ER Externships for Current CVM Students

[ISU_CVM_2021]

I am a first year student at Iowa State University CVM and am looking for some externships for winter/summer breaks over the next few years. I am very interested in emergency work. I am already spending time here in our hospital's small animal ICU, but am looking to expand my experience. I am looking for recommendations for ER clinics that not only welcome externs, but actually like to have them around and want to teach them. If anyone has had a great experience anywhere, I want to hear about it. I just don't want to set something up with a clinic that isn't really interested in teaching me anything, been there done that and it's a waste of everyone's time. Recently we had an emergency veterinarian from WRVC in Wisconsin discuss their externship/internship program and it sounded very educational and hands on, and I am looking for other options similar to this. Any information is appreciated!

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[LetItSnow]

I am a first year student at Iowa State University CVM and am looking for some externships for winter/summer breaks over the next few years. I am very interested in emergency work. I am already spending time here in our hospital's small animal ICU, but am looking to expand my experience. I am looking for recommendations for ER clinics that not only welcome externs, but actually like to have them around and want to teach them. If anyone has had a great experience anywhere, I want to hear about it. I just don't want to set something up with a clinic that isn't really interested in teaching me anything, been there done that and it's a waste of everyone's time. Recently we had an emergency veterinarian from WRVC in Wisconsin discuss their externship/internship program and it sounded very educational and hands on, and I am looking for other options similar to this. Any information is appreciated!

(We only take 4th-yr students on actual 4th-yr externships, so this is a bit of a tangent post.)

Just keep in mind that ... you have your goal, but they have higher priorities and you need to respect that. Whenever I hear a pre-vet or 1st through 3rd year student talk about not wanting a place that "isn't really interested in teaching me anything" I always feel like they might need reminding that the ER's primary reason for existence is to serve clients and patients - not train people (interns/residents aside). Students sometimes are so wrapped up in their goals/needs that they forget that there are more important things happening.

I love having students here with us, but they need to keep a few things in the <front> of their mind:

1) I'm happy to teach, but many shifts are very, very hectic/busy, and my priority has to be seeing/treating patients. Teaching is the last priority for me, no matter how much I like to do it;

2) You can learn best by speaking up and asking questions. Don't be afraid to ask to do something within reason. It's your responsibility to learn and be motivated - not my job to motivate you. If someone shows up, stands in the corner, and doesn't show any interest or ask questions ... I'm not going to expend energy trying to get them engaged. I'll be open and receptive to them, but they have to take some initiative.

Good luck finding a place to gain experience! ER work is fun - hope you can find something cool.

 

[Lab Vet]

(We only take 4th-yr students on actual 4th-yr externships, so this is a bit of a tangent post.)

Just keep in mind that ... you have your goal, but they have higher priorities and you need to respect that. Whenever I hear a pre-vet or 1st through 3rd year student talk about not wanting a place that "isn't really interested in teaching me anything" I always feel like they might need reminding that the ER's primary reason for existence is to serve clients and patients - not train people (interns/residents aside). Students sometimes are so wrapped up in their goals/needs that they forget that there are more important things happening.

I love having students here with us, but they need to keep a few things in the <front> of their mind:

1) I'm happy to teach, but many shifts are very, very hectic/busy, and my priority has to be seeing/treating patients. Teaching is the last priority for me, no matter how much I like to do it;

2) You can learn best by speaking up and asking questions. Don't be afraid to ask to do something within reason. It's your responsibility to learn and be motivated - not my job to motivate you. If someone shows up, stands in the corner, and doesn't show any interest or ask questions ... I'm not going to expend energy trying to get them engaged. I'll be open and receptive to them, but they have to take some initiative.

Good luck finding a place to gain experience! ER work is fun - hope you can find something cool.

I'm not an ER person, but just wanted to weigh in here. I see both sides to this discussion.

1. First, the student attempting to gain experience: Traveling for externships is expensive- in time and money. It's not for free. Different vet schools allot their students a different quantity of blocks (and thus weeks) to obtain extramural experiences. NCSU officially grants us 3 blocks (6 weeks). I met a student from the Ohio State University while on externship who was granted 12 weeks of externships to go off-site in her clinical curriculum. NCSU does allow us to use vacation blocks to go off-site for externships, but no academic credit is given. You can put it on your CV, but said experience will not appear on your transcript. Also, for non-credit experiences (i.e. those obtained on vacation blocks), you are not covered by the University's liability insurance. You can still make it work with AVMA PLIT (will cover you in the absence of university liability). Students go off-site for a variety of reasons. One, to simply gain experience in field. Two, to case programs/clinics for further training/potential jobs. Three, to satisfy a credit requirement. There may be others. It is VERY frustrating to travel significant distances simply to shadow. Travel isn't cheap, and students are responsible for covering their living expenses at their home base, as well as wherever they're traveling to for experience. As I student, I personally find the expectation of advanced training programs (i.e. to be seriously considered for a position here, we want you to travel here for 2 weeks - month), to be a bit unrealistic. First, I don't have the option to do that for every program I want to apply to. There simply isn't sufficient time in my clinical schedule. Secondly, I can't afford it. If I am putting out cash to go somewhere, I (like the OP), would like to know up front what that experience is going to look like. As for LIS' comment that it's the student's job to show interest and get involved- I agree, to a point. It's difficult for a student to come into a situation (new to the culture, new to the practice, new to the staff), and just jump in and start doing things. OP- always ask before acting. I personally feel that it is the responsibility of the hosting clinician to offer to a visiting student the opportunity to be involved in hands on work. After all, the student is present as a guest of the host facility. He/she is not a staff member, and doesn't have the professional right to insert himself/himself without a proper invitation from a staff clinician. After the initial invitation is made, OP- I agree with LIS, it's up to you. Try to find out as much as you can about a facility before ponying up the cash to go there. Also, one person's hell is another person's heaven. A classmate and I both went to the same facility this summer. I was frustrated by the experience, he quite enjoyed it. We come from the same curriculum, and worked with the exact same people. Students are looking for different things from a program. Try, to the best of your ability, to stack the deck in your favor by asking specifics about the experience before committing. You're doing exactly that by posting here.

2. Second, the hosting facility: I agree, LIS, that the vet's first responsibility is to the client and patient. That being said, why would a facility agree to take on student externs if they don't have any intention of getting them involved? The AVMA doesn't require facilities to host fourth year students (this is voluntary, at least to my knowledge). I'm sure you remember back to your vet school days how awkward it can feel to walk into a practice/facility as a student, not knowing anyone/anything about how the place does business, and figuring out where you fit into all of that. It's a difficult position to be in. ER practices are busy, so there likely isn't the same quantity of down time as there is in other specialties to 'mentor' a vet student. That being said, I don't think that it's unrealistic to outline what the student can expect before committing with respect to hands-on involvement and time with the doctors. I completely agree that it's the student's responsibility to demonstrate motivation and initiative (it's not kindergarten). This is realistic and right. I just mention that it can be tough, from the student's perspective, to know what they can/can't do if they haven't been properly oriented to the experience (and expectations of performance) up front.

To the OP- my extramural experiences varied significantly with respect to what I was actually allowed to do, from a hands-on perspective. Much of the experiences was shadowing, coupled with a significant component of didactic (classroom, seminar) teaching. One of my extramurals was stellar- folks there let me do/try EVERYTHING. This was the exception, rather than the rule. I did find it incredibly frustrating to travel significant distances, and not be invited to 'do more.' This had nothing to do with my motivation- I'm an eager beaver, and even asked to be involved (on multiple occasions). Rather, this was facility policy- my hands were tied. Was it worth it? Yeah, I'd say that it was. I learned a lot, although not in the way that I originally thought that I would. I learned a lot about group culture/dynamics, how different places perform similar tasks, some solid medicine, etc. When it came to practical skills, however, I'd say that my yield was quite low (with the exception of one location). LIS has given you some good perspective here. I do, however, sympathize with your wanting to know what to expect (as far as yield) before committing the funds and the time. Good luck!

 

[LetItSnow]

I'm not an ER person, but just wanted to weigh in here. I see both sides to this discussion.

I think you misinterpreted me, because there aren't really two "sides". I am strongly in favor of getting students 'real world' experience, and a student should want to be in a facility that will give them as much learning as possible. And it is very reasonable for a student to ask "how much will I be involved if I'm at your facility?" Two points of clarification:

1) The OP is looking for experience 1-3 years, not a 4th-yr externship, which is different because of the different level of experience/knowledge. For example, if I'm comfortable with a student and see that they are prepared/knowledgeable/etc, I'll happily let them scope a gastric foreign body with coaching. I generally wouldn't let a 1st- through 3rd-year student do that.

2) I have had a few experiences with students who seem to think that a functioning hospital's highest priority should be them, and that the entire time they are there should be centered around them and their learning. That just isn't going to happen - a hospital's priority is to its patients and clients first and foremost, and any teaching has to happen after those priorities have been fully met. Ideally, teaching happens alongside it, but there are times where a student simply can't be in the middle of things. Whenever I see a student talk about wanting a place that will "not only welcome externs, but actually like to have them around and want to teach them" it sets off just a little alarm bell.

That doesn't mean the OP would be like that. I don't know the OP, and he might be amazing. It just means that when I've heard similar things from students, I have occasionally had bad experiences, and I wanted to make sure he considered the perspective of the host facility.

My philosophy when students are with me in the ER is - the more you've taken time to be prepared, ask good questions, show interest, etc., the more 'hands on' I'm going to get you.

When a student and I come back from an exam room and I say to the student "Ok, talk to me about the case. What are you thinking, what's your differential list, and what dx do you recommend?" .... if they can't start saying things that are remotely reasonable (and I sure don't expect them to have perfect - or even great - answers), then you can bet it will limit their involvement.

If we have a 2-year-old male neutered cat who has been in/out of the litterbox unproductively for the last 14 hours, vocalizing, and has a big hard round lump in the caudal abdomen .... and the student can't get "urethral obstruction" somewhere on their differential list .... there's not a chance I'm going to let them unblock it. On the flip side, if the student says "well, this is almost definitely a UO, other differentials would include <blah>, I'd like to do some bloodwork, maybe rads and/or ultrasound the bladder/urethra, and if it still looks like a UO, hospitalize it for unblocking and fluid therapy. Oh, and can we please give the cat some buprenorphine?" .... well damn, that student is going to get to unblock the cat and write up its treatment sheet, because they just aced it. That's also the student I'm going to have talk to the owner about FLUTD, the underlying causes, short-term and long-term therapy, etc.

Bottom line: These are real patients, not a classroom. I will let a student do almost anything so long as the student is prepared and demonstrating competency, but my patient is more important than the student. Any place where that isn't true is a place I wouldn't want my animal treated.

 

[Lab Vet]

I think you misinterpreted me, because there aren't really two "sides". I am strongly in favor of getting students 'real world' experience, and a student should want to be in a facility that will give them as much learning as possible. And it is very reasonable for a student to ask "how much will I be involved if I'm at your facility?" Two points of clarification:

1) The OP is looking for experience 1-3 years, not a 4th-yr externship, which is different because of the different level of experience/knowledge. For example, if I'm comfortable with a student and see that they are prepared/knowledgeable/etc, I'll happily let them scope a gastric foreign body with coaching. I generally wouldn't let a 1st- through 3rd-year student do that.

2) I have had a few experiences with students who seem to think that a functioning hospital's highest priority should be them, and that the entire time they are there should be centered around them and their learning. That just isn't going to happen - a hospital's priority is to its patients and clients first and foremost, and any teaching has to happen after those priorities have been fully met. Ideally, teaching happens alongside it, but there are times where a student simply can't be in the middle of things. Whenever I see a student talk about wanting a place that will "not only welcome externs, but actually like to have them around and want to teach them" it sets off just a little alarm bell.

That doesn't mean the OP would be like that. I don't know the OP, and he might be amazing. It just means that when I've heard similar things from students, I have occasionally had bad experiences, and I wanted to make sure he considered the perspective of the host facility.

My philosophy when students are with me in the ER is - the more you've taken time to be prepared, ask good questions, show interest, etc., the more 'hands on' I'm going to get you.

When a student and I come back from an exam room and I say to the student "Ok, talk to me about the case. What are you thinking, what's your differential list, and what dx do you recommend?" .... if they can't start saying things that are remotely reasonable (and I sure don't expect them to have perfect - or even great - answers), then you can bet it will limit their involvement.

If we have a 2-year-old male neutered cat who has been in/out of the litterbox unproductively for the last 14 hours, vocalizing, and has a big hard round lump in the caudal abdomen .... and the student can't get "urethral obstruction" somewhere on their differential list .... there's not a chance I'm going to let them unblock it. On the flip side, if the student says "well, this is almost definitely a UO, other differentials would include <blah>, I'd like to do some bloodwork, maybe rads and/or ultrasound the bladder/urethra, and if it still looks like a UO, hospitalize it for unblocking and fluid therapy. Oh, and can we please give the cat some buprenorphine?" .... well damn, that student is going to get to unblock the cat and write up its treatment sheet, because they just aced it. That's also the student I'm going to have talk to the owner about FLUTD, the underlying causes, short-term and long-term therapy, etc.

Bottom line: These are real patients, not a classroom. I will let a student do almost anything so long as the student is prepared and demonstrating competency, but my patient is more important than the student. Any place where that isn't true is a place I wouldn't want my animal treated.

Agreed.

 

[ISU_CVM_2021]

(We only take 4th-yr students on actual 4th-yr externships, so this is a bit of a tangent post.)

Just keep in mind that ... you have your goal, but they have higher priorities and you need to respect that. Whenever I hear a pre-vet or 1st through 3rd year student talk about not wanting a place that "isn't really interested in teaching me anything" I always feel like they might need reminding that the ER's primary reason for existence is to serve clients and patients - not train people (interns/residents aside). Students sometimes are so wrapped up in their goals/needs that they forget that there are more important things happening.

I love having students here with us, but they need to keep a few things in the <front> of their mind:

1) I'm happy to teach, but many shifts are very, very hectic/busy, and my priority has to be seeing/treating patients. Teaching is the last priority for me, no matter how much I like to do it;

2) You can learn best by speaking up and asking questions. Don't be afraid to ask to do something within reason. It's your responsibility to learn and be motivated - not my job to motivate you. If someone shows up, stands in the corner, and doesn't show any interest or ask questions ... I'm not going to expend energy trying to get them engaged. I'll be open and receptive to them, but they have to take some initiative.

Good luck finding a place to gain experience! ER work is fun - hope you can find something cool.

I think you misinterpreted me, because there aren't really two "sides". I am strongly in favor of getting students 'real world' experience, and a student should want to be in a facility that will give them as much learning as possible. And it is very reasonable for a student to ask "how much will I be involved if I'm at your facility?" Two points of clarification:

1) The OP is looking for experience 1-3 years, not a 4th-yr externship, which is different because of the different level of experience/knowledge. For example, if I'm comfortable with a student and see that they are prepared/knowledgeable/etc, I'll happily let them scope a gastric foreign body with coaching. I generally wouldn't let a 1st- through 3rd-year student do that.

2) I have had a few experiences with students who seem to think that a functioning hospital's highest priority should be them, and that the entire time they are there should be centered around them and their learning. That just isn't going to happen - a hospital's priority is to its patients and clients first and foremost, and any teaching has to happen after those priorities have been fully met. Ideally, teaching happens alongside it, but there are times where a student simply can't be in the middle of things. Whenever I see a student talk about wanting a place that will "not only welcome externs, but actually like to have them around and want to teach them" it sets off just a little alarm bell.

That doesn't mean the OP would be like that. I don't know the OP, and he might be amazing. It just means that when I've heard similar things from students, I have occasionally had bad experiences, and I wanted to make sure he considered the perspective of the host facility.

My philosophy when students are with me in the ER is - the more you've taken time to be prepared, ask good questions, show interest, etc., the more 'hands on' I'm going to get you.

When a student and I come back from an exam room and I say to the student "Ok, talk to me about the case. What are you thinking, what's your differential list, and what dx do you recommend?" .... if they can't start saying things that are remotely reasonable (and I sure don't expect them to have perfect - or even great - answers), then you can bet it will limit their involvement.

If we have a 2-year-old male neutered cat who has been in/out of the litterbox unproductively for the last 14 hours, vocalizing, and has a big hard round lump in the caudal abdomen .... and the student can't get "urethral obstruction" somewhere on their differential list .... there's not a chance I'm going to let them unblock it. On the flip side, if the student says "well, this is almost definitely a UO, other differentials would include <blah>, I'd like to do some bloodwork, maybe rads and/or ultrasound the bladder/urethra, and if it still looks like a UO, hospitalize it for unblocking and fluid therapy. Oh, and can we please give the cat some buprenorphine?" .... well damn, that student is going to get to unblock the cat and write up its treatment sheet, because they just aced it. That's also the student I'm going to have talk to the owner about FLUTD, the underlying causes, short-term and long-term therapy, etc.

Bottom line: These are real patients, not a classroom. I will let a student do almost anything so long as the student is prepared and demonstrating competency, but my patient is more important than the student. Any place where that isn't true is a place I wouldn't want my animal treated.

Thank you for your insight, and I understand what you are saying. I agree that teaching takes a backseat to performing your duties and serving your patients and clients. My worry is that I'll be offered an externship, only to get stuck with cleaning/stocking/kennel duties and other basic tasks. Sometimes clinics are just looking for someone to do mundane duties for free in order to free up their staff. I also agree about speaking up and asking questions. Being an older student (32), I understand the power of asking questions and really putting yourself out there.

While I may only be a 1st year student, I strive to act and think like a graduated doctor. Years of clinical experience have allowed me to work with a large number of veterinarians that have helped mold me into the student I am, and the doctor that I want to be. Like you have said, I do not expect that a doctor would lecture me on topics or cases, but to have the opportunity to be present during examinations, discuss their thought process, and be willing to answer my questions is what I am looking for. Some doctors will go out of their way to show/teach techniques and skills, others may not be so willing. Both are understandable and both are well within their rights. I just want the opportunity to learn and grow within a clinical setting.

Also, I enjoyed your blocked cat example. As I was reading the first sentence, I was thinking to myself that it sounded like a urethral obstruction, and for the most part I also came up with the same diagnostics. That's the kind of experience I am hoping to find, somewhere where the doctor is willing to interact with me about cases and just give me the opportunity to be what I would call a "practicing student". If those opportunities get overshadowed by a hectic day, then so be it. As long as I am able to be a part of it, it is a learning opportunity.

Again, thank you for sharing your views, I will keep them in mind in my future experiences.

 

[LetItSnow]

My worry is that I'll be offered an externship, only to get stuck with cleaning/stocking/kennel duties and other basic tasks.

For sure. I did not mean to discount your concerns. I just know that when I've seen similarly-worded posts, it raises a red flag. But I definitely agree - as a vet student you need to be in the thick of it, learning material that will help you be a better clinician when you graduate.

Also, I enjoyed your blocked cat example. As I was reading the first sentence, I was thinking to myself that it sounded like a urethral obstruction, and for the most part I also came up with the same diagnostics. That's the kind of experience I am hoping to find, somewhere where the doctor is willing to interact with me about cases and just give me the opportunity to be what I would call a "practicing student". If those opportunities get overshadowed by a hectic day, then so be it. As long as I am able to be a part of it, it is a learning opportunity.

Very few of us care if you even come up with the same diagnostics/differentials - as long as your clinical thinking makes sense and there's some generally good reason for whatever you're recommending. For instance, I was 'taught' that you always always always do bloodwork / UA / rads on a LUTD cat. In reality, do I spend $279 of my client's money on rads prior to unblocking a UO cat? Not a chance. I take a placement radiograph to confirm u-cath placement for $70 after I unblock them, which gets me my radiograph to better assess urolithiasis at the same time for cheaper. Different ways to, uh, skin a cat. And I prefer ultrasound to evaluate the urinary tract, anyway.

FWIW, I know I sounded 'negative', but most of us in practice really enjoy having good vet students around. They keep us on our toes, we're excited to teach the things that we enjoy doing, etc. To the degree the student has their stuff together, I give them more rope to go after a case - talking to owners, working the case up, doing procedures, whatever. That's the kind of place you probably want to be for things. I'd welcome you up here, but we don't do full 'externships' except for fourth-year students. We take vet students for shadows and things, but not more formal externships 'n stuff.

Best of luck! ER work is exhausting and often infuriating, but is also pretty fun and hectic and has those gem cases that are super satisfying.