#vetstudentdownunder

[lizziedoesvetpath]

Final exams start Monday and I am NOT LOVING the studying... But it means I'm going to be a vet in 2 weeks!!!!

At the moment studying is a lot like looking after a toddler - "Study for another 30mins and you can have a cookie! And a shower!" - bribes get me everywhere 😂

[vetdownunder]

The Anatomy of Vet School

Most of my posts from the past year have been about my final year rotations and my experiences in each. Someone recently asked me to explain what rotations actually are and what they involve. I thought I’d take this opportunity to demystify the structure of vet school to any aspiring vet students out there. The following is based on my course in Australia, a 5 year combined undergraduate (Bachelor of Science, BSc) and postgraduate (Doctor of Veterinary Medicine, DVM) degree, although many vet schools follow a similar system.

FIRST YEAR

Who am I and what am I doing here?

First year is, to put it bluntly, a bit of a waste of time. It comprises basic foundation units which are not at all veterinary related. I had cell biology, statistics, agriculture and even a unit called ‘What is Science?’, which left me more confused about science than before I began! I found myself twiddling my thumbs waiting for this year to be over so I could learn something relevant to my chosen profession.

The next few years of vet school are dedicated to learning (and cramming) theory - all the ‘-ologies’ (physiology, parasitology, pharmacology and so on). This is accompanied by placements, where students spend several weeks on farms and at veterinary clinics in order to gain experience in agriculture and practice. The number of placement weeks varies between courses. Mine entailed 7 weeks of farm placement and 15 weeks of clinic placement.

SECOND YEAR

What does a normal animal look like and how does it work?

Second year covers primarily anatomy and physiology, as well as microbiology, parasitology and biochemistry. My lasting memories of this year involve rote learning the names of every bump on every bone and every detail of every organ in every species, to the extent that I could draw and label the outside and inside of any animal from memory.

THIRD YEAR

What does an abnormal or diseased animal look like and how does it go wrong?

After learning the normal body inside out in second year, this year is spent learning everything that can go wrong with the body - pathology. One of my units was called ‘Systemic Pathology and Medicine’, abbreviated to SPAM, which ruined the the Monty Python sketch (https://www.youtube.com/watch?v=Gxtsa-OvQLA) for me forever. Pathology is accompanied by radiography, pharmacology, nutrition, toxicology, behaviour, welfare, an introduction to One Health, and the basics of surgery and anaesthesia.

In my course, a research project was also launched towards the end of third year, to be conducted throughout fourth and fifth year. This is a requirement of the masters level postgraduate degree (the Doctor of Veterinary Medicine, DVM).

FOURTH YEAR

How do I fix an abnormal or diseased animal?

Fourth year is the dreaded year from hell, when students spend more time in the lecture theatre than they do at home. We often brought sleeping bags, pyjamas and kettles to class and basically moved in for the year. Lectures cover surgery, diagnostic imaging, theriogenology (reproduction) and medicine (small animal, production, equine, wildlife and exotics). This is the year when everything from the past four years starts to come together and students begin to feel like real vets.

FIFTH YEAR

Let’s give it a go!

During fifth year, students finally get to close the textbooks, step out of the lecture theatre and put all that new knowledge into action. This is the year you’re allowed all the fun of being a vet, but with just a fraction of the responsibility! It’s also the last chance to try things under supervision before you do it for real out in the big bad world. 

The final year of my veterinary course (and most others I’m aware of) primarily consists of rotations. Veterinary medicine covers an enormous range of fields compared to that of human medicine (think of all the human medical specialties and then factor in all the different species vets look after). Rotations are short (one or two week) blocks dedicated to each major field or speciality of the veterinary industry. They are designed to provide students with a foundation in all aspects of the profession. The year group is divided into small groups of around eight students which rotate between 15 different rotations (listed below). These amount to a total of 24 weeks. During these rotations, students form part of the department’s veterinary team and have the opportunity to develop their skills in each area with the guidance of experienced vets. For example, during the two week equine rotation, students may accompany vets on lameness call outs, treat a foal in the hospital, or scrub into and assist with a colic surgery. Whereas, during the two week diagnostic imaging rotation, students may position a surgery patient for stifle radiographs, evaluate an echocardiogram, or radiograph the fetlock of a lame horse.

The other component of final year is streaming. A stream is a broad division of the veterinary industry by species: small animal, production animal, equine, mixed, and wildlife and zoological medicine. Students elect one stream in which to advance their knowledge and skills during final year. This is either the field the student wishes to pursue as a graduate vet, or simply one they have an interest in. A further 12 weeks of placement is undertaken in this field during final year. I selected the wildlife and zoological medicine stream, which allowed me to research platypus in Tasmania, spend two weeks with the vets at my local zoo and participate in wildlife field operations in South Africa.

Primary care

Small animal medicine

Surgery

Anaesthesia

Diagnostic imaging

Ophthalmology, shelter, wildlife and behaviour

Emergency and critical care

Dermatology and dentistry

Equine

Production

Intensive industries

Public health

Anatomical pathology

Clinical pathology

After hours

I hope this post provides a bit of an insight into vet school and what to expect each year. To find out more about each rotation, have a read of my previous posts. As always, if you have any questions, please don’t hesitate to ask.

[lizziedoesvetpath]

If an alpaca tried to castrate me I'd punch it, and I'm not going to apologise for that

My classmate on camelids

[vetdownunder]

A Note On Religious Slaughter

In my third year of vet school, I had to write an essay on an animal welfare issue. I chose to research ‘halal slaughter’ because I wanted to increase my knowledge in order to form an educated opinion. The essay ended up winning me an award and sponsorship from Meat and Livestock Australia. It also provoked an ongoing interest in animal welfare associated with slaughter and euthanasia.

Halal slaughter conditions vary considerably according to differing interpretations of the Quran. It is generally accepted that animals must die from exsanguination (draining of blood) in order to be classified as ‘halal’. Therefore, animals are either slaughtered without any prior stunning (i.e. conscious) or after being reversibly stunned.

Conscious animals are capable of feeling pain, fear and stress. For this reason, livestock should be rendered unconscious before they are killed by ventral neck incision. In Australia, most abattoirs stun animals prior to slaughter. This can be done via a number of methods, including gas, electric stunners and non-penetrative captive bolt (NPCB). The issue with these reversible stunning methods is that animals can regain consciousness prior to death. They therefore rely on worker efficiency to ensure throats are cut and animals are effectively bled out before the effects of stunning wear off. In addition, there are few reliable methods of determining whether animals are, in fact, dead before they can regain consciousness. Any movement is often just attributed to post-mortem muscle twitching - but who’s to say it’s not conscious movement?

A small percentage of Australian abattoirs have been exempted from stunning standards and permitted to slaughter conscious animals for religious purposes. This is just disturbing.

The alternative (non-halal) slaughter method involves prior stunning by penetrative captive bolt (PCB) which results in irreversible unconsciousness. This method eliminates the risk of an animal regaining consciousness after having its neck cut, and therefore eliminates any pain, fear and stress post-stunning.

I fully appreciate that some swift knife action and rapid bleeding may once have been the most effective and humane method of slaughter. However, new large scale production industries and an increasing demand for meat from a rapidly growing population necessitate change. In modern times we have new knowledge and new technology that allows us to more humanely kill our livestock. Is it not our moral responsibility to utilise the best and kindest methods at our disposal?

I respect the religions of others, but I simply cannot justify animal suffering for a human belief. The more I research halal slaughter, the more uncomfortable I become with it. Don’t take my word for it though - do your own research and reach your own conclusions! The facts are out there if you do a bit of digging!

[vetdownunder]

Surgery Rotation

My final rotation of the year! It seems like yesterday that I was following a hand drawn map of the hospital to locate the ophthalmology room for my very first rotation. How far I’ve come!

On this rotation we began with a small group of four students (rather than the usual eight) which was then divided in half, with two students beginning on soft tissue and the other two on orthopaedics. I was assigned to soft tissue surgery for the first week and it was hectic! My buddy and I were run off our feet trying to complete the work of four students. We arrived at 7:30 each morning and didn’t leave until after 7:00 at night when our patient records were completed. Once home, our evenings were spent frantically researching surgical procedures to avoid looking like complete idiots when the specialists inevitably quizzed us the following day.

Students were assigned to cases and responsible for collecting a history during the initial consultation with the owner, performing a physical examination, scrubbing into the surgery, writing a detailed surgical report, looking after the patient in hospital, administering medications, overseeing wound care, recording vitals and the progress of recovery, and eventually discharging the patient. Our ultimate goal was to get our patients through all of those stages and discharged as quickly as possible, to minimise the number of animals in our care and allow us to leave the hospital at a semi-reasonable hour each day.

Although being a group of just two students meant that we had an insane workload to keep on top of, we did get special treatment in the form of being allowed to scrub into almost every surgery! Students in previous groups were lucky to scrub into five surgeries during the whole rotation, whereas I scrubbed into ten just in the first week! Even so, being specialist surgery, our job primarily consisted of passing surgical instruments and cutting suture material (which was never quite the right length). One day towards the end of the first week, the surgeon surprised me by letting me place two sutures: a simple interrupted and a cruciate. That was two more than my fellow student, so I counted myself lucky!

During the first week, I was involved with a huge variety of soft tissue cases (prepare for big words) including an abdominal hernia repair, ventral bulla osteotomy, two dermoid sinus removals, multiple wound repairs, adrenalectomy, thyroidectomy, melanoma removal and skin flap, tongue biopsy, emergency plication to correct an intussusception, gastropexy, and ovariohysterectomy.

The most memorable case from this rotation was a soft tissue sarcoma removal from the hind leg of an elderly Golden Retriever. The surgery was performed on Monday and I arrived early the following day to find her leg very swollen. Over the week, the leg continued to swell and her condition steadily declined. By Thursday her breathing was laboured and I could hardly hear a heart beat. Our patient was transferred to the ICU to spend the night in an oxygen tank. The following morning she was much the same, still struggling for each breath. The vets had tentatively diagnosed her with von Willebrand Disease, an inherited clotting disorder caused by a defective or deficient protein. This meant the swelling in her leg was likely pooled blood as a result of uncontrolled bleeding from the surgical site. The disorder had never been detected previously and so it was an incredibly unfortunate and unforeseen complication. On Friday evening I went to check on her before heading home and reached the ICU just as someone yelled, “SHE’S ARRESTED!”. The emergency team sprung into action and began CPR. Her owners were contacted and the decision was made to let her go. It was a devastating end to what should have been a simple mass removal. Everyone involved was deeply affected by her death.

At the end of the first week, the resident came to see us in the student tutorial room. He told us we had done a fantastic job and he really appreciated our help. The hard work of final year students is often taken for granted, so the few times people have acknowledged and appreciated my efforts have really stuck with me!

Just as we were beginning to feel comfortable with soft tissue surgery, Monday came around and it was time to switch to orthopaedics. New surgeries, new patients, new team. At least I still had my student buddy for support and entertainment. There was an interesting mix of cases on orthopaedics, including bilateral hip dysplasia, intervertebral disc disease, two medial patellar luxations, shoulder arthroscopy, stifle arthroscopy and joint tap, and many tibial plateau levelling osteotomies.

Over the two week rotation, we had several tutorials on wound management, brachycephalic airway syndrome, neurology and fracture management. On the last Friday we had a short exam, followed by an orthopaedic cadaver lab, where we practiced our surgical approaches to the hip and stifle joints, and performed a femoral head ostectomy (a procedure in which the head of the femur is cut off to remove the hip joint).

The last surgery finished late on Friday and the hospital was eerily quiet. It was the strangest feeling saving my final reports, packing up my belongings and preparing to leave the hospital for the last time. The four of us didn’t really know how to react. We congratulated one another on finishing and headed home in stunned disbelief, unsure whether to laugh or cry. We didn’t have much time to process these feelings before our minds became consumed with panicked thoughts of the impending exams. It was time to put our heads down and bums up for one final push to the finish line!

[vetdownunder]

End of an Era

24 weeks of rotations, 15 weeks of placement, 1 postgraduate research project, over 50 assessments, 12 flights and 3 final exams later, I’ve finally reached the end of fifth year! We hit the ground running immediately after our fourth year exams and worked tirelessly right up until Christmas. Although I didn’t have a moment free to appreciate it at the time, fifth year gave me the freedom to explore my interests and presented countless opportunities to travel and work abroad. My experiences have allowed me to grow as a vet - taking charge of cases, making my own decisions and taking responsibility for the outcome. The past 13 months have without a doubt been the highlight of vet school.

[vetdownunder]

Diagnostic Imaging Rotation

I had been dreading this rotation all year and it was finally upon me. Countless stories of students crying and having breakdowns were circulating and didn’t inspire a great deal of enthusiasm. The first couple of days were really quite overwhelming. It seemed as though there was a new assessment every five minutes!

Each day generally began with an online quiz for which we frantically revised the night before. Once finished, we would convene in front of the light boxes for interpretation rounds. This involved five students being selected at random to look at a series of radiographs we’d never seen before, interpret them using a systematic approach, and arrive at a diagnosis. This was both timed and assessed. Each day would cover a different topic: musculoskeletal, thorax, abdomen, equine, and so on. In a desperate attempt to beat the tears, our group diffused the tension with humour. I don’t remember how it started, but we began referring to interpretation rounds as ‘the grilling’ or ‘the roasting’. The puns were endless. When asked if we were ready, the response was “I’ve been marinating all night!”. As the first person of the day stepped up to the hot seat, someone would mime lighting a grill. If the radiologist was being especially harsh, we’d say “the grill is hot today!”, and if they were giving someone a hard time, someone would make a sizzling noise in the background. Laughter was the only way to get through it.

On the first day, we had a short ultrasonography tutorial and a quick practice scanning a nurse’s dog. Each student was assigned a day of ultrasonography during which we observed the specialist performing scans and pretended to understand the grey shapes on the screen. Another day was spent on ‘interpretations’ where we interpreted all of the radiographs taken that day. The remaining students were assigned to radiography, which involved positioning real patients and taking the radiographs according to requests from clinicians. These were also timed and assessed, with many ways to instantly fail. If there weren’t any real patients, we were assessed on the dummy dog (named Emily) who was frustratingly inflexible. In the evenings, we would convene again for rounds and share any interesting cases with the group.

Towards the end of the second week, we had yet another timed exam where we had to take radiographs of a horse’s foot, fetlock or carpus. I forgot to check the exposure parameters on one of my shots, but it happened to be on the right setting by coincidence. On the final morning, we had an online theory exam.

As much as it pains me to admit it, I think I actually enjoyed diagnostic imaging! It was great to finally learn how to read radiographs and I improved considerably over the two weeks. Not a single tear was shed in our group, which was perhaps our greatest achievement.

[vetdownunder]

Primary Care Rotation

The primary care (aka general practice) rotation is essentially two weeks in which to become comfortable dealing with the cases that will make up 95% of our workload as vets. This includes vaccinations, ear infections, itchy skin, sore eyes, dental disease, wounds, lameness, and so on. The rotation also focusses on developing our client communication skills through consultations with pet owners.

For the majority of the days we pretended to be real veterinarians. We assigned ourselves to cases which we followed from beginning to end. When our patients arrived, we greeted the owners, collected a detailed history and performed a thorough physical examination of the patient. We reported our findings to the responsible vet and together we formulated a diagnostic and treatment plan. The vet then conveyed this to the client. If any procedures needed to be performed (such as blood collection, ultrasound scan or wound clean), we were allowed to assist. The patient’s hospital report was also our responsibility.

To assess our client communication skills, we had to record our consultations using hidden cameras and microphones (with the client’s permission, of course). Believe me when I say there is nothing more uncomfortable than watching yourself pretending to be a vet. Sooo cringe-worthy! I am awkward at the best of times, but when the camera is rolling, everything seems to go pear shaped. Like when I put my stethoscope in my ears backwards, took it out, looked at it for a moment, and then put it back in the same way. Face palm. I wasn’t the only one with embarrassing footage though. One of my classmates tripped over a dog, another couldn’t hold onto her cat, and someone else had a stubborn dog that planted his butt firmly on the ground and refused to let anyone take his temperature. Between us, we could’ve made a hilarious blooper reel!

In between consultations, the primary care vets organised some informal tutorials on vaccinations, ear and eye medications, and eye examinations. These were really, really helpful.

One day of the rotation was spent “on procedures”. I scrubbed into a digit amputation and lump removal in a dog. I also watched a cystotomy (surgery involving an incision into the urinary bladder) in a dog with a bladder stone. I had another day in the dental clinic where I got to brush up (pun intended) on my scaling and polishing, and watch several extractions. Another day I was stationed at an external vet practice to observe the vets consulting and pick up some tips and tricks from the experts. I also had a day in the exotic pet clinic. I saw some really interesting cases there, including a rabbit respiratory emergency, a python exhibiting neurological signs, and a ridge-tailed monitor that fell from a height and fractured its spine resulting in paralysis of its hind legs.

The final day of the rotation was examination day. We started with an online exam which covered random topics that did not at all reflect what we’d been learning over the fortnight. Straight after that I had a history taking exam. I had to pretend to be a vet and collect a history from the ‘client’ (an actor) while an examiner sat in the corner of the room with a clipboard. I freaked out and forgot everything I knew. There’s a reason I didn’t pursue an acting career! I walked straight out of that exam and into the next. The clinical skills exam should have been easy, but my nerves got the better of me and my hands shook so much that I managed to shatter a glass tube! The final assault was playing my consultation recording in front of a small audience while the examiner critiqued my words, body language and expressions.

At the end of the day, we each had an individual feedback session with one of the primary care vets. When it was my turn, I was feeling a bit like a lamb for slaughter, but my skin was thick and I was ready for the next wave of criticism. Lay it on me! I was completely taken aback when I was instead flooded with praise and encouraging words.

I really appreciated the kindness, patience and support from the primary care staff. It makes all the difference at this point in the year (and degree).