@ Teaching > Student Rotation / Externship

Exotics Service SAMS 5415
Syllabus for Senior Students on Exotics Rotation

Department of Small Animal Medicine & Surgery
College of Veterinary Medicine
University of Georgia

Instructors / Staff

• Dr. Stephen Hernandez-Divers, BVetMed, MRCVS, Dipl. ZooMed, Dipl. ACZM
• Dr. Bran Ritchie, DVM, PhD, Dipl ABVP (avian)
• Dr. Sonia Hernandez-Divers, DVM, Dipl ACZM - Adjunct faculty
• Melissa Christian, RVT - Technician
• 2-3 nursing assistants

Course Description and Objectives

This clinical rotation focuses on medical and surgical problems of exotic pets, wildlife and zoological species. The animals seen will be primary care and referrals from veterinarians practicing outside the university, but there will also be regular visits to an aviary, and local zoo/nature reserves. Most students spend 3 weeks on the exotics rotation, but rotations may vary. The objective of this block is to develop your problem solving skills in exotic animal medicine. This is done through daily discussions in rounds and by evaluating your thought process in the records that you will keep. This will assist you in dealing with similar problems that may be encountered in private practice, zoo or institutional work. Even if you do not intend to practice exotic animal medicine as a specialty, almost every companion animal practice will see exotic pets on a frequent basis.

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. Technicians and assistants are an important part of the healthcare team and should be utilized regularly to help with patient receiving and diagnostic procedures. The technician, Melissa Christian, RVT, should be updated regularly regarding case progress (e.g., changes in therapeutic plans, results of diagnostic tests, charges to be entered etc.). Students will be expected to utilize paraprofessional staff effectively and learn how to interact with technicians and assistants in a professional manner.

Each student should label one of the file slots (middle column, bottom 5 slots) with his/her name – this will be your file slot during your rotation where faculty may return records for your attention. In addition each student should place contact information on the dry erase board on right of the examination rooms. Students can either take primary responsibility for their own cases at weekends, but it is generally better to work in pairs and divide weekend duties equally - students will be responsible for weekend treatments.

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 and faculty approved add-ons.

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

Emergency receiving
Emergency cases are received 24/7. Students will organize an on-call rota for emergencies.

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 intern / faculty include:

1. Supervision of the students 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 submissions and results
   4. Helping with procedures on the patient
   5. Advising the student regarding diagnostic strategy and therapeutic intervention
2. Facilitating that case's progress through the VTH. If needed,
   1. Helping the student schedule procedures through support services (e.g., anesthesia, radiology)
   2. Accompanying the student on consultations with surgery, dermatology, oncology, etc.
   3. Advising the student regarding case financial matters
3. Intervening when a case is not going well. Generally, this involves
   1. Accompanying the student to talk to difficult or upset clients
   2. Accompanying the student to talk to the Cashier or Hospital Director when financial concerns arise
   3. Talking to the client or RDVM on behalf of the student
4. Monitoring the medical record
   1. Reviewing the medical record daily
   2. Reading student SOAPs
   3. Proof-reading, editing, and co-signing discharge instructions
5. The intern / faculty 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
   6. Read students SOAPs daily and critique them
6. Attend case and subject rounds
7. Participate in grading of students (and, if resident, in grading of interns)

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).

You should keep the intern and faculty abreast of all 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. The intern or faculty will advise you and, if needed, help you to communicate with clients and RDVMs.

Student Duties on the Exotics Service:

1. You will be a "team player" by working well with the technicians, assistants, caretakers, and your classmates. You will help your classmates as needed, knowing that many procedures require more than one person. You will keep the number of cases assigned to you up to date on the wipe board in the exotics ward so that the case distribution will be as equitable as possible. If you know you have the fewest cases, you will volunteer to take the next emergency case.
2. You will arrive early enough in the mornings to examine and care for all your patients prior to rounds at 8:00am on weekdays. You should allow 30 minutes per ICU case and 15-20 minutes per ward case. Your ICU orders will be completed prior to 8:00 am each day. You must complete treatments by 8:00-9:00am on weekends (as determined by weekend clinician), at which time clinicians and students will review each case and distribute new emergency cases.
3. Students are expected to take a vital role in
   1. Cases presented to the hospital during normal receiving hours
   2. Taking over night-time emergency cases being transferred the next morning (distributed by faculty/intern)
   3. Daytime emergency cases presented to exotics or transferred from the daytime emergency service (distributed by faculty/intern)
4. For each new case, students (with direct intern or faculty supervision) are expected to
   1. Review the detailed case history form that all clients are expected for each new case
   2. Perform a complete physical examinations and fill out all required fields in the medical record
   3. Give a fee estimate for diagnostic evaluation and therapeutic intervention to all clients
   4. Ensure that each client leaves a deposit and contact telephone numbers when an animal is admitted
   5. Formulate a diagnostic plan for each patient
   6. Start a medical treatment sheet and attach to cage front, along with a completed cage card
   7. You will write up your admitted patients on the large dry-erase board of inpatients and any laboratory work on the large dry-erase board of lab tests. Please ensure that all laboratory tests are properly submitted (ask the tech or intern for assistance if necessary) and in the case of blood please request that all samples are SAVED in case further tests are required.
5. For in-patients, students (with direct intern or faculty supervision) are expected to
   1. Call the owners of all inpatients to give a progress report (as agreed during case rounds) and current state of their bill in the morning between 8.00 a.m. and 9.00 a.m. and before you go home. Note EVERY client communication in the treatment/progress sheets or use the client communication forms.
   2. You will ensure that all daily treatments and procedures (incl fluids and supplies) are included in the daily cost sheet and that the technician adds all incurred fees (except hospitalization) to the clients bill on a daily basis.
   3. Keep the medical record for each patient orderly and updated daily, include a daily physical evaluation
   4. Make sure that each patient is identified, clean, comfortable, and appropriately treated, and that orders for each patient are complete and accurate
   5. You will SOAP each inpatient's record each day. Daily weights and SOAPs are due by 8:00am on weekdays and 9:00am on weekends. Each active problem will be SOAPed. Problems that are clearly related can be combined (for example, decreased Ca and increased Phosphorus do not have to be SOAPed separately, but can be combined as a specified metabolic bone disease). In most cases you will begin with a large number of problems and gradually see which ones can be combined so that you will work down to one or two major problems. Remember that problems can be historical, physical, or laboratory in origin. Stay focused on your patient as you SOAP. Read textbooks for assistance in assessments, but do not copy information (such as long rule out lists) from textbooks. The content of your record should be applicable to your specific case. Be sure to include a diagnostic and therapeutic plan for each problem for each day. Tests and treatments you are doing should be boxed and checked off when done. Tests you may want to do should be listed but not boxed. When administering drugs, be sure to include the dose, route, and frequency of administration. Be sure to summarize any client communication that you perform.
   6. Return all radiographs to radiology by 8am
   7. Check for recent clinical pathology, pathology or other test results before afternoon case rounds
6. Be available through rotation with your fellow students to provide assistance for night and weekend emergencies.
7. For patient discharges you will ensure that
   1. Patient discharges are arranged with intern and/or faculty prior approval for between 4.00 p.m. and 5.30 p.m. The hospital closes at 6.00 p.m.
   2. The intern and/or faculty has reviewed and verified your medical records, and signed any discharge instructions before discharging a client.
   3. Medical records have been taken to the cashier for auditing prior to discharge.
   4. Your patient's medical records are up to date and that any radiographs, ultrasonograms, and endoscopy videos are prepared in advance to show the owner.
   5. Three copies of the following are to be prepared before discharge; discharge instructions, blood or laboratory reports, endoscopy reports, etc. One copy of these materials are provided to the client at discharge. One copy should be faxed to the referring veterinarians office, and then returned to the case record for inclusion with the referral letter.
   6. You and the technicians/assistants are responsible for cleaning your patient’s cage during its stay and after discharge.
8. You will prepare for case rounds that are held in the exotics area every morning (8-9 am) and afternoon (3-4 pm) be willing to participate in the discussions. When your case is being discussed, you will bring the record, radiographs and any other pertinent information. On the first day of presentation, give the signalment, chief complaint of the owner, summary of the history, pertinent physical examination findings and any pertinent diagnostic test results. Summarize the major problem, your major R/O, and your plans for that day. On subsequent days, give the signalment, major problems, and current status of the diagnostic and therapeutic plans. Please try to be well organized.
9. If the clinic is quiet each blood donor ferret and rabbit must be physically examined and soaped at least once on every rotation.
10. Prepare for subject rounds (radiology, pathology, didactic) generally given on Tuesday and/or Thursday mornings (or whenever time allows at faculty discretion). Further instructions will be given by faculty.
11. You will learn to utilize technical staff effectively and with due consideration and professionalism. The exotics technician can help perform and submit most diagnostic tests with you if you effectively communicate the need for these tests. They can also perform daytime treatments as long as these are listed on the treatment sheets. The assistants are also available to assist you. Learn to make these technicians and assistants part of your animal care team. Technicians and assistants have the ability to make veterinarians’ days much more pleasant!
12. Speak to a staff member if you have any problems, queries or complaints. Unlike most of our patients, we do not bite!

Please note:
You will be professional in appearance with clean, clinically appropriate smocks, slacks or skirts (no jeans), and shoes. Please wear a lab coat and ensure that your name badge is clearly visible. You will strive to keep the hospital professional in appearance by cleaning up after yourself and your patients in the ward, examination rooms, conference room and exercise areas. Your patients will be well cared for and will go home clean.
The reading room has all the exotic books available in the reserve section, and a number of books are also available in the cupboard on the left of the examination rooms.
There is a no food or drink policy in the hospital.

Student Evaluation:
You will be evaluated based upon your patient care, medical records and communication skills as appropriate. The evaluation form and the descriptions of each category are in your protocol book. Evaluation is based on: subject knowledge, the utilization, organization, and content of the problem oriented medical record, ability to identify and solve problems, willingness to participate in sit down rounds, organization and clarity of case rounds, technical abilities, ability to efficiently carry out plans, patient care, ability to relate well to people even in stressful situations, professional appearance, initiative, enthusiasm, and communication skills.

A verbal evaluation will be provided if necessary during the second week. A final written evaluation will be completed on the last day of the block and submitted to the Dean's office. Overall block evaluation is "satisfactory" or "unsatisfactory". In order to receive a "satisfactory" evaluation, the student must perform passing work in each of three major areas: knowledge and records, technical skills, and professionalism.

Attendance:
Students cannot expect to miss any weekdays without making the days up to receive a grade for the course. On weekends, students should maintain the care of their own patients or collaborate with colleagues to ensure that all inpatients treatments are always covered.

Ethics:
The medical record is a contemporaneous legal record. Therefore they must never be falsified in any manner. All information recorded must be accurate. Once written, no record may be destroyed or changed. All records must be dated and clearly and completely identified as belonging to a specific patient.

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 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).

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).

^  Top of page