Surgery confidence

Re: Surgery confidence

Hannah Wynne Richards — Tue, 11 Sep 2012 15:37:26 GMT

Whether Vet2vet's 4/5 veterinarian practice or my 2/3 veterinarian practice would be better for you depends on both the individual practices and also on what sort of person you are-I flourished in a practice with a family atmosphere-some might find it claustrophobic-but it suited me 4/5 people is big enough for there to be pre-existing rivalries-and it's no fun being in the middle of a feud which pre-dated your employment-but where you're forced to take sides Having said that, a single boss if uncongenial is really hell Good luck anyway

Wynne

Re: Surgery confidence

Bob Russell — Tue, 11 Sep 2012 13:35:52 GMT

I would echo some of the comments about being left-handed - I am too!

I went through college and a lot of years struggling with confidence in surgery. Things that seemed easy for others I had to find my own ways to do things. This was not good for confidence at all.

I went to an abdominal surgery CPD weekend at Bristol and one of the tutors came over looking a bit concerned. He asked me if I was left handed and he went ah-ha! A bit of a eureka moment as in years nobody had even thought about it (including me!). He showed me how to tackle things a bit differently.

Unfortunately the damage is done to a certain extent and I am an unenthusiastic surgeon but you are in the early stages of your career! A supportive practice is critical, ideally one where the other vets are not going to rush off to do other things!

You are in a far from unique position so don't feel you are on your own, you are definitely not!

Re: Surgery confidence

Rajat — Tue, 11 Sep 2012 11:51:15 GMT

Anon - everyone has given you excellent advice. I was a nervous surgeon too (as many of us were when graduating) - and what helped me the most was to follow the basic principles, and to think about what I was doing and the next step of what I wanted to do. Also spay neuter programs abroad really help- it helps to gain confidence and speed as you are doing 5-10 neuters per day (less if youre slow- good thing is no one minds too much in a good program because regardless of speed, you are volunteering your time for free!) I did one with Vets without Borders in far fluing places in india, and it was a very very rewarding experience on many different levels. I can strongly endorse them- and they have good funding so you aren't practising medieval medicine.

No reasonable boss expects you to do bitch spays in 20-30 minutes 1 year out. It is far better to do it well in 45-60 minutes then identify where you're slow (for me it was the intradermals which took a lot of time) and work on that.If you are aiming for speed at the moment, it may lead to errors- aim for perfecting your technique first and the time taken will naturally fall away as you get better.

Re your other ops- I didn't do any of those one year out. Though I did have my peers talk big about doing the gastrotomies in the middle of the night and the GDV they fixed- I know I didn'[t have enough knowledge or skill to do those ops and I didn't take any jobs which expected that of me - not fair to the patient or anyone else IMHO.

A good job is paramaount- an understanding boss + boss or other vets who enjoy teaching/a learning environment. Be prepared to travel (I had to as a new graduate) and I am sure you can find a good job quickly which fits the bill

Best of luck!

Raj

Re: Surgery confidence

bob lehner — Tue, 11 Sep 2012 10:28:56 GMT

[quote user="Emily Herskind Nightingale"]I am 5 years post qualified and can tell you that not a day goes by when I dont question what I have done with respect to either an op, consult, phone call, interaction with staff, euthasia.. the list goes on.[/quote]

Ditto - but 38 years qualified.

Veterinary practice is a learning curve from the day you start until you fall off your perch at the end.

Re: Surgery confidence

Busybee — Mon, 10 Sep 2012 21:45:19 GMT

Well I'm 2 years graduated and still find bitch spays scary! I did a spay/neuter clinic abroad in the summer after uni which definitely helped build my confidence. Unfortunately, when I got my job in the UK 2 months later, I didn't do another one for about 6 months, so my confidence dropped again. I'm still in that job now, and in two years, I've probably only done about 5 bitch spays and assisted on 4 more - very few bitches in our area are spayed (despite my best efforts!) and I only operate at most one day a week. I have done pyos and caesareans though. My surgical skills in other areas have improved no end though and I find this helps on those surgeries I struggle with. Personally, I've done one enterotomy, few caesars, few pyos, one assisted GDV, various lump removals, tail amputation, aural haematoma, digit amputations, dentals inc extractions, numerous castrations and stitch ups. No cystotomies! I know people who have graduated same year as me who haven't done half as much as this and some that have done ten times as much! It's very variable so try not to compare yourself to others in your year too much. Like Holly said, try and at least see as much surgery as possible - I try and see a new op, then next time, try it with assistance/being watched, then 3rd time, go for it on my own if I'm happy.

Re: Surgery confidence

Vet2Vet — Mon, 10 Sep 2012 21:36:22 GMT

Just to clarify what I meant by multi-person , I was thinking 4-5 as opposed to 1-2 . In my first job , it was a 5 person practice and fairly busy too . I think it is good to have the opportunity to follow up your cases where possible but within the setting where older/ more experienced colleagues are present to help and offer advice where needed . I do think things have really changed in vet practice in the last 20 years . In general , practice has become a lot more specialised and it is more difficult to achieve competence as a "GP" than ever before . I do think that work experience / permanent work in a charity hospital are very good ways to get good all round surgical experience . Definitely , I would probably avoid locum work if possible ( especially very short stints ) . This is because it is very variable and can be very stressful . All experience is good experience at the end of the day . Some of the lessons I have gained the most from were not that comfortable at the time .

Re: Surgery confidence

Holly Norman — Mon, 10 Sep 2012 21:29:48 GMT

Ouch! It sounds like your first job wasn't ideal and this has certainly knocked your confidence. I am also a 2011 graduate and it sounds like I'm at the same surgical level so don't worry! Lots of people in my year are also at this level. Yes, we all have that vet friend who tells us all about that GDV she did... by herself... standing on her head... in half an hour(!) but I promise the rest of us are still struggling with surgery! A lot of my friends still have someone scrubbed in for bitch spays. I currently do all castrates, spays and dentals although my bitch spays still take an hour and much swearing. I've done small lump removals but had my confidence knocked when I was left an enormous lipoma to remove that turned out to have infiltrated the abdomen. I haven't done any abdominal surgeries and I find them really scary. I agree with the previous posts- what about a neutering clinic or trying to find a few weeks at the Dogs Trust, Blue Cross or PDSA? Even if you offered to work for board and lodging in exchange for the experience? I think it's ok at this point to discuss your skills at a job interview and explain that you want more support for certain procedures. I started my second job with only neutering experience and now I fight tooth and nail to scrub in on ex laps, Caesars, etc. I explained this to my boss and wrote a list of surgeries that I wanted to see, even if they came in at 3am and I wasn't on call. I think having this willingness to learn helped to balance out my inexperience. If you want to PM me for a chat feel free. Please don't think that you're alone in feeling like this!

Re: Surgery confidence

Fiona French — Mon, 10 Sep 2012 20:14:14 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Martin Atkinson"]but she is also left handed which doesn't seem to help[/quote]

I can assure you that left-handed people are often more dexterous ( think about it) because they spend their lives having to contend with things that are designed the wrong way round.

[/quote] I'm left handed, and have always been taught techniques by right handed vets, but I have always just worked out how to do it and don't feel that I am at a disadvantage. Some instruments are difficult or impossible to use left handed, such as Gelpi retractors, but I just use them with my right hand.

Re: Surgery confidence

Evelyn Barbour-Hill — Mon, 10 Sep 2012 19:24:01 GMT

[quote user="Martin Atkinson"]but she is also left handed which doesn't seem to help[/quote]

I can assure you that left-handed people are often more dexterous ( think about it) because they spend their lives having to contend with things that are designed the wrong way round.

Re: Surgery confidence

Gillian Mostyn — Mon, 10 Sep 2012 17:57:30 GMT

[quote user="An On MRCVS"]I am a 2011 graduate who worked a small animal maternity leave contract. [/quote]

I know this doesn't help you now, but this wasn't an ideal job choice for a new grad. Your first job needs to be somewhere that wants to nurture you and look on you as an investment in the practice's future. I suspect this boss just wanted anyone who could tide the practice over until the usual vet came back. They would have little interest in teaching you as they would know you'll be leaving soon. I'd hazard a guess that when you get a permanent position you'll be amazed at how supportive most practices are.....

Re: Surgery confidence

Gillian Mostyn — Mon, 10 Sep 2012 17:52:31 GMT

To the OP - take your time to find a more supportive practice team. Make sure you spend a day in the practice before you agree to work there to get a 'feel' for the place. Although the boss needs to be patient, so does everybody else and a load of shirty nurses can do no end of harm to your confidence. Honestly, all a boss is looking for is enthusiasm for the job and a kind,empathetic approach to your work. That can't be taught - everything else can.

Hang in there - it does get A LOT easier!

Re: Surgery confidence

Julie Innes — Mon, 10 Sep 2012 15:14:30 GMT

I remember my first year in practice- I was constantly terrified! Terrified of bitch spays (although ironically less terrified of other surgery- think it was the fact they were "routine"), terrified of being called out, of doing something wrong. It wasn't much fun, so I sympathise with any new graduate.

the only advice I can give is that it does get easier and your confidence does build over time! Don't be too hard on yourself in the meantime.

And as for interviews, as a boss myself I am far more amenable to someone who isn't superconfident- it means you will be concientious and ask if you aren't sure. Newly qualified vets oozing confidence would be far more of a worry to me!!

All the best in finding your next job!!

Re: Surgery confidence

Gillian Mostyn — Mon, 10 Sep 2012 13:32:14 GMT

[quote user="Martin Atkinson"]Another thing that struck me is that some people seem to have no sense of time. [/quote]

I agree completely. I have had a few new/recent grads working for us and some have had very poor time management. Their surgery is slow, understandably, but it isn't the time from first incision to last suture that I watch - that takes as long as it takes. It is the general lack of hurry during the morning - not planning pre-meds so that the animal will be sedated at the right time - wasting 15 minutes chattering and wandering around before getting the next animal out of the kennel etc etc. I think it is because students are used to doing large procedures that take all morning, so the thought of doing a handfull of neuters as well as a couple of bigger ops in one morning seems totally unreasistic to them.

Re: Surgery confidence

Clive Ansell — Mon, 10 Sep 2012 13:19:43 GMT

I was very lucky. As a 4th and final year student I spent several weeks in a very busy RSPCA hospital, and with a good mentor I was able to get a lot of supervised surgical experience from a large case load of routine neutering and stitich ups to pyometras, large lump removals and simple fracture repairs. Surgical experience gained in small animal at university was almost nil, I did one half of a cat spey, but it was so far removed from planet real world to be of no practical help at all.

Re: Surgery confidence

Michael Woodhouse — Mon, 10 Sep 2012 12:18:57 GMT

Have you tried somewhere like the Dogs Trust? I had a friend who went there to do a lot of bitch spays to build her confidence. I know it sounds wrong but there is less pressure when you know the animal is unowned.

(The place I saw practice was great as they had an RSPCA cattery attached so they'd keep the cat spays for late morning/afternoon after back from the farm calls - I was left to it with a vet in earshot after a while. I must have spayed 30+ cats by I graduated and that is a fantastic confidence boost. It also makes you quick - now I can go 2 months without spaying a cat)

Re: Surgery confidence

Martin Atkinson — Mon, 10 Sep 2012 11:23:30 GMT

Another thing that struck me is that some people seem to have no sense of time. I asked my new graduate to make up the pre-meds for today's ops (or rather she even asked me if she should do it) I went out 20 minutes later and she was just getting round to it. It is not a personal criticism of her but rather what seems to be a modern mindset: which also seems to apply to my nursing staff. When I want something doing I want it done NOW and that applies to myself, I just wonder if that then translates to surgery if there is no sense of urgency or realisation that the sooner it's done the less stress there is, less tissue damage and the quicker the recovery. I also wonder if it;s a legacy of the vet school situation where there is a relaxed attitude with no sense of urgency (although I'm advised that ops are generally pretty frantic I find this hard to believe) and new grads. come out with this mindset. (Prepares for brickbats).

Re: Surgery confidence

David Mills — Mon, 10 Sep 2012 10:59:45 GMT

Would also go with looking for a smaller place, 4-5 vets at most. I know my old place in the lakes is looking for a new assistant and there was great- sensible surgery lists, relaxed boss, good mix and enough very competent general surgeons on hand. Surgery is one of those things that I worried about as a new grad especially compared to my peers and there was always a similar comparison as Mr Ness alludes to. Ignore it. It's not about numbers but rather basic surgical competence and the advice above is very sound about going back to basic techniques and ignoring all the op descriptions taught at college. Surgery is a set of basic techniques that are applied across a wide range of scenarios. But like driving a car or anything else technique based the best way is to learn the basics well then practice as much as possible. There'll come a time in a couple of years when you'll be doing surgery without realising it and that sick feeling you get contemplating a bitch spay simply won't be there. Its not something that can be taught, it'll just happen. In terms of practical advice WVS do neutering courses in India with English vets as teachers, there are also quite a few elsewhere. Otherwise volunteer opportunities at charity practices are available but make sure you let them know you need practical experience- these aren't advertised so contact your nearest one direct. If you're anywhere near London we offer them here.

Re: Surgery confidence

Hannah Wynne Richards — Mon, 10 Sep 2012 10:22:28 GMT

I'd say the opposite to Vet2 vet A multi person environment is one where the pack instinct can kick in, and someone new and lacking in confidence can easily end up badly bullied It happened to me, and the nurses behaviour in your last practice sounds as though it's happened to you I found my feet after going to work in a small (3 veterinary surgeon ) practice where there was 1 other young assistant and an older boss (Peter Shepherd) who was prepared to be supportive

Be honest at the interview I'm not looking for an assistant but would far rather 1 who was lacking in confidence to 1 who was too gung-ho-that lot are an absolute menace to their patients

Good luck

Wynne

Re: Surgery confidence

Martin Atkinson — Mon, 10 Sep 2012 10:20:06 GMT

Tricky one this. I have had a 2011 graduate seeing practice with me for the past year because she can't find a job. I have tried to give her as much surgical experience as possible and both myself and the nurses try to be patient but firstly she is very reluctant to take on anything other than that which has already tried which leads to a Catch 22 situation and even on the things she has done loads of time, she still is very slow and has sudden lapses of surgical skill and confidence but she is also left handed which doesn't seem to help (any other southpaws out there who can comment on that aspect). I wish I knew the answer to how to help her, she is otherwise a very competent vet with an amazing knowledge and diagnostic skills but once again I can't help but feel it is fear of litigation and discilpiniary committees which is holding her back to some extent. Even she sometimes says she may just have to accept that she is not a surgeon, but it won't help in general practice.

Re: Surgery confidence

Malcolm Ness — Mon, 10 Sep 2012 08:54:36 GMT

[quote user="An On MRCVS"] I am not a gifted surgeon [/quote]

I hate that term "gifted" - it is all to do with study, practice and the application of good technique. From what you write, it seems to me that you have a very good attitude to your work and that is a big plus point.

[quote user="An On MRCVS"]Confidence is an issue for me[/quote]

Over-confidence is the worst thing a surgeon can have and the fact that you lack confidence in surgery as a recent graduate is, in my opinion, a good thing and an indication of your potential.

[quote user="An On MRCVS"] No enterotomys, cystotomys etc[/quote]

I have been graduated a while now but I can still remember the bar-room discussions between my recently qualified colleagues - surgical "big-willy competitions" along the lines of , "I've done six fractures, five cruciates, seven enterotomies and a brain transplant. What have you done?". Most of it is bluster and certainly not evidence of competence or even acceptable practice.

[quote user="An On MRCVS"] knew my real surgical abilities.[/quote]

If they want a surgeon, then they will advertise for a surgeon - if they want a developing practitioner with a good attitude and a willingness to learn then you are in with a good chance.

[quote user="An On MRCVS"]How do you get quicker at surgery[/quote]

You get quicker by getting better and that involves study, practice and the application of good technique. Bear in mind that your undergraduate course contained hardly any useful training in surgery. Go back to basics - read the first few chapters of a good surgery book (the "boring stuff about sutures,draping, instrument handling, infection, surgical biology etc). Practice suturing and knotting until it is second nature and practice techniques on cadavers. Finally, become self-critical - look at every op you do and evaluate what you could have done better and next time, do it.

[quote user="An On MRCVS"]my confidence in general has taken a hit[/quote]

I second what has been said by others - confidence comes with time but it is never absolute. Professor Pearson, formerly of Bristol vet school had a phrase about surgeons who had, "an excess of confidence over competence" - it wasn't a compliment !

Re: Surgery confidence

CatherineThomas — Mon, 10 Sep 2012 07:06:24 GMT

I know how you feel. In my first job I spent 6 months not having an ops day, so all I could ever do were the things left for me by the time I'd finished my consults. That usually meant dentals and cat castrates or the occasional cat spay. One time we had a locum there who felt that this was wrong and saved a bitch spay for me to do with her. She was then told off for letting me do a bitch spay. But then at the same time I was expected to be able to do the on-call work on my own, so I ended up doing more caesarians than bitch spays. I was also berated for being slow and was constantly being interrogated about what I had done and why. When you hardly ever get to do surgery you can't expect to speed up. It really knocked my confidence.

Fortunately I knew someone who ran a budget neutering clinic so when I left that place I spent two weeks doing work experience for them. It was great experience because I spent all day neutering and really managed to speed up. Then I felt much more confident when I started my next job.

Re: Surgery confidence

Rob Loxley — Mon, 10 Sep 2012 00:28:01 GMT

[quote user="An On MRCVS"]Looking for some opinions here please...[/quote]

There are some good practical CPD courses aimed at this very thing

Re: Surgery confidence

Evelyn Barbour-Hill — Mon, 10 Sep 2012 00:06:38 GMT

[quote user="Emily Herskind Nightingale"]Just because you weren't as speedy as some of your colleagues may have liked (been there done that myself with nurses threatening to turn off the iso and wake the patient up in 5 minutes in an attempt to chivvy me on a bit)[/quote]

That should be a sackable offence. Saints preserve us from nurses too big for their boots. A nurse should button her lip and mind her own b***** business.

Anywhere you are berated for being slow is a job to extricate yourself from.

I reckon that unless the new graduate is very lucky, the first job will always knock the confidence a bit. That's OK. The dreadful thing is if the second job, for whatever reason, knocks it even more. I was lucky in that Geoff Parkin rescued me from the misery of my second job.

Be absolutely honest with whoever you apply to next and tell them what you told us - but don't talk yourself down. If the boss sneers faintly and says "well, I don't really regard what you've done so far as surgery" (yes, happened to me) that's clearly not a job you want anyway. If he says "don't worry, speed will come with time; and maybe I can send you on a practical course or two" that could be your dream job. Fer cripes' sake, when you're one year qualified nobody should expect you to be knocking off an enterotomy just like that.

Time is money? No, it doesn't have to be. A place where everything is costed by the minute and the assistants' net value added per hour is assessed every month as a KPI (or similar management-speak) would be my idea of hell. I dare say it might suit some but not me, nor I think you.

I'm not sure you should be looking for a post in a several-vet practice. I fear that there you'd be working as a sort of triage assistant – you see the case initially and do the first tentative diagnosis and then it gets taken off you for the interesting stuff. I would think an ideal situation (not saying you'll find it) would be just you and a principal, in a practice that does not contract out its OOH.

I don't think you should be locumming, feeling as you do at present.

[quote user="Emily Herskind Nightingale"]Finally, don't expect to feel confident all day every day- none of us do. I couldn't get an IV on a cat the other day ( see prev post re drowning dog..) and that shook me a bit but the ability to analyse, evaluate and keep wanting to improve and learn from experiences is what ultimately will make you the best and most human vet of all.[/quote]

Just so.

Re: Surgery confidence

James Laidlaw — Sun, 09 Sep 2012 23:15:51 GMT

It sounds like you need a job in a clinic that can provide you with support and back up ad allow you the time to progress and develop your surgical skills. It's not something that comes with doing more complicated procedures, just with more procedures, even routine ops. Having the support of a boss and colleagues that can realise you're learning and not pushing you to be as fast as possible will be the biggest thing you need right now, hopefully your next job will allow for that. Look for a supportive environment that has employed new graduates and looked after them before. Good luck!

Re: Surgery confidence

Lucie Allcutt — Sun, 09 Sep 2012 22:56:05 GMT

I wish I could offer you more specific advice but I just wanted to say keep your chin up, we've all been there! As you already know the only thing that's going to make you faster and more confident is time and practice!

I'm no expert at job searching but I would always urge you to be honest in interviews because it won't do you any favors to end up somewhere that expects you to be Mr/Ms.SpeedySurgeryVet - especially if you are going to end up berated for being 'slow' - go for a job that is advertising for new grads and wants to/can take the time to mentor.

Good luck, the right job is out there somewhere for you!