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InFocus

“You can show [EMS students] that learning doesn’t stop when they leave vet school; rather, part of the joy of veterinary medicine is lifelong learning”

I recently read an article about factors that can bring joy to your work – physical and psychological safety, meaning and purpose, and choice and autonomy, to name a few. And I followed this up with an article on the problems of extra-mural studies (EMS). It seems (according to the student who wrote the piece, at least) that plenty of practices see students coming to gain experience with them as a bind rather than a blessing. How, I wonder, can that be? I’m just so delighted when I have a student working with me. What a joy it is to teach!

Last Thursday, I had an entropion operation to do. Now, I’d like to say I’ve done more Hotz-Celsus surgeries than I’ve had hot dinners, but that would be a bit of an exaggeration, though it’s safe to say that another eyelid surgery isn’t exactly a novelty for me. But it was the first one that Ryan, a final-year student working with me, had ever done, and with a bit of supervision, he did it really well. OK, he took 10 minutes more than I would have, but the smile on his face when he completed it was worth half an hour of surgical time! You could say the same for a student who, at the beginning of the week, can’t tell the difference between nuclear sclerosis and cataracts, but in a day of EMS learning can tell you whether a 10-year-old dog only has age-related changes in the lens or an opacity that needs surgery.

It seems […] that plenty of practices see students coming to gain experience with them as a bind rather than a blessing. How, I wonder, can that be?

Truth be told, that was exactly what happened on the first day of my EMS – “seeing practice”, as we called it in those days – with Dr Keith Barnett at the Animal Health Trust. The first case I saw with him was an aged dog with a hazy-looking lens. “What’s the diagnosis?” he asked me, with the owner looking on. “Cataracts?” I ventured. He put his hand to his forehead and exclaimed in an exasperated tone that he had spent half an hour explaining the difference between cataracts, nuclear sclerosis and normal ageing changes in the lens during his lectures to us. The rest of the day was spent in a similar fashion, with me getting a diagnosis of uveitis and glaucoma or the difference between trichiasis and distichiasis confused. The last case of the day was a dog with a hazy lens similar to our first. “Nuclear sclerosis,” I said, trying to sound confident. “You are quick on the uptake,” said Dr Barnett in a somewhat patronising voice. But he told me I could work with him for the rest of the summer, which was what started me on the path to veterinary ophthalmology.

Why was I telling you that? – to show you the delight it is to teach a student how to come to terms with the apparent complexities of ophthalmology. Obviously, they could follow me on Instagram (@bowteye), where I post a new case each day, but that’s nothing like coming and seeing cases with me in real life. And surely that should be what excites us about welcoming students to our practices to do EMS! It’s all worth the effort.

My interest in ophthalmology was sparked at 608 Veterinary Group in Solihull, learning with John Heath, who, quite apart from being a lovely man and a brilliant teacher, was simply passionate about eyes. He let me operate with him, and I even got to the stage of doing a parotid duct transposition under his guidance, so I feel it is only right that I should pass on that enthusiasm to students working with me.

My interest in ophthalmology was sparked at 608 Veterinary Group in Solihull, learning with John Heath, who, quite apart from being a lovely man and a brilliant teacher, was simply passionate about eyes

Do you remember your EMS? Were you just as enthused by a vet you worked with? I hope so, and I hope we can all do the same for others – not leave the student in the corner of the room merely to watch as we consult or operate but ask them questions and involve them. You can even learn from them too!

Have you ever thought of EMS as CPD? Your EMS students have just been taught what is new and cutting-edge, so why not ask them what their lecturers are telling them about in advanced cancer care or arthritis analgesia? OK, so they may not know much more than you do – but what a good chance for them to read through their notes, or to do a bit of Google Scholar searching for the most recent research. Then you both can learn together! You can show them that learning doesn’t stop when they leave vet school; rather, part of the joy of veterinary medicine is lifelong learning – life-long learning that doesn’t have to mean going to congresses and sitting in lectures, but co-creating knowledge in practice.

You can show them that learning doesn’t stop when they leave vet school; rather, part of the joy of veterinary medicine is lifelong learning […] that doesn’t have to mean going to congresses and sitting in lectures, but co-creating knowledge in practice

Maybe you can get them to research cases from your practice. If you’ve just operated on an aural haematoma, get them to look up the research on treatment techniques. They’ll find Jon Hall’s 2016 JSAP review of haematoma treatment by UK vets: treatments that include needle drainage with or without local deposition of corticosteroids and surgery involving linear incision with stents, sutures alone or even just local corticosteroids. Or maybe they’ll find Dan O’Neill’s epidemiological review of over 2,000 dogs with the same condition, published the same year. And maybe they’ll find something completely new. Who knows?

There are papers out there on treatments from buttons to carbon dioxide laser therapy! So get your EMS students to look back in your records and see what treatments your practice used and with what success. That will be a learning exercise for them and you. What could be more joy-giving than that?!

David Williams

Fellow and Director of Studies at St John's College, University of Cambridge

David Williams, MA, VetMB, PhD, CertVOphthal, CertWEL, FHEA, FRCVS, graduated from Cambridge in 1988 and has worked in veterinary ophthalmology at the Animal Health Trust. He gained his Certificate in Veterinary Ophthalmology before undertaking a PhD at the RVC. David now teaches at the vet school in Cambridge.


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