What is a vet expert?

Well, it’s been almost 18 months since I sat down to write anything, so I thought it was about time to take a moment to reflect on the past few years of my emergency and critical care (ECC) residency.

Unfortunately, I ruptured some ligaments in my ankle last week and some forced bed rest has reluctantly been accepted.

In this two-parter, I hope to cover some of the big learning points, both personally and professionally, over the past few years as I look towards the finish line of my residency at the RVC.

Change

I can’t put into words how much things have changed since I last wrote. My last piece (VT51.25) was at the beginning of my first year of residency and I was most definitely feeling a bit burnt out. The first six to 12 months of a residency are such a steep learning curve that you often forget to look at how far you’ve come, because you’re so focused on just keeping afloat while settling into the day-to-day (or night-to-night) role.

I’m not sure what could make that first year easier as I think, inevitably, it is always going to be a step up from previous roles. I definitely felt the pressure going from a rotating internship straight into the residency without having a speciality internship in the mix.

While I remember commenting on the apparent over-utilisation of internship roles and adding more rungs to that speciality ladder, I can now look back and say that it would’ve helped the transition from general practitioner to intern to resident be a little smoother.

I can’t say the same for other specialities – and I certainly sympathise for those surgery wannabes who have to push through several internships before even being considered for many residencies – but for me, an ECC-specific internship may have helped.

Having said that, I am much more comfortable in my position now – turns out, residency programmes work for a reason.

Think about approach

I guess what is probably needed is for us to think about how we approach internships and residencies, and what the end goal is. If we look to our human counterparts, specialisation and sub-specialisation appears the way forward – as we learn and discover more, it becomes more difficult to keep up to date.

A human consultant will have gone through five years of medical school, two years of foundation training, two years of core training, and potentially three to five or more years of training within their chosen speciality before they’re considered an expert in their field.

While I’m not suggesting we need to start investing as much into our training pathways, it does beg the question: at what point do we adopt a similar model? After all, the American College of Veterinary Nephrology and Urology will soon be an additional speciality that requires members to be board-certified in another discipline. Makes sense, though – the kidneys are baffling.

Could an opportunity for sub-specialisation exist elsewhere? I would love for fellowships to be embraced by our profession, but more on that in part two of the series.

It’s easy for me to talk about extending the training pathway. I’m fully aware of my privilege within society and the profession. I don’t necessarily have a huge number of time constraints to pursue further training, so I would happily take more time to invest in additional training roles if it were going to complement my career. I am also aware not everyone has these opportunities,  so we do need to try to come up with a balance.

I should be sitting my board exams next year and if things go well (fingers crossed), I could be a diplomate of the American College of Veterinary Emergency and Critical Care by the age of 29. Do I feel like an expert in the field? Well, I think I do my job well, and the residency and the RVC have trained me to practise at a high standard within the ER/ICU. But, I’m not sure I can quite call myself an expert just yet…

End goals

So, what is the end goal of a residency? Is it to become an expert in a given field?

I think it’s a step along the way, but very much like undergraduate veterinary school is about getting you safe to practise as a vet, I think residency is about getting you safe to practise as a specialist. The learning, I’m sure, will continue afterwards.

I guess what I’m trying to say is that as much as I love my job and have thrived during the residency, I think I initially expected to feel slightly differently at this stage.

I think this misconception exists that as a specialist, you know the answer to absolutely anything related to your speciality. Maybe it’s the imposter syndrome talking, but I certainly don’t feel like I know all of the answers – a lot of the time, I just know where to look (shout-out to vetlit.org for keeping me up to date with literature).

While I am confident I can deal with sick ICU patients, and manage both first opinion and referral emergencies as they come in, I have all the more respect for my faculty because their experience is what makes them specialists. I can’t count the number of times I’ve seen a case for the first time and it’s not been the “textbook”, but my senior on the case has seen similar previously.

All of our seniors have something different to offer, but they all have accumulated years of experience within the field – that is what makes them experts. Essentially, you get better at what you practise and clinical experience triumphs over the textbook.

If the end goal of a residency isn’t to become an expert, what is it then? Well, to get better at a skill in which you need practice, and a sure-fire way to improve the efficiency of your practice is to cram a whole load of practice into a short period of time.

The thought of doing a routine bitch spay is much more nerve racking to me than managing an anuric, hyperkalaemic acute kidney injury patient – I’m sure it’d be like riding a bike, but I’m definitely out of practice.

I believe residencies provide the ideal opportunity to get good at a skill or a speciality, quickly. It forces in a bunch of experience into a relatively short amount of time and before you know it, you’re out the other end. That’s what a residency is great for – cramming in experience – but ongoing clinical utilisation of that experience will take longer.

Ultimately now, I know a lot more about a little, compared to when I was in general practice and knew a little about a lot more.

I can’t believe how quickly the first two years of my residency have gone, and it saddens me to be figuring out the rota for my final six months. I truly will be sad to finish my residency as it has been the single largest block of time I’ve been able to devote entirely to learning and improving myself.

Yes, the salaries aren’t fantastic and no, I don’t have a huge amount of time off.

Has it been worth it? Absolutely. Our residency salaries have had some adjustments this year and it has certainly helped, and I’m sure I will feel much more comfortable on the other side of the residency, but I really wouldn’t let it be a barrier to anyone thinking about a residency.

Confidence builder

So, where do we go from here? I realise this article has been a little all over the place.

As I said, you get good at what you practise, and I’m out of practise at writing, but I hope it has provided some musings for you. I am so grateful for the opportunity I have had at the RVC to complete my ECC residency, and I’m sure the final stretch will go incredibly quickly.

A huge part of my residency has been training for my future – not just for an exam – but it’s time to start thinking about what kind of specialist I want to be as I move out into the wider world.

If I could have one learning point from this article, it would be this: the residency has helped me build confidence in a specific area, as well as helping my development overall as a veterinary surgeon.

But I’m not done yet – there is always more to learn. The more you learn, the more you realise you don’t know.

That’s all, folks

If you have a question or want to discuss a topic from my ECC Endeavours series, please feel free to drop me an email at [email protected] and I will try get back to you as soon as possible. Until next time, take care.

As always, the views expressed in this article are mine alone, and do not necessarily represent the views of my employment or affiliated institutions.