As I’ve done quite a few clinical tips now, I thought it would be interesting to ask our receptionists what their top tips from the front line would be.
Sara, one of our excellent branch manager team, says communication is essential. Passing on as much information as possible to the clinical team can sometimes be challenging if presented with a very worried or upset client on the phone.
Sara also says remaining calm is key, and she always does her best to reassure clients and ensure the patient turns up at the right surgery at right time.
I recently had a male cat presented that was “just a bit quiet” – it wasn’t moving much and, uncharacteristically, had not eaten breakfast that morning.
The owner had barely removed our feline friend from the carrier when I thought: “This guy’s got a blocked bladder.”
Abdominal palpation confirmed my intuitive diagnosis.
I’ve been thinking about this a lot recently – what does it mean? Am I just getting old and have a subconscious feel for what’s coming in through the door?
Then I heard a programme on Radio 4 (that confirms my age!) that said “gut feelings” were actually learned behaviour, and were your subconscious popping ideas into your conscious brain.
So my tip would be to go with those hunches – you might just be right!
When you apply to vet school, there are certain boxes you have to tick: achieve the right A-Levels (or Advanced Highers), complete a number of weeks of work experience, and pass that dreaded interview.
What nobody tells you, however, is that being a vet student requires a number of other skills that seemingly have nothing to do with the veterinary profession.
Star Baker
After completing a week of EMS at a vet practice, there is the unspoken expectation that you should produce some form of teeth-rotting goodness as a thank you. Your vets would probably appreciate a box of Celebrations, but they’re going to be far more impressed if you turn out to be harbouring secret Mary Berry-esque talents.
Not only that, many clubs and societies use baked goodies to lure in new members, and some vet schools even host an anatomy themed bake off, for which the more exceptional entries often leave us questioning whether their creators are in the right profession.
Salesperson Extraordinaire
Fundraising is a common theme at vet school, whether it’s for a charity event, to reduce the ticket price of halfway ball or for a veterinary society to hold a practical session.
Getting fellow students to part with their hard-earned cash can be more difficult than you’d expect, but persuasion is a great skill to develop, especially when you may find yourself moving on to trying to entice large pharmaceutical companies to sponsor a much bigger event.
Perseverance (or rather bugging people on Facebook and through emails) can really pay off.
Catwalk Designer
Jordan (far left) and the other Glasgow Gnomes prepare for the AVS sports weekend.
Vet students are notorious for their love of fancy dress. Perhaps the results aren’t quite what you’d expect to see on the cover of Vogue, but it is astonishing what we can whip up out of nothing in five minutes flat (or perhaps three hours that may have been better dedicated to studying).
Movie characters, gnomes, circus, thrift shop, “anything but clothes”… There hasn’t been a theme that has baffled us yet.
Rally Driver
We may not all be the next Sébastien Loeb or Lewis Hamilton, but driving is a pretty important skill. Granted, not every vet student holds a licence, but those that do find it a lot easier to get to the numerous EMS placements we have to fulfil during our time at vet school.
Many of us have other attributes from being sporty or musical, to being a fluent multi-linguist or technology whizz. These may stem from trying to boost our personal statements prior to applying for vet school or could just be personality traits.
However, if you don’t enter vet school as a “well-rounded” person, you’ll certainly come out as one.
Itchy Charlie by Dan Boldy [CC-BY-SA-3.0], via deviantART.Given my interest in dermatology a lot of itchy canine and feline individuals are passed in my direction.
They often have a history of recurrent microbial skin infections either in the form of Staphylococcal pyoderma or Malassezia dermatitis, which is treated as and when it occurs.
I’m often surprised to find these individuals are not receiving routine parasite control, even when many of them have been prescribed it (sadly it is not effective while still in the packet), particularly as we do have both lungworm (Angiostrongylus vasorum) and Sarcoptes about in our practice locality.
My tip would be start to look for the underlying cause when these patients keep coming back – starting with Sarcoptes (and I personally prefer the blood test because I rarely find mites on scrapings).
Fine-needle aspiration (FNA) of a mass. Image source: BSAVA ’09 Congress Times.
We recently had a case where a freely mobile, soft mass on the ventral abdomen, which had been present for a number of years, had started to get larger.
We carried out a fine-needle aspiration (FNA) biopsy, and I fully expected this to confirm the presence of a lipoma (a benign fatty tumour common in dogs).
However, I was really surprised when the cytology revealed the presence of a mast cell tumour, with a surgical procedure to follow.
My tip would be that it is definitely worthwhile checking out those seemingly innocuous “lipomas” with FNAs.
Argentinian Tango dance duo German Cornejo and Gisela Galeassi. Image: Fuentes/Fernandez
Before the full force of third year hit, the first week back at vet school started with everyone catching up on tales from their summer holidays.
Before long, it was like we’d never left and the four months of freedom seemed to fade into a distant memory. However, one particular topic of holiday gossip that I have been dwelling on is extramural studies (EMS).
Everyone had undertaken some form of EMS over the summer, whether it was just a week or two, a solid two months, clinical, preclinical, large or small animal – there is a lot of room for variation in our placements, but I was still surprised to hear of how different some of my friends’ experiences had been, despite doing theoretically similar placements.
A number of us had embarked on our first clinical placements, and although we’re all at the same stage of our studies and therefore should be able to get involved during veterinary placements to a similar extent, the truth is somewhat different.
Just among my friends, there were experience levels at both ends of the scale, with some students having been simply told to observe consultations and others being allowed to scrub into surgical procedures.
This wide range of experiences can be attributed to many factors, including:
the veterinary practice
how well the vet knows the student (either from previous experience or length of placement)
how well the staff have judged the student’s knowledge and ability based on stage of the veterinary course
attitude and competency of the vet
the individual student’s skills, experience and attitude
I was advised by a final year student last year to undertake the majority of my clinical EMS at one single practice if possible, because by getting to know the vets well (and vice versa), they’ll be able to judge your level of competency better and encourage you to get more involved. I can now begin to appreciate this advice more, having listened to the anecdotes from my friends.
The practical teaching we receive at vet school is just not enough to be able to adequately develop and refine essential clinical skills that will be needed everyday in general veterinary practice. The solution to this is EMS, and we are constantly being told that we, as students, need to take responsibility for our own learning and ensure that we get the most out of EMS by getting involved. And I whole-heartedly agree – we can’t be spoon-fed forever and need to be proactive in gaining the right type of experience.
However, you could be the most enthusiast student in the world and read up on cases every night, and yet still be very limited in what you are allowed to do. While getting the most out of a placement is up to us, it takes two to tango, and we need the vets’ support too in order to enable us to do this.
I know taking on students and teaching or letting them practice techniques can be time-consuming and inconvenient, but we need to gain experience somehow. At some point during their training, all vets would have had to see practice and learn in the same way, so is it not just a way of giving back to the profession?
I can also appreciate that some people are just not natural teachers (after all we’re training to work in a vet clinic, not a school), but a little bit of patience and some advice can go a whole lot further than just ignoring a student.
It may sometimes be inappropriate for a student to be asking questions or trying things out – in the consultation room in front of the client, for example – but these situations can be fine when approached the right way. I was lucky enough to stand in with vets that would always try and get me to see/hear/feel things. If they found something interesting in the consultation room, they’d always explain to the client that I was a student and ask if they minded me having a look. This seems far more reasonable to me than telling a student they are to observe only.
Another approach I experienced myself was the vet taking the animal to the surgery room to take blood samples and allowing me to perform my own clinical examination (having not actually been in the original consultation).
As mentioned previously, there can be many factors involved in getting a “good” clinical placement. It also depends how busy the surgery is – if there are four clients waiting to see the same vet, it’s understandable for the vet to whizz through them without having much time for questions or explanations (whenever this happened to me, the vet apologised for not explaining, even though she really didn’t need to!).
I have to agree there are advantages to going back to a veterinary practice you know. I did work experience for three years before university at the practice I did my EMS at this summer, and definitely felt welcomed as part of the team, which can be difficult at an entirely new practice.
Yes, it is our responsibility to find the balance between getting involved to gain experience and not interfering with consults, but we also need vets to help us a bit too. Undertaking EMS is the only way we will prepare ourselves for the future, and we’re extremely grateful for the vets that encourage and help us every step of the way (partly why most vet students are pretty good at baking). I think it’s just a case of finding the right practice for both you and the vets you’ll be learning from.
Many clients have difficulty persuading their cat to take tablets. Image source unknown.
OK, a potentially controversial one this…
There is a lot of evidence highlighting resistance to antibiotic therapy both in the human and veterinary fields. My understanding is that this is, in part, due to poor compliance.
I’ve certainly come across clients who have difficulty giving tablets to their cat, and have also seen cases that “appear” to respond poorly to amoxicillin/calvulanic acid but then respond rapidly to Convenia.
So, my argument is that injecting a long-acting preparation licensed for the treatment of soft tissue infections in cats (having bactericidal activity to the “usual suspect” oral bacterial flora of the cat) is preferable to giving oral meds that owners find difficult, and in some cases impossible, to administer.
I might even suggest this may result in less resistance.
I now try to avoid running food trials in mid-summer. Certainly on first presentation, with no previous history of allergic dermatitis, I tend to treat accordingly and wait to see what happens later in the year as vegetation dies back.
Food allergic dermatitis does not have a seasonal basis, so if the signs resolve or exacerbate over the course of the year, food allergy is not the primary cause (although some cases can confuse us as they have both an element of food allergy and atopic dermatitis).
I have also seen cases started on food trials in the summer months that appear to get better as the year progresses, only for the owner to become reluctant to challenge as the dog is “better” – whereas, in reality, the improvement is the result of reduced exposure to an environmental allergen.
So I usually wait and see if the signs persist to suggest a non-seasonal allergic dermatitis, and THEN do a food trial.
Jordan and her fellow stewards “hard at work” at the 2014 BEVA Congress.
As a student steward at the British Equine Veterinary Association (BEVA) Congress, my responsibilities included helping set up the trade exhibition, handing out welcome packs at the registration desk and escorting speakers to the appropriate rooms. However, we were also able to sit in on lectures and act as the legs for the microphone whenever there were any questions.
The congress provided a great opportunity for networking and meeting other students from across both the UK and the world, as well as many veterinary professionals from every corner of the globe.
One of the lectures I sat in on was a Q&A session, “Ask the editor”, about publishing clinical research. A particularly sensitive topic was the process of peer reviewing research papers. The main point of discussion that interested me was the huge variation in quality of reviews depending on the reviewer, especially when veterinary schools were brought in to the argument.
As someone with no experience of research, the general impression I got was that one of the issues with peer reviewing is many reviewers are practising vets who – having done a veterinary degree rather than a research-based degree – are never taught specifically how to write a paper, and therefore aren’t taught how to review one either.
And then came the inevitable “well perhaps that should be introduced to the veterinary curriculum”.
In my opinion, absolutely not. The format of the veterinary degree is primarily geared towards producing vets. The majority of veterinary students will have chosen veterinary school because they wanted to be a vet, not because they wanted to learn how to review scientific papers.
BEVA 2014 was obviously a very sombre event.
Is the veterinary course not intensive and long enough without adding in extra skills that would be of limited use to the everyday clinician with no interest in research?
This also brings me back to the controversy surrounding the opening of new UK veterinary schools. One of the arguments countering the “too many graduates and not enough jobs“ point is a veterinary degree doesn’t necessarily lead to a career as a vet. Some graduates opt for other aspects of the profession, such as research.
I have to disagree – with extramural studies forming such a huge chunk of the course, it is certainly preparing students to be practising vets, not researchers. If you want to end up in research, do a bioveterinary science degree instead. That way, students aiming for a research career would get the scientific background knowledge of veterinary and research experience, without having to undertake hours in a veterinary clinic, learning practical skills they’ll never use.
I understand some students may want to practise as vets and yet still become involved in research. However, I believe masters’ courses are available, or the option of intercalation, which would allow them to gain some research experience.
I strongly believe not only the vast majority of veterinary students would resent a more research-based degree, but also it would produce less-competent clinicians as a result.
Research should be an option, but not a compulsory part of becoming a vet.
“Canine Atopy” with dermatitis around the eye, caused by rubbing. Via Wikipedia Commons.
My colleagues and I use immunotherapy on a fair number of dogs to treat atopic dermatitis. Research tells us it can be a valuable tool in some dogs, but at the same time up to a third of dogs respond poorly.
We are lucky in our practice as anecdotally we find the majority of dogs do well, and we only get 10% to 15% that do not respond. This may be because:
We are really hot on parasite control in our practice – we have a large urban fox population and see cases of angiostrongylosis – so we advise Advocate on a regular, monthly basis. So it is unusual for us to see atopic dogs that flare due to concurrent parasite infestation.
We strongly advise owners to do and/or preserve with food trials – and some, okay, just one or two, do respond and relapse on challenge.
We also try to make sure we keep the perpetuating factors, for example, pyoderma and Malassezia dermatitis, to a minimum with medicated wipes and shampoos.
The older the dog when it starts immunotherapy the less likely it is to respond and we advise our owners accordingly.
Good luck with those frustrating allergy cases – hopefully there are some tips here to help. And cats also do well on immunotherapy.
