Entertain. Inform. Engage. Inspire.
Entertain. Inform. Engage. Inspire.
New Grad Tips from Darragh The Topical Vet
By Darragh O' Hanlon MVB MRCVS| 29th June, 2020
Con-grad-ulations to the Class of 2020! You all have taken different paths to get here, and you’ve overcome various obstacles to finally be able to join the veterinary profession. This is an exciting time, and it may be that some of the following is of interest as you begin to enjoy success in your career.
Support:
As you make that transition from student to professional, it is important to choose a first job that supports you through the opening weeks, months – and perhaps even years. No matter what the job, it is worthwhile enquiring about the rota, whether there is time off in lieu of weekend work, and/or if any out-of-hours work is involved.
- In some cases seeing practice has opened up a door into familiar surroundings, certainly this is a good option if you have positive relationships to build upon in a professional capacity.
- Small animal internships come in many guises: rotating, medicine, surgery, anaesthesia etc. These are useful stepping stones and prerequisites for academic practice/specialisation. Make sure it is a recognised internship in a bona fide institution. Speak to the outgoing intern in advance, and make sure the hard work you put in will be rewarded.
- If you are searching further afield, subjectively I would prioritise a one-centre clinic to gain familiarity with the team, clients and patients. If the centre is near a major transport hub this will make travelling home on those long weekends a lot easier. More and more veterinarians are accomplished certificate holders, and having that experience in the same clinic can really help support you as you come across those challenging surgical/opthamological/medical etc. cases.
- Particularly in the United Kingdom, graduate schemes are coming on board that are marketed towards this transition period. In some cases these offer CVE, however it may be in-house and prescriptive. Like with anything in life, read the terms and conditions.
While salary, hours, rota, CVE and time off in lieu are on the table, consideration should be given to prioritising a healthy supportive clinic, with staff members who show good signs of mentorship. Such a first job will help with your professional development, which can be augmented by prioritising your CVE above all else.
Continuing Veterinary Education (CVE):
It is good practice to start keeping a record of the various webinars, meetings, symposia and courses you are attending. This is important due to the regulatory approach taken by the Veterinary Council of Ireland, whereby you will have to provide proof of these undertakings. The Royal College of Veterinary Surgeons (continuing professional development) permits self-certification, however they may audit you – whereby you will have to provide evidence of your undertakings. For those of you lucky to work further afield, check your CVE responsibilities with the relevant statutory body.
Periodontal disease is the most common problem in small animals (WSAVA Dental Guidelines). Dentistry is inevitable and inescapable, and taking the time to be proficient with modern equipment and the latest techniques will stand to you on any surgery day. Using some of your CVE allowance/leave for dentistry will result in better outcomes for you, the patient, and the practice.
Don’t forget the informal aspect! Keep in touch with your classmates, bounce ideas off each other. Get involved in local veterinary groups, online fora (e.g. Veterinary Information Network, British Small Animal Veterinary Association etc.) and knuckle down into the latest trends (e.g. raw food diets, CBD oil, maropitant’s many purported uses {Kinobe and Miyake, 2020}) so that you’re well informed when talking with clients.
Communication:
Your consulting style will develop as you do professionally. Communication skills have been identified as a weakness for recent veterinary graduates (Lewis and Klausner, 2003). This is a skill like any other, and can be practiced and mastered. Broadly speaking there are three different types of consulting styles (Cornell and Kopcha, 2007):
- Historically veterinarians have adopted the role of guardian – this is whereby all information is presented by the veterinarian, and typically only the veterinarian’s preferred option is elucidated. The veterinarian is the primary decision maker. Elderly individuals may be more accustomed to this approach as this role may be what they are used to. Similarly in emergent patients this approach may be more appropriate.
- Rarely a teacher role is seen, this is where information is pooled from many sources (veterinarian, client and elsewhere), and all options presented with no weight given to the veterinarian’s preference. With this approach, the client is the primary decision maker.
- A collaborator role involves the provision of all information and education regarding the available options, with the preferences of the veterinarian and client explored. The perspectives of the client must be actively sought, so as to negotiate any potential barriers. The decision making is shared between each party, and a partnership in care is formed. Human studies suggest that a collaborator type role results in better outcomes for the patient, and higher satisfaction for both clinician and client.
Adopting a problem-solving approach supported by good use of evidence-based medicine will add assertiveness to your approach. Clients will appreciate that the bespoke plan for their companion is borne out of evidential experience.
In certain situations, don’t be afraid to pause before answering. The time spent taking a temperature or auscultating with a stethoscope can allow for a more detailed and considered response.
Time Management:
In a review of over 200 veterinarians, Hansez et al. (2008) determined that for nearly one third of respondents, time management was a major source of stress. Poor time management skills can lead to various issues such as extended working time, client communication deadlines missed and delays in surgery or consultations. For small animal practitioners, phone harassment during practice was an important source of stress. Phone communication skills can be improved by simply focussing on outcome-based communication (e.g. identifying the message to be conveyed before picking up the phone). Assertiveness, using calendar/scheduling software to your advantage, completing your clinical notes as you progress through cases/consults are all simple time management optimisations that will result in less stressors. Another often overlooked option is admitting a patient as an in-patient for further investigations, for example if a complicated consultation requires a tailored investigative work-up.
Euthanasia:
Whether planned or unplanned, I challenge any veterinarian not to be stressed by euthanasia. The character of care provided has the potential to ameliorate or aggravate grief. For that reason, a systematic, controlled, compassionate approach is recommended. In some clinics there will be a practice policy that you can familiarise yourself with.
- Ideally euthanasia is by appointment at the end of consulting periods (i.e. quiet times of the day), and the client(s) can be directed to a private setting in a pre-prepared consultation room.
- Familiarise yourself with the case a priori, and ascertain if a decision has been made or if the client is seeking guidance. Ask open-ended questions to determine the client’s perspective about the illness and values on end-of-life care, and ensure that there are no unanswered questions.
- Discuss the euthanasia procedure, making sure to do this in stages. Minimise medical jargon, and pause to ensure the client is not becoming upset by anything relayed. Provide information regarding care of the body (e.g. cremation arrangements).
- The grief response is unique to each individual, with a vast spectrum of possible emotional responses. For this reason it is important to acknowledge and validate any emotional responses.
- Identify client support systems (e.g. supportive individuals such as friends, family, colleagues etc.), and provide information on support services:
- Grief counselling (check locally, for example Connolly Counselling Centre)
- Pet loss support:
Finally, do not forget your own care. Many of these cases will involve a close working relationship between client and veterinarian in order to optimise end-of-life care. The loss of both the client-veterinarian and patient-veterinarian relationships can often be overlooked, and may be a source of stress for the veterinarian.
Summary:
Every day in small animal practice brings new patients, new procedures, new clients and new challenges. The constant is you, and the team supporting you. Veterinary nurses are invaluable team members, especially offering a helpful hand to new and recent graduates. Nurses are independent, strong advocates for the patients under their care. I have always been blown away by their ability to get that cat to finally eat, or give the diarrhoea patient a bath before the day really gets busy. Nurses will gatekeep the phones for you and monitor not only the pulse of the patient, but of the client as well! It’s no surprise that one informal interview technique used is leaving the new graduate in the procedure room amongst the nurses!
Have fun, back yourself and enjoy each day, knowing that you are making the world a better place for animals and their owners. Well done again to all of you, and enjoy each successful step you take.
Thanks,
Darragh.
References:
Darragh O’ Hanlon is a small animal veterinary surgeon based in Dublin. Since graduation he has experienced academia, private practice and regulatory practice. Working in a busy progressive hospital, he has a keen interest in dermatology, oncology and palliative care.