DISCUSS: News on Future veterinary schools

[DVMDream]

---

Members don't see this ad.

Maybe students will actually be able to perform surgery upon graduation.

I am going to have an unpopular opinion on this. While I think every veterinary student should have surgical skills upon graduation, I am strongly in the box of not every veterinarian should perform surgery. We don't expect every medical school student who graduates to be able to perform surgery, it isn't realistic, not everyone who attends medical school has a capacity for surgery. The same is true for those attending veterinary school. It needs to be normalized that some people are just not suited for surgery and that is ok because they have other strengths such as treating a complex DKA case.

Yes, I realize that kind of makes veterinary medicine lean more on specialization, but we can't ignore the fact that not every single person who graduates is suited (mentally or sometimes physically) to perform surgical procedures.

 

[WildZoo]

Can we talk about which schools do a better job with this?

Shelter med (usually called spay/neuter because that's what you're primarily doing) is a required clinical rotation at UTK, so every student has two weeks of doing surgery every day. Mostly cat spays and neuters but a decent number of dogs too, I don't remember my number breakdown anymore unfortunately. There are also surgery days on the community practice rotation but most students only do ~4 surgeries there.

I didn't do any external rotations that involved surgery and felt well-prepared for spay/neuter/uncomplicated mass removals upon graduation. I know they've been doing more cavadaver and simulator work for other procedures in the last several years, but of course that's not the same as live surgery. I would say the vast majority of students from any institution are going to need more mentorship for more complicated stuff.

Just my experience there, I'm unsure about other institutions 🙂

 

[pp9]

Can we talk about which schools do a better job with this?

It is hard to outright say 'x school has poor surgical training' because there can be so much variation in the student experience.

Example: I graduated from UofI with 1 spay and 1 neuter, but I had classmates that got into our shelter med rotations (key phrase being 'got in') and did a lot more spay/neuter that way. Afaik though, none of us were primary surgeon on anything beyond that, considering on-campus rotations only.

UofI did have a soft tissue surgery elective I took (edit: on cadavers), but it's just not the same. And I've heard of some students coming out of other schools with less surgical experience than I did (1/2 a spay or neuter, or just one of the two).

IMO schools (or the CoE) need to get on top of with what students are taught, or not being taught. The standard is that we should be graduated as 'competent mixed animal vets' and I really don't think that's happening. It would have been fantastic to get not only more spay/neuter, but uncomplicated foreign bodies, laceration repairs, enucleations, GDVs etc in school (considering SA med only here). All of those surgeries are going to interns/residents. Vet schools are no longer using clinical year to teach 4th years, they are using 4th years primarily to support the interns/residents that are getting the bulk of the training and teaching. That has changed from the vets of the 80s/90s/earlier 2000s, who did usually get more primary surgical experience while in school and came out of school capable of doing at least some solo surgery.

You obviously do still learn in 4th year, but I feel like we've reached a point where 4th years do more paperwork and service/hospital support work than they do 'clinical learning.' You can grill us in rounds for an hour a day about some niche thing you'll see one time in IM, but that doesn't help me be a decent GP vet on day 1 in the real world. With that said, there is a general profession-wide push towards specialization and I think we are starting to see that in our education, too.

 

[pp9]

I am going to have an unpopular opinion on this. While I think every veterinary student should have surgical skills upon graduation, I am strongly in the box of not every veterinarian should perform surgery. We don't expect every medical school student who graduates to be able to perform surgery, it isn't realistic, not everyone who attends medical school has a capacity for surgery. The same is true for those attending veterinary school. It needs to be normalized that some people are just not suited for surgery and that is ok because they have other strengths such as treating a complex DKA case.

Yes, I realize that kind of makes veterinary medicine lean more on specialization, but we can't ignore the fact that not every single person who graduates is suited (mentally or sometimes physically) to perform surgical procedures.

This is totally fair - but students should have reliable opportunity on campus if they want the experience.

Edit: Devil's advocate - but then would you also agree that someone surgically oriented shouldn't have to go through IM? Or rather are you saying a school shouldn't have to provide more surgical training because not everyone is going to be a surgeon?

Edit x2: and to be clear, I completely agree with the idea that not everyone should perform surgery. I'm one of the people that shouldn't because I really hate it/would rather tinker with meds and repeat labs all day, but I feel that some surgical/tissue handling competence is implied when a school says they are graduating 'mixed animal practice-ready vets.'

 

[battie]

I am going to have an unpopular opinion on this. While I think every veterinary student should have surgical skills upon graduation, I am strongly in the box of not every veterinarian should perform surgery. We don't expect every medical school student who graduates to be able to perform surgery, it isn't realistic, not everyone who attends medical school has a capacity for surgery. The same is true for those attending veterinary school. It needs to be normalized that some people are just not suited for surgery and that is ok because they have other strengths such as treating a complex DKA case.

Yes, I realize that kind of makes veterinary medicine lean more on specialization, but we can't ignore the fact that not every single person who graduates is suited (mentally or sometimes physically) to perform surgical procedures.

I actually fully agree. I don't like surgery. I do it to be helpful to my hospital group, and now it's a bonus point for me since we have lost so many doctors that do cut. It's one of my first benefits I raised in my letter asking for a raise. But I also wonder if I would be more comfortable with surgery if I'd had a good foundation in vet school (half a spay and half a neuter here!) and then in my first year of school (didn't perform a single surgery due to the saturation of how many doctors did like surgery but didn't want to teach).

I think there is absolutely a cultural shift happening now. If there is someone around who loves to cut, I give them the case and take it back after surgery. And they're happy to let me handle the floor while they're in surgery. I think the problem is that any small animal GP is going to be expected, at least as a new/recent grad, to do spays, neuters, and mass removals. It's oddly treated as a privilege to not cut, rather than the other way around.

 

[pp9]

I also wonder if I would be more comfortable with surgery if I'd had a good foundation in vet school (half a spay and half a neuter here!) and then in my first year of school

I want to add that having next to no surgical experience in vet school, and then none in my rotating/ER life limited my job opportunities when I was looking for jobs both right after my rotating, but also when I was still ER and looking to leave BP (right before I got my zoo internship). I had a few interviews that specifically asked me about my surgical experience and 2-3 said that they needed someone who could handle being solo in the ER. So there's that.

But other people in other circumstances will be able to find clinics that can mentor you in the OR for those that are reading that and panicking. I myself couldn't find that clinic at the time/where I was looking.

 

[JaynaAli]

I feel like surgery is like everything else…we need a baseline education and minimum competencies in it because you *can* go out and do it, but then it’s up to the student to pursue more experiences, electives, and trainings if that’s something they plan to use. And most people will do it to some degree so there should be plenty of opportunities.

My school had what I feel like were above average opportunities for surgery. Things have changed so much there I don’t know what goes on now, but we all did at least 3 spays and 3 neuters as primary and assisted a classmate on 3&3 more, and we did cadaver surgeries for things like a splenectomy and an R&A. Then on the general practice rotation most people got at least one other surgery and often more, and we had an optional shelter elective which was surgeries all day for 3 weeks. I didn’t do the shelter rotation. My two preceptorships I arranged for myself in private practice let me cut as many of their daily surgeries as I wanted, so I got to do over a dozen S/N at each of those independently, plus some mass removals and even a couple GI surgeries under heavy supervision. As an intern we obviously assisted the surgeons and did a lot of closing but also did a GP rotation and I got a couple more S/N and later on they let me do an amputation for a client that otherwise couldn’t afford the surgeons fees for her cat. And after all that, it’s been over a decade now since I have cut anything. I did assist my friend with an enterotomy and gastronomy a year or two ago. Definitely don’t miss surgery.

 

[katiemcat]

UF has honestly recently really stepped up their surgical training. It used to be you were only guaranteed one spay OR neuter. But now our HQHVSN rotation is required for all small animal tracked student.

I am someone who isn’t meant to do surgery and it makes me incredibly anxious. I just don’t have an aptitude for it. If all surgeries were like cat spays and neuters maybe I would feel differently. But on my surgical rotations I was always yearning for medicine. Perhaps that’s why I feel my calling is IM 😂

 

[battie]

I've gotta say, we have a heavy population of CSU grads at my hospital for obvious reasons. Most of them took the now defunct terminal surgery elective and it absolutely shows. The confidence these ladies came in our hospital for GI surgery was lit, with one of them having done at least one nephrectomy.

I get the actual ethical/moral concerns for terminal surgery as a training tool. They absolutely took advantage of every surgery they could to make the deaths of those dogs count for future patients. The class is no longer offered and now that I'm on the other side, I'm not sure if that's a good or bad thing.

Not trying to start a debate on the ethics/morals of terminal surgery by any means.

 

[fauna]

UF has honestly recently really stepped up their surgical training. It used to be you were only guaranteed one spay OR neuter. But now our HQHVSN rotation is required for all small animal tracked student.

I am someone who isn’t meant to do surgery and it makes me incredibly anxious. I just don’t have an aptitude for it. If all surgeries were like cat spays and neuters maybe I would feel differently. But on my surgical rotations I was always yearning for medicine. Perhaps that’s why I feel my calling is IM 😂

It's funny because I work in specialty surgery now and I love it. But, I love it from my current perspective as a scrub nurse. I feel like I will never truly know if I am truly cut out (no pun intended) for surgery until I actually do my first surgery.

 

[battie]

no pun intended

Always intend your puns

 

[pp9]

It's funny because I work in specialty surgery now and I love it. But, I love it from my current perspective as a scrub nurse. I feel like I will never truly know if I am truly cut out (no pun intended) for surgery until I actually do my first surgery.

Going into vet school, I was excited about surgery and wanted to do it as a vet (not as a boarded surgeon, though) and I learned really quickly that what I really liked was scrubbing in and assisting still do. but primary surgeon? nope. Although I do love lac repairs/wounds.

 

[Trilt]

I've gotta say, we have a heavy population of CSU grads at my hospital for obvious reasons. Most of them took the now defunct terminal surgery elective and it absolutely shows. The confidence these ladies came in our hospital for GI surgery was lit, with one of them having done at least one nephrectomy.

I get the actual ethical/moral concerns for terminal surgery as a training tool. They absolutely took advantage of every surgery they could to make the deaths of those dogs count for future patients. The class is no longer offered and now that I'm on the other side, I'm not sure if that's a good or bad thing.

Not trying to start a debate on the ethics/morals of terminal surgery by any means.

We had a pig terminal surgery lab and it was the most helpful like... five hours of my vet school career. I hate that it seems to not be in the curriculum any more.

 

[DVMDream]

This is totally fair - but students should have reliable opportunity on campus if they want the experience.

Edit: Devil's advocate - but then would you also agree that someone surgically oriented shouldn't have to go through IM? Or rather are you saying a school shouldn't have to provide more surgical training because not everyone is going to be a surgeon?

Edit x2: and to be clear, I completely agree with the idea that not everyone should perform surgery. I'm one of the people that shouldn't because I really hate it/would rather tinker with meds and repeat labs all day, but I feel that some surgical/tissue handling competence is implied when a school says they are graduating 'mixed animal practice-ready vets.'

I think basic surgery still needs to be taught as veterinary school is still too broad of a field to not include it. However, I think out in the "real world" we need to recognize that just because someone was accepted to veterinary school does not equal them being a good surgeon or even someone who wants to do surgery. We need to tailor our expectations to individual strengths.

Yes, veterinary school needs to still provide the skill set and have the experiences available so people have the potential to become good, competent surgeons if they so choose that is what they enjoy doing.

 

[battie]

We had a pig terminal surgery lab and it was the most helpful like... five hours of my vet school career. I hate that it seems to not be in the curriculum any more.

I think this is primarily student driven. When I gave tours at Illinois, a large minority of students said they wouldn't attend a school with terminal surgery at all. Plenty of emails from prospective students asking if we did terminal surgeries because they weren't going to apply if we did, even as an elective.

 

[JaynaAli]

I think this is primarily student driven. When I gave tours at Illinois, a large minority of students said they wouldn't attend a school with terminal surgery at all. Plenty of emails from prospective students asking if we did terminal surgeries because they weren't going to apply if we did, even as an elective.

I think you’re probably right, but the school I attended did away with them in 2009 when I was in undergrad there, and it was mostly driven by donors and the public. The college newspaper reported that a donor was revoking a $5m donation pledge because a student reported “concerns” about ethics of the terminal surgery program to said donor. The school denied all allegations and said the donation was never specifically earmarked for the school, but they also stopped the TS program so I assume the truth is probably somewhere in between and they ended it to appease their biggest donor.

 

[pp9]

I think this is primarily student driven. When I gave tours at Illinois, a large minority of students said they wouldn't attend a school with terminal surgery at all. Plenty of emails from prospective students asking if we did terminal surgeries because they weren't going to apply if we did, even as an elective.

Which is always ironic because some LA anatomy cadavers are raised specifically for euthanasia, but since it doesn't fall under a terminal surgery, no one thinks about it. It's easy to find a lot of dogs/cats coming out of shelters, and that's almost assuredly where ours came from. But no way are cadaver-prep places finding that many mini-ish horses and young cattle that consistently unless they are purpose-bred (considering UofI only, I know other schools take donated full size carcasses but we only had mini-sized ones).

I understand the concern and respect it to some degree, but it's lacking the understanding that learning an extremely valuable skill on one animal is going to allow you to save countless animals for the rest of your life. Just make it optional.

Truthfully, terminal surgeries falling out of favor might be one of the biggest reasons for the overall lack of surgical education in vet school now. Of course you're not going to let a student 'try' on an owned animal, and there isn't enough time in the year for junior surgery to end up being more than a handful of surgeries per group each year. So, short of finding other places that will give you the chance to do more than spay/neuter, your first experience with a certain surgery is likely going to be on someone's pet anyways.

 

[battie]

But no way are cadaver-prep places finding that many mini-ish horses and young cattle that consistently unless they are purpose-bred

I talked to the old anatomy lab manager (who left after @SkiOtter 's class) and the ponies came from kill pens and the calves were purpose bought for sure from cow-calf operations if I remember correctly.

your first experience with a certain surgery is likely going to be on someone's pet anyways

And this is why I'm so hesitant to do surgery. I was taken to the board for a surgery *I did correctly and had no hand in the direct follow up care*. I got out of surgery at 11:30 am, had him sleep off drugs cause he was a crackhead 9 mos old golden and left at 8pm. Next time I saw him was when he had an anesthetized incision repair where the body wall was fully closed and the skin/sub q was dehisced and infected. Me and the overnight doc that took him in (did initial rads then rechecks at 10 hours) were the only docs taken to the board. None of the docs who had him in hospital for the subsequent 36 hours nor anyone that saw him for rechecks. Make that make sense. 🙄

 

[pp9]

I talked to the old anatomy lab manager (who left after @SkiOtter 's class) and the ponies came from kill pens and the calves were purpose bought for sure from cow-calf operations if I remember correctly.



And this is why I'm so hesitant to do surgery. I was taken to the board for a surgery *I did correctly and had no hand in the direct follow up care*. I got out of surgery at 11:30 am, had him sleep off drugs cause he was a crackhead 9 mos old golden and left at 8pm. Next time I saw him was when he had an anesthetized incision repair where the body wall was fully closed and the skin/sub q was dehisced and infected. Me and the overnight doc that took him in (did initial rads then rechecks at 10 hours) were the only docs taken to the board. None of the docs who had him in hospital for the subsequent 36 hours nor anyone that saw him for rechecks. Make that make sense. 🙄

Ooh interesting, we were told differently about the calves at least, but to be fair we were told by a different person. Would trust SH's info obviously.

Purpose bought though - in my mind, no different than an animal bought for a terminal surgery but you just never see the living part. People just aren't realizing that these animals were not euthanized only because they were already sick, for example.

Not to totally derail this, but I'd also want to know if every single person refusing a school over terminal surgery is also refusing their vaccines, medications, animal-tested cosmetics, etc.

ETA: Also one of my lawsuits was the opposite - I saw an infected spay incision on ER that went on to dehisce a bit a day or so later. Didn't help that owner wasn't restricting dog. The GP who did the spay/saw the dog when it dehisced didn't get the heat, I did even though my only role was prescribing clavamox and reinforcing post-op instructions. Suit didn't go anywhere but it's still absolute BS. Was ironically also a crackhead golden

 

[battie]

Didn't help that owner wasn't restricting dog.

This was reportedly one of the problems. Crackhead was allowed to do things unsupervised. Cone was too small (to be fair, sent home by "us" but not me). We did have a slew of surgical dehiscences last summer though; he was the first one of something like 8-10 cases across all the doctors who cut and all 3 hospitals. Literally the only connection was the batch of nocita tbh. We ended up doing a **** ton of work to figure out why and never really did.

Not to totally derail this, but I'd also want to know if every single person refusing a school over terminal surgery is also refusing their vaccines, medications, animal-tested cosmetics, etc.

Good point. And I wonder how clients will feel if we start getting surgical complications secondary to virtual or artificial surgical training in school labs. There's absolutely nothing like live tissue and nothing can prepare you for that besides live tissue

 

[fauna]

To sort of merge the two topics, do you think more (especially newer) veterinarians would actually like surgery if they had more/better opportunities to learn and practice in school? It is completely fine to be a veterinarian and not want to do surgery and there are careers that allow for that, as discussed. But, in other words, how much of disliking surgery is coming from feeling under-prepared and under-trained versus it just sincerely not being your thing?

 

[battie]

But, in other words, how much of disliking surgery is coming from feeling under-prepared and under-trained versus it just sincerely not being your thing?

Me 100%. I got no surgery mentorship during my first year out. Now, with my job in personal flux, wherever I end up, I'm going to be like, "You want me to do surgery? Send me to a surgery class," as part of my contract.

 

[SkiOtter]

Didn't help that owner wasn't restricting dog.

Lol I had one this week that JUMPED A FENCE on Monday.

 

[fauna]

Me 100%. I got no surgery mentorship during my first year out. Now, with my job in personal flux, wherever I end up, I'm going to be like, "You want me to do surgery? Send me to a surgery class," as part of my contract.

This is a big part of why I think my current goal would be to do a rotating internship my first year out of school!

 

[WildZoo]

This is a big part of why I think my current goal would be to do a rotating internship my first year out of school!

Most rotating internships are not going to give you much, if any, surgery experience. I'm sure there are exceptions but generally the surgery interns and residents are doing surgery and the rotating interns are observing, maybe doing some closures.

 

[JaynaAli]

I did a private practice internship at a place with no residents, and even then I got minimal primary surgeon experience. We did lots of lac repairs on ER and closed sq/skin most of the routine surgery cases. We did a GP rotation I did a couple dentals and spay/neuter, but the only “actual” surgery they let me do on my own was an amputation my last month. This may vary program to program, but even at a place with house officers we didn’t get to do much and I think time doing CE courses or just learning on the job would have been more effective, tbh.

 

[katiemcat]

It's funny because I work in specialty surgery now and I love it. But, I love it from my current perspective as a scrub nurse. I feel like I will never truly know if I am truly cut out (no pun intended) for surgery until I actually do my first surgery.

I was doing cat neuters as a tech and so I thought I was going to love surgery…. Until I got inside my first abdomen. Mind blank, panic, can’t itch my face, can’t pace or ponder, I'm hot and these gloves are too tight.

Like anything it’s a skill that takes practice, I would say I have had more surgical experience than the average vet student due to UFs new policy. I can do it, it’s just not something I’m incredibly gifted at or took to instantly. I also just don’t like it really.

Once again gonna add that while spays are “routine” procedures they can quickly become not so much… Opening up my first pregnant animal I was like holy hell these vessels are HUGE? I saw a dog last week that came in for a nephrectomy because it had a ureter ligated during its spay (thankfully only one) at a very large corporate chain.

 

[WildZoo]

Yep spays are treated as routine because we collectively do them so often but it is still a major procedure. You're removing a whole organ system!

 

[battie]

My worst surgery was a post-partum and post-first heat spay. Major life regrets

 

[supershorty]

This is a big part of why I think my current goal would be to do a rotating internship my first year out of school!

Do not do a rotating internship if your goal is specifically for hands-on surgical training during that year. You're very unlikely to get it, particularly in an academic rotating. As WildZoo said, those training opportunities are for the surgery residents and surgery specialty interns, if a practice has them.

I'm finishing up a rotating internship as a surgery-focused intern, and I got more opportunities than many of my internmates because of how hard I worked and how much effort I put in to be "extra," but a rotating internship is about learning to be a great doctor and, frankly, paying your dues as you work toward whatever your ultimate goal is. You'd likely get more cutting experience during that first year of training if you were outside a rotating internship and out in practice.

 

[katiemcat]

My worst surgery was a post-partum and post-first heat spay. Major life regrets

My first post-partum spay almost made me cry during the operation 😂😂😂😂😂

 

[pp9]

This is a big part of why I think my current goal would be to do a rotating internship my first year out of school!

echoing what wz and shorty said. I was primary surgeon on precisely zero cases during my rotating. Scrubbed in/assisted on who knows how many, definitely closed a lot. I’m not counting ER lac repairs in that, but that’s not what I have in my mind when I say ‘surgery.’

There are rotating out there that let you be primary but they are few and far between. Don’t go by VIRMP description to find them, ask around and ask current interns

 

[pp9]

To sort of merge the two topics, do you think more (especially newer) veterinarians would actually like surgery if they had more/better opportunities to learn and practice in school? It is completely fine to be a veterinarian and not want to do surgery and there are careers that allow for that, as discussed. But, in other words, how much of disliking surgery is coming from feeling under-prepared and under-trained versus it just sincerely not being your thing?

To some extent, yes. I probably still wouldn’t love it, but I wouldn’t be in quite as dramatic a state of existential dread for days when I have a planned surgery coming up (which is relatively uncommon for me, but they happen). Meanwhile, I can titch meds up and down and do CRIs/tree of life stuff in my sleep, whereas that has some people running for the hills. I think of one of my favorite internmates I say that, who did end up doing a surgery residency lol.

It’s hard to find experience once you’re out of school. As a zoo vet, I’d love to be able to do a solo c-section and uncomplicated foreign body surgeries. Probably a pyo too. I still haven’t done more than assist on any of those, and it’s been several years since I have. So for me to feel good about those at this stage, I would need to study videos for a few days, then scrub in on several and then do several on my own but with legitimate hovering/oversight. That’s not really feasible with 1) a full time job that I can’t just walk away from at the drop of a hat 2) not really having someone who is going to call me and say ‘hey I have a fobo, come over’ AND also let me do stuff when I don’t work for their clinic. The next option is CE, and good surgery CE courses are usually really expensive and not with live tissue (but if anyone has suggestions, let me know).

 

[battie]

The next option is CE, and good surgery CE courses are usually really expensive and not with live tissue (but if anyone has suggestions, let me know).

Pretty much all our baby doctors have done the CSU course, and that will be my goal for next year

 

[Trilt]

To sort of merge the two topics, do you think more (especially newer) veterinarians would actually like surgery if they had more/better opportunities to learn and practice in school? It is completely fine to be a veterinarian and not want to do surgery and there are careers that allow for that, as discussed. But, in other words, how much of disliking surgery is coming from feeling under-prepared and under-trained versus it just sincerely not being your thing?

I graduated with 100+ surgeries under my belt (obviously mostly spay/neuter) and definitely am surgically inclined/like surgery a lot more than a lot of people. I definitely think having that experience made me not terrified about surgery once I graduated and I just kind of continuously added to my repertoire as I progressed in my career.

I'm actually writing this at work as my techs are prepping an ex lap for me, lol.

 

[fauna]

Thank you to everyone!!

but a rotating internship is about learning to be a great doctor and, frankly, paying your dues as you work toward whatever your ultimate goal is.

This would definitely be my goal. One of the surgeons I currently work for first did a rotating internship, then did a surgical internship, and then a residency. And, from what it sounds like, she really enjoyed that decision and got a lot out of it.

I currently love surgery, and generally if somebody asks what I would want to do after vet school, I say surgery l. but like @pp9 touched on, I realize that I very well could just enjoy the scrubbing in and assisting part. So, I am leaving my options open to the fact that vet school could change my mind to a lot of things.

 

[pp9]

Thank you to everyone!!

This would definitely be my goal. One of the surgeons I currently work for first did a rotating internship, then did a surgical internship, and then a residency. And, from what it sounds like, she really enjoyed that decision and got a lot out of it.

I currently love surgery, and generally if somebody asks what I would want to do after vet school, I say surgery l. but like @pp9 touched on, I realize that I very well could just enjoy the scrubbing in and assisting part. So, I am leaving my options open to the fact that vet school could change my mind to a lot of things.

Also something to consider is whether or not you can do the on-call life for the rest of your career. That in and of itself is a no for me. It does depend on academia vs. PP and how your hospital runs/whether you have residents...but in my PP experience (multiple residents, 2 surgical interns, and 5-6 surgeons that shared the on-call across three locations) my surgeons still got called in a lot. They can make excellent money, though

 

[supershorty]

One of the surgeons I currently work for first did a rotating internship, then did a surgical internship, and then a residency. And, from what it sounds like, she really enjoyed that decision and got a lot out of it.

Maybe. That's also just the standard path to becoming a surgeon (I'm saying this for your own knowledge - it was unlikely that those were active decisions she made vs that's what you have to do to get a residency )

 

[supershorty]

if anyone has suggestions, let me know

They aren't on live tissue, but the cadaver CEs that the Oquendo Center hosts in Las Vegas are phenomenal, from my understanding. One of my OG classmates went the GP --> ER where she cuts her own emergencies route and has raved about those CEs.

 

[Minnerbelle]

I graduated with 100+ surgeries under my belt (obviously mostly spay/neuter) and definitely am surgically inclined/like surgery a lot more than a lot of people. I definitely think having that experience made me not terrified about surgery once I graduated and I just kind of continuously added to my repertoire as I progressed in my career.

I'm actually writing this at work as my techs are prepping an ex lap for me, lol.

Ditto. I got a ton of cutting opportunity as primary surgeon as a student, and the benefit of that wasn’t just that it made me proficient. It was that it set me up for a career in cutting where I had the confidence to say, yeah I’ll try that new thing if you (someone more experienced) could be on standby should I need help. And most of the time I didn’t even need the help. Just someone to peek and check that my first however many enterotomy closures looked ok, that kind of thing. But extremely rare anyone had to ever scrub in.

The more you need hand holding, the more you need step by step instruction, the fewer opportunities you get post-grad, and the more scared you get to try anything more than you are capable of… which may not be much. That sets these graduates up for a career where they feel like surgery is not for them. Sure, not everyone is meant for sx and that’s fine. But there are a lot of people I think who could have enjoyed it who don’t get to due to lack of exposure in school, because it only gets tougher to get exposure out of school.

For that reason I think it’s so important that all students who *want* the hands on surgical experience get enough of it in school that they feel comfortable at least doing dog/cat spay/neuters independently with maybe someone in the building to help bail them out should they run into some complication. That is a hefty goal for the number of students each school graduates a year, but I think it’s important if we as a profession expect gps and non-specialized ER docs to cut.

As far as med students not doing sx, well they wouldn’t because only surgeons/OBs who go through residency do them, and there is no expectation for PCPs to do surgery in the US healthcare system. But when I spoke to my good friends who are MDs here who were trained in South America, they said upon graduating med school in their country, it was expected any doctor could do an appendectomy, c-section, and cholecystectomy… as it was them in a hospital in the jungle… or the patient would die.

 

[pp9]

it was expected any doctor could do an appendectomy, c-section, and cholecystectomy… as it was them in a hospital in the jungle… or the patient would die.

Interesting! What's their malpractice situation? Safe to assume they are less litigious down there?

If I did a c-section or septic abdomen on something tonight, and I was literally the only option, I would be setting myself up for board action and litigation. But I've also never had legit training on those surgeries, where it sounds like your friends have. Also gotta wonder for myself where 'do no harm' comes into play in all of this. Is it more harmful to give a major surgery the ol' college try, knowing I really wouldn't have any idea what I was doing, or to tell a client I refuse and they need to drive x hours to the next willing vet or euthanize? Part of these rhetorical questions are rooted in board complaints/suits I've seen colleagues suffer through, and not always with a favorable outcome.

Edit: Don't get me wrong, I know thousands of vets have found themselves in this exact position many times. I just think we are in the day and age where even if we are the only chance for a pet, we can expect that a bad outcome has a very high chance of being held against us

 

[battie]

I just think we are in the day and age where even if we are the only chance for a pet, we can expect that a bad outcome has a very high chance of being held against us

I think this is where the importance of informed consent and air tight records come in. 66% of cases lost in CO are due to bad records. I was taught you can only under report and not over report. Every student and baby doctor that I work with, I tell them to write records as if they're going to the board.

As an extension, I tell every client if I have or have not done a procedure. 100% of people have gone elsewhere when I've told them 1) I have not done the procedure and 2) I'm not comfortable giving it the ol college try if I don't have to. My only exception is actually GDVs cause they really only have me and flipping the stomach over doesnt scare me.

 

[pp9]

I think this is where the importance of informed consent and air tight records come in.

True, but based on how some state boards behave (which is based off of social media posts, so grain of salt of course), I truly don't know if this would be enough for those certain boards to let you walk

 

[battie]

True, but based on how some state boards behave (which is based off of social media posts, so grain of salt of course), I truly don't know if this would be enough for those certain boards to let you walk

I would love to see someone sue the board for a BS finding. **** like this should be somewhat standard per the standard of care for the area you're in.

 

[Minnerbelle]

Interesting! What's their malpractice situation? Safe to assume they are less litigious down there?

If I did a c-section or septic abdomen on something tonight, and I was literally the only option, I would be setting myself up for board action and litigation. But I've also never had legit training on those surgeries, where it sounds like your friends have. Also gotta wonder for myself where 'do no harm' comes into play in all of this. Is it more harmful to give a major surgery the ol' college try, knowing I really wouldn't have any idea what I was doing, or to tell a client I refuse and they need to drive x hours to the next willing vet or euthanize? Part of these rhetorical questions are rooted in board complaints/suits I've seen colleagues suffer through, and not always with a favorable outcome.

Edit: Don't get me wrong, I know thousands of vets have found themselves in this exact position many times. I just think we are in the day and age where even if we are the only chance for a pet, we can expect that a bad outcome has a very high chance of being held against us

I’m not saying untrained primary care vets should be doing cholecystectomies… we have surgeons for that. And yes there are liability issues there even if it were life or death. Hell the death rate is high enough with surgeons doing cholecystectomies with ruptured mucoceles that the ethical line would be blurry to “try” when humanely euthanasia is a perfectly viable alternative and a huge proportion of vets can barely safely spay dogs when they graduate.

What I meant was more that just as primary care vets are expected to be able to perform desexing surgeries, in countries where trained surgeons are not readily available for common surgeries, there are some where medical schools do train med students to perform them.

My point was that if primary care vets without additional formal training is expected to perform surgery, I think it’s the responsibility of vet schools to provide adequate training for that at least for the students who want it.

 

[Minnerbelle]

I would love to see someone sue the board for a BS finding. **** like this should be somewhat standard per the standard of care for the area you're in.

As you said, I think it comes down to documented informed consent.

It’s a problem if you misrepresent yourself and don’t fully explain foreseeable complications and what of those you are able to or not able to address, and how those things might be different with a boarded surgeon. And also what is the expected outcome/prognosis, what will the animal/owner experience throughout the process, what does the recovery look like, and how does that compare to options not involving surgery (including euthanasia).

And it’s a problem if you don’t document all of that. But the documentation is really a cya, and a bulk of the risk with litigation truly comes down to the original communications between you and the client. If you set the expectation correctly with the client in the first place, the chances of litigation goes down dramatically. I’m pretty gutsy with accepting risky surgeries if the patient is either going to die or have an unacceptable QOL without it, and the prognosis is good should the animal survive it. I tell clients the only alternatives are euthanasia, a surgeon attempting, and if that’s not an option… me attempting, but that is really a precursor to euthanasia/death if it doesn’t go well intra- or post-op. That the pet can go peacefully now, or they can take the chance and either be saved or go down fighting (and potentially suffering big time in the process). In the event it doesn’t go well, if the owners are going to regret having gone forward with surgery or wished they’d had a surgeon do it (or worse they would then go to a surgeon to fix the situation), me taking on the surgery is not a good idea.

There’s also a difference between attempting a life-saving procedure that is very much within the repertoire of other veterinarians of similar skill/training level as you that you just haven’t performed before… And a procedure that is beyond what you are reasonably equipped to do. With the latter, it’s hard to say a client truly ever had “informed consent.” The more elective the procedure is, and the more numerous or severe the foreseeable complications are, the more it becomes a liability issue because you chose not to “first do no harm.” You can never waive your liability due to negligence, and being reckless is being negligent. Sometimes that line is blurry, but other times not so much.

 

[pp9]

You can never waive your liability due to negligence, and being reckless is being negligent. Sometimes that line is blurry, but other times not so much.

Yeah I guess that's where interpretation matters. If I was the last stop between death for a septic abdomen, and the owners were absolutely set on surgery, I would feel reckless doing it even if I informed them about my lack of skill/expertise until I was blue in the face. All hypothetical, of course, because I'd rather eat my own shoe than be in that situation

That said, I could always get a call that one of our zoo animals made a bad choice and needed something emergently. We work with local surgeons, but that doesn't mean they'd be down to come in on an emergency basis considering they often donate their time to us. More nuance to zoo animal surgery than whether or not I can do it, though.

 

[Trilt]

Interesting! What's their malpractice situation? Safe to assume they are less litigious down there?

If I did a c-section or septic abdomen on something tonight, and I was literally the only option, I would be setting myself up for board action and litigation. But I've also never had legit training on those surgeries, where it sounds like your friends have. Also gotta wonder for myself where 'do no harm' comes into play in all of this. Is it more harmful to give a major surgery the ol' college try, knowing I really wouldn't have any idea what I was doing, or to tell a client I refuse and they need to drive x hours to the next willing vet or euthanize? Part of these rhetorical questions are rooted in board complaints/suits I've seen colleagues suffer through, and not always with a favorable outcome.

Edit: Don't get me wrong, I know thousands of vets have found themselves in this exact position many times. I just think we are in the day and age where even if we are the only chance for a pet, we can expect that a bad outcome has a very high chance of being held against us

Tbh both of these examples are surgeries where I find in the anesthesia/peri-op stuff is way more of a PITA than actual surgery.

I could walk anyone with mid tissue handling skills through a c section. On average they're easier than a normal spay, just a bit stressful because the clock is ticking on the pups under anesthesia and they need appropriate resuscitation.

Septic abdomen anesthesia sucks and they almost always need long procedures while the BP is trash and I don't begrudge anyone not touching those... but the key to avoid getting sued is to just really talk to people and document document document.

We actually somewhat often end up with those cases as transfers at my ER on weekends when BP doesn't have surgeon availability, or the owners have *some* money but not enough for the bigger specialty hospitals (we're semi-rural so often like 30% cheaper).

I just actually sit down, get good rapport, and have a "these are the realistic odds" conversation with people. I make sure people are aware euthanasia is also a reasonable option and that I don't judge them if they decide not to surgerize, because sometimes they feel really pressured from other hospitals. Even cases that end in euth on the table or peri-op death I've pretty much universally had owners be just really thankful we *tried* after appropriately framing things.

 

[Trilt]

I guess just fundamentally, too: I can't spend my whole career absolutely terrified of a board complaint. I'm a good vet. I work hard at staying up to date and spend a lot on time making sure clients understand their options, helping them pick, then documenting it haha.

I make mistakes occasionally because I'm human or overwhelmed, but by grace they're usually not big ones and if someone takes me to the board, I honestly know that I was doing the best I could with the information I had at the moment and it kinda is what it is, ya know?

I'm not a very anxious person at baseline, though.

 

[Minnerbelle]

Yeah I guess that's where interpretation matters. If I was the last stop between death for a septic abdomen, and the owners were absolutely set on surgery, I would feel reckless doing it even if I informed them about my lack of skill/expertise until I was blue in the face. All hypothetical, of course, because I'd rather eat my own shoe than be in that situation

That said, I could always get a call that one of our zoo animals made a bad choice and needed something emergently. We work with local surgeons, but that doesn't mean they'd be down to come in on an emergency basis considering they often donate their time to us. More nuance to zoo animal surgery than whether or not I can do it, though.

Haha septic abdomen, I don’t actually mind. If I know the source (GIT, pyo, etc…) and I actually know how to repair it, the problem isn’t me. The problem is how sick the pet is.