Offsite Electives

Students will gain a hands on experience in a high volume, multi-doctor rural mixed practice, providing wellness, sick patient, surgical, and emergency medicine both in the clinic and on the farm. 

This elective rotation at Veterinary Specialty Hospital offers fourth-year veterinary students a comprehensive clinical experience in small animal surgery, including soft tissue, orthopedic, and neurological surgery. Because the caseload consists primarily of complex referral cases, students will function largely in an assistant role rather than as primary surgeons, as routine procedures are not a focus of this practice. A significant portion of the surgical caseload involves oncologic surgery, and students will also follow patients requiring chemotherapy planning and monitoring. In addition to surgery, students will be exposed to internal medicine cases, reflecting the multidisciplinary nature of specialty practice. Cardiac workups are performed and submitted to a double board-certified internist and cardiologist for evaluation and treatment recommendations. Diagnostic imaging,  including radiography, ultrasound, and CT is reviewed by an off-site board-certified radiologist.  Students will participate in all aspects of patient care, from initial examination and case planning through pre-operative workup, anesthetic planning, surgical assistance, and post-operative management. Under the mentorship of a Diplomate of the American College of Veterinary Surgeons, this rotation will challenge students to think critically, communicate professionally within a specialty hospital team, develop surgical confidence, and embrace the ethical responsibilities of veterinary practice.

CLINICAL ACTIVITIES:

• Major learning objectives of the externship
  • Receive practical, real-world clinical experience from a large, emergency & specialty referral hospital and VetCOT Trauma Center
  • Gain insight into the career paths of various specialties
  • Refining critical thinking and problem-solving skills by performing patient assessments, assisting with procedures, learning medical protocols, and practicing clinical decision-making
• Expected hours for daily activities (i.e. discussion/rounds, observation, online learning, and/or clinical experience)
  • didactic lectures- one hour daily
  • Patient review/discussion rounds- one hour daily
  • Clinical experience- 8 to 10 hours daily
• Day-by-day schedule
  • Morning didactics from 7am-8am, Grand Rounds 8am-9am, with department specialist until end of day. Internal Medicine is 7am-6pm M-F.  Appointments are seen in the morning and procedures and discharges are done in the afternoon (every day).  We have six total IM doctors and the externs time might be split among all of them, depending on extern's interest and the daily caseload. However, most externs in IM stay with Dr. Noonan for the bulk of their time.
• Volume/type of caseload
  • Hospital-wide, we see a daily average of 124 outpatients, 20 inpatients, 16 surgeries, and 41 emergencies. We are a small animal practice. Dogs and cats only.
• Activities:
  • Students are expected to listen to phone or exam room conversations with owners.
  • We encourage students to familiarize themselves with cases and practice formulating differentials, diagnostic, and therapeutic plans for patients.
  • Accompany the internist to do initial physical exams and (typically) repeat them. Once the patient visit has started, the student may be asked to help with the following tasks:
    • Record history in the medical record.
    • RDVM medical record review, if relevant – transcribe pertinent findings into the medical record if appropriate.
    • Write a physical exam/take exam notes for the doctor – this may or may not go in the medical record, depending on the case and the doctor. Even if the internist would prefer to enter his/her own exam in the record, the student should take the opportunity to write exam notes for every patient seen during the shift.
    • Formulate a problem list with differentials and be prepared to discuss this with the internist.
    • Formulate a plan and be prepared to discuss with the internist.
    • Formulate a discharge plan and be prepared to discuss with the internist.
    • Help the doctors and technicians with patient work-up – this may include helping with venipuncture, obtaining radiographs, point-of-care ultrasound, obtaining/delivering medication, etc.
    • Assist with internal medicine procedures, such as endoscopies, bronchoscopies, FNAs, bone marrow aspirates, trach./broch. washes, CSF collection, feeding tube placement, ballooning, joint taps, etc...
    • Accompany the patient to its various diagnostic or therapeutic destinations – ex. ultrasound, CT, surgery.
    • Assist the technicians with patient treatments and care, set up and breakdown of procedures, and end of day clean up.
  • What to do with downtime:
    • Read about the underlying condition of the patients.
    • Research answers to questions asked during interactions with the primary doctor.
    • Ask the technicians if you can do anything to help.
    • Ask to see cases or watch procedures on patients being seen by other doctors or follow an internal medicine patient who has been transferred to a different doctor/department.
• Case Examples in Internal Medicine:
  • Endocrine disorders- such as complicated diabetics, addison's disease, cuching's disease, pancreatitis
  • Gastrointestinal diseases- such as esophageal strictures, megaesophagus, esophageal dysmobility, GI and esophageal foreign bodies, IBD, PLE, perianal fistulas
  • Hepatic disorders- such as potosystemic shunts, microvascular dysplasia, hepatic lipidosis, cirrhosis, cholangiohepatitis, gall bladder disease
  • Immune-mediated diseases- such as IMHA, IMTP, evan's syndrome, immune-mediated polyarthritis
  • Infectious diseases- such as leptospirosis, FIP, blastomycosis, babesiosis, cryptococcosis

SCHOLARLY ACTIVITIES:

• We have daily didactic rounds/lectures for our interns, residents, and externs from 7am to 8am. They include:
  • Journal Clubs- ECC, Sx, and IM
  • Didactics/Lectures- ECC, radiology, neurology, rehab, integrative med, cardiology, social work/client communication, internal medicine, anesthesia, surgery, ortho rounds, ECG rounds, oncology, and radiation therapy
• Intern/Resident Presentations are monthly 

Bringing into exam rooms for appointments to interact with clients and patients. 

Performing treatments (blood draws, cystocentesis, injections, etc.). 

Surgical scrub-in/assistance.

Case reviews. 

Shadowing and assisting the doctor and staff in general small animal integrative holistic practice appointments and surgical procedures.  Improving communication skills with clients by discussing treatment plans, differentials, client concerns and cost of treatment.  Potentially counseling clients through quality of life assessment and end of life decisions.

We are a certified gold Feline Friendly 4-DVM feline only urban practice. We have  heavy internal medicine and dentistry case loads. Students will shadow DMVs in rooms and in surgery. One DVM does regular abdominal ultrasounds. We have a traveling cardiologist who comes in several times monthly. They will have access to the computer software system to look at cases and come up with assessments and treatment plans. They can often practice exam skills on drop-off patients. They can shadow technical and reception teams if desired. They can discuss practice management with the practice manager if desired. 

We are a rural, independently owned small animal general practice located in Northwestern Vermont.  Our team is passionate about animal care and client relationships, and we strive to provide quality medical care, a low stress environment, and preventative care strategies to keep our patients happy and healthy throughout their lifetimes.  Our practice includes 2 veterinarians and 5 veterinary technicians.  We offer wellness appointments, general surgery and dentistry, and same day urgent care appointments when available. We are happy to help coordinate and support our clients when the situation requires a referral to a specialty or emergency practice.

Students will be mentored by experienced DVMs and the Medical Director. Supervision is tailored to the student’s current proficiency level and university requirements, moving from direct observation to supervised hands-on participation as competence is demonstrated.

During the externship, students will focus on four primary areas of professional development. First, they will build Diagnostic Proficiency by refining their ability to perform thorough physical examinations and develop comprehensive diagnostic and treatment plans. This is complemented by gaining hands-on Clinical Skills through common procedures such as venipuncture, catheter placement, and surgical assisting. Beyond technical tasks, the program emphasizes Client Communication, allowing students to observe and practice the delivery of medical recommendations and participate in sensitive client discussions. Finally, externs will gain a deep understanding of Professional Workflow within a high-volume practice, mastering the administrative and operational side of veterinary medicine, including professional medical record-keeping (SOAPs) and essential inter-departmental coordination.

Student will shadow tech to gain knowledge of how rooms and appointments work. Will then go back into room with vet to work up the case if sick or perform preventative exam and vaccinations.

Student will learn how to draw blood and then will draw blood on their own if they are comfortable.  Blood is drawn away from the client so there will be no pressure on the student.

Main focus is to learn how to approach sick pet, how to perform annual exam and get the patient on vaccination schedule rather than having them come 3-4 times a year.  Also how to talk to client about diagnostic work up and why, not just running every blood test.  I always ask students and new vets what they are looking to gather from blood work.  I find a lot of vets end up looking for abnormalities and then seeing if that can be tied the pet's issue.

I want the student to feel comfortable with the client and to talk at their level and not over client's ability to understand. I feel being able to communicate with client is the most important part of veterinary medicine.  Anyone can give shots but if there is no open communication then the client is not likely to return. 

General practice hospital focused on the spectrum of care for small animals in Puerto Rico.