Saturday, November 08, 2014

BEVA Congress Farriery Day Asks Key Questions about Evidence-Based Hoofcare

“What would you do?”

That was the question at the British Equine Veterinary Association (BEVA) Congress Farriery Day earlier this fall in Birmingham, England.  One thing that came out of this day long poking and prodding of contemporary farriery was that you might think a bit before answering that question the next time someone poses it.

An international roster of speakers asked each other that question. Thanks to interactive components in the lecture hall, they could also ask the audience. But most of all, the audience looked to the speakers for answers to that question.

In farriery, experience teaches that answers are never easy, and that outcomes are never completely predictable. Never say never. Or always. But that doesn’t stop people from asking what you’d do in a case like this. Or this. And they usually ask it without providing any history and very few details. They’re just curious, but if you answer, that answer will live forever in that person’s memory, and those who ask questions may have an answer in mind that they hope to hear.

While most of the day was devoted to foot-specific veterinary and farrier cases and questions, the program began with a philosophical foundation wedged beneath it. It was probably forgotten as soon as the slides of diseased hooves filled the screen, but it’s worth a review and shows how prescient the early speakers were in remarking on the state of the farrier profession, the art of the farrier and the inter-relationships of farriers with other professionals and even the horses they treat. Would later speakers present and interact true to form?

As veterinary medicine attempts to tie farriery into a neat evidence-based package, the presentations and discussions repeatedly focused on the unexpected consequences that arise in treating foot problems and the inevitable creative problem-solving skills needed for successful results. 

Professor Stephen May
The day began with Professor Stephen May, MA, VetMB, PhD, DVR, DEO, DipECVS, FHEA, FRCVS, of the Royal Veterinary College moving rapidly through the last four centuries of farriery with remarks and insights into how and why farriers and veterinarians parted ways in the 18th and 19th centuries. While he spoke from the veterinary point of view, his concern was the communication between veterinarians and farriers, and all that hangs in the balance.

Professor May remarked that the very basis of the veterinary profession was the idea that farriery was not enough, and that it required science. Most farriers, on the other hand, resisted the move toward science, and preferred to rely on their experience and their skills. The ones who did give value to science became the early veterinarians.

"Today much of a professional’s reputation is based on his or her ability to communicate, more than on skill." --Stephen May

How much have things changed? Professor May feels that today much of a professional’s reputation is based on his or her ability to communicate, more than on skill. He painted a picture of the isolated practitioner in any profession who becomes enamored of a theory or treatment to the point of practicing--and espousing--pseudoscience, if no colleagues are on hand to challenge the ideas and bring the idea back into realistic focus.

Vet-farrier relations begin here:  "Examiner" Chris Pardoe, AWCF, PhD tests a vet student at the Royal Veterinary College in England on her ability to pull a shoe. He's allowing her to cheat a bit by having the school's "Blacksmith Buddy" hoof holder stand in for a real horse.  (photo courtesy of Renate Weller)
Professor May’s carefully drawn portrait of the anti-scientific farrier was clouded by the next speaker, Chris Pardoe, BSc, AWCF, PhD, also of the Royal Veterinary College. Pardoe carefully and almost painfully recounted some of his experiences as a farrier pursuing a PhD in his field.  He said that when he started, he had one paper from an academic journal that could be considered a “farriery paper”; it detailed the use of the egg bar shoe for navicular syndrome. Now, more than ten years later, he has more than 1000.

Chris Pardoe earned a PhD in farriery
When he began, he went to the library at the RVC, but could find no books on farriery there. “There were more books on ferrett physiology than on farriery,” he lamented.

He became interested in what other universities with vet schools were doing to teach vet students about farriery, and found little to encourage him in Great Britain. Vet students were unprepared for the farriers they would meet in the real world after graduation.

Pardoe’s lecture broke new ground when he compared the vacuum that the vet students were in with the vacuum that some farrier apprentices also inhabit. They experience everything almost secondhand through their masters, and if their masters don’t work routinely with vets, then the apprentices don’t learn how to communicate or “work with” a vet.

“There were more books on ferrett physiology than on farriery.” --Chris Pardoe, referring to the selection of books in his vet college library when he began his PhD

And he didn’t stop there. The more advanced farriers in Great Britain may opt to pursue a higher distinction from the Worshipful Company of Farriers, in the form of the Associate or Fellowship levels. In order to satisfy the requirements of the Fellowship, a farrier must write an original thesis, even though he or she has had no academic experience in using a research library, accessing academic journals and reference books, or creating or evaluating references.

One of Chris Pardoe's slides illustrated some of the ways that he teaches vet students about farriery without having a horse in the lab. The Blacksmith Buddy, made in the USA by California horseshoer Wes Champagne, has a detachable, nailable hoof on a stand that simulates a horse's leg height and position. Chris made use of one of the detachable hooves by giving it a quarter crack and demonstrating crack repair.

Chris Pardoe worked with the RVC to gradually initiate a successful “exposure to farriery” program for vet students. His goal now is to see each and every vet school in Britain build a forge and employ a farrier to teach the students what they need to know, as well as how to work with a farrier. 

“They want to know it,” he told the audience. But without an effort such as he describes, will they get it?

At the same time, Pardoe proposes that these inroads of farriers into the vet colleges would create pathways that could be utilized by practicing farriers who need to avail themselves of the services of reference librarians and other professionals who can teach them the skills needed to create theses that will not just pass their Worshipful Company requirements but stand the test of science as well.

“Bring vets and farriers together, and learn together,” Pardoe concluded.

Professor Renate Weller organized the
farriery day and posed thought-
provoking questions.
Professor Renate Weller, Dr Med Vet, PhD, MRCVS, followed Chris Pardoe, and opened with the remark to Chris that, “There are a lot of papers out there, but are they the right papers?” It was her mission to explain how clinical expertise and research are combined in the interest of the patient when evidence-based medicine is applied. 

She gave the details of an experiment she attempted, which was searching the PubMed database of veterinary science literature, looking for papers on farriery in peer-reviewed journals. She found a grand total of 157 papers published since 1970.  She compared this to 3,841 papers published on the subject of equine diagnostic imaging.

Even of the 157 papers, there were more review articles and editorials than actual cases.

Most papers came from The Netherlands, the United States, and Europe. The most prolific authors were the USA’s Steve O’Grady, The Netherlands’ Willem Back, and Switzerland’s Michael Weishaupt. She noted that no farriers were represented as authors.

"I should note that not one of these papers was written by a farrier." --Renate Weller

Professor Weller then described most of the non-peer-reviewed resources that are available to both veterinarians and farriers, with a much appreciated, and unexpected, nod for the Hoof Blog. She also observed that much of the continuing education available to farriers is planned and conducted by manufacturers, which is unusual for any profession.

None of the first three speakers offered a case history and if they had photos of horses or hooves or shoes, they were for window dressing and not related to the discussion. Perhaps the audience quickly forgot these thoughtful and very perceptive examples of what sets farriers and veterinarians apart but everything they said was certainly true, and not characteristic of conference content.

So often, people see farriers and veterinarians as separated by education alone. The idea of education as a culture or an environment that can shape thinking and experience is nothing new but we do also tend to think of the horse as the great equalizer.

But what happens when it's not the great equalizer?

While no two farriers are alike in educational background or work ethics, farrier do tend to value experience and skill, just as Professor May described hundreds of years ago, while veterinarians will put value on the science at work in both the problem and the solution.

Given Dr. May's comment about the success of professionals who are good communicators, how much time and emphasis are devoted to teaching communication? Farrier apprentices may learn to communicate by referring back to experiences with a training farrier: What would he have done? Or said?

The farriery profession cannot meet the veterinarian halfway without books--and those books must be stocked in academic libraries. It confuses the issue even more that many of the most popular and useful books in farriery today are over 100 years old: Dollar and Wheatley, Lungwitz, Fleming and Russell. 

"Useful" is a core value for a farrier in selecting which book to pull off his or her shelf, while a veterinarian would no doubt be trained to first consult the most recent references.

Speaking honestly about the increased challenges that farriery will face as veterinary medicine embraces the evidence-based model is critical, even if it painful to hear or anticipate. It brings to mind one of the witticisms often said of farriery, that it is a profession that “can’t be taught, it must be learned.”

No one at the BEVA Congress had an answer, other than Chris Pardoe’s sincere and obviously valid proposal, and the ever-present conversational dodge of answering a question with a question, even (and often especially) “What would you do?” 

Perhaps people need to be asking that more often of the future of their professions or careers and how they work together and communicate with others, as often as they ask it of the case at hand.

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