Veterinary large animal hospital internship guidelines

Comment on this policy

Introduction

Internships should be designed as a one-year program to provide increased experience and education in multiple clinical disciplines. A rotating 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 hospital. 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.

Specialty internships should be a one-year internship in a specialty area following a large animal rotating internship or after suitable experience in practice. A specialty internship provides additional knowledge and training in a specialty area. The internship should prepare the specialty intern to be more proficient in the area of specialty and/or help prepare for residency in the area of specialty. The internship should emphasize mentorship, direct supervision by a boarded specialist, and didactic experiences including a seminar presentation and scientific publication. 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.
    • 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.
  • 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. This 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.

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 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 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 and may include journal clubs, seminars, lectures, morbidity/mortality rounds, etc. The intern should be expected periodically to deliver presentations during rounds and a seminar to senior clinicians and peers. Client communication expectations should be clearly communicated with the intern.

Funding to attend a professional meeting is desirable to promote the importance of continuing education and lifelong learning.

A specialty internship must include a strong didactic component. Teaching rounds must be held at least weekly and may include journal clubs, seminars, lectures, morbidity/mortality rounds, radiology rounds, clinicopathologic conference, etc. The specialty intern should be expected to periodically deliver presentations in morbidity and mortality rounds, journal club, and other types of rounds specific to the specialty. A professional seminar presentation to senior clinicians and peers should be required. A scientific publication in the area specialty should also be highly encouraged.

Clinical experience and responsibilities

A large animal, hospital-based 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 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 during business hours and via telehealth after business hours. The level of supervision can be expected to decrease as the intern develops greater medical and surgical proficiency. Client communication expectations should be clearly communicated with the intern. The degrees 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. An internship should not include patient care responsibility in a satellite site where the intern is the only veterinarian in the facility.

Scheduling

The percentage of time the intern is assigned to daytime emergency, overnight emergency, first opinion (primary care), and specialized assistance of board-certified veterinarians should be appropriate for the learning objectives and allow time for adequate study. Interns should be afforded opportunities to pursue elective rotations or spend additional time on services relevant to their career goals. An intern should spend no more than 50% of the program on primary emergency duty with the exception of emergency specialty internships. Most of the program should consist of time spent on clinical service with a senior, preferably board-certified veterinarian in person for the introductory period and via telehealth at the completion of the internship. A senior veterinarian should be always available for in-person consultations during normal working hours but does not need to be on site during after-hours patient care. 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.

Faculty and clinical resources

Internships must provide access to qualified faculty in disciplines appropriate to the type of internship. An appropriate number of experienced clinicians, full-time or part-time diplomates in each advertised specialty area (if indicated), clinical residents, 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 to faculty throughout the internship. At a specialty hospital, full-time diplomates should be in the building and available to the intern at least four hours per day, four 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. 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.

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. An intensive care area should be available to ensure interns receive adequate experience in emergency and critical care. Elective 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.

Internship programs should list which of the following suggested equipment items are available:

  • Bone plating equipment
  • Computed tomography
  • Magnetic resonance imaging
  • Digital radiography
  • Echocardiography
  • Electrocardiography
  • Endoscopy
  • Ultrasonography
  • Laparoscopy
  • Arthroscopy
  • Basic clinical laboratory equipment on site or point of care testing
  • Nuclear medicine
  • Blood gas analysis
  • Diagnostic laboratory available
  • Motorized dental equilibration and examination equipment
  • Cellular phone (smartphone)
  • Laptop if needed for electronic medical records

Current medical textbooks and 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.

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.

Related policies

Related resources

Additional resource