Learning advanced surgeries WITHOUT internship, residency, board certification

[thetrukillat]

Current student just wanting to know what opportunities are available, or in what way, could I learn new (to me) and advanced surgical procedures after graduation, without going the internship + residency + board certification route?

***BEFORE YOU REPLY PLZ READ BELOW***

• I'm NOT asking if I should go or consider the internship + residency + board certification route, NOR am I asking for anyone to convince me.

I'm really not being stubborn, its just unfortunately not a practical option for me: I have the same story as most (loans on loans on loans), but I'm older & married w/ kids (do not have the time or flexibility), and since its the one of the lowest paid professions that requires a 4 years post-secondary degree, I know there's no REAL link between aforementioned route and salary.

• I know that board certification isn't required to perform advanced procedures, since all the vets I shadowed for are doing surgeries they aren't board certified for (and exceptionally well, I might add)

Since my first round of rotations, I noticed that the 4th years don't really get the amount of hands-on surgery that I was expecting from a profession that doesn't require specialization and allows you to practice (and even start your own practice) with just the 4 year vet degree. I just want to learn how to effectively & safely perform all these really cool advanced procedures I read about in veterinary surgery books without going at it blindly.

Can anyone who has taken my preferred path point me in the right direction?

Thanks!

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[racccjlm]

What specific procedures are you interested in learning? Small or large or exotic animal? The answer is going to depend on the complexity of the surgery - some advanced procedures are better left to specialists.

One avenue to consider is interviewing/signing on with a practice that offers mentorship/likes mentoring. If surgery is an interest, interview with that in mind. You can learn a lot from the people that you work with. I've also seen some general practitioners reach out to specialists near them to ask about shadowing on their surgery days a few times. This may also afford time for dialogue about which procedures the specialists feel could be performed without significant advanced training (e.g. sure, I think entropion surgeries and even certain types of reconstructive blepharoplasties are possible in the right general practitioner hands; conjunctival grafts and cataract surgery, not so much). If shadowing isn't an option, some may have videos that they would be willing to share. Access to cadavers to practice "advanced" procedures prior to jumping in on live patients is also an option you could explore.

 

[thetrukillat]

What specific procedures are you interested in learning? Small or large or exotic animal? The answer is going to depend on the complexity of the surgery - some advanced procedures are better left to specialists.

One avenue to consider is interviewing/signing on with a practice that offers mentorship/likes mentoring. If surgery is an interest, interview with that in mind. You can learn a lot from the people that you work with. I've also seen some general practitioners reach out to specialists near them to ask about shadowing on their surgery days a few times. This may also afford time for dialogue about which procedures the specialists feel could be performed without significant advanced training (e.g. sure, I think entropion surgeries and even certain types of reconstructive blepharoplasties are possible in the right general practitioner hands; conjunctival grafts and cataract surgery, not so much). If shadowing isn't an option, some may have videos that they would be willing to share. Access to cadavers to practice "advanced" procedures prior to jumping in on live patients is also an option you could explore.

This is the type of response I was looking for...I really appreciate it.

To answer your question, nothing crazy, at least not at first - I'm merely just looking for opportunities where I can learn new things gradually, and I'm not the type of person to bite off more than I can chew. I'm really interested in orthopedics (not having to turn away fracture or CCL cases would be great), brachycephalic procedures w/ laser therapy, pretty much anything that's common but not too difficult to learn as I progress through my career.

I had heard from recent graduates that they were only allowed to do 1 live spay and 1 live neuter during their entire 4 years, so that was kind of discouraging to hear at the time, having applied and just been accepted. Of course when I got here the school is really pushing internships, and I've heard nothing but bad reviews.

I guess I should have asked in my OP, but having never been to a CE event, I was curious if the wet labs are helpful in this area or not?

 

[racccjlm]

I think others would be better able to weigh in about orthopedics and brachycephalic subjects (beyond me!) but there are certainly wet lab CE events that could put you in touch with surgery specialists, and give helpful hints you wouldn't necessarily pick up from books or on your own. There are pockets of general practitioners that like and are competent in straight forward CCL (lateral suture, TPLO, TTA) & fracture repairs, brachycephalic surgeries, etc. Joining a practice where you have a mentor to this regard would be advantageous. Since you're still a student, take advantage of your access to surgery professors and bend their ears, too. They might have other suggestions.

 

[thetrukillat]

I think others would be better able to weigh in about orthopedics and brachycephalic subjects (beyond me!) but there are certainly wet lab CE events that could put you in touch with surgery specialists, and give helpful hints you wouldn't necessarily pick up from books or on your own. There are pockets of general practitioners that like and are competent in straight forward CCL (lateral suture, TPLO, TTA) & fracture repairs, brachycephalic surgeries, etc. Joining a practice where you have a mentor to this regard would be advantageous. Since you're still a student, take advantage of your access to surgery professors and bend their ears, too. They might have other suggestions.

I’ll definitely look into it. Thank you for your advice!

 

[KCgophervet]

I had heard from recent graduates that they were only allowed to do 1 live spay and 1 live neuter during their entire 4 years, so that was kind of discouraging to hear at the time, having applied and just been accepted. Of course when I got here the school is really pushing internships, and I've heard nothing but bad reviews.

Just want to jump on this and say that while you can graduate with so few surgeries under your belt, that doesn't mean you have to. You can get a lot more surgery experience under your belt during vet school, you just have to put in the effort to make it happen. Doing shelter med/spay/neuter rotations will get you a lot further as far as basic tissue handling and soft tissue surgery experience. For more exciting things some you'll just have to watch at the vet school while your professors/residents/interns do more of the hands on but even just seeing a procedure before attempting one can be helpful. If you can find GP or private practice specialists to mentor for externships the level of hands on may vary with the clinicians comfort level, so making those connections early will be to your benefit. If surgery is your jam then try to shadow/volunteer/be present in the surgery department - the more they know you the more you may be allowed to do/see while you're on rotation there.

 

[battie]

I just did an externship at a hospital where they do a lot of surgeries in house, and this is because of mentorship practices established by the previous owner that the current owner implements. If an associate wants to be involved in surgery, the longer term doctora that do these surgeries have the associate participate in about 15-20 of those surgeries. The point is to see the surgery and minorly assist.

Then they go do the CE courses with cadavers to really nail down the principles of the surgery without worrying that this is the first or second time seeing it done. They've already got experience of "learning" the techniques and arent caught up in a rush of remembering everything they just learned in the CE lectures while doing the CE lab.

After the CE course, the associate then assists with 15-20 more of those surgeries, but with a growing level of responsibility where the last 5 or 6, they're the surgeon and the more experienced clinician is standby assistance.

It seems like a great model where the surgical clinicians at this hospital feel they learn surgeries pretty well this way. If you're interested in doing an externship at this place, I can get you contact info.

 

[supershorty]

I just did an externship at a hospital where they do a lot of surgeries in house, and this is because of mentorship practices established by the previous owner that the current owner implements. If an associate wants to be involved in surgery, the longer term doctora that do these surgeries have the associate participate in about 15-20 of those surgeries. The point is to see the surgery and minorly assist.

Then they go do the CE courses with cadavers to really nail down the principles of the surgery without worrying that this is the first or second time seeing it done. They've already got experience of "learning" the techniques and arent caught up in a rush of remembering everything they just learned in the CE lectures while doing the CE lab.

After the CE course, the associate then assists with 15-20 more of those surgeries, but with a growing level of responsibility where the last 5 or 6, they're the surgeon and the more experienced clinician is standby assistance.

It seems like a great model where the surgical clinicians at this hospital feel they learn surgeries pretty well this way. If you're interested in doing an externship at this place, I can get you contact info.

Could I get their contact info from you, please? Not that externships are in my immediate future, but hopefully in the next couple years.

 

[battie]

Could I get their contact info from you, please? Not that externships are in my immediate future, but hopefully in the next couple years.

Just messaged!

 

[SocialStigma]

Disclaimer: I'm a surgeon

Echoing what most people have said, the best way to become competent and confident with surgery is to accept a job post-graduation where you will have strong surgery mentorship in a practice that does a lot of surgeries in-house. I would also recommend trying to observe as many surgeries as possible during your clinical rotations and doing extra rotations in surgery beyond the required weeks. At many schools, 1st-3rd year vet students can volunteer to take on call shifts where they will come in help set up the OR, clean surgery instruments, and observe after hours/emergency surgeries. I would highly recommend doing this as well if this is an option. When I was a resident, I often got the volunteer student to scrub in too along with the student who was on the surgery rotation, since they clearly had an interest in surgery. Attending the ACVS annual conference is also a good way to get exposed to surgery CE, and they do have a GP stream. Having said that, the majority of the wet labs offered through the ACVS conference are generally reserved for residents/diplomates.

There's no reason why GPs can't perform BAS surgery, simple fracture repairs, lateral sutures, etc but the limiting factor will probably be equipment expense (for ortho implants, drills, saws, etc), ability to monitor patients postop, and address any complications that arise. A BAS surgery is very simple but can the staff manage a brachycephalic patient with a prolonged recovery postop, re-intubate, or perform a temporary tracheostomy if necessary? TPLOs are generally routine surgeries but you can lacerate the cranial tibial artery and get massive arterial bleeding - most GPs are not going to have vessel sealing devices or hemoclips to address that quickly, which means the dog could get to the point of needing a blood transfusion by the time the bleeding is controlled.

 

[Minnerbelle]

I think it depends on how much surgery you want to do. I feel like there are some things that would be dicey for a gp to do like TPLOs and other plating type things (as in, if things went south, you’re more likely to end up in hot waters).

But there’s a lot that you CAN do! And if you’re proactive enough, you absolutely can do some or a lot of what you’re interested in. It also comes down to your clientele, your hospital’s culture, and you/your hospital’s risk tolerance.

Current student just wanting to know what opportunities are available, or in what way, could I learn new (to me) and advanced surgical procedures after graduation, without going the internship + residency + board certification route?

***BEFORE YOU REPLY PLZ READ BELOW***

• I'm NOT asking if I should go or consider the internship + residency + board certification route, NOR am I asking for anyone to convince me.

I'm really not being stubborn, its just unfortunately not a practical option for me: I have the same story as most (loans on loans on loans), but I'm older & married w/ kids (do not have the time or flexibility), and since its the one of the lowest paid professions that requires a 4 years post-secondary degree, I know there's no REAL link between aforementioned route and salary.

• I know that board certification isn't required to perform advanced procedures, since all the vets I shadowed for are doing surgeries they aren't board certified for (and exceptionally well, I might add)

Since my first round of rotations, I noticed that the 4th years don't really get the amount of hands-on surgery that I was expecting from a profession that doesn't require specialization and allows you to practice (and even start your own practice) with just the 4 year vet degree. I just want to learn how to effectively & safely perform all these really cool advanced procedures I read about in veterinary surgery books without going at it blindly.

Can anyone who has taken my preferred path point me in the right direction?

Thanks!

I did a lot of shadowing/scrubbing in on my day off type thing during my first few years out, and became comfortable with the surgeries I was interested in. Shelter and community medicine folk who do a lot of surgeries are good to get to know, as are the boarded surgeons you refer out to. I worked at a couple of hybrid GP and limited specialty hospitals (mostly GP but had a boarded surgeon full time doing day surgeries), and that was a double edged sword. I learned a ton from having a surgeon there to teach me things. But it meant I was getting fewer of these cases for myself to do. So then branching out and working in hospitals where the clientele could afford $1000-1500 for me to do sx but could not afford the $3000+ for a boarded surgeon to do something was a sweet spot for me.

 

[thetrukillat]

I just did an externship at a hospital where they do a lot of surgeries in house, and this is because of mentorship practices established by the previous owner that the current owner implements. If an associate wants to be involved in surgery, the longer term doctora that do these surgeries have the associate participate in about 15-20 of those surgeries. The point is to see the surgery and minorly assist.

Then they go do the CE courses with cadavers to really nail down the principles of the surgery without worrying that this is the first or second time seeing it done. They've already got experience of "learning" the techniques and arent caught up in a rush of remembering everything they just learned in the CE lectures while doing the CE lab.

After the CE course, the associate then assists with 15-20 more of those surgeries, but with a growing level of responsibility where the last 5 or 6, they're the surgeon and the more experienced clinician is standby assistance.

It seems like a great model where the surgical clinicians at this hospital feel they learn surgeries pretty well this way. If you're interested in doing an externship at this place, I can get you contact info.

I'd definitely appreciate that contact info...Thank you!

 

[battie]

I'd definitely appreciate that contact info...Thank you!

You might need to message me; sdn isnt giving me the option of messaging you!

 

[deleted498041]

Disclaimer: I'm a surgeon

Echoing what most people have said, the best way to become competent and confident with surgery is to accept a job post-graduation where you will have strong surgery mentorship in a practice that does a lot of surgeries in-house. I would also recommend trying to observe as many surgeries as possible during your clinical rotations and doing extra rotations in surgery beyond the required weeks. At many schools, 1st-3rd year vet students can volunteer to take on call shifts where they will come in help set up the OR, clean surgery instruments, and observe after hours/emergency surgeries. I would highly recommend doing this as well if this is an option. When I was a resident, I often got the volunteer student to scrub in too along with the student who was on the surgery rotation, since they clearly had an interest in surgery. Attending the ACVS annual conference is also a good way to get exposed to surgery CE, and they do have a GP stream. Having said that, the majority of the wet labs offered through the ACVS conference are generally reserved for residents/diplomates.

There's no reason why GPs can't perform BAS surgery, simple fracture repairs, lateral sutures, etc but the limiting factor will probably be equipment expense (for ortho implants, drills, saws, etc), ability to monitor patients postop, and address any complications that arise. A BAS surgery is very simple but can the staff manage a brachycephalic patient with a prolonged recovery postop, re-intubate, or perform a temporary tracheostomy if necessary? TPLOs are generally routine surgeries but you can lacerate the cranial tibial artery and get massive arterial bleeding - most GPs are not going to have vessel sealing devices or hemoclips to address that quickly, which means the dog could get to the point of needing a blood transfusion by the time the bleeding is controlled.

Just to chime in and agree with this... I have the strong opinion that unless you can anticipate surgical complications and know how to address them, you can't do the original surgery. I see plenty of BAS cases that have had their nares done but the rDVM was uncomfortable doing the massively long palate or removing the excessively huge saccules. Or I've seen cases where a BAS dog is sent over intubated because it upper airway obstructed post-op and they weren't comfortable doing a trach. I don't think there's anything wrong with a GP doing surgeries beyond routine spay/neuter, but I don't think it can be stressed enough the need to be able to perform plan A, B, C, and D and have the equipment, instrumentation, and staffing necessary to do so.

 

[VIN-Foundation]

Can anyone who has taken my preferred path point me in the right direction?

I haven't taken the exact path you are considering (I did GP for a while and then a residency) but that never stopped me from offering an opinion

The best way to learn surgery is to work with an experienced surgeon, who you can scrub in with initially and then later is available to scrub in with you when you're in surgery and the Shih Tzu hits the fan. So I would focus on trying to get a position where there is someone willing and able to mentor you in this way. In many cases, this is going to be a multi-doctor practice that has a history of hiring and mentoring recent graduates and has one or more doctors that do a lot of the surgery in the practice.

For the less common surgeries, it's a numbers game. To become proficient at a procedure you need to be doing a certain number of those procedures. This is more likely to happen in a larger practice that is funneling the procedures to one doctor.

CE is good, as are CE labs. But these days almost all of these are cadaver labs. These are great for learning regional anatomy and instrumentation. But as my residents are tired of hearing me say, if it wasn't for bleeding anyone could do surgery. There's just no substitute for surgery on real patients. And the best way to learn that is to work with an experienced surgeon.

 

[CalliopeDVM]

There are many ways to learn the surgeries - continuing ed, wetlabs, mentorship in practice - but one of the biggest challenges regarding these more "advanced" surgeries is that GPs usually don't have the caseload to get very practised at it, nor to afford the specialized equipment that some of those surgeries require.

I noticed that the 4th years don't really get the amount of hands-on surgery that I was expecting from a profession that doesn't require specialization and allows you to practice (and even start your own practice) with just the 4 year vet degree.

You almost assuredly can get more if you want to, even as a student, if you made that a priority. If surgery is what you want to do, there will be rotations, externships, and summer opportunities that allow you more experience.

 

[missdarjeeling]

I'm a newbie recent grad GP who likes soft tissue surgery, and even in a busy practice with an excellent mentor who enjoys surgery, it's been a little tough to get more experience. Most of the procedure caseload is dentals, and aside from one minor mass removal, I've only done spays and neuters so far. Every case that we've had recently where we could've done a potential foreign body or splenectomy had some issue or circumstance that required us to refer.

The biggest hurdles I see are definitely, 100%, absolutely the equipment expense and staffing concerns that SocialStigma and CalliopeDVM mentioned, on top of the caseload concerns. Even if I had 100 TPLOs under my belt, my practice would never agree to buy me the equipment needed to actually do one. In the past 4 months, I've diagnosed a grand total of 3 cruciate tears, and my colleagues haven't seen that many, either. That's not nearly enough for corporate to justify the expense of the equipment. To make it worth it, they'd need to charge much more money for a procedure like that, in which case, why wouldn't the client just go to a boarded surgeon instead? And with a caseload that low, I feel like it'd take me forever to get enough practice to feel good about doing the procedure. The hospital also has no capacity to keep patients overnight, and there aren't enough licensed techs to go around even with routine, run-of-the-mill GP surgeries. We're limited in terms of staff and equipment in what we can handle in terms of post-op complications, so even if we could do a procedure, it's often in the best interests of the patient to go to a 24 hour facility.

I know there are GPs out there who do more than we do, so it's a matter for finding a place that can accommodate what you want to do, if you decide to go into GP. In my admittedly limited experience, shelter med seems to be a good way to learn and do a fair amount of surgery. At the shelter internships I did, I met a few doctors who did CE labs for more advanced surgical techniques to expand their skills. One doctor was really interested in orthopedics and was able to secure equipment for fracture repairs, so that may be another option. Out in my state, there's a low cost clinic that does dental procedures and surgery only, and their doctors are not boarded. They do lateral suture, MPLs, splenectomy, foreign body, FHOs, perineal urethrostomy, and a few other procedures, even though they also don't have overnight care. So places like that may be another option.

 

[lelakenz]

I just did an externship at a hospital where they do a lot of surgeries in house, and this is because of mentorship practices established by the previous owner that the current owner implements. If an associate wants to be involved in surgery, the longer term doctora that do these surgeries have the associate participate in about 15-20 of those surgeries. The point is to see the surgery and minorly assist.

Then they go do the CE courses with cadavers to really nail down the principles of the surgery without worrying that this is the first or second time seeing it done. They've already got experience of "learning" the techniques and arent caught up in a rush of remembering everything they just learned in the CE lectures while doing the CE lab.

After the CE course, the associate then assists with 15-20 more of those surgeries, but with a growing level of responsibility where the last 5 or 6, they're the surgeon and the more experienced clinician is standby assistance.

It seems like a great model where the surgical clinicians at this hospital feel they learn surgeries pretty well this way. If you're interested in doing an externship at this place, I can get you contact info.

Hi! I know you posted this a while ago, but I am currently STRUGGLING to find external rotations in SA surgery for summer because of Covid. Could I also please get the contact info for this place? It sounds incredible!

 

[battie]

Hi! I know you posted this a while ago, but I am currently STRUGGLING to find external rotations in SA surgery for summer because of Covid. Could I also please get the contact info for this place? It sounds incredible!

Sure! It seems I can't message you. If you message me, I can give you the contact info

 

[Surgeonfish]

Current student just wanting to know what opportunities are available, or in what way, could I learn new (to me) and advanced surgical procedures after graduation, without going the internship + residency + board certification route?

***BEFORE YOU REPLY PLZ READ BELOW***

• I'm NOT asking if I should go or consider the internship + residency + board certification route, NOR am I asking for anyone to convince me.

I'm really not being stubborn, its just unfortunately not a practical option for me: I have the same story as most (loans on loans on loans), but I'm older & married w/ kids (do not have the time or flexibility), and since its the one of the lowest paid professions that requires a 4 years post-secondary degree, I know there's no REAL link between aforementioned route and salary.

• I know that board certification isn't required to perform advanced procedures, since all the vets I shadowed for are doing surgeries they aren't board certified for (and exceptionally well, I might add)

Since my first round of rotations, I noticed that the 4th years don't really get the amount of hands-on surgery that I was expecting from a profession that doesn't require specialization and allows you to practice (and even start your own practice) with just the 4 year vet degree. I just want to learn how to effectively & safely perform all these really cool advanced procedures I read about in veterinary surgery books without going at it blindly.

Can anyone who has taken my preferred path point me in the right direction?

Thanks!

Not sure if you have heard of AOVET. They do a lot of basic / advanced fracture management courses with lectures and practicals which are very helpful.

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