It’s amazing how quickly time flies by. It seems like only yesterday I was welcoming the students into the vet school who, now six years on, are just about to graduate and start work. In some ways they seem just the same excited, enthusiastic but slightly nervous individuals they were when they arrived. But now, with heads brimming with knowledge, they are nervous not at what vet school would expect of them, but rather what they should expect of the real wide world out there. We prepare them very well for their exams, I think, and generally they sail through them. But quite how well we train them for the veterinary world into which they are just about to plunge is a little less clear.
The problem with teaching them in a hospital environment is that, quite understandably, we like to do things as well as we possibly can. Gold-standard care: that’s surely what a referral hospital should be all about. So, every case gets worked up with full bloods and the most up-to-date imaging possible. Indeed, just about every test you can imagine. Let’s face it, these animals are coming in for specialist treatment and that’s generally what their owners are expecting – only the best for their darling pooch or kitty. Even the cases that come in through the RSPCA, which is our equivalent of what other vet schools might have as a first-opinion clinic, get the best treatment possible. Their surgery is done in our sterile theatre with every anaesthetic measurement from end-tidal CO2 monitoring to pulse oximetry.
We want the students to know the best that’s possible. The only trouble is how they then cope in a branch surgery that hasn’t got these diagnostic and therapeutic options
Of course we want the students to know the best that’s possible. The only trouble is how they then cope in a branch surgery that hasn’t got these diagnostic and therapeutic options. That’s surely the part that EMS plays, you might say. Every student spends weeks in veterinary practices seeing how to put what they’ve learned in vet school into practice. It should work really well. It did for me, I must say, with a great series of practices – we did call it seeing practice in those days – who managed to do things well, but not at the level I was used to at the vet school. Cat spays were anaesthetised at the vet school by first inducing them with thiopentone, then paralysing them with suxamethonium, intubating them and then giving them intermittent positive pressure ventilation for a minute or two while the paralysing agent wore off, before keeping them anaesthetised with halothane. In most first-opinion practices cats were anaesthetised off the needle with a couple of millilitres of Saffan alone, which gave you 15 or maybe 20 minutes of anaesthesia to do the operation. If the cats started waking up, a mask allowed you to keep them under with halothane.
These days, Intubeaze and intravenous catheters, propofol and isoflurane have improved matters for sure. Just about everyone will be using those. But on the other hand, do we do the surgery in full theatre scrubs, gowns and gloves in a sterile theatre as at the vet school, or is it appropriate to do it in a clean but not sterile surgical top with hands sterilised for 90 seconds with Sterilium but without gloves, or should a sterile gown and gloves be a bare minimum?
I work in 30 different practices as well as the vet school. They vary in what they do from, dare I say, a clinic that doesn’t believe in premeds but just anaesthetises animals off the needle with propofol and charges a fraction of the price of more upmarket practices, right through to chrome and glass emporia that offer the same standards as the vet school, and at a similar cost. I suppose that this gives the population the sort of choice they demand, though the surgeons and anaesthetists at the vet schools and specialist referral centres would probably say that every veterinary centre should have intravenous catheters and pulse oximetry as a bare minimum. They would say that pets deserve the best. But in these days of the cost-of-living crisis, not everyone can afford the sort of costs that a gold-standard practice offers.
Is gold standard the only option? Could a silver or bronze standard be acceptable as long as animals were kept safe?
Is gold standard the only option? Could a silver or bronze standard be acceptable as long as animals were kept safe? Gold standard can all too easily slip into what we might call over-treatment. If we have a CT scanner and offer it as a routine diagnostic option we risk identifying what might be called incidentalomas – lesions that are not relevant but only show up on the scan. Offering only gold-standard treatment options beyond the financial range of most pet owners ends up with owners unable to afford what is promoted, potentially resulting in euthanasia if that is the only other option available.
I’m not sure we are adequately equipping our students with the wherewithal to cope with those difficult situations
So, we come back to our new graduates, facing not so much the fear of the 15-minute spay as I did, but rather, the difficulties of owners left with only the gold standard or nothing. And truth be told, I’m not sure we are adequately equipping our students with the wherewithal to cope with those difficult situations. Maybe it’s up to those of you who have employed these wonderful young people to support them in these taxing times. I always try to be on the end of the phone for my students newly coping with the world of work, but make sure you’re there for them too!
