Internships should be designed to prepare veterinarians for high-quality service in practice or advanced specialty training. The primary purpose of an internship is to provide a sound educational program for the intern rather than a service benefit to the hospital. This guideline is intended to establish reasonable expectations for internship providers as well as participants. The key to providing or completing a successful internship experience is establishing a clear, mutual understanding of what is being provided and what is expected in return.
Create an employment contract or agreement that describes what is being provided and what is expected.
- Specify working hours and on-call responsibility.
- Specify the level of faculty and staff support to be provided.
- Salary should be commensurate with responsibility and level of training.
- State whether there will be an opportunity to earn additional cash compensation; include an estimate of the additional income potential.
- Specify all benefits, such as, sick days, vacation, health/liability insurance, professional dues, meeting expenses, etc.
- Specify regulatory requirements; state/DEA license requirements; who covers the cost.
- A non-compete clause is not typically included in an internship employment agreement. If a non-compete clause is necessary, include reasonable time and distance parameters.
A formal orientation program should be in place to ensure a successful clinical training experience. An internship orientation manual should be provided that describes hospital policies, standard protocols and procedures, as well as specific learning objectives and the performance evaluation process including minimum post-internship competencies as determined by the program director. An appropriate evaluation form and rubric should be utilized to evaluate performance at regular intervals; at least quarterly for a one-year internship. An experienced veterinarian should be assigned as a mentor.
An effective internship must include a strong didactic component. Teaching rounds should be held at least weekly and may include journal clubs, seminars, lectures, morbidity/mortality rounds, clinicopathologic conference, etc. The intern should be expected periodically to deliver a professional presentation or seminar to senior clinicians and peers. Funding to attend a professional meeting is desirable to promote the importance of continuing education and lifelong learning.
Clinical experience and responsibilities
A rotating internship should include primary case care responsibility for first-opinion and emergency/critical care cases. Primary case care responsibility for complex cases under the supervision of a boarded specialist is considered optimal to maximize the value of the educational experience. Internships should provide the opportunity to be the primary surgeon on a broad range of elective and entry-level procedures to ensure appropriate progress is made. Participation in daily patient rounds with a boarded specialist in attendance is optimal. Patient rounds should include an in-depth discussion about the mechanisms of disease and a thorough review of case management plans for each patient being managed by the intern and by the service. Direct support and supervision mean the supervising veterinarian is in the building and available to the intern. The level of supervision can be expected to decrease as the intern develops greater medical and surgical proficiency. An internship should not include patient care responsibility in a secondary training site where the intern is the only veterinarian in the facility.
The percentage of time the intern is assigned to daytime primary emergency; overnight primary emergency, first opinion (primary care) clinics, and elective time should be appropriate for the learning objectives and allow time for adequate study. An intern should spend no more than 25% of the program on primary emergency duty. The majority of the program should consist of time spent on clinical service with a senior, preferably board certified veterinarian. The intern must be allowed to progress at a reasonable rate without being overwhelmed by the caseload. The amount of elective time required will vary based on the entry skill level of the intern, but should be expected to decrease as the intern develops greater proficiency.
Faculty and clinical resources
Internships must provide access to qualified faculty in disciplines appropriate to the type of internship. An appropriate number of general practitioners, full time or part time diplomates in each advertised specialty area, clinical residents, and credentialed veterinary technicians should be available to provide adequate support for the educational program. An adequate number of credentialed veterinary technicians should be assigned to the intensive care unit to ensure adequate support to meet the learning objectives. Interns should expect to have ready access to faculty throughout the internship. A full time diplomate should be in the building and available to the intern at least 8 hours per day, 4 days per week; a part time diplomate should be in the building and available to the intern at least 20% of the work time. Indirect support is provided when the diplomate is available for consultation by telephone.
It is essential that a diverse and sufficient number of medical and surgical cases are available to support the internship program. The caseload should ensure that adequate numbers of outpatients, inpatients, surgeries, and emergency cases are available throughout the year to support the learning objectives.
Physical facilities should reflect contemporary standards and provide an appropriate learning environment. Clinical and didactic areas should provide adequate space for instruction and be well-maintained. An intensive care area should be available to ensure interns receive adequate experience in emergency and critical care. Effective biosecurity protocols for human and animal safety are essential. Adequate diagnostic and therapeutic equipment must be available to support the learning objectives.
- Bone plating equipment
- Computed tomography
- Magnetic resonance imaging
- Digital radiography
- Basic clinical laboratory equipment on site
- Nuclear medicine
- Blood gas analysis
- Diagnostic laboratory available
- Physical therapy equipment (underwater treadmill)
Current medical textbooks, a computer with access to online search engines for scientific literature and online journals should be available on-site. Secondary training sites should meet similar facility standards.
Internship providers should collect and utilize appropriate outcome measures to monitor program quality, identify areas for improvement, and assist candidates in the selection process. Examples include: the number and percentage of interns who have completed the program per year for the past 5 years, the number of interns from the program who applied for a residency in the past 5 years, and the number of interns from the program who accepted a residency in the past 5 years including the completion rate. Comprehensive exit interviews covering each area of the internship should be conducted upon completion to identify areas for program improvement.