Internships are popular with newly graduated vets as a stepping stone to specialisation, so to enrol as an intern after four years in mixed practice was a decision that Padraig Egan did not take lightly
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GRADUATING from Edinburgh on a rainy July day in 2007 was the start of a thoroughly enjoyable four years in mixed practice for me. The move to enrol on a surgical internship after four years in practice was not taken lightly. Internships tend to be considered as the learning ground for newly graduated vets looking to build a solid foundation in a particular discipline. I felt after four years I had a good grounding in the basics of the profession and, nearing the end of my CertAVP in small animal surgery, that a career move towards a training programme in surgery would prove most fruitful for my career ambitions; hence, I began focusing on obtaining a dedicated surgical internship.
I spent a long time looking into the positives and negatives of university- and private practice-based internship programmes. I endeavoured to talk to those supervising the internship programmes before applying to make sure I would be gaining what I wanted from the internship, and also tried to visit centres to get a full understanding of the practice dynamics and how I would fit in as a surgical intern – something I strongly advise anyone thinking of undertaking an internship to do. In the end I applied and was accepted for a position at Fitzpatrick Referrals, a private orthopaedic and neurosurgery referral centre run by Noel Fitzpatrick (aka ‘The Bionic Vet’). I was impressed by the heavy caseload and pioneering surgeries offered to patients; there was also a distinct ‘family’ feel to the practice that played a big role in making the decision to accept a position there.
An intern's life
There are six interns and we rotate through various roles on a weekly basis providing dedicated surgical assistance to one of the four surgeons operating, offering veterin-ary support to the kennel team and providing pre- and postoperative diagnostic imaging; hence at least two-thirds of our time is spent in theatre assisting with surgical procedures. The working day can vary from a sedate 8 am to 8 pm to the extreme of working until 1 or 2 am depending on the workload. Teamwork is paramount to the success of the intern team, and the tight bond between the team members was obvious when I visited the practice.
Scrub, drape, retract, close
While on surgery I scrub for anything between two and eight surgeries a day; ranging from routine fracture repairs right through to total hip and knee replacements. We are expected to quickly learn the steps of the surgeries we scrub for and the individual expectations and likes of each surgeon. A lot of my life is now spent holding Gelpi, Senn and Meyerding retractors and the record now stands at holding four sets of Gelpis with one hand during a spinal surgery! However, the interns' participation is not limited to being a human retractor; we help in surgical procedures under the careful and direct supervision of the senior surgeons and get to carry out some of the simple steps in routine surgeries. Teaching occurs mainly during surgery, when we are quizzed on surgical techniques, diagnostic imaging and the evidence behind why we are carrying out each procedure.
A factor that motivated me to apply for this position was the strong ethos placed on clinical research. Research is carried out on commonly accepted surgical procedures as well as pioneering joint replacement and limb sparing/salvage surgery. All interns are expected to submit research papers to peer-reviewed journals during their 12-month tenure, as well as endeavouring to present research abstracts at scientific meetings.
A support network within the practice allows those not familiar with research to call upon the experience of the specialists for help and guidance. I already have two research projects that I am engaged in, and hope to present a clinical research abstract at BSAVA congress next year. We have weekly journal club meetings where an intern presents a recent research paper and we discuss the positives and negatives of the paper with the senior clinicians. Although daunting at first, the experience has rapidly improved my presenting skills as well as my ability to critically evaluate clinical research papers. Our weekly learning commitments are rounded off on Friday mornings when we carry out a review of the week's radiographs with a senior surgeon.
An internship after four years in practice?
Some may regard the undertaking of a surgical internship after four years in practice as madness; going from the top of the pile to the bottom. My experience so far has been very positive, and I would recommend anyone feeling stagnant or unfulfilled in general practice to consider undertaking a dedicated internship in a field they enjoy; it may change your whole career plan.
There are obvious sacrifices made when undertaking an internship; the wages are low and the hours are long. However, if you are willing to give it your all there is a wealth of knowledge to absorb. I feel my future will focus on gaining a senior training scholarship in small animal surgery; a dedicated surgical internship with a strong grounding in research can only help me fulfil this ambition.
I will not leave this internship and start carrying out joint replacements and spinal surgery; however, I will be a much improved orthopaedic diagnostician, a more competent orthopaedic surgeon and will have an excellent grounding in orthopaedic evidence-based medicine. I'd recommend the experience to recent and older graduates alike.
▪Decide and focus on what type of internship you want – rotating or discipline-specific.
▪Spend a couple of days visiting the centre before applying for an internship.
▪Do your homework – what has the institute been researching and publishing?
▪Ask plenty of questions – is this the right position for you?
▪Prepare yourself for the realities of becoming an intern.