I love statistics. Numbers are so wonderfully illuminating. When I am running statistical analyses, I am in my ‘flow’ state and time just drifts by. So, the numbers first!
Podcast Episodes: 3
Paid clients: 9
The numbers are good, but I had a site reset back in April which wiped all the statistics before that. I am grateful that people are reading and, hopefully, learning. I would like to spread the message and information even more broadly, so welcome suggestions on how to reach the intern/resident-bound population. Maybe in a few more years, once the students I have advised are graduating, they will come back and read the topics on internship/residency applications.
I continue to enjoy thinking up ideas and writing posts. I’m not doing as good a job having posts loaded up ahead of time- I’m usually only 1-2 weeks ahead as other pursuits have taken my free time. I have 12 posts written which need to be loaded into posts, and ideas for 106 more topics. WordPress continues to tell me my posts aren’t ‘optimized’ for readability. And I know blog posts 2000-3000 words are statistically better reads than my short posts, but I like keeping things simple and know the time of my readers is incredibly valuable.
What I’ve learned this year is that people are seeking resources to help their applications and they have found value in my services. The reviews have been generally positive. Some examples:
“Yes, the template worked beautifully, I ended up with some very strong recommendation letters!”
“I am really happy with how this has turned out. It’s really formed into something I am proud to put out. I have made some adjustments and am sending for one final review.”
“Thank you for getting back to me so quickly on these! I really appreciate and agree with the feedback.”
This coming year, I might scale back to posting once a week. I wasn’t as productive with the blog during the pandemic as I rediscovered an old fun hobby which is taking more of my creative time. And I feel less compulsion to get the information Out There, now that I have the most essential pieces of advice posted. But, of course, maintaining good content is critical to blog success, so I feel compelled to continue to write and post.
Thank you for reading and participating, and I hope you keep coming back for quality content this year!
You would think a letter of recommendation (LOR) is a simple thing. You ask someone to write it for you when you apply to vet school, they do so, it is read, and that contributes to your evaluation. All of that is true, and I want to drill down on the details of the letter of recommendation through the VMCAS. I’ll share how I interpret each of the questions your letter writer will fill out.
Title – I’m not entirely sure why this is here. So many degrees confer a title of “Dr.” that it doesn’t tell me much. Maybe if it was written by a Member of the Order of the Companions of Honor this would be relevant.
Name & Phone Number – Basic information. The phone number is provided in case someone wants to call the LOR writer. I’ve never been called for a vet school applicant.
Occupation – This is relevant so that the reader knows if the writer knows what they’re talking about. As a general rule, the applicant wants this to be “Veterinarian” or “Professor” (or Assistant or Associate Professor). Veterinarians have been through vet school and academics know at least a bit what is expected of a difficult academic program. “Practice manager” or some other veterinary-adjacent title would also be fine. Other occupations, like “Engineer” would make me wonder why this person is writing a LOR.
Institution, Practice, or Place of Business – Again, this provides context for the reader about the LOR writer.
Waiver – This indicates if the applicant has indicated they do or do not want to see the LOR. I don’t think I’ve ever seen a student select that they DO want to see it. There is an implication that an LOR writer will be more honest if the applicant can’t see the LOR. There is also sometimes an assumption by the applicant that, if they select that they DO want to see the LOR, that the LOR writer will take offense and not write as strong a LOR. I personally give all my students their LOR before I submit it so they can see it anyway.
How long have you known or observed the applicant – This is very important. I will interpret the information from an LOR writer who has known the applicant for 2 weeks very differently than if they have known them for 2 years. As a general rule, longer is better because it implies the LOR writer knows the applicant better.
In what capacity have you known the applicant – This is also very important. If they were a volunteer observer that is different than if they worked directly with me (e.g. as a technician or research student). Again, ideally the LOR writer has worked directly with the applicant.
Approximate number of candidates I have evaluated in the past five years, for admission to veterinary medical colleges – This is trying to determine if the LOR writer knows what they’re doing. I don’t find this particularly meaningful. A new DVM graduate may not have evaluated anyone, but I believe they know more about being a veterinarian and going through vet school than a professor of animal science who has written a dozen LOR in the past 5 years.
Initiative/Originality – Honestly I think an applicant can score anything on this metric and I personally think it would be fine. Most professionals with whom I work on a regular basis “Need occasional prodding”.
Motivation (for becoming a veterinarian) – If “is uncertain of career goals” is marked, I would flag that applicant as potentially weak. I think some evaluators would interpret “Simply wants to be a professional (any type)” as a poor indicator, but I personally would not. I would have classified myself in that category when applying to vet school and here I am 25 years later as a successful veterinary professional.
Intellectual Capacity – If an applicant is not “above average” or higher, I would flag that applicant. Vet school is intellectually demanding.
Personal and social maturity – I think this is a silly question. Most applicants are in their early 20s. I expect most applicants to be “Below average” for this in reality. I suppose if there is a second-career or later-in-life applicant with “Exceptionally mature” I may consider that a positive. But people do so much growing in vet school- even older students- I don’t think where you start out matters very much.
Dependability and reliability – This is HUGE for me. If an applicant isn’t “above average” on this, I would probably rank them very low. Step #1 is to Show Up.
Emotional stability – Based on my experience teaching veterinary students for 20+ years, I would put a significant majority in the “easily upset” bundle. Given that is my expectation, I put no weight at all on this question.
Leadership – Again, I don’t think this is very useful. While I DO believe every veterinarian IS a leader, I also believe that is a skill you acquire throughout vet school. I suppose if an applicant was given “Outstanding leader” I would look through their application looking for other evidence in support of that (e.g. club officer roles).
Ability to work with others – This MUST be “works well with others” or “excellent interpersonal skills”. I personally do NOT want to work with anyone who is “occasionally uncooperative” or “lacks interpersonal skills”. This is a baseline requirement. If the person is not good to work with, I don’t want them as a student or a future colleague.
Character and integrity – If the applicant is scored “untrustworthy” or “occasionally compromises ethics for personal gain”, I won’t rank them. Again, being ethical is a baseline requirement.
Verbal skills – If the applicant is scored as “articulate, clear, fluent” I will take note of that as a positive. Any other answer here is perfectly fine. Although communication is absolutely essential to being a competent professional, I expect students to learn a lot of that during vet school. They don’t need to come in with those skills.
Acceptance of feedback and instruction – Even though having a Growth Mindset is essential to developing as a professional, I think I’m OK with “sometimes resistant to feedback” or better. Receiving feedback is HARD. I respect that. Hopefully the student will grow during vet school. “Resistant to constructive feedback” is a pretty serious negative mark in my book.
Ability to handle animals – I 100% don’t care. I’ll teach you this during school.
Applicant’s overall potential – I think this question probably lends itself to grade inflation so is meaningless to me. I expect most evaluators will put very high marks for this regardless of the applicant’s actual performance because, in America, we continue to creep to giving better and better grades regardless of performance. I think most LOR writers think they have to give a top mark to an applicant for them to even be considered, so they do.
Comments – Far and away the most important section of the LOR, and the system TELLS the letter writer that in the instructions. This is one reason why, as an applicant, you prefer LOR writers who have written letters before, understand academia, and know what to say. As an evaluator, this is by far the most important section because it provides a narrative account of the applicant. It provides the most accurate picture of them.
There you have it, a lot of sections and considerations for a LOR writer. As an applicant, there’s not a lot you can do to affect what is entered for any of these except, of course, to follow my advice in the How to Be Successful series. Everything you need to EARN a great LOR can be found there.
Pimping is the term used when the senior clinician asks those on the team a series of questions. Pedagogically, it is intended to encourage Socratic thought and discussion. It determines the knowledge level of the students (and interns and residents) to allow more specific, targeted teaching. It ties basic theoretical knowledge with practical clinical knowledge.
The usual format goes something like this:
Discussion of a case.
Senior clinician poses a question, typically to the entire team. Some examples from my recent rounds sessions:
“Does anyone know why we might want to avoid acepromazine in this patient?”
“What do you all think may happen when we give this 2-year-old Labrador midazolam?”
“Why might we prefer propofol over alfaxalone in this case?”
Silence ensues as people reflect on their knowledge and attempt to formulate an answer. I personally tell students that I can outwait them, and will let the silence stretch uncomfortably long, particularly if I know they know the answer (e.g. “What’s typical normal blood pressure in an awake dog?”).
If the question is a little challenging, I may go ‘up the ladder’ and ask the intern or- if they don’t know- the residents if silence stretches for very long.
Eventually some student puts forth an answer, often in the form of a return question because they are unsure in their answer. If it isn’t exactly correct, I’ll try to shape it to provide a learning opportunity for the team. Some examples:
“Acepromazine isn’t reversible?” “Yes, that’s a very important consideration when deciding on selecting acepromazine, but I don’t think is relevant to this particular case.”
“It may not get sedated?” “That is true! And, moreover, it may get particularly excited.”
“Propofol is less expensive?” “Actually, on a mL-per-kg basis, propofol and alfaxalone cost about the same, even though propofol is less expensive than alfaxalone on an mL-per-mL basis.”
If the answer is correct, I will try to provide some positive commentary and possibly lead into further discussion.
Mimics your clients. Although clients may not ask as technical questions as the senior clinician, they will certainly ask you questions to which you need to have answers. Developing this answering skill will prepare you for the exam room.
Tests your knowledge. If you don’t know the answer (or if you can’t hazard a guess), that suggests you need to study that topic more. If you routinely have no idea what the answer is, that strongly suggests you need a lot more study time.
Provides opportunities for discussion. Answers (correct, partially correct, and incorrect) provide learning opportunities to help clarify important points. The back-and-forth also encourages subsequent questions from students which can improve their individual understanding.
Pimping sometimes has a negative connotation and does indeed have a dark side. Asking clinically insignificant questions, obscure esotera, and similar impossible-to-answer questions can make students feel incompetent and worsen their sense of self-confidence. Indeed, in Brancati’s farcical article, he says “Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions- questions that his attending may be unable to answer.” Obviously, pimping, like any tool, can be used for good or for ill.
On occasion I do ask a question which is difficult, but I honestly don’t expect to get an answer. Some examples:
“Does anyone know why dogs with portosystemic shunts have a hemogram consistent with iron deficiency?”
“Any idea what we call the reflex which causes the heart rate to go down after ligating an aortic aneurysm like a PDA?”
“Any of the residents know what metabolite of atracurium can be associated with seizures?”
To be clear, I don’t ask these questions to humiliate anyone and I try to make it clear this is esotera. Some of the information the senior residents should know for boards, but I make that clear, “This is ridiculous information you should know for boards but has no clinical implication.”
Brancati notes two dangerous responses to a pimping question: the dodge and the bluff. I have seen students, interns, and residents use both of these strategies. Dodges typically manifest as the student asking a different question. I have no problem with this- I love it when students ask questions- and I use the question as a learning opportunity. But I get back on topic.
The most common bluff I see is feigned erudition, where a student provides some answer which is, in itself, esoteric and not answering the (usually clinically relevant) question I am asking. I suspect students (and interns and residents) do this to appear knowledgeable. In some residents, it does reflect a deeper understanding, which I appreciate. But when students start going on about coronary steal phenomenon, I know they’re just trying to appear knowledgeable and may not know the practical clinical knowledge I want them to have.
Some students seem to focus on and crave esotera. Esotera is often distinct, definite, and manageable. It is facts. Clinical medicine is fuzzy. We often don’t know the answer. We have to make educated guesses. I think some students are intimidated by that and seek refuge in certainty and data. I try to encourage them to focus on clinically meaningful information. I’ll often say something like, “I appreciate your depth of knowledge. I want to make sure you have the important clinically-significant information down before exploring that depth.” Most specialists love esotera, but we realize we aren’t training specialists- we’re training general practitioners. We need to focus students on what is clinically relevant and what they will see in day-to-day practice.
The art of pimping is not taught directly- it is taught by example. Just as one might watch someone dance and attempt to mimic the movements, so most instructors learn pimping. New faculty have a tendency to ask esoteric questions but, as they gain experience in this art form, their questions evolve to clinically meaningful ones. Pimping is not intended to undermine, dismiss, or invalidate students. It can be a valuable, useful skill for elevating everyone’s knowledge.
What do you think? Have you ever been subject to an “aggressive” pimping?
The standard letter of reference (SLOR) can be found at the VIRMP website, so there’s no mystery as to what’s on it. Let’s break down each section. I have truncated some of the questions for brevity’s sake.
Letter writer’s qualifications
This is not one of the questions asked, but when the SLOR generates, this is at the top of the form. It includes the letter writer’s institution, degrees, and board certifications. I’ve written before about the people from whom you want to get letters of recommendation, and this is where evaluators see that information.
How long have you known or observed the applicant?
As an evaluator, this is important. Someone who worked with the applicant for 2 weeks while on a clinical rotation will know this person in a very different way than someone who has directly mentored them for 2 years. That’s not to say a letter from someone with whom you have spent 2 weeks on clinics is not valuable- it is. This just puts the relationship into context for the evaluator.
Are you currently working with the applicant?
Ideally, you get letters of reference from the position you currently occupy. If you had a strong mentoring relationship with a clinician from a previous institution, you may include them, but generally programs want to know about what kind of clinician you are now rather than in the past.
In what capacity have you known the applicant?
Obviously, for a clinical training program, the evaluator wants to know the letter writer has worked with them in a clinical setting. Other contact, such as in the classroom and as a mentor, can help frame the context of the letter (e.g. how well the letter writer knows the applicant).
Hypothetically, if your institution permitted internal hiring, how likely would you be to offer a position to this applicant?
This is a 7-level Likert scale. I suspect a score any less than a 6 or 7 would remove you from consideration as an applicant. If the letter writer wouldn’t want to work with you, why would I? There is a 50-word free-text entry. I typically write something like, “Amazing applicant, would love to have them stay” if I feel that way.
In your opinion, how likely do you think this applicant is to successfully complete an internship program if the applicant matches? For residency applicants, I believe this is the same as “In your opinion, how likely do you think this applicant is to obtain board certification in her/his primary specialty area?”
Again, a 7-level Likert scale. A 6 is suspect; anything lower I believe would result in you not being ranked. Programs hate taking people who don’t complete them.
How would you evaluate the work ethic of this applicant?
Another 7-level Likert. I think a 5 or higher would probably still get you considered, although obviously a 7 is what you want a letter writer to put. Nobody wants to work with someone who doesn’t have a strong work ethic.
How would you evaluate the difficulty of training the applicant?
As before, I think a 5 or higher would be acceptable here. I suspect most people writing a strong letter of recommendation would enter 7.
Commentary on questions 5-7:
I expect most letter writers will put ‘7’ down the line. This section does not distinguish you in any positive way from any other applicant. This is the bare minimum to be reasonably competitive. Any mark less than a 7 will probably be noted by evaluators. Depending on the applicant pool, they may only evaluate applicants with 7 in each of these categories. This section is more about weeding out applicants than identifying good ones.
Please rate the applicant on each of the following attributes. Then there are sections on knowledge and clinical skills, stress and time management, interpersonal skills, and personal characteristics. For residents, research and teaching skills are added to the list.
I expect any competitive applicant to be at a 4 or above in all of these categories. Some letter writers will put ‘7’ all the way down, which is really not helpful for evaluators (and unlikely to be true). As an evaluator, I look at the scores below a 4. If it’s what I consider to be very important to me (e.g. any of the interpersonal skills), I will look very critically at the rest of their application and probably not consider them further if we have a strong applicant pool.
Please use the text box below to elaborate on any ratings you made.
This is probably the most important part of the SLOR, and the VIRMP tells you that in the directions: “Based on feedback from the SLOR reader survey, the absence of comments is interpreted as a negative evaluation of the candidate.”
Here is where I look for all the things I want a letter of recommendation to say. Are they humble? Are they easy to work with? Are they receptive to learning? As I’ve said before, I can teach a student if they are reasonably intelligent and easy to work with. But I cannot change their personality if they are difficult to work with.
If interested, would you like to be contacted by programs for additional information or clarification regarding this candidate’s suitability for a position?
I have no idea why this is here. Of course “yes” is always selected. I’ve never been directly contacted about someone for whom I wrote a letter for an internship. For a residency, we all just call and chat with each other anyways.
Residency-specific question: Please rate the applicant’s competency in her/his primary specialty area of interest:
I think this is a dumb question. I don’t expect resident applicants to be competent in my discipline; I WILL TRAIN THEM TO DO THAT.
Residency-specific question: In your opinion, what is this applicant’s level of interest in research?
Again, I think this is a dumb question. I don’t really care what their interest level is, they HAVE to do a project. They know that going in. I suppose some people may want to confirm that the applicant is at least a little interested in research. But I’ve known dozens of residents who don’t like research, do a project to fulfill the residency requirements, get board certified, and go on to be perfectly competent clinicians.
Those are the elements of the SLOR and my personal take on them. What do you think is the most important part of the SLOR?
Every now and then, I review letters of intent from intern or resident applicants that have something along the lines of, “When I was a student, I regularly worked 80-hour shifts,” or “When I was an intern, I often did 14-day-long shifts.” I understand, working that much is ridiculous. Being able to do it successfully demonstrates significant grit. It’s hard to push through that and still have a smile on your face. Unfortunately, for internship and resident applicants, this level of work is expected.
In the VIRMP standard letter of recommendation, there is a question, “How would you evaluate the work ethic of this applicant?” This is not a question designed to separate the top 5% from the rest. This is a question designed to determine: “Can this person perform the minimal duties required for this position?” For better or worse, we have an expectation in medicine that people work long, ridiculous hours and shifts. I have an acquaintance who’s in a human surgery residency program who worked 45 days straight, most of which were 12+ hour days. I’m not saying this is right. I’m not saying it’s good (it isn’t). But it’s the way things are.
So, I expect anyone entering an internship or residency can pull an 18-hour shift without complaint. I expect that they can work 7 days straight. For better or worse, there are dozens (or hundreds) of applicants who CAN and WILL do this. So if you can’t or won’t, there’s someone else who will. I think this is a tragedy because it precludes people with families or physiologic conditions which don’t allow for them to work this much. Nonetheless, it is “industry standard”, at least right now.
As a result, your ability and willingness to work that hard isn’t noteworthy. It is expected. It doesn’t make you remarkable or enhance your application. It’s space you don’t have to waste, because you have to keep the letter to one page. Use that space to provide an example of how good you are to work with, or how diligent you are, or some other valuable, unique characteristic. Now, if you want to assure the reader that you CAN work that hard, by all means mention that you HAVE worked that hard. But don’t expect it to set you apart. Everyone applying to an internship or residency is willing to work hard. What do YOU bring to the program?
The faculty interview typically involves meeting the faculty members of the department, the department head, and various other administrators. These may include the hospital director, the associate deans (typically research and academic affairs), the dean, and various directors (research centers, specific services, etc.). Beyond the general questions to ask during your interview, I think there are some specific questions to ask some of these individuals to get the best information so you can make an informed decision as to whether or not you would be a good fit there.
This is probably the most important single person in the interview, since they make the ultimate recommendation to the dean (who usually accepts it). DO NOT BRING UP ANYTHING THAT SHOULD COME UP DURING THE NEGOTIATION DURING THE INTERVIEW. This includes salary, equipment, new hires, spousal hires, etc. You could easily spend several hours speaking with the department head, but often will only have 30-60 minutes. Therefore, I will try to prioritize the questions from most essential to least essential.
What is the department’s historic success with promotions and tenure decisions?
What is the mentoring system? Are third year reviews conducted?
What is the timeline for hiring the position? Next steps? More interviews to conduct?
What is your ideal candidate? What are you looking for?
What do you want the culture of the department to be? What is your role in accomplishing that?
Can you send me a copy of the department strategic plan?
In addition to learning about how the hospital functions, I think it’s important to understand how it interacts with the academic departments and academic faculty.
How are the faculty evaluated for clinical service? Is it provided to the department chair from the hospital director?
What medical record system is used and what good and bad experiences have they had?
What is the administrative structure like for the staff? How do they interact with the faculty (i.e. do they answer to faculty section chiefs or to a staff member who answers to the hospital director)?
What is the administrative structure like for the faculty? What are the sections? How does the hospital board function (advisory or decision-making)?
How is new equipment acquired and budgeted? How are equipment replacements handled?
How are new staff hired? Do the faculty participate? How are new staff positions added? What’s the training like for new staff?
Associate Dean of Academic Affairs/Students
This person has a LOT to do with your day-to-day job and, again, you could probably spend several hours with them. Usually you only have 30-60 minutes. So these questions are prioritized as well.
Can you give me an overview of the preclinical curriculum?
What are the rotations for the clinical year? What are required? What are the tracks/areas of emphasis?
How many students are on each rotation for each block (specifically the rotation of your discipline)?
How is the curriculum determined (faculty driven, committees, dean, etc.)?
What are the preclinical elective course options and how are new electives added?
What is the culture of the students like?
What kinds of problems are the most difficult for you to deal with?
What can faculty do to make your job easier?
Associate Dean of Research
Unless you have a high research FTE or are in a non-clinical position, in my experience this person doesn’t have a lot of necessary information. An hour meeting is often too long, and 30 minutes can sometimes even be a bit of a stretch to fill with discussion and questions.
What are the approval committees (IACUC, Clinical Research, IRB) like? How hard/easy is it to work with them? What have challenges been in the past getting approvals?
What resources are there for grant writing and statistical consultation?
What research resources are in the CVM (flow cytometry etc.)?
Are graduate students under this office or the Associate Dean for Academic Affairs?
What is the course approval process for grad student courses like?
Although the dean is the final decision-maker for hires and negotiations, usually they approve what the department head recommends. This person is thinking of high-level strategic ideas, so work on getting that from them. Fortunately, you usually only have 30 minutes with the dean, so you don’t need to ‘fill’ the time very much.
What is your vision for this position/service? What would you like to see happen with it in the future?
What is your vision for the college?
What is the most important task or role for this position to fulfill?
What do you feel are the biggest challenges facing the college?
Not only does asking these questions give you information, it indicates to the people that you are interested in the position and engaged with the interview. It’s always frustrating for me when candidates don’t have questions of their own. Or their questions are not particularly meaningful. Obviously, don’t just read the questions as I have written them. Use your own ‘voice’ and try to make them casual, rather than interrogative. For example, instead of “What is the most important task or role for this position to fulfill”, I would probably say, “What do you think is the most important task or role for this position?” Good luck!
I believe our culture has a problem. The problem is that we have a simple narrative : “If you work hard enough, you will be successful.” I think this is a problem because it’s not entirely true but it’s not entirely false. Making success seem so simple is reductionist, doesn’t credit the efforts of millions of people, and leads to poor decision-making, as well as poor life choices and outcomes.
It’s possible I have this perspective because I grew up in Los Angeles. Do you know how many people move to the City of Angels to “get their big shot”? Some of them are incredibly talented and exceedingly competent. Experts in their craft. And yet, you will never hear about them. They won’t be in a movie you’ve heard of. They won’t feature in a TV series. Why not? Is it because they didn’t work hard enough? Of course not. It’s because they weren’t in the right place at the right time. Let’s look at some examples.
Harrison Ford – Although he had been in several small roles- and met George Lucas on American Graffiti- he was installing a door the day George Lucas happened to come by, recognized him from American Graffiti, and thought of him for Star Wars.
Rosario Dawson – Sitting on her front porch, discovered by a novice director and photographer to star in their coming-of-age play with a series of actors with no experience.
Charlize Theron – Throwing a fit in a bank trying to cash a check, in line behind her is a talent agent who gives her his card.
Me – Had an Assistant Scoutmaster who happened to be a veterinary surgeon and well-known alumnus of WSU and veterinarian to animal-welfare proponent Betty White.
Now, I would argue that success isn’t 100% due to luck. I like the concept that hard work creates opportunities for luck and, when luck comes around, if you have been working hard, you are more likely to find success. But luck is EXTREMELY important in your life success. You are lucky you were born where you are (assuming it’s a developed nation). You are lucky if your parents had money to buy you books and send you to school. Luck is all around us.
I think the failure to acknowledge luck in our success is a major problem. I think it leads to a lack of empathy for others. “That person isn’t successful because they didn’t work hard enough” is often a belief people have. Maybe they COULDN’T work hard enough. Maybe they have a health problem. Maybe their family was dysfunctional. Maybe their parents were sick and they had to work all the time and couldn’t go to school. Maybe they live in an area with systematic racism. There are way more reasons people aren’t successful than reasons they are successful.
Conversely, luck can adversely affect people and yet people may internalize that failure as “not working hard enough”. I’ve been doing veterinary anesthesia for 20 years and my arterial catheter placement success rate is probably 85%. Are those 15% I don’t hit because I’m not competent? I’m sure I can get better- you always can- but I think it’s likely that a large chunk of that 15% is due to random chance. Sometimes, you can do everything right for a patient and it still dies. We’ve talked before about handling failure. I think we need to acknowledge the place random chance has in both success and failure.
Yes, hard work is necessary. It is important. If you don’t work hard, it will be more difficult to be successful (although some highly privileged people succeed nonetheless). But I believe we have to acknowledge how important luck is. At a certain point, you can’t hard-work yourself out of a situation or into another situation. Work hard, create opportunities, put yourself in a position to be successful. But realize there are many things outside your circle of control. Once you have done what you can, be content and realize you can’t control everything. Luck plays a big part in our life, for good or ill.
I was a first-year vet student before I even heard of internships. I was maybe a sophomore or junior before I learned about specialties. I recently saw a post on the APVMA Facebook group asking some very basic questions about veterinary medicine. This is probably not necessary for anyone who’s a senior vet student but, for those of you interested in veterinary medicine, I think you may learn something.
Caveat: Ask 10 veterinarians how they got to where they are and you’ll get 12 different answers. There are options to come from homeschooling, doing graduate degrees, going to community college while working full time, going into practice before doing a residency, etc. This description is the most ‘typical’ path, but many roads lead to Dublin.
High School – Take classes required for entry into college. Get experience spending time in a vet clinic. Work summers, volunteer at a clinic, etc.
College – Research the classes required for the vet schools you may be interested in and take those. Almost all schools require science courses like organic chemistry, genetics, and biochemistry. Realize that, during vet school, you will routinely take 20-22 credits/semester of mostly science courses. Try to take at least 15 credits/semester and at least a few semesters with 2-3 heavy science courses during your undergraduate years. Once you have met the course requirements, you may apply to vet school. This may be as early as your sophomore year, but most people apply in their senior year.
Vet School – Most vet schools in the US have 4-year programs. Each year consists of a typical academic year (either 2 semesters or 3 quarters) and a summer. The summers between your 1st and 2nd years and between your 2nd and 3rd years are typically “free” for you to spend as you like. The summer between your 3rd and 4th year is typically spent on clinic duty, which extends into your 4th year. Some schools may have you in clinics before the 4th year. The Caribbean schools and some others do not have breaks- you go continuously through so the total time for school is ~3.5 years (2.5 continuous pre-clinical years and 1 clinical year). At some schools, your time on clinics is only 9 months long (the summer between 3rd and 4th year is off).
Specialty Internship – This is a single year spent in your specific discipline (ophthalmology, surgery, oncology, etc.). You may spend time in other disciplines, but the majority of time will be in your discipline. This option is pursued if you are not selected for a residency. See my article on specialty internships for more details.
Fellowship – These are rare but becoming more common in veterinary medicine. If you want to become even more proficient in an area of your discipline, you can do a 1-2 year fellowship.
This is a very high-level view, and I have posts addressing most of these details throughout the blog. Again, there are many professional paths you can take, and these are only the most common, basic options. What do you want to know about veterinary medicine?
A year or two ago I was having a conversation with someone who had been an educator for decades. I tossed out a passing reference to Bloom’s Taxonomy and they said, “What’s that?” I was astonished. I consider this to be an extremely foundational principle for any educator to understand and use.
Bloom’s Taxonomy is a way to conceptualize how people learn and process information to make it useful to them. We often say in education that “we want the student to understand this.” But what does “understand” MEAN? What do we want the student to be able to DO? Does “understand” mean that we want the student to be able to take a patient, apply appropriate diagnostics, make an assessment, and create a treatment plan? That’s a lot of assumption built into that word.
Instead, Bloom’s Taxonomy is a pyramid of understanding. First, you need KNOWLEDGE. You need the basic facts of the topic. Next, you need to APPLY this information. You use what you know in a practical fashion. Next, you need to ANALYZE the information. Be able to compare and contrast. Next you need to EVALUATE it. Prioritize and justify your rationale. Finally, you need to CREATE something. Like a diagnostic plan or a treatment plan.
I find this incredibly useful because it helps to clarify what, exactly, I need the students to learn. I write learning objectives using words that align to each of the levels of the Taxonomy. This helps to guide my entire lesson plan. I start with the outcome- what I want the students to be able to do with the information (i.e. the Analyze, Evaluate, and Create levels)- and then work backwards. This is the principle espoused in the book Understanding by Design which I think is great.
There is a tendency (which I suffer from) to neglect the Knowledge level of the Taxonomy because I really don’t care if students memorize things. I want them to be able to APPLY what they know. I prefer open-book open-note exams because that simulates the real world. When I used to work emergency, I would occasionally hit up the textbooks there to see how to handle a case. If we let the senior students use these resources, why not let the pre-clinical students use them? Our world has moved on from when we need doctors to memorize tons of facts. We have access to the whole of human knowledge in our pocket. We need people to interpret information and evaluate it, not just memorize it.
I encourage anyone who is teaching to use Bloom’s Taxonomy as a starting point. It has been elaborated on and expanded in recent years, so you can get a lot more intricate. But I think this is a fundamentally essential approach to education. We can’t just have students memorize. We need them to be doctors. We need them to think. Bloom’s Taxonomy offers a straightforward way to approach this problem.
This is a guest post from a reader who reached out to me for advice on pursuing an internship and residency. When I followed up a year later, he had changed courses. I asked if he could share his experience, and this is what he wrote. Enjoy!
Like most of you, I had a very clear idea of what I wanted to do with my DVM (or VMD) before I set foot in the door. And like most of you, that idea changed. And it changed again, just for good measure. The DVM, although largely a clinical degree, is quite a versatile degree. This has been discussed ad nauseum at conferences, symposiums, professional development courses, and guest lectures so I won’t belabor the point here. Initially, I dismissed this as a nice idea that didn’t ultimately mean anything. After all, why would I train as a veterinarian if I wasn’t going to be seeing patients?
Something people often overlook when discussing the versatility of our training is exactly what the training entails. Certainly, learning how to diagnose and treat disease in animals is the primary focus of our education. More than anything though, veterinary school reinforces the inductive (or clinical) reasoning used to make reasonable conclusions from the available data. This, in my opinion, is where the versatility lies.
One of my first interests was public health, which gradually transformed into laboratory animal medicine. A summer internship in this field, however, tempered my enthusiasm. It was mostly a good experience, but it would have been a poor fit for a number of reasons, primarily the lack of opportunities to collaborate on basic science research without additional training. After this came an interest in diagnostic imaging, a specialty that could allow me to maintain a research and clinical career. Until my 4th year, I was convinced that this was the right choice for me, so my efforts were focused on putting together a competitive application to match for rotating small animal internships.
The summer after my first year, I participated in the NIH T35 program, which trains veterinary students in hypothesis-driven research (an experience I recommend). A seminar in this program was focused on alternative career paths for veterinarians, and one of these was the NIH T32 program. This program helps train DVMs to become independent investigators by awarding a select few institutions generous grants. These grants are then used by the institutions to provide a competitive stipend to DVMs pursuing a PhD. As I started to write my personal statement for the VIRMP, a question kept hounding me. Do you really want to do this?
Pursuing a clinical specialty had been my goal for quite some time because it would allow me some time for research, teaching, and clinical service, especially if I were to find a position in academia. However, after witnessing a problematic situation with a brand-new faculty radiologist and the expectations our school had regarding their appointment, I started to wonder what this would really look like. There were other considerations that introduced doubt, but this was fresh in my mind.
Small animal rotating internships are great for learning, networking, and becoming an excellent doctor, but they are inherently not a fun experience. I won’t lie and say this didn’t factor into my decision not to pursue specialty training. Another significant problem I started to contemplate was the time investment that this advanced training in diagnostic imaging would require. A small animal rotating internship is required before applying to any diagnostic imaging residency, unless years of experience are substituted. The match rate to diagnostic imaging residencies has been sitting at around 15% for years, so most applicants must also do a specialty internship if they hope to match. Most of these residencies are three years, but there are more four-year programs popping up. The total time spent in this advanced training could range anywhere from 4-6 years, depending on skill, connections, and a good deal of luck. Of course, there is also the issue of being paid very little for the duration of this training, more in private practice certainly, but the residency programs are fairly uniform. For a person passionate about diagnostic imaging, these might not be insurmountable obstacles, but I realized I was not that person. So, what was I passionate about?
A recurring theme through all of this was research, so why not start there? Thinking back to my time in the NIH T35 program, I started to consider doing a fellowship through the NIH. Browsing through the list of participating institutions, and going through those institutions to find participating mentors, I found someone whose research interests in wildlife epidemiology, antimicrobial resistance, and emerging zoonotic diseases very closely matched my own. This mentor was a DVM/PhD to boot! After a Zoom meeting, we agreed that I should submit an application, start re-learning some technical skills like programming, and plan to start working in her laboratory. The entire process felt much more natural and less anxiety inducing than The Match.
Money: Certainly, obtaining board certification in diagnostic imaging would have been a more lucrative career choice. Matching for a residency though, is no guarantee. The prospect of potentially going through two years of advanced training, on a low salary, without something tangible to show for it was not appealing. The salary I will make on an NIH T32 fellowship is about twice what I would make in any of the academic post-graduate clinical training programs.
Time: Becoming a radiologist is an enormous time commitment, taking up to six years depending on the caliber of your application and where you end up matching. For me, this is almost untenable both financially and professionally. My fellowship will take no more than three years to complete, largely because this is the length of the grant but also because my mentor expects high productivity from me.
Research: This program will train me to be a researcher. Almost all of my time will be spent doing research, teaching, and learning how be successful in science. Post-graduate clinical training programs include some degree of research, but the primary focus is understandably on developing advanced clinical knowledge, skills, and abilities.
Versatility: Holding a PhD as well as a DVM will open many sectors for employment that might be unavailable without this credential. Academia would be my preferred destination for many reasons, but there are many high-quality research programs in government and in the private sector as well.
If you are considering a career in research and you have any questions, please feel free to contact me at email@example.com.