What makes a good extern? How do I know I'm being a good one?

[luvpup]

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Hi yall! I'm entering my 3rd year of vet school and have had a couple of externships during my school breaks to help learn more, however I guess I just have been having a bit of self doubt in terms of if I'm being a good student extern/future vet. I do the basics, I try to be helpful, especially with staff, I try to ask questions, I'm on time, I'm professional and eager to learn. However, it's obvious that I'm not that confident as I'm pretty timid.

For context;
I have done an externship last summer and my DVM mentor and I got along so well! I even externed with her again this summer. That clinic loved me so much as well that they already sent me a job offer for winter break, which I think is great! The way she taught/I learned was essentially we would review cases together, she let me be more hands on, especially in client communication/ writing SOAPs and get out my comfort zone, she'd ask questions and even if I didn't know the answer, she didn't hold it against me and used it as a teaching moment but without that "pressure"/feeling "dumb". All in all, it made me think what I'm doing currently is "good". I think what helped the most is that she also is kind of like me in terms of "timidness/personality" plus being a minority like me, so its nice to see someone "like me" and understand that.

Onto my 2nd externship this summer. It went really great as well. The staff and my new DVM mentor were eager to make me learn new things. My new mentor really pushed me to get out of my comfort zone, so I started to take on more cases as if I was the vet looking at the pets. I'd do my physicals, create a treatment plan and talk with clients, etc. That was really helpful for me and even if he'd ask a question & I didnt know something he reassured me that its okay to say "I don't know". Once I left, the staff and vets let it be known that I'm always welcome to come back and are eager to see me again! I saw that as a win as well.

Onto my 3rd externship this summer, and I'm starting to have a bit of self doubts. This vet is pretty "popular" around the area and heard many good things about him from previous externs. Given my past 2 externships this summer, I really wanted to "prove/show" myself. He definitely asks me a lot in depth questions, especially in terms of disease processes/certain body mechanisms etc (rather than broad medicine concepts that I'm usually asked) and I usually respond with saying "I don't know" or give an answer that is 90% of the time wrong. I can tell that he doesnt seem tooo satisfied with my answers. I do a whole lot of shadowing and not much hands on. I feel like I'm kind of being "disappointing" or being a lack in something. During the week he expressed how students who really get his attention are those with great confidence, which definitely IS NOT me. Due to this comment, I have started to worry that maybe I'm not doing good enough? He mentioned I need to respond with more confidence because owners will see right through me (which is true) & if he asks a question to just give an answer. I guess in a way, I am struggling to "keep up" with him & I dont feel useful at all in this clinic either. A common thing i would do at my other externships was have my laptop on standby to always review topics, especially on topics I didnt know the answer for, that way I can come back & ask my own questions for better understanding, however I am not really able to access my laptop/notes in this clinic. Also, don't get me wrong, they are all lovely people, but maybe I'm doing something wrong when I originally thought I was doing ok and maybe thats why I feel like I am not learning as much as I normally would because maybe they also think I'm not worth to be so hands on?

Maybe i needed to vent/rant and maybe it's a me problem but I wonder, given this scenario, what if the past 2 externships was just the mentors "dealing" with my timidness/non-confidence/"lack of knowledge" but never truly expressed that I need to change that ASAP? They knew about it but they helped me work through it(kinda like "positive reinforcement"). However in this new place, it seemed to be more of a "need to shut that down ASAP". If that makes sense? I guess this turned out to be more of a how to be confident rather than how to be good student extern... or both? Lol

Sorry I know this was long, I guess a lot of things i need to vent out!

 

[pp9]

For me, a good extern is on time, off their phone, and shows interest. They prep their cases the night before and come ready to discuss differentials and plans. They are autonomous when appropriate. I don't expect a student to know all of the answers, but I do expect them to look something up when they don't know and circle back on it with me when there is a minute. These externs get to draw blood, place catheters, do exams, go on 'field trips' to visit animals, whatever.

A bad extern is late regularly/has crappy attendance, is constantly in their phone, doesn't get things done when asked, seems bored, isn't interested in helping the team, only partakes in animal-facing tasks, requires heavy direction. They might be unprofessional/too 'comfortable,' put in minimal effort, have done no prep work for the day's cases, etc. Sometimes they just have awful personalities. These externs don't get to do as much and are often handed the anesthesia clipboard and told to record.

It could just be that you and this third vet don't mesh super well. I'd need a little more info on what having a wrong answer 90% of the time actually looks like. If you're being asked super deep-dive niche questions, meh whatever. If you're being asked stuff you absolutely should know, then you might have a knowledge base issue. If this vet has a rep for allowing externs to be hands-on, and you are being told you can't be hands-on, then yes this vet might not be impressed with you. If you are not being told this, then sometimes you just need to jump in or ask if you can do something. Having a mid-way sit down with this vet and checking in could be worth it.

We get about 8-10 externs a year, so definitely not a ton by any means. Right now I'd say we lean 25% being genuinely good externs according to my opinion. 50% neutral/fine, 25% we cannot wait for them to leave. So it's common to be a meh extern, harder to be a good or bad one.

 

[luvpup]

Thank you for the distinction that's really helpful!

Questions vary from "give me top 5 round cell tumors" which I may give 3 and say I'm not sure what the other 2 might be vs it might be like give me your top 9 diseases Cavaliers can get, which I might get 4/5. Other times it might be like "what might be another component that can come from laryngeal paralysis?" & it turns out to be GOLPP (which I truly didn't know, I dont think I learned that in school). I do think I probably have a knowledge based issue, especially if I'm asked on the spot, because I might know it but i forget it if I'm asked randomly & they are intently waiting for an answer asap when i tend to think for a hot minute before I answer.

Based on previous externs they mentioned he would make them shadow everything, but haven't heard anything about hands on. I definitely want to be more hands on, especially to be of use during my time here. I'll try to be more proactive or offer to do things even if its just blood draws. I already ask if I can perform physicals, which they let me, so maybe if I extend my neck more, I can do more? Although sometimes I'll ask to help but doesnt seem like they hear me, which is probably due to my low voice rather than them actively ignoring me I hope.

I'll definitely try to see where I'm at midway towards my externship, I understand I can't impress every vet, but I hope at least I'm not a bad "dumb" extern and try my best!

 

[pp9]

Thank you for the distinction that's really helpful!

Questions vary from "give me top 5 round cell tumors" which I may give 3 and say I'm not sure what the other 2 might be vs it might be like give me your top 9 diseases Cavaliers can get, which I might get 4/5. Other times it might be like "what might be another component that can come from laryngeal paralysis?" & it turns out to be GOLPP (which I truly didn't know, I dont think I learned that in school). I do think I probably have a knowledge based issue, especially if I'm asked on the spot, because I might know it but i forget it if I'm asked randomly & they are intently waiting for an answer asap when i tend to think for a hot minute before I answer.

Based on previous externs they mentioned he would make them shadow everything, but haven't heard anything about hands on. I definitely want to be more hands on, especially to be of use during my time here. I'll try to be more proactive or offer to do things even if its just blood draws. I already ask if I can perform physicals, which they let me, so maybe if I extend my neck more, I can do more? Although sometimes I'll ask to help but doesnt seem like they hear me, which is probably due to my low voice rather than them actively ignoring me I hope.

I'll definitely try to see where I'm at midway towards my externship, I understand I can't impress every vet, but I hope at least I'm not a bad "dumb" extern and try my best!

The tumor question, I struggle to name a 5th. The other two questions are too subjective/vague to be a good question, especially if they are asked out of the blue. If you are seeing a case the the vet suspects is GOLPP, the history/exam would be part of your hint (also fwiw I completely forgot this is a thing but haven't seen a dog routinely in a few years now). Honestly it can be hard to ask a student a good question because there is so much bias in what someone thinks is an easy question or the obvious answer(s). That's why writing test questions is surprisingly difficult.

If others were not more hands on, then this clinic may just not allow externs to be hands on. That's a question worth asking before you schedule these externships. Try not to be too hard on yourself, you aren't supposed to know everything at this stage. But definitely speak up and ask for opportunities when appropriate!

 

[luvpup]

The tumor question, I struggle to name a 5th. The other two questions are too subjective/vague to be a good question, especially if they are asked out of the blue. If you are seeing a case the the vet suspects is GOLPP, the history/exam would be part of your hint (also fwiw I completely forgot this is a thing but haven't seen a dog routinely in a few years now). Honestly it can be hard to ask a student a good question because there is so much bias in what someone thinks is an easy question or the obvious answer(s). That's why writing test questions is surprisingly difficult.

If others were not more hands on, then this clinic may just not allow externs to be hands on. That's a question worth asking before you schedule these externships. Try not to be too hard on yourself, you aren't supposed to know everything at this stage. But definitely speak up and ask for opportunities when appropriate!

That makes sense! I definitely agree half the time was more so the question was asked to vaguely so id follow up with more questions so I know exactly what answer he's trying to get from me. He did mention I can't be saying "uhs or ums" as that shows no confidence in your answers so I think that's also something I need to work on.

Unfortunately I think that seems to be the case for this externship in terms of more shadowing than hands on. I did ask prior which I was told there would be a "lot of hands on" but based on my 1st week of my 2 week externship, I might have to be more proactive about it (if they let me) but thank you for your advice! I'll definitely try to see if I can be more involved!

 

[battie]

He mentioned I need to respond with more confidence because owners will see right through me (which is true) & if he asks a question to just give an answer.

I'm not a big fan of "just say something". I've been telling clients, "I don't know, but I'll find out for you," so much this last month since going back to GP, my homework list is wild. And every single client has been okay with that. Most prefer honesty rather than making things up.

You can be confident while not knowing the answer. That's why we have the resources we have (VIN, plumbs, each other, etc.).

what if the past 2 externships was just the mentors "dealing" with my timidness/non-confidence but never truly expressed that I need to change that ASAP?

Oh trust me, fam. They would not be inviting you back if they were just dealing with you. Also, you're a third year. You've got time to build your confidence. ASAP has nothing to do with it.

I agree with PP that you could simply be experiencing a mish mash of personalities between you and this third doctor. All you can do is take what people say at face value, pending the context of the situation. If the other two docs told you outright they liked you and want you to come back, then awesome. Take your time to gain that confidence that this third doctor is talking about. It's not going to be perfect at the end of two weeks; but improvement is always possible

 

[luvpup]

I'm not a big fan of "just say something". I've been telling clients, "I don't know, but I'll find out for you," so much this last month since going back to GP, my homework list is wild. And every single client has been okay with that. Most prefer honesty rather than making things up.

You can be confident while not knowing the answer. That's why we have the resources we have (VIN, plumbs, each other, etc.).



Oh trust me, fam. They would not be inviting you back if they were just dealing with you. Also, you're a third year. You've got time to build your confidence. ASAP has nothing to do with it.

I agree with PP that you could simply be experiencing a mish mash of personalities between you and this third doctor. All you can do is take what people say at face value, pending the context of the situation. If the other two docs told you outright they liked you and want you to come back, then awesome. Take your time to gain that confidence that this third doctor is talking about. It's not going to be perfect at the end of two weeks; but improvement is always possible

I agree! I definitely feel bad saying something out of thin air rather than just saying "i don't know but let me figure it out".

Thank you, that makes me feel better! I guess in comparison I know my classmates/third years express more "knowledge"/confidence than I, and I feel like maybe I'm behind.

I'll definitely try to implement that into this externship. I also think it might also just be a mish mash but I'll try to make the best of it for the next week I am there!

 

[gartersotter]

Other times it might be like "what might be another component that can come from laryngeal paralysis?" & it turns out to be GOLPP (which I truly didn't know, I dont think I learned that in school).

I just wanted to isolate this part here. If you are in a 2+2 program, I promise you learned this in school. 3+1, maybe not, but I would expect a third year to know this. I hear from students all the time that they "didn't learn this in school" when it is a subject from a lecture I gave them a year ago. I would recommend ensuring that you're not saying something like this to preceptors or professors because it comes across as being an excuse. We'd much rather hear "I don't know, but I'll look that up and get back to you."

Otherwise it sounds like you're doing well and maybe your personalities just don't align.

 

[pp9]

I just wanted to isolate this part here. If you are in a 2+2 program, I promise you learned this in school. 3+1, maybe not, but I would expect a third year to know this. I hear from students all the time that they "didn't learn this in school" when it is a subject from a lecture I gave them a year ago. I would recommend ensuring that you're not saying something like this to preceptors or professors because it comes across as being an excuse. We'd much rather hear "I don't know, but I'll look that up and get back to you."

Otherwise it sounds like you're doing well and maybe your personalities just don't align.

Mehhh...I can guarantee you I didn't learn this in my 2+2 school (ETA: UofI is more of a 2.5 + 1.5 I guess)

And just to prove it to myself, I searched my OneNote (literally every vet school lecture is still in my OneNote/cloud) and yup, nothing. This is something that I learned during my rotating, probably during intern rounds early on. Granted, UofI definitely had some curriculum issues at the time. Idk if OP has looked back through their notes to see if this was actually covered or not, not that it matters imo.

I would never expect someone to remember every single thing that was covered. That's kind of the problem with vet school education, people act like you should have everything memorized but it's just not possible. Even moreso for someone who is just seeing things clinically for the first time...things did not start 'sticking' for me until I was the doctor seeing these various diseases we learned about (or didn't...) for 3 minutes back in second or third year. Edit: And this is also why I always whip out the dreaded 'Why don't you look this up and get back to me?'

I hear from students all the time that they "didn't learn this in school" when it is a subject from a lecture I gave them a year ago.

FWIW, our faculty used to snap at us all the time that 'you absolutely covered this' when we absolutely did not. Faculty on the clinic floor are not always up to speed on didactic curriculum changes (although this isn't necessarily accurate for your specific situation, just me giving benefit of the doubt to OP). My class in particular was the first class that sat through some curriculum adjustments and the gaps were not apparent until we hit clinics and clinicians had entire rounds rooms of students with blank faces hearing about things for the first time. One instance I can recall off the top of my head was learning about meningeal worm on my farms rotation as a fourth year...

 

[gartersotter]

Mehhh...I can guarantee you I didn't learn this in my 2+2 school

And just to prove it to myself, I searched my OneNote (literally every vet school lecture is still in my OneNote/cloud) and yup, nothing. This is something that I learned during my rotating, probably during intern rounds early on. Granted, UofI definitely had some curriculum issues at the time. Idk if OP has looked back through their notes to see if this was actually covered or not, not that it matters imo.

I would never expect someone to remember every single thing that was covered. That's kind of the problem with vet school education, people act like you should have everything memorized but it's just not possible. Even moreso for someone who is just seeing things clinically for the first time...things did not start 'sticking' for me until I was the doctor seeing these various diseases we learned about (or didn't...) for 3 minutes back in second or third year. Edit: And this is also why I always whip out the dreaded 'Why don't you look this up and get back to me?'


FWIW, our faculty used to snap at us all the time that 'you absolutely covered this' when we absolutely did not. Faculty on the clinic floor are not always up to speed on didactic curriculum changes (although this isn't necessarily accurate for your specific situation, just me giving benefit of the doubt to OP). My class in particular was the first class that sat through some curriculum adjustments and the gaps were not apparent until we hit clinics and clinicians had entire rounds rooms of students with blank faces hearing about things for the first time. One instance I can recall off the top of my head was learning about meningeal worm on my farms rotation as a fourth year...

You bring up several good points and I retract my "I promise you learned this." I didn't take into consideration the newer schools, whose curriculum I am less familiar with, and those undergoing significant curriculum changes.

I don't think faculty should snap at anyone that something has been covered, and I definitely don't expect my students to remember everything! Clinics is where you take that amorphous goo of unformed knowledge you learned in didactics and start making connections so it actually sticks. I more wanted to point out that I raise an eyebrow when students say they never learned something when I'm the one that taught it six months ago. A much safer answer is "I'm not sure, but I can look that up and get back to you."

 

[pp9]

You bring up several good points and I retract my "I promise you learned this." I didn't take into consideration the newer schools, whose curriculum I am less familiar with, and those undergoing significant curriculum changes.

I don't think faculty should snap at anyone that something has been covered, and I definitely don't expect my students to remember everything! Clinics is where you take that amorphous goo of unformed knowledge you learned in didactics and start making connections so it actually sticks. I more wanted to point out that I raise an eyebrow when students say they never learned something when I'm the one that taught it six months ago. A much safer answer is "I'm not sure, but I can look that up and get back to you."

Oooh also a great point, I didn't think of this either! It looks like OP attends Texas A+M so doesn't apply here, but I bet there will be a lot of externs with very spotty education, both from a didactic and clinical standpoint. That's one of the most significant problems with a distributive model imo.

In our faculty's defense, this was NAVLE-basic stuff that totally should have been covered and just wasn't. The most notorious example was that we just flat out didn't cover the liver during second year pathology lol

 

[luvpup]

I just wanted to isolate this part here. If you are in a 2+2 program, I promise you learned this in school. 3+1, maybe not, but I would expect a third year to know this. I hear from students all the time that they "didn't learn this in school" when it is a subject from a lecture I gave them a year ago. I would recommend ensuring that you're not saying something like this to preceptors or professors because it comes across as being an excuse. We'd much rather hear "I don't know, but I'll look that up and get back to you."

Otherwise it sounds like you're doing well and maybe your personalities just don't align.

I see! I am in a 3+1 program but it may be possible it was briefly mentioned somewhere and maybe I missed it somewhere, I was just reviewing my notes and couldn't seem to find it but again, maybe I missed something! I generally don't mention to them that "I didn't learn it from school", but now that you mention it, I will make sure to keep that in mind for something I don't recall for sure! Thank you!

 

[luvpup]

Oooh also a great point, I didn't think of this either! It looks like OP attends Texas A+M so doesn't apply here, but I bet there will be a lot of externs with very spotty education, both from a didactic and clinical standpoint. That's one of the most significant problems with a distributive model imo.

In our faculty's defense, this was NAVLE-basic stuff that totally should have been covered and just wasn't. The most notorious example was that we just flat out didn't cover the liver during second year pathology lol

Yes I do attend TAMU! Not to be biased but the education is really great imo! The subjects they teach us can go pretty in depth, which is why I feel bad if I am asked an in-depth question and I don't seem to know. I am not sure if its because I feel pressured "on the spot" and this clinic is just giving me a bit of "insecurity" compared to past externships. However, I tell myself that the pressure is good, I think over time it can help me think better on my toes.

Normally in my externships, if I didn't know something, I would go back to my laptop and look at my notes that way I'd have an answer (and usually more questions lol!), plus I like to reflect on what I learned and write it down in my laptop through my docs. In this specific clinic, it just seems like I never have that "time" or "luxury" to look up things and I feel bad because it feels like I am not doing my research! This clinic does seem a little more fast paced and I do not really have a "place" for me to put my laptop down & research, so maybe it could be that? I guess I am just worrying that giving them any answer on the spot makes it seem like I didn't put much thought into it.

 

[pp9]

I guess I am just worrying that giving them any answer on the spot makes it seem like I didn't put much thought into it.

It depends. If you are blurting things out that don't make sense or are blatantly wrong/off base just for the sake of saying something, then you aren't putting much thought into it. But if you are in the same neighborhood as the correct answer (or heck, even in the same zip code), that's different. If you brainstorm for a minute or two and genuinely can't come up with a single thing, then just say 'Yep I've got nothing, I need to brush up on this and get back to you' is fine in my book. Not every vet will be satisfied by that but most probably will.

Don't forget to run through DAMNITV as you brainstorm things. Also if you don't have it, getting a copy of the Small Animal Ddx book can be helpful for vet students. There is one that fits into a large pocket.

 

[luvpup]

It depends. If you are blurting things out that don't make sense or are blatantly wrong/off base just for the sake of saying something, then you aren't putting much thought into it. But if you are in the same neighborhood as the correct answer (or heck, even in the same zip code), that's different. If you brainstorm for a minute or two and genuinely can't come up with a single thing, then just say 'Yep I've got nothing, I need to brush up on this and get back to you' is fine in my book. Not every vet will be satisfied by that but most probably will.

Don't forget to run through DAMNITV as you brainstorm things. Also if you don't have it, getting a copy of the Small Animal Ddx book can be helpful for vet students. There is one that fits into a large pocket.

Gotcha, that makes sense! Thank you!

Also funny you say that, I was recently gifted that book & should have a copy of that arriving soon! I think it will be really helpful!

 

[battie]

I would never expect someone to remember every single thing that was covered. That's kind of the problem with vet school education, people act like you should have everything memorized but it's just not possible.

This isnt expected in human med school either. And their level of death is greater than ours in the majority of situations.

Gaps of knowledge is the greatest lacking force in vet med. I'm slowly rolling towards that we need more 2+2 programs these days