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AVA Clinical internship guidelines

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Ratification Date: 08 Dec 2016

General

Veterinary clinical internship programs are usually completed over a 12 month period; the maximum time to complete an internship is 24 months.

It is optimal but not essential that graduates have completed 1 to 2 years in general practice prior to commencing an internship.

Employment Conditions

In most cases veterinary interns’ minimum employment conditions are covered under the Animal Care and Veterinary Services Award 2010. The award covers minimum wages, sets requirements relating to the structured training program, and specifies what allowances, professional development and superannuation conditions must be provided.  These are the minimum conditions; there is nothing to stop providers offering better conditions or interns negotiating higher wages and conditions.

There are some practices where an enterprise bargaining agreement may be in place. The rate of pay for an intern under an enterprise agreement cannot be less than the relevant rate of pay under the Animal Care and Veterinary Services Award 2010.

written employment contract or agreement must be created. It should describe what is being provided and what is expected. It should include:

  • The goals of the program and expectations of both parties
  • Working hours and on-call responsibility
  • Agreed clinical duties and responsibilities
  • The salary which must be commensurate with responsibility and level of training.
  • Whether overtime is or may be required; and how the intern will be compensated for the overtime
  • All benefits, such as, superannuation, personal leave, annual leave, carer’s leave, professional dues, meeting expenses, etc.
  • Any regulatory requirements, such as veterinary registration and radiology licences, and who covers the cost
  • The provision and type of structured training and supervision and whether this includes formal teaching time (such as lectures and tutorials)
  • The level of support and supervision to be provided and percentage of working time direct supervision will be provided
  • The access that the intern will have to the practice for observation and study outside normal working hours
  • A non-compete clause is not typically included in an internship employment agreement. If a non-compete clause is thought to be necessary, it should be for a reasonable time and distance parameters.

Orientation

A formal orientation program should be in place to ensure a successful clinical training experience.

A manual should be provided that describes hospital policies, standard protocols and procedures, as well as specific learning objectives and the performance evaluation processes.

Supervision

Internships must provide access to qualified veterinarians in disciplines appropriate to the type of internship. There should be at least one specialist in each discipline included in the internship.

A specialist veterinarian should be assigned as the primary mentor to assist the intern throughout the program.

The percentage of working time where direct supervision is provided should be no less than 70%. 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.

An appropriate performance evaluation should be undertaken at a minimum every six months.

Clinical Experience and Responsibilities

Primary case care responsibility for complex cases under the supervision of a specialist is considered optimal to maximise the value of the educational experience.

Participation in daily patient rounds with a specialist in attendance is optimal.

Patient rounds should include a thorough review of case management plans for each patient being managed by the intern and by the practice.

An internship should not include patient care responsibility in a secondary site where the intern is the only veterinarian in the facility.

Case review and didactic Training

While internships are primarily based around experiential learning, an effective internship must also include didactic components.

Clinical rounds/case discussions should be held at least twice weekly and may include journal clubs, seminars, lectures, morbidity/mortality rounds, etc.

The intern should be expected periodically to deliver a professional presentation or seminar to work colleagues or delivered at professional meetings or conferences.

The intern should be expected 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.

Rostering

The majority of the program should consist of time spent on clinical service with a senior, preferably specialist veterinarian.

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.

The intern must be allowed to progress at a reasonable rate without being overwhelmed by the caseload.

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

Clinical Resources

An appropriate number of general practitioners, clinical residents, specialists, and veterinary nursing staff should be available to provide adequate support for the educational program.

It is essential that a diverse and sufficient number of medical and surgical cases are available to support the internship program and the learning objectives.

Adequate diagnostic and therapeutic equipment must be available to support the learning objectives.

Current medical textbooks, a computer with access to online search engines for scientific literature and online journals should be available on-site.

Interns should expect to have ready access to practice/faculty throughout the internship.

There should be desk space assigned to the intern to allow them to study, research and write up cases.

Facilities

Physical facilities should provide an appropriate learning environment and be of contemporary standard.

Effective biosecurity and work health and safety protocols for human and animal safety are essential.

Continual improvement across intern programs

Internship providers should 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 also be available to assist future intern candidates in assessing the internship program.

References

AVMA Veterinary Internships Guidelines. https://www.avma.org/KB/Policies/Pages/Veterinary-Internships-Guidelines.aspx

Checklist to assist those seeking an internship position:

Employment information

  1. Is there a written contract?
  2. Is the salary and conditions at or above the minimum wages specified in the Animal Care and Veterinary Services Award?
  3. Is the salary commensurate with the level of responsibility expected and your level of training and experience?
  4. Is there a requirement to work overtime and if so how will you be compensated?
  5. What are the benefits that you will be entitled to:
    • Annual leave
    • Personal/sick/carer’s leave
    • Study leave (Who pays for expenses associated with study leave?)
    • Does the practice pay for your veterinary registration, radiation licence, and AVA membership?
  6. Is there a non-competing clause? Is this reasonable (both in time and distance)?
  7. Have you discussed the goals and expectation of the program? Are they in line with your goals and expectations?

(AVA Members – If you are unsure of relevant employment conditions please contact the AVA HR Hotline on 1300 788 977)

Orientation

  1. Is a formal orientation program provided?
  2. Is an internship orientation manual provided?

Supervision

  1. Does the intern have a mentor who is a veterinarian in the practice?
  2. How many full time specialists in each specialty area give direct support of internship program?
  3. What other specialists, part-time or external to the practice give support to the internship program?
  4. What veterinary residents and other senior veterinarians give direct support of internship program?
  5. What is the number of certified veterinary nurses in direct support of internship program?
    1. On a 24/7 basis
    2. Only after hours
    3. Only during working hours
  6. What caseload is available - include only hospital areas where intern will be assigned
    1. Average number of cases presented daily
    2. Average number of outpatients presented daily
    3. Average number of inpatients each day
    4. Average number of surgeries performed daily
    5. Average number of emergency cases seen daily
  7. Are written performance evaluations provided? If so, how often?

Clinical Experience and Responsibilities

  1. Does the intern have primary case care responsibility for first-opinion and emergency/critical care cases?
  2. Describe back-up available for interns when assigned to emergency duty.
  3. Is the intern the primary surgeon on a broad range of elective and entry-level procedures?
  4. Does the intern have primary case care responsibility for complex cases with supervision by a specialist?
  5. Are patient rounds held daily with a specialist in attendance?
  6. What is the percentage of time the intern will be directly supervised?

Case Reviews and Didactic Training

  1. How often are clinical rounds held?
  2. Does the intern deliver a professional presentation or seminar to senior clinicians and peers?
  3. Does the intern have an opportunity to attend professional meetings? If so, is funding provided?
  4. Is the intern required to complete/submit a publication?

Rostering

  1. Working hours and any after-hour duties
  2. Percentage of program intern is assigned to daytime primary emergency.
  3. Percentage of program intern is assigned to overnight primary emergency.
  4. Percentage of program intern is assigned to first opinion (primary care) clinics.
  5. Percentage of program intern is provided elective time.
  6. Percentage of program intern is required to work at a secondary (satellite) clinic.

Facilities

  1. Does the intern have access to current medical textbooks?
  2. Is a computer with internet access provided?
  3. Does the intern have access to search engines for scientific literature and online journals?
  4. Does the primary hospital have an intensive care unit?

Equipment – check all that apply

  • Bone Plating Equipment
  • Computed Tomography
  • Magnetic Resonance Imaging
  • Digital Radiography
  • Echocardiography
  • Electrocardiography
  • Endoscopy
  • Ultrasonography
  • Laparoscopy
  • Arthroscopy
  • Basic clinical laboratory equipment on site
  • Nuclear Medicine
  • Blood Gas Analysis
  • Diagnostic Laboratory
  • Physical Therapy Equipment (underwater treadmill)
  • Other (text box)

Outcome Assessment

  1. The number and percentage of interns who have completed the program per year for the past 5 years
  2. The percent of interns who confirmed in their exit interview that their learning expectations were met by the program
  3. The number of interns who completed their membership during a subsequent residency or in the following year in the past 5 years
  4. The number of interns from the program who applied for a residency in the past 5 years
  5. The number of interns from the program who accepted a residency in the past 5 years including the completion rate.
  6. Is an Exit Interview required? Are results available to prospective applicants?

Date of ratification by the AVA Board: 09 December 2016