I AM sure modern police detectives solve crimes by careful, painstaking sifting of evidence. Only on the TV does the old detective’s hunch pay off. Diagnosis in clinical practice is very similar.
The orthopaedic equine practitioner knows that in the majority of lameness cases, careful nerve blocking is required before any imaging can be undertaken to reach a diagnosis. The days of the old practitioner like myself diagnosing occult spavins are long passed!
Yet in certain situations a practitioner’s experience can help a colleague make a diagnosis without actually needing to see the animal. As a young man I was faced with a pony mare with a foal at foot, off food, with a slightly subnormal rectal temperature, making regular diaphragmatic thumps.
A call to the late Sam Ellis, the partner with the most equine experience, quickly put me on the right lines. It was a case of hypocalcaemia. This is a very rare condition in the horse. Unlike in the cow, it occurs at peak lactation. It was beyond my experience, but not his.
I have been qualified 47 years and have only seen this and one other case. Case pattern recognition helped Sam to make the diagnosis as it did for me when I came across the subsequent case.
As practitioners, do we have to actually see a case for case pattern recognition to be able to help us?
Obviously, no must be the answer. Our diagnosis may well be based on what we were told at veterinary college. Will such a rare condition be mentioned? Will we record it as we take notes during the lecture? Will it be in the lecture handouts?
The content of undergraduate lectures is extremely variable. Older lecturers who have been in practice are likely to give lectures with a very wide content. Younger, less experienced lecturers are likely to concentrate on the common conditions or go into considerable depth into their own particular field of interest or research.
We are more likely to have heard about the condition after graduation if we have started in some way to specialize, i.e. if we are concentrating on equine practice and are completing the Professional Development Phase (PDP). However, recognition of hypocalcaemia in the mare is neither a day one competence nor a tick box on the PDP.
On the other hand, if we are completing an RCVS postgraduate certificate in any equine subject, hypocalcaemia is likely to be mentioned. Would a veterinary textbook help us? Maybe if it is well indexed or has a good list of differential diagnoses with each common condition.
The regular reading of excellent veterinary journals like the Veterinary Record, Equine Veterinary Journal and Equine Veterinary Education is bound to be helpful. I think the word regular is important. With such a rare condition, brief scanning of the journals is unlikely to be helpful as one is liable to miss the vital article.
CPD courses are also likely to help, particularly if they are well chosen. Also, there are some useful webinars available. These days there is some very high-powered advertising with glossy brochures. Practitioners need to study the content of these courses carefully to see that they cover the topics which they really require. They should make sure they are really getting value for money.
As a member of BEVA, I would like to give a plug to the excellent BEVA courses available, particularly the half-day regional meetings which being local allow practitioners to do a morning’s work and just take the afternoon off to attend.
How can busy practitioners aid their learning?
The most important aid to learning is organisation of information. There is little point in reading journals or attending CPD meetings if the learning which has been achieved cannot be retrieved.
It might be argued that with modern search engines knowledge can easily be retrieved. In many instances that is certainly true. If the search words include “hypocalcaemia” and “horse”, the number of references found will be large. However, if you have not made a diagnosis there is a problem. What words do you search under?
Practitioners need to have either a paper filing system or an electronic retrieval system. If useful material is found when reading a journal this must be recorded and indexed for later retrieval. If notes are supplied at a CPD meeting, interesting useful facts need to be recorded for future use.
In many ways, handwritten notes taken at the time are the easiest to retrieve. These will need to be edited if the CPD has been at a congress as the notes taken will be lengthy. Certainly, many CPD course notes are supplied on a memory stick which must make retrieval easier particularly if a specific reference programme like “Endnote” is used.
Reflective learning
Veterinary graduates are not alone in that postgraduate learning is not an automatic skill acquired at graduation. Graduates have to learn to learn effectively.
As professionals we need to learn by self-reflection. The easiest way to learn this skill is to join a “learning set”. I am a director of VetLearning, a company which specialises in workbased learning with impact for practitioners.
We help candidates to obtain Royal College certificates, MScs and even doctorates. Details can be obtained from the website, www.vetlearning.co.uk.
Meeting regularly with one’s peers, whether a physical meeting or a Skype conference, not only helps candidates to learn but also raises their interest in practice. It aids practitioners to learn not only clinical skills but also the so-called “soft skills”.
The desire to carry out reflective learning may initially be because of the candidate’s requirement to get an extra qualification. However, very soon the desire for reflective learning becomes ingrained in the professional’s approach to practice so that every facet of the working day is reflected upon and the professional’s practice is enhanced.
Day one competencies
I talk to a large number of veterinary students, my daughter included, about their plans for their immediate future after qualification. Modern students, in my opinion, work extremely hard during their clinical years, so I am not surprised that many want to take time out to so-call “chill” after graduation and the final-year holiday.
The decision on what sort of practice they want to aim at needs considerable thought. To some this is straightforward, e.g. they want to work in a good small animal practice near where they were brought up or they have set their sights on being an academic so they will be looking for university or institutional posts.
A bad idea?
In my case, I had a passion to go to work in Africa so although I did a couple of locums and spent some time at the School of Tropical Medicine at Edinburgh, my ultimate goal was to get to Kenya and get to work.
My professors at Bristol thought this was a thoroughly bad idea as they thought I ought to go and work in a good mixed practice for two years first. They were right but I was lucky and my first posting was to Mombasa where there were four experienced veterinary surgeons who could give me vital guidance.
So for many years I used to advise students seeing practice to go to a good mixed practice for a couple of years and decide what type of practice they enjoy. I no longer give this advice as I think it is just too stressful for a new graduate to be expected to treat a pony with hypocalcaemia one minute, then do a caesarean section on a cow and then come back and do a busy evening surgery.
I now suggest to new graduates to go for the type of work they think they will enjoy.
If that does not work out, they can easily re-train and try another branch of practice. We at VetLearning are pleased to give them a free consultation on 01357 23885.
