Dealing with new graduates

RE: Dealing with new graduates

Anthony Todd — Tue, 19 Mar 2019 11:05:31 GMT

[quote user="Julian Earl"]I think that even referring to them as morons, if not actually accusing them of being so is beyond the pale.[/quote]

For sure, not "morons"but how should we describe a first slip who misses an easy slow nick?

in fact newbies are going from >95% knowledge and <5% skill to the same %age of knowledge and a gradually increasing skill gained mainly by practice or repetition [like our first slip]

And, unfortunately, what is required in practice is a lot of skill, from handling clients and animals to handling suture material, but not so much knowledge.

As someone has said most of practice is mundane....

RE: Dealing with new graduates

Julian Earl — Tue, 19 Mar 2019 10:30:14 GMT

[quote user="An On MRCVS"] don't want to move jobs as I'm tied to the area, the rota isn't that bad compared to other local practices and I'm paid well, but I'm coming close to breaking and calling them all morons (which they act like).[/quote]

I think that even referring to them as morons, if not actually accusing them of being so is beyond the pale. My view and experience of newer graduates is much more favourable. Their knowledge is good, their practical skills less so and variable of course, but we all had to learn. I was an incompetent surgeon when newly qualified because I had received no real guidance pre-qualification. I adapted my taught bitch-spey technique in a way that I was very happy with and later on I considered myself very adept but did learn the hard way!

There is no doubt whtsoever that when a fresh vet I was most competent at those tasks of which I had done a lot as a student: pregnancy testing cows, disbudding calves, butbitch speys not so because many had been done at all. My advice is to offer kind, advice and support and helpful hints to guide them trough those difficult early months. In my first job I was given my first bitch spey, a big fat chocolate Labrador which took ages and the only support was thewonderful New Zealand nurse Christine G., who was extrehely experienced and helpful in many ways. My boss, Mr Jolly offered no help at all. In my subsequent job, David and Brian, the two bosses were a welcome contrast and helped me develop better skills I think. I swore to be a boss like the latter two and not like the late Mr SJ from my first job.

Regarding locums, the truth never hurts. One locum who claimed to be experienced had never speyed a cat and took two hours for his first! Which I only discovered on my return from my routine fertility dairy-visit, and his experience turned out to have been meat inspection for several months. His time with us did not end well!

ow to deal with new grads? Be patient, kind, helpful and honest.

HTH?

RE: Dealing with new graduates

Rach — Tue, 19 Mar 2019 01:06:10 GMT

[quote user="An On MRCVS"]

[quote user="Neil Wheadon"]

Only a thought

Does

[quote user="An On MRCVS"]We've written clinical protocols on how to diagnose and deal with most conditions.[/quote]

mean

[quote user="An On MRCVS"]improving themselves and their confidence, but just as a way of getting answers without having to think or work too hard.[/quote]

GP's are subject to this, but without free thought and a feeling that there has to be a set way of doing things can lead to problems?

[/quote]

No - the protocols were written last year after there were repeated requests for them.

I've used the words 'protocols', they're not law and to be followed to the letter, it's basically a 'how-to' guide; again because rather than going to look it up in a textbook a group of new-starters wanted it written down so they could just follow instructions rather than work through it themselves.

[/quote]

Why not suggest they come up with the protocols/guidelines themselves and you just give it a once over to check it’s sensible? Encourages them to think for themselves and reduces the burden on you. I created a load of these for myself as a new grad and still refer to some now (with a few adaptions over the years!). They are sometimes a godsend especially out of hours - all the pertinent (in my opinion) information in one spot, saves searching aimlessly for the BSAVA manual which has inevitably gone missing and wasn’t the colour you were looking for afterall!

RE: Dealing with new graduates

An On MRCVS — Mon, 18 Mar 2019 16:25:50 GMT

[quote user="Neil Wheadon"]

Only a thought

Does

[quote user="An On MRCVS"]We've written clinical protocols on how to diagnose and deal with most conditions.[/quote]

mean

[quote user="An On MRCVS"]improving themselves and their confidence, but just as a way of getting answers without having to think or work too hard.[/quote]

GP's are subject to this, but without free thought and a feeling that there has to be a set way of doing things can lead to problems?

[/quote]

No - the protocols were written last year after there were repeated requests for them.

RE: Dealing with new graduates

Neil Wheadon — Mon, 18 Mar 2019 13:33:24 GMT

Only a thought

Does

[quote user="An On MRCVS"]We've written clinical protocols on how to diagnose and deal with most conditions.[/quote]

mean

[quote user="An On MRCVS"]improving themselves and their confidence, but just as a way of getting answers without having to think or work too hard.[/quote]

GP's are subject to this, but without free thought and a feeling that there has to be a set way of doing things can lead to problems?

I experienced this at AHVLA, nearly everything we did was scripted. I stayed in the one area where I could interpret, when that was removed centrally, I left

Neil

RE: Dealing with new graduates

An On MRCVS — Mon, 18 Mar 2019 12:45:28 GMT

Original Anon here.

Firstly, I should apologise for the tone of my post. It was the end of a long week that I had no spare time as I was doing my job and then the work of multiple other vets, as well as having to deal with serious case mismanagement where basic clinical knowledge was lacking and clinical protocols provided were ignored. I would never tell a new or recent graduate vet that they weren't good enough and should consider an alternative profession.

I don't want to tar all new graduates and students with the same brush. We have some really good new graduates now and have some good students visiting us regularly. However the proportion of them are lower compared to in the past.

I still help all the new graduates when they ask me questions - I will always make time for them as I realise it's often a confidence thing and they just need helping through. I will always make them work through the case themselves rather than giving them the answer straight out. But things like asking for advice at what drug to use and then immediately asking for the dose rather than checking a formulary, or asking the protocol for a blood sample then ringing back to ask what colour a serum or Li-Hep tube is.

As a practice we did go through a period where vets weren't staying long term, so from information gained from exit interviews we now have a formal introductory programme where there is a timetable over two weeks of learning protocols, using computers, spending time on reception, with nurses, doing all the blood samples and cannula placements etc. They are then not officially on the rota for another 2-3 weeks to spend time at the hospital learning basic clinical skills, coming in on consults with senior vets, then doing consults with a senior vet either with them in the room or sat just outside for advice. We have reviews 2 weeks after starting, then monthly for the first six months, then every three months for a year to see how they are getting on. It is made clear from day 1 that the reviews are not used as a judging process by us, it's for them to give feedback on how we are doing to help their development. However they often won't say anything or just say they're fine and happy (even after trying to get more out of them).

As a practice we've invested in mentoring support and experience - senior vets have been on CPD days around mentorship and developing the new graduate. We're an IVC practice, so new starters will be offered a place on the new graduate programme they run. We've written clinical protocols on how to diagnose and deal with most conditions. In the introductory period there is a session on how to approach certain consults (gastroenteritis, the itchy dog, 'generally unwell', euthanasia).

When they start going to branches initially they will be placed with another vet, then when they start consulting on their own they will have periods blocked off to give time for catching up.

The support and help is there, but it is getting more common for individuals to not use this support as an aid to improving themselves and their confidence, but just as a way of getting answers without having to think or work too hard.

I'm not trying to make it an 'us vs them' situation, as we're all in it together and need to work as a cohesive group - I just wanted to see if it was me setting unreasonable standards (because I didn't feel I was) feeling this way or if there was a general consensus across the UK.

RE: Dealing with new graduates

Jill Butterworth — Mon, 18 Mar 2019 10:56:38 GMT

[quote user="Michael Woodhouse"]I don't want them staying because they feel obligated, but supported and part of the practice family.[/quote]

This is it, in a nutshell. When I decided to be a vet, first as a nurse and then as a vet student, I fell in love with my practice: the team, the loyalty, the laughs, the tears, the sense of belonging to each other, and the community. My favourite jobs and my own practice, were where I felt the memory of those feeling the most. This can never easily be recreated with a pigeon style of management (fly in, squawk a lot, s**t on a few people, and fly out again). Because of 7 years of mixed practice nursing experience before university, I had no illusions about what life would be like (but even then it was a shock to discover how it feels when the buck stops with me), and remember recognising that my compatriots had no idea, after just a few weeks standing in the consulting room. At that time, I felt that all prospective vets should spend a year as nurses/kennel or farm assistants, to be sure of what they wanted. Those days were a bit different, as there were very few qualified nurses and so there were chances to do things which would be deemed unacceptable nowadays.

RE: Dealing with new graduates

Anthony Todd — Mon, 18 Mar 2019 09:33:07 GMT

[quote user="Michael Woodhouse"]whether we should routinely castrate dogs............. [/quote]

Of course, "it stops psychocanines biting people", don't you know....!!

It's a strange sexual paradox and is, or was, said to be "for the dog's own good".

Cryptorchid? Probably??

Some "sexual vagrants" definitely; anything else; why??

RE: Dealing with new graduates

Michael Woodhouse — Sun, 17 Mar 2019 23:32:07 GMT

I'm replying to this in a separate post as it's mildly controversial.

[quote user="Anthony Todd"]I'd like to know what new graduates could teach experienced vets, even dinovets, that would actually be of use to them[/quote]

I do actually agree in the main. I spend a lot of time doing CPD, interacting online, reading and I'd be pretty gutted if I learnt something new about cattle medicine or bovine fertility from a vet student. I keep generally up to date in most areas. We see less than 1 rabbit per month so that's not really a major area in the practice.

I think what is useful is discussing how other vets and practices approach things. That can lead to a really positive discussion and does make me think about how I approach cases. If you are feeling particularly dastardly ask them whether there is value in pre-anaestheic bloods, or whether we should routinely castrate dogs.............

RE: Dealing with new graduates

Michael Woodhouse — Sun, 17 Mar 2019 23:25:45 GMT

[quote user="charlievelyn"]Personally, I find this type of 'us' and 'them' language really disheartening.[/quote]

I'm sorry if that's how it comes across. For many reasons it's in all our best interests if we can find some real solutions here. No one wants people leaving the profession early and when we recruit we look for people who we hope will stay with us for a long time. It is inevitable that taking on a new grad will be costly in terms of time and support and we all simply hope that once they have found their feet they stay and 'repay' that to a degree. I don't want them staying because they feel obligated, but supported and part of the practice family.

One of the biggest problems seems to be the dichotomy where these days students/new grads are supported/mentored and protected more than ever and yet greater numbers leave the profession and we constantly hear about increasing stress and mental health issues in the profession.

I'm not convinced that the clients have changed that much in the ~13 years I've been working. I'm not sure the training has changed that much. What has changed is the profession itself - huge reduction in mixed practice and huge increase in corporate ownership. I think the graduates themselves have changed also, we have moved into an instant gratification world, where information has never been so readily available.

I think one problem is the teaching in universities - getting taught by specialists is nice but they are out of touch with general practice approach and disease incidence. The specialist hospitals scare you shitless that every equine colic needs surgery, lunging through the night and 100's of litres of fluids, when most are just Buscopan deficient. Maybe we need the vast majority of the teaching to be done by practitioners with a small specialist input for completeness? Ban students from spending time on EMS in referral institutes?

Taking on a new grad means you are willing to support someone through the early part of their career. Don't employ them if you aren't. I can't see why that experience cannot be gained in general practice, most of us managed. Perhaps we need to go back to compulsory OOH for a period of time? We've discussed this before but working at night alone pushes you out of your comfort zone and forces you do do things on your own (even if you can call in support, it's less available than asking someone in the same building)? OOH work made me a much better vet.

RE: Dealing with new graduates

Anthony Todd — Sun, 17 Mar 2019 18:58:50 GMT

[quote user="Tricia Goulden"]

How about asking new graduates what they hope to gain from their employment, what they believe their strengths and weaknesses are and working with them through communication and support to be the best vets they can be?

[/quote]

That sounds like a good start although everything said, bad or good etc. etc. on this thread doesn't hide the fact that new graduates need better practical, manual and inter-personal [??] ?PR?] training and therefore skills.

Even though their knowledge is great applying it, and only when relevant, is the important part.

I've already mentioned previously a colleague still in practice who's assistant leaves the consult when challenged or questioned by a client [I kid you not; just walks out!!]

While I'm sure "mutual respect" is important it isn't vital like the ability to "handle" tissue or animals, let alone transfer information and appear competent to cynical clients who have been on Google all night.

Despite David Mills' demur wouldn't it be great PR and solve a big problem if the RSPCA hospitals, and even others, started a "resident" scheme for new grads; adequately paid, loads of work, vets who can teach well and impart the tips and tricks, both inter-personally and professionally?

Doesn't the AMC in New York do this??

RE: Dealing with new graduates

Liz Barton — Sun, 17 Mar 2019 17:54:41 GMT

[quote user="Anthony Todd"]

[quote user="charlievelyn"]Mutual respect is vital for our profession to thrive and we all have much to learn from one another, older vets from new vets too, though obviously new graduates will have bigger leaps to make! [/quote]

I'd like to know what new graduates could teach experienced vets, even dinovets, that would actually be of use to them, not esoteric and rare diseases which they can now either look up on line or refer, but actual day to day stuff.

[/quote]\

Slightly incredulous about this comment Anthony Todd

Reverse mentoring for a start! When charlievelyn talks about mutual respect there is huge opportunity. We don't necessarily know if we are in fact stuck in a rut; i.e. we don't know what we don't know (the blind part of the Johari window). Not just on a clinical level, but also non-clinical. Having mentoring sessions which work both ways help us both develop and improve.

For example, a new grad with a handle on social media or new tech could hugely help with the social media presence of the practice. They could also aid with retention by feeding back on the practice and the culture, but only if their opinion is valid and valued.

I had some great discussions with my first boss about the pros and cons of tinkering with our GA protocols; it was a real two way conversation so I felt encouraged and valued as well as challenged to justify my ideas with good science balanced with costs. Win-win.

My favourite quote from the wisest person I know was 'Seek to learn something from everyone you meet'.

RE: Dealing with new graduates

Anthony Todd — Sun, 17 Mar 2019 17:46:22 GMT

[quote user="David Mills"]Bizarre.[/quote]

But there is a difference although not in the care.

On the one hand a client,attends a charity or private takes his or her animal for a procedure and pays a fee for the procedure to be done by a competent experienced named veterinary surgeon or practice.

On the other a person, not a client of a veterinary surgeon, and not yet an owner, is given, or pays for, an animal that has had a procedure performed by a qualified veterinary surgeon, who theoretically could be the same vet!

I say there may sometimes be a difference in the surgery, definitely in the representation by the practice of the surgeon, and therefore could be an awkward situation for the practice and probably the newby vet.

As I have asked, what is a better solution? How will new vets learn essential manual skills?

RE: Dealing with new graduates

Glen McIntosh — Sun, 17 Mar 2019 17:37:39 GMT

[quote user="bevs2251"]

Same in Australia. New grads today - hopeless (except those now being trained up at the "country" universities.

[/quote]

Thats interesting.

These “country” universities are the vet schools that struggle to get Boarded specialists/diplomats on staff because of their rural locale. As a result most of the clinical (and a lot of the academic) teaching is done by very competant GPs with an interest and sub-specialist qualifications (eg certificates/memberships) in their particular areas of expertise, but with their feet still firmly planted in the real world.

Similar to many vet schools prior to say 15 - 20 years ago in Australia and the UK, prior to the transformation of university vet schools into specialist referral centres.

I wonder if that has anything to do with it?

RE: Dealing with new graduates

David Mills — Sun, 17 Mar 2019 17:19:37 GMT

[quote user="Anthony Todd"]I was thinking of it from the full fee paying client in a private practice where most clients would not expect the op. to be done as "training" or practising, however good the surgeon, and certainly not by a new-grad?[/quote]

So there are now two tiers of animals, those belonging to charity-using clients, and those paying "full fees", so the former should accept a potentially lower standard of care? And no, I'm talking about basic standards here for routine procedures, not scope of service. The natural logical conclusion to your argument is that it is somehow acceptable to use charity-client pets as practice, when in reality the client is using the charity not through choice but necessity. Bizarre.

RE: Dealing with new graduates

Anthony Todd — Sun, 17 Mar 2019 17:11:22 GMT

[quote user="David Mills"]So, not really an option.[/quote]

I was thinking of it from the full fee paying client in a private practice where most clients would not expect the op. to be done as "training" or practising, however good the surgeon, and certainly not by a new-grad?

How do others propose newbies get the practice in surgery after graduation because, I think we can all agree, practice in manual skills makes better and even perfect?

RE: Dealing with new graduates

David Mills — Sun, 17 Mar 2019 16:03:24 GMT

[quote user="Anthony Todd"]That's why I favour "internship" at a charity or uni; the basic manual skills have to be learnt by practice, they can't be taught.[/quote]

I am a bit bemused about this grouping of "charity or uni" and the idea altogether.

I can't see the logic of why a charity should take an intern other than for the charity's own benefit. Veterinary charities are self-sufficient entities, which are run like businesses, and do not have the capacity to take on interns purely for some altruistic betterment of the profession. Yes, we take on approximately 15 new grads each year and they are part of a structured year-long training programme with the intention that they will go onto to work for us for some years. And we have launched an intern programme at our Brighton hospital this year. In return for a modest but reasonable salary, these new grads will learn a lot, see a lot, and progress quickly (hopefully) but the selection process is rigorous and chronically oversubscribed.

This, however, is part of our business model, not a gimme for the profession to train up better vets. Whilst the general culture of the profession is admirable in that teaching is passed on, and vets are happy to do so in most cases, this is outwith what companies including should be expected to do.

The only way I could see it could work is if the universities set up their own charities (with the help of existing charities, ideally) or paid for interns to spend a final 6-12 months with a charity hospital. RVC have recently bought an existing veterinary practice with this type of first-opinion exposure in mind, it will be interesting to see how that works out in the coming years. It is encouraging that (some) institutions have seemingly recognised the issues facing new grads.

Then of course is the question of capacity. Veterinary graduates are being produced in ever greater numbers - Nottingham are doubling their intake this year to "help with the graduate recruitment crisis" , Surrey are about to produce graduates, Keele want in, as do Aberysthwyth, and I'm sure other second-rate universities will want a piece of the financial pie soon.

There will be something in the region of 1000 veterinary graduates/year henceforth.

The PDSA have 52 hospitals, the RSPCA around 6 of any capacity, the Blue Cross 3-4, and the smaller charities somewhere in the region of 10 between them, not all hospitals but clinics and rehoming centres. That's a maximum of, generously, 80 suitable charities, all with different business models and focuses. Even if you took off equine and farm vets from the graduates (about 20%), that would mean around 10-12 interns at each hospital.

So, not really an option.

RE: Dealing with new graduates

Tricia Goulden — Sun, 17 Mar 2019 15:43:45 GMT

RE: Dealing with new graduates

Anthony Todd — Sun, 17 Mar 2019 13:19:49 GMT

[quote user="Neil Wheadon"]Where do I start?[/quote]

Apart from the advances in analgesia and the advance in rabbits' medicine I'd be very surprised if most older vets weren't pretty familiar with all the items mentioned aided now by the ready availability of information sources.

Most older vets I know don't have too many knotting problems, whatever knot, because that largely comes with a lack of practice experience and repetition.

What isn't so readily available and is, frankly, in practice, much more important, is the way to do things and interact with clients which was what I was suggesting. Most of these skills demand practice and success can't be measured easily nor can they be easily taught.

Young vets leaving the profession, knowing it all, yet still unhappy, is the problem and will continue if all that is needed is knowledge.

RE: Dealing with new graduates

Neil Wheadon — Sun, 17 Mar 2019 11:36:40 GMT

[quote user="Anthony Todd"]I'd like to know what new graduates could teach experienced vets, even dinovets, that would actually be of use to them, not esoteric and rare diseases which they can now either look up on line or refer, but actual day to day stuff.[/quote]

Where do I start?

Aberdeen Knot

Feline Cystitis

Gingival Flaps

Analgesia

Rabbits!!

Need I keep going, it's symbiotic

Neil

RE: Dealing with new graduates

Utlendigur — Sat, 16 Mar 2019 22:20:29 GMT

Just speechless at this comment.

RE: Dealing with new graduates

Anthony Todd — Sat, 16 Mar 2019 20:53:38 GMT

[quote user="charlievelyn"]I think first opinion exotics is a good example of this. I know my teaching and exposure was far more comprehensive than my colleages, simply because so much more is happening within this area than ever before.[/quote]

Point taken, but I'd like to see the numbers in an average small animal practice, not a specialised rabbit practice.

Of course there are many areas of veterinary science to explore and "gain respect" but, if a newbie is in a typical SA practice, it's the basics "ears and a-holes etc" as someone once put it, that are, or were, the essentials.

RE: Dealing with new graduates

charlievelyn — Sat, 16 Mar 2019 20:43:28 GMT

I think first opinion exotics is a good example of this. I know my teaching and exposure was far more comprehensive than my colleages, simply because so much more is happening within this area than ever before. The other vets, including my older bosses, in my team have been amazing: they’ve asked me to lead a new push to become a rabbit-friendly practice, produce materials for clients and have included different treatment/anaesthetic protocols I’ve seen used frequently by the specialists at Edinburgh in our practice manual for everyone to access. Going back to my previous point, also an excellent example of how to nurture confidence in a new graduate! But as we all independently research new cases or areas of interest, the capicity to share new knowledge is surely endless.

RE: Dealing with new graduates

Anthony Todd — Sat, 16 Mar 2019 20:19:16 GMT

Knowledge is only of value if it can be used, and is relevant to the day to day cases most vets see, and often.

99 times out of 98 it is the basic stuff that is used, and that is the stuff that isn't taught well so newbies don't realise that the rare or unusual are just that.

Nobody can be taught surgery without practising it.

RE: Dealing with new graduates

Jill Butterworth — Sat, 16 Mar 2019 18:26:13 GMT

For the OP: how about buying your new grads a copy of 'Top 100 Consultations in Small Animal General Practice'? and Claire's New vet's Handbook too?

I concur that we have had so many EMS students in the last 10 years, it's been really hard to give them all a fair opportunity.