First Impressions Of Fourth-Year Rotations

The fourth year of veterinary school is a new world compared to the first three years.

During her externship in South Africa, fourth-year veterinary student Samala Van Hoomisen performed field work with penguins and other marine wildlife.

What’s interesting about transitioning from a student to a doctor is the way in which the everyday scenery around you changes.

Like how the small-animal hospital, once a familiar and comforting place where real veterinarians work at a leisurely pace, modulates into a meshwork of clinicians whose lives are filled with never-ending patient cases, emergencies, constant pages and sleep deprivation. 

This is not obvious during the first three years of veterinary school. Veterinarians here (aside from the dentistry folks) never really sleep, and coffee is a staple in the food pyramid.

Then there are the ICU and ward nurses, whom you know only in hallway passing during previous years–they become the most familiar faces in the hospital.

During fourth year, you discover that they are the souls of the hospital unit, existing on some sort of alien energy … never running out of patience for the animals they care for.  Honestly – I have unending respect for my profession.

Fourth-year is challenging, and an unexpected continuum of ups and downs. Sometimes you’re prepared, and other times, you fail miserably. 

Simply stated, you take what you’ve studied over the past three years and apply it to real patients. As prepared as possible, you dive into clinical cases, hoping for the best.

If you’re unlucky like me, you get assigned to small-animal medicine for your first rotation, and your first patient is a hyperosmotic, non-ketotic (HONK) syndrome dog.

How this happens, exactly – I do not know. I like to believe it is nothing more than bad luck.

At the time, I was not prepared for the questions: What leads to coma in these patients? What levels of blood glucose do you expect? What do you expect serum osmolality to be? What are the most common underlying causes of HONK attacks?

Unprepared, I was blank, stupid … paralyzed.


Rotations became less stressful when I began externships outside of the university setting.  My field of interest, international conservation wildlife medicine, led me to some amazing experiences.


What I do remember is being prepared to treat any animal presenting with diabetes mellitus/insipidus, hepatitis, renal failure, Cushing’s/Addison’s disease and hypo/hyperthyroidism. That was my basic preparation. 

Yet my brain had nothing on HONK syndrome. As far as I was concerned, I had failed all expectations.

And that was my introduction to fourth-year rotations. I was instantly reduced to a quarter-inch blob of nothingness.

But rotations continue, and you move on to the next and then others, until you realize that regardless of the rotation, you’re never totally prepared.

By my fourth rotation, I recognized and learned to despise the “question trap.” This is where you’re asked a question, and if you don’t answer it with confidence within two seconds of being asked, you get the eye-roll and the standard “look it up.”  The conversations go something like this. 

Doctor: “Samala, why are we concerned with a creatinine level of 1.7 mg/dL in this dog?”

Me: After three seconds of silence, “Well, although this is only a mild increase, it does constitute renal disease.”

Doctor: “And why is that value of particular importance in this case?”

Me: Five seconds of silence while trying to understand where they’re going with the question and construct a thoughtful response “Well, because …”

Doctor: “Why don’t you go look that up, and tell us in rounds today.”

ARGH. It is so frustrating! This happens to everyone. You never get more than seven seconds to answer a question … some students even stop asking questions altogether out of fear of looking stupid.

Still, you learn the answers cold, and never forget them. It’s all about weighing the humiliation against the learning experience.

“Seasoned” Veteran of Rotations

After “seasoning,” you forget the everyday details, and begin thinking in bigger terms. Like, why am I on this rotation? 

What experiences can I gain from my current patients? The answer is easy–to become familiar with the pathophysiology behind the multitude of cases that are presented. To LEARN!! 

That’s when I started worrying less about performance and began looking for guidance during each session. Apparently, we’re not expected to know everything upon entering each rotation. And honestly, you don’t have the experience of the school’s clinicians–you just learn as you go.

Externships

Rotations became less stressful when I began externships outside of the university setting.  My field of interest, international conservation wildlife medicine, led me to some amazing experiences.

I spent six weeks in D.C. at the USFWS working on public policy, two weeks on a directed research project titled “Anesthesia of Deep Diving Marine Mammals,” four weeks at the Minnesota Zoo and four weeks in South Africa working with penguins and marine mammals. 

Still a toss-up, my two favorite externships were in D.C. and South Africa. Both experiences deviated drastically from the clinical setting of the Veterinary Medical College. During my D.C. experience (summer 2007), I made extensive contacts with Ph.D.’s in all areas of biology working on public policy that addressed a variety of international animal species. I focused on public policy regarding the South African penguin, which was only one species of 11 petitioned for addition to the U.S. Endangered Species Act. My extensive research on this species, as well as their utilization in research regarding global warming, led me to my next rotation in South Africa.  

South Africa was amazing. The externship was strictly “field-work-oriented,” which is what I was craving.  The first two weeks, I worked at an organization called SANCCOB, rehabilitating penguins for release back into the wild. We mainly treated malaria and associated respiratory complications while I was there.

Yet with three to four necropsies a day, I continued to grieve daily over the deaths of these awesome creatures. 

The second two weeks of my externship were spent on Dyer Island, examining the breeding behaviors of local shore birds. Dyer Island is uninhabited and protected from all human contact outside of researchers from Cape Nature, the government organization that works to protect shore birds in South Africa. 

My part was analyzing aspects of breeding behavior in more than nine species of shore birds, including the South African penguin. I observed and recorded the behaviors of the penguins in their natural environment, where they were constantly in contact with predators (Cape fur seals) from a colony on an adjacent island. It was a fabulous learning experience.

Fellow Classmates

I’ve experienced numerous changes in the behavior of my fellow classmates–as well as myself–throughout this final year of veterinary school.

First, we’re all in the same boat: everyone is equally presented with the challenges of modulating from student to doctor. That alone has helped me to develop bonds with classmates that I didn’t predict in the past. Is it because we suddenly need each others’ help and guidance? I suspect that’s part of it. 

Second, we’re all reduced to “blobs” by the incessant questions/evaluations of our superiors. To me, it makes sense that we learn to connect more with our colleagues due to questioning our own decisions even if that wasn’t the case in the past.

I attribute most improvement to the humiliation of fourth-year rotations. As much as I hate the process … in that sense, I’ve truly grown up. 

Future Plans

I am absolutely planless. My plan is to let things unfold. 

My emotions–scared to death of such a nebulous future. 

I’m left-handed, and therefore like to think that my indecisions are due to that, although “that” is not reasonable thinking.

Mostly, I can’t think beyond the moment, as I get too wrapped-up in accomplishing the present. I need to take things one day at a time.

How is it that my classmates have managed to either secure their future jobs already, or have lined up future interviews (and I have not?!). I’m behind, yet I’m leaving all doors open. At this moment, that is all I can offer. 

Samala Van Hoomissen is a fourth-year veterinary student at the University of Minnesota College of Veterinary Medicine. She is a former VPN columnist who wrote about her experiences as a veterinary student. She graduates in May.

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