionally, professional development which educates veterinarians about growth enhancing debriefing processes, thought to enhance resilience, is also indicated. Arguments can be made for face-to-face, online or mixed mode delivery – to address social support, flexibility around work and study commitments and to limit financial obstacles to inclusion.
There may also be benefits surrounding research development as McArthur et al outline that understanding the factors associated with resilience would ‘…illuminate how veterinarians and students manage challenges and stressors in their personal and professional lives. It would also illustrate factors that enable veterinarians to manage their work successfully, derive a strong sense of satisfaction from their career, and maintain commitment and enthusiasm despite experiencing adversity. In turn, such understandings can inform veterinary education and thereby help students build a capacity for resilience in their future career.’
University of Adelaide’s current research
Footnotes
[1] Arbe Montoya, AI., Hazel, S., Matthew, SM., McArthur, ML.(2019) Moral distress in veterinarians, Veterinary Record 185, 631 <https://veterinaryrecord.bmj.com/content/185/20/631 >
[2] Cake et al 2017; McArthur et al 2017; Mastenbroek et al 2014; Gardner & Hindi 2006; Gardner & Parkinson 2011; Meehan M 2019; Milner et al 2015; and Moffet et al 2015. See full References.
[3] https://www.vetmindmatters.org/about/
[4] Scott-Howman and Walls, in Gardner and Hini, 2006, Work-related stress in the veterinary profession in New Zealand.
[5] https://vetidealist.com/burnout-veterinary-medicine , ‘Burnout in veterinary medicine: let’s talk action’, 2018.
[8] Mcarthur, M L ; Matthew, S M ; Brand, C P B ; Andrews, J ; Fawcett, A ; Hazel, S, 2019, Cross-sectional analysis of veterinary student coping strategies and stigma in seeking psychological help, Veterinary Record, 8 June 2019, Vol.184(23), p.709.
[9] Cake MA, McArthur MM, Matthew SM and Mansfield CF, 2017, Finding the Balance: Uncovering Resilience in the Veterinary Literature, JVME 44(1), AAVMC.
[10] McArthur M, Mansfield C, Matthew S, Zaki s, Brand c, Andrews J and Hazel S, 2017, Resilience in Veterinary Students and the Predictive Role of Mindfulness and Self-Compassion, JVME 44(1), AAVMC.
Additional References
Gardner, DH and Hini D, 2006, Work-related stress in the veterinary profession in New Zealand, New Zealand Veterinary Journal, 54:3, 119 -124.
Gardner DH and Parkinson TJ, 2011, Optimism, self-esteem, and social support as mediators of the relationships among workload, stress and well-being in veterinary students, JVME 38(1), AAVMC.
Mastenbroek, N J J M ; Demerouti, E ; Van Beukelen, P ; Muijtjens, A M M ; Scherpbier, A J J A ; Jaarsma, A D C, Measuring potential predictors of burnout and engagement among young veterinary professionals; construction of a customised questionnaire (the Vet-DRQ), The Veterinary record, 15 February 2014, Vol.174(7), pp.168.
Meehan M, 2019, Practical strategies to manage work-related stress in the veterinary profession, Vet Record, 11 May.
Milner AJ, Niven H, Page K and LaMontagne, 2015, Suicide in veterinarians and veterinary nurses in Australia: 2001-2012, Australian Veterinary Journal, vol 93, No 9.
Moffet J, Matthew S and Fawcett A, 2015, Building Career Resilience, InPractice, vol 37 pp 38-41.
‘Work-related stress and its impact on the veterinary profession’, BSAVA Congress, May 9, 2015, Vet Record, p 481.
‘Burnout in veterinary medicine: let’s talk action’, 2018, The Veterinary Idealist https://vetidealist.com/burnout-veterinary-medicine/ Accessed on 3rd Feb 2020.
A range of intensive Career and Wellbeing courses are available as part of The University of Adelaide Short Courses series.