Goodwill and gratitude are integral to extramural studies (EMS), with student placements often depending on vets grateful to predecessors who did the same for them. This puts an onus on the students to make the most of the experience; however, as Claire Millington of the RCVS communications department explains, practices can also help placements go well
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The four parties of EMS
Each of the four parties with an interest in EMS placements – the student, the university, the host practice and the RCVS – has a distinct role. For practices, this is principally to let students observe real-life veterinary work and to let them practice (under appropriate supervision and direction) the skills and procedures they have been taught at university. Practising under supervision must also be subject to each student's level of competence, which, in part, will depend on which point they are at in their course. And as the structure of some courses is changing, practices may see some students in the earlier years of their degree. Guidance for practices on EMS, including course structures, is provided by the RCVS and the universities – and students are expected to bring copies of this with them to their placement.
‘Practices expect students to be a conduit for information and to contact the practice well ahead of the placement,’ says Ed Hall, EMS coordinator at the University of Bristol (pictured right). ‘It's useful if you can nominate a person in the practice to act as a contact point with the student – it can be an assistant or a veterinary nurse and doesn't have to be the senior partner.’ He also points out that students on placement receive no funding, so any help with accommodation is gratefully received.
Students have a responsibility to prepare properly for each placement and to behave professionally once there. The online EMS ‘driving licence’ for students (developed at the universities of Edinburgh and Bristol and the Royal Veterinary College) is a free tool for students to use to prepare for EMS. There are both clinical and preclinical versions, which set out what is generally expected in different types of practices.
‘Students do need to understand basic farming and animal husbandry before coming to us for clinical EMS,’ says Clare Tibbs, a partner at Tibbs and Simmons farm animal practice at Redhill. ‘This will help them avoid saying daft things in front of farmers, such as cows have only 180-day pregnancies.’
Practices can ask students to do these EMS driving licences before they arrive – and to bring the certificate to prove it.
‘They should also go over their lecture notes because we know what stage they are at in their course and will ask what they've done,’ says Mrs Tibbs. ‘Some say they've not done this or that for a while – they should spend a weekend before they arrive going over what they've done that might be relevant. It's the same when we recommend they read up on something – some don't but others are really enthusiastic and come back with loads of stuff, which is interesting for us too.’
Start with realistic objectives
‘Each student should try to speak at the start to the person nominated as their contact so they can say what they want from the placement,’ says Professor Hall, although he points out that students can feel overwhelmed, so it's sometimes helpful if the practice initiates this discussion.
Students are also encouraged to link their objectives to the Day 1 competences required of veterinary surgeons, so if a desired objective seems unrealistic, or the student is not yet ready, this could help a practice suggest some alternatives. The RCVS also expects this year to introduce a new section of the online professional development record, for students to record their experiences on EMS and in clinical rotations, to be known as the student experience log. This will provide a running record of the student's practical and clinical experience, and help to identify the gaps that need to be filled, or where further practice is needed.
‘We ask what year the students are when they come, and what they are happy to do,’ says VN council member, Liz Cox (right), who arranges EMS placements at Golden Valley Vets, a small animal hospital in Nailsea, Somerset. ‘Obviously, a third-year will spend more time observing, and a final-year student is likely to do more surgical procedures, with a vet scrubbed in alongside to supervise.’
At some universities, students are encouraged to develop relationships with a ‘base practice’ that they can return to for further EMS. This helps practices to gauge the student's competences and minimises disruption. Over time, the student can start to be a useful extra pair of hands as they become more familiar with the practice protocols.
‘When I started my first clinical placement I was really conscious that EMS is a goodwill thing,’ says Bertie Phipps (right), president of the Liverpool University Veterinary Society for students. ‘I spent the first couple of days trying to make sure I didn't tread on any toes before asking if I could try some things like taking a blood sample or placing a catheter. You can adapt your objectives as you go along – try to build a rapport with vets, nurses and reception staff, be quietly confident, and ask if a vet or nurse will show you something.’
Factoring in some extra time for EMS can also help placements go well. ‘As well as offering a variety of cases, I do think practices need to be willing to give students time,’ says Ms Cox. ‘Things can take two or three times as long if you're supervising a student.’
She also points out that students need to ask questions, although it is a skill in itself to know when to ask. ‘Students often don't want to interrupt if someone's in the middle of a complicated procedure, but they can always leave it 10 minutes and ask afterwards. Or ask the VNs – sometimes the nurses can talk about things in terms that are more relevant to a student.’
Straighten out problems early on
Most placements do go smoothly but if there are problems it's best that practices try to sort them out while there is time to do something about it. Talk to the student about what's wrong and consider contacting their university's EMS coordinator to help straighten things out. If a practice has serious concerns about a student, it should contact the EMS coordinator at the university straightaway.
‘There can be a personality clash, it may not be what the student was expecting or there may be a misunderstanding about what students can do,’ says Professor Hall. ‘We have fewer issues about professionalism; although we can and will pull a student from a practice if their behaviour is unacceptable, we'd be happier to get a phone call early on.’
One area of friction can be students not displaying interest. As Professor Hall points out, all students need to gain a basic level of competence in all main animal species, no matter what their ambitions are for their later career. ‘If someone isn't engaging, ask them why; some students can simply feel daunted,’ he says. ‘If they are indifferent, though, the practice can contact the relevant EMS coordinator to try to sort it out.’
The RCVS guidelines on EMS do not require a set number of weeks to be spent in specific types of practice, and there is considerable flexibility for the student and their tutor to plan placements to suit the student's individual learning needs. So there is little excuse for a student not to take an interest in any placement.
‘It makes a real difference if students engage – vets want to take them out to show them more interesting things,’ says Mrs Tibbs. ‘We fully appreciate that not everyone wants to do large animal practice but it's no good turning up and saying you don't want to do this or that, or to get dirty.’
At the end of the placement a practice should be asked to complete a feedback form on the student. All the universities use the same feedback form, which helps those practices that take students from different vet schools. Feedback is important to the student's ongoing training, so it's important that a practice is clear and honest in its assessment. The university may discuss this feedback with the student. If a practice wants to give more detail than the form allows, it can contact the relevant EMS coordinator directly. The university will also ask the student to give feedback on their placement.
Why offer EMS?
All the unpaid time and effort practices put into offering EMS highlights just how much goodwill is involved. So why do practices do it? ‘We very much like having students – it keeps you on your toes and up to date with current thinking,’ says Ms Cox. ‘We have the odd vet who has been known to be disappointed if there's not a student in!’
‘Students bring new ideas into the practice and tell you about what they're learning – you do miss things in Veterinary Record and it keeps you in touch with veterinary education,’ says Mrs Tibbs. ‘There is no business case for having students, though – I offer placements because I think, well, somebody did it for me.’
With the increased flexibility provided by the RCVS guidelines, it is hoped that more students will be able to return to the same practice for subsequent placements, so that mutual familiarity and trust can develop. In this way, students are more likely to become a useful member of the practice team.
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