Incredibly burnt out 2nd year student

[savethecows]

Hi y'all,
I'm a 2nd year 2nd semester student that's starting to struggle with imposter syndrome and burn out. I had a mentally taxing last semester due to the social circumstances of the school itself, and am struggling to rekindle the motivation I had at the beginning of the semester. Most days I feel like I am not capable of the program and my brain itself is starting to experience difficulty memorizing things which has never happened before. My friends are also experiencing some form of burnout and are also having difficulty re-motivating ourselves, especially with how much more intense this semester has begun compared to previous semesters. I know 2nd year is the worst year, but honestly, I feel so dumb when I look at vet path. It's so many large, scientific words and my brain just goes blank.

Does anyone have any tips on how to get through burnout and imposter syndrome? As of now I am just trying to shoot for straight B's in my classes and am okay if I get C's because I just want to get through this.
Please let me know if you have any advice.
Thank you.

Edit: Most places I've extern at say I'm going to be a good doctor. They say I am great with clients, patients and working out how to figure out the problem. But honestly, I feel like I am trusting my instincts more than anything when I do things. I'm just struggling with the fact that there is so much information and how on earth I'm supposed to get this information to stick in my head and come back to me when I need it.

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[JaynaAli]

You’re not expected to retain everything you learned in vet school. One of the major skills you will learn in school is how to find and vet resources. There are very few instances where you can’t take two minutes to look something up or text a friend. You’ll retain what you need on a daily basis. No one cares what your grades were when you’re a vet and no one will ask you whether you were an A student or a C student (the exception is for internships and residencies but that’s a small portion of students and even that doesn’t matter after your residency is secured). You could get a C on everything from here on out and be a wonderful vet. I’m not saying don’t try your best, but it sounds like you need to maybe take some time to do something fun and shift your focus a little for mental health reasons.

 

[WildZoo]

If you're hitting a brick wall with learning things, it's better to take a break than to keep slamming your head against the wall. I agree with what Jayna said - put some focus back on yourself as a person and your mental and physical health. Your brain will thank you for it, and it will be easier to learn. You certainly don't have to be able to regurgitate everything you learn in vet school and nobody expects that. Trust the professionals who say that you're going to be a good doctor! They would know. And if you're trusting your instincts to do those things, that just means your instincts are already where they need to be. I looked things up constantly when I started working, and still do fairly often to double check myself on the less common things. The tiny details of information aren't as important for being a doctor as learning how to think like a doctor. If you're feeling severely burnt out then it would also be a good idea to take advantage of any counseling/mental health support services that are available to you.

 

[Trilt]

Second year sucks. I dealt with it by binge lecture capturing my classes and running/volunteering/cooking all day instead of living in the school pressure cooker all the time. Oh and being fine with B's and C's. It worked great.

You won't remember everything, and you don't *have* to remember everything to be a good vet. I work with recent grads/interns nowadays and absolutely jokingly ask them details that have loooooong left my head. It's important to accumulate resources and learn how to look things up at this stage, and at least pass the classes. Everything else will come when you start actually doing clinical cases.

 

[TheDogFather]

Your mention of pathology reminded me of just how trivial a lot of the coursework really is. During one pathology lecture, for at least twenty minutes two or three of our more tightly-wound class members went back and forth with the instructor about just how many test points it might cost if a lesion was classified as multi-focal instead of diffuse. Even the professor became exasperated by it all. After the instructor convinced the students that an incorrect answer would not end their veterinary careers, he kept us past the end of class so he could quickly read (not teach) the four or five PowerPoint slides that twenty minutes cost us. That second-year episode cemented what I was already thinking--that I was there to memorize quantity, and not to learn quality. I put in my time and did my best, but after that I never again worried about a string of Cs.

 

[JaynaAli]

Your mention of pathology reminded me of just how trivial a lot of the coursework really is.

*gasps in pathologist*

(jk)

 

[WhtsThFrequency]

Your mention of pathology reminded me of just how trivial a lot of the coursework really is. During one pathology lecture, for at least twenty minutes two or three of our more tightly-wound class members went back and forth with the instructor about just how many test points it might cost if a lesion was classified as multi-focal instead of diffuse. Even the professor became exasperated by it all. After the instructor convinced the students that an incorrect answer would not end their veterinary careers, he kept us past the end of class so he could quickly read (not teach) the four or five PowerPoint slides that twenty minutes cost us. That second-year episode cemented what I was already thinking--that I was there to memorize quantity, and not to learn quality. I put in my time and did my best, but after that I never again worried about a string of Cs

Lol. As a pathologist, I felt the same way about anatomy. Every single tiny branch of every single nerve and artery and vein. If nothing ever goes wrong with it, who cares what it's called. Perhaps a specialized surgeon, but that's about it.

This also brings up the issue that creating tests is, well, hard. Especially multiple choice tests, which inevitably cater to that triviality to some degree no matter how you slice it. I didn't realize how difficult it was until I became a professor and it's very frustrating for us too - and why I much prefer written tests and PBL-style learning as opposed to multiple choice and lecture. The latter is just memorization, the former is integration and critical thinking. We do a mix of both where I teach, and you would be amazed at how many people are great multiple choice test takers/memorizers, but they can't write out a diagnostic flow process to save their lives. Or they may be able to match a disease with a buzzword, but can't verbalize exactly what is causing the disease or how the lesion occurs. Due to the fact that we have to test people the way we do, academic learning will always have a quantity over quality component (which sucks, but c'est la vie until vet med becomes more advanced in their teaching methods, which is a slow process).

That being said, grades don't matter unless you are looking to pursue specialization.

Also, a lot of learning (true learning, not learning for a test) is NOT memorizing everything - that's impossible. True learning is knowing where to look for the answer. I google things on a daily basis and know what sources are legit and what are not, because there is no possible way I could retain everything I was taught in vet school (or hell, even residency).

 

[Drjc1977]

Hi y'all,
I'm a 2nd year 2nd semester student that's starting to struggle with imposter syndrome and burn out. I had a mentally taxing last semester due to the social circumstances of the school itself, and am struggling to rekindle the motivation I had at the beginning of the semester. Most days I feel like I am not capable of the program and my brain itself is starting to experience difficulty memorizing things which has never happened before. My friends are also experiencing some form of burnout and are also having difficulty re-motivating ourselves, especially with how much more intense this semester has begun compared to previous semesters. I know 2nd year is the worst year, but honestly, I feel so dumb when I look at vet path. It's so many large, scientific words and my brain just goes blank.

Does anyone have any tips on how to get through burnout and imposter syndrome? As of now I am just trying to shoot for straight B's in my classes and am okay if I get C's because I just want to get through this.
Please let me know if you have any advice.
Thank you.

Edit: Most places I've extern at say I'm going to be a good doctor. They say I am great with clients, patients and working out how to figure out the problem. But honestly, I feel like I am trusting my instincts more than anything when I do things. I'm just struggling with the fact that there is so much information and how on earth I'm supposed to get this information to stick in my head and come back to me when I need it.

This is a common concern with veterinary students. You and your class mates and everyone else who ever atteneded veterinary school have been programmed to get that 4.0 grade no matter the cost. You are now a student and you no longer have to beat out that other student for admission. You do the best you can do and then let it go. I thought I would be one of the worst veterinarians to ever have graduated. The thing is, when you are away from that professional school and teacher pressure, information you labored to put into your head comes back. You will be consulting reference material but you will not be relearning what you already have learned. I had a classmate who got so fed up with the grade chase that he said, "Give me a 2.0 and call me doctor." Today he literally has an international reputation as one of the top bovine practioners in the world. As for me, I do not have the reputation he has but I do have the respect and love from many clients and peers and am considered a good veterinarian. Budget your time wisely, don't worry about what grade the other guy gets and remember you having that spot in your class means you beat out at least 10 other applicants. Budget your time wisely and be nice to yourself. You will do well.

 

[TheDogFather]

Lol. As a pathologist, I felt the same way about anatomy. Every single tiny branch of every single nerve and artery and vein. If nothing ever goes wrong with it, who cares what it's called. Perhaps a specialized surgeon, but that's about it.

This also brings up the issue that creating tests is, well, hard. Especially multiple choice tests, which inevitably cater to that triviality to some degree no matter how you slice it. I didn't realize how difficult it was until I became a professor and it's very frustrating for us too - and why I much prefer written tests and PBL-style learning as opposed to multiple choice and lecture. The latter is just memorization, the former is integration and critical thinking. We do a mix of both where I teach, and you would be amazed at how many people are great multiple choice test takers/memorizers, but they can't write out a diagnostic flow process to save their lives. Or they may be able to match a disease with a buzzword, but can't verbalize exactly what is causing the disease or how the lesion occurs. Due to the fact that we have to test people the way we do, academic learning will always have a quantity over quality component (which sucks, but c'est la vie until vet med becomes more advanced in their teaching methods, which is a slow process).

That being said, grades don't matter unless you are looking to pursue specialization.

Also, a lot of learning (true learning, not learning for a test) is NOT memorizing everything - that's impossible. True learning is knowing where to look for the answer. I google things on a daily basis and know what sources are legit and what are not, because there is no possible way I could retain everything I was taught in vet school (or hell, even residency).

Obviously I was a vet student and you have my sympathies. "This question isn't fair!" "Couldn't this crystal clear statement be interpreted differently?" "This answer is obviously False, but can I get partial credit for answering True?" Week after week after week....

With respect to veterinary medicine becoming more advanced in its teaching methods: 2-1/2 years ago, schools moved some or all of their curricula online virtually overnight. Clinical years were scaled back/eliminatedI and no one has noticed a difference. Expensive diversity offices have sprung up, created out of thin air. I endured a semester of both virology and bacteriology, as well as a year of parasitology, which were all PowerPoint-a-thons. Stifle problems--the most common orthopedic affliction in dogs--maybe two lectures--which can be distilled down to "if you don't specialize, your going to refer these anyway". Why exactly do we need to spend at least 1/3rd of our training "learning" about species we will never treat? Is it because most of the large animal courses might attract only four or five students and become a financial burden? Is it just to get us past our licensing examinations? For the single budding pathologist, radiologist, and ophthalmologist in a given class it can make some sense, but realistically next to none of us are those mythical "real doctors who treat more than one species", at least in any depth. We're supposed to refer those to specialists who trained out our schools but likely did not attend those institutions. We should be watching surgeries from Day One. Every surgical, ophthalmic, and dermatologic procedure should be videoed and available for review. Ditto for each cytology, radiographic and sonographic interpretation. Clients are blamed for having high expectations, but they have no idea how little practical information is imparted during vet school. We're supposed to pick that up from some "mentor" who can pay the whole staff "what they're worth", has almost-resident level training in every aspect of veterinary medicine, and run a clinic, all at the same time.

I'm always interested in faculty takes on veterinary instruction. I don't envy the responsibilities of vet school instructors. I do find it tough to keep a straight face when I am asked why pet care costs so much when GPs treat their animals pretty much the same way we did 30 or 40 years ago.

 

[battie]

I don't necessarily agree with these statements:

Clinical years were scaled back/eliminatedI and no one has noticed a difference

Based on the vet med Facebook pages I frequent, plenty of clinicians working with graduates from 2021 and 2022 feel that COVID certainly affected the clinical confidence of graduates. The national average NAVLE pass rate also dropped 5%+ as well, which is actually pretty surprising to me. The average is now 85% and for reference, schools need to maintain a 80% pass rate to maintain good accreditation status.

"if you don't specialize, your going to refer these anyway".

Referral is not possible for the majority of clients. I would say less than a third of my GP clients took up my offer for referral when I was at a bougie GP/ER hybrid hospital in a neighborhood where the average home price of 750k (in a city where my home cost half of that). The orthopedic surgeries done in that hospital were done by two GP docs with a special passion for surgery and the CE hours to match. And even though I don't do those surgeries, I can use those two power point lectures to talk to the clients I see on ER about treatment options before giving them a discharge instruction that include the names and phone numbers of those GPs.

GPs treat their animals pretty much the same way we did 30 or 40 years ago

I mean, do we really though? Diabetics, Addisonians, hypothyroid, CKD, cancer, parvo puppies, etc. aren't better off now than they were back then?

 

[Trilt]

Having worked with a doc who does try to treat many of his patients the same way as 30 years ago...

ha.

 

[Trilt]

I mean, if you synthesize everything down to bare details, sure, parvo puppies still get fluids and antibiotics, diabetics still get insulin, yada yada, but you can do that all the way back to the advent of the techniques/medications.

"Enterotomies are still just sewing the edge of intestines back together!"

I've worked with people who graduated in the depth of COVID. It was not a smooth or easy swap to online. I've 100% heard about having one case on a rotation that they missed half of, or everything online, or whatever and how much they felt they lack from it. I'm honestly shocked it wasn't more than a 5% decrease in NAVLE pass rates.

I'm also curious what diversity offices have to do with any of it, as that seems rather randomly tossed in the middle of that.

 

[battie]

I've 100% heard about having one case on a rotation that they missed half of, or everything online

As a class of 2021 COVID student, I had only 2 procedures for my whole Ortho surgery rotation: a bone biopsy and a last minute toggle pin procedure. For my soft tissue procedures, I had 3 (one of which was actually during my Ortho rotation at 2am). Our primary care rotation was completely online and we got randomly divided between small animal, exotics, equine, and production med. COVID absolutely caused that.

 

[WhtsThFrequency]

Obviously I was a vet student and you have my sympathies. "This question isn't fair!" "Couldn't this crystal clear statement be interpreted differently?" "This answer is obviously False, but can I get partial credit for answering True?" Week after week after week....

With respect to veterinary medicine becoming more advanced in its teaching methods: 2-1/2 years ago, schools moved some or all of their curricula online virtually overnight. Clinical years were scaled back/eliminatedI and no one has noticed a difference. Expensive diversity offices have sprung up, created out of thin air. I endured a semester of both virology and bacteriology, as well as a year of parasitology, which were all PowerPoint-a-thons. Stifle problems--the most common orthopedic affliction in dogs--maybe two lectures--which can be distilled down to "if you don't specialize, your going to refer these anyway". Why exactly do we need to spend at least 1/3rd of our training "learning" about species we will never treat? Is it because most of the large animal courses might attract only four or five students and become a financial burden? Is it just to get us past our licensing examinations? For the single budding pathologist, radiologist, and ophthalmologist in a given class it can make some sense, but realistically next to none of us are those mythical "real doctors who treat more than one species", at least in any depth. We're supposed to refer those to specialists who trained out our schools but likely did not attend those institutions. We should be watching surgeries from Day One. Every surgical, ophthalmic, and dermatologic procedure should be videoed and available for review. Ditto for each cytology, radiographic and sonographic interpretation. Clients are blamed for having high expectations, but they have no idea how little practical information is imparted during vet school. We're supposed to pick that up from some "mentor" who can pay the whole staff "what they're worth", has almost-resident level training in every aspect of veterinary medicine, and run a clinic, all at the same time.

I'm always interested in faculty takes on veterinary instruction. I don't envy the responsibilities of vet school instructors. I do find it tough to keep a straight face when I am asked why pet care costs so much when GPs treat their animals pretty much the same way we did 30 or 40 years ago.

In full disclosure, by advancement in teaching methods I was referring more to moving to active teaching sessions focusing on application rather than powerpoint parades (ugh), rather than topics themselves really (but I'll get to that in a sec). Sitting in a class and listening to people talk is least effective manner of teaching (minus the occasional wonderful lecturer, but those are not the norm), compared to things like problem-based learning, multi-system integrated sessions/team-teaching, clinical jigsaws, flipped classrooms, peer-peer teaching, using diagnostic scripting and concept mapping techniques, etc. These are all things that I knew very little about until I started teaching in human medicine, and I can tell you that overall they are light years ahead of us in that regard. I don't see nearly as many veterinary schools updating their teaching methods and I feel like that is detrimental to creating well-rounded vets who can think diagnostically rather than just memorizing that buzzword A goes with buzzword B.

I do agree with some aspects of what you say in terms of the topics. I teach both vet students and med students. We get the med students sometimes complaining about having to learn tons of cardiology or nephrology when they know they want to be an orthopedic surgeon, for example. Now, this is something that has more of an argument against it, because in the body no system exists in isolation. Even though you may specialize, you still have to understand how the rest of the body works because everything interacts.

In veterinary medicine, it is a bit more complex because you are correct in that the species variation makes true systems integration more difficult due to volume. I'm not opposed myself to the idea of track training given the current species-level division in our profession -and this is because of how much veterinary medicine has advanced in the last 50 years. We know more and are doing more than every before, so the cognitive load is becoming absolutely nuts. Pathology is actually a great example because the amount of information we need to know for every species and every disease process is mind boggling. There is a reason our board exam is taken over several days, and eventually had to be split between residency years. I can't imagine putting all the treatments and stuff on top of that - I have definitely had to push a TON that stuff out of my brain. I don't even remember what the correct dosage for Pred is anymore. I don't think I could even do a spay anymore.

Tl;dr. Vet med on the whole needs to become more advanced in how they teach and focus on making diagnosticians rather than memorizers. And given the aforementioned ever-increasing cognitive load that gets heavier year after year as we increased the depth of out knowledge about disease, we may eventually get to a point where we need to consider species level (although not discipline level - I agree with battie that GPs often do a lot more than they used to) track training for GPs -just my own personal opinion. Either that or, and people are going to hate me for saying this, but - making internships the norm before full licensure. One year of clinics (I know some schools do 2-2, but speaking generally) is not enough IMO.

 

[battie]

Either that or, and people are going to hate me for saying this, but - making internships the norm before full licensure. One year of clinics (I know some schools do 2-2, but speaking generally) is not enough IMO.

Now that internships are starting to pay better on the private practice level (I've seen some at the 80k level), I can totally see this.

Likewise, I also think doing 2+2 programs like a lot (all?) human med schools do would be helpful. Illinois has first and second years in clinics for 8 and 7 weeks respectively. We joked and called it rotation vacation because that's how it's treated. You have to try to fail those rotations. They aren't treated as legit learning opportunities by anyone. In hindsight, I would have rather had those rotations during second and third quarter of 3rd year.

 

[finnickthedog]

Now that internships are starting to pay better on the private practice level (I've seen some at the 80k level), I can totally see this.

I don't think pay is the only issue. From everything I've heard about internships, I think that even if I was paid decently well that I'd have been completely burnt out by the end of it. I'm sure in theory that I would have been a better doctor faster... but if I don't even want to be a doctor anymore, then I'm not sure how helpful that actually is.

I have no issue with the concept of needing more training prior to full licensure but I would hope that if it became mandatory that internships (as they currently are) wouldn't be the only option.

 

[JaynaAli]

I don’t regret my internship and it was necessary because I wanted to specialize, but it did suck and I should have earned way more than $28k. (In 2015 but even with inflation that’s crazy low) And if I wasn’t specializing I wouldn’t have done it and I’d have been just fine.

 

[battie]

I don't think pay is the only issue. From everything I've heard about internships, I think that even if I was paid decently well that I'd have been completely burnt out by the end of it. I'm sure in theory that I would have been a better doctor faster... but if I don't even want to be a doctor anymore, then I'm not sure how helpful that actually is.

I have no issue with the concept of needing more training prior to full licensure but I would hope that if it became mandatory that internships (as they currently are) wouldn't be the only option.

That's true. 80+ hours a week is flat trash. I pulled 62 last week (5 twelves) and was pretty out of it. And not for nothing, I feel like the people I know who are in residency now are way happier compared to their internship

 

[JaynaAli]

Residency was better than internship imo for sure. It’s a different kind of stress. In my own experience, there’s way less grunt work/crappy responsibilities plus you’re more confident in your own clinical decisionmaking for a lot of stuff. Plus in general you like the cases more because they’re in your field of interest. The stress of residency is balancing clinics and that type of learning with the sheer amount of reading materials and stuff you’re expected to learn on your own time outside of clinics. +/- research responsibilities and writing your own papers. There’s just soooo many textbooks and articles to read and retain key points from, and that all has to be self-motivated.

 

[Trilt]

If we ever move to requiring internships, there needs to be a way higher proportion of more general practice oriented ones. Working at a specialty hospital for a year might get you very good at the ER cases that occasionally pass the GP threshold, but learning dentistry, surgery and the daily management of super financial cases - all bread and butter in GP - is totally missed. How insane would it be to require even further training that just doesn't cover the majority of normal GP work?

If I had planned on straight ER work and the internships were paying 60-80k when I graduated, it definitely would have been a bit different mental calculus. Or one of the ER training programs that steps you up in responsibility and pay, assuming they don't have the absurd multi year commitment at the end still.

 

[WhtsThFrequency]

I have no issue with the concept of needing more training prior to full licensure but I would hope that if it became mandatory that internships (as they currently are) wouldn't be the only option.

Oh definitely. And there is also the financial part to consider as well. It wouldn't be as easy as just requiring an internship, the system would have to be changed significantly. And like Trilt says, more general/internal medicine-type focused ones that aren't just at specialty hospitals. Some people are lucky and have great mentors at their first jobs that help them transition, but there are just as many who flounder because of lack of support (and not all clinics have the time and personnel to truly mentor).

 

[WhtsThFrequency]

Residency was better than internship imo for sure. It’s a different kind of stress. In my own experience, there’s way less grunt work/crappy responsibilities plus you’re more confident in your own clinical decisionmaking for a lot of stuff. Plus in general you like the cases more because they’re in your field of interest. The stress of residency is balancing clinics and that type of learning with the sheer amount of reading materials and stuff you’re expected to learn on your own time outside of clinics. +/- research responsibilities and writing your own papers. There’s just soooo many textbooks and articles to read and retain key points from, and that all has to be self-motivated.

I miss residency TBH. It was hard as hell with the mental load, but I was indeed doing what I loved. The smartest I ever felt in my life was in my third year of residency My PhD was so much worse. I still maintain that (the PhD) was harder that either vet school OR residency in terms of burnout and mental health.

 

[pinkpuppy9]

people are going to hate me for saying this, but - making internships the norm before full licensure. One year of clinics (I know some schools do 2-2, but speaking generally) is not enough IMO.

I completely agree with this. After having completed my internship and subsequently training new interns (and watching them transform over their year), I will always continue to recommend people do one themselves.

If we ever do get to the point of mandating some type of post-graduation training, I hope that some actual oversight/accreditation of the 100s of ‘programs’ will happen. We are already seeing that quite literally anyone can list an internship in the match with whatever salary they want to pay.

Side note: FWIW, not every internship is a brutal year full of abuse. I really enjoyed my intern year, and I was at one of the older, well established programs. Don’t get me wrong - I worked my ass off and had some really ****ty situations (I did work for ~48 hours straight once…) but overall, I probably averaged 60 hours a week, which is on par for most GPs I know. I had one, if not two, days off each week. On call was not bad at all. If you’re interested in an internship but don’t want to work 80 hours a week, choose and rank wisely. Read those surveys and talk to current/past interns.

 

[finnickthedog]

Maybe I'm just spoiled at this point, but even 60 hours a week sounds like a lot to me. Especially to make significantly less money and have to deal with on call--I really hated being on call in school.

I do about 40 hours a week. And that includes my callbacks, charts, etc.

 

[WildZoo]

I completely agree with this. After having completed my internship and subsequently training new interns (and watching them transform over their year), I will always continue to recommend people do one themselves.

If we ever do get to the point of mandating some type of post-graduation training, I hope that some actual oversight/accreditation of the 100s of ‘programs’ will happen. We are already seeing that quite literally anyone can list an internship in the match with whatever salary they want to pay.

Side note: FWIW, not every internship is a brutal year full of abuse. I really enjoyed my intern year, and I was at one of the older, well established programs. Don’t get me wrong - I worked my ass off and had some really ****ty situations (I did work for ~48 hours straight once…) but overall, I probably averaged 60 hours a week, which is on par for most GPs I know. I had one, if not two, days off each week. On call was not bad at all. If you’re interested in an internship but don’t want to work 80 hours a week, choose and rank wisely. Read those surveys and talk to current/past interns.

Oh man most of the GPs I know are not working 60 hour weeks unless they're at a practice that also does on call. The most common schedule I've seen from my classmates is four 10-hour days a week, and that's what all the full-time docs at the place I work part time are doing as well.

I think extra training is a good idea, but a long way to go in setting up the right infrastructure and types of programs that would be useful before I'd recommend it for most of the people that are planning to work in GP.

In the current system what would be nice would be more resources available to help new grads find practices that are going to provide good mentorship and support. Definitely have classmates and friends who did so, but of course also have others who were told they would get mentorship and then were thrown to the wolves. It would be cool to make some kind of mentorship/teaching certification available for GP docs who are interested, because there are people out there who want to be in that role for new grads.

 

[TheDogFather]

With respect to what Battie posted a few days ago: licensing examination pass rates may have dropped a bit, but for those who do pass salaries are high and various bonuses abound. Even if you passed the test by a single point multiple clinics will be waiting outside your door with butterfly nets to snare you as a potential associate. I don't know how the Facebook posters were measuring clinic confidence, but at almost every continuing education event I have attended since I graduated just over 12 years ago, clinical confidence has come up as a topic, however briefly. The emphasis on specialization, the proliferation of overnight facilities--while positive development seems to have dampened a lot of desire and interest in taking on cases that have not been served up in vet school. Not true of everyone, and your experiences may differ and I can accept that.

You brought up the expense, availability, and willingness (or lack thereof) of a large percentage of clients to accept referral. Exactly. I've taken just about every orthopedics oriented class offered by the Oquendo Center, IMEX Veterinary, the AO Foundation. A good bit of dental CE (even though I felt we got a great grounding in the subject at my school), and parcels of ophthalmology training (when you can find anything beyond the raw basics) here and there. The courses and the instructors were great. I have been able to help out in numerous cases where amputation/euthanization were the only options. Am I even close to being a diplomate? By no means. I am just getting started on learning ultrasonography to the point that I can think about charging for for my level of ability. I just cannot accept that a lot of this cannot be folded in to a four-year program. I'd gladly trade my superficial large animal training and what few trivial facts I retain from virology, bacteriology, parisitology, avian medicine, etc. for the chance to serve my patients better. I'd also have the equivalent of a year-and-a-half of vet school tuition in my bank account.

Yes--we as GPs can offer better, more effective treatments to our patients. However, that has little to do with better training and more to do with the natural progression of medical research. As Trilt mentioned, we still administer insulin to diabetics, fluids and antibiotics to parvovirus puppies, thyroid supplementation to hypothyroid dogs, and so on. Exactly. Experiences will vary, but I was never taught how to really scan for enlarged adrenal glands, imaging orthopedic structures, using ultrasound to help patients understand what is and isn't true heart failure, properly measuring and assessing tibial plateau angles--that is, the stuff my clients really need to help them make decisions based on finances and what is truly in the best interests of their pet.

Further, with regard to Trilt's post. One cannot expect a perfect transition from the same old lecture format to complete online training without a few hiccoughs. The point is that when it is tried, new methods of delivering information can happen. Whether or not it was a great idea--that is water under the bridge, but as Frequency has pointed out so well, veterinary education has vast room for improvement. It's nice to hear someone on the inside simply admit that. I know a couple vets on curriculum committees and from what I have heard from them, changes in teaching methods makes for great fodder at meetings but there is little real appetite to modernize our training. As far as bringing up diversity offices--I could have added the great "vet tech vs. veterinary nurse" controversy or fretting about whether or not a dental procedure should be termed a COHAT. For a profession that (for all I read) is in such dire crisis, those topics seem fairly frivolous. We could easily diversify the workforce by promoting opportunities for foreign vets to work at all levels of the profession and sort out the details in time. But hey....that sort of thing could affect our bottom lines.

 

[Trilt]

I completely agree with this. After having completed my internship and subsequently training new interns (and watching them transform over their year), I will always continue to recommend people do one themselves.

If we ever do get to the point of mandating some type of post-graduation training, I hope that some actual oversight/accreditation of the 100s of ‘programs’ will happen. We are already seeing that quite literally anyone can list an internship in the match with whatever salary they want to pay.

Side note: FWIW, not every internship is a brutal year full of abuse. I really enjoyed my intern year, and I was at one of the older, well established programs. Don’t get me wrong - I worked my ass off and had some really ****ty situations (I did work for ~48 hours straight once…) but overall, I probably averaged 60 hours a week, which is on par for most GPs I know. I had one, if not two, days off each week. On call was not bad at all. If you’re interested in an internship but don’t want to work 80 hours a week, choose and rank wisely. Read those surveys and talk to current/past interns.

But again, you work ER now, right?

Doing an internship in an ER and working in that field afterwards makes sense.

But again, and I'm sorry to harp on it, but doing a classic rotating internship as a pre-req for GP work makes no sense to me. Of course it'll make you a better vet - so will a year of being a vet!

It's simply not the same caseload. The budgets are different. The priorities are different. The relationships with clients are different! ESPECIALLY in a big specialty hospital... there are no specialists to transfer to in the morning for most GPs. The available resources are also waaaaay different, and the buck stops with you in a way that is just difficult to explain to people who haven't lived it.

 

[Trilt]

PS: Dogfather, highly recommend the fastvet online courses (and in person!) if you're getting into ultrasound.

They won't get you measuring an adrenal, but changing the approach of ultrasound from something that's a big and expensive diagnostic test to be run (re: full abdominal ultrasound) to an extension of the physical exam and with the quick ability to assess multiple cavities is a game changer.

... and I've found the bleeding adrenal mass before, too. That one I could have measured!

 

[WhtsThFrequency]

Further, with regard to Trilt's post. One cannot expect a perfect transition from the same old lecture format to complete online training without a few hiccoughs. The point is that when it is tried, new methods of delivering information can happen. Whether or not it was a great idea--that is water under the bridge, but as Frequency has pointed out so well, veterinary education has vast room for improvement. It's nice to hear someone on the inside simply admit that. I know a couple vets on curriculum committees and from what I have heard from them, changes in teaching methods makes for great fodder at meetings but there is little real appetite to modernize our training. As far as bringing up diversity offices--I could have added the great "vet tech vs. veterinary nurse" controversy or fretting about whether or not a dental procedure should be termed a COHAT. For a profession that (for all I read) is in such dire crisis, those topics seem fairly frivolous. We could easily diversify the workforce by promoting opportunities for foreign vets to work at all levels of the profession and sort out the details in time. But hey....that sort of thing could affect our bottom lines.

Some of this is also due to the student body, to be fair. Changing from traditional lecture to even a basic flipped classroom tends to cause...ahem....let's just say a lot of friction. Students are like cats, they don't like change. And it's nothing new - I think back to when I was a student and our clinical pathology professor decided to change from lecture to a flipped classroom with groups working on cases and presenting them and discussing them as a class - students lost their minds. HoW cAn wE lEaRn iT iF YoU dOn'T lecTurE oN itttttttt...Um, you READ the prep material, and then we use class time to APPLY it. But they didn't see it that way. They were vitriolic enough about it in course reviews that he stepped away from teaching that course for a bit. And he was an EXCELLENT professor, it was not a failure on his part at all.

Sadly, there is also an element of "customer service" in teaching. I hate that it is that way, but c'est la vie. We as faculty are beholden to reviews - our ratings go on all our maintenance of appointment documentation. Students are so used to the lecture model, having gone through it their whole lives and gotten As, that they think it is the best way. It is not.

Also speaking on the faculty side, there are a lot of older professors who have always done it way X and don't want to learn how to do it Way Y. We NEED new, vibrant faculty well-versed in medical education if we hope to make any change. And as you might imagine, retirements in academia tends to be few and far between. It's hard for us younger/newer faculty to instigate any change when the administration remains the same. I'm lucky in that my (human med) institution is extremely progressive. The vet school, less so.

Lastly, changing the curriculum is also difficult because of accreditation. I had no clue how much curriculum mapping goes into making even a single course. It's absolutely wild how many hoops there are to jump through.

 

[WhtsThFrequency]

I feel bad hijacking this thread with my med ed rants

 

[battie]

I feel bad hijacking this thread with my med ed rants

I'm actually here for it! I personally have had an eye on teaching since undergrad and loved working with the vet students in the lower years. If in 5-10 years clinical ER med can't be a thing in my life, I would seriously consider teaching. So it's cool to hear the other side of the equation

 

[JaynaAli]

I will add that it’s also kinda awful how little effort there is in teaching residents (future faculty) how to teach. I didn’t officially enter academia as a professor and I’m sure I would have learned more then, but as a resident we were still fully responsible for clinical education for the 4th year students. The curriculum I was teaching was designed by the faculty and it was info I knew well because it was my intended specialty, but my only “education” in how to teach was to watch senior resident teach the rotation for one rotation then I was tossed into it on my own to educate ten seniors for three weeks. I worry about how effective I was. I hate to add stuff on to a resident’s workload, but I probably would have benefited from some actual instruction on how to teach effectively. Same goes for developing lectures…I was told to give lectures to the 2nd and 3rd year class and my only real guidance was “here’s last year’s PowerPoint”. I did learn a lot about teaching during residency, but it was mostly through personal trial and error lol.

 

[TheDogFather]

I am no good at incorporating other posts into my own so:

To Trilt: I will add that site to my list of sources. I've taken a couple short courses from Greg Lisaindro, whom you may know is one of the bigger proponents of FAST-type ultrasound examinations. I have a two of his books as well. I've taken and reviewed an online abdominal course from a company called WAVE (We Are Veterinary Education) and will be pursuing their cardiac training as well. Ditto for some muscle-skeletal videos from Sonopath. I've dabbled with ultrasound for a few years but never felt I could in good conscience charge for my rudimentary skills. We've recently purchased some new probes for our machine and that lit a fire under me. With air travel more expensive and less predictable I have no appetite to attend any of the hands-on academies right now. It would probably be more productive to bring in a sonographer or a radiologist for a day or two of focused practical in-clinic scanning.

To Frequency: your comments provide some real interesting insight into veterinary training. I'll wager that students who read them will gain some encouraging perspective if they are feeling roughed up by their various curricula. I'll concede that you have to cater to the student body. I understand that vet schools have waiting lines for admission, but I've also read much about how universities have created expensive, resort-like campuses and have to give the students what they want to keep the $$$$ rolling in. I'm also aware stick-in-the-mud professors and accreditation red tape as obstacles to revamping veterinary education. It's become fashionable to dump on pet owners for high expectations, failing to understand our "educations" and being too hesitant to "pay us what we are worth". To me, no one is more to blame for that than the profession as a whole. Heck, we are smarter than physicians because we study so many species and master their care, right!? Of course we have made huge leaps and bounds in what we know, but it has not been communicated to we in general practice and in turn to our clients. A guy brings his in limping dog and gets a reflexive referral for a $4,000-$6,000 TPLO and told how much of a bargain that is compared to a human procedure. A kind soul brings in an itchy stray cat or dog and a steroid is all they can afford--why, that is not today's "standard of care". You already know all of this so I'll quit, but again, far from hijacking this thread, you have greatly enhanced it.

 

[Trilt]

To Trilt: I will add that site to my list of sources. I've taken a couple short courses from Greg Lisaindro, whom you may know is one of the bigger proponents of FAST-type ultrasound examinations. I have a two of his books as well. I've taken and reviewed an online abdominal course from a company called WAVE (We Are Veterinary Education) and will be pursuing their cardiac training as well. Ditto for some muscle-skeletal videos from Sonopath. I've dabbled with ultrasound for a few years but never felt I could in good conscience charge for my rudimentary skills. We've recently purchased some new probes for our machine and that lit a fire under me. With air travel more expensive and less predictable I have no appetite to attend any of the hands-on academies right now. It would probably be more productive to bring in a sonographer or a radiologist for a day or two of focused practical in-clinic scanning.

Fastvet is run by the Lisciandros. I taught myself how to use our ultrasound from his first edition focused ultrasound book, wish the website courses had existed then!

I actually think the focused/point of care ultrasound approach appropriately takes away a lot of the concerns with charging when you're not a ✨a radiologist ✨. I tell people I didn't see evidence of bleeding, or an obvious mass, or I tell them "oh crap I really do think the adrenal looks weird, lets schedule you for a full ultrasound." I don't pretend to be more than I am, but I find the big things well before a scheduled ultrasound would.

 

[redpangolin]

Hi y'all,
I'm a 2nd year 2nd semester student that's starting to struggle with imposter syndrome and burn out. I had a mentally taxing last semester due to the social circumstances of the school itself, and am struggling to rekindle the motivation I had at the beginning of the semester. Most days I feel like I am not capable of the program and my brain itself is starting to experience difficulty memorizing things which has never happened before. My friends are also experiencing some form of burnout and are also having difficulty re-motivating ourselves, especially with how much more intense this semester has begun compared to previous semesters. I know 2nd year is the worst year, but honestly, I feel so dumb when I look at vet path. It's so many large, scientific words and my brain just goes blank.

Does anyone have any tips on how to get through burnout and imposter syndrome? As of now I am just trying to shoot for straight B's in my classes and am okay if I get C's because I just want to get through this.
Please let me know if you have any advice.
Thank you.

Edit: Most places I've extern at say I'm going to be a good doctor. They say I am great with clients, patients and working out how to figure out the problem. But honestly, I feel like I am trusting my instincts more than anything when I do things. I'm just struggling with the fact that there is so much information and how on earth I'm supposed to get this information to stick in my head and come back to me when I need it.

Hope your semester is getting better! Do you mind sharing with program you are attending?

 

[Doctor Ham]

Obviously I was a vet student and you have my sympathies. "This question isn't fair!" "Couldn't this crystal clear statement be interpreted differently?" "This answer is obviously False, but can I get partial credit for answering True?" Week after week after week....

With respect to veterinary medicine becoming more advanced in its teaching methods: 2-1/2 years ago, schools moved some or all of their curricula online virtually overnight. Clinical years were scaled back/eliminatedI and no one has noticed a difference. Expensive diversity offices have sprung up, created out of thin air. I endured a semester of both virology and bacteriology, as well as a year of parasitology, which were all PowerPoint-a-thons. Stifle problems--the most common orthopedic affliction in dogs--maybe two lectures--which can be distilled down to "if you don't specialize, your going to refer these anyway". Why exactly do we need to spend at least 1/3rd of our training "learning" about species we will never treat? Is it because most of the large animal courses might attract only four or five students and become a financial burden? Is it just to get us past our licensing examinations? For the single budding pathologist, radiologist, and ophthalmologist in a given class it can make some sense, but realistically next to none of us are those mythical "real doctors who treat more than one species", at least in any depth. We're supposed to refer those to specialists who trained out our schools but likely did not attend those institutions. We should be watching surgeries from Day One. Every surgical, ophthalmic, and dermatologic procedure should be videoed and available for review. Ditto for each cytology, radiographic and sonographic interpretation. Clients are blamed for having high expectations, but they have no idea how little practical information is imparted during vet school. We're supposed to pick that up from some "mentor" who can pay the whole staff "what they're worth", has almost-resident level training in every aspect of veterinary medicine, and run a clinic, all at the same time.

I'm always interested in faculty takes on veterinary instruction. I don't envy the responsibilities of vet school instructors. I do find it tough to keep a straight face when I am asked why pet care costs so much when GPs treat their animals pretty much the same way we did 30 or 40 years ago.

Academic veterinarian.

I see a MASSIVE difference in the COVID students. The learning gaps are huge, and the communication skills are severely lacking. There is also a higher level of generalized anxiety among this group than I have seen in previous cohorts.

Veterinary education is definitely changing. There is a huge shift towards emphasizing general practice, and a restructuring of how coursework is presented. Ultimately, our role is to present the material and provide expertise - but the onus to learn is on the student. If they need guidance, or additional resources, we are there to provide them. But I cannot force a student to learn.

I also strongly disagree with the statement that true mixed animal practitioners are mythical. Not in the real world, and certainly not in vet school. There are a significant number of students who are pursuing "traditional" mixed animal practice. The group that is becoming mythical is the true equine practitioner, if you want to be honest.

 

[TheDogFather]

I don't move in academic circles so I certainly cannot say you don't see the gaps and skills to which you referred. However, it seems to me that that has not slowed down searching for/hiring new graduates. Have wide swaths of the classes of 2020-2024 been written off due to the deficiencies that you note? Small clinics go wanting are corporate groups seem more than happy to throw substantial financial and other enticements to anyone who passed their licensing examination by the skin of their teeth. It think there just might be a gap in what academia deems important versus what potential employers are seeking. Give them a warm, licensed body and they will either look past or rectify those perceived problems.

I've been out since 2010 so again I will take your word for a greater emphasis on general practice. Given the expense of attending veterinary school, that is the least that these institutions can do. I know not everyone goes into general practice, but the bulk of students do. No doubt that expertise and material abound, but the problem is in how and what is presented. Brute force memorization versus actual teaching (which really does seem reserved for residents--for the most part). As an example, take the TPLO--the "preferred" method for treating the most common orthopedic injury in dogs. One or two lectures on the topic versus a semester of esoteric factoids on bacteria and viruses and year of parasite life cycles. No time? Groupls like AO, IMEX, Oquendo Center, Nexus, and others convey a large amount of practical lecture and hands-on material in three to four days. Ditto for other groups and aspects of general practice like ultrasound. I cannot believe that that sort of training cannot be incorporated into four years of veterinary school. Teaching to the licensing examination seems like a weak excuse to not do that. Just change it. The examination should not be sacrosanct. There truly is too much to know about large, or small, or production, or exotic medicine to force-feed it all to everyone. Offer it, but don't require it. Flip the programs on their heads. If a small animal student takes an interest in mixed- or equine practice, let him pursue the continuing education later, vs. forcing the focused small animal student to spend thousands upon thousands of dollars and many hours becoming competent in what should be part of the curriculum. It will be interesting to see how this new emphasis on general practice progresses. I remember back to my first year being told that there was a problem filling rural and inner city needs for veterinarians. How has that come along in the past seventeen years?

Finally, with respect to mixed practitioners. Sure they exist, but it seems they do in small numbers. The requirements of large animal medicine are out-of-step with the current self-care, set boundaries, and strive for work-life balance zeitgeist. I know I am a small sample, but there are maybe three vets in my that can be considered mixed but they are all older and despite their best efforts, cannot manage to constantly provide "standard of care" treatments at affordable levels to their clients. I know there were a number of students in my class that tracked mixed- or companion, but other than the ones that came from veterinary families (three or four) I believe most have "re-discovered their passion for small animal medicine and surgery". The main reason most of those who tracked mixed did so? They thought it might give them an edge in either passing or achieving a better score on their licensing examination.

I much appreciate your indulgence of my ramblings!

 

[EB73674]

I don't move in academic circles so I certainly cannot say you don't see the gaps and skills to which you referred. However, it seems to me that that has not slowed down searching for/hiring new graduates. Have wide swaths of the classes of 2020-2024 been written off due to the deficiencies that you note? Small clinics go wanting are corporate groups seem more than happy to throw substantial financial and other enticements to anyone who passed their licensing examination by the skin of their teeth. It think there just might be a gap in what academia deems important versus what potential employers are seeking. Give them a warm, licensed body and they will either look past or rectify those perceived problems.

I've been out since 2010 so again I will take your word for a greater emphasis on general practice. Given the expense of attending veterinary school, that is the least that these institutions can do. I know not everyone goes into general practice, but the bulk of students do. No doubt that expertise and material abound, but the problem is in how and what is presented. Brute force memorization versus actual teaching (which really does seem reserved for residents--for the most part). As an example, take the TPLO--the "preferred" method for treating the most common orthopedic injury in dogs. One or two lectures on the topic versus a semester of esoteric factoids on bacteria and viruses and year of parasite life cycles. No time? Groupls like AO, IMEX, Oquendo Center, Nexus, and others convey a large amount of practical lecture and hands-on material in three to four days. Ditto for other groups and aspects of general practice like ultrasound. I cannot believe that that sort of training cannot be incorporated into four years of veterinary school. Teaching to the licensing examination seems like a weak excuse to not do that. Just change it. The examination should not be sacrosanct. There truly is too much to know about large, or small, or production, or exotic medicine to force-feed it all to everyone. Offer it, but don't require it. Flip the programs on their heads. If a small animal student takes an interest in mixed- or equine practice, let him pursue the continuing education later, vs. forcing the focused small animal student to spend thousands upon thousands of dollars and many hours becoming competent in what should be part of the curriculum. It will be interesting to see how this new emphasis on general practice progresses. I remember back to my first year being told that there was a problem filling rural and inner city needs for veterinarians. How has that come along in the past seventeen years?

Finally, with respect to mixed practitioners. Sure they exist, but it seems they do in small numbers. The requirements of large animal medicine are out-of-step with the current self-care, set boundaries, and strive for work-life balance zeitgeist. I know I am a small sample, but there are maybe three vets in my that can be considered mixed but they are all older and despite their best efforts, cannot manage to constantly provide "standard of care" treatments at affordable levels to their clients. I know there were a number of students in my class that tracked mixed- or companion, but other than the ones that came from veterinary families (three or four) I believe most have "re-discovered their passion for small animal medicine and surgery". The main reason most of those who tracked mixed did so? They thought it might give them an edge in either passing or achieving a better score on their licensing examination.

I much appreciate your indulgence of my ramblings!

First year student here who actually, sincerely wants to practice mixed animal medicine - love me some horses, goats/ruminants, dogs, and snakes! I'm curious - did the people who you knew that tracked mixed/companion & then took small animal jobs decide this RIGHT after school or did they spend a few years in mixed and then switch? Frankly, as much as I want to stick with mixed/companion going forward, combining it with the current jobs that are out there, I'm a little skeptical of finding the job that will offer me both satisfaction with having my dream patient base AND offer me work-life balance. In theory, I'd be willing to start my own single-doctor ambulatory practice, but I honestly can't think of anything worse than being on-call 24/7 for emergencies & having to do the entirety of my own practice management. The vets that I've been around that seem sincerely the most happy are the ones working multiple jobs part-time - sure it doesn't offer as much stability or benefits, but you can often negotiate more on compensation and you aren't stuck in the same monotony of a single practice environment. We might be moving in the direction of better work-life balance doing relief or multiple part-time positions, which might allow more access to rural/inner-city populations.

Dunno here, just some thoughts while procrastinating my renal exam. But I really appreciate your thoughts too!

 

[TheDogFather]

I don't keep in very close contact with anybody and we've pretty much scattered to the four winds, but to the best of my recollection almost everyone (and the number wasn't that great) who went into mixed practice and stayed with it either came from a rural background, had a relative that owned a mixed practice so that both the experience and facilities were in place, or both. I know of one student that took over a mixed practice. He came from a farming family. Another student came from a suburban background. She entered mixed practice but she was also a devoted equestrian before vet school. As far as I know she still treats horses and small animals. Another equestrian works at a facility that no longer takes equine patients. Again, to the best of my knowledge only two students are strictly equine practitioners or equine heavy. Here and there I have picked up bits and pieces of those who tracked mixed but stepped away from the large animal aspect of practice. A decent number of the small animal types have left clinical practice and do mobile work, but I cannot put a number on it. Most of what I know is second- or third-hand. I cannot speak to the career paths of the off-shore or private school that was newly minted when I was in school who did their fourth-year training with us. Off the top of my head we had four or five students who eventually became diplomates in one field or another and I know of two off-shore student that did the same. I believe only one of my classmates became a large animal specialist. Kind of convoluted, but since you asked....

As far as the whole "quality of life, work-life balance, boundaries" thing, it remains to be seen how long that can hold out. I'm satisfied with what I have going on. Are we as in-demand as the schools tell us, or are we headed for a shake-out like those experienced previously by the dental and law, and pharmacy profession? A lot of tech workers who just a few months ago enjoyed free food, laundry services, in-house gyms, and transportation are wondering what just hit them.