December 15, 2016

 

 Ready for the real world

Tufts at Tech’s novel teaching model prepares veterinary students for the realities of practice

Posted Nov. 30, 2016    

Four years ago, the Cummings School of Veterinary Medicine at Tufts University and Worcester Technical High School in Worcester, Massachusetts, did something unprecedented. Together, they opened a small animal hospital on the trade school campus where students from both institutions could receive on-the-job training by providing subsidized veterinary care to underserved pet owners throughout the Worcester area. 

There is no prior model for Tufts at Tech Community Veterinary Clinic, located a little more than 6 miles from the veterinary school in North Grafton, Massachusetts. Fourth-year Tufts veterinary students spend three weeks at the clinic as part of their primary care rotation, managing a mix of basic and urgent care cases while under the mentorship of veterinary staff and volunteers. Discussions with clients about diagnoses, treatment options, and service costs are left entirely to students.

Scheduling appointments, taking patient histories, and supporting the veterinary students in all they do are the juniors and seniors at Worcester Technical High School who are working toward graduating with a diploma and as approved veterinary assistants (see story). 

Fourth-year students at the Cummings School of Veterinary Medicine at Tufts University and students in the veterinary assisting program at Worcester Technical High School gain real-world experience working together at the Tufts at Tech Community Veterinary Clinic. Seen here are Dr. Jenni Grady, Tufts at Tech clinical instructor; Megan Pritts, WTHS junior; Abigail Sefton, Cummings fourth-year student; and Betsy Hensley, certified veterinary technician and WTHS instructor.

Part of the Tufts at Tech paradigm is to reverse the trend among new veterinary graduates who feel unprepared to work in a small animal primary care setting. Students’ experience at the Worcester clinic differs sharply from their rotations at Foster Hospital for Small Animals at the Cummings Veterinary Medical Center. At the teaching hospital, the cases are often complicated and student learning is impacted by the cadre of specialized veterinary faculty, residents, and interns involved in each case.

 





Veterinary student Kelly McMullin, who was nearing the end of her second week at Tufts at Tech, explained, “On day one, we’re told to be doctors, and that’s very much not the experience I’ve had in my other clinical rotations. There’s a lot more hand-holding that goes on elsewhere, but here, you’re the doctor; you make the decisions.” 

Foster Hospital clientele are typically middle- to upper-income animal owners willing to spend hundreds if not thousands of dollars for veterinary care. Tufts at Tech serves low-income cat and dog owners on some form of government assistance, including food stamps and subsidized housing. Most Tufts at Tech clients reported an annual household income of less than $25,000. The clinic is not free, however. Prices at the cash-only clinic are set at roughly 25 percent of the national mean for equivalent care, and fees are paid at the time of service. 

“We have to talk to clients about money here, and you get a sense of the value of each test you’re doing,” said Michael Nystrom, another Cummings School veterinary student at the clinic. “It’s nice being in a situation where cost isn’t a factor, and you can run every test. But then, it’s also nice having the experience of knowing what to do when the situation isn’t ideal.”

McMullin agreed, calling it a “culture shock” going from a referral hospital with clients who can afford specialized veterinary care to working with pet owners with just $20 to spend on their cat or dog. “It makes us more resourceful as doctors, and it’s more practical,” she said. “In private practice not everybody has hundreds of dollars to spend. It focuses your priorities and makes you a better clinician.”

Beginnings 

The idea for a clinic where Cummings’ fourth-year veterinary students could gain primary care experience was conceptualized by two faculty members in the veterinary school’s Department of Clinical Sciences: Drs. Elizabeth Rozanski and John Rush. With Dr. Emily McCobb, director of Cummings’ shelter medicine program, they were aware of a large, underserved population of pets in the greater Worcester area where a new clinic could operate without competing with local veterinary practices. 

Dr. Rozanski served on the advisory board for the veterinary assisting program at Worcester Technical High School with instructor Christina Melvin, a certified veterinary technician who wanted her students to get hands-on experience working in a clinic with clients and patients alike. Out of that collaboration emerged the Tufts at Tech Community Veterinary Clinic, which officially opened its doors in April 2012.

We’ve got these private, often upper–middle-class veterinary students partnered with an urban, public high school veterinary assistant student to provide subsidized, low-cost care to a qualifying population. There’s nothing else like that around.”
Dr. Greg Wolfus, director,
Tufts at Tech Community Veterinary Clinic

“Our expectation was the clinic would be a primary care/ preventative care clinic mostly providing vaccinations and some basic care,” recalled Dr. Rozanski, an associate professor certified by the American College of Veterinary Internal Medicine in internal medicine and by the American College of Veterinary Emergency and Critical Care. “We thought 75 to 80 percent of patients seen at the clinic would present healthy, but more than 55 percent of the patients are ill.”

Within the first month, 104 patients were seen at Tufts at Tech, with no advertising. Today, the clinic treats 5,000 to 6,000 patients annually.

“Tufts at Tech is more successful than we ever imagined,” said Dr. Rush, a professor certified by the ACVIM in cardiology and by the ACVECC.

The Dude

Gently and deftly managing what one former Tufts student described as the controlled chaos that is Tufts at Tech is clinic director Dr. Greg Wolfus. Sporting a beard and ponytail and calling everyone “Dude” or “Bro,” regardless of gender, Dr. Wolfus radiates Zen-like calm as up to 16 students and clinic staff flit about the treatment area. After graduating from Cummings School in 1998, the California native remained in Massachusetts, working as a small animal practitioner until 2012, when he was hired to oversee the Tufts clinic at Worcester Technical High School. 

Tufts at Tech is heavy on teaching financial literacy, Dr. Wolfus explained, and students learn through one-on-one discussions with clients. “The veterinary student comes up with the plan and the estimate, approved by the veterinarian, and then (the veterinary student) communicate(s) that with the client,” he said, adding that students always recommend the best treatment plan.

“If CT is indicated, then that’s what they recommend,” Dr. Wolfus continued. “Of course, we know our clients have limited income, and the majority can’t sell their car to pay for a CT scan. So students come back with plan B or plan C, depending on what the client can afford. Eventually, the client and student come together to decide the best action plan for that animal, and this person, at that moment.” 

Tufts at Tech is a self-sustaining nonprofit business paid for by a cocktail of revenue from service fees, corporate support, philanthropy, and grants. Dr. Wolfus is vigilant against the clinic further discounting or giving away services. After a client tells the attending veterinary student she doesn’t have the $50 she originally said she would be able to pay for her dog’s treatment, Dr. Wolfus emerges from the treatment area to talk with her. “How quickly can you get to an ATM?” he asks the client. The client leaves and returns with the money a short time later. 



Visiting veterinary student Ridoan Pasha (left) from Chittagong University in Bangladesh watches with Tufts fourth-year veterinary student Andrew Gestrich as Dr. Greg Wolfus (right) prepares to radiograph an anesthetized patient presented with multiple bite wounds.

Dr. Wolfus is unapologetic about Tufts at Tech’s non-negotiable fee policy and his enforcement of it. “What’s my job here?” he asked. “My job is to educate students. My job is to provide veterinary care to those who otherwise wouldn’t receive it. I have to do those things while keeping the clinic cost-neutral to the university, so I can’t give away the farm, or else, we can’t help anyone else.” 

Veterinary students encounter a variety of cultural backgrounds as well as families with limited resources when they rotate through Tufts at Tech. Around 80 percent of Worcester Technical High School’s student body qualifies for federally assisted breakfast and lunch. Approximately 20 percent speak English as a second language. Tufts students become more culturally aware from working with these students and clients, Dr. Wolfus noted.

“We’ve got these private, often upper–middle-class veterinary students partnered with an urban, public high school veterinary assistant student to provide subsidized, low-cost care to a qualifying population,” he said.  “There’s nothing else like that around.”

Additional images of the day-to-day operations at Tufts at Tech Community Veterinary Clinic are available at the JAVMA News photo galleries.