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Tag: neutering

Dystocia, pt 1: labour stages
Now most female canine patients are spayed, it comes as no surprise reproductive emergencies are not as common.

One confusion seems to be not knowing how to determine a true dystocia emergency – especially when given advice over the telephone – from the process of normal parturition.

Another concern is how to confidently form a diagnostic pathway to determine the cause of dystocia – especially for reasons other than obvious physical abnormalities (for example, fetopelvic disparity and fetal malposition).

Often, once we decide to go down the medical treatment pathway – whether the result of findings or owner/financial constraint – no one is confident as to what medication should be used and how often drugs can be given safely.

This series of blogs will address these issues in a step-by-step manner. Hopefully, by the end, you will be confident in the diagnosis and management of dystocia.

Labour stages

Before moving on to the signs of dystocia, let’s go through the signs of labour.

First stage labour

First stage labour is characterised by panting, tremoring, nesting behaviour, a drop in core temperature – usually a drop by almost 1°C 24 hours prior to second stage labour – and a drop of progesterone to below 2mg/ml.

Third stage labour occurs generally within 15 minutes after passing a puppy or kitten. Image © foto ARts / Adobe Stock
- dogs: approximately 6 to 12 hours
- cats: approximately 6 to 24 hours
Second stage labour

Second stage labour is landmarked by the water breaking, visible abdominal contractions, and the allantoic/amniotic sac or fetal parts visible from the vulva.

If vulval discharge is present, they should be clear. Excessive amount of bright red haemorrhage, green or black discharge prior to delivery, or purulent material can indicate a pathological process requiring immediate veterinary attention.
- dogs: approximately 3 to 6 hours
- cats: approximately 6 to 24 hours
Third stage labour

Third stage labour this is when passage of all the placenta has occurred, generally within 15 minutes after passing a puppy or kitten.

Clues

Now we understand the normal progression of parturition, a few clues exist in the history that could suggest dystocia may be present.

Some breeders will often know the ovulation timing of the patient – especially if AI was performed. Tests such as progesterone levels, luteal hormone (LH) levels, cytology and vaginoscopy are some ways where it can help time the ovulation.

The normal gestation length should not be any longer than 66 days from the LH surge or, if the ovulation history is unknown, 72 days from the last known breeding.

History of prior dystocia is a warning, as most animals with prior parturition difficulties are more likely to develop dystocia again.

The same goes for animals that have previously required a caesarean. Their risk of requiring future caesareans is high, with further risk of uterine rupture if dystocia happens again.

Animals that have previously had a caesarean are at high risk of requiring future caesareans, with further risk of uterine rupture if dystocia happens again. Image © Pilipipa / Adobe Stock

Intervention signs

Owners often telephone after the failure of normal progression of delivery. The signs that always require immediate intervention are:
- more than 4 hours have passed from the rupture of the first chorioallantois
- more than 2 hours between delivery
- more than 30 minutes of strong abdominal contraction and no delivery
- presence of green or black discharge before delivery
- large amount of bright red haemorrhage
- abnormal amount of pain during contractions
- collapse of the bitch or distracted mothering
Any of these signs require immediate presentation to the veterinarian. Delivery of stillborn puppies is also an indication where veterinary attention is indicated.

Finally, if owners are concerned, it is best to advise veterinary assessment rather than try to convince them everything is okay based on what they describe over the telephone.
November 20, 2023
Cutting edge (Goad in Goa, pt 2)

My recent trip to India comprised two weeks of intense sun, gorgeous beaches and delicious food that truly tested the constitution of my stomach. The majority of my time, however, was spent doing what I had gone all the way out there to do: surgery – lots and lots of surgery!

After 10 weeks of my clinical EMS was shut down by the pandemic, I had felt the desire to both travel and gain extra experience wherever possible, and so a surgical course based in Goa sounded like the perfect solution.

Spays for days

Image courtesy Animal Rescue Centre, South Goa.

For my friend and I, the holy grail of all surgeries was the dreaded bitch spay. At the end of our placement – after what we presumed would initially be just watching, then maybe some helping, probably followed by a whole lot of cat castrating (the gateway surgery for newbies) – it was our hope that we would maybe (maayyybe) even be allowed to attempt a bitch spay for ourselves.

It didn’t ever occur to me that I would be executing my first bitch spay, from start to finish, by day three. Nor did I ever imagine that I would leave having done a total of 10… essentially one per day (although on some days we did two each).

Ironically, cat castrates were few and far between – even dog castrates for that matter – and of the 25 total surgeries I performed in those weeks, 16 were spays.

Left in the dark

The main thing I took away from the trip (aside from sore fingers) was a newfound appreciation for the fundamentals of surgery.

As was initially advertised to us, the clinic we found ourselves working in was charity based, and so lacked many of the facilities I think I’d learned (without even realising) to take for granted back home. Instruments were sterilised in an autoclave, there was no inhalant anaesthesia available, and no patient monitoring beyond CRT, pulse and breathing rate.

Plus, since there was no surgical lighting, and only one table was directly beneath the light, it meant a really deep-chested bitch spay on the other end of the room felt like operating in the dark.

How does it feel?

With no surgical lighting and only one head-torch to share between the two of us, the vet monitoring us joked towards the end of the placement that I could perform surgery by braille.

Although I wouldn’t recommend this approach to anyone, it gave me an incredible appreciation for the feel of normal versus abnormal anatomy – and that’s something no amount of revision or surgical observance could ever have given me.

Anaesthesia was purely parenteral, with top-ups being given as needed. We were all quite surprised by how well this worked for the majority of surgeries, with only a few hiccups along the way (and by hiccups I mean that, on one occasion, my patient turned around to look at me while I still had my fingers inside its abdomen).

The EMS placement’s main advertising pull had been as an opportunity to gain “incredible surgical experience”, says Eleanor.

Expect the unexpected

No matter how much they teach you, or how well you learn the steps, there will always be a surgery – usually a bitch spay – that throws you a curveball (unfortunately, our patients haven’t read the textbook and are under no obligation to behave).

Whether it’s a ginormous blood vessel masquerading in a portion of facia, or a large glob of fat obscuring your view, every spay (even every castrate) has the potential to be entirely different to the previous one; surgery is not an endeavour for people who can’t roll with the punches or adapt their plan to a new situation.

I’ve heard the phrase, “no plan ever survives first contact with the enemy”, but I think my own proverb would read: “No surgical plan ever survives first contact with the patient.”

Well taught

One of the best instruments a vet can have at their disposal is support. My friend and I could not have asked for a better teacher, and the skills taught to us will undoubtedly be invaluable to us during the next stage of our careers.

I wouldn’t say that surgical programmes like this are for the faint hearted, but it provided me with experience that I simply would not have been able to gain had I not stepped out of my comfort zone.

March 29, 2023
Tales of an Indian winter

It had been an ambition of mine since the beginning of vet school to do some type of work abroad, whether it be preclinical or clinical, a paid position or volunteer work.

A big reason I undertook an intercalated MSc was for the option it presented for a three-month research period in Western Australia. Sadly, COVID-19 put a stop to that and my research never wandered further than my desk – but, if anything, the pandemic made me feel even more passionate about travelling for my EMS.

Gone to Goa

Weekends spent “lolling on the beach” were well-deserved, says Eleanor.

A friend and I both settled on a small rescue centre in Goa, India, for the placement (neither of us feeling quite brave enough to go it alone) and despite planning it almost a year in advance, the date caught up with us quite quickly. Before we knew it, we were there.

Let the record show that the motivation for this trip was not to escape from the harsh English January weather, nor to fill up on delicious curries, although the temperature did make a welcome change and I’m unsure a takeaway will ever cut it again.

The whole reason for the placement was to gain the kind of surgical experience that just isn’t readily available to students in the UK.

Understandably, vet practices can take a while to warm up to students enough to trust them to carve into somebody’s beloved animals, but this makes for generation after generation of new grads who feel completely out of depth with a scalpel in their hands.

Great(er than our) expectations

The placement’s main advertising pull had been as an opportunity to gain incredible surgical experience, but we had gone into it with some trepidation that it wasn’t going to be nearly as busy and hands-on as we’d hoped. It turned out to surpass our expectations and go right out the other side…

Weekends spent lolling on the beach were well-deserved after numerous 11-hour shifts with numb fingers and thumbs from uncooperative clamps and needle holders.

The surgical side of the trip deserves an article of its own – but suffice it to say that, between the two of us, my friend and I neutered almost 50 dogs and cats, including 15 unassisted but supervised dog spays. It was an incredible rewarding feeling when each surgery finished, knowing we were doing even just a small bit in the effort to reduce India’s stray population.

Eleanor found her EMS placement in Goa “incredible rewarding”.

Learning valuable lessons

Let it be said, I am not the most confident of travellers, and 18 hours of travel across three planes and four airports are not for the faint of heart, but neither is India – and while I have entirely fallen in love with the country, its beauty and its animals, there was a lot of disorganisation that made my poor little control-freak brain spin.

I think that learning to take each day as it comes, and constantly adapting to new situations or pressures has taught me a lot of valuable skills in a very short space of time.

In particular, the vet who taught and supervised us was invaluable in making the placement such a success. She gave us an incredible amount of patience and taught me skills in both surgery and how to face a stressful situation that I will carry with me throughout my career.

March 16, 2023
What about vets on the front line?
Our profession is generally pretty good at pulling together in the face of adversity.

I’ve always loved the community feel of being able to go to CPD events, and usually know someone, or have connections with someone, who is there.

I love being able to send a message to my uni friends at any time of day or night – be that for clinical advice, moral support or reassurance on something entirely non-vet related – and get a reply. Failing that, you can often seek an answer or support from one of the vet Facebook groups on numerous topics.

In light of COVID-19, the veterinary world has rallied together… to a point.

One for all, and all for…

Those who have been furloughed are finding a wealth of free online CPD available to fill their time and keep connected clinically. Not only are there webinars, but there’s a plethora of online workouts or discussion groups to actively engage in.

That all sounds lovely, but what about those of us who are still working? What support is there for the minimal staff left in clinics who (despite all these figures on turnover being down) are battling ridiculous increases in workload?

Less is… less

There’s less staff in most clinics, to varying degrees, but I have heard horror stories about severely restricted numbers and even certain groups furloughing everyone but vets.

Whatever business decision may lie behind that, these clinics must be in chaos. Vets, who are already stretched trying to do their “normal” jobs (it is currently far from normal), are also running their own bloods, cleaning, answering phones, chasing and taking payments, sorting insurance claims and ordering stock, among other things.

These tasks may be alien to some of us, and trying to navigate previously undiscovered depths of the practice management system at the end of an exhausting shift adds unnecessary stress.

We love our nurses and receptionists as it is, but those who are currently deprived of them will be unearthing a a gargantuan respect for them in the future.

Crisis consulting

Consulting in this environment makes you realise how much multitasking we would ordinarily do. Currently, my consults look like this:
- Owner arrives and calls reception.
- I try to work out which car he or she is in, then take a brief history from 2m away.
- Take the animal into the practice.
- Find a nurse to assist with the handling.
- Examine the animal.
- Telephone the owner from the practice or go back outside to discuss with him or her from a safe distance, before returning to the animal to give treatment.
- Give the animal back to the owner.
- Dispense medication, then ask the owner to call reception again to pay…
This takes a lot longer than normal consults, so working to offer the same number of appointment slots is both relentless and draining.

Lies and abuse

Everyone is used to certain number of disgruntled clients, but the barrage of abuse those on reception are receiving from clients is unprecedented.

It would seem many members of the public are not getting the “stay at home” message and are furious when we explain a nail clip is not an emergency. As a result, we are now seeing clients exaggerating, or just plain lying, in order to be seen.

A choice example last week was a dog booked for a potential euthanasia, but turned out to be a weight clinic. We then had to stifle our disbelief and anger at these time wasters before moving on to the next client, who has desperately tried to hold off from having to make the difficult decision to say goodbye to their dearest pet under these circumstances – and yet we can only offer words of comfort from a distance and inject from the end of a drip line, which really doesn’t seem enough.

Unfortunately, the COVID clearout seems to be worse than the annual Christmas clearout, and these scenarios are not isolated, but heartbreakingly frequent.

Lost in translation

And what support do we get? We get the RCVS and BVA back-pedalling on their original statement, to then shirk responsibility and leave it “up to individual practices” to interpret the “guidance” how they wish.

After the clarity of the original stance on vaccinations, this ambiguous follow up was very disappointing. The truth is many vets feel that corporates and business owners will take this as a green light to return to business as usual, while firmly claiming that it is most definitely not business as usual.

I can agree with that – the way we are working is certainly not the usual, but if we are now to do vaccines and neutering again, what exactly are we missing? Stable med checks, done via telephone rather than in person?

Taking the high or low road?

We get colleagues taking the moral high ground, questioning our commitment to the oath we took on graduation to put animal heath and welfare above all else. Just because I don’t think vaccinations are currently a priority, it doesn’t mean I don’t care about my patients anymore – human health has to come first.

We get corporates issuing yet more paperwork to encourage us to document risk assessments – while seemingly offsetting the responsibility to us – so that if their business gets sued for denying to provide care or (God forbid) agreeing to see an animal that results in transmission of COVID-19 between owner/vet, it was the vet or receptionist who took the phone call’s fault for making that decision.

Aside from this, the phones are ringing off the hook and vets are running around like blue-arsed flies, so practically, where are we going to find the time to fill in these bloody forms?

Horseplay

Before any of that, the request to risk assess mild ailments is fundamentally flawed when we are being told to go out and do horse boosters.

While equine vaccinations and other routine work that is now being pushed again, because equine turnover is the most severely affected of all veterinary sectors, we are told to maintain safe social distancing at all times.

With equine vets reported to be one of the most dangerous occupations, is it sensible to expect us to administer vaccines with no one holding the horse? In some, if not most, cases, that will probably be okay. But with owners consistently lying to us to be given an “emergency” appointment, how long before an owner lies about his or her severely needle/vet-shy horse and one of us pays the price?

Heading for burnout

I don’t pretend to understand the intricacies of business management, but you cannot flog a dead horse. Many vets who have barely had time to inhale lunch are working different and longer shifts just to cope with the “emergencies” – and yet you’re asking us to do more?

It’s incredulous that the veterinary sector seems to think itself superior to all the other thousands of businesses up and down the country that are struggling or facing collapse. By continuing to pile the pressure on to staff with increasing risk of burnout, you might preserve some income, but you’ll be lucky to have any vets left by the end of this.

Is anybody listening?

We are angry that the higher-ups in the profession are treating us this way. We feel guilty for being jealous of, or feeling antipathy towards, our furloughed colleagues. We are emotionally drained. We feel guilty because this can only be a fraction of how front-line NHS staff must be feeling – and above all, we are exhausted.

In a profession with an already poor record for mental health and suicide, we are now even more stretched, under even more pressure from all angles – and no one seems to be listening.
April 29, 2020
Commonly held beliefs that don’t do us any good, pt 2

Belief #2: if you can’t afford to care for an animal then you shouldn’t have one

You, young doctor or nurse – living in your privileged society of excess, with your years of study, working in an industry that exists largely to minimise animal suffering – have certain expectations of what “taking care of an animal” looks like.

Of course, we should always strive to do the best we can for any animal in our care, but we need to learn to put judgement aside when an owner’s abilities don’t stretch to meet our expectations.

Saying “if you can’t afford to care for a pet then you shouldn’t be allowed to own one” is a subjective and biased opinion.

What defines an appropriate level of “caring for your animal” is based to a large degree on your background, prior experiences with animals and financial circumstances.

Where is the line?

Let’s agree that if someone takes an animal in your care, it is his or her responsibility to meet its basic needs – make sure it doesn’t starve, freeze or cook to death; don’t cause it unnecessary suffering through wilful abuse or neglect; and satisfy at least some basic emotional needs of connection, and freedom from fear and pain.

Beyond that, where is the line?

You could argue provision for core vaccinations should make the cut into what constitutes basic levels of care, but I can assure you many unvaccinated animals around the world live very happy lives.

I’ve seen many colleagues spit venom about “careless owners” who “don’t deserve to own an animal” when a dog presents with a pyometra, so should we make neutering a minimum requirement of pet ownership?

Should every pet owner have the means to pay for at least full bloods and an ultrasound? What about major life-saving surgery? An MRI? Chemotherapy? Specialist referral?

If a line in the sand does exist, then it’s poorly defined – and, like the line between beach and ocean, it’s a line that will shift with every wave, tide, and storm.

Collision course

So, how does this belief hold you back?

If you subscribe to this way of thinking, you’ll be on a constant collision course with a large part of the population. It’s a mindset that will set you up for daily antagonistic interactions with the people who present their animals to you, instead of creating those all-important relationships that were mentioned in part one.

None of this will benefit your patients, your clients, or yourself. To put it simply: you’ll only make yourself resentful and miserable.

Burden of care

Where things do become complicated is when individuals expect a high level of veterinary care without being willing to pay for it.

When the burden of care – and blame for lack of provision of its gold standard – are shifted solely on to the shoulders of the veterinary community, the relationship starts falling apart.

This, of course, is rubbish – and should be treated as such.

It’s a problem that vets who have the capacity to provide high levels of care will grapple with, and can be the topic of many more blogs.

For the purpose of this post, let’s just say we should always aim to help – to the best of our abilities, and with a consistent level of caring and lack of judgement – any person who presents their animal into our care, despite their individual expectations and capacity of what constitutes a good level of care.

March 11, 2020
EMS: life, death and lost holidays

EMS is something I haven’t touched on too deeply, which is odd considering how much of a vet student’s life it takes up.

For those not familiar with the term, EMS stands for extra-mural studies: work experience conducted outside of university term time.

Each vet school organises its EMS slightly differently, but at Bristol we’re required to complete a total of 12 weeks preclinical work experience over the first two years of our course (“preclinical” essentially meaning anything from shadowing a vet nurse in practice to shovelling manure in a stable). It’s basically to get everybody up to speed where animal handling skills are concerned, regardless of individual animal backgrounds. Levelling the playing field as it were.

As a second year student, this is the world I’m living in and, since I completed roughly 12 weeks of work experience to get into university in the first place, as you can imagine, EMS has become a big part of my life, and roughly a third of this year‘s summer holidays.

Pros and cons

There are highs and lows to every aspect of uni, but it can be difficult not to let the sheer volume of extra work that needs to be done get to you. Vet students, after all, have some of the highest numbers of contact hours among their cohorts, up there with medicine and dental students, who are also required to carry out extra non-curricular work when the majority of the student body are taking three or four months off.

But it’s important to remember there’s a reason for it, and although you’re not yet aiding diagnoses or learning neutering techniques, preclinical EMS teaches you a lot of skills you’ll need to have by the time you first step into practice, such as patience with and confidence around animals.

It can also help prepare you for the harder aspects of the job, and that’s really what I want to address here.

“Preclinical EMS essentially means anything from shadowing a vet nurse in practice to shovelling manure in a stable,” explains second-year vet student Eleanor Goad. Image © Nigel Baker / Adobe Stock

There at the end

Working on a farm for any decent period of time will allow you to become familiar with two things: life and death.

Death is a part of the veterinary career that’s easy enough to understand as a concept, but far more difficult to teach in practice; vets face the death of patients regularly enough that their mental health as a profession rivals that of human medicine for being so staggeringly low. In my mind, it’s definitely an area of our education that could be improved upon, but the trouble is it’s so difficult to do.

For example, I have been volunteering at my local practice for almost seven years and yet I have never seen an animal euthanised. This isn’t for lack of opportunity but, rather, a case of respecting the owner. I’ve had to leave many a consult once the bad news is broken, regardless of the level of training because, quite understandably, having your animal euthanised is a very personal and emotional experience that you wouldn’t want a stranger observing – especially one with an open notebook and poised pen.

The (other) problem with death

The trouble is, giving patients the space they want and deserve might not be in their best interest in the long run – especially if it goes on to produce a generation of veterinarians who’ve never seen euthanasia until a whole three or four years into their training.

Nobody wants some trainee hovering over such a private and, often, devastating moment – I know I certainly wouldn’t – but if the procedure is to be done with the same level of maturity, professionalism and understanding as it demands, this takes observation and learning, like anything else.

This is one of the reasons why I think EMS plays such a vital role in shaping young vets outside of the lecture theatres and in the real world.

Perfectly placed

My latest placement is on a pig farm, and despite being one of the most enriching and enjoyable weeks I’ve completed so far, it has hit me, emotionally and personally, in way I had not anticipated.

I’ve spoken before about how working with livestock intended for human consumption is different from working with cherished pets (and it definitely is), but an animal is still an animal and, especially when you’re starting out, it can be difficult to acclimatise to the professional separation the job often entails.

That said, I’m incredibly glad for my experiences over the past week and in every placement I’ve been lucky enough to visit. Farmers and veterinary professionals alike offer up so much of their time and experience to help you improve your own skill set in ways you never even knew it needed. You grow in ways you didn’t expect and your opinions change a little bit each day in light of everything new you learn.

On paper, EMS might sound like a lot of lost holiday time and long days of manual labour but, in reality, you only get out what you put in. And what you get out is often invaluable.

July 22, 2019
Staying motivated

When your course is a minimum of five years long, and your days are filled with lab work, lectures and study, it can be easy to lose sight of the big picture – the real core driver behind why you wanted to be a vet in the first place.

Forgive me if I’m wrong, but I’m sure no 18-year-old, fresh from 14 years of full-time education, has ever signed up for their degree purely for a love of spending the fleeting British summertime in an exam hall and 9am-5pm every day staring at a white board.

For most of us, investing the money and dedicated years of our lives that university demands are all part and parcel of building the foundations for our futures.

What’s it all for?

For vets especially, many options are available: whether you’re driven towards specialised surgery, welfare, research or first-opinion practice, it all starts with the same degree, the same path, the same investment.

However, while the journey may be unavoidable, the repetitive humdrum of student life (and life in general for that matter) can make it difficult to keep your eyes on the end goal.

How bad do you want it?

It’s not a matter of commitment. Trust me; if you even manage to get an interview for a veterinary course, you’re as committed as they come. There’s no way you’ll find a teenager voluntarily scooping poop – from a staggering variety of sources – on their weekends without a real solid mindset as to where they want to be.

“There’s no way you’ll find a teenager voluntarily scooping poop – from a staggering variety of sources – on their weekends without a real solid mindset as to where they want to be.” Image © chelle129 / Adobe Stock

When I was applying to vet schools, the standard requirements for work experience ranged from four to 12 weeks. I just about managed the latter, but I had friends around me doubling that – don’t ask me how.

Getting sidetracked

University life can be repetitive, not to mention full on… in a particularly heavy week, I managed to have a dream about revising ectoparasites, so let me tell you, sometimes there really is no escaping it.

Through all this it’s understandable you might lose track of the driver that got you here in the first place, let alone what you want to do when you leave. When you‘re struggling to keep your head above water to deal with the task in front of you, how on earth are you supposed to look so far ahead?

Personally, I didn’t realise I’d reached this point until very recently.

The epiphany

My university had organised “practice consult sessions” with some of its vet surgery’s genuine clients. Each client came to us with his or her dogs and had been told by our teaching staff to be as difficult as possible in an attempt to get us out of our shells.

In groups, we had to practise gathering a patient history – not easy, as it turns out, when the client’s been instructed not to play ball – and describe a simple neutering, addressing both pros and cons.

Not only did this supply a very realistic “hands-on” scenario, it forced us to use the collective knowledge provided to us in countless lectures and seminars and regurgitate it in a manner that was both professional and understandable. For example, a lot of the clinical terms we’re encouraged to memorise aren’t commonly used by the general public, so you must find easier ways of explaining things without oversimplifying anything important like surgical risks.

Remind yourself

I can’t describe how motivated I felt when I came home after that practical – I was buzzing.

I had stood behind real vets in real consultations for so long, watching how they interacted with clients and patients and itching, from such a young age, to do what they did. I wish I could carry that feeling with me every day, but, of course, after a while you find yourself treading water again.

I think the important thing is to give yourself moments every now and then to stop and reflect on how far you’ve already come, as well as where you want to go. The course, the workload, life in general – none of it’s easy. But if you want it enough, it’s so, so worth it.

April 23, 2019
Supporting new grads: are you up to the job?
As I discussed in my previous blog post, if you are a boss, partner or practice manager, it’s important to consider whether your practice is suitable for a new graduate, before taking one on.

Perhaps you’re considering taking on a new grad for the first time, or maybe you’ve employed them before, but are struggling to attract candidates for your job vacancies – or it might be your new grads are leaving you after a short spell of employment.

If any of these apply, or you’re simply looking for inspiration on what you could do to offer support to new grads, I’d like to offer some suggestions from the new grads themselves.

Friendly face of support

Every new graduate looks for “support” in his or her first (or, in my case, second) vet role, but what exactly does that look like?

By far the most important aspect of support is communication – we’re all different, and the key to a great working relationship with a new grad is asking him or her the kind of support wanted or needed, and discussing how you can provide that.

This should also be considered a fluid, flexible conversation that continues through the first few months of employment – the rate at which a new grad gains confidence and experience will vary due to individual personalities, but will also greatly depend on caseload.

Being patient, friendly and answering questions are all important when dealing with a new grad. Image © .shock / Adobe Stock

Never assume

If your practice doesn’t see many cats, your new grad’s first cat spay might not happen for several months, and you can’t just assume having performed a lot of other surgeries, he or she will be fine to just get stuck in, when he or she may never have used a flank approach before.

On the contrary, some new grads can be dangerously over-confident, and that’s where your clinical and character judgement will be vital in ensuring the safety of their patients.

It can be a very delicate balancing act between pushing a new grad to improve, and not letting him or her charge in all guns blazing without the right skills.

Suggestions

The answer is not straightforward – no “one size fits all” new graduate induction plan exists – but a number of areas can be considered to help your new grad settle in.

I’m not suggesting you action all of them, or even that they’d all be suitable for every new grad or practice – they’re just ideas to think about.
- Provide a booklet with practice protocols – for example:
  - vaccine protocol
  - neutering advice (ages)
  - treatment protocols for common ailments (as a starting point)
  - what should be included in estimates for operations
- Order uniform or name badges and have them ready for the first day. It may seem trivial, but it symbolises being part of the team. Being asked 10 times a day who you are, or “are you new here?” gradually chips away at what little confidence you have as a new grad.
  Ordering a name badge for your new grad can help him or her feel part of the team. Image © kegfire / Adobe Stock
- Have him or her spend a morning on reception to learn how to book appointments and other tasks, to get used to the computer system.
- Put a nurse or receptionist in consults with the new grad to help him or her navigate charging for consults, saving notes, making up estimates and so on.
- Have the new grad observe some consults or accompany other vets on call-outs to help him or her grasp how the practice runs and to introduce some of your regular clients.
- Allow the new grad to pick up consults from a general list at his or her own pace.
- Book out double appointments for the new grad initially, then shorten these as he or she gets more confident – and, therefore, faster.
- Always have a more experienced vet available (in the prep room, perhaps) to answer those quick questions while the new grad is consulting. He or she need not be twiddling his or her thumbs, but, if performing procedures, ensure your new grad knows he or she can pop in and ask without feeling like an inconvenience.
- Decide on a maximum length of time for a consulting block and allow breaks for the new grad to catch up or have five minutes to gather his or her thoughts.
- Assign a formal buddy or mentor within the practice (not the boss) for him or her to go to as a first port of call for any problems – clinical or non-clinical.
- Provide regular constructive feedback – we don’t know if we’re doing okay unless you tell us!
- Have formal scheduled progress review meetings to let the new grad discuss any issues in a fair manner (the boss informally asking “how are you doing?” in front of half the staff will not always elicit an honest response).
- Have a working list of procedures or cases your new grad wants to gain experience in so all staff know to try to involve him or her if they get one in. Similarly, have a list of procedures he or she is happy to do alone (and an expected timescale) so reception staff don’t book in three bitch spays on day one.
- Supervision for operations – ask your new grad whether he or she wants someone scrubbed in, either in the same room or just within shouting distance, for different procedures.
- Have goals for the new grad to work towards without pressurising him or her.
- Show the new grad respect. Don’t undermine him or her in front of clients, even if he or she is in the wrong – better ways of addressing it exist without shattering the new grad’s confidence and credibility.
  Assigning your new grad a buddy or mentor can help as a first port of call for any problems he or she may encounter. Image © michaeljung / Adobe Stock
- Take on board any suggestions the new grad may have in practice discussions – he or she will have the most up-to-date knowledge, and it can be a huge confidence boost to have your ideas taken up.
- Try not to put your new grad to the bottom of the pile for holidays. In fact, some bosses almost force new grads to book a holiday after two months because they know they’ll need it.
- Give the new grad a Christmas at home (or at least the choice of doing so). Nobody wants to work at Christmas, but is it advisable to have a stressed out new grad – who will likely still need backup in December – on call for the busiest “my dog’s eaten the Christmas pud” poisoning fest of the year? He or she will have likely moved a long way from home and will be particularly lonely at this time of year.
- Have formal second on-call in place for as long as the new grad needs. Don’t assume he or she will be fine after six months – this will vary greatly depending on caseload.
Making a difference

From discussing our varying inductions and levels of support with my university friends, by far the most important thing is just being patient and friendly – even when it’s crazily busy.

Taking 30 seconds to answer a question will make a huge difference for the new grad, rather than letting us spend ages unable to find the answer in an ancient textbook.

If you take an interest in your new grad’s learning and development, rather than just employing us for cheap labour, you’re already heading in the right direction and your efforts to welcome us into the profession will be greatly appreciated.
February 27, 2018
In at the deep end

Being a new grad is scary. And, although I don’t think I’ve been dropped in the deep end as much as some of my colleagues may have, I feel entirely overwhelmed the majority of the time and question several times a day whether I actually went to uni.

Starting in practice has made me realise how little I actually know…

The first challenge was getting my head around flea and worming treatments – with so many products on the shelf (yet somehow someone is still to come up with one that just kills every ectoparasite and endoparasite), where do you start? It’s ridiculous something so simple that so many vets seemingly do without thinking about is actually so complicated and never explained at uni.

Without a net

“No matter how confident I was under supervision, as soon as that safety net wasn’t there, things were much scarier.” IMAGE: retrostar / Fotolia.

Surgery is a whole new ball game too. I’ve done plenty of neutering, but always with someone there to confirm what I was doing was correct. However, on my own, scalpel in hand, I suddenly realised I had no idea what I was doing. Or rather, no matter how confident I was under supervision, as soon as that safety net wasn’t there, things were much scarier.

Consults themselves are okay – I just feel like I’m constantly in a communication skills tutorial, putting on a friendly face, trying to assure the owner their decrepit dog that is trying to eat me and of a breed I’m not keen on is just lovely.

However, it’s all the resulting admin that seems to take all the time – writing clinical notes, charging, recording batch numbers, etc. Nobody tells you at uni how much paperwork there is in the real world.

Fraudulent feelings

I feel like an imposter, blundering along, feeling entirely unqualified to give out professional advice. Any minute someone is going to tell me it was all a mistake, I’m not qualified enough to be a vet and I need to go back to uni.

And I’m getting paid for it, which feels completely alien, after years of unpaid EMS. Why would someone want to pay me for not really having a clue what I’m doing?

Some things I’m sure of (or as sure as you can be when you’re dealing with medicine and animals), but most things seem to trigger a very distant memory from vet school, leaving me wondering why I didn’t take things on board more at the time or whether I’ve actually just got a really poor memory, and how an earth I passed any exams if I can’t remember what any drugs are called.

Unfair comparisons

One of the main things I’ve come to appreciate is how good other vets are – those that are a few years qualified seem in a totally different league.

To begin with, I was despairing a bit. I felt completely inadequate compared to vets who have a bit, but not a massive amount, of experience, yet seem to be able to deal with anything. However, I’ve been telling myself that I’m not seeing the stages in between – I realised I hadn’t really come across many “just-qualified” vets on EMS (except interns), so I was comparing my ability with someone a minimum of two years out, not six weeks.

It is difficult to not compare yourself to others around you, but it only causes distress, especially if, like me, you’re a new grad surrounded by good vets.

Everyone has to start somewhere.

September 15, 2017
Getting the most out of EMS placements

A few weeks ago, I finished my last final year rotation, and I’m days away from finishing my last ever EMS placement – where has the time gone?!

Everybody warned us final year would fly by, but this is ridiculous. Surely it can’t be almost a year since I sat in one of the small animal hospital meeting rooms, practically shaking with fear on my first day of emergency medicine – my first day of final year – and yet, here I am.

With 12 weeks of preclinical and 26 weeks of clinical EMS under my belt, I’ve picked up a few handy tips along the way.

On the whole, I’ve had some fantastic placements, seen some incredible things and travelled to a number of far-flung destinations, but (as ever), with hindsight, there are a few things I may have done differently.

So, for those students in their earlier years, here are some things to bear in mind.

Plan your placements

This sounds obvious, and the majority of placements will need to be planned well in advance (often a year or more), purely due to practice availability. But, if you have the luxury of choice (if the practice has lots of free dates), really think about what you want to achieve before final year, and try to have at least a taste of small animal, farm and equine before rotations, if possible.

I got to final year and realised I’d had very limited experience in farm practice, so felt a bit lost at the beginning of the farm rotation. However, having now done more farm EMS – which accidentally ended up all happening at the end of final year – I feel so much more confident.

Also, think about how much EMS you want to do at which stages of the course.

You have to spread it out and start somewhere, and while you need to give yourself some downtime in final year, I think you also get a lot more out of placements the further through the course you are.

Listen to recommendations

Talk to people in your year and in the years above.

Some practices are really keen to teach, which results in a much more helpful experience for you and them alike.

The quality of your EMS placements can make a real difference – don’t get stuck somewhere you’re only allowed to stand in the corner and watch.

Do a spay clinic

Spay clinics allow you to gain hands-on experience that may be tricky to come by otherwise.

The quality of the surgery might be different to what you would see in the UK, but these clinics allow you to get hands-on experience, which may be more tricky to come by at home.

You will practise tissue handling, suturing and ligature placement – all transferable skills.

Again, listen carefully for recommendations as some clinics are better than others.

Be adaptable

There’s more than one way to skin a cat – likewise, you’ll see many different approaches to the same technique, which could be something as simple as giving an IV injection.

I was “told off” in the university hospital for giving a horse an IV the way I’d been shown on EMS. The following week – on the first opinion part of our rotation – I was told to do it a different way, again.

Learn how your supervising vet would like you to do things to stay out of trouble, but in the end you will find your own preference.

Take tips on board

The vets you meet on EMS have been in practice a while – they’ve made their mistakes and got the T-shirt, so take stock of any handy tips they might give.

Recently, one vet expressed surprise I was rectalling cows with my “strong” hand (I’m right handed), but didn’t really expand on why they were taught to use the left.

Another, older vet, strongly advised me to switch to my weaker arm because “years of having your hand squeezed inside a cow will give you horrendous arthritis”, and you’d rather that happen to your left hand and keep your right hand working. Subsequently, I swapped and soon felt competent with my left hand. I do still think the right hand is better for horses though…

Most importantly, while it can be difficult to tread the line between being too imposing and too shy, you do need to put yourself out there. Offer to do things to help you know you’re capable of, such as setting up a fluid bag.

And, most importantly, enjoy yourself!

April 3, 2017