Diary of a Fourth-Year Vet Student: Student Doctor, Student Surgeon

I'm on my first rotation of my fourth year of vet school, also called the clinical year. This particular rotation is unique to Oregon State University because of the many years-long relationship they have with Oregon Humane Society in Portland. Every vet med student spends three weeks at OHS sometime during their clinical year.

In some ways, this is a good rotation to begin with. We are treated like, and are expected to act like, doctors. We are expected to make diagnoses, suggest appropriate rule-out and monitoring tests, and suggest appropriate medications. We are also responsible for patient care for hospitalized patients--cats and dogs who are too sick to be housed with the other animals and too sick to be adopted. They might need surgery. They might need drugs to treat infections. They might just need some TLC and encouragement to eat. We see our patients three, four, five times a day for several days in a row. Sometimes they get better. Sometimes they don't, which is hard on everyone. Last week, I had a parvovirus-infected dog who had been placed in isolation. For every visit, I had to put on booties over my shoes, a disposable (one-time use) plastic gown, and gloves. One night, I woke up around 1:30am worried about my patient. I quietly left my room and went down to isolation and put on all that PPE. I opened the door to find my classmate Claudia already there before me. She woke up a few minutes before I did, also worried about my patient (she also had a patient in isolation who had pneumonia). Turns out that my pup was indeed having a bit of a crisis (spiking a fever associated with secondary pneumonia) and we spent about an hour sorting out some changes in her treatment. We were tired and not thinking clearly and not working all that quickly, but we made some choices that turned out to be good ones. In this rotation, I'm learning a lot about medicine and how to be a vet.

Because this is an enormous shelter that has a goal of finding a home for every adoptable dog and cat, we also get to do lots of spays and neuters during our rotation here. During the fall term of our third year, we each did one cat spay, one dog neuter, and one dog spay. I also did a bonus 1/2 cat neuter (I did one testicle, a classmate did the other). That is typical for most vet programs. But with the OHS rotation, we are getting considerably more experience than that. After the end of my second week, I've done 8 or 9 dog neuters, 6 or 7 kitten spays, one adult cat spay, one dog spay, and 10 or 11 cat neuters (the actual tally is on a sheet back at OHS). In fact, just yesterday afternoon, I did a puppy neuter, two kitten spays, and an adult dog neuter--and I completed all of these surgeries in less than 2 hours. I was also working 90% solo (I had a bit of a struggle with one of the kitten spays and needed help resolving that--one of her uterine horns had wrapped around her bladder and I didn't recognize that was the problem--easy to fix, just exteriorize the bladder, unwrap the uterine horn, poke the bladder back in, and continue on). To give you an idea how amazing it is for me to do those surgeries in 2 hours, our student surgeries last year on just a single animal were usually three or more hours long (partly because of our inexperience but also partly because of the incredibly fussy and complicated protocols we had to follow). Yesterday, it was just me (no assistant), the animal on the table, a vet tech floating around monitoring anesthesia (we had three student surgeons working at the same time), and a clinician gowned and gloved ready to help if we had questions, but perfectly content to stand back and let us do it on our own. An experienced vet can do a dog neuter in 10 minutes, and a kitten spay in 15 minutes. We student vets aren't quite there yet!

Surgery is a terrifying thing. You make an incision, look inside and see guts moving around, and it really hits home that there is a living, breathing animal underneath that surgical drape. It is also a very complicated thing, even for simple procedures like dog neuters. You've got a lot of tools that need to be held and manipulated in a certain way. You've got suture--how to hold the needle, which pattern to use for which tissue. You've got tissue that can bleed--subcutaneous tissue in particular can bleed a lot and it can make your surgical field look messy and scary but you have to totally ignore it and move on. You've got lots of tissue that you don't want to touch--but it's always right there in your way. You've got a time pressure on you to get that animal off the table as quickly as you can. You've got other surgeries going on around you and it cannot become a race. You don't win by finishing first, you win by doing it right.

Kitten spays are quite something. It's like doing dollhouse surgery. You almost need magnification. The incision is typically the width of your index finger--or less if you are really good. Their tissues are tiny and delicate. And as I learned earlier this week, it is very easy to tear that tissue by accident if you don't handle it gently. My rookie mistake could have killed the kitten if it wasn't corrected right away. I was terrified and totally freaked out (screaming inside, more or less hanging together on the outside), but the clinician very calmly walked me through how to fix the problem. She then told me, we've all made this mistake, and it's good that you did it here where you can learn how to fix it and learn how to prevent it. Even so, I had to go outside and have a cry when I finished up with that kitten. Later that evening, I confessed my fears and anxiety to Claudia, and she and I went down to the cattery to check on the kitten. Kitten was eating, purring, looked just fine. Yesterday, I had to take some super deep breaths when the techs laid another kitten on the surgery table in front of me. Was I ready for that? We are all gowned and gloved and masked so you get really good at reading eyes and other body language signals. My classmates, working on their own dogs and cats, looked up and sang out, you've got this kitten! You can totally do this! So I did. Then I did a second kitten. And while I was a bit tentative with my tissue handling, that probably reduced resulted in a better job overall.

So we are looking after each other, learning to make decisions for our patients, learning how to handle tissue and do surgeries efficiently and safely, learning how to diagnose problems, learning, learning, learning.

Diary of a Fourth-Year Vet Student: A Primer on Clinical Rotations

The most common questions that I get asked by friends who are not involved in vet med concern the fourth-year clinical rotations. Misconceptions abound, probably fostered in part by the many popular hospital dramas that over-simplify everything. This is definitely a blog-worthy topic!

What I'm going to describe applies to the great majority of vet schools that have teaching hospitals. Surprisingly, there are vet schools that do not have teaching hospitals attached to them. Their students still have to do fourth-year clinical rotations but they have to take them at another school. Sometimes there are formal arrangements between schools, and sometimes the students have to arrange these activities themselves. OSU has a large teaching hospital, so for the most part, OSU vet med students complete their core rotations here.

The fourth year of a vet med education consists of those core clinical rotations and a certain number of weeks of internships (e.g., taking a course at another university) or preceptorships (working with a vet in an environment such as a clinic or dairy farm). Most vet schools require students to declare a "track" in their third year. Large Animal, Small Animal, General, and something like Non-Traditional are typical tracks. The differences between the tracks are not huge and mainly take the form of more or fewer weeks available in the year's schedule to spend in internships/preceptorships.

Vet schools use the same clinical rotation scheduling software that nearly all human med schools use. It is clunky and fairly shitty but that's just the way of it. I've known my fourth-year schedule for some months now. Minor tweaks are possible but big changes are often not approved. 

Core clinical rotations consist of anywhere from 1 to 4 weeks spent in a particular service area of the teaching hospital. The "big four" rotations are small animal (SA) medicine, SA surgery, large animal (LA) medicine, and LA surgery. There are also rotations in imaging (mainly radiology but our school also has equipment for MRI and CT), anesthesia, cardiology, oncology, theriogenology (AKA reproduction), rural veterinary practice (farm calls), diagnostic services (largely pathology and necropsy through the Oregon state vet lab which is housed in the teaching hospital), clinical pathology (laboratory analysis of fluids and tissues from patients submitted by LA and SA services), and SA ICU (can be day or overnight shifts) and LA hospital overnights.

Finally, OSU has an unusual clinical rotation that I don't think any other vet school offers. Through a long-standing partnership with the Oregon Humane Society in Portland, every OSU vet student spends three weeks with OHS doing lots and lots of spays and neuters. That is actually my first rotation.

Every track has a set number of elective hours that a student is required to take. These are courses that we take at OSU. They are compressed into one or two weeks and do not stretch out over a full term like a regular course. I took most of my electives in my third year so only have one left to take next year. It's worth pointing out that if I took a similar "elective" at another school, it would count as an "internship" for my vet med program at OSU.

For three years, my class has been moving through our program as a cohort. The big change comes on Monday. There are two or three students per rotation, but every student has a different rotation order. As a result, I will not see around two-thirds of my classmates at all next year. Literally not see them--our rotation schedules are so different that we may not even be in the state at the same time, much less in the teaching hospital at the same time.

On top of all of that, each student has to arrange internships and preceptorships for the gaps in his or her schedule. Our vet school lacks any sort of career services, and all of us have to find and arrange those internships on our own. We also have to pay travel, food, and lodging for those weeks IN ADDITION to paying tuition for that time. It's a racket, plain and simple. I have arranged some preceptorships that I will not officially put on my schedule so I don't have to pay the tuition for them.

If you are observant, you will have noticed that one thing that I have not talked about is vacation. That's because there is none. You may have a week here and there that you didn't fill with an internship but that's all you get. It will be a year-long push to the end goal: the DVM.

I think this is a decent introduction to fourth-year vet student rotations. The next post will be about the national board exam. It's on all of our minds!

Diary of a Third-Year Vet Student: I'm Not A Third-Year Vet Student Anymore

At 9am this morning, my class sat down to fill in bubble sheets for our last lecture-based exam of our vet school careers (Small Animal Medicine dermatology unit).

After the exam, almost the entire class decamped to a parking lot across the street from the vet school, in order to create a plausible-deniability barrier, and proceeded to become raucously, publicly intoxicated.

Fourth-year clinical rotations begin in just a few days (more details on that in the next post). We will no longer be a cohort of fifty-six, and that's both exciting and bittersweet. I will not see some of my classmates again until graduation, a full year away.

We of course all face one more exam: the national veterinarian licensing board exam, known by its acronym NAVLE. The testing period is mid-November to end of December. More to come on that too.

But that seems a lifetime in the future. Right now, we are still together, celebrating this momentous transition.