Veterinary large animal ambulatory internship guidelines

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Introduction

Internships should be designed as a one-year program to provide increased experience and education in multiple clinical disciplines. An internship provides practical experience in applying knowledge gained during the curriculum and an opportunity to obtain additional training in the clinical sciences. The internship should help 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 practice. The internship should emphasize mentorship, direct supervision, and didactic experiences. 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.

Employment information

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 during routine and after hours.
  • Identify the reporting structure for interns (e.g., college-based internship committee, department head, etc.).
  • Salary should be commensurate with responsibility and level of training. The compensation should be equivalent to, or exceed, the living wage for the location of the internship.
  • 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, provision of work vehicle, etc.
  • Indicate any personal wellbeing services that are available to the intern.
  • Specify regulatory requirements, state/DEA license requirements, and who covers the cost.
  • Noncompete clauses should not be part of the employment agreement.
  • Internship programs should follow current Accreditation Council of Graduate Medical Education (ACGME) guidelines for work/life balance that encourage a maximum of 80 hours per week of scheduled clinical activity. Interns should also get an average of one day free per week from clinical experience or education over any two-week period.

Orientation/Supervision/Mentoring

A formal orientation program should be initiated at the beginning of the internship to ensure a successful clinical training experience. An internship orientation should be provided that includes written 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 for competency-based assessment performed at regular intervals, at least quarterly for a one-year internship. The competency assessment should not focus solely on knowledge-based acquisition but also include demonstrated performance in certain key areas of essential professional and clinical skills, personal conduct, character, and applied knowledge. An experienced veterinarian should be assigned as a mentor at the beginning of the internship and should be present at all performance evaluations. Performance evaluations must use multiple evaluators (attending faculty, intern peers, self-evaluations, and other professional staff members). The intern mentor should be available to provide guidance during the internship.

Didactic training

An effective internship must include a strong didactic component. Teaching rounds should be held at least weekly either in person or virtually and may include journal clubs, seminars, lectures, morbidity/mortality rounds, etc. The intern should be expected periodically to deliver a presentation during rounds and a 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

An ambulatory large animal 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 an experienced general practitioner or boarded specialist is required 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 after appropriate supervised surgeries.

Participation in daily to weekly case rounds with the supervising veterinarian 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 overseen by the intern and by the service. Direct support and supervision mean the supervising veterinarian is reachable via phone or telehealth during business hours and available to the intern when reasonably requested. The level of supervision can be expected to decrease as the intern develops greater medical and surgical proficiency. The degree of, and timelines for, supervision should be clearly laid out prior to commencing the internship and can be adjusted as needed based on the supervising veterinarian’s evaluation of and discussion with the intern. Client communication expectations should be clearly communicated with the intern.

Scheduling

The percentage of time the intern is assigned to daytime emergency, overnight emergency, first-opinion (primary care), and elective time should be appropriate for the learning objectives and allow time for adequate study. The majority of the program should consist of time spent on ambulatory clinical service with a senior veterinarian in person for the introductory period and via phone for the completion of the internship. A senior veterinarian should be available for in-person consultation at all times, if requested by the intern on a case-by-case basis. An intern should spend no more than 50% of the program on primary emergency duty. The intern must be allowed to progress at a reasonable rate without being overwhelmed by the caseload. The amount of elective time needed to prepare to see patients will vary based on the entry skill level of the intern but should be expected to decrease as the intern develops greater proficiency. Interns should be afforded opportunities to pursue elective rotations or spend additional time on services relevant to their career goals.

Faculty and clinical resources

Internships must provide access to qualified faculty in disciplines appropriate to the type of internship. An appropriate number of experienced practitioners, full-time or part-time diplomates in each advertised specialty area (if indicated), credentialed veterinary technicians, and appropriately trained veterinary assistants should be available to provide adequate support for the educational program. Interns should expect to have ready access for transfer of a patient to a referral facility throughout the internship if needed for ongoing patient care.

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 individual patients, herds, surgeries, and emergency cases are available throughout the year to support the learning objectives.

Facilities

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. Effective biosecurity protocols for human and animal safety are essential and should be communicated to the intern at the start of the internship. Adequate diagnostic and therapeutic equipment must be available to support the learning objectives. If an ambulatory vehicle is provided, it should be adequately stocked for the intern to provide routine ambulatory services. Advanced diagnostic equipment may be shared among practice veterinarians as needed.

Internship programs should list which of the suggested equipment is available:

  • Digital or computed radiography
  • Functional practice vehicle stocked with medications and supplies needed for routine appointments
  • Motorized dental equilibration and examination equipment
  • Sterilized portable surgery kits
  • Cellular phone (smartphone)
  • Laptop if needed for electronic medical records
  • Endoscopy
  • Ultrasonography
  • Basic clinical laboratory equipment on site or point-of-care testing tools
  • Diagnostic laboratory available

Current medical textbooks, a computer with access to online search engines for scientific literature and online journals should be available on site.

Outcome assessment

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 five years, the number of interns from the program who applied for a residency in the past five years, and the number of interns from the program who accepted a residency in the past five 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.

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