Getting the most out of EMS - Veterinary Practice
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Getting the most out of EMS

GRAHAM DUNCANSON issues a wake-up call to the practising arm of the profession on extra mural studies, noting in particular the problems faced by students interested in mixed practice

LET me begin with a declaration of vested interest as I have two areas of bias. First of all I have a daughter who will be starting her final year this September. Second, I am a director of a company called VetLearning which provides a wide range of work-based learning opportunities culminating in further qualifications. One of the mainstays of VetLearning is the encouragement of self-reflective learning centred on dialogue with one’s peers.

What is required by the profession is the provision of good Extra Mural Studies (EMS).

The majority of the veterinary surgeons who are going to join the practising arm of the profession this summer will be going to join small animal practices.

I have conversed with these students at length and they all seem to have not only received an excellent education at veterinary school but have also carried out some very useful EMS. They also seem to be confident that they will receive good support from older colleagues in small animal practice.

Some new graduates, with whom I have discussed their futures, want to become equine practitioners. These students have received on the whole excellent EMS at the large equine first opinion and referral practices.

Sadly, some of these new graduates may be unable to find purely equine jobs. I have encouraged them by describing how a year or so in a small animal practice will improve their surgical skills beyond all recognition.

If they can continue their interest in equine work and attend equine CPD (such as the excellent BEVA new grads dentistry course held at Newmarket in November), they may well be able to obtain an equine job when they have been qualified one or two years.

It is the new graduates who want to go into mixed practice who seem to be struggling.

Like their small animal colleagues, they seem confident with their small animal skills. The majority are well aware of the importance of communication skills. They have no worries about the small animal consultations except being rushed, which is entirely understandable. They are keen to practice their small animal surgical skills.

It is the farm work which seems to worry them. The learning curve is likely to be very shallow if they are spending the majority of their days inside doing small animal work.

Farm animal teaching at veterinary school seems to be extremely variable when individual species are concerned. On the whole, cattle medicine and surgery is well taught and new graduates seem to be confident on the theory.

Manual examinations

This is particularly so with bovine fertility. Most graduates are happy doing manual examinations of cows but are considerably more familiar with scanning cattle.

More senior members of the profession would do well to remember that performing rectal examinations on cows is not like riding a bicycle. You do forget unless one has had a very large amount of experience. Certain bovine surgical skills seem to be poorly demonstrated to undergraduates and so new graduates will need to be mentored unless these skills has been learnt on EMS.

Historically, veterinary students had a little book to record the skills they had performed.

As far as I am aware these record books have been dropped which may be for the best as they had become rather a rubberstamp exercise. In fact I worry that the Professional Development Phase (PDP) might become the same in a mixed practice context. However, some sort of record-keeping is worthwhile for two reasons.

Firstly, the undergraduate and the EMS tutor can quickly assess the gaps in the undergraduate’s knowledge. I do not mean the undergraduate’s theoretical knowledge as I am sure that will be entirely adequate by the time finals have been passed. I mean the hands-on practical knowledge.

Secondly, some record is useful for the undergraduate’s first employer. I suppose it might be of use in the selection process but what I think is much more important is that it will guide the more senior members of the practice as to what mentoring is required.

I know there are some practices where there are a large number of new graduates and only a few more experienced colleagues. This is a very difficult situation. The comradeship of the new graduates will be beneficial but the mentoring will be non-existent.

How can we help students to get a balanced farm animal EMS? Sadly, luck plays a part. One Bristol student who I was very privileged to have taught managed to see three bovine uterine prolapses.

In fact, the third one she did almost entirely on her own with very little input from me except keeping a lecherous Welsh cowman away from her! On the other hand, she never attended a bovine caesarean section as a student.

As EMS providers we must do more than rely on luck. Equally, students can do a lot to make their own luck.

In my view, EMS providers should:

  • welcome students on arrival;
  • give students careful instructions verbally and in writing;
  • get students to sign the health and safety instructions;
  • if possible assign each student to an individual vet (that does not mean that the student has to stay all the time with that vet but that one vet helps the student to arrange his or her time and that vet will sign out the college form);
  • obtain the student’s contact telephone numbers (always stressing to students that if they are rung after hours they do not have to come nor will they be judged harshly if they do not go out on an out-of-hours call);
  • encourage the students to check the calls available for the next day and plan who they should go with, try to help students to achieve their goals (i.e. if they need experience with beef cattle they do not want nor need endless days of pig work –obviously this will not be easy and it is better for the students to be out with a practitioner rather than hanging about in the surgery hoping a call will come in for beef cattle);
  • try to get students to do as many simple tasks as possible, e.g. filling syringes;
  • try to get students to do as many difficult surgical procedures as possible (it is definitely worth explaining why they are not allowed to do a certain procedure, e.g. sorry the last intravenous injection I carried out in a cow on this farm was a disaster);
  • if practitioners have hands-free in their vehicles this is helpful so students can hear conversations with clients;
  • try to discuss different types of procedures with students so that even if they do not see the procedure performed they will have an idea how it can be performed and how that explanation fits in with what they were taught at college; and finally
  • try to keep students not only busy but also happy.

I have been practising for nearly 50 years and I have found large animal practice most enjoyable and I hope my daughter and other young people will find the same. EMS providers should try to understand individual student’s needs.

Feed-back form

It may well be appropriate to ask students to complete a feed-back form. This could include questions like: was the placement worthwhile, was the placement what they expected, would they like to return, would they like to be allowed to do more tasks (ask them to give examples), would they like to work with more different practitioners, were they made to do mundane tasks and how could the placement be improved (they could be asked to give examples)?

EMS providers should not:

  • put students at risk doing dangerous procedures;
  • push students into doing procedures they are not happy to perform;
  • compare students’ competence (this will vary with which year they are in and at which college they are attending);
  • ask students questions (unless the students wish for this);
  • compel students to do mundane personal tasks, e.g. cleaning the car;
  • compel students to do mundane practice jobs, e.g. folding up end-ofmonth accounts;
  • expect students to go TT testing for days on end just because they are an extra pair of hands to do the paperwork (naturally to see one TT test is appropriate and also if there is no other work being carried out students have to expect to do some boring repetitive jobs);
  • expect students to work longer hours than the practitioners and just let students stand around during consults but do tasks of interest to the student, e.g. listening to hearts, rumens, etc., etc.

Students should help their own learning by: always book in advance; always being friendly, cheerful and appear interested; always carrying their kit with them (waterproofs, boots, warm clothes) so that they are ready to go with a practitioner at a moment’s notice; always carry some academic work to carry out if there is a suitable time; always bring food and drink they require; give their contact phone numbers to all the practitioners as well as to the receptionists.

If there is more than one student, agree amicably which student will help which vet and volunteer to do workbased tasks, e.g. preparing the practice newsletter.

What students should not do is: sit around the workplace chatting either to each other or the lay staff and ask inappropriate questions in front of clients, e.g. why ever do you suture the skin like that?

Naturally, students will create a good impression to all the staff if they volunteer to carry out non-academic tasks, e.g. making coffee, doing the washing up, cleaning the instruments and holding in-patients for nurses to carry out checks.

In conclusion

There is no doubt in my mind that EMS in several farm practices is a vital part of undergraduate education for veterinary graduates who want to become either mixed practitioners or farm animal practitioners.

While the RCVS still insists on a long list of large animal “day one” competences, then I feel it is vital for all potential veterinary graduates.

It has become apparent, however, that many practices probably through no fault of their own cannot provide worthwhile farm animal EMS. I feel sympathy for veterinary students who are already heavily penalised financially who may have to travel long distances and live away in expensive accommodation to obtain EMS.

I do not see an easy solution. My generation were given a grant of £6 (perhaps equivalent to £150 today) a week for EMS carried out away from home. I cannot imagine this happy state will happen in future.

I really admire the modern students, who are much more impoverished than I was, who still make a cake to give to the practice as a thank you present.

There are a few veterinary surgeons who provided me with excellent EMS who are still alive. I would like to thank them and apologise that I never made them a cake.

They can always e-mail me on and I might persuade my daughter, who makes excellent cakes, to send them one.

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