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
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