Stress levels of veterinarians have been shown to be higher than stress levels within the general population, and among all veterinarians, young veterinarians exhibit the highest stress levels (1, 2). In addition, serious psychological distress was more common among veterinarians who had been in practice for <5 years compared to those who had been in practice longer (3). Many factors contribute to these high stress levels including client complaints and expectations, ethical dilemmas, client financial limitations affecting patient care, educational debt, and professional demands (3, 4). Also, growing evidence suggests that well-being in the veterinary profession may be lowest for young veterinarians (5, 6), and the transition to practice may be a particularly stressful time with a high risk for medical errors and lack of support (7). Training practice-ready veterinarians to be able to cope with these stressors is vital for improving overall mental health among young veterinarians.

The most important skills for success in the transition to practice were found to be professional skills such as communication, confidence and self-efficacy, problem-solving, teamwork, recognizing one's own limits, and decision-making skills (8, 9). Some of these professional skills were ranked more important for early-career success by veterinarians and veterinary students than technical skills (10). Veterinarians must be able to successfully communicate with clients, staff, and colleagues, and self-care skills may be vital for coping with the high levels of stress in the veterinary practice.

Historically, non-technical skills received limited focus in the veterinary medical curriculum, and many veterinarians reported that they had not received any formal training in conflict resolution or self-care during their veterinary training (11). A lack of substantial emphasis on these skills may have resulted from time barriers with a substantial amount of information to cover in the veterinary medical curriculum with little time for extensive training in these non-technical competencies. In addition, it has been suggested that historically, it was thought that veterinary students would learn communication skills and other non-technical skills passively through their clinical year experiences (12).

As veterinary schools are beginning to recognize the importance of these non-technical professional competencies, training for these skills is becoming more widespread (12–15). Recently, the American Association of Veterinary Medical Colleges published a competencies-based framework for veterinary colleges incorporating the competency of “attends to well-being of self and others” [(16), p. 13]. As training in professional skills and well-being is becoming increasingly prevalent within veterinary colleges, questions then arise regarding which specific skills and knowledge should receive focus in these courses.

Gathering a detailed perspective of the experiences of new graduates could provide unique insight into what skills and knowledge should receive focus for veterinary school professional skills courses. This qualitative study aimed to gather rich and detailed data on the new graduate veterinary experience including what professional skills are most important for success during the transition to practice. The primary research questions included:

Regarding the experiences during the transition to practice, five themes arose and were grouped into the category Trials and Tribulations of New Veterinary Graduates including setbacks and adaptation; self-sufficiency and self-doubt; changing clientele and ethical dilemmas; leadership and conflict; and good vs. bad mentorship. Three themes were grouped within the category of Skills Vital for Success in the Transition to Practice including client communication, conflict management, and self-care.

This qualitative study provided detailed data on new veterinary graduates' perceptions of their experiences in the transition to practice. By analyzing the experiences and challenges of the focus group participants, topics are suggested for incorporation into professional skills training to enhance day 1 preparedness of new veterinary graduates (see Table 2). This list of topics is not meant to be all-inclusive, but rather, draws from the experiences of the new graduates within this study to offer suggestions as to what could be potentially incorporated into professional skills training.

Several challenges were identified in the focus group that may contribute to high levels of stress and relatively low levels of well-being among new veterinary graduates (1, 6). The start of the veterinary career was associated with a sudden expectation of self-sufficiency and responsibility that was coupled with a sense of self-doubt. Self-doubt and fear of making mistakes were mentioned several times during the focus group, and this finding was consistent with a previous study that found three out of four veterinarians had made a mistake within the first 18 months of their career, and these mistakes often had an emotional impact (7). Some of the other challenges new veterinary graduates reported included discrimination based on age, ethnicity, and gender, sleepless nights, and adapting to overwhelming caseloads. Euthanasia was also considered emotionally challenging for some especially when it involved an ethical dilemma. It is estimated that U.S. veterinary schools offer an average of around 7 h of training in death, dying, and bereavement (20). When considering professional skills training to support veterinary well-being during the transition to practice, special attention should be given to self-care, responding to discrimination, mistake-making, and training on grief and bereavement related to euthanasia including coping with one's own grief.

Client financial limitations are extremely common with ~1 in every four households experiencing a barrier to receiving veterinary care (21). One of the most common ethical dilemmas faced in veterinary practice was financial barriers to pet care (22), and over half of veterinarians experienced moderate to very high stress when faced with financial limitations affecting pet care (4). During the focus group, four of the new graduates shared that a challenge faced in the transition to practice was client financial limitations to care. Some participants stated that they were unsure of how to proceed if a client declined their initial recommendations due to financial limitations. This is consistent with previous findings that suggested one of the communications skills that veterinary students were least confident in was discussing financial issues with clients (23).

While teaching veterinary students how to provide gold-standard patient care is paramount, an additional focus should be placed on learning how to provide care over a spectrum as “acceptable outcomes can be achieved at many points along the spectrum of care” [(24), p. 1389]. In addition, training could be provided to veterinary students on how to cope with moral distress which is considered severe emotional distress that may be perpetuated by morally challenging stressors (25). Objective Structured Clinical Examination (OSCE) techniques have been used to evaluate knowledge in navigating ethical dilemmas in both human and veterinary medicine (26, 27) and could be an effective evaluation tool for ethical cases incorporated into the curriculum.

Taking on a leadership role and the subsequent conflict associated with that role arose as a common theme during the focus group. New graduates act as a leader in the care of the animal which often requires communication and collaboration with clients and support staff to provide care. Some focus group participants described conflict and frustration arising when clients or support staff asked them to deviate from gold standard protocols. These statements were consistent with a diagnosis-focused identity which was described by Armitage-Chan & May as placing “greatest value on patient diagnosis and treatment” [(28), p. 6]. To better prepare students for navigating this type of conflict, it has been recommended that a stronger focus be placed on professional identity development throughout the veterinary curriculum (29). In addition, it has been suggested that identity development and increasing self-awareness are major aspects of leadership development (30).

Mentorship was mentioned frequently during the focus group. The new veterinary graduates shared that a good mentor is willing to answer questions, advocates and supports them, and empathizes with them regarding their challenges. A previous study on mentorship found that veterinary mentors often have personality traits of extroversion, conscientiousness, and openness (31). Openness of mentors to answer questions and seek new graduate's feedback seemed to be especially important to the new graduates in this study. It is recommended to teach students how to find good mentorship during the transition to practice as good mentorship was perceived to be highly important to new graduates. In addition, finding a good mentor may be particularly important as new veterinary graduates who reported having inadequate support in the transition to practice had higher levels of stress (32). A few of the focus group participants who mentioned that they had good mentors still experienced challenges in the transition to practice which demonstrates a need to assess structures and training that could further improve mentorship. Future research could evaluate what makes a good or bad mentor as well as establish standards for mentorship.

Three themes arose when new veterinary graduates were asked about the most important non-technical skills for success in the transition to practice including client communication, conflict management, and self-care. In previous studies, client communication was ranked as one of the most important skills or attributes at the start of the veterinary career (8, 33), and in one study, 88% of recent veterinary graduates stated that client communication was very important (9). Conflict management was perceived as a vital skill for success in the transition to practice, yet, for a few focus group participants, this was also one of their least confident skills. This finding does not come as a surprise as 71% of North American veterinarians reported that they did not receive training in conflict resolution (11).

Self-care was seen as one of the most important skills for success during the transition to practice. The finding that new graduates were placing a strong emphasis on self-care was encouraging as the Merck Animal Health Veterinary Well-being Study suggested that well-being was lowest for young veterinary graduates (5). Researchers from Colorado State University suggested providing additional training in well-being during the veterinary curriculum (34). Increased training in topics surrounding self-care may be important in preparing new graduates for coping with the stressors of clinical practice.

One main implication of this research is to recognize the important data that can be gained by seeking the story and listening to the voices of new veterinary graduates. Focus groups could be conducted with new veterinary graduates from a veterinary school to evaluate areas of deficiency and gaps in the curriculum by identifying challenges that the new graduates are facing. It should also be noted that just because a competency is perceived to be of high importance to new veterinary graduates, it does not necessarily indicate that a competency improves day 1 practice readiness (35). The value comes from uncovering the unique challenges faced by new graduates to identify areas veterinary educators could better prepare their graduates in order to promote well-being during the transition to practice.

Veterinary educators should make every effort to best prepare their graduates for practice readiness but should also consider that no level of training may be sufficient at fully preparing new graduates for the challenges of practice. This also suggests that it may be beneficial to offer professional skills training at the start of the veterinary career when many of these challenges are first being encountered which could be done through professional development programs, leadership training, continuing education, or formal mentorship programs.

Finally, as some non-technical professional skills were ranked more important than technical skills in the success in the transition to practice (10), veterinary educators should place a high emphasis on teaching these skills within the veterinary curriculum. This study and others that have evaluated professional skills necessary for success in the transition to practice could be used as a foundation to teach professional skills which may lead to increased new graduate preparedness. Increased new graduate confidence in professional skills may potentially decrease stress in the transition to practice and may result in higher quality patient care.

The datasets presented in this article are not readily available because data contain potentially identifying information. Requests to access the datasets should be directed to addiereinhard@gmail.com.

The studies involving human participants were reviewed and approved by University of Kentucky Institutional Review Board (IRB #54904). The patients/participants provided their written informed consent to participate in this study.

AR, ES, and KH conceived of the study and formulated focus group questions. AR conduced the focus group and drafted the initial version of the manuscript. AR analyzed and coded transcript with the assistance of BH and ES. All authors edited the manuscript and approved the final version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.