Conquering National Boards (NAVLE)

The NAVLE is a necessary evil, meant to rattle and unnerve even the strongest vet student.  There are a couple of key planning steps that I believe every student can take to help give them the best chance of passing this test.  These tips are solely my opinion and based on my experience with clinics and boards.

Step 1: Research the steps you need to take and the timeline required for registering for the NAVLE.  I would suggest looking into the process (https://www.nbvme.org/navle-general-information/navle-process-summarized/) and the deadlines no later than just before starting your clinical year.  For U.S. students, you need permission through your state of residence to sit for the NAVLE, so your first contact will be the necessary state office (or their respective licensing board website for directions/forms necessary).  They have their own deadlines, apart from the deadlines posted on the NAVLE website, so be sure to check those dates first.  Once the state approves you to sit for the test, the NAVLE coordinators will send you an email with your registration code, a few months before the testing window opens up.  Everyone gets their code on the same day (in alphabetical order, from what I can tell) via email.  If you have a specific day that you want or need to take the exam, you need to sign up for the exam immediately once you receive your registration code.  The testing centers are scattered throughout the U.S. (coordinated by Prometric) and it would be best to have a first and second choice for testing centers.  You should be aware that the fall testing window is much longer than the testing window allotted for the spring exam.  This means if you are planning to take the test in April, it is even more important that you schedule your exam date/time as soon as you receive your registration code (ie: 10 minutes versus 5 hours following the email will make all the difference).

Step 2: Choose a study source.  Whether it be VetPrep, ZuKu, the A to Z guide or old class notes, stick to one study source.  It is likely a good idea to research the major sources/programs that other students have used before you have to make a decision.  Personally, I used VetPrep and really liked the format.  The questions were straight forward, the program was very easy to use and the statistics were helpful to guide you in how to focus your study strategy.  Even when you get most of the questions wrong, you still learn from them.

Step 3: Have a study plan.  This may be the single most important step.  I don’t support going into this exam without having planned for it.  Each student has to have their own study plan, unique to their study skills and how they learn best.  Some students will need more time and perhaps a multimodal approach (ie: organized study program plus other modalities), whereas others may need far less time and/or resources.  I would suggest starting to study about 3 months prior to your test.  If you’re doing one of the study programs, figure out how many questions you need to do per day to finish it, or reach a point that you’re comfortable with.  It’s important to give yourself some guidelines and goals.  Remember to reward yourself along the way.  Studying for NAVLE is daunting task and deserves many rewards.  Clinics are busy, to say the least.  If you have any control over when you schedule certain rotations, try to schedule some lighter rotations just before NAVLE to give yourself a better shot at having time to study.  I have to say, I was very fortunate and was able to schedule my 2 week vacation just before my exam window and that pretty much saved me.  I got 80% of my studying done during my “vacation”.  I found it really difficult to study during clinics, even during my lighter rotations.  When I had free time all I wanted to do was sleep! Fight the urge.  Plow forward.  You can do it.

Step 4: Understand the test.  Count on this test taking you at minimum 6.5 hours, start to finish.  There are 6 sections of 60 questions, for which you are allowed 65 minutes to complete each section.  There are 45 minutes of break time allotted.  These break time minutes may be used in between each section.  You can use all of the minutes or none of them in whatever intervals you want.  For instance, you could do 2 sections (130 minutes) and then take a 30 minute break, if you want.  Then do 2 more sections and take your final 15 minute break before the final section.  Or you could take an 8 minute break after each section.  Or you could take no breaks and finish 45 minutes earlier, though I don’t advise this.  You will want to get up and stretch your legs and use the restroom at least once.  You are only scored on 300 of the 360 questions.  The 60 “test” questions are mixed in throughout the exam and you don’t know which questions count and which ones don’t.  I personally finished each section in about 60 minutes, which left me 4-5 minutes to go back and look at questions that I wasn’t really sure about.  The test has nice options that allow you to mark questions you want to re-look at, if you have time.  It also lets you type in notes at the bottom of questions, in case you need to think out loud on some questions.  Also, a common question that students ask when studying for NAVLE, you do not need to know normal lab values.  Or I should say, I did not have to know any, nor did any of my rotation-mates.  And there is an on-screen calculator, in case you would need one.

The nice thing about doing the VetPrep program is that you can do their “practice tests” to give yourself a good idea of what it is like to sit for each section.  Their practice tests are split into 30 questions each, so you’ll have to take 2 practice tests in a row to get a feel for what it’s like to sit for one section at a time.  Also, if you look at some of the FAQs on the NBVME website you will notice that it says students need to get about 65%-70% (at a minimum) of the questions correct to pass.  This is the minimum range that you should try to aim for on VetPrep when it shows you your stats! Look at the breakdown of what type of questions you’re hitting this range on and which question types you aren’t.  For instance, if you are in the 70-80% range on cat questions, but in the 15% range on porcine, DO MORE PIG QUESTIONS! Also a nice feature of VetPrep, you can select what type of questions you want to be quizzed on.  I will admit, my overall stats for questions correct on VetPrep were about 60% correct and I somehow still passed NAVLE.  So, don’t sweat it too much if your VetPrep stats aren’t exactly where they should be.  Like I said in the beginning, every student needs their own study plan unique to their abilities.  Don’t panic because your friend has 70% of VetPrep finished 2 weeks from the test and you only have 30% of it completed. Worry about yourself and be comfortable with how your study plan is progressing.

Step 5: Just before test day, COOL DOWN! Don’t try to get 500 questions done 2 days before the test.  Don’t fry your brain and burn yourself out just before the marathon! I suggest taking the few days before the test to go over tables, charts or items you meant to look up that you know you can be tested on.  For instance, if you’re doing VetPrep, use the weekend before the exam to look over all of the Powerpages.  Believe it or not, this exam is one you do need to cram for.  The catch is that you need to cram for months, not days or hours.  These powerpages(or something comparable) are the best form of cramming you could do just before the exam (I’m talking days before, not hours).  Take time to mentally and emotionally prepare for the test.  Meditate, pray, go for a run; do whatever you have to do to get yourself into a positive state of mind before test day.  I always suggest having a backup plan.  Confirm with yourself that you will do your very best, and if you don’t pass, you will simply restudy and retake it the next test window.  It won’t be ideal, but you will make it work.  Yes, this test is singly the most important test of your career, but not passing on the first try is not the end of the world and you certainly won’t be the first overworked, overstressed, unpaid vet student to not pass this monster.  You will simply retake it.  But have confidence in yourself! You have all the skills you need to pass this test! I promise.

Step 6: Test day.  Get a good nights sleep and show up early for the test! The worst thing you could do is not leave yourself enough time to get to the testing site early and relax.  Like I always say, plan for the worst and hope for the best 🙂 Leave yourself time for traffic, school buses, old ladies crossing the street, hitting every light on red, construction re-routing, random acts of God, etc.   Just leave early. Early early.  Don’t forget your print out of your permission to take the exam! They WILL NOT let you take the test without this print out.  Make sure you have all forms of identification with you.  Dress in something comfortable! But be advised, if you wear anything with a hood or pockets, the testing centers will feel you up.  If you have baggy clothes on thy make you turn your pockets out, lift your sleeves up and remove all caps/hats before entering the test.  They used a wand on me each time I entered the testing room and made me turn my sweatshirt hood inside out and patted me down.  If you wear a sweatshirt, you have to keep it on throughout the test unless you come out of the test to take it off and store it in your locker.  Any of you who took the awful GRE should be familiar with this crazy process.  They are quite strict for this exam.  Understandably so, I guess.  You can bring a snack and keep in in your locker for break times.  You CANNOT bring any notes or study materials for break times or to look at before the test.  This is against NAVLE rules, so don’t even risk it! It would really suck to get caught looking at notes on your ipad or phone and be dismissed from your test.  Just don’t bring anything, other than your IDs and maybe a snack.

A few other notes/tips for NAVLE: Don’t rush into taking this exam.  Remember that you can’t take the exam until you are within 10 months of your graduation date.  Clinics will help to prepare you for this exam.  The more rotations you have before the exam, the better prepared you will be for thinking through the questions.  I realize most students take the NAVLE during the first testing window available after they start clinics and leave the second testing window open, just in case they don’t pass the first time.  Though it is nice to get this exam over with early in your clinical year, passing the test so that you only endure it once should be your top priority.  To do this properly, you should allow yourself enough time to develop your study skills and logical/critical thinking throughout your clinical year.  Bottom line, don’t rush to take this test just to get it over with.  For students starting clinics in January, consider waiting until fall to take your test.  Students starting in September, you do not need to rush yourself to take the fall exam.  Waiting until spring will give you much more time to plan and prepare properly.  Those starting in May, you should have good prep time to take it in fall, but don’t be afraid to wait until the April test window! Your clinical rotations are super helpful in preparing you for this test.

I spoke with a few of the UMN students who did not pass NAVLE on their first try and they mentioned that they were the weakest in their large animal questions.  They attributed this to the fact that they were tracking small animal and did not spend enough time studying their large animal questions.  This definitely makes some sense.  If you consider, students with a strong background in small animal are much more likely to be able to rationalize and think critically through a strange small animal NAVLE question to pick the right answer, as opposed to trying to think through a large animal question of which they know little to nothing about.  This is true for the opposite situation with those that are strong in large animal but weak in small.  I was absolutely the first to complain (daily!) about having to track mixed animal and being forced to take large animal rotations (I’m clearly a small animal gal).  But boy am I glad I had to take those large animal rotations when it came time for NAVLE! I can honestly say those rotations saved me during that test.  It also made studying for the test a lot less painful, as I did not have to spend a tremendous amount of time reviewing large animal material.

Overall, I did not feel NAVLE was the worst experience of my life.  I did not leave the test in tears, as I heard many do.  I was exhausted, no doubt; had trouble formulating complete sentences or thoughts for a few days after, but recovered after a week or so.  As with all of vet school, I think having a solid support system is most important.  All you can do is everything you can do.  Leave the rest to fate.  Good luck fellow SMU Vet Med kids! You can do this!

As always, I would appreciate any comments or questions, especially by other SMU graduates regarding their own thoughts or opinions about their experience with NAVLE.

Advice for finding your first veterinary job?

I’d like to reach out to those SMU veterinary students/graduates who have gone before us and ask them to comment on their experience with job hunting.  It would be fantastic if you would share your knowledge and pass on some much needed advice for those preparing for this challenge.  Candidness is always appreciated. 

– When did you start searching for jobs and what resources did you use to find open positions?

– What was the interview process like for you? Advice for approaching an interview as a new grad?

– What are/where you biggest struggles with your first job as a DVM?

– Tips on balancing finances, ways to be money savvy, creative ways to make extra money?

– For those that are doing/did an internship, what was the match process like for you?

 

Thank you so much for taking the time to reply to this! Your underclassmen truly appreciate the help.

Emergency/ICU

I have a decent amount of experience in small animal practice, but it was General Practice so we did not do a huge amount of emergency medicine.  Needless to say, I wasn’t sure if I would sink or swim on this rotation.  I can honestly say this turned out to be my favorite rotation so far.  I learned a TON and got the most experience in the shortest amount of time. 

For this 2 week rotation you spent one week in the ER and the other week in the ICU.  They let you choose one day off each week, but it could not be a weekend day.  For your week in ER you needed to be there at 3pm and were expected to stay until 11pm, or whenever your last case was finished.  Most nights I was out by 12am and one night I left at 3am.  There was a little down time to work on NAVLE questions and what-not, but most of the time you were seeing cases.  I had hear from a few other students that the 4th years were just glorified history takers for this rotation.  I’m guessing someone told the clinicians that at some point, or wrote it in their rotation evaluations, because the resident told us during orientation day one that this was not our purpose.  She explained that we were meant to do as much of the work up as possible on our own and if the animal needed a procedure we got the first shot at it.  I placed a few IV catheters, helped with CPR and unblocked a cat, so I did get to work on some of my technical skills.  One of the residents was big on having the student do all of the talking with the client, which was actually really nice.  It definitely helped me realize what I was capable of and what I needed to work on, as far as explaining things to frantic and upset clients. 

You know how Dr. Dickinson always says, “If you’re not humbled a little bit every day, you’re not doing your job”? Well I had a really interesting experience on this rotation that really drove that message home.  There is one resident on this service who has a bit of an arrogance about them and sometimes makes people (students and other clinicians/surgeons alike) feel bad about what they didn’t catch that this person would have.  There was a 2 year old dog who came in for ADR, intermittent cough and vomiting for months.  They did a basic workup that included an abdominal ultrasound.  During the US the radiologist (who’s a little younger and newer to the UofM) thought that the multifocal lesions in the liver could be cancer, but they would have hedged on something other than cancer because it just didn’t look like any typical kind of cancer in the abdomen and the dog was young.  Another more seasoned radiologist thought it was most likely cancer.  Well the ER resident came back to the ER and was frustrated that the one radiologist would not say this was cancer, when that was absolutely what it looked like.  The resident told all of us that if we ever make the mistake of not calling something cancer when that’s clearly what it is, we were failures.  This person told us being wishy washy doesn’t help anyone.  Well, the cytology from the FNA of the liver came back with inflammatory cells and intracellular bacteria.  The dog had a horrible migrating foreign body.  The resident never apologized for their remarks about the “wishy washy” comments of the radiologist, but I’ll bet they regretted bashing that person just a little…. Good lesson for the 4th years to learn.  Don’t be a know it all, THAT doesn’t help anyone.

The week in ICU was good, just a little slower than ER.  The ICU was always packed with animals, but they were usually post-op surgery patients or medicine cases.  So the ICU docs didn’t have cases every day.  When we did have a case it was there for half the week.  I liked working on the ICU  cases because it gave you a chance to really think through every aspect of critical care.  We talked a lot about the rule of 20 and used that as our outline for the care of each patient.  I remember learning about this from Dr. Roberts, but we really put it to use on this rotation.  The clinicians gave us some great resources to help us too.  I contacted Dr. Roberts for some help with a Phosphorus replacement calculation and he reminded me of a vet math lecture he gave to us with all the necessary calculations you would need to do (fluids, meds, supplementing, ect.).  I reviewed that lecture and was bummed I didn’t set that one aside earlier in my 4th year.  It was super helpful and I could have used that on my medicine rotations earlier in the year. 

At my mid-rotation evaluation with the head clinician I was told that I had very good basic knowledge, for an island student.  I know she meant it in the nicest way and was trying to pay me a compliment, but it definitely reinforced the fact that the island students are evaluated as island students and some clinicians will equate your weakness to being an island student.  I took the compliment and let the rest go.  The point of this rotation for me was to make me less afraid of handling emergencies and give me some good resources to turn to in the future.  I accomplished my goals with ER/ICU and look forward to treating emergencies in general practice. 

If you’d like any of the resources I picked up during this rotation, let me know.  I’d be happy to share them.  They are definitely helpful to have on hand. 

Large Animal Medicine

I was pretty nervous about LAM, since my experience is predominantly small animal.  It really turned out to not be so bad.  For this rotation you needed to have morning treatments done by 7 or 8 am, depending if your animal was in the large animal hospital (ruminants and isolation cases) or the equine center.  This means you needed to be at the hospital by 6 or 7am.  Man, these were some early mornings.  We did stall-side rounds usually at 8am and rounded on patients for about an hour-hour and a half.  If there were appointments scheduled for the day we spent the rest of the time preparing for those.  Otherwise we worked on treatments for in-hospital patients or did our own work (ie: studied for NAVLE or work on setting up interviews). The LAM, LAS and equine dentistry students divided up the on-call shifts for nights and weekends and we each ended up having 2 on call shifts during the two week rotation.  So that wasn’t bad at all (as long as you didn’t get called in….).  If you had a hospitalized patient on the weekend you were expected to come in and do the morning treatments and make sure they had enough meds for the day.  The techs and clerk duty students do the treatments for the remainder of the day and night, so that was pretty convenient.  If you didn’t have any patients in the hospital you still needed to come in for morning rounds on Saturday and Sunday, but could leave right after if your rotation-mates didn’t need help.  We actually got to do some pretty cool procedure labs for this rotation, which we asked for.  We had a rectal exam lab, nasogastric tubing, ultrasound (abdomen and thorax) and abdominocentesis lab.  There were 5 students on our rotation, so we all got plenty of experience.  That was actually pretty cool because it forced me to review some large animal stuff that should definitely help me with my NAVLE studying.  There were a few days where clients wanted or needed their horse euthanized and they elected to donate it for teaching purposes.  This allowed us to practice procedures after the horse was euthanized.  Also great experience. 

The worst part of this rotation was the clinician’s time management and organization.  We would round in the morning and many days we didn’t have any appointments, so they would tell us to review a topic for discussion later in the day and then we were on our own.  We would sit around and do random things all day and then at 5pm when we were supposed to be rounding they would decide to change treatment regimens and do extra procedures on our in-hospital patients and we wouldn’t end up getting out until 7pm.  That became super frustrating because theses were things that could have been done much earlier in the day, had they planned accordingly and we could have been out by 5pm.  Even though I was glad the rotation was relatively slow, the colossal waste of time sitting around waiting for the clinicians to make decisions was a huge pain. 

I will say this rotation made me so much more comfortable around horses than I ever expected to be.  I came in early each morning to help one of my rotation mates with her patient, who was this sweet, sweet Tennessee Walker.  There was something about that horse that made my heart melt a little.  Never expected that to happen, as I’ve always sworn I was strictly small animal and would never lay a hand on a horse after vet school.  Now I find myself planning to maybe own a few in the future.  Weird things can happen in clinics, I guess. 

If you are not a large animal person and would prefer to have the least number of cases possible (to minimize your stress of course) on this rotation, take it in November, December or January.  Those months are just too cold for owners to even go out and look at their horse to see if it’s sick, much less trailer them to bring them to the hospital. 

I had an interesting conversation with a few MN students who ended up not passing the NAVLE.  They said that tracking small animal ended up working against them for NAVLE because though they knew their small animal questions, they really struggled with any of the large animal stuff.  I guess this is the single upside to them making the island students track mixed. 

Small Animal Ultrasound

Fantastic rotation and super laid back.  Anyone going into small animal practice would benefit from this rotation.  Ultrasound is a really great diagnostic tool that complements radiographs really well.  If you don’t have time for two solid weeks of ultrasound consider doing some CE to get extra hand guided experience. 

**Side note: island students are required to take an entrance exam to take this rotation.  The MN students were required to take an extra abbreviated US course with labs in order to take this rotation in their 4th year.  You are given access to the Moodle site with about 15 US lecture ppts and then there’s a 55 question online Moodle exam that you have to complete before the rotation.  You have to get at least a 70% on the exam in order to take the rotation, so if you are going to MN and want to take this rotation I would highly suggest taking the entrance exam BEFORE you start clinics.  I put it off and regretted it.  I was trying to do davenport and study for this exam at the same time.  Sucked big time.  If you want to take this rotation let me know and I will send you some helpful stuff for the exam. 

For this rotation we were required to be there at 8:15am for morning rounds with the ultrasound technician, which lasted an hour to hour and a half.  The day ended at 4pm, so long as no one scheduled a scan in the 4pm spot (we did not have a 4pm scan the entire two weeks).  The tech brought in a teaching animal (owned by a doctor or tech from another service) or we were allowed to bring in our animals (so long as they were presumed healthy, university politics) for scanning.  We focused on a different system every day, spending time practicing our scanning technique during rounds.  If there was any free time throughout the day (and there often was) we would practice on teaching animals again.  The technicians are truly awesome.  Great personalities, fun to work with and really great teachers.  Routinely, a patient comes to ultrasound and the technician does the initial scan, capturing images of all major systems/organs for the radiologist to review.  Then the student on the case is allowed to scan the patient, so long as the animal is relatively comfortable and not critically ill.  You are allowed to scan for as long as time permits and then the radiologist is called down to do a quick scan and review the tech’s images when you’re done.  The student presents the case and the ultrasound findings to the radiologist and usually the radiologist then asks you questions about your findings and your recommendations moving forward.  We also had 8 unknown cases to go through, where we were given signalment and minimal hx and select xrays and ultrasound images.  We had to have differential lists, image findings and recommendations.  It’s pretty much just like we had to do for radiology, but this wasn’t as formal as that, mostly because it wasn’t strictly graded.  This was a little more laid back and we didn’t have to turn in a paper copy with our answers or anything.  The head clinician just went over them with us the second week and pointed out the important stuff.

We had a lot of down time during my rotation, so myself and the other student got a whole lot of scan time with teaching patients.  I feel very comfortable with finding all the parts 🙂 and my ability to identify abnormal things within those parts will improve over time with more experience.  We did have one rounds day of echo’s, but were told we would really learn echo if we were signed up for cardiology (which I am in a few months).  Again, I highly suggest fitting this rotation into your schedule (or taking CE) if you plan to actually charge clients for your ultrasounds in the future.  Great skill to have.  For MN kids, maybe try to fit this rotation in sometime before boards, only because there’s usually lots of down time where you could be studying.  Just a thought.

Next up, LAM! Ugh, not exactly looking forward to this one but hopefully I end up surprised at my enjoyment.  Fingers crossed. Wish me luck!

Radiology, Bovine Sx, SAM 2

Hey all,

Sorry for the lag in posts.  Clinics have been busy, to say the least. Just wanted to give you a quick update on rotations I’ve had since Christmas time.  Please let me know if you have questions and feel free to comment! Also, please pass on the word about this blog to new SMU students.  Hoping to give any/all island students a chance to hear from someone in clinics and an available contact, if they’re interested.  Thanks in advance!

Radiology: Good rotation.  Laid back, perfect hours, no weekend/holiday duties–made me think about being boarding in radiology!  Started at 8:30am with rounds covering different systems with either a clinician or resident.  Rounds last about an hour and a half, then half the students go to the radiology reading room and the other half practice taking rads with the technicians.  Reading with the radiologist can be a little intimidating, depending on who you are reading with.  Some of the clinicians are real laid back and just chat with you about what they see most of the time, with an occasional question or two.  One of the radiologist focuses more on quizzing you (esp. because they are the one primarily in charge of grading you), in a nice way, but still a little more intimidating.  You just hope that if you don’t know the answer the other student reading with you will! Overall I felt pretty well prepared for radiology.  Poteet and Werner’s notes were very useful for review as well as having Thrall handy for additional reference.  The Radiology service also has several text resources available in the conference room if needed.  The techs are super skilled and knowledgeable at their job.  They are a great resource and you should try to pick up on the little tips they have to help you get the best image. 

We were given an online Moodle test with 30 questions that pertained to positioning, technique, radiology physics and artifact questions.  We were also required to complete 10 unknown cases, radiography with a very brief signalment and history, where we needed to list our findings and differentials.  Both of these were factored into our final grade for the rotation.  We were allowed to work together for the unknown cases, but not the Moodle test.  Overall I liked radiology and sort of wished I could repeat it, just for the additional experience.  I will say the comments I got in my post-rotation evaluation included things like, “needs to speak up more, seems like she knows the information but is too quiet to tell for sure”.  I’ve never had anyone describe me as quiet….but apparently you need to be quite boisterous for some clinicians to really hear you.  

Bovine Surgery: LOVED this rotation! It seems students get a hell-of-a lot more hands-on experience in large animal rotation than in the small animal rotations.  I was nervous going into this rotation because I’m a small animal person and haven’t thought about any large animal stuff since I left the island 5 months ago, but I did just fine.  We were split up into groups of 4-5 students and spent time working on team projects together.  The first day was a little rough, as I didn’t really know what to expect for discussion and what I needed to have prepared.  It got a lot easier after the first day though.  We were given a bunch of powerpoints (which we flipped through during daily discussion) and all you really needed to do was go through these the day before discussion and you would be well versed and informed for the following day’s discussion with your group.  we had about 4 surgery labs + a necropsy and the rest of the days were classroom stuff.  The surgery labs were awesome.  The students did everything from start to finish.  I had a really great surgery team to work with and we all did our part to help each other.  We did a whole bunch of surgeries and procedures on dairy cows.  Though I won’t really be using these particular surgeries in the future, I got to work on surgical technique, especially suturing! From this rotation I learned not to be so scared of large animal rotations.  As it turns out we were given most all of the information we needed in class and there are plenty of text available if you do a little searching.  Message me if you want the bovine sx lectures.  They’re pretty useful if you’re going into large animal. 

My second SAM was waaaaay better than the first.  I actually got sleep and I think my cortisol level was in the normal range for the entire 2 weeks.  I made a deal with myself before this rotation that I was not going to spend more than 1 hour on a discharge, no matter how complex the case was.  That really made my life easier.  I kept my discharges short and basic and the clinicians actually appreciated that much more.  I really felt like I was much more capable of appropriately managing my time on this SAM rotation.  It helped that I wasn’t wasting as much time learning new people and places in the hospital along with protocols and the computer system.  My rotation-mates were super helpful and we always came in early to help whoever had in-hospital patients.  I highly recommend doing this on these type of rotations.  If you help people they will generally return the favor when you really need it.  I managed a low B on my first SAM and knew I had a lot of work to do to improve in pretty much every area (basic knowledge, PE skill, Hx taking, clinical skin, etc.), but got a solid A the second time around, and I could just tell how much better I was doing the second time around from just a little more experience.  I’m envious of the Minnesota students that they get to take 4 medicines if they track small, whereas SMU students have to do 2 LAM and 2 SAM.  I could add more SAM’s if I replace them with my electives, but I really need all of my chosen electives. 

**Some great resources for helping you with discharges for owners: 1) Clinical Veterinary Advisor (must buy the book to get an access code for the website because that’s where the client information sheets are located, they are not in the text!), 2) Small Animal Practice Client Handouts (you must order the text which comes with a CD to download all the handouts, there are like over 1500 handouts on various medical conditions/procedures)

Finishing my second week of ultrasound this week! I’ll give you a full report about this rotation soon.  Hope you are all well!

 

Externships

I will give you my thoughts on veterinary externships and hopefully some of my classmates from SMU will join the discussion to give their perspective as well. 

An important mentor of mine (who is a vet), advised that I take as few externships as possible so that I can spend more time at the hospital learning from the experts in the individual specialties.  I did take their advice and set my schedule up to include the minimum 3 1/2 externship blocks (7 weeks total).  I completed my first externship about a month ago at a small animal rehab and sports medicine specialty practice.  I absolutely loved my experience there, but I did not get the hands-on experience that most students are looking for in their externship experiences.  I understood that hands-on was not going to be an option for this externship site, because the veterinarians there had special certification for this particular type of medicine.  I still managed to learn a ton and was able to discuss my future goals with the veterinarians and received a great deal of guidance and resources moving forward. 

My impression of externships is that they provide a much needed break from the university hospital setting.  They usually require A LOT less paperwork and therefore allow a lot more free time for the million other things you are responsible for in 4th year.  Also, the folks at these practices seem more focused on helping you learn, probably because it’s a change of pace from their day to day routine.  I’m sure this will vary depending on what externship site you choose to venture to. 

Some advice for choosing externships? I would say try to arrange them in your schedule following the tougher rotations so that you can get a breather from the hospital.  Also, really spend some time selecting your externship sites.  I would advise doing a fair amount of research on the facility to find out what other students experiences were like, what the staff was like, days/hours expected to be there, how much hands-on experience students receive, etc.  I believe most of the universities have externship evaluations that students are required to complete so that others can read about their experiences and decide if that facility is a place they would like to contact for their own externship.  This is a very helpful resource for those who don’t have contacts at a bunch of practices.  I suggest researching externship opportunities right away, following your clinical site acceptance, so that you can contact the facilities right away.  Many of them will only take one student at a time and it’s possible other students may get there before you.  Another thing to consider is the location of the externship site.  For those completing clinics a long ways from home, externships near your hometown may give you some time to spend with your family.  Consider scheduling your externships over holiday blocks if you would like a better chance to be off clinics and home for the holidays (provided the practice isn’t emergency based….). 

Externships are wonderful opportunities to get hands-on, individualized experience that is more similar to what you will be doing when you officially graduate.  Try to make the most out of your externship opportunities and choose places that will really enhance your experience and knowledge.  For those that have a special interest, choose sites that will increase your exposure to these areas that the hospital can’t.  I would suggest not picking a site because you know the staff and it will be easy, but rather pick a place that will teach you things you may not get at your university hospital. 

I’ll comment on this post with other thoughts and ideas following my externship at a small animal referral center, which starts tomorrow!

Happy Holidays all!!

First SAM Rotation, CHECK!

People will scare you about SAM rotation.  Some will tell you they were at the hospital all day and half the night.  Others will tell you they got drilled by their resident/clinician for not knowing something, weekends are non-existent, etc.  Well, it’s mostly all true.  But here’s the silver lining- you will learn A TON.  SAM might be the straw that breaks the poor, tired, mentally/physically/emotionally exhausted camels back, but that camel should feel way more confident moving forward.  I was originally scheduled for my 2 SAM blocks 6 months into clinics, but I chose to move one of them up (to my 4th rotation), mostly because I was scheduled for an externship for my 5th rotation and I wanted at least one SAM under my belt before I went into that. 

Let’s talk about scheduling issues for a minute.  Setting up your schedule is tricky because there are so many things to consider; When am I taking NAVLE? When do I want my vacation to be? Am I going to graduation and if so, what rotation should I be on when that happens? Where am I doing my externships? How many externships do I want? How should I space out my hard rotations? What are the hard rotations? –Many, many things to consider.  At the end of the day you can only do so much to influence your schedule (some students can’t do anything, unfortunately) and whatever happens will happen.  The point is, try to think about this stuff in 7th semester and if your coordinator gives you the opportunity to move things around, these are the things you want to take into consideration.  MN is pretty damn good about letting you switch things, up until you start your first rotation.  Ok, back to SAM.

Daily Schedule for SAM: The days alternate.  One day you see appointments (intake days) and the next day you take transfers (patients sent to SAM from other services, usually ER/CC) and do procedures that were schedule for your patients from the previous day.  On appointment day you need to be to the hospital by 9am for morning rounds.  The first appointment gets scheduled for 10am.  We had 6 students, 1 intern, 2 residents and a senior clinician on my SAM rotation.  So that’s 4 doctor’s schedules that the students have to pick up.  It’s a lot, to say the least.  You can count on having at least 2 appointments per day (most days).  If those patients are hospitalized overnight you are in charge of making a treatment sheet for them (including any and all treatments, feeding, exercise that they will need for the next 12 hours).  If you have a patient in the ICU you need to come in about 7am to do their PE and SOAP, which is expected to be done by 8am.  You then talk to your clinician about how the patient looks today and what your plan is for them.  Keep in mind, if you have a patient in the hospital you still have to take appointments and stick around for procedures.  This is why it can get very overwhelming.  You end up with a whole lot of irons in the fire and it’s easy to get overwhelmed.  If you start to feel overwhelmed you need to speak up to either your clinician or your rotation mates and ask for help.  Usually your rotation mates will ask people that have patients in the hospital if they need help with them in the morning and come in early to help, but it depends on the students… I got lucky and the students I was on rotation with were pretty damn good at watching out for each other.  Also, the clinicians warn you that teamwork is a BIG part of your grade.  This is true for every rotation, so don’t be an asshole to your rotation mates.  After your appointments/procedures are finished for the day you need to enter your PE, Hx and discharge into the computer.  This is what you will spend most of the night doing.  Writing a discharge is difficult for many reasons.  First, you have to understand what was wrong with your patient and why they came in.  You have to know why you did what you did and what your other differentials were, and why the other differentials were less likely.  Then, you have to put it all in layperson terms and write it out.  This is all part of the CYA process.  The best part? Every clinician wants their discharge written a different way! There’s a standard format (this varies from one service to the next, by the way), but most of the clinician just pick their own way to write the discharge instructions for the owner.  The discharge is sometimes expected to be done by the time the owner leaves with the pet (usually true for procedure days or the day an ICU patient goes home) otherwise it needs to be done within 24 hours of the patient leaving their appointment.  The writing is the worst part of the whole experience, because it’s so time consuming and cumbersome.  Instead of using your time at night to research your case for the next day or study up for the rounds topic you get stuck spending all this time on a discharge that your clinician will inevitably change anyway.  This was the super frustrating part for me because it deterred me from taking more patients during the day.

Weekends: SAM students are expected to be at the hospital on weekends.  It sucks but it’s just the way it is.  Either Saturday or Sunday you will cover transfers.  If you have a patient staying in the hospital you are expected to be there the following day to do their 8am PE and treatments (if they have treatments at 8am).  You are also expected to do a second PE around 5pm if your patient is still in the hospital.  Then your SOAP is due by 8am the following morning.  SOAPs are a serious pain in the butt.  Again, every clinician wants them done differently.  Some don’t want a diatribe of everything you know about IBD, others want you to spill your brains.  You pray you have the clinician who wants short and sweet.  More writing.  Always writing.

What I liked about the rotation: I am amazed at how much I learned in 2 short weeks.  I impressed myself with what I remembered from class.  My SAM notes saved my life for rounds and for my cases.  Strongly encourage you taking the time to organize your notes or making study guides as a quick reference for SAM.  I loved my clinicians.  They were super fun to work with.  Always cracking jokes and having a good time, but serious when it came time to helping you learn about your patient or during rounds.  I loved that we rounded in the morning and at the same time every day.  Consistency with the schedule was great.  The Thursday before the end of the rotation they passed out these templates for students to write down their Hx, PE findings, problem list, dxx, assessment and plan.  They apparently discussed the need for better organization to our thought process during their clinician rounds and someone put this template together.  I thought it was a great idea and very helpful.  The SAM clinicians want you to organize your thoughts the same way every time.  They want you to write down your problem list, then go through each problem and list your differentials.  So if your dog has diarrhea as a problem, they want you to list the primary vs. secondary causes of diarrhea.  And they want it this way every time diarrhea is on your problem list.  This was hard for me to get used to because I really had to go back to my notes to figure out the primary vs. secondary stuff.  I just had a general list of the most likely causes for this patient.  But it was a good learning opportunity and a great method to get used to moving forward.  Our SAM group loved to bring in food.  Every day was food day.  It just made the day so much better when you could look forward to snacking all day.  The last Friday of rotation we had a giant pot luck with both SAM services.  Food is a great perk for SAM.

Things I didn’t like about SAM: Again, all the writing.  It sucks.  It’s time consuming and boring and your clinicians change it all anyway.  One tip I will offer, and I don’t know how other university’s computer systems are organized, but at UMN you can search for your patients problem from previous cases and read their discharge to get ideas for your own.  Copying and pasting is technically plagiarism, so I won’t tell you to do that…Many of your clinicians (even on other services) will tell you to look at “fluffy’s” discharge from last month for guidelines of what they want for your current patient.  This will save you loads of time and frustration.  Talk to other students and figure out if there is a quicker way to do things.  There usually is, you just have to ask.  Weekend duty sucks.  It makes the rotation seem super duper long and you get very little time to recharge.  Tip: don’t take more than one renal failure patient! These cases can be exhausting and suck the life out of you (not to mention your patient…).  Another tip for not being an asshole to your rotation mates: if on the first weekend of rotation you don’t end up having a case in the hospital (so you get the day off), step up and take a transfer case the following weekend and let the others have an opportunity for a day off.  It’s just the right thing to do.

Overall, SAM was a great rotation and I’m actually looking forward to my next one next year.  I am even considering dropping one of my electives to take a 3rd SAM (we’ll see if I actually do…).  Try not to be too afraid of SAM, but be afraid enough to prepare yourself academically, mentally and emotionally.  Also, good references are never a bad thing.  Clinical Vet Advisor, Ettinger, the NEW plumbs, 5 minute consult are all references that can help you tremendously.  And don’t forget about your contact on the island! I used Dr. Dunayer and Roberts as a lifeline for a rounds challenge during SAM.  They both responded very quickly to my email and were incredibly helpful.  They are not just there to teach you while your on the island.  They are there to help you the whole way through.  USE YOUR RESOURCES!

Next up, externship at a small animal rehabilitation facility! So excited! Enjoy your Thanksgiving at the beach! You’ll be home soon!

Oncology

The cancer.  All my patients had the cancer.  I was warned a while ago that taking the oncology rotation might depress you.  I was prepared going in to see a lot of sadness and death.  Much to my surprise I saw very little sadness (from clients) and no death.  As it turns out there are great treatment options for pets with cancer, but they do all come at a price. This rotation was very, very busy.  You had at least 2 cases a day and the discharges were often pretty darn exhausting.  Clients get a hell-of-a lot of info when they come in for the first time, so typing that all up take a lot of time.  Luckily, the resident was really great about giving us previous cases to look at to help us write the discharges a bit faster.  Discharges are expected to be ready to go by the following day (ideally by 8/9 am).  So, needless to say, I had little to no free time on this rotation.  Days were spent at the hospital trying to stay alive and learn something and nights were spent writing discharges and trying to muster up energy to research the rounds topic for the following day. 

What I really appreciated about this rotation was the time the clinician took to go over a good physical exam.  He gave us really great tips and pointed out things to look for that I never would have realized.  If you don’t take oncology for any other reason, take it for the physical exam practice. 

Structure of the Day: So we were expected to be there in time for the first appointment (usually 8:30 or 9am).  The students chose their cases the night before (ideally) so you should have read over the patient history, looked at any previous lab work or radiographs, have some idea of differentials if the type of cancer hasn’t already been diagnosed, have a plan for obtaining a solid diagnosis, and if you’re really good have MST (median survival time) for each of the tx options. 

The chemo and radiation patients would arrive between 7-8 am and the dogs play in the oncology room with each other and the staff for the entire day.  It’s super cool, kinda like doggie daycare.  The staff is very dedicated to making sure chemo is a fun experience for the dogs.  Cats don’t really like to play together, so we just kept them in a nice, quiet area.  The students are encouraged to do PE on the chemo patients because they all have abnormalities that are somewhat more obvious than your average patient.  Having overnight duties or weekend duties are rare in oncology (I actually didn’t have any while I was there), but possible. 

Things I liked/learned: Learning really good physical exam skills/tips and tricks, how to ask the right questions and in the right way to get good hx from owners, writing a thorough discharge, helping owners make final decisions for their pet, talking owners through evaluating pain and quality of life for their pet, got some super duper great informational handouts for owners to help educate them about their pet’s cancer type (also helped me learn!), the resident was very understanding that we had a lot of work to do and really tried hard every day to get us out by at least 5pm, and learning to manage a busy schedule.

Things I didn’t like: this rotation was really busy and the clinician and resident had a lot of outside responsibilities, which often pulled them away from helping the 4th year students learn.  There were many days that we just didn’t have time to round.  I feel like rounding really helps because it gives you a chance to hear what the clinician/resident expects you to know about a topic and what they think is important.  Something I found particularly difficult was that a decent amount of the information we learned in the classroom at SMU was already outdated by the time I got to my oncology rotation.  Also, some of the info was different simply because oncologists do different stuff at different hospitals.  For instance, the I-131 patients at UofM are required to stay in the hospital for 3 to 4 weeks because MN has super strict laws with radioactive biological agents, as opposed to other states.  Also, we learned about Palladia (tyrosine kinase receptor inhibitor) in onco at SMU, but not a whole lot of detail about it.  This is a newer cancer drug that is now used for a ton of different cancer types.  Bottom line, oncology is a quickly evolving field.  It’s hard to keep up.  Here is a website that Dr. Milner (from UofF) gave us to use as a resource.  It has awesome links with really great info for students/vets.  SAVE THIS ONE! http://www.vsso.org/Cancer_Information_1.html

Feel free to ask questions if you have any.  Also, please tell other students about this blog if you find it at all helpful.  If you have suggestions for making it more helpful/useful I welcome your ideas! I would like to offer you the information I wish I would have had when I was in your position.

I start SAM tomorrow.  I’m sort of terrified.  Trying to stay positive. Wish me luck!

Dermatology

Hi All!

Sorry for the gap in posts.  Time really gets away from you in clinics.  So dermatology was a good rotation.  Unfortunately during the block that I took it we only had one clinician and we had 4 students.  So there was a day or two in there that I didn’t even have an appointment (usually because it cancelled last minute).  The daily schedule for derm was amazing, but unfortunately we really got spoiled, then got drop-kicked back into reality on the next rotation.  Our clinician for derm couldn’t get to the hospital until about 8:30 in the morning, so we didn’t have to be there until about 9am (for the first appointment), because we didn’t round in the morning (like a lot of rotations).  It was hard to go from getting to the hospital at 9am to the next rotation where I had to be there for 7:15-7:30 am.  Also, a lot of the appointments were “rechecks” as opposed to “diagnostic” appointments.  For those who don’t know what that means, a diagnostic appointment generally means it’s the first time the patient is being seen by that service.  Diagnostic appointments take a bit more preparation because you really need to get a good history to come up with a good differential list.  Recheck appointments are easier and less time consuming because you just find out if the previous evaluation and tx plan is working or if you have to switch it up. 

If I learned anything in derm it was how to evaluate and manage allergies in dogs.  We had a ton of patients with allergies, who also had secondary skin infections as a results.  I watched several intradermal allergy skin tests and an incisional biopsy, practiced fine needle aspirates, skin scrapes, tape preps and ear sway cytology.  I became pretty proficient in reading skin and ear cytology (which is a really great skill to have!!).  We also had a handful of endocrinopathy patients who presented for chronic skin issues and their owners didn’t realize there was an underlying disease causing it.  One thing I really did realize (which I know Dr. Bauer talked about in our derm block at SMU) is that animals can have a ton of concurrent problems that the owner will readily ignore, but when they can see the problem (ie: skin issues) they are suddenly concerned and finally bring them in to be seen by their vet. 

I acquired some really great resources in this rotation, including a derm drug reference with every drug used in dermatology, what conditions it’s used for, including the ba-jillion different shampoos, foams and sprays.  I also snagged a whole bunch of client informational handouts for the most common derm diseases.  I would encourage you to do this if you have the chance on your rotations.  These handouts are super helpful for writing your discharges and just a great resource to have moving forward.  You never know what your future employer will have on hand, and bringing your own stuff might just make your life a lot easier. 

All-in-all derm was a success, but just a little slow.