A user’s guide to adapting your mindset for the “real world”

Spoiler alert: The real world doesn’t come with a syllabus.

The transition to clinical practice can be a difficult time for newly-minted veterinarians. One of the “painful revelations” described in the literature is the discovery of “the divergence between the precise and unambiguous knowledge underlying the training and the unpredictability and imprecision of their everyday practices.”^[1] We suggest that this is true for other health professions as well, and not limited to veterinary medicine.

In the academic world things are predictable and clearly outlined. The path to success (high grades) is laid out in the course syllabus. Everything is scheduled so you just turn up and do what you are expected to do. There are rules to follow–rules which are usually explicitly defined for you. You are responsible only for yourself and your own performance. And no one dies.

The scientific method of the academic world is predicated on orderly investigation leading to predictable outcomes or ‘right answers’. This is exemplified in the use of protocols for diagnosis and treatment- a step by step guide to success that anyone can follow and arrive at the correct solution. However, this approach promotes the “illusion of the single answer”^[2] and doesn’t take into account the numerous variables and complexities of context. It diminishes the value of expertise and experience.

In the real world things are unpredictable and can be overwhelmingly complex. Schedules fall by the wayside. You suddenly have independent responsibility for patient care. Mistakes can happen and can have serious consequences. The path to success is unclear and even what success looks like is unclear! There are no “grades” anymore and no one is going to tell you what to do or how to succeed…And sometimes patients die.

If you show up in the real world equipped only with linear causal thinking strategies^[3] from academia, you are in for some “painful revelations.” No matter how much you ‘practice’ individual skills and/or practice medicine, you will never overcome the everyday unpredictability and “surprises” of veterinary medicine. What?! The “gold standard” isn’t always possible?

Having unrealistic ideals and expectations can affect mental health as well. The quest for perfection, based on the belief that uncertainty can be eradicated, can lead to feelings of personal failure, which may result in leaving the profession and tendencies toward anxiety, mental illness, and suicide.^[4]

As one study observed, “idealized notions of practice may combine with actual experience in ways that render veterinary medicine a precarious and potentially demoralizing occupation.“^[5]

Armitage-Chan and May^[6] suggest that identity plays an important role in how the real world is perceived and offer a framework for understanding different veterinary identities.

• Diagnosis-Focused Identity: Prioritizes definitive diagnoses and evidence-based treatments. When these aren’t possible (not an uncommon scenario in general practice), practitioners may feel like they have failed.
• Challenge-Focused Identity: Embraces the broader context—client communication, environmental challenges, and business realities. These practitioners find satisfaction in overcoming contextual challenges.

General veterinary practice might therefore be a more satisfying work environment for vets with a challenge-focused identity. Veterinarians with a diagnosis-focused identity may not thrive in general practice unless they are able to re-negotiate their identity priorities. Alternatively, they may find a more suitable work environment such as specialty referral practice or academia (yes- this is an important point!).

1. Be honest about uncertainty
Avoid the temptation of using protocols and scientific principles to mitigate the uncertainty of clinical practice. Teach students to make good decisions in imperfect situations. Talk openly about how expertise develops over time through experience and reflection.

2. Share your real world experiences
Share your experiences of navigating the real world with students. Let them know that you are not perfect, and that they will not be perfect, but that being imperfect does not mean being ineffective.

3. Emphasize context
Acknowledge that students will face contextual challenges. Introduce concepts like the Spectrum of Care,^[7] which embraces variability and emphasizes that care must be adapted to each unique patient, client, and situation. There is no universal “gold standard” that can be automatically applied to every patient.

4. Encourage a challenge-focused identity
Help students navigate uncertainty and contextual problem-solving. Avoid focusing solely on the "right answer." Reflect on your own identity—where do you fall on the diagnosis–challenge identity spectrum? How might this influence your teaching?

5. Reevaluate what you teach
Ask yourself:

• Do students know what’s essential, what’s nice to know, and what’s just “cool”?
• Are you preparing them for what actually happens in practice—like the frequency of spays and neuters?
• Can you invite recent grads to share their first-year experiences?

6. Tie concepts to real world applications
If you can’t link a concept to real-world use, consider whether it is worth teaching. “Because it’s on the test” isn’t a good enough reason on its own for students to learn. Passing exams isn’t the end goal—practicing competently and compassionately is.

1. Recognize the shift
The strategies that helped you succeed in school won’t all work in practice. That doesn’t mean you’re unprepared—it just means you need to adapt. Timely, contextual competence—not perfection—is what success looks like in the real world.

2. Practice communication
Even veterinarians need to talk to people- you’ll need to talk with clients, staff, and colleagues. Build your communication skills now—they’re every bit as important as your technical ones.

3. Re-think uncertainty
Uncertainty can’t be eliminated. But if you approach it as a challenge it doesn’t have to be a scary thing.

4. Seek feedback
Ask your instructors how they’d approach real world challenges. Reflect on their answers—how would you adapt them to your own style?

5. Build social capital
Relationships matter. Cultivate connections with peers, mentors, and professionals at all stages. Support networks can help you weather tough times and grow your career.

6. Explore the profession early
If you're a student, get into the workplace as often as possible. Shadow vets. Talk to recent grads. Learn from those already walking the path.

Let’s retire the idea that “practice makes perfect.” The real world isn’t about perfection. It’s about progress, presence, and compassion in the face of uncertainty. Yes, the real world can be unpredictable, but that doesn’t mean you’re unprepared. With reflection, adaptability, and a willingness to learn from experience, you can thrive—even without a perfect diagnosis or a flawless plan.

Instructors: Remember what that threshold between school and practice felt like. Let that memory guide how you teach, support, and connect with your students.

Students: Learn not just to pass your courses, but to practice with resilience, empathy, and adaptability.

Remember: An imperfect veterinarian can still bring expertise, healing, and comfort to animals and people. You don’t have to be perfect to make a difference in the real world.

^[1] Clarke, C.A. and Knights, D. (2018) ‘Practice makes perfect? Skillful performances in veterinary work’, Human Relations, 71(10), 1395–1421, available: https://doi.org/10.1177/0018726717745605

^[2] Berg, M. (1997) ‘Promises and problems of the protocol’, Soc Sci Med, 44(8), 1081-1088, available: https://doi.org/10.1016/S0277-9536(96)00235-3

^[3] 1+2=3 not W!

^[4] Nett, R., et al (2015) ‘Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians’, JAVMA, 247(8), 945–955.

Quit warning: one in three vets say future not bright – BVA survey

^[5] Clarke and Knights 2018

^[6] Armitage-Chan, E. and May, S.A. (2018) ‘Identity, environment and mental wellbeing in the veterinary profession’, Vet Record, 183(2), 68, available: https://doi.org/10.1136/vr.104724

^[7] The Spectrum of Care Initiative - AAVMC