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Sunday, May 22, 2016

Not Smart Enough? Vet Student Challenges

Recently I received the following email from a worried veterinary student, Brittany. 
I'm in my 3rd year of veterinary school and have been struggling a bit more than usual lately. Vet school has never been easy (I'm convinced those who say it is are lying to the world haha), but I've always done moderately well. I focus more on attempting to learn the material and making excellent reference materials than on making top scores on each exam (unfortunately the two techniques are often more mutually exclusive than I would have expected). I also try to be kind to myself with my expectations, which is a goal I still struggle with. Like most in this profession, I am highly self-critical and a perfectionist.

Lately, I've started to feel a bit of a panic at the thought that I'm simply not smart enough to be a good or even decent veterinarian. Information is jumbled in my brain, and I cannot easily recall the entirety of things I think I should know by now (such as pathophysiology, common signalment, common clinical signs, diagnostic findings, & treatment options for a standard disease process). Instead, I will have lumps & bumps of information-- but the holistic knowledge is still missing despite it having been presented to me in various classes during the past 3 years. I just don't feel like I'm "getting it", but I also feel that I'm at the point where I should be having more "aha! Of course it's __X___" moments instead of "that kinda sounds familiar" moments.

I apologize if this doesn't really make sense. My brain is a bit frazzled, and I only hope that all of this is simply a result of being burned out & needing my upcoming vacation quite badly. I guess I'd just like some input from someone who has been in my shoes before and walked farther down my intended path. I know you can't really comment on my intelligence (or lack thereof), but any insight on how you felt as an almost graduate (and recent graduate) would be immensely helpful.

I can promise you that you are not alone.  If you polled your veterinary class I would put money on most of your classmates feeling similarly.  I don't know of any vet who hasn't had feelings like this.  I know that I sure did!  When you're in school you are constantly it with a wide variety of diseases, physiology, anatomy, drugs, toxins, surgical equipment, and dozens of other things.  It's unreasonable to expect every person to retain and understand every bit of that knowledge. 

Veterinary school is not intended to get you to the point of knowing everything by the time you graduate.  That's impossible!  No matter how smart you are or how hard you work you simply won't remember every little fact or detail. Even if you are a straight-A student!  You are getting hit with new information every day, some of it so similar that it is easy to get jumbled.  You also are trying to figure out different anatomy and physiology for the dozens of species that we learn about in school, each of them needing different care, surgery, and medications.  A drug safe for one species may be toxic to another.  Colic in horses is extremely different from that in dogs.  It's actually more of a wonder that vet students come out remembering as much as they do!  Human medical students have it really, really easy by comparison.

Stop and take a look at your internal medicine text book.  Flip to the back and look at the page number.  If it's like most of the books it's over 1000 pages.  Do you really think that it's reasonable to expect a person to remember every detail on all of those pages?  And while internal medicine covers a lot, you still have parasitology, toxicology, surgery, pharmacology, anesthesiology, and numerous other "-ologies".  Through the four years of school we are taught information from tens of thousands of pages of texts!  And no, that's not an exaggeration!  I can promise you that even the editors of those books don't know every detail on every page. 

Also remember that you learn a disease and then move on to the next one.  How long do you spend talking about atopic dermatitis?  Probably a lecture or two, and then you're on to dermatologic problems you'll encounter much less frequently in private practice.  But this time of year I see potentially atopic dogs almost every day.  In vet school you simply don't have time to really see cases again and again.  It's one thing and then move on.  When I was on my surgical rotations I didn't see a single ACL tear, yet I've had three dogs come in with them in the last month.  The speed and case load in school is absolutely not representative of what you see in practice.

So what is school for if it's not to memorize these thousands upon thousands of facts?

It's to teach you how to think.  How to work through a diagnostic process.  Where to find the information that you need.

If you haven't been to a veterinary conference yet, you will find that the busiest vendors are usually the ones selling textbooks.  You sometimes have to squirm through other attendees to get close enough to look at the books.  Who are they selling to?  Experienced veterinarians.  Often people with decades of experience.  NOT students.  Why are they so busy?  Because there isn't a single vet (or human doctor) in existence that never has to look something up!  Sometimes we just want a reminder to make sure we're on the right track.  Other times we're completely stumped and really need to delve into the case.  In any veterinary practice you will find dozens of text books on the shelves, all ready for the skilled vets to grab.

Look at some of the trade journals and magazines that reach private practitioners (not the ones focusing on research).  You find case studies, diagnostic algorithms, articles on things as simple as how to interpret a urinalysis and what to do with chronic ear infections, and dozens of other tools.  Again, these publications are useful for experienced practitioners, not students.  They are needed because we forget things or need reminders.

We can't remember everything.  With enough time you certainly will be able to rattle facts off the top of your head and you will look things up less frequently.  During school you learn how to go through the process and how to think through a case, even if you don't know every detail.  This is especially important when you get the weird cases that doesn't follow the textbook examples.

I graduated from vet school with a solid B average, right at the 50th percentile in my class.  I had several Cs and several As, but I landed smack in the middle of my class.  I struggled through many classes, especially ones with lots of detail such as pharmacology.  Right now I could tell you the mechanism of action and dosage of dozens of drugs.  Back in school?  Nope, not very easily.  I've also forgotten the information on dozens of other drugs!  If I need them I know I can pull our my veterinary formulary and quickly look them up.  Why do I know them so much better now than back then?  Because I had to look up the doses so many times (dozens!  hundreds!) that it finally stuck in my thick skull.  But having to look up the information didn't stop me from being able to practice. 

Seeing cases day in and day out really help solidify the information in your brain.  I hardly look at information on otitis externa (ear infections) any more because I've seen so many hundreds (maybe thousands?) of cases that I've finally remembered what causes it and what I need to do.  That gets me through 90% of the patients.  What do I do with the other 10%?  Look it up or call a specialist.  The longer you practice the more your studies make sense.  You also start to better understand the kinds of things you see commonly.

Here's something that may seem don't have to have all of the facts memorized for rapid recall!  Take Cushing's disease (hyperadrenocorticism) for example.  In vet school I struggled to remember the two pathways and how it was caused.  Now I can draw a diagram from memory.  Other than doing well on a test and proving to my professors that I learned the information it really didn't matter that I had it memorized.  After seeing several cases after graduation it all finally started making sense.  And you know what?  I still have to look up the dosages of the drugs we would use to treat it, even though I know which drugs are an option.

Brittany, you said it yourself...people in veterinary medicine tend to be perfectionists and self-critical.  Your struggle is something that every vet has faced to one degree or another.  If you can pass classes with a C average or better and then pass your final board exams, you have all of the tools necessary to be a successful and skilled veterinarian.  Being a doctor is a continual process of learning.  I'm a far better clinician and surgeon that I was in 1997 when I graduated from vet school.  I'm not as good as I will be in 2027, with another 11 years under my belt. 

Last year I wrote a similar post, one that many people may find helpful as it directly relates to this situation.  Click here.

Brittany, I wish you the best of luck!