Reading this triggered my recollection of stories from clients or conversations I've overheard between pet owners in the dog park - along the lines of ..."my vet told me he had "x" months to live, and that was over a year ago." These have never bode well for the veterinarian; the inference was that either the vet was wrong and incompetent or was trying to bilk the client to spend excessive amounts of money for additional work-up or treatment. I'm wondering how often veterinarians actually seek out a second opinion for histopath results. All of this underscores the takeaway from Dr. Kristin Zersen's recent discussion of the incidence of premature death in dogs with "benign" histopath findings after a splenectomy for nontraumatic hemoabdomen. Veterinarians need to be sharing this kind of information with their clients when discussing treatment options and the range of outcome possiblities. Coincidentally, this past week the New York Times had an article about the "medical gaslighting" of women by physicians. They referenced a 2020 publication in The Medical Journal of Australia that reported a 14% incidence rate of diagnostic errors - the publication states: "Some form of diagnostic error occurs in up to one in seven clinical encounters, and most are preventable." Another publication in JAMA Internal Medicine (2010) reported that upwards to 83.3% of diagnostic adverse events are preventable as over 96% were due to a human failure (e.g. a knowledge-based mistake or a mistake in the transfer of information). The consequences for diagnostic-related adverse events (of any type) resulted in a greater mortality rate (29.1% vs 7.4% for other types of adverse events). If we look to veterinary medicine and the broad topic of medical errors, this 2019 article published in Frontiers in Veterinary Science reported that 15% of medical errors resulted in patient harm, with drug and communication errors the most frequently encountered of errors in the veterinary practice setting.  

All veterinarians and some veterinary technicians (depending on the state in which they are employed) must be licensed to practice veterinary medicine. Licenses are issued for a defined period of time (varies from state to state) and must be renewed in order for an individual to be able to practice. Included in the requirements of a licensee - for the renewal of a license - is the mandatory fulfillment of continuing education (CE). Continuing education requirements of veterinarians and veterinary technicians in the USA vary from state to state. Variables include the number of required hours of CE, the interval or frequency of CE fulfillment and reporting, accepted methods of delivery (e.g. in person (seminar) vs. virtual and synchronous / interactive or asynchronous / non-interactive), subject matter type (e.g. medical vs. non-medical topics), and finally, caps on certain of those variables (e.g. non-medical topics, or online and non-interactive study).  As such there is no "one size fits all" approach to helping colleagues fulfill their CE requirements. The American Association of Veterinary State Boards Registry of Approved Continuing Education (AAVSB RACE or "RACE") has long been regarded as the authority on: 1) the establishment of the standards of quality veterinary medicine continuing education, 2) accreditation of CE program Providers, and 3) oversight of those approved CE Providers. As stated on their website, their "goal is to support the AAVSB member boards by ensuring that all RACE-approved continuing education programs meet appropriate standards of quality." Most of the state boards of veterinary medicine in the US regard "RACE-approved" program completion as qualifying for CE fulfillment in their jurisdiction. There are exceptions. New York, for example, has established its own standards and conducts its own approval process of prospective continuing education providers. As such, if a CE provider wishes to be supportive of NY state licensees in meeting their CE requirements, they must also seek accreditation as a CE provider in NY state (even if they are already deemed a "RACE-approved" CE provider). I am a veterinarian and over the course of my career I have held licenses to practice veterinary medicine in 4 different states. Historically, and for as long as I can recall, the onus was always on the individual veterinarian or veterinary technician (in these states) to maintain their own records regarding CE fulfillment. Each state varies in the reporting requirement. Some states require that professionals submit proof of CE completion by providing copies of CE certificates when renewing their licenses, while others are not required to submit those except in the instance of an audit (for example). Since 2009 or 2010 (around the time that VetVine became an accredited CE provider), one obligation and requirement of AAVSB RACE-approved CE Providers has been the maintenance of records. Record keeping has always been a requirement of RACE-accredited CE Providers. They are obliged to maintain records and to demonstrate proof of an individual's successful completion of CE in the event of an audit. The CE Providers must be able to demonstrate that an individual met the requirements associated with a particular program including proof of attendance or that the individual met the contact / viewing time requirement as well as completion of an evaluation. In the case of online, non-interactive CE programs, individuals must also pass a post-test associated with the approved CE program. These records must be maintained for at least four years after RACE approval and the Provider must be able to provide copies of these records, in the event of an audit by RACE or a state Member Board, within 10 days of such a request. In or around October of 2020, RACE notified its CE-approved Providers of a new system they were implementing in partnership with an entity called "CE Broker" for CE course application submission. This was followed in November of 2020 with an announcement that "New Race Standards" - which included a requirement of Providers to "upload attendee lists" into their portal - would become effective January 2, 2021. Their claim was that this improvement would assist attendees of CE programs in keeping track of their CE completion. This new reporting requirement of CE Providers was to sync up with "RACEtrack" - a system that permits individuals to keep track of their CE participation. Their goal was to provide a single system that would "provide a seamless connection between CE Providers, licensees, and regulators." In theory this seemed like a great idea. RACE's announcement of this requirement of CE Providers was jarring. There was essentially little to no time to prepare for this huge shift in required record-keeping, reporting, and departure from the customary issuing of CE certificates (which our constituents heavily rely upon). Further, the Providers were requested by RACE to "Please encourage all attendees of any RACE program to create a free RACEtrack account to track their CE." This single request was suggestive, to me, that RACE was leaning on the Providers to be the instruments for driving the change in CE tracking for its Member (state) Boards. Mind you, none of our many, many, many CE program attendees ever inquired (then nor any time since) about whether we would / could report their CE participation via RACEtrack. In February 2021, VIN News reported on this issue and brought to light a number of concerns shared by various CE Providers regarding these mandates. Shortly thereafter, RACE hosted a virtual Town Hall to discuss these change requirements and to address questions from CE Providers. Subsequent to that Town Hall, Providers were granted an extension (June 1, 2021), to permit them an opportunity to ramp up and come into compliance with the new reporting requirement. On June 23, 2021 an email was sent by RACE reiterating that the requirement was effective June 1, 2021. They also stated "The AAVSB RACE team understands that not every provider will be able to comply with the roster upload requirement immediately. As a result, the RACE Committee will allow Providers a grace period until January 2022 to meet this requirement without it adversely affecting your RACE Provider status." To date - since the initial announcement of this new system in 2020 - VetVine has not received a single request from any individual utilizing our platform to report their CE fulfillment via CE Broker / RACEtrack. Our constituents do continually request and entrust us to provide them with CE certificates that document their CE completion. Per an email communication earlier this month related to the ongoing coverage of this story by the VIN News Service, Edie Lau (Director, Editor, and Reporter) indicated to me that (at this time) only one Member Board (South Carolina) is requiring their licensees to use the CE Broker / RACEtrack system for CE reporting. This means that the remaining 60 (or so) North American regulatory bodies affiliated with AAVSB RACE have not implemented use of this system as a requirement for keeping track of the CE fulfillment of their licensees. So what exactly is wrong here? Quite a few things, actually. While this idea of a centralized system to coordinate CE Providers, licensees, and regulators seems like a good one, the implementation of it has totally lacked foresight and makes no sense. The roll out has been akin to putting the cart before the horse. Why is a requirement (aka burden) being placed on the CE Providers when only one state board has adopted its use? Who thought it was a good idea to make the Providers the instruments of this change? Shouldn't each and every one of the Member boards have signed on in agreement to actually use this centralized system? Shouldn't each of those Member boards have adopted use of RACEtrack and informed their licensees of this new reporting requirement ... before imposing a requirement on the CE Providers? The AAVSB Member boards themselves (not RACE) are charged with qualifying whether their licensees have met their stated CE requirements - not RACE! If the vast majority of these Member boards have not embraced this system (and continue to verify in the manner they have historically relied upon), why should it be a requirement of Providers to report this information to RACE? This RACEtrack reporting requirement calls for a massive change in operations for RACE-approved CE Providers. For CE Providers like VetVine - who offer online, on demand video programming for users to access asynchronously, 24/7 - these changes in reporting requirements are huge. VetVine literally has scores and scores of videos and CE learning opportunities. Think of our platform as something similar to Netflix. Individuals consume content in a piecemeal fashion - an hour here, 15 or 30 minutes there, etc. We are not equipped and sufficiently staffed to meet the new reporting requirement for each and every program that we host AND issue CE certificates of completion to our constituents who are still expecting those certificates. It's duplicative of effort and a requirement that seems to only be required by AAVSB RACE (not the vast majority of individual state boards). It's got to be one or the other. I don't mind change or technological improvements. I think that this centralized system makes perfect sense. What does not make sense is this mandate of CE Providers. We were not hired to be instruments of change for RACE. And, by all appearances, the state boards - for whatever reason - don't seem to be embracing use of this system.  Other issues and concerns that have been expressed by CE Providers center around the sharing of information and privacy. The reporting requirement of Providers includes publicly searchable information (e.g. profession (vet or vet tech), state and license number), coupled with the program(s) they've completed. That information can be mined to reveal the activities and subject matter(s) of interest of these individuals. We, as CE Providers, have no control over how that information is accessed or leveraged by this third party entity known as CE Broker / RACEtrack. This reporting requirement may actually put some Providers in breach of the assurances provided to their constituents as expressed in their privacy policies. On December 17, 2021 CE Providers received another email reminder stating " beginning January 1, 2022, you are required to upload RACE Attendee Lists for your programs." It's December 23, 2021 and I am wondering: 1) How many users of VetVine's CE platform have ever heard of RACEtrack? 2) How many of you have established a RACEtrack account for purposes of tracking your CE participation? 3) For those affiliated with a state board of veterinary medicine, what is the status in your jurisdiction ... are you requiring your licensees to use RACEtrack as a method for keeping track of / reporting their CE completion? 4) To our valued Members - veterinarians and veterinary technicians - if you don't use RACEtrack for keeping track of your CE completion, how do you feel about having your information reported and shared in this fashion? This post was edited by Sheri Berger at December 23, 2021 3:37 PM EST

Over the past couple of years I’ve had the real honor of working with colleagues and industry experts to produce and host a number of educational offerings on end-of-life topics. It’s been a very enlightening experience. I also have a heartfelt appreciation for the industry partners who’ve supported these endeavors - businesses focused in improving our caretaking as well as the end of life experience we provide for clients, our patients, and those of us doing the work. While working on these projects I often took pause to reflect back on personal experiences from my days working in both the general and specialty veterinary care practice settings. I found myself saying “if only I’d known then what I know now.” It wasn't self-criticism, as I practiced as I was taught and observed. Typical of joining any organization or being hired into a new workplace, we all tend (and are expected) to adapt to the culture of that place. Our onboarding usually includes learning about the organization's mission or mentality including “this is how we do things.”Working in the trenches – day in and day out – it’s often difficult to think outside of the box. I’ve seen that play out throughout my career working in private practice. People establish their habits and comfortable ways of doing things just to get through their busy days. Carving out the time or space to consider how or why we might do things differently – especially if we don’t perceive a need for change or improvement - is not top of mind. After all ... “if it ain’t broke, why would I fix it?”  Especially if that change might impact your routine and/or cost you a few extra bucks.  Right?!   When I first met Dr. Kathleen Cooney - CAETA's Founder and Director of Education - I was truly overwhelmed by her passion for advancing end-of-life care for our veterinary patients. I recorded a 3-part series with her on Euthanasia and the Human-Animal Bond, and during our time together found myself getting choked up on a few occasions - recalling less than pleasant euthanasia experiences from my days in practice, as well as personally - with one of my own pets.  From the onset I knew and believed in the importance of bringing this information to our audience, however the emotional tugs really cemented how vital it was to support colleagues, pet parents, and our patients during one of the most delicate of times - a beloved animal's end of life.  The more I delved into this project, the more I was surprised by the memories that surfaced.  Fast forward to this past month or so, and Alexandra Yaksich, AHT penned a 3 part series about the AVMA's new companion animal aftercare position statement. As I read her posts, again, memories surfaced of poor end-of-life experiences I had during my practice career. Aside from the heart-wrenching, sudden death of one of my dogs (and my perception of a poor experience provided by the hospital where she died), I thought back to what "aftercare" looked like when I was in practice (1989-2007). My active years in practice included working in the general practice setting, the university setting during my residency, and then private specialty practice. Without fail, but for the exception and rare instance in which an owner left the practice with their deceased pet, the disposition of dead animals invariably involved placing them in a black trash bag. I recall some practices that I worked at in which animals were not bagged, but were just tagged and placed in the freezer - in advance of an aftercare provider (e.g. crematory) coming to retrieve them. I recall that both of these methods never, ever looked or felt right to me. I never questioned it, though. I had seen this practice everywhere I had ever worked. I guess you could say that it was "standard." One of our Human-Animal Bond program sponsors - Euthabag - was unknown to me until recently. Dr. Cooney had introduced me to Dr. Celine Leheurteux - a veterinarian who created this product in an attempt to ante up in how we care for the bodies of our deceased patients. When I first heard about her product, one of the immediate thoughts that came to mind was "yeah, that's going to be a tough sell." Afterall, who's going to shell out more money - especially after a pet is dead? I then recalled an in-home euthanasia experience that I had over 20 years ago.  The first pet I owned on my own - as an adult - was a Doberman pinscher. She had many health issues throughout her lifetime and was also a wobbler. I came home on a late Saturday afternoon after work - the year was 1998 - to find her splayed out on the floor, in pain, and unable to rise. I knew that it was time to euthanize her. It was going to be very difficult for me to get her to the veterinary hospital, so I called on a couple of work colleague friends to see if they could help. They came to my place to perform an in-home euthanasia. They were so gracious, so kind. Without any discussion, they indicated they would take her body back to the hospital and place it in holding while I arranged plans for her aftercare. I recall that they gently wrapped her body in the comforter that had become hers, and then before exiting my apartment - to prevent "leakage" of bodily fluids - they placed a black garbage bag over her back half / hind end. It was as dignified and respectful as could be. I watched them exit my place and walk toward the elevator and can still recall that last visual of the black garbage bag. It was so sad and so surreal. And here, over 20 years later, I still vividly recall that visual and experience. As I got to know Celine and learn more about Euthabag, I became more curious about the product and asked if they would send me a sample. I received the sample and looked it over - it's simple, aesthetically clean, stores easily, and seems sturdy. I took out a stuffed toy to simulate what it would be like to place an animal into this body bag and zipper it closed. I set it aside on a table and just left it there. I took notice of it several times over the next couple of weeks. The more I looked at it and handled it, the more I realized the impact that this simple body bag would have in the end-of-life experience we provide. The aesthetic of the body bag alone, and doing away with the garbage bag, is a huge cultural shift. It shifts our mindset to one of truly providing a dignified death experience. And this impacts not only our client's experience but also that of the veterinary team. It truly honors the human-animal bond. And yet, it's just one cog in the wheel. The end-of-life experience begins before an animal's death, and the impacts of that experience can be felt for months and even years after the fact. Our pet loss support service is a testament to that - grief knows no timeline. One last thought about this body bag ... one day I had set a glass of red wine on the table next to the sample I had received. I accidentally knocked the glass over - red wine everywhere including all over the light grey body bag. I scrambled to do clean up and figured I would now have a sample with red wine stains. Not!  I cleaned up the mess and took the bag over to the sink to rinse it off. No red wine stains anywhere. Nice to know. ;)   

I'm thrilled to share this podcast with VetVine Members. Me and my colleague - Dr. Lori Kogan from Colorado State University - were interviewed by Allison White - a Licensed Clinical Social Worker - for her Animal Academy Podcast. We had an opportunity to chat about VetVine, the Human-Animal connection, and pet loss. It was a wonderful 36 minute conversation! I hope you enjoy.  If you can't play it here, you can also visit Allison White's podcast page.     This post was edited by Sheri Berger at October 22, 2020 6:30 PM EDT

A new puppy or kitten visit provides veterinary caregivers an opportunity of a lifetime. Literally. That first appointment is an opportunity to establish a partnership with the client to provide care through the lifetime of their new animal companion. When you think about it, that's a huge responsibility and it includes educating a client about the essentials to disease prevention (e.g. wellness exams and preventative care measures) as well as financial tools that can help pet owners manage the costs of that care over the lifetime of that pet. If we blow the opportunity and fail to establish a meaningful connection with that client, we stand to lose out on an income-producing opportunity (for years to come) and perhaps even worse, a client without someone partnered to ensure the best possible care for their animal. New puppy or kitten “packages” or wellness plans that bundle essentials such as vaccinations, endo- and ecto- parasite prevention or management, and preventative dental care help us to guide and support our clients in caring for their pets in healthy, happy times. At the end of life, however, we know that many veterinary practices miss the mark in guiding and ensuring a continuum of care for pets and their owners.  As an animal approaches the end of its life – whether naturally due to age or associated with a chronic or terminal illness – there are many opportunities for veterinary professionals to provide guidance, support, and to prepare clients for a good end-of-life experience (both for the client and the animal patient). A bad end-of-life or euthanasia experience can lead to client attrition. One statistic I’ve heard is that around 20% of clients will not return to a veterinarian with another pet after having a euthanasia experience that’s left them feeling angry or upset. I recently read the Pet Loss Best Practice Guidelines for Veterinary Teams (June 2020) published by Seneca College's Social Service Worker and Veterinary Technician Programs in collaboration with VCA Canada and funded by Seneca Innovation. They studied the client experience with veterinary teams during their pet's end of life. The project involved client surveys, a literature review on the pet loss experience in the context of veterinary practice responses, and interviews with industry experts. The purpose of this project was to establish Best Practice Guidelines to strengthen the industry's capacity to respond to clients' needs. "The strongest memories for a client are typically their first and last day with their pet.” This sentence – included in the Guidelines document - resonated with me personally and I took pause to contemplate that further.  While most veterinary professionals are not party to that “first” day, we are party to most “last” days of that relationship. As such, we are privileged to be entrusted by pet families to care for their animal companions during this time and we have a tremendous responsibility to provide for the best death experience possible. So how can veterinary practices ensure a continuum of care at the end of life? We do a pretty good job in early life with wellness plans and promotion of preventive care measures. How can veterinary practices raise the bar on the back end and do death well? I’ve been delighted to work with people involved in end of life care, training in euthanasia best practices, and in pet loss and grief support. I am especially proud of the work that VetVine is doing to support veterinary colleagues who are committed to learning more in these areas and in elevating the end of life experience that they provide in their practices: The Human-Animal Bond Program – approved for up to 8 hours of CE credit by AAVSB RACE and NY state can be viewed at no charge and compliments of our Sponsors including ASPCA Pet Health Insurance, BioResponse Solutions, Euthabag, and CAETA. VetVine’s Virtual Pet Loss and Grief Support Service is a resource for clients experiencing anticipatory grief or grieving the loss of their animal companion.  We are proudly partnering with veterinary and pet care professionals to serve as an extension of their practice or business to provide this important support and to ensure a continuum of care. Contact Us to learn more about how your practice or business can partner with VetVine in this regard.