A Year of Challenges: Spring Grads, Instructors Find Frustrations and Benefits in a Pandemic Year

by Maureen Blaney Flietner

THIS SPRING’S VETERINARY GRADUATES have had a year like no other, going from “virtual reality” to a reality still not close to what had been the norm before the COVID-19 pandemic.

Veterinary schools have been challenged to provide the clinical rotations, client interactions, externships, and more that are part of the fourth year while keeping everyone safe. Everyone has had to adapt, innovate, and accommodate to meet a national crazy quilt of regulations and varying COVID infection rates.

Accommodations

Such an evolving situation has a learning curve that is sure to include frustrations and concerns. But even then, positives can be found.
At Washington State University (WSU), fourth-year students preloaded their course year with a month of vacation time last summer, said Raelynn Farnsworth, DVM, clinical associate professor of veterinary clinical science and interim director for the Veterinary Teaching Hospital.

“We started them up doing half in the clinic and half in online exercises. Most rotations in the clinic involve wearing KN95 masks and, if within six feet for 15 minutes or longer, an added face shield. Hands-on has been a little less than normal as we can’t have as many students crowding around things as we used to.”

While many externships were canceled, one opportunity arose: a virtual externship with Gary Marshall, DVM, founder and medical director of Island Cats Veterinary Hospital, Mercer Island, Washington, that was chosen by several WSU students.

“The goal is to have the student on an online connection pretty much most of the day. We use Zoom, Facetime, or Doxy.me,” he explained. “This way they can get a bit of a feel for what a typical day is like: the phone calls, exams, emails, lab results, procedures, and all the questions from staff as I go about my day. This allows quizzes [for] the student in real time. Along the way, there is lots of mentoring. We talk about places to work, contracts, expectations, and I often provide connections to other colleagues as well.”

At the University of Wisconsin–Madison, classes were completely virtual until July, when students returned to the clinic floor. But even then, most rotations were split with alternating days in clinic and at home watching instructional videos or working on paperwork, explained Elizabeth Alvarez, DVM, DABVP, clinical assistant professor and section head of Primary Care Service.

The University of Missouri initially had a short period of remote-only learning until it was able to better assess the situation and work through how to best continue to provide veterinary services and student education, explained Joanne Kramer, DVM, MS, DACVS, teaching professor and interim assistant dean of clinical education.

“We then met with every student, looked at their clinical schedule, and helped them optimize their experiences so that they met all AVMA Council on Education requirements, graduation requirements, and their own career goals. They pivoted right with us through it all.”

At Cornell University, a delay in entering clinical rotations was due to a partial shutdown of the university’s Hospital for Animals because of New York State restrictions.

“To ensure students stayed on track, clinical faculty used 3 weeks to develop a remote 11-week course for fourth-year [students] that provided intensive instruction in eight clinical disciplines,” explained Jodi A. Korich, DVM, associate dean for education. “The calendar also was reorganized to reduce breaks later in the year so students would make up those missed weeks and students were given opportunities to use open slots in schedules to repeat shortened rotations.

“To maintain the teaching objectives for these rotations,” she said, “faculty held remote rounds on Zoom, students participated in telehealth appointments, students ‘attended’ surgeries and ultrasound labs using cameras and web platform technology, small-group learning provided opportunities to practice clinical reasoning under the supervision of clinicians, students strengthened their professional skills with interactive exercises on various topics. In August 2020, students were able to resume in-person clinical rotations.”

Frustrations

But as would be expected, COVID restrictions have frustrated students. A few we spoke with at the end of February revealed their concerns.

Cornell’s Michaela Fontaine said “the hardest thing about COVID was that we lost about 14 weeks of in-person clinical learning. Cornell was able to put together a substitute course during the time period we could not be in the hospital early in the pandemic that focused on other aspects of being a successful clinician, such as communication, but I have realized in the past six months being in the hospital that online learning can never replace the learning that happens in the clinic.”

Fontaine said other frustrations include not having the freedom to choose when and where to do externships, not having a normal graduation ceremony, and no senior week celebrations.

“It’s tough to think that all of the work we have put in during the past four years will not be celebrated the way we had always planned for,” she said.

University of Wisconsin student Nicole Kuha admitted that her fourth-year experience felt a lot less personal than she thought it would be.

“Client communication is through the phone, we round virtually while spaced out in different rooms throughout the building or from home, and we have to ‘distance’ while we are not actively working on a case with a doctor,” she said. “There was a feeling of separation, but this has been improving over time. Some services are still cut back in the number of cases seen per day due to decreased staff or number of interns, residents, students, and clinicians allowed in the building at a time. While the cases I do see teach me a lot, some of the more notorious rotations were definitely more laid back than I thought they would be.”

Her main concern? Since she hopes to get an emergency/exotics internship, she is worried that she is missing out on exposure to different things to prepare her for an internship or first job.

WSU’s Marisa Carrera noted that client conversations are harder without face-to-face contact.

“It’s difficult to assess client understanding and build personal relationships over the phone,” she said. “A number of rotations did get canceled (dermatology, Seattle shelter medicine, in-person external rotations), which affected some students more than others.

“Online learning cannot compare to in-person learning. It is hard to stay fully engaged throughout the virtual workday. Not being able to feel enlarged lymph nodes, hear heart murmurs, palpate abdominal organs, or draw blood are just a few drawbacks of virtual learning.”

The University of Wisconsin’s Maxwell McCaughey noted that it “has been a unique challenge going through my clinical year with all the COVID protocols in place: curbside pickup, social distancing, spending intermittent days learning remotely instead of in the hospital, and the overall deficit of socialization with friends and family on the rare off days to balance out the hard work.”

Challenges

Faculty faced some curveballs. Those ubiquitous masks, for example, brought problems that were not related to breathing difficulties.

Since most people tend to take in faces as a whole rather than look at separate features, students and instructors lost many of the nonverbal communication cues they were used to.

“It’s hard to see if a student is ‘getting’ it or not unless they’re vocalizing,” explained Farnsworth. “They can’t see if we are just waiting for them to ask or answer. You lose a lot.”

Alvarez noted two other mask problems.

“When students are in rounds on Zoom and are unknowingly muted, they could have been talking for a good five minutes but no one is aware because they can’t see their mouth,” she said. “Another thing that we find more difficult with wearing masks at the clinic is the amount of pet hair that seems to somehow get in them as we work.”

Client communication over the phone required extra teaching attention that wouldn’t have been needed if people were face-to-face, said Alvarez.

Technology could also be an issue.

“Most students and instructors found out we didn’t have enough bandwidth for everyone in the household to be online at the same time,” said Kramer. “Changing rounds times and WiFi issues were a frequent frustrating occurrence in the initial transition. We also learned we didn’t have enough real-life bandwidth to keep up with an ever-changing situation unless we kept bringing the focus back to what was essential and let smaller issues go.”

“Our number one problem at the start was IT,” recalled Alvarez. “Owners were trying to call but not connecting. We had a bad WiFi signal. It was super frustrating, even to get a video camera where you wanted it to be.”

At the beginning, she explained, she would often be working alone with the camera on a tripod. A patient would inevitably knock it over or students would tell her they couldn’t see what was being shown. At least engagement was not a problem, Alvarez said with amusement, since she was sure it was entertaining as she practically stood on her head trying to get the camera at the right angle.

Korich, too, said they encountered surprises along the way. But they became very good at troubleshooting, thanks in large part to an educational-support services team that helped them adapt quickly and effectively to an online teaching environment.

“One of my favorite parts of my job is training future veterinarians,” said Marshall, “but teaching virtually turned out to be way more exhausting to be ‘on stage’ all the time than I thought. Sometimes it feels like it’s my job to entertain as well as teach. It’s also much harder to pass the student along to team members throughout the day. Other veterinarians weren’t as excited to have a student watching them on a screen while they work. But if they were in the clinic, they wouldn’t mind interacting with them about cases.”

Unexpected Benefits

Kuha found that “even though virtual rotations were overall not ideal, we had a lot of time to discuss specific problems in greater detail than we do now that we are in the clinic. For example, I took ophthalmology online over the summer, and while I didn’t get hands-on experience until my ophtho elective, we spent a lot of time talking about medications, disease processes, and how everything works in much greater detail than we did on the actual in-clinic rotation. So there was a tradeoff, and I still think the online rotation was very useful.”

Carrera said WSU has done “an incredible job at keeping students in the clinic as much as possible and attempted to prioritize fourth years’ learning during these times. They’ve also been very understanding and willing to work with everyone in certain scenarios that may be out of our control.”

While curbside service poses its own difficulties, noted Fontaine, “it also allows clinicians to take additional time with students to work through thorough physical exam findings and differential diagnoses.” He added that students are able to take as much time as is needed to learn to do a procedure or to ask questions.

“I think that the delay in starting our in-person clinical time made everyone much more excited to be back in the hospital and more enthusiastic about what we were learning once we were finally able to be back in person,” Fontaine said.

McCaughey said the pandemic “certainly hasn’t hurt the job market for us. There are many clinics hiring for growth right now. It seems like everyone knows someone who got a new pet or ‘quarantine comrade’ in the past year, and with that surge in pet ownership has come the increased demand for vet care. One silver lining is that with much of my learning opportunities performing patient exams, tests, and procedures, the owners can’t be in the room. Therefore, I get extra time and extra help from faculty, staff, and technicians to learn how to do things the right way and ask questions.”

While speaking about WSU specifically, Farnsworth probably best summed up the year for all.

“This class is to be commended for going with the flow,” Farnsworth said. “They rolled with what was happening. Their resilience is huge. I think the schools deserve the same commendation. Often, they would have to get something in place and it would have to be changed the next day. It’s been pretty amazing. The students are getting what they need. It may not be a better way but a different way.”

Maureen Blaney Flietner is an award-winning writer living in Wisconsin.

 

Photo credits: Grassetto/iStock via Getty Images Plus, photo courtesy of Gary Marshall, photo courtesy of Maxwell McCaughey, Photo courtesy of Elizabeth Alvarez, damircudic/E+ via Getty Images, Everyday better to do everything you love/iStock via Getty Images Plus