On the job training…..a good idea?

Less than two years into my veterinary career, I found myself the Practice Principal of a busy, sole charge practice. The experience was invaluable. I found myself managing a busy caseload and a small team of support staff when I was barely in my mid 20’s and I thrived on it. The downside was that while more senior veterinarians were just a phone call away, for the most part I as a relatively inexperienced recent graduate was required to make clinical decisions and perform procedures with very little guidance. Being a keen surgeon even then, I had free rein to attempt any procedures I deemed within my skill set, while referring what I considered more complex procedures. An excellent learning experience? Yes. Did I learn from my mistakes? Absolutely!

But I cringe a little, even years on, when I remind myself of those patients that may have had better or faster outcomes with a more experienced or better trained surgeon. What if someone had closely supervised my first cruciate ligament surgery? Would I have done a better job, thereby ensuring an earlier return to function of the leg? Or if I’d had more guidance during my first intestinal resection and anastomosis? Would that mean that the patient would have spent less time under general anaesthetic and at risk of hypotension, thereby ensuring a faster recovery?

On a larger scale, why is it that so many veterinarians, including many new graduates are less than keen on performing non-routine surgeries? Is it simply a matter of interest, or is there a confidence issue at play? Taking things a step further, in smaller one or two vet practices, could increased surgical confidence among the veterinarians lead to less surgical cases referred and a higher profit margin?

What all this has made me realise that in veterinary clinical practice, in my opinion, there is a little too much emphasis on ‘learning on the job’. After all, unlike human doctors, we graduate with the ability and the expectation to perform both routine and non-routine surgical procedures competently. In the last decade or so, veterinary students in Australia have had less and less opportunities to perform surgery on both live animals and cadavers, mainly due to financial and animal welfare concerns. Therefore anything that we haven’t had the ability to practice at university, in most cases anything beyond a desexing procedure and basic non-routine surgery, will need to be learnt on the job. The veterinarians we are learning from have varied experiences and skill sets, and often little or no experience training novice surgeons, leading to a situation where the novice surgeon is at risk of suffering large gaps in their learning or worse still, the absorption of less than desirable habits. Combine this with the fact that busy veterinary practices are essentially fast moving, stressful environments, and it would seem that to ‘learn on the job’ may not be the ideal sole mode of learning when it comes to complex technical skills such as surgery.

So what’s the solution? How do we ensure we ‘raise’ surgically confident veterinarians who make good clinical decisions? Well, while I agree that to learn on the job is both inevitable and essential, I feel that we need to be more proactive in our approach to the acquisition of surgical skills. Success does wonders for confidence and we need to provide veterinarians with more opportunities to perform surgery successfully, make mistakes without terrible repercussions and be guided by those with more experience throughout. Surgical wet labs using cadavers provide fantastic opportunities for just that. Not only are they a stress-free environment where keeping the patient stable is not a concern, but there are specialist or highly experienced surgeons present whose sole purpose is to ensure that you gain certain skills. These are skills that cannot be learned from books, journal papers or seminars. In fact, research has showed that the only way to learn technical skills is by doing, and by doing repeatedly.

The teaching clinicians are not distracted by their own patients, phone calls from clients or practice management issues. In other words, there is an emphasis on teaching, not productivity. Similarly, the attendee is away from work, more relaxed and therefore much more receptive to new information.

It seems to me then that investing in your staff to ensure they gain these skills outside the practice may lead to a win-win situation. On one side, you have a veterinarian with improved skills and the confidence that accompanies that. From the employer’s point of view, there are benefits when it comes to the client and case retention that comes from reduced referral, increased practice income, as well as better patient outcomes, which after all is what it’s all about.

Written by Deepa Gopinath

Deepa has been vetting for eleven years across Sydney, London and Glasgow.  Scotland, although beautiful was very cold and Deepa knew it was time to leave when she started to answer people with an “Aye!” Her main interest is in surgery and she is a member of the Australian College of Veterinary Scientists in small animal surgery.  She also spent time at Sydney Uni teaching surgery to budding vets. Outside being a vet, Deepa has a food blog www.onesmallpot.com where she gets to dabble in her favourite hobbies- cooking, eating, writing and photography.

Twitter: @onesmallpot
Instagram: onesmallpot

Hip Surgery Tips

Surgical conditions of the hip are common. Early intervention, along with good management can make the life of your patients healthier and less painful. Being sure you have the best technique to approach and operate in the coxofemoral joint is integral to good practice.

Find out out top 3 hip surgery tips below:-

Tip 1: Anatomy Matters

In addition to the bony anatomy it is also important to consider the vascular, muscular and soft tissue anatomy when assessing femoral head fractures.

The weight-bearing part of the acetabulum is the dorsal aspect of the lunate surface, to match this, the main weight bearing aspect of the femoral head is the dorsal part of the head. Thus the loss of a non articular area of the femoral head can be tolerated to a degree. However it should be remembered that any damage to articular cartilage will set in motion a process of inflammation leading ultimately to DJD.

Tip 2: Femoral Physeal Fractures

These fractures can be difficult to identify radiographically as the joint capsule is usually intact and the fracture may be minimally displaced. The dog is generally non-weight bearing lame and has pain and crepitus in the hip. Frog leg, extended hip and lateral views may be required to identify the problem.

If detected early, the physis is usually not severely damaged and can be reduced before being appropriately stabilised. Fixation of physeal fractures should ideally be performed with smooth pins that allow continued physeal growth. This will give the best chance for good long-term function.

Tip 3: Reminder for Clients

Hip dysplasia is an inherited abnormality causing the hips of affected dogs to develop abnormally. The round head of the femur (thigh bone) does not fit properly with the cup in the pelvis. In severe cases the joint is completely dislocated. Some dogs become lame by 8 months, but most develop early arthritis and hip pain from 2 – 8 years of age. Once arthritis has developed there is no cure although the pain can be managed in many dogs.

For more great tips and to put your hip skills into practice check out our  Hips in Practice Workshop – February 20th – 21st, 2015

Spend two full days with specialists and explore the multiple ways you can build your skills and your patients quality of life.

This workshop is designed for veterinarians who want to offer a comprehensive health care program for the lifespan of the animals they care for. Surgical conditions of the hip are important and most are manageable in general practice.

(Payment plans available on request)

BOOK NOW >> https://www.regonline.com.au/practical_Hips_2015

Our recommended tools of choice are are the IMEX ESF Equipment, for more information visit their website https://www.imexvet.com/

What are some of your hip surgery tips? Let us know in the comments below.