Clinics: do's and don'ts and what to expect?

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gogreenfolks

gogreenfolks

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excited and nervous. y'all got tips?
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Show up on time or early. Don't case dodge. Help out your fellow students (even if they don't help you). Don't case hog.

Overall, be a decent person and treat others how you would want to be treated.

A lot of passing in clinics is about attitude. Yes, you should be able to figure things out/look up information on cases, but if you are a piss poor person to work with, clinics will be rough.
 
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DVMDream said:
Show up on time or early. Don't case dodge. Help out your fellow students (even if they don't help you). Don't case hog.

Overall, be a decent person and treat others how you would want to be treated.

A lot of passing in clinics is about attitude. Yes, you should be able to figure things out/look up information on cases, but if you are a piss poor person to work with, clinics will be rough.
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This is a huge one. You guys are all in it together, and the more you can help each other the better.
 
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Pretend you are the only one on the case, like you won't be double checked by a clinician. Come up with differentials, a plan, treatment options, dosages, etc. Then when you present not only will you be way more prepared but you will also learn soooo much more.

Also be respectful of others opportunities. If it's the last day of the block and only one chance to do something presents, if another is more likely to do/need that in practice let them do it. Unless it's a puppy. Hog all puppy cases :p
 
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jesskb said:
Pretend you are the only one on the case, like you won't be double checked by a clinician. Come up with differentials, a plan, treatment options, dosages, etc. Then when you present not only will you be way more prepared but you will also learn soooo much more.
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This. A million times, this. As a caveat, don't be afraid to be wrong (because someone is double checking you). I learned twice as much by coming up with the wrong answer on clinics as I did from the cases that I got right off the bat.



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make sure you always have a piece of paper/tablet/notebook on you. Bring your own pens and highlighters. Be prepared to work late every day, even if you won't.
 
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katryn said:
This. A million times, this. As a caveat, don't be afraid to be wrong (because someone is double checking you). I learned twice as much by coming up with the wrong answer on clinics as I did from the cases that I got right off the bat.



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Exactly this. Don't be afraid to be wrong. The clinicians don't expect you to be right all the time, they expect you to work hard and at least have formulated some type of plan/answer. (granted you aren't answering a medicine question with "perform a TPLO" or asking if you really need to specify that the pet has diabetes mellitus or if you can just put diabetes since there "really isn't any difference".. you will get angry looks with that.)
 
Don't let mediocre or negative reviews get to you. Some clinicians don't put as much into them as others, and some of the reviews just won't make any sense to you. Just take away whatever useful constructive bits that you can and move on.
 
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Also, if there are rotations that you "won't use later" (this was anything large animal for me), still go in with the mind set that you have something to learn. There is a surprising amount of overlap and a few unexpected correlations (eg. colic presents like and is worked up very similarly to a canine GDV). This attitude literally saved me from failing a rotation where I was having a hard time, because the clinician was so surprised by the attitude even though I was derping cases left and right.


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Always have snacks on hand. Being hangry is a real thing.

Invest in comfortable shoes.

A spare outfit is a good idea, especially on large animal rotations. I would usually have TMS, sucralfate and molasses on my pants by lunch time.

Before leaving for the day, always check in with your rotation-mates to see if they need a hand with anything. They will appreciate that you asked.

If you will need time off (weddings, interviews, medical appointments), tell people as soon as possible. Lack of planning on your part does not constitute an emergency on their part.

Respect the technicians.
 
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Coquette22 said:
Always have snacks on hand. Being hangry is a real thing.

Invest in comfortable shoes.

A spare outfit is a good idea, especially on large animal rotations. I would usually have TMS, sucralfate and molasses on my pants by lunch time.

Before leaving for the day, always check in with your rotation-mates to see if they need a hand with anything. They will appreciate that you asked.

If you will need time off (weddings, interviews, medical appointments), tell people as soon as possible. Lack of planning on your part does not constitute an emergency on their part.

Respect the technicians.
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Yes to all of the above... especially that last one. The technicians can seriously make or break a rotation for you, they will go out of their way to help you if you are nice to them and often times they are good people to chat with/commiserate with/have late night discussion with, overall they seriously make the wheels turn and can be your greatest asset.
 
residents are overworked, sleep deprived and usually way behind on everything.... and sometimes cranky.

Don't take anything personally.
 
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Coquette22 said:
Always have snacks on hand. Being hangry is a real thing.

Invest in comfortable shoes.

A spare outfit is a good idea, especially on large animal rotations. I would usually have TMS, sucralfate and molasses on my pants by lunch time.

Before leaving for the day, always check in with your rotation-mates to see if they need a hand with anything. They will appreciate that you asked.

If you will need time off (weddings, interviews, medical appointments), tell people as soon as possible. Lack of planning on your part does not constitute an emergency on their part.

Respect the technicians.
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So a snack in addition to the molasses you end up wearing?
 
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DVMDream said:
Yes to all of the above... especially that last one. The technicians can seriously make or break a rotation for you, they will go out of their way to help you if you are nice to them and often times they are good people to chat with/commiserate with/have late night discussion with, overall they seriously make the wheels turn and can be your greatest asset.
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So freakin true. I worked as an icu tech during the didactic part of school, so they all knew me. They would gripe to no end about 4th years who didn't do their own icu treatments for their patients.

Come fourth year, they regularly told me "oh go home, LIS, I'll do your treatments for you" since they all knew me.....

It was a beautiful thing cutting out of there when other peeps were hanging out for a few hours just to do a lousy tpr and some injections.
 
rdc said:
residents are overworked, sleep deprived and usually way behind on everything.... and sometimes cranky.

Don't take anything personally.
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Is true.

But there also is a line that some of them crossed. And the ones who crossed it did it regularly.

Being tired is not an excuse for being abusive or unprofessional.

The ones I felt bad for were the good residents who you could just see struggling to be professional, trying to find time to teach, trying to be patient, when you knew all they wanted to do was go drink or sleep. Those were the rockstars.
 
LetItSnow said:
So freakin true. I worked as an icu tech during the didactic part of school, so they all knew me. They would gripe to no end about 4th years who didn't do their own icu treatments for their patients.

Come fourth year, they regularly told me "oh go home, LIS, I'll do your treatments for you" since they all knew me.....

It was a beautiful thing cutting out of there when other peeps were hanging out for a few hours just to do a lousy tpr and some injections.
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We were required to do the 8AM and 8PM treatments on our patients in ICU, not showing up to do them got you a phone call with get your ass here now. And ignoring that/not showing up got you a remediation/rotation repeat.
 
DVMDream said:
We were required to do the 8AM and 8PM treatments on our patients in ICU, not showing up to do them got you a phone call with get your ass here now. And ignoring that/not showing up got you a remediation/rotation repeat.
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That lead to some students attempting to change up treatment times, so instead of treatments being when they'd have to do them at the 8's.... they'd attempt to throw them on at 6 or 7 or 9 ... every once in a while it would work out for them, but usually it backfired with the techs moving the treatments to the 8's and then chewing out the student. Those were the students the techs bitched about....there was definitely an ICU **** list that you didn't want to be on as a student.
 
DVMDream said:
That lead to some students attempting to change up treatment times, so instead of treatments being when they'd have to do them at the 8's.... they'd attempt to throw them on at 6 or 7 or 9 ... every once in a while it would work out for them, but usually it backfired with the techs moving the treatments to the 8's and then chewing out the student. Those were the students the techs bitched about....there was definitely an ICU **** list that you didn't want to be on as a student.
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Yeah. It was amusing when people would move treatments an hour or two to get out of it .... Thinking that nobody would be onto them. So obvious. Our icu techs didn't put up with that nonsense either. And they knew which students would pull that crap. I was happy to be on their good side; they made my life so much easier.
 
LetItSnow said:
Yeah. It was amusing when people would move treatments an hour or two to get out of it .... Thinking that nobody would be onto them. So obvious. Our icu techs didn't put up with that nonsense either. And they knew which students would pull that crap. I was happy to be on their good side; they made my life so much easier.
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I honestly feel like moving my treatments so I wouldn't have to do them would never occur to me. I had a frustrating patient on medicine last year who needed something done pretty much any time you thought about it, but I did all of her treatments with no real complaints. Plus, she was a super cute happy lady so I couldn't be that mad at taking care of her!
 
We were only responsible for 7am (ICU) or 8am (IMC/General) treatments for our inpatients. The more I talk to students from other schools, the more I appreciate our clinical year being pretty damn humane. Helped that I managed to spend ~50% of clinics off campus, too...

I'm struck by how much the clinics suggestions remind me of pre-school rules, though:
"Bring snacks!" "Bring a change of clothes in case of 'accidents'!" "Share!" "Be nice to others!" "Do your homework!" etc... :laugh:

When they were rotating in, I just told underclassmen to live by "Don't be a dick." and things would pretty much fall into place. Worked for me.
 
We did "7s and 11s" at VMCVM (7am, 11am, 7pm, 11pm) and you were generally expected to do all treatments unless you were physically in surgery or seeing an appointment. Our ICU is staffed better now, but I think students are still expected to perform the majority. It effing sucked. Of course I was somewhat biased because I had little interest in treating anything to begin with, but it could get really annoying when you had multiple patients plus appointments plus surgery.
 
We were responsible for all treatments BETWEEN 8 am and 8 pm at UCDavis in the general wards (where most of our patients stayed). We were not responsible for treatments on the patients we had in ICU but the ICU nurses did appreciate when we did come down and do the more boring/time consuming things like icing incisions, especially when they were swamped. It made a HUGE difference to do those little things to get on their good side.

I worked in the neuro ward during 1st-3rd year so the general ward nurses knew me pretty well. Echoing that it really helps when they're on your side. If you have a giant recumbent dog that you need help with, especially.
 
nyanko said:
Don't let mediocre or negative reviews get to you. Some clinicians don't put as much into them as others, and some of the reviews just won't make any sense to you. Just take away whatever useful constructive bits that you can and move on.
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Truth! I failed surgery the first time I took it because of a panic attack. I had to add medication to management of my anxiety to cope with course work and I learned this the hard way. They dinged me on patient care even though the surgery and ICU techs knew how much time I spent caring for my patients and diving in to help them where possible. The resident I had was doing her senior clinician rotation the second time I took it - I was fair to my blockmates but took as many difficult cases as I could. I spoke up in rounds. Had all my treatments planned out. Asked questions during procedures despite being anxious. I know I did A work but she gave me a barely passing C since I didn't kiss her ass. And for taking time to see the psychologist in the building even though I did my treatments before the appointments or made plans with a blockmate to take care of things ahead of time.

And I echo what everyone says about the techs. If you have an ICU patient and you are free - do the walks or other time consuming treatments. I hated having to carry out the iso protocols for lepto dogs but they appreciated not having to especially when every cage was full. And as a student - they have more experience than you - learn from them as much as you do the docs. If you have tech students - learn to delegate too - gives them experience and helps you manage everything easier.

I also highly recommend checking in with a counselor or advisor regularly, especially if you are struggling. It seemed like a lot of classmates were gliding through with no trouble while I flailed. The more open I got about my anxiety amd depression the more I realized even the "normal" people were struggling.
 
as far as clinics go, for those of you who already did it, if you had to rate yourself on a scale of 1-10 on clinical know-how before and after clinics, how would you rate yourself? do you feel like that last year really prepared you enough?
 
Log8 said:
as far as clinics go, for those of you who already did it, if you had to rate yourself on a scale of 1-10 on clinical know-how before and after clinics, how would you rate yourself? do you feel like that last year really prepared you enough?
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Before clinics, I'd have rated myself a 2. After clinics, I'd rate myself like a -3 (clinics is really good at pointing out all your faults). After a year of practice, I might be a 2 again. All of this is based on my own perceptions. My boss has been very impressed with me (though my surgical skills are and always will be total ****). My point being that your own perception of your knowledge and skills probably isn't the most accurate, so our assessments probably aren't useful.
 
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Coquette22 said:
Before clinics, I'd have rated myself a 2. After clinics, I'd rate myself like a -3 (clinics is really good at pointing out all your faults). After a year of practice, I might be a 2 again. All of this is based on my own perceptions. My boss has been very impressed with me (though my surgical skills are and always will be total ****). My point being that your own perception of your knowledge and skills probably isn't the most accurate, so our assessments probably aren't useful.
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See, I'd actually rate myself a bit higher after clinics, I do feel like I learned a lot on clinics. Definitely not where I would put myself above a 5.... my confidence now that I am practicing has diminished significantly. I find myself second-guessing a lot, I am sure that is normal, but damn it sure does take a toll when you questions all the things you do... should I have started that animal on abx? Should I have told that lady to come in immediately instead of the next morning? Should I have done y instead of z? Definitely would say my rating before clinics was probably around a 2, then maybe up to 5 after, but now I feel like I am back down to a 2, if not lower.
 
I don't honestly know where I would place myself on the scale, but my clinical skills overall went up by the end of clinics. For the most part, I would have said clinics didn't prepare me that much (maybe upped by 1 point), but then my very last rotation (internal med), I finally had a clinician that refused to think for us (you had to have a complete PE, assessment, diff list, and plan including potential treatments before you spoke with her) and suddenly the light clicked on. That one rotation probably shot my rating up 2-4 points.

I'm 2 years out now. If I had to rate myself now, I'd put myself at a 6-7. I've still got loads to learn and things I haven't seen. But I'm comfortable with where to go looking for answers. And I'm not a second guessing kind of person, there are inherent risks to the choices we make as clinicians and it's not worth agonizing about if it's going to happen or not. If it does, you regroup, learn from it, and move on.


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Still don't know jack **** post-clinics (comparatively), but I'm now significantly better at figuring out what I don't know and working through it. :) I don't know that I could put a number value to it.

I had some fantastic off-campus rotations that threw me to the wolves in surgery and more real-life medicine, and despite being a little stressful, they were so very helpful. I can't imagine how I'd feel if I was always at the school where your ideas and my plans were run through the filter of an intern/resident/etc before implementation. Getting to do things yourself (and watching them work... or sometimes not work and revising) really helps.
 
Trilt said:
Still don't know jack **** post-clinics (comparatively), but I'm now significantly better at figuring out what I don't know and working through it. :) I don't know that I could put a number value to it.

I had some fantastic off-campus rotations that threw me to the wolves in surgery and more real-life medicine, and despite being a little stressful, they were so very helpful. I can't imagine how I'd feel if I was always at the school where your ideas and my plans were run through the filter of an intern/resident/etc before implementation. Getting to do things yourself (and watching them work... or sometimes not work and revising) really helps.
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And this is why I took small animal internal medicine so many times. At least where I went to school... the students had to go through coming up with problem list, diagnostics, plan, treatment plan, etc. Yes, we were given guidance by the residents and clinicians but it was our job to go through the whole shebang alone and then discuss what we wanted to do and why. People thought I was insane to do that to myself multiple times but it was the ONLY rotation that really put the majority of the decision making the students' hands with just a touch of guidance and suggestions.
 
DVMDream said:
And this is why I took small animal internal medicine so many times. At least where I went to school... the students had to go through coming up with problem list, diagnostics, plan, treatment plan, etc. Yes, we were given guidance by the residents and clinicians but it was our job to go through the whole shebang alone and then discuss what we wanted to do and why. People thought I was insane to do that to myself multiple times but it was the ONLY rotation that really put the majority of the decision making the students' hands with just a touch of guidance and suggestions.
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I think it depends a lot on the school. We were definitely expected to come up a problem list/plan/etc in all our -ologies and IM. Obviously the extent to which we could do that would kind of depend on the rotation... like for cardio you'd kind of make things up pending actual echo results, etc. But in IM the extent of your involvement was really dependent on which intern or resident you worked with.

You couldn't have paid me to take IM again, though, lol - I had five weeks as my very first rotation. Learned a lot, was very happy to be done with 4am mornings.
 
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Actually, that's not true. There's one clinician I would have happily taken another two weeks of IM with and would have walked out a better vet. But many of the others I would have been a better vet, but much more miserable student. :p
 
Trilt said:
I think it depends a lot on the school. We were definitely expected to come up a problem list/plan/etc in all our -ologies and IM. Obviously the extent to which we could do that would kind of depend on the rotation... like for cardio you'd kind of make things up pending actual echo results, etc. But in IM the extent of your involvement was really dependent on which intern or resident you worked with.

You couldn't have paid me to take IM again, though, lol - I had five weeks as my very first rotation. Learned a lot, was very happy to be done with 4am mornings.
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They only required small animal track people to take 4 weeks of IM.... I took 8 weeks. I never had to go in at 4AM, thankfully, definitely had some late nights to midnight and had to be back around 5:30-6AM, but never a 4AM morning. Definitely was on-call for ICU and got called in many times at 2AM and would leave at 4AM and then have to be back by 6AM, but that wasn't specific to IM.... we were on-call for ICU if on canine rehab, IM, ophtho, onco, and primary care. Overall, we were very lucky for timing of things, especially compared to what I have heard about schedules for other schools.

Yeah, there was some variation with some of the residents, but overall most of them allowed us to come up with everything, I mean IM was not an easy rotation but it was the one that kept teaching me the most, so I was willing to do it a number of times over what was required.
 
DVMDream said:
They only required small animal track people to take 4 weeks of IM.... I took 8 weeks. I never had to go in at 4AM, thankfully, definitely had some late nights to midnight and had to be back around 5:30-6AM, but never a 4AM morning. Definitely was on-call for ICU and got called in many times at 2AM and would leave at 4AM and then have to be back by 6AM, but that wasn't specific to IM.... we were on-call for ICU if on canine rehab, IM, ophtho, onco, and primary care. Overall, we were very lucky for timing of things, especially compared to what I have heard about schedules for other schools.

Yeah, there was some variation with some of the residents, but overall most of them allowed us to come up with everything, I mean IM was not an easy rotation but it was the one that kept teaching me the most, so I was willing to do it a number of times over what was required.
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Anyone who isn't equine/large animal has to take four weeks for us. Mine was like a day off from five because the first rotation is just a little weird on the edges.

IM here we have to check the transfers that get posted from ER at 4AM and divy them up among students, then have ICU treatments due on our patients by 7am and IMC by 8am. But rounds start at 8am, period, and they also expect you to have called and updated owners by the time they start, so it was really "have everything done by 7:40ish and hope to god you can leave some messages." If you end up with two intensive ICU patients, or an ICU and a couple IMC, having to get into the school before 5am to get things done becomes a very realistic thing. Especially because I took the rotation at the beginning of the year and had to constantly look for things/ask techs questions/prepare a lot for early morning grilling on cases.

Just talking to students from other schools I think our schedule in general is pretty humane to us, too, but that was rough. Learned a lot, but I wasn't champing at the bit to do it again.
 
Trilt said:
Anyone who isn't equine/large animal has to take four weeks for us. Mine was like a day off from five because the first rotation is just a little weird on the edges.

IM here we have to check the transfers that get posted from ER at 4AM and divy them up among students, then have ICU treatments due on our patients by 7am and IMC by 8am. But rounds start at 8am, period, and they also expect you to have called and updated owners by the time they start, so it was really "have everything done by 7:40ish and hope to god you can leave some messages." If you end up with two intensive ICU patients, or an ICU and a couple IMC, having to get into the school before 5am to get things done becomes a very realistic thing. Especially because I took the rotation at the beginning of the year and had to constantly look for things/ask techs questions/prepare a lot for early morning grilling on cases.

Just talking to students from other schools I think our schedule in general is pretty humane to us, too, but that was rough. Learned a lot, but I wasn't champing at the bit to do it again.
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Yeah, we had to have all treatments done, plans made up to discuss with residents/clinicians on already hospitalized patients and any ICU transfers evaluated, divided up, treated and again plans made by about 7:20-7:30AM... then they went to rounds at 7:45AM and we had to call owners to update them and be ready for our rounds to start at 8AM, sharp. I'd hunt for transfers online around 5:30AM, if there were none I could safely arrive around 6:30-7AM and be fine... if there were some, I might show up at 6:00-6:15.... obviously you get faster and timing gets better the further along clinics go. Towards the end, I rarely showed up before 6:45, even with transfers. The interns on ICU/Emergency had until 8AM to post transfers, so there was no point in getting there uber early, most of them were up by 6:30-7 so that we could get started on them.
 
When I see the schedules other schools have, AVC's was slack by comparison. I did 6 weeks of large animal IM and 6 weeks of small animal IM (for which I frequently got asked, "Are you nuts? Do you hate yourself?")* but our hours weren't too crazy. Morning treatments and SOAPs had to be done by 8AM for patient rounds. Most days I'd arrive between 7 and 7:30. You were responsible for treatments on ICU patients between 8 and 4, and on wards patients from 8 to 10. Though you could usually organize with other students so that only one person was doing all the wards on a given day. A student was scheduled for ICU treatments until 10PM. So most days I'd be 7 to 6 or something, hardly the killer days that other schools had. The trade off is we had a much lower caseload than other schools.

*Not surprisingly, my IM skills are way higher than my surgical. But I work with two very strong surgeons who appreciate my love of IM.
 
dyachei said:
the lower the expectations, the better
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Sad-Crying-Meme-Face-18.jpg
 
Mostly just joking. I mean, part of the process of becoming a vet is that you start off unskilled. Then as you gain knowledge you start to understand exactly how much you don't know. At some point you feel like you have a good understanding and feel skilled but there's still so much you don't know that you don't know. So you make progress over time.
 
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