;

AVA clinical veterinary internship guidelines

Print

Ratification Date: 23 Feb 2024

Policy

  1. Internships should be structured training programs designed to provide mentored, experiential clinical training for veterinarians seeking to advance their competence and prepare for membership, residency, advanced specialty training or high-quality clinical practice.
  2. Internships should be a mutually beneficial arrangement that provides both an educational program for the intern and a service benefit to the hospital – achieving a balance between these aims is important.
  3. A formal written employment agreement should be in place between employer and intern; recommendations for inclusions in this agreement are outlined below.

Background

Veterinary internships are valuable as they help develop and enhance veterinarians’ skills; with the individual veterinarian, practices, pet owners, patients and the veterinary profession ultimately benefiting.

Veterinary clinical internship programs may be offered by university or private/corporate practices and taken up by veterinarians that are new graduates or experienced veterinarians seeking to upskill or change direction. Interns typically rotate through several speciality areas but may focus on a single area. Internships are usually completed over a 12-24 month period.

For an internship to be positive and formative, working conditions must support the mental, physical and social health of the intern and facilitate their optimal learning and performance, whilst being of benefit to the hospital (Lunn et al 2019). Establishing a clear, mutual understanding of what is being provided and what is expected in return is necessary to create this balance between the health and learning of the intern and case/business outcomes.

The AVA Clinical Internship Guidelines are intended to establish the obligations and reasonable expectations for internship providers as well as participants.

Recommendations

  1. Employment Agreement

All interns should have a written employment agreement that specifies responsibilities, salary, after-hours requirements, and relevant insurances that protect the intern.

Minimum employment conditions are dictated by existing statutory and regulatory frameworks such as the Animal Care and Veterinary Services Award 2020, National Employment Standards and the Fair Work Act, 2009.

The Animal Care and Veterinary Services Award 2020 outlines specific requirements relating to the structured internship training program. These should be considered a minimum and working conditions should exceed this safety net. 

  • Interns must receive payment that meets or exceeds those documented in the award for required practice duties.
  • At the commencement of the internship an agreement will be entered into which includes clarification of the following matters;
    • The goals of the program and the expectations of both parties.
    • The time devoted to the agreed clinical duties and responsibilities associated with the training program i.e. the rostered hours.
    • Whether overtime is or may be required; and how the intern will be compensated for the overtime.
    • Whether on-call is or may be required; and how the intern will be compensated for on-call responsibility.
    • The provision and type of structured training and supervision and whether this includes formal teaching time (such as lectures and tutorials)
    • The name of the interns’ primary clinical supervisor and/or mentor. Ideally this person is a specialist in a relevant discipline.
    • The access that the intern will have to the practice for observation and study.
  • Agreements must be recorded in writing and kept as a part of the time and wages records kept by the employer.

Any changes to the working conditions agreed prior to commencement should be by mutual agreement and in writing.

It is recommended that second year interns be designated as “Senior Intern” and that this role attract a higher level of pay and responsibility.

Veterinary practices must have current professional indemnity insurance and operate from premises that are approved by the relevant registering authority and are appropriately equipped with diagnostic and therapeutic equipment for the provision of advanced training. The agreement must ensure that the intern is adequately covered or aware of all appropriate insurance, including income protection, professional indemnity, vehicle and any other insurance relevant to the particular needs of the delivery of veterinary services.

  1. Induction program

Internship providers should have mechanisms in place to induct new interns into the veterinary business when they commence and at the beginning of each rotation to a new service. Induction should cover workplace procedures, occupational health and safety policies and procedures of the practice, customer service, drug prescriptions and staff responsibilities. A manual of practice policies and procedures pertaining to the day-to-day administration of the practice is to be commended as a basic requirement for ALL employees to follow.

  1. Case responsibility

Internships vary in their expected degree of case responsibility. This should be specified in writing in the employment agreement. Where case responsibility is expected, interns appreciate and benefit from a gradual or phased transition to greater responsibility with a safety net of senior clinicians and specialists. The volume, range and complexity of workload can be gradually increased, in consultation with the intern, as their confidence and competence grow (Allister 2020, Gates et al 2021). Primary case care responsibility for complex cases under the supervision of a specialist is considered optimal to maximise the value of the educational experience.

The first year of an internship should not include patient care responsibility where the intern is the only veterinarian in the facility.

  1. Caseload

Interns benefit from exposure to a broad caseload where they can gain proficiency through repetition of basic tasks and acquire greater understanding of the approach to complex cases.

Where the internship is rotating, the services involved along with the schedule for rotation through the services should be documented in advance. (Lunn et al 2019) The percentage of time the intern is assigned to first opinion (primary care) clinics and overnight primary emergency should be appropriate for the learning objectives. An intern should spend no more than 25% of the program on primary emergency duty, unless the internship is in emergency medicine and critical care.

Caseloads that are both too high and too low can inhibit learning. The workload of interns (hours, pace, breaks) must be closely monitored and managed to maintain their health and learning. Long work hours have been documented to have a negative impact on the well-being of interns (Lunn et al 2019).

There should be a reasonable amount of time assigned during working hours for research activities relating to cases seen.

  1. Clinical supervision, feedback and support

Clinical supervision and support are integral to the learning experience of an intern. Interns learn from actively shadowing specialists, discussing cases with them and other skilled members of the team. Daily rounds allow case management plans to be reviewed in association with a specialist.

The percentage of working time where direct supervision is provided should be no less than 70% for at least the first year of an internship. Direct support and supervision mean the supervising veterinarian is in the building and available to the intern. Access to indirect supervision by telephone should be available at all other times.

Any requirement for teaching under-graduate students should be agreed in writing prior to commencement.

Interns require regular performance feedback delivered in a psychologically safe setting to facilitate growth in their confidence, skills, applied knowledge and self-awareness. Daily, on-the-job feedback is provided by the clinical supervisor. More formal evaluations and meetings are recommended on a monthly or quarterly basis (Lunn et al 2019).

An appropriate number of veterinarians, veterinary nursing and administrative staff should be available to provide adequate support for the educational program. Intern time spent performing nursing or administrative duties should be limited.

Clinical support is vulnerable to staffing changes. In these cases, a conversation between employer and intern should specify the arrangements made to provide meaningful learning support.  

  1. Mentoring

Interns are encouraged to have a mentor in addition to their clinical supervisor. This person may be within the practice or external, for example as part of the AVA graduate mentoring program.

  1. Didactic Learning

While internships are primarily based around experiential learning, an effective internship also includes regular didactic components such as tutorials, journal clubs, seminars, lectures, morbidity/mortality rounds, etc.

The intern should be expected to periodically deliver a professional presentation or seminar to work colleagues or at a professional meeting or conference.

The intern should be encouraged to publish at least one journal article during their internship.

Funding to attend conferences or other CPD opportunities is desirable to promote the importance of continuing education and lifelong learning.

  1. Building professional support networks

Facilitating interactions between interns within and in outside practices is beneficial, as is encouragement of interns to participate in the wider veterinary community.

Involvement of interns in the AVA should be promoted. Payment of AVA membership will assist this. Interns may have an AVA mentor, utilise AVA resources, be involved with branch activities and/or attend continuing education courses and conferences.

  1. Continual improvement of the internship program

Internship providers are encouraged to monitor their programs’ quality and identify areas for improvement.  Exit interviews should be conducted upon completion to identify areas for program improvement.

The provider should keep records of:

  • The number and percentage of interns who have completed the program per year for the past 5 years
  • The percent of interns who confirmed in their exit interview that their learning expectations were met by the program
  • The number of interns who completed their membership during a subsequent residency or in the following year in the past 5 years
  • The number of interns from the program who applied for a residency in the past 5 years
  • The number of interns from the program who accepted a residency in the past 5 years including the completion rate.

These details should be made available to assist future intern candidates in assessing the internship program.

  1. Normalise and encourage help-seeking

Professional emotional support (psychologist, counsellor, coach etc) should be made available and accessible for interns without fear of career detriment. Early discussion that normalises help seeking and demonstrates its’ benefits, helps to reduce the recognised stigma which works against help-seeking behaviour in veterinarians (Allister 2020).

Resources include AVA telephone counselling, the workplace employee assistance program and relationships between the workplace and providers of psychological and coaching services.

  1. Workplace Culture

There is ample evidence that positive workplace relationships and systems contribute to employee satisfaction, motivation and retention (Moore et al 2014, Wallace 2017, Kersebohm et al 2017)

Engagement with AVA workplace wellness and sustainability policies (see below), programs such as AVA Employer of Choice, and attendance at Veterinary Business Group events, assists with the creation and maintenance of a supportive and positive culture.

  1. Dispute resolution

Workplace relationships are strengthened when employees can have open and honest conversations with their employers. A means to air grievances should be provided. Where the psychological safety needed for such a conversation is lacking, interns are encouraged to take an alternative path to address their concerns. They may consult:

  • A trusted peer or colleague
  • Their AVA mentor
  • The AVA HR advisory service
  • The Fair Work Authority in their respective jurisdiction

Relevant AVA policies and positions statements - workplace wellness and sustainability:

  1. Great veterinary workplaces(2023)
  2. Safeguarding and improving the mental health of the veterinary team (2021)
  3. Animal welfare and human wellbeing – vulnerability of clients and veterinary staff (2023)
  4. Equality, diversity and inclusion  (2017)

References

Allister R. Veterinary Transition Study - investigating the transition from veterinary student to practising veterinary surgeon: prospective cohort study. 2020 http://dx.doi.org/10.7488/era/551

British equine veterinary association internship guidelines https://www.beva.org.uk/internships

Gates MC, McLachlan I, Butler S & Weston JF. Experiences of employers, work colleagues, and mentors with new veterinary graduates and preferences towards new graduate support programmes, New Zealand Vet J 2021, 69:1, 38-50, DOI:10.1080/00480169.2020.1805373

Kersebohm JC, Lorenz T, Becher A, Doherr MG. Factors related to work and life satisfaction of veterinary practitioners in Germany. Vet Rec Open. 2017;4(1):e000229. doi: 10.1136/vetreco-2017-000229.

Lunn DP et al. AAVMC Internship Program Guidelines 2018. J Vet Med Ed 2019, 46(2);139-144 https://doi.org/10.3138/jvme.0718-082r

Moore IC, Coe JB, Adams CL, Conlon PD, Sargeant JM. The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics. J Amer Vet Med Assoc. 2014,245(5):513-24.

Wallace J. Burnout, coping and suicidal ideation: An application and extension of the job demand-control-support model, Journal of Workplace Behavioral Health 2017,32(2), 99-118, DOI: 10.1080/15555240.2017.1329628