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Internship in Exotic Animal, Wildlife and Zoological Medicine

• Internship description
• House officer syllabus
• Interns at work

Exotic Animal, Wildlife & Zoological Medicine Internship Description

The exotic animal, wildlife and zoological medicine 1-yr internship emphasizes clinical training in basic and advanced principles of exotic animal medicine and surgery. The clinical work is approximately distributed as follows: 45% avian, 35% mammals (incl primates), 15% reptiles (incl venomous), and 5% fish/amphibians/ invertebrates. There will also be opportunities to participate in clinical research, and publications in peer-review scientific journals or other veterinary periodicals are encouraged. Past interns of this program have been very successful at achieving residency/zoo placements. This program is also accredited by the Royal College of Veterinary Surgeons as an approved center for specialist training in zoological medicine.

A typical day starts at 7.30-8.00am and finishes at 6.00-7.00pm, but is dependent upon case load. The exotic animal, wildlife and zoological medicine service consists of one faculty member (Dr Stephen Hernandez-Divers, boarded in zoological medicine), one intern, one full time technician, three part-time technicians and senior students taking the elective exotics rotation. Interns are encouraged to attend a national or international conference, as well as college or university seminars or special lectures throughout the year. The intern will work under the supervision of senior faculty members and will be responsible for:

1. participating in the daily activities of the medical service of the hospital including primary case responsibilities and case rounds;
2. participating in weekly visits to a local zoo, nature center, or aviary;
3. providing assistance in instruction and supervision of senior veterinary students assigned to hospital duty;
4. providing supervision to the wildlife treatment service;
5. providing emergency weekend and night-time care for all species seen by the small animal teaching hospital (i.e. exotics and domestic dogs/cats) on a rotating basis with the other small animal medicine interns;
6. participating in the annual visit to the Georgia Southern University Raptor Center; and
7. presenting one 45-minute seminar to the College.

In addition, funds are available through the Pamela de Journo Endowment Fund for an intern research project. Grant proposal, animal use proposal, and research project development will be encouraged under faculty mentorship.

This is a non-degree graduate student program leading to an official University Certificate of Internship. Tuition for this graduate program is $25/semester. However, a one time application fee of $50 and student fees of approximately $460 each fall and spring/semester and approximately $270 for summer semester are required and are the responsibility of the individual. Professional liability insurance is provided, but health insurance and parking expenses (approx $360/year) are the responsibility of the individual. Ten days of annual leave and 12 days of sick leave are available.

Requirements:
Candidates must be fluent in written and spoken English (foreign graduates where the primary language is not English must provide TOEFL scores. All applicants must be licensed to practice veterinary medicine in their country of origin by the commencement date of the internship (July).

Preference will be given to candidates that can fulfill the following:

1. 2 years of practice experience in small animal/exotic or zoo animal medicine, or completion of a 1-year small animal rotating internship. General clinical competency is required for emergency duties including dogs, cats and exotics.
2. Previous veterinary experience at a US institution with a reference from the supervising veterinarian (e.g. externships at US veterinary hospitals, zoos, or private practices). An externship at the College of Veterinary Medicine, University of Georgia can be arranged.
3. Excellent academic record and previous veterinary publications. Submission of a class rank helps in the evaluation of non-US veterinary graduates.

The successful candidate will be licensed to practice within the College of Veterinary Medicine by virtue of a faculty license. The faculty license permits veterinarians from non-AVMA (American Veterinary Medical Association) accredited vet schools to practice within the internship program of the hospital, and may be obtained without examination. [To obtain a regular Georgia state license, one must be a graduate of an AVMA-accredited institution or have completed the requirements of the ECFVG (Educational Commission for Foreign Veterinary Graduates, www.avma.org/defaultecfvg.asp) program of the AVMA, and take the Georgia State Board examination. The internship cannot be used to satisfy the clinical evaluation portion of the ECFVG because of the licensure requirements.]

International applicants are required to provide two official/certified copies of their academic records from each institution of higher education that the applicant has attended. These records must include all course work. Photocopies are not acceptable. Separate proof of degrees is also required. If the original language of the academic record is not English, a certified English translation must be attached to the original. Applicants who graduated from a non-English language veterinary school must submit official TOEFL scores (see www.ets.org/toefl/ for details). These scores must not be more than two years old. Foreign applicants that have completed a year of academic study in the US can provide a university transcript in lieu of TOEFL scores. Foreign applicants must also consider application and processing time for visas well ahead of the start date.

The University of Georgia is an Equal Opportunity/Affirmative Action Institution and does not discriminate on the basis of race, color, sex, religion, national origin, age, disability, or veteran status in its programs or activities.

Further details of this internship and the matching program can be obtained from www.virmp.org

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Exotics Service SAMS 7500: Syllabus for Exotic Intern

Instructors / Staff

• Dr. Stephen Hernandez-Divers, BVetMed, MRCVS, Dipl. ZooMed, Dipl. ACZM
• Dr. Sonia Hernandez-Divers, DVM, Dipl ACZM - Adjunct faculty
• 2-3 nursing assistants

Rotation Logistics

Duration & organization:
Exotics is a 3-week rotation. There is a permanent exotics intern (unless on vacation) and up to 5 students at any one time. Any issues regarding clinic duty schedule should be brought to the on-clinic faculty member, Dr. Hernandez-Divers.

Nurses are an important part of the healthcare team and should be utilized regularly to help with patient receiving and diagnostic procedures. Nurses should be updated regularly regarding case progress (e.g., changes in therapeutic plans, results of diagnostic tests, charges to be entered etc.). House officers are expected to lead by example regarding how to leverage paraprofessional staff effectively and how to interact with nursing staff in a professional manner.

Block Schedule:

Exotic animal receiving
New cases are received on Mondays, Tuesdays, and Thursdays from 9:00 a.m. to 10.30 a.m. Rechecks can be scheduled for Mon, Tues, Thurs or Fridays from 9.00 a.m. to 10.30 a.m. Friday consists entirely of recheck appointments unless faculty approved.

Wednesdays
Visits are generally arranged to aviary or zoo. The intern has a weekly walk-through visit at Bear Hollow.

Case Assignment:
The receiving schedule is assigned the day before, during afternoon case rounds. Late additions or overnight emergencies are assigned the following morning.

Exotic Intern
The intern receives the bulk of the cases on the exotics service and is therefore an essential component of small animal hospital service. Faculty members on the exotics service have a supervisory and consulting role but do see some of their own cases, especially if receiving is busy and there are more than 4 appointments. The purpose of this structure is to give the intern maximal first-hand experience managing and thinking about exotic cases and in working with VTH clientele (i.e., the client and/or the referring veterinarians). The on-clinics faculty is the intern's supervisor for each case.

Duties of the faculty supervisor include:

1. Supervision of the intern's diagnostic and therapeutic plans. This includes, but is not limited to,
   1. Listening to the case history & reviewing RDVM information
   2. Physically examining the patient
   3. Reviewing diagnostic test results
   4. Helping with procedures on the patient
   5. Advising the intern regarding diagnostic strategy and therapeutic intervention
2. Facilitating that case's progress through the VTH. If needed,
   1. Helping the intern schedule procedures through support services (e.g., anesthesia, radiology)
   2. Accompanying the intern on consultations with surgery, dermatology, oncology, etc.
   3. Advising the intern regarding case financial matters
3. Intervening when a case is not going well. Generally, this involves
   1. Accompanying the intern to talk to difficult or upset clients
   2. Accompanying the intern to talk to the Cashier or Hospital Director when financial concerns arise
   3. Talking to the client or RDVM on behalf of the intern
4. Monitoring the medical record
   1. Reviewing the medical record daily
   2. Reading senior student SOAPs
   3. Proof-reading, editing, and co-signing the referral letter

While the intern may consult with more than one faculty member during the course of a case, major decisions regarding a case should always be discussed with and sanctioned by the on-clinic faculty. The intern should never be reluctant to page the supervising faculty. Indeed, you are expected to find your faculty supervisor and consult with/update them about the progress of your case on a daily basis.

You should keep your faculty supervisor abreast of your client and RDVM communications and with any difficulties regarding these. Most incidents of client unhappiness can be traced back to poor, incomplete, or insensitive communications (particularly regarding prognosis, pet death, or fees). Communications problems are best addressed at the earliest sign of a possible problem. Your faculty supervisor will advise you and, if needed, help you to communicate with clients and RDVMs.

Senior Students
Senior student cases are assigned by a faculty member the day before during afternoon case rounds (or the following morning in the case of over-night emergencies or late additions to the schedule).

Intern Duties on the Exotics Service: Service & Teaching

Service:

1. The intern will take primary responsibility for cases referred to the Exotics service. Such referrals primarily come from outside veterinarians but many cases present as first opinions because the owner was unable to locate an exotic veterinarian for referral. The intern will see cases coming in through the regular Exotics appointment schedule.
2. Each morning, the intern will accept and distribute amongst themselves emergency transfer cases that presented the night before (picked up from the intern on night emergency duty).
3. The intern will accept emergency transfer cases that present during daytime hours (picked up from the intern on day emergency duty).
4. The intern will (with due consultation with their faculty supervisor)
   1. Perform complete daily physical examinations on each of their patients
   2. Give a fee estimate for diagnostic evaluation and therapeutic intervention to all clients
   3. Ensure that each client leaves a deposit when an animal is admitted
   4. Formulate a diagnostic and therapeutic plan for each patient
   5. Keep the medical record for each patient orderly and updated
   6. Make sure that each patient is identified, clean, comfortable, and appropriately treated, and that orders for each patient are complete and accurate
   7. Keep clients updated at least daily and often twice daily (this may be done by the senior student, but it is the intern's responsibility to see that it is done)
   8. Contact the referring veterinarian on the day of admission with details of projected case work-up, keep the referring veterinarian updated at least weekly during patient hospitalization, and call the referring veterinarian on the day of patient discharge (or death)
   9. Write complete and accurate referral letters within 7 days of patient discharge
   10. Utilize exotic nursing staff and students to submit diagnostic samples, requests, and perform treatments
   11. Work cooperatively with ICU, anesthesia, radiology, and surgery nursing staff
5. The receiving schedule is typically assigned by faculty, but the intern may be called upon to help assign the schedule on an as-needed basis.
6. Most RDVM consultation calls are performed by the faculty members, but the head exotics technician and intern may be asked to handle consultation calls on an as-needed basis.
7. Exotic intern and faculty will provide emergency "back-up" duty for interns on the night emergency service. Such back-up duty consists of consulting on patient physical examinations, giving advice regarding patient diagnostic and therapeutic plans, and/or helping with procedures after-hours.

Teaching:

1. The intern will work with the senior student that is assigned to their case and will
   1. Ensure that the student understands the case and the diagnostic/therapeutic plans
   2. Teach students diagnostic and therapeutic procedures as needed
   3. Involve the student in all diagnostic and therapeutic procedures
   4. Review relevant pathophysiology with the student on an ongoing basis
   5. Supervise student communication with clients
2. Read students SOAPs daily and critique them.
3. Attend case rounds as described above.
4. Participate in grading of students (and, if resident, in grading of interns).

Consultation / Interaction with and Transfer to Other VTH Services

SAMS Departmental policy is that case transfers go FROM FACULTY TO FACULTY. The purpose of this rule is to minimize any information being "lost in the cracks". This means:

1. You must bring your faculty supervisor with you when seeking to transfer a case (or to send a case to surgery, neurology or oncology, even if that case is ultimately returned to our service).
2. You should seek a faculty member, not an intern or student, on the target service to discuss the transfer.

Surgery:
In most cases, the case stays with exotics but a surgeon may be asked to assist the faculty or intern during surgery.

The need for a surgeon on an exotics case should first be discussed with your exotics faculty supervisor. If that individual agrees, then you and your supervisor will approach a faculty surgeon for consultation and possible assistance or more rarely transfer.

Please be aware that surgery is an extremely busy service. Priority is given to emergency and critical cases. Elective procedures may have to wait or be discharged and re-admitted through the surgery service. Have all case materials (record, laboratory data, radiographs) organized prior to consultation. Do not interrupt the surgeons' work with a "quick" question, and do not enter the operating room and attempt consultation while surgery is in progress.

Oncology:
The need for an oncology consultation should first be discussed with your exotics faculty supervisor. If that individual agrees, then an oncology consultation form is turned in. If you have questions about staging of an oncology case, consult your medicine faculty supervisor first. If that individual does not know, then an oncologist may be consulted. Prior to turning in an oncology consultation form, you must have the following information organized:

1. Thorough description of the tumor, including exact location and measurements (fill out body map)
2. Histopathologic diagnosis (with copy of biopsy report)
3. Results of all laboratory data
4. Results of all staging tests (radiographs, ultrasound exams, bone marrow cytology, etc.)

Without this information, the oncologist cannot formulate a prognosis or treatment plan.

Please be aware that oncology is an extremely busy service that all areas of the hospital consult. It is essential that your case materials are complete and organized prior to seeking consultation. Do not interrupt the oncologists' work with a "quick" question.

As with surgery, cases for transfer must involve consultation with an oncology faculty member at which both you and your medicine faculty supervisor are present.

Neurology, Ophthalmology, & Dermatology:
These services have consultations forms that must be filled out prior to consultation. There is a charge for ophthalmology and dermatology consultations. Case consults with these services must also go from faculty to faculty. Have all case materials organized prior to consultation/transfer.

Anesthesia:
Anesthesia requests must be filled out completely and turned in before 4:30 p.m. for procedures to be done the following day. The intern must have anesthesia requests initialed by their faculty supervisor.

1. Do not have patients drop off at 8:00 a.m. if they are having major procedures (e.g., laparotomy) or if they are sick. Patients coming in on the morning of a procedure should be relatively healthy and undergoing minimally invasive procedures (e.g., dental, radiography, etc) only. If you have a question about whether it is appropriate for a patient to drop off, see your supervising faculty member.
2. You are responsible for coordinating all ancillary services (e.g., anesthesia, radiology, endoscopy) involved with your anesthetized patient. If you need help, see your supervising faculty member.

Pain management consultations may be had with the anesthesia service. These consultations are currently free of charge (there is a consultation form). A pain management flow chart exists for intensive care cases (see an ICU nurse for more information).

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Interns at work

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