Reduced Surgical Training at University Has Thrown a Greater Emphasis onto Post-Graduate Internship Training
Roger Clarke, BVSc (Qld), MRCVS, FACVSc
Associate Professor, Bundoora Veterinary Hospital
I am a Senior Academic Associate of the University of Melbourne and a partner in a private practice employing 14 veterinarians. Many new graduates and students pass through this practice and I have an ample opportunity to assess the adequacy of the surgical teaching received by these students and new graduates when they come to work for me after graduation. Most are not adequately prepared for the common surgical procedures that they are expected to perform. Some graduate without even having performed a routine de-sexing procedure on a live companion animal. They are well aware of their deficiencies and this only intensifies their emotional and psychological stress as they try to acquire surgical experience under difficult circumstances.
The Australian Veterinary Association (AVA) has tried to alleviate this situation by its policies, one of which is called the "New Graduate Friendly Practice" programme. In this programme, a practice can seek accreditation from the AVA as a practice conforming to guidelines designed to make the transition from veterinary school to private practice as smooth as possible.
A practice receives accreditation after confirmation that they are following the published guidelines from previous employees of the practice. These reports are scrutinized by the committee of the Association.
20 AVA Guidelines for 'New Graduate Friendly' Practices
Their first job can "make or break" a newly graduated vet. The aim of these guidelines is to increase awareness amongst both new graduates and employers of the employment needs of new graduates.
The employment of a new graduate carries certain responsibilities and requires greater input and support from the practice than employment of an experienced graduate. Not every practice has the resources to employ and appropriately support a new graduate and some practices, even with appropriate resources, do not wish to expend the time and effort necessary to employ a new graduate. This is perfectly understandable and, of course, the prerogative of each practice.
If a practice chooses to employ and appropriately support a new graduate, the benefits to the practice and the profession as a whole are considerable and include the following:
The employer has the opportunity to train a new graduate in the way he/she sees as appropriate. In some instances the new graduate may progress to partnership within the practice or return to the practice in later years. The investment in a new graduate, therefore, can have a direct personal gain for the practice.
Even if a new graduate moves on from the first practice after one or two years, as is often the case, if he/she has been well supported during those years the benefits to the profession as a whole are important. The new graduate who is appropriately nurtured during the first year in practice will have a more positive attitude to the profession as a whole and will be better trained and skilled than one who has received no support from more experienced colleagues in their formative years. Those graduates will have greater potential value to the profession because they won't be cynical and scarred by their early experiences and they, in turn, will provide positive role-models for younger vets who follow in their place.
New graduates lack experience but they have very recently been exposed to the newest and latest knowledge, techniques and directions of the veterinary profession through their veterinary education. The fresh outlook and new knowledge that they can bring to a practice is considerable if they are listened to and respected.
20.2 Adequate support from an experienced veterinarian
A new graduate needs immediate access to the advice of an experienced veterinarian for the first several months in practice (this time period will vary depending on the skills of the new graduate but 3-6 months would be advisable on average). This advice may be available by telephone but the physical presence of the experienced veterinarian is often required, particularly to assist and provide guidance in diagnostic or treatment procedures. In small practices where there is only one other veterinarian apart from the new graduate, if the experienced veterinarian cannot be available at all times during this initial phase he/she should make adequate arrangements with a colleague or neighbouring practice to provide meaningful support for the new graduate.
20.3 A supportive work environment is important
The principal and staff, including nurses, should have a positive attitude to the employment of a new graduate. The practice should have regular staff or practice meetings and provide regular opportunities for discussion of cases. There should be adequate nursing assistance (i.e., not a high proportion of inexperienced junior staff) and adequate diagnostic facilities appropriate to case load and species treated.
It is important that veterinarians who employ new graduates are receptive to new ideas (which the new graduate may bring to the practice) and willing to impart their knowledge and experience in an educational and constructive manner. They should preferably be actively involved in continuing education.
20.4 Reasonable working hours
The definition of reasonable is clearly contentious but it is important to recognise that new graduates will perform well below their abilities if their inexperience and anxiety about developing skills is compounded by fatigue induced by unreasonable working hours. A maximum of 10 hours per day is desirable and, especially if the new graduate is on call after hours, it is preferable that the majority of working days in a week be no longer than 8 hours (if this involves working without a reasonable break in the middle of the day). A maximum or 45-50 hours per week is desirable. However, it is recognised that in many rural practices work may be seasonal, requiring longer hours to be worked in peak periods.
20.5 Provision of 1 week continuing education leave in addition to normal annual leave
20.6 Payment of 1 week conference registration per year after one year of employment
It has been suggested that this payment be equivalent to one week pay at the AVA minimum rate.
20.7 Adequate back up for after-hours duty and fair sharing of after-hours responsibilities
This is not an issue for some practices these days because of after-hours emergency services that exist in many of the major cities. However, for those many practices that do their own after-hours calls or who share this with neighbouring practices, it is important that the burden of after-hours duty not be disproportionately loaded onto the new graduate.
A new graduate should not be required to attend after-hours calls without adequate support for the first 6-12 months of practice. This should involve, where possible, the attendance of a second veterinarian at any call for the first month. For the first 3-6 months (depending on the new graduate's confidence and skills), there should always be another veterinarian on back-up call who is available for immediate advice over the telephone and can physically attend the call to assist with surgery or other procedures if necessary. It is preferable that the veterinarian be from the same practice but it is acceptable to arrange back-up support from another practice within reasonable distance, having regard to the location and type of cases treated.
20.8 Introduction to clients in rural practices.
New graduates in rural practice should go on calls with experienced veterinarians to common farm problems before being let loose on their own. As many of these calls will be to established clients this will also serve to introduce the new graduate to clients of the practice.
20.9 The skills and knowledge of new graduates should be permitted to develop and be nurtured
While it is more common for new graduates to be inappropriately "thrown in the deep end" without adequate support, there are some practices where new graduates are so closely supervised that they never get a chance to develop adequate diagnostic and surgical skills in their first year of practice. Clearly the degree of supervision provided will vary according to the skills of the new graduate but principals need to recognise that, if they choose to employ a new graduate, they need to permit the new graduate to gain the confidence to make their own diagnostic and treatment decisions and perform procedures.
20.10 Use employment contracts
Much misunderstanding and heartache between employers and employees can be avoided if employment contracts (workplace agreements) are utilised that clearly state the terms of employment.
20.11 Responsibilities of new graduates
20.11.1 Realistically assess career needs and interest
New graduates should endeavour to realistically assess their career needs and interests prior to accepting employment. Failure to do so can result in serious job dissatisfaction, which could have been avoided if more suitable employment had been sought.
20.11.2 Make a fair and realistic commitment to your first job
A new graduate should endeavour to commit to their first job for at least 12 months unless unforeseen circumstances arise or employment conditions are untenable.
20.11.3 Know and understand the practice philosophy
The new graduate should ensure that they are familiar with and appreciate the practice philosophy in relation to payment of accounts, treatment of bad debtors, treatment of injured wildlife, treatment of unowned animals, dress standards etc.
20.11.4 Appreciate and respect the role that lay staff play within a practice
Lay staff are an enormously important resource within a practice. They can impart much knowledge and experience to the new graduate and their roles and responsibilities within the practice should be respected.
20.11.5 Appreciate that a new graduate will usually initially reduce, not increase practice profitability
For a reasonable period of time (depending on his/her skills), a new graduate, if appropriately supported and not exploited, will in all probability cost the practice money. This is an investment made by the practice principal/s who (hopefully) have undertaken to employ a new graduate for many of the reasons outlined` above and who appreciate the longer-term benefits to the practice and the profession of supporting them. However, the new graduate should be cognisant of the mutual responsibilities both employee and employer have in ensuring that the new graduate contributes as fully as possible to the practice.
20.11.6 Ensure that you fully understand the employment conditions (pay, working hours, after hours responsibilities, holidays etc.) offered prior to accepting a position.
20.11.7 Appreciate that veterinary science is a profession not just a job
If you want to only work 35 hours week, from 9 am to 5 pm, with no after hours, evenings or weekend work, then seek employment in an alternative area. Veterinary science, especially veterinary clinical practice, is hard work and can play havoc with your social life, but it is an enormously rewarding profession for those prepared to commit themselves to it.
This programme has worked very well for our practice, and has forced us to structure our training programmes along mentor lines with the more experienced graduates being responsible for their younger colleagues.
Even with this internship programme in place, the removal of live animal surgical teaching programmes from our Universities is still evident in the increased lack of surgical confidence shown by new graduates. I strongly support the AVA policy on the ethical use of pound dogs for teaching veterinary students. Illogical and emotive legislation banning the ethical and regulated use of these dogs has done little to reduce the numbers destroyed needlessly in Council pounds each year.