Introduction to Clinical Rotations

Wayne Sylvester, DVM, MSc 

• Associate Professor
• Email Address:  WSylvester@sgu.edu
• Telephone: 444-4175 Ext:3600
• Office Location: Small Animal Clinic
• Office Hours: By appointment

Alfred Chikweto, BVM, MSc, PhD

• Associate Professor
• PathoBiology Department
• Email Address:  achikweto@sgu.edu
• Telephone: 444-4175 Ext: 3345
• Office Location: Small Animal Clinic
• Office Hours: By appointment

Kerri Nigito, DVM, CPH, MPH, DABVP (Food Animal Practice)  

• Assistant Professor
• Large Animal Medicine and Surgery Department
• Email Address:  knigito1@sgu.edu
•  Telephone: 444-4175 Ext: 3839
• Office Location: LARF
• Office Hours: By appointment

• LARF or Private Farms

• Necropsy Laboratory

• Clinical Pathology Laboratory

• Parasitology: Bacteriology Laboratory

• Zoom for online students

Notes from previous terms.

Necessary resources will be posted on SAKAI by faculty members responsible for each section.

Large Animal Internal Medicine, Bradford P. Smith, 5th edition.

Material covered in previous courses (example: anatomy, physiology,

LAMS 501, LAMS 502, LAMS 503, LAMS 516, LAMS 519, SAMS 520, SAMS 522, SAMS 515, SAMS 526, SAMS 527, SAMS 514) is considered appropriate material 

1. Students who need accommodations should contact Student Accessibility and Accommodations Services (SAAS), located in the Welcome Center, inside the International Students Office.
2. Information can be found at mycampus.sgu.edu/group/saas

Supplies, attire and etiquette expected, and schedules for each rotation may be found within the individual rotation content.

• Companion Animal Medicine Rotation (SAC) - pg. 16
• Surgery and Anesthesia Rotation – pg. 18
• Emergency and Critical Care Rotation – pg. 22
• Radiology – pg. 28
• Ambulatory – pg. 31
• Diagnostics – pg. 36

This revised course is a combination of 3 courses (Laboratory diagnostics, Ambulatory Services, and Small Animal Clinical Services) previously offered by 3 different departments. This will be a 2 credit course giving students exposure to the practical aspects of laboratory diagnostics (necropsy, clinical pathology, and parasitology), large animal medicine and surgery, ambulatory services, small animal medicine and surgery, emergency medicine, and shelter medicine. Teaching will be conducted in small groups of about 10 students predominantly in a laboratory format contrasting to regular didactic lectures. This applied course will build on the concepts from theoretical lecture and lab courses covered in terms 1-5 and aims to prepare 6th term students for their year 4 clinical rotations at the associated schools/colleges. Students will rotate through several different areas, mentioned above, over 10 weeks throughout the term.

Upon successful completion of this course, the student will be able to:

1. Perform and interpret physical exams on farm and small animals and apply the appropriate diagnostic and treatment plans.
2.  Demonstrate effective client and colleague communication in a professional and concise manner. 
3. Prepare and deliver a case presentation using clinical cases.
4. Manage cases including history taking and client interaction, physical examination, diagnostic work-up, problem solving, development and implementation of therapeutic plan.
5. Describe radiographs using standard terminology, propose a diagnosis, and recommend further diagnostic tests and treatment. 
6. Perform a complete necropsy and collect samples for histopathology and other ancillary diagnostic tests.
7. Make a morphologic diagnosis and generate a list of differential diagnosis.
8. Perform fecal, blood, urine, body fluid and cytologic examinations for parasitology and clinical pathology, make a diagnosis and recommend treatment and control strategies.

1. Introduction of SAMS 528 course. Wednesday, January 19^th, 2022 at KB Taylor Hall Blue from 1:30pm-3:20pm. All 6th term students must be present.
2. Please find the rotation schedule under “Syllabus” folder in Sakai 
3. **Rotation-specific schedules and details can be found in their individual sections of this syllabus.

Beginning of term Orientation  

Orientation will take place Wednesday, January 19^th from 1:30- 3:20pm at KB Taylor Hall Blue

Location for Rotations: 

• Companion Animal Medicine (SAC), Surgery and Anesthesia, and Emergency and Critical Care take place at the Small Animal Clinic. 
• Radiology takes place at the SAC conference room. 
• Ambulatory takes place at the LARF and private farms
• Parasitology takes place in the Bacteriology laboratory
• Necropsy takes place in the Postmortem/Histopathology laboratory
• Clinical Pathology takes place in the Clinical Pathology laboratory

Rotation Days and Times:  

• Companion Animal Medicine (SAC): 1:30pm until done on Tuesday - Thursday 
• Surgery/Anesthesia: 1:00pm until done on Tuesday-Friday  o Students assigned to Tuesday surgery should evaluate surgical patients on 

Monday afternoon at 5:30pm or another time previously arranged for students in Monday afternoon selectives.

• Emergency and Critical Care:
• Tuesday-Friday 5:00pm-8:00pm (*However, working with emergencies cases may take longer
• Radiology: Thursday or Friday afternoons, either starts at 1:30pm4:30pm, a few groups  start either  at 2:30pm or at 3:30pm  (see schedule in rotation section for more specific details)
• Ambulatory: Tuesday-Thursday 12:45pm - until done (see schedule in rotation section for more details) 1:30pm for LARF sessions
• *Parasitology: Tuesday and Thursday 1:30 - 3:30pm
• *Clinical Pathology: Tuesday, Wednesday and Thursday/Friday 1:30pm - 3:30pm. 

For online students in groups 10,  Clinical Pathology sessions are from   2.00pm to 4.00pm.

• *Necropsy: Tuesday, Wednesday, Friday 1:30pm - 3:30pm

*However, on occasions, necropsy sessions may take slightly longer.

If there is any conflict between rotation dates and times and selectives, please let one of the Course Directors know as soon as possible at knigito1@sgu.edu, WSylvester@sgu.edu, or achikweto@sgu.edu.   

ATTENDANCE AND PARTICIPATION IN ALL ROTATIONS ARE MANDATORY.

Companion Animal Medicine Rotation (SAC)

Clinicians:  

 SAC Clinicians

Overall Rotation  Goal: 

The primary objective of this rotation is to improve the student's ability to verbally present a case to both colleagues and clients in both informal and formal settings. This rotation is specifically intended to prepare students for rounds during their 4^th year rotations. Under the supervision of the SAC clinical faculty and internal medicine specialists, students will be directly involved in all aspects of case management including history taking and client interaction, physical examination, diagnostic work-up, problem solving, and development and implementation of a therapeutic plan. Students will be divided into groups of four or five students per clinician.  

Rotation Overview: 

TuesdayThursday  

• Students will rotate once through the Companion Animal Medicine (SAC) rotation during the term.
• Case receiving and patient rounds will take place promptly at 1:30pm and will end when all appointments and emergencies have been completed (generally between 4:30 and 5:30pm).
• Students will be assigned to work with a SAC clinician each day in groups of  5 or 6 (depending on the number of outpatient appointments and attending clinicians). 
• The student groups are expected to assist in the receiving of their clinician's scheduled appointments and/or walk-in emergencies.
• All students are expected to participate in the receiving of cases where each student will have primary responsibility for a minimum of one case. 
• Each case received will be reviewed with the assigned clinician. 
• Students will be responsible for writing medical records including history, physical examination findings and patient discharge summaries for outpatient visits. 
• Treatment sheets, patient summaries and SOAPs may be required for hospitalized patients.  

Supplies & Attire: 

• Students are expected to bring supplies necessary for work in the clinic. These include, but are not limited to stethoscope, bandage scissors, calculator, pens, small notepad
• White coats must be worn over scrubs. 
• Appropriate closed-toe shoes are required.

Other  Important  Information

• Responsibilities, protocols and procedures at the Small Animal Clinic are listed in the Small Animal Policies and Procedures Manual, which may be found on SAKAI. 
• Experiences will vary among students depending upon the cases presenting to the SAC during the assigned week. 
• Case and special topic discussions as well as radiograph reviews will be used to supplement instruction when needed. 
• When students are not receiving cases, students are expected to perform diagnostic procedures, participate in rounds, provide medical care for hospitalized patients or perform other service duties. 
• Please feel free to contact the course director or main contact of rotation with any concerns that you may have pertaining to your experience during the Medicine rotation.

Surgery & Anesthesia Rotation

Clinicians: Dr. Francesca Ivaldi (main contacts for surgery), SAC clinicians

Anesthesia Clinicians: Dr. Miccio (main contact for anesthesia) 

Anesthesia Technician: Naudia Dundas

Surgery Specialists: Dr. Guerrero and Dr. Bruhl-Day

Anesthesia Specialist: Dr. Restitutti 

Overall Rotation Goals: 

 The surgery and anesthesia rotation is designed to introduce students to the clinical surgical and anesthesia setting and to prepare them for their 4^th year surgery and anesthesia rotations. 

 Surgery: 

 The four-day clinical rotation will focus on the clinical diagnosis and management of surgical problems observed in small animal practice using clinical cases presented to the Small Animal Clinic. Hands on experience will be provided primarily through assistance in major procedures, and through the performance of elective procedures. The student is reminded that this is not a surgery course and primary surgeries may be limited. Additional surgical training will be gained during the 4^th year; and, for those interested in surgery, electives related to surgery should be selected. 

 Anesthesia: 

 Students will participate in induction, maintenance and recovery of the Small Animal Clinic surgical patients.  Students will be expected to prepare an anesthetic protocol, discuss relevant anesthetic drugs, discuss possible complications, and perform anesthesia on a client-owned animal (including PAP dogs and cats) and/or feral cats under direct supervision.

Rotation  Overview: 

Monday 5:30pm

• Students will meet surgery patients Monday at 5:30 pm in the SAC treatment room. The anesthetist student will meet with Ms. Naudia Dundas for the anesthesia orientation. The student surgeons will meet with Dr.  Ivaldi.  

Tuesday-Thursday/Friday 1:00pm – until done

Students will be working with client-owned patients. These patients will be either inpatients or patients that have been recently admitted by SAC clinicians. 

• Surgeries will be assigned the surgery patients/cases on the Monday of their rotation. Information regarding the patient’s name and type of surgery will be provided. Surgeries are subject to change based on clinic need. 
• Students may be assigned as surgeon, assistant surgeon, scrub nurse, or anesthetist on the following surgical procedures (including but not limited to):  
  • Orthopedic procedures including fracture repair, patella luxation repair, cranial                 cruciate ligament repair   
  • Soft tissue surgery including foreign body removal, intestinal biopsy, abdominal exploratory, cystotomy, etc. 
  • Routine spay   or neuter 
  • Dental prophylaxis
  •  Mass removal
• Students assigned to surgeries are expected to review the patient record at least the evening before the procedure and come to their clinical rotation prepared to discuss the patient, preoperative workup, surgical procedure, and plan for surgical recovery. 
• Students will be responsible for reviewing class notes, textbooks and other study materials from all the relevant courses in preparation for the surgical and anesthetic procedures to be performed that day/week. 
• Students will be expected to follow surgical protocols during the surgeries and perform appropriate pre-operative and post-operative duties as assigned by the clinician on the case. 
• Students will be expected to discuss actual clinical cases and to participate in clinical rounds (including decision making and plan development) in both surgery and anesthesia.  

ALL STUDENTS SHOULD BE PREPARED TO PERFORM ANY OF THE ROLES FOR ROUTINE SPAYS AND NEUTERS.

Friday

• Students come to the clinic at 1:30pm on Friday to check on in-house patients and finalize any medical record writing. 
• Students talk to clinicians about the cases which the students want to present at the end of the term before finals.
• Students should discuss with clinicians if there is a need for the students to come in on Friday.

Groups: 

• The group will be divided into 2 or 3 groups of 4 to 6  students.   

Hours: 

• Surgeries will take place on Tuesday, Wednesday, and Thursday afternoons as well as selected Fridays as determined by the main contacts for surgery. Students will meet their instructors at the Small Animal Clinic at 1:00 pm for rounds and assignment of duties. Students performing surgery on Tuesday are expected to evaluate their patient prior to arriving to their rotation on Tuesday. Students generally meet at the clinic on Monday at 5:30pm to evaluate the patient, perform preoperative blood work if not already performed, and surgical orientation. On Friday, in-patient follow-up and medical record writing should be finalized.

Patient Care and Case Load:

• Because this rotation is a clinical rotation, the patient and caseload depend on cases which present to the SAC.  
• The specific surgeries performed will vary between weeks. There will be procedures scheduled every day of the rotation, but no surgical procedure can be guaranteed. 

Medical   Record Requirements: 

• During this introduction to clinical surgery, the student is expected to prepare medical records documents that are relevant to the procedure performed. 
• In the case of routine spays, neuters and mass removals, students are expected to complete all the following: 
  •  Physical examination form, surgery report, treatment sheet, discharges  instructions.   
• In the case of advanced soft tissue or orthopedic surgeries, the student is expected to complete a surgery report. Completion of discharge instructions will only be required if the patient is expected to be discharged the day after the surgery.
• Medical records for the patients will be the responsibility of the group in charge of the case and can be divided as the group sees fit. In general, most groups following these guidelines: 
  • • Anesthetist: Physical examination (recheck form), anesthesia record sheet, and post op treatment sheet. o Assistant Surgeon/Scrub nurse: Treatment sheets for pre-op day and surgery day, discharge form 
    • Primary       surgeon:             Surgery             report  
• General guidelines for record writing: 
  • • Written records must be legible, meticulous, and complete. 
    • Each form or document reporting patient information needs the correct date (day, month, and year).
    • The name or initials of the student must be reported legibly at the end of every note or page, and whenever requested.  o Record keeping must be such that it is possible for anyone to retrieve the needed information at any time by just reading the records.

• The majority of medical records forms should be completed the same day and should remain in the patients file. 
  • • Surgery reports must be completed the evening after the surgery and will be typed into EzyVet to incorporate them into the patient’s electronic record.
    • If the patient's file is not easily located, any additional paperwork can go in Dr. Ivaldi's mailbox. 
• Students should note that for controlled substance administration, the first and last name of the patient's owner must be reported on the anesthetic record sheet. 
• The anesthetic record sheet must be completed in all its parts and handed in to the instructor in charge at the end of the procedure, once the patient has recovered from anesthesia. In the case that the anesthesia instructor is not available at this time, the anesthetic record should be placed in the patient's file.

Surgery Etiquette and Attire: 

• Backpacks, food, or drink are not permitted in the clinic. 
• Conversations should focus on the tasks at hand and kept to a reasonable volume to minimize disturbance to other faculty, staff, students, and patients. 
• Since students (other than the anesthetist) will be standing for the entire surgery, good quality footwear is essential to minimize leg and back strain. Students are expected to wear surgical scrubs always and closed toe comfortable and protective footwear with hard soles. Crocs with holes are not permitted. Sneakers are acceptable. 
• No one is allowed inside the surgery areas without a cap,  mask, and booties. 
• White lab coats are to be worn always when not in the surgery suite. 
• It is highly recommended that students have lunch to prevent low glucose levels during surgery sessions. 
• The use of cellular phones is not permitted when on rotation in the Small Animal Clinic. They must either be stored in the student's bag or, if they remain with the student, must be turned off or to vibrate (at minimum).
• Students are expected to behave and communicate among themselves, with faculty and staff in a professional manner. 
• To demonstrate their knowledge and confidence, and to avoid ambiguity and misunderstandings leading to potentially catastrophic or fatal mistakes (e.g. wrong drug, route of administration or dose), students must strive to convey scientific and clinical information to colleagues, co-workers and clients in the most appropriate, correct, complete, and accurate manner.           

Emergency and Critical Care Rotation

Faculty: SAC clinicians

Overall Rotation Goal: 

The Emergency and Critical Care rotation is designed to increase the student's comfort level with assessment, monitoring, treatment, decision making, case management and care of in-house and emergency critical care patients. 

Rotation Schedule Overview: 

Tuesday-Friday

• All students rotate through the emergency and critical care rotation once during the term.  Students on ECC rotation are graded on participation, motivation to learn. There are 4 possible emergency shifts available: 

o Tuesday – Friday 5:00pm – 8:00pm  o Each student needs to rotate twice.

Rotation  Specifics: 

This service is responsible for receiving walk- in emergencies and urgent referral cases as well as treating and monitoring of the in-house patients. The emergency phone will be manned by the students from 5:00pm to 8pm on Tuesdays through Fridays.  After 8:00 pm, the phone will remain at the clinic with the technician on duty.   The students will be on service and in the clinic every night until 8:00pm only. Students will be assigned groups and shifts, with at least 4 or more students on the clinic floor always. 

This rotation will function as a "team" service and all clinicians and students should be familiar with all the cases in the hospital. Each student will be responsible for physical exams of each patient on the service. ICU orders prepared by the primary clinician will be posted for each case. It would be helpful to bring a thermometer, stethoscope, bandage scissors, pens, penlight, and a calculator. Please let the clinician know if you have any allergies (i.e. latex gloves, bleach, etc.) 

While on service with the SGU emergency critical care medicine rotation you will be expected to be on your best professional behavior. The clinician will provide all emergency services with your assistance.  As the caseload allows, each student will be assigned to a case. If you are assigned to a case, you will be responsible for knowing everything about that case; discuss exam findings and assessment, and develop a treatment plan, and writing a case transfer sheet. You will also be responsible for discussing the case with your colleagues. More than one student may be assigned to one case. The clinician must approve all emergency cases and be present for any procedures. The clinician or technician will perform the diagnostic tests using laboratory machines. You should wear scrubs and closed toe shoes while on service and always act professionally. There should be no outside visitors.  Food and drink should be kept in the clinic kitchen and only consumed there.  There will be no removing of hospital supplies. Children and pets will not be permitted in the clinic. Report any incidents (breaks, spillages, injury) to the technician or clinician on duty.  

Attendance is mandatory!

When not receiving cases, performing diagnostic procedures, participating in rounds, or otherwise performing service duties, all students should assist the technical staff in the treatment and monitoring of all patients. If time allows, "round table" type of discussions may occur on any area related to emergency and critical care. 

Treatments: 

The in-house patients will all have a treatment sheet attached to their cages. The treatments may include a TPR, walk outside (if possible), drug administration, and fluid monitoring. All the instructions should be clearly indicated on the flow sheet. You are to make NO adjustments to the sheet; this is the responsibility of the primary clinician (unless clearly indicated by a clinician). Please briefly record ALL findings on the treatment sheet along with your initials, after the treatments are performed, and notify the clinician of abnormalities. If you have any concerns, please call the clinician. 

Rounds: 

All students are expected to report to rotations at 5:00 pm Tuesday to Friday, rounds may be delayed depending on caseload and students should be prepared for that.

On Tuesday – Friday, all rounds will take place at 5pm for the respective small groups.  

When rounding cases, the student should present the patients’ signalment, history, important physical exam findings, active problem list, DDx, diagnostic plans, and any interventions / treatments and plans for the patient.  They should also provide a summary of the patients’ overall status (i.e. improving, stable, static, and declining). Cases should be discussed thoroughly yet concisely. Interventions discussed should be categorized as follows: Fluid therapy, medications, diagnostics, monitoring, nutrition, nursing care, etc.

ALL STUDENTS ASSIGNED TO THE SHIFT ARE EXPECTED TO BE READY AND ON TIME FOR ROUNDS. If a critical emergency is taking place at that time, the rounds may be delayed. 

Receiving cases: 

Students will be responsible for receiving phone calls from owners and veterinarians. It is essential that the emergency cell phone be answered when it rings. Make every effort to be polite, professional, and helpful always. Please answer the phone by saying "St George's University Small Animal Clinic Emergency Service", this is __________. How may I help you?" For each call, fill out the phone log (in treatment room) with name, phone number, primary concerns and plan. You should discuss each phone call with the clinician on duty.  More in-depth instructions for phone cases and receiving cases are in the SAC policies and procedures manual on Sakai. There will be shifts when cases arrive in a staggered fashion and shifts when several cases seem to arrive at the same time. When possible, more than one student should triage the patient, perform a primary survey, and welcome the owners. 

Triage: 

Each case should be triaged immediately upon arrival. When more than one case is presented to the service at one time, the student should categorize the severity of each case according to the principles of triage (taught to you in 4^th term).  Follow the A, B, C's, then D’s and E’s: animals with respiratory distress, tachycardia, inability to walk, active hemorrhage, abdominal distention, seizures or unconscious should be considered most critical and evaluated first. Animals with any of these problems are considered more critical than any patient free of these problems. Any patient showing any of these should be taken immediately to the treatment area. 

 Primary Survey:

 A primary survey is a cursory, yet thorough physical exam that allows you to make an assessment of patient's vital signs. Emphasis is placed on mentation (neuro), cardiovascular stability, ventilator and respiratory competency; and renal parameters (can the patient urinate) and to uncontrolled hemorrhage. Based on the primary survey, you may choose to administer emergency supportive treatment either in the emergency room or in ICU/treatment area (by bringing the animal back prior to discussing the case with the clinician). Ideally, attempt to obtain a "brief history" before leaving the owners. 

 Client communication: 

 Please recognize that our patients are critically ill and family members and owners can be emotionally distraught at presentation. Be compassionate yet professional. If you feel it is in the best interest of the patient to remove the animal to the ICU/treatment area, please explain this to the owner and inform them that someone will be out to speak with them as soon as possible. 

 Following the primary survey and intervening with any necessary emergency support, a complete physical exam should be performed (secondary survey) and recorded and a thorough history should be obtained from the owner. At this time, one student should take primary receiving responsibility of the case and discuss the case (history, problems, assessment, and plan) with a clinician. If a second student is assisting, preparation of laboratory samples and instrumentation of the patient under guidance of the clinician can be addressed while the primary receiving student speaks with the owners. 

 PLEASE REMEMBER TO ALWAYS BE SAFE AND LISTEN CLOSELY TO THE RECOMMENDATIONS OF THE ATTENDING CLINICIAN.

WEAR GLOVES WHEN HANDLING ANY PATIENTS DEMONSTRATING

CLINICAL SIGNS OF ZOONOTIC DISEASES SUCH AS RABIES OR WHOSE VACCINATION STATUS IS UNKNOWN OR WHOSE PRIMARY DISEASE IS QUESTIONABLE.

KEEP CLINIC DOORS LOCKED ALWAYS AFTER HOURS AND ENTER

THROUGH THE FRONT DOOR AND PLEASE MAKE ARRANGEMENTS TO HAVE A CAR AVAILABLE SO THAT THERE IS NO WALKING HOME ALONE AT NIGHT.

Appointment Flow for All Services at the SAC

1. Students review patient medical record if the appointment is for an existing client/patient.  (5)
2. Two students go and greet the client in the reception area. (1)
   1. One student walks with the client to the examination room. (1)
   2. One student takes the patient to take the weight. (1)

**Please note that in some instances the front desk team will perform Step 2, in that the front desk team will take the patient’s weight and place the client and the pet into the examination.

3. The clinician, a technician, and the other students meet the client in the room as the student and the client enter. (1) 
4. Introduce yourself to the client and the pet and define your role. 
5. One or two students start taking the history.
6. As the students are taking a history, the other students are listening and perform a physical exam on the patient.  (5)
7. The clinician observes and asks any remaining history questions and performs a physical exam on the patient while talking to the students about the case, in the exam room with the client. (10)
8. The clinician and the students create a plan in the room and discuss the plan with the client. (5)
9. The technician listens to the plan and begins the estimate on the exam room computer, clinician/students may add to the estimate, technician gets the necessary diagnostics ready in the examination room, and/or leaves to prepare the treatments or further diagnostics. (5)
10. Once the client has been updated on the plan, the estimate is approved and signed by the client, payment is collected and processed (5 minutes)
11. Diagnostic tests that can be done in the consultation room are done by the necessary students and/or technician, and/or the patient gets taken to the treatment room for further diagnostics if needed. (5)
12. Clinician and students can further discuss the case while diagnostics are being performed, outside of the room. (5-10)
13. Technician collects diagnostic test results. (1)
14. One or two students fill out the necessary medical records. (5)
15. One or two students start to prepare discharge instructions. (5-10)
16. Technician adds charges to Ezyvet. (5)
17. Medications are are calculated, requested and collected from the Cubex and drug labels are typed and printed. (10)   
18. Clinician walks back to the room with available students to discuss results and the plan with the client. (5)
19. One student explains the discharge instructions to the client. (5)
20. One or more students administer medications to the patient if necessary. (5)
21. One or two students walk patient and client out to reception for check-out. (1)
22. Clinician notifies front desk staff if a recheck appointment needs to be scheduled. (5)
23. Clinician and students get ready for the next appointment. (5)

Radiology

Radiology Specialists: Dr. Thomas Hanson (main contact) 

Rotation Goals:

The aim of the rotation is to impart to the student the basics of the skills required to accurately describe imaging abnormalities on radiographs of various cases presented during the lab sessions. Some ultrasonography images, CT or MR images may also be given during this course.

This rotation builds on the knowledge acquired during the 5^th term lab sessions. 

Rotation Objectives:

On completion of this course the student, using standard imaging terminology, will be able to verbally describe: 

• The projections/image planes presented
• Analyze the images for artefacts or errors
• The relevant abnormal features present on the case images
• Recognize normal anatomical variants
• Compile a reasoned list of differential diagnoses
• Propose an imaging diagnosis consistent with the image findings
• Suggest further diagnostic tests or treatment.

Small group sessions:

There will be two sessions of two to three hours twice in the term. These practical sessions will include case discussions and film reading. 

 Grading for the rotation will be based on the student’s performance in the session, including knowledge base and active participation. A radiographic case will be assigned to each student for presentation on the second session. Presentation duration will be 5 minutes. 

Rotation dates, times and group information can be found on the next page.

Venue: Charter Hall Lab (before mid-terms) and Charter Hall Lab or the Small Animal Clinic’s conference room (after mid-terms)

SAMS 528 RADIOLOGY ROTATION SCHEDULE

TH = Thomas Hanson

Ambulatory Services

     I.     Course Schedule  

There are effectively 3 groups (Groups A, B and C) during the ambulatory rotation weeks. Students will go out with the Ambulatory Service to local farms TWO days of each week; once with Bus #1 and once with Bus #2, and stay at the Large Animal Resource Facility (LARF) ONE day of each week (This will be with other supporting faculty). 

Ambulatory service (Bus 1 and 2) will focus on herd management, preventative medicine, animal nutrition and the development of sustainable farming through client empowerment. Ambulatory services buses will depart promptly at 1pm from the LARF. However, please have at least half of the group arrive at 12:45pm to prepare the boxes if you are going out on one of these buses. The rest of the group may arrive at 12:55pm. 

LARF sessions start PROMPTLY at 1:30 pm and will include a review of large animal physical examination and clinical skills.  

Punctuality is of tremendous importance to this course.  In many instances travelling time may be protracted; consequently, it is important that everyone be on time to the LARF to have a timely return to base. If it is your job to stock the van, please be at the LARF at 12:45 pm. 

Remember that the roads are steep and that there are a lot of sharp corners on the coastal roads. If you suffer from motion sickness, then it is recommended to take medication prior to your departure.

Bringing water is highly recommended!

Schedule: Spring 2022

Ambulatory 1^st ROUND SCHEDULE (January 24^th  –  February 25^th)

*Where the LARF session is Bovine PE and common clinical skills

Ambulatory 2^nd ROUND SCHEDULE (March 7^th – April 8^th) 

*Where the LARF session is Equine PE and common clinical skills

Note: online students will follow the same schedule except be live on Zoom at the same designated times for case reviews and live LARF Zoom Sessions. 

Ambulatory Rotation Groups – Spring 202

Weeks 2 and 8: Group Number 1 & 2

Weeks 3 and 9: Group Number 9 & 10

Weeks 4 and 10: Group Number 7 & 8

Weeks 5 and 11: Group Number 5 & 6  

Weeks 6 and 12: Group Number 3 & 4  

The above schedule is subject to change due to availability of cases and extreme weather conditions.

It is designed to be as fair as possible to all students.

Grading

Medical records

20% of the grade will be attained from the medical records that are turned in after every ambulatory trip. This grade will be generated as a group grade. Medical records are due the following afternoon by 1:30pm AST and should be emailed to the overseeing faculty member before the next day of rotation (e.g. Tuesday afternoon group will submit their records on Wednesday afternoon by 1:30pm).  The grading of the medical records is part of the weekly assessment score.  **See grading rubrics posted in SAKAI for more details on expectations of your medical records.

Weekly assessments based on student performance and professionalism

10% of the grading will be based on weekly assessments using the specific Professionalism grading rubric.  On island students will receive formative feedback on their clinical skills using the Ambulatory

Services Clinical Competency Form. This form was created using AVMA’s nine clinical competencies. Participants/Attending veterinarians will each fill out grading/assessment forms for each student on a weekly basis, each student composite score will be published on ExamSoft for their exclusive access.  The clinical competencies required of you will be provided in a rubric attached in your Resources tab on SAKAI.   

**See helpful hints document posted in SAKAI and the example medical record

*Rubrics for Medical Records and Professionalism evaluations are provided on Sakai.

OSCE EXAMINATION

A midterm and final OSCE examination will take place.  The midterm OSCE is MANDATORY but formative so will NOT be included in the course grade.  The final OSCE is also MANDATORY and will be summative and worth 20% of the course grade.  You will receive feedback and it is required that you participate as part of the professionalism evaluation of the course.  

For online students: no midterm OSCE will be offered however, an online equivalent will be made available to you for the FINAL OSCE.  

II. Other requirements

It is imperative that students adhere to the following dress code.  Failure to do so will result in the student being sent home. Please always be conscience of biosecurity. Please dress professionally; you will be dealing with members of the public and representing yourselves, the school and your profession.  Please leave your jewelry, valuable electronic accessories, and valuable sunglasses at home as we are not responsible for their loss or damage.

The following is compulsory attire: 

1. Your nametag
2. A clean pair of clean coveralls or a complete set of clean scrubs.  
3. Rubber boots OR Rubber pullover boots may also be worn if they are covering a pair of closed-toe shoes. They must be cleaned/disinfected between farm visits.
4. A functional watch
5. Each student must have their own stethoscope
6. Notebook and pen
7. It is also strongly recommended to bring a clipboard and thermometer.

Diagnostics

I. Detailed Diagnostic Laboratory outline a. Necropsy

• Develop the student's skill and experience in performing necropsy examinations of the common domestic species. Students will perform a complete necropsy in groups of 4-5 per case.  
• Develop the student's ability to recognize lesions in various diseases.  During a necropsy session, one student will record all the findings in a necropsy form provided.  
• Use necropsy cases to develop the student's ability to integrate clinical signs, clinical pathology data, radiology, and gross and microscopic lesions into pathophysiological concepts of disease, diagnosis and/or cause of death.  At the end of necropsy each group will be asked to summarize the main findings in an assigned case and give a morphologic diagnosis and differential diagnosis based on the gross findings.   
• Guide the student on how to write concise and complete necropsy reports. Each student will be expected to write one necropsy report on the case he/she participated in.

b. Clinical Pathology

• Critically interpret the results of laboratory tests in the light of history and clinical signs so as to form a rational diagnosis or differential diagnosis.
• Develop the ability to indicate further tests or course of action to reach a diagnosis.

c. Parasitology

• Learn to identify common parasites in feces, blood, urine, skin scrapings, and body fluids through appropriate procedures and tests.
• Interpret the significance of results in relation to history and clinical signs of cases submitted.
• Determine appropriate actions which may be suggested to the attending Clinician.

II. Other requirements  

1. All students are expected to wear protective attire during the laboratory sessions including white laboratory coats, gloves, and closed toed shoes.  For necropsy, the protective attire will include scrubs and protective rubber footwear (boots).
2. Identification badges should be worn during the laboratory session.  
3. Leave your working place clean and tidy after the laboratory session.  
4. Wash your hands thoroughly before leaving the laboratory.
5. Eating or drinking (except water) is strictly prohibited in the laboratory.

III. Course goals (Instructor’s point of view)

1. This course seeks to reinforce the student's practical necropsy and clinical laboratory skills, and to strengthen the student’s ability to interpret necropsy and clinical laboratory results
2. Emphasis will be placed on the importance of:
   1. Correct sample collection and shipping of samples to laboratories.
   2. Provision of all relevant clinical information.
   3. Provision of clear directions on tests requested. IV. Course Schedule  

             1. Necropsy

• Tuesday, Wednesday and Friday from 1.30 to 3.30 PM in the Postmortem room/Histopathology laboratory * However, on occasions, laboratories may take slightly longer.

2. Clinical Pathology

• Tuesday, Wednesday, Thursday or Friday 1.30 to 3.30 PM in the Clinical Pathology laboratory.

4. Parasitology

➢ Tuesday and Thursday from 1.30 to 3.30 PM in the Microbiology laboratory.

V. Grading and assessment policy, and grading rubrics  

The final rotation grade will be determined by the total grade earned during the separate rotations. 

• For necropsy, assessment will be based on attendance, participation, and a written necropsy report  
• For Clinical Pathology, students will be assessed on attendance, participation, interpretation of several clinical pathology cases and a quiz.
• For Parasitology, assessment will be based on participation and a quiz during the rotation.

Supporting Faculty and Staff for all rotations