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Tag: clinical skills

  • New vet schools are not the solution

    New vet schools are not the solution

    We’ve barely had a day of news in the past year that didn’t include Brexit. Yet, do any of us really know what the real consequences will be?

    Within the veterinary profession, specific factors are undoubtedly going to be influenced by Brexit, even if we don’t know the extent of these yet. They do, however, include a great deal of legislation on welfare and meat hygiene, but also the future of the UK veterinary workforce.

    It has been suggested the proposed coalition of Keele University and Harper Adams for yet another UK vet school may help boost numbers of veterinary professionals in the UK post-Brexit, especially when it is suspected we may be facing a shortfall.

    I disagree.

    Not a new problem

    Stressed.
    Is training new vets going to be of detriment to the health and well-being of those in the profession already? IMAGE: GianlucaCiroTancredi/Fotolia.

    Yes, the veterinary profession has a shortage of experienced veterinary surgeons right now, but this was the case before the EU referendum was even in the pipeline – SPVS, for example, called for veterinary surgeons to be added to the UK’s shortage occupation list in 2015.

    Sure, post-Brexit, it is likely to get worse – for example, the uncertainty surrounding the whole situation is (anecdotally) already seeing some of our EU vets searching for jobs overseas and leaving. This isn’t just “vet news” either – the BBC (despite the ambiguous statistics quoted) also recognised the effects of Brexit on the veterinary profession in an article this week.

    But opening new vet schools isn’t the answer. For example, there is increasing awareness in the veterinary profession of the importance of mental health and a resultant expanding of the resources available for those who are struggling.

    We also frequently hear buzzwords such as “compassion fatigue” and “burnout”, which we need to do more about.

    My point is: we need to look after our current vets. This would prevent them getting tired and fed up, and ultimately leaving the profession – or, at least, leaving a clinical practice role.

    Sold the wrong idea?

    The Voices from the Future of the Profession report produced by the BVA/RCVS Vet Futures initiative in 2015 stated 50% of recent graduates thought their working lives did not meet their expectations. This disillusionment, set among a feeling of being undervalued, overworked and lacking a good work-life balance (something I’ve written about at length) leads to vets turning to other careers before they have a great deal of experience – this is what should be addressed.

    We need to focus on the well-being of the vets we have instead of luring even more school leavers into a profession they have false preconceptions of.

    More new graduates will not solve the problem – and this is coming from one. They will simply dilute the profession and struggle because there are less “experienced vets” to mentor them and help them hone their skills and knowledge. Ultimately, a large proportion of these will become stressed and leave within a couple of years – the vicious cycle is thus complete.

    Teaching tussles

    On a vet school level, irrespective of Brexit, this announcement is too not welcomed. At Glasgow, I have met clinicians that have chopped and changed between vet schools because there aren’t enough experts willing to teach, resulting in a bidding war between the universities.

    We now have nine vet schools across the UK and Ireland. The Aberwysth-RVC programme (for which updates on their plans were announced earlier this week) and the Keele-Harper Adams course are only going to add fuel to that fire. Where are we going to suddenly magic up so many more diplomats and EU specialists to teach? Or, for that matter, clinical skills and first opinion teachers?

    Couple-of-years-qualified graduates aren’t going to have the same breadth of experience to prepare students for a variety of surgical or clinical scenarios – they are not an adequate substitute.

    Reasoning questioned

    Pounds
    Is it simply a case of money, as Jordan claims?

    The plans for new vet schools is not about saving the profession, nor is it about Brexit. It is down to academic institutions seeking high-achieving school leavers to attract more undergraduates and gain more funding.

    It is ludicrous a university can just decide to open a vet school off its own back and threaten the resources of current vet schools, which include teaching staff and the availability of EMS placements, especially since many of the new course models (Nottingham, Surrey and the two proposed courses above) do not have their own teaching hospitals and, instead, use external practices.

    It is true the new courses will be monitored and analysed once they have an intake of students to assess whether the graduates will be allowed to practice as veterinary surgeons, but by then, it’s too late.

    There needs to be regulation to prevent it getting to that point, for the sake of the profession and the disillusioned school leavers applying en masse to these new courses.

  • Fortnight of firsts at practice placement

    QuoteI spent a couple of weeks at a mixed practice on extramural studies. It was a placement of firsts – first experience at a very “young” practice (lots of newish graduates), first clinical farm experience and first surgery experience.

    It gave me an insight into the difference between older, more experienced vets and new grads – from the way they approach consultations and cases to the time/skill difference in surgical procedures. Obviously, a lot of this comes with experience, but it was reassuring to know I’m not quite as lost as I thought I was (and it also helped me recognise areas to work on).

    I did work experience at farm practices before uni, but hadn’t been to one as a proper student. It entailed the bread and butter of farm practice – being shoulder deep in a cow’s rectum.

    My younger brother found it particularly fascinating, always asking me when I got home each night how many cows I’d seen. Appealing as it sounds, I found reproductive physiology and pharmacology began making a lot more sense.

    One day we were called out to castrate 34 calves, which turned out to be a day of avoiding hailstones while the vet cut, twisted, pulled and I injected. Nearing the end of the never-ending stream of beef calves, the vet invited me to have a go. A few minutes later, covered in blood, cow poo and sweat (it required a surprising amount of elbow grease), I had performed my first surgical procedure.

    The following day I found myself being told to scrub up, then was guided through a cat castrate. It was a bit surreal, because the vet started off with “cats are a bit like calves…” I couldn’t help wondering how many students castrated a calf before a cat…

    Cat's testicle
    “I couldn’t help wondering how many students castrated a calf before a cat…” Image ©iStock.com/rarinlee

    A few days later, the same vet supervised my second unassisted castrate. I had a real sense of achievement, having been able to perform the procedure without being told what to do. I know it’s a simple surgery and may seem like peanuts to a qualified vet, but it was quite a step for me – and everyone has to start somewhere.

    I also scrubbed in on an exploratory laparotomy on a ferret, which was unusual to say the least, especially when the huge mass we were investigating in the abdomen turned out to be fluid filled and exploded slightly after a needle was stuck in. Since it was attached to the uterus, the vet decided to spay the ferret, which sparked the conversation of why ferrets aren’t often spayed and the resulting hormonal changes involving the adrenals.

    Overall, I had a tiring couple of weeks, but felt the vets were eager to get me involved and my clinical skills certainly progressed further than I expected.

  • It takes two to tango

    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.

    ems-quote2The 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.

  • Clinical EMS 101

    Dunce
    Vet school doesn’t prepare you for making a complete idiot out of yourself.

    At vet school, you learn some basic clinical skills and are taught how to conduct a general clinical examination to prepare you for EMS placements in veterinary surgeries. What they don’t prepare you for is making a complete idiot out of yourself.

    Before my first clinical placement I told the vets I would be working with that I had only just finished second year and had no pharmacological knowledge as of yet, non-existent surgical experience and very little understanding of small animal medicine in general.

    Luckily, all the vets in the practice were very good at judging the level of my understanding and seemed to find the right balance between patience and pushing me for answers.

    Things seemed to be going OK. I’d successfully taken blood samples and started to make sense of abdominal palpation. However, applying clinical skills taught at vet school isn’t necessarily straightforward – cadavers have a distinct lack of weapons in the form of claws and teeth, but I was coping with that reasonably well and taking note of the vets’ advice on particular techniques.

    This was until a few days in, when I found myself working with the head vet…

    In the same morning, I managed to spray penicillin all over my face while trying to administer an injection, incorrectly insert an endotracheal tube despite being 99% sure it was OK, and cover myself in guinea-pig blood while clipping nails, leaving me to wear the stained tabard for the rest of the day.

    To add insult to injury, I later misread the scales and recited the incorrect weight without thinking (it didn’t occur to me that there’s no way a fully grown border collie could weigh 10kg).

    Isolated, these incidents might not seem like the end of the world, but when they all happen in the same day in front of the head vet and when one of the clients involved is your neighbour, you do feel like shouting “I am a vet student – honest”, despite feeling like a complete moron.

    This was, however, followed by days of mini-triumph, such as inserting an IV catheter correctly for the first time or scaling and polishing a dog’s teeth myself.

    The important thing to remember is that you are inexperienced, and you just have to accept there will be days when nothing seems to go your way, get past them and carry on with your head held high – even if it is covered in yellow spots of penicillin.

  • A vet school storm on the horizon

    Following last year’s announcement that the University of Surrey is to open a new veterinary school (taking in the first cohort of students in autumn 2014), it would appear that the University of Ulster (Northern Ireland) is now jumping on the bandwagon.

    These proposals have indeed kicked up quite a storm in the veterinary world.

    There seems to be little positive attitude towards this news, with many of us panicking about academic standards, graduate prospects and EMS availability.

    With neither of these being Russell Group universities, it has to be questioned whether the academic standards will be comparable to the current UK vet schools.

    It is notoriously difficult to get into vet school, but will the two new universities have lower entry requirements? If so, this would be providing a back up option for many applicants and, as a result, decrease the currently high standard of veterinary students. If the graduates are indeed less knowledgable, or have less well-developed clinical skills, would this encourage the employment of poorer quality vets in second-rate practices?

    Evidently, more veterinary graduates would mean more competition for jobs, hence pushing down the salaries that graduates would be willing for work for.

    It has been suggested that the restricted number of graduates being able to go directly into clinical practice would mean that more veterinary students would be encouraged to take a different career route (research or veterinary education, for example). But if the aim is not to produce veterinary professionals, why not instead increase the intake on veterinary biosciences courses for those more interested in research?

    I also think it unfair to expect new graduates to begin teaching at vet schools immediately, even if that is what they’re interested in doing. Their credibility and respect from their students would be dramatically reduced if they’ve not actually had any experience in practice and can’t give clinical case examples to the possible vets of the future.

    Another concern is the availability for EMS opportunities. With an increased number of students throughout the UK as a whole, it will become increasingly difficult for students to gain clinical EMS placements. To further the competition, Surrey will not be opening its own teaching hospital as such, and it is expected that final year rotations will instead take place in veterinary practices in the surrounding area, reducing their availability for students from other universities to undertake EMS.

    Could this be the future employment opportunity for UK veterinary graduates?

    Of course, there are a lot of “ifs” and “buts” here, and potentially the two new vet schools could produce better graduates than the rest of the UK – but this would still increase the competition for graduate jobs and EMS placements.

    In my opinion, the main concern is not the repercussions of opening these two vet schools themselves, but the catastrophic effects that would result from further universities following suit.

    With little legislation able to dictate requirements for opening a new vet school, the prospect of having as many veterinary education institutions as medical ones could soon become a reality. Before we know it, we could be inundated with veterinary graduates, some of questionable quality, and the next generation of veterinary professionals will be fighting tooth and nail for a severely underpaid job.

  • One year as a vet student

    Jordan

    Having received my results for the professional exams, I can finally say that I’ve finished my first year at vet school!

    Being brutally honest, the first term was a bit of a culture shock. I had focused so much on getting into vet school and being a vet that I didn’t really think about what it would be like when I actually got there.

    Coming from a town on the edge of the countryside in the heart of England and moving to Glasgow was quite a change. Although the vet school is on the edge of the city in a fairly green area, it wasn’t the same as being able to cycle 10 miles on quiet country roads to the farm where my horses are kept.

    I think what I found the hardest was not being able to ride. I had gone from riding my horse every day to having a lesson with the uni riding club once a week. Owning a horse is a lifestyle, and not something I wanted to give up.

    While the first term was largely spent getting used to the mountainous workload, I managed to squeeze other things into my time. Many of my friends from home went to uni a year earlier than me and have told me that Fresher’s Week is the craziest uni experience. But none of them are vets, and they don’t know what AVS Sports weekend is (an annual event hosted by the Association of Veterinary Students). This year, it was held in Glasgow, so we didn’t do any traveling, but certainly experienced the madness of meeting people from every other vet school, who came in all shapes and sizes – penguins, mimes, power rangers and more.

    Another annual inter-vet-school event for us is Dick Day, where Glasgow competes against Edinburgh – The Royal (Dick) School of Veterinary Studies – in various team sports. Again, this year, it was held in Glasgow. Unlike AVS, the sport on Dick Day is serious and there was a strong sense of rivalry between the schools. I was part of the vet hockey team, but unfortunately we did not defeat the Dick vets in our match.

    After battling through a long term of learning at a hundred times the rate we were used to and facing the stress of the class exams, I started the second term knowing better what to expect. I threw myself into getting fit for Easter by swimming, cycling and gyming. I also took up a weekly creative writing class that was put on by the Glasgow uni English department, to rekindle my love of writing.

    At Easter, I had my first taste of EMS in the form of my first time lambing. The placement was great – we got loads of hands-on experience and got involved in all aspects of lambing time. We learnt loads, and everything from those seemingly endless sheep lectures started to sink in. Although tiring, we enjoyed every bit of it.

    I also spent a week in Norway doing a charity dog sledding challenge to raise money for the Warwickshire and Northamptonshire Air Ambulance, who saved my life when I had a serious riding accident two years previously. My family and I had spent a year raising money by doing bucket collections, making Christmas decorations, selling Valentines Day cupcakes, and selling bedding plants. The challenge was fantastic – I loved working with the dogs and getting to see the beautiful Arctic landscape.

    However, the day after I landed back in the UK, I was driving back to Glasgow to face revision and the end of year professional exams. I especially began to feel the pressure, because I had arranged to be abroad during the summer when resits would be scheduled (not a wise move, and not something I’d recommend).

    We had exams in five subjects: anatomy, physiology, biomolecular sciences, animal husbandry and veterinary professional and clinical skills (VPCS). While I felt most of them went OK, I was almost certain I’d mucked up VPCS after the first day of practicals, having gotten flustered and putting sharps in the wrong bin (we make such idiots out of ourselves when we’re nervous).

    During the first month of the summer holidays (while avoiding thinking about the inevitable doom that results would bring), I did some dairy EMS. I’d never been on a dairy farm before and found the experience extremely useful in improving handling skills and my understanding of the dairy industry. I was pleasantly surprised by how much I’d retained from the two cattle lectures we’d had so far.

    Without warning, our results started to trickle in, one subject at a time… and so began the momentary relief after receiving one and then the rising anticipation for the next one. Finally, the last one came in, and by some miracle (or so it felt), I had passed all of them! All that worrying about being away for resits was extinguished, and now I could get on with preparing for the next set of EMS I had planned… six weeks in Bolivia in a wildlife sanctuary.

    And so I have passed first year. It’s been hard work and no doubt second year will be harder, but vet school hasn’t defeated me yet!