vmed 5458 & vmed 5463 equine medicine and surgery …...vmed 5458 & vmed 5463 equine...

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VMED 5458 & VMED 5463

EQUINE MEDICINE AND SURGERY CLINICS PROTOCOL

cfm- revised 1/2017

Table of Contents: Page:

Introduction 02

Objectives 02

Prerequisites 03

Standard Block Operations for rotation “A” and “C” and holiday blocks 04

EQUINE TECHNICIAN ASSIGNED ORIENTATION:

I. Patient Assignments 06

II. Patient management responsibilities 06

Preparation of surgery patients: 06

Patient Admissions 07

Treatment of In-hospital Patients 09

Policy for Operation and Management of the Equine ICU 10

Visitation by Owner/Agents 13

Discharge of a Patient 14

Biosecurity Protocol of the Large Animal Hospital 14

General Hospital Protocol 20

Proper Disposal of Waste 20

Tools you are required to have 21

CLINICIAN BLOCK COORDINATOR ASSIGNED ORIENTATION: 22

I. Student Assignments 22

II. Rounds 22

III. Emergency Duty Rotation 23

IV. Medical Records 24

V. Professionalism 24

VI. Dress Code 24

VII. Client/Patient Confidentiality 25

VIII. Block Evaluations 25

IX. Clinical Proficiency Evaluation Sheets 25

X. Clinical Competencies Assessment 25

XI. Grading 41

Example of Progress Sheet (Figure 4) 42

Example of Block Graded Sheet (Figure 5) 43

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Introduction:

Welcome to an experience of a lifetime. Congratulations! You have made it to the next phase of

your education. We hope that your equine clinical experience will be rewarding towards both

vocational and professional personal attributes. The equine clinical program is also a personalized

learning experience tailored towards special needs of our E.C.F.V.G candidates and externs as well.

However, it is up to you to get the most out of your experience. Become involved in every aspect

of your clinical experience. You are not only a student but becoming a colleague in one of the

greatest professions in the world! Best of luck.

Objectives:

To provide an opportunity to apply and reinforce knowledge learned in didactic courses during

years 1-3 (Phase I) relating diseases of horses to clinical situations.

To develop entry-level skills in equine medicine and surgery through:

o Assisting with patient diagnostic evaluation with the opportunity to perform various

diagnostic procedures including:

Picking up and inspection of a front & hind foot.

Application of hoof testers.

Taking heart (pulse) rate.

Taking a rectal temperature.

Taking a respiratory rate.

Ausculting the heart.

Ausculting the thorax.

Ausculting & percussing the abdomen.

Palpation of digital pulse and hoof temperature.

Assessment of mucous membrane color & capillary refill time.

Palpation of mandibular lymph nodes.

Performing a palmar digital or abaxial perineural nerve block.

External palpation of distal limb joints, flexor tendons and suspensory ligaments.

o Practicing various therapeutic techniques such as:

Intravenous injections

Intramuscular injections.

Intradermal/SQ injections.

Administration of oral medications.

Application of a foot or distal limb bandage.

Transtracheal aspirate

Nasolacrimal catheterization.

To gain knowledge of medical record keeping through management of patient records.

To formulate a patient treatment plan through discussions with clinicians-in-charge and house

officers (interns & residents) and review of the literature.

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To obtain basic surgery skills through observation, assistance, and hands-on surgical procedures

including:

o Aseptic preparation.

o Application of lower limb bandage.

o Placement of skin sutures.

o Retraction of tissues.

o Practice of aseptic gloving/gowning and draping.

o Instrument handling.

o Hemostasis

To obtain basic medical skills through observation, assistance, hands-on performance of medical

procedures including:

o Venipuncture to obtain blood.

o Fluorescein staining of the cornea.

o Estimation of body weight.

o Obtaining a PCV and total protein value.

o Calculation of drug doses based on body weight.

o Assessment of a CBC & chemistry panel.

To become familiar with management of equine emergency and critical care cases by

performing or assisting with:

o Passage of nasogastric tube.

o Abdominocentesis .

o Placement of an IV jugular catheter.

o Estimation of degree of dehydration based on skin turgor.

o IV fluid administration.

o Administration of analgesics used in equine patients.

o Triage of wounds.

To practice preventative health maintenance, prevention of disease transmission, biosecurity

measures. This may include vaccination, sample submission for EIA, deworming, management

of equine isolation patients.

To obtain communication skills through phone and personal discussion with clients regarding

updates of hospitalized patients, participating with the clinician-in-charge in communication

with clients regarding evaluation and treatment of their animal.

Prerequisites: VMED 5362 Diseases of Horses

You will be expected to know/review the didactic material presented in VMED 5362, equine

topics presented in VMED 5270, VMED 5263, VMED 5365, and be able to perform the

diagnostics and therapeutics included in the VMED 5362 laboratories.

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Block Operation:

Introduction:

The welfare of your patients should be your utmost priority. A TEAM APPROACH,

composed of students, clinicians, house officers, and technicians is VITAL in order to

accomplish this. Interaction with clients, peers, clinicians, technicians, and staff persons

plays an important role in your training.

Courtesy and understanding for those involved, including the client and referring

veterinarian, is absolutely essential. *Your interaction will be a factor evaluated in your

block grade.

Orientation:

Orientation begins promptly at 9:00 a.m. on Day 1 of the block in the Large Animal

Reception Area. It will include:

ACTIVITY/TOPIC TIME PLACE PRESENTOR

DAY 1

LA receiving protocol 9:00 AM L.A. reception Office Staff

Hospital Protocol 9:15 AM Hospital Equine

Technicians Block Protocol, Scheduling, EM

Duty 10:30 AM

Students round room (SRR)

Block coordinator

Assignment of Cases 1:00 PM ICU/Hospital Faculty/HO's

Equine Web-based record system 2:00 PM SRR

Equine Handling and Restraint 3:00 PM Hospital Equine Techs.

Ambulatory Protocol 4:00 PM Garage Dr. Chapman

DAY 2

Hospital hygiene 8:00 AM Hospital Brandi Sharp

Surgery Protocol 8:30 AM LA Surgery Sx nurses

(The block ends at 9:00 a.m. on Day 1 of the next block, ie when orientation begins

for incoming students.)

A brief orientation will be performed for students starting on the “C” rotation the

first morning of the rotation. You are expected to have read the orientation

information in the handbook and on the Moodle page, as this will explain how the

rotation works and what is expected of you. Meet in the Student Rounds room at

8:00 am for case transfer with the other students on the rotation.

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Holiday blocks (7C (Thanksgiving) and 8A (Christmas))

Block 7C extends through the Thanksgiving holiday (Thursday, Friday). The equine hospital

provides an emergency service over this period. Students are expected to be available over

this holiday if they are scheduled on the emergency schedule, or if they have inpatients that

require care over this period of time. Students cannot assume that they will have this time

off.

Block 8A runs from early December to early January and students are expected to

participate in hospital duties over this period. The hospital is open for the first 2 weeks of

the rotation, as usual. There is then a 2 week period where the hospital is closed. However,

all of the students on block will work for one of those 2 weeks that the hospital is closed.

Through this time the students are expected to be present in the hospital as we will continue

to see routine cases, with the exceptions of weekends and specific holidays (Christmas day,

the 26th of December, New Year’s eve and New Year’s Day), when they will be on

emergency coverage only. The dates that the hospital is closed is decided by the hospital and

changes every year. The students on the service will be contacted prior to the rotation so that

they can be forewarned about the dates and arrange their schedules accordingly. Case

transfer will occur on the 1st day of the holiday period and on the 1st day of the 2nd week of

the holiday period. Student attendance at these case transfers is mandatory, so vacation

must be scheduled around these dates.

See the example below from 2014-2015. Emergency days are marked in yellow. Normal

clinic days are in green.

Block 8A (week 2)

12/15/2014 M Open

12/16/2014 T Clinic case rounds 8:00 AM SRR All/Mitchell

12/17/2014 W Lameness 8:00 AM SRR Dr. Mitchell

12/18/2014 Th Clinic case rounds 8:00 AM SRR All/McCauley

12/19/2014 F Herd Health 8:00 AM SRR Dr. Andrews

Block 8A

12/22/2014 M Case Transfer 8:00 AM ICU All

12/23/2014 T

12/24/2014 W Christmas Holiday

12/25/2014 Th Christmas Holiday

12/26/2014 F

Block 8A

12/29/2014 M Case Transfer 8:00 AM ICU All

12/30/2014 T

12/31/2014 W NEW YEARS HOLIDAY

1/1/2015 Th NEW YEARS HOLIDAY

1/2/2015 F

Block 8C

1/5/2015 M Case Transfer 8:00 AM ICU

1/6/2015 T Clinic case rounds 8:00 AM SRR All/Riggs

1/7/2015 W Upper Respiratory Disease 8:00 AM SRR Dr. Riggs

1/8/2015 Th Clinical case rounds 8:00 AM SRR All/Andrews

1/9/2015 F Wound Management 8:00 AM SRR McCauley

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EQUINE TECHNICIAN ASSIGNED ORIENTATION

SECTION:

I. Patient Assignments:

A. Clinicians will assign patient responsibility to students on a case by case basis.

1. Patient responsibility extends 24 hours per day, 7 days a week for hospitalized

patients.

B. Technical support is available to assist you in case management, improve student

safety, and to provide the best overall coverage for our patients but does not relieve

you of your 24 hour responsibility.

A. Ultimately, you are responsible for monitoring, treatments, feeding and

grooming your patient(s) every day. a. *A significant portion of your grade will reflect these responsibilities.

II. Patient management responsibilities of student:

A. Daily physical examination and treatment of your patients, by 8:00 a.m.

B. Daily SOAP of the patient’s problem(s) (see Figure 1 for an example of

the general layout).

1. Progress sheets are to be computer generated using the Equine Clinics

Website (www.vetlsu.net), printed out and must be signed.

C. Submit Salmonella surveillance samples as required (see section IX).

D. Feed your patient as prescribed by clinician or house officers (this may be 2-

4x daily).

E. Thoroughly groom patients twice daily.

F. Timely submission of clinical laboratory, diagnostic, and ancillary service

requests as per discussed with supervising faculty clinician.

G. Timely and accurate administration of treatments as prescribed.

H. Preparing after-hours & weekend treatments, for attending technicians and

students on duty.

1. Creating daily and updating ICU/treatment schedule for patients as indicated by patient

status and discussion in rounds(s).

III. Preparation of surgery patients:

1. Complete surgery check sheet (located in Rounds room).

2. Submit and evaluate pre-surgical blood work (day prior to surgery). Consult with

clinician / HO on which blood work is necessary.

3. Obtain a weight on your patient

4. Submit surgery/anesthesia request forms (day prior to surgery) to anesthesia prep

(located in Rounds room).

5. Have shoes removed if requested by clinician. A technician can assist with this.

6. Review surgical procedure in detail, and be prepared for questions regarding the

procedure, possible complications, and post-operative management.

7. Submit intraoperative radiograph request if indicated

8. Prepare and administer peri-operative medications, usually morning of surgery.

9. Prior to walking your patient into the surgery induction room.

http://www.vetlsu.net/

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1. Pick and clean out hooves.

2. Groom and brush coat of patient.

3. Wash oral cavity of patient with water. A dose syringe and a bucket is

provided.

IV. Patient Admissions Protocol:

A. You will assist the house officer in signing-in patients admitted after regular

business hours and use the following protocol:

1. All admissions must be approved by a clinician.

2. All horses arriving after hours must have a completed sign-in sheet by the owner or agent.

a. Paperwork/Packets are in the Large Animal Receiving area.

i. This will be covered by receptions at orientation.

b. Patients that have been admitted to the hospital in the past will

already have been assigned a case number. This number must be

obtained to maintain accurate medical records.

i. The protocol for retrieving the case number will be discussed

by the large animal receptionist during Day 1 orientation. ii. Check to see if previously hospitalized patients are Salmonella

positive. If so they must be stalled in isolation, unless have been

tested negative for shedding Salmonella.

3. For new admissions, the house officer on duty or backup emergency

clinician or technician on duty will assign a case number from the log

book in the Large Animal Receiving Office.

a. It is very important that the owner’s name is entered in the log book

to indicate that the number has been assigned.

i. This will be the responsibility of the admitting clinician, HO,

or technician.

ii. This case number is to be used all medical records activities.

b. The case number is to be recorded on the sign-in sheet.

c. The sign-in sheet will have a have a carbon copy. The top sheet

(white) is to be placed in the box on the receptionist’s desk in the

Large Animal Office and the carbon copy (yellow) stays with the

patient’s record.

B. Stall Assignment:

1. After hours, the technician on duty will assign a stall (most likely in ICU).

a. As a matter of information, only bedded stalls which have a green

stall card on the gate are to be used.

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2. During business hours, patients will be placed in an out-patient stall (stalls

# 11-16). From there a designated technician will have a stall prepared for

any cases that will be hospitalized.

a. Please get in contact with your designated technician as to what stall

to use for your patient if he/she going to be hospitalized.

C. During normal business hours, obtain the record from receptionists, once patient

arrives.

a. For scheduled appointments:

1. rechecks – print off previous discharge summary and review case prior to

admitting the patient.

2. Scheduled new appointments: review anatomy, disease conditions,

diagnostic testing relevant to the presenting problem prior to admitting the patient

D. Introduce yourself to the owner/agent and then obtain a history, including feeding

and special instructions. a. if an owner, trainer, hauler is dropping the horse off, make sure to get a contact number

before they leave

E. Obtain a complete history by asking questions such as:

1. What is the problem?

2. When was problem noticed?

3. Was your horse examined by another veterinarian?

a. What were their findings and treatment, if any?

4. If a lameness:

a. What leg affected?

b. When was horse last shod?

5. If respiratory noise or respiratory induced exercise intolerance:

a. Describe noise

b. When does the noise occur (i.e. during exercise)?

c. Any nasal discharge?

d. Any coughing?

6. Also inquire about the insurance status, date and results of last EIA test

(Coggins), vaccination and deworming status and current circumstances

relating to presentation.

7. Type of feed, amount, and how often fed.

*Horses coming from the racetracks will often be transported by a hauler, so the

clinician in charge may have the history.

F. Perform a physical exam

1. For cases presented for lameness evaluation a complete physical

examination (TPR) is not necessary unless the animal is being hospitalized.

a. However it is very important that you examine the musculoskeletal

system by palpating the limbs for joint effusion, swelling, tenderness,

conformation, etc.

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2. Be sure to get a lameness exam form to record the lameness exam findings.

10. Place the stamped stall cards provided in the patient’s record at the time of admission

with the owners/patient information and attending clinician’s and student’s names, on

the front of the patient’s stall.

H. Provide water and hay unless animal is being specifically to be maintained NPO.

1. If amount and type of feed is unknown, ask clinician in charge.

2. Patients should be fed around 7 am and 5 pm or more frequently as

directed.

V. Treatment of Hospitalized Patients:

You are responsible for the care and treatment of your case(s). The system of

technician support does not relieve you of this responsibility. It is set up to assist you

in providing the best possible care.

A. You are responsible for (7 a.m. & 7:00 p.m.) treatments and physical exams of

their patient(s) during the weekdays, weekends, and holidays.

B. Treatments and monitoring of equine patients:

1. It is the responsibility of the service in charge (faculty, house officer,

technician, students) of the patient during normal business hours.

2. In the event there is any loose manure/diarrhea noted please inform the

respective house officer overseeing your patient.

3. Any concerns, such as, IV catheter problems/swellings, colic, bandage

issues should be reported to the respective house officer overseeing your

patient immediately.

4. Administration of medications are the student’s responsibility from 7 am

& 7pm. You should not give any medications unless you have double check

the dosage, know the reason for administering the medication, know the

appropriate route the medication should be administered and the side effects

of the medications. Double check the treatment sheet and the medications

before administering. If any mistake is made during administration, please

notify the HO or clinician you are on service with immediately!

C. Weekend/Holiday treatments:

1. You are expected to be physically present to care and treat your case(s)

on Saturday and Sunday (or holiday) mornings and will have case

rounds with your clinician &/or house officer before leaving.

2. Hourly treatments are done by the technicians, except @ 7am and 7pm.

Please make note: you are responsible for the morning and afternoon

treatments of you patients on weekends and holidays.

5. After your morning care of your patient, the care of the patients will be

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the responsibility of the technicians, and when necessary the primary

and secondary on-call students. Detailed care and treatment must be

written on the stall/ICU treatment sheets.

D. Each patient should have a box labeled with the stall number and patient’s name,

medication, dosage, route of delivery, in the in-patient medication treatment room.

Please keep your medication box neat, clean and tidy at all times! Additionally, it is

the student’s responsibility to clean up after themselves when preparing medication

etc. If you do not have the appropriate / necessary equipment to prepare

medications, or are unsure how do so then please notify your clinician and/or HO.

E. Refrigerated medications must be clearly labeled with the patient’s name,

medication’s name and amount, case number and attending clinician/student.

Reconstituted medications must be labeled with the date and strength..

F. Medications to be administered after-hours (including weekends and holidays) must

be prepared as much as possible in advance and clearly labeled with the patients

name, stall number, time of administration, route of administration, drug and dose.

Note: if you do not have your medication prepared and labeled appropriately you will be

called (at any time, including at night) by the ICU technician to come and make up your

medications

1. Any ICU or after-hours treatments must be signed-in on the treatment log

sheet.

2. Have the medical record therapeutics sheet completed in the record such that

the duty person can sign and check off completed treatments.

G. Carts in front of the stall and medication boxes are an extension of you patient –

therefore it is the student’s responsibility to make sure that these areas are kept neat

and clean at all times.

H. Standard Treatment Schedule:

SID = (q 24 hours) 7 a.m.

BID = (q 12 hours) 7 a.m., 7:00 p.m.

TID = (q 8 hours) 7 a.m., 3-4:00 p.m., 11 pm-12:00 a.m.

QID = (q 6 hours) 7 a.m., 1-2:00 p.m., 7-8:00 p.m., 1-2:00 a.m.

*Please mix/draw in respective syringe, label appropriately, and stow appropriately

your 11 pm-12:00 am and 1-2 am treatments.

I. The ICU techs will be responsible for monitoring and doing appropriate TID/QID

treatments for horses in the main hospital when they are assigned to be on duty

during the night, weekends and holidays.

J. The ICU tech will also be responsible for doing hourly walk-by examinations on all

horses in the hospital day and night.

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K. Alert house officers/clinicians to IV catheter problems such as clotting, swelling

around the catheter cutaneous junction and/or displacement at any time day or

night.

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VI. Policy for Operation and Management of the Equine Intensive Care Unit

A. Priority of cases for admittance to ICU will be horses that are:

1. Recumbent.

2. Have respiratory distress.

3. Have gastric reflux.

4. Require IV fluids.

5. Post surgical colics.

B. The following patients may be admitted directly to ICU

1. Recumbent patients.

2. Respiratory distress patients.

3. Neonatal foals

4. Neurologic patients (non-infectious) needing to be housed in stall 10 (neuro stall)

5. And or laminitis patients needing slung in stall10.

*All other patients should be evaluated in examination rooms or outpatient stalls

prior to admittance.

C. To admit a patient, the clinician will contact the ICU technician for stall assignment.

D. When ICU care level falls below ICU-2 (no longer requiring fluids), the patient may

be moved back into a stall in the general hospital.

1. Contact your assigned technician o arrange for a stall to be prepared.

2. The clinician and/or technician assigned to that patient will be responsible for

moving the horse.

E. Patients that must be placed in isolation:

1. A hospitalized horse that develops non-projectile diarrhea that persists for

>24 hours regardless of body temperature or white blood cell results must be

moved to isolation.

2. A hospitalized horse that develops projectile diarrhea (< 24 hrs.) must be

moved to isolation.

3. Foals that have diarrhea for more than 24 hours will be moved to isolation.

4. Vacated stalls will remain unoccupied until cleaned, disinfected and cultured.

They will not be reused until Salmonella cultures are negative.

F. No horse with infectious/contagious disease (diarrhea, strangles, viral

respiratory disease, etc.) may be placed in ICU.

1. These patients go directly to isolation through the north gates.

G. Patient cleanliness/grooming will be maintained by you. Remember it is the

students responsibility to groom their patients twice a day. Additionally, carts and

medication boxes should also be kept clean and neat at all times!

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H. Persons entering and exiting stalls are responsible for cleaning up shavings and

debris tracked into ICU or aisles in the hospital. Please sweep up after yourself

and clean footbaths as needed (at least 2x day).

I. Sharps and biohazards must be disposed in biohazard containers.

J. Equipment used must be cleaned, disinfected, and returned to its proper location.

K. Treatment orders for procedures to be performed by the ICU technician must be

completed by the clinicians and/or students assigned to the patient.

1. Medications will be obtained from the pharmacy by clinician/student and placed

in the assigned area.

2. Medical records for ICU patients will be kept in ICU at all times.

L. Salmonella Surveillance Program.

1. All horses entering the hospital should be considered positive for Salmonella and

handled appropriately. Only horses entering the hospital that have conditions

including colic, being administered I.V. fluids, or hospitalized in ICU must have

fecal samples submitted to the diagnostic lab for surveillance Salmonella

cultures.

2. All horses that present with diarrhea or a history of diarrhea, fecal samples will

be collected as part of the diagnostic work-up and the client will be billed.

Diagnostic cultures are not considered part of the routine surveillance

program. 3. Daily fecal samples are to be collected for 5 days beginning at admission.

4. Weekly samples after day 5.

5. Samples for horses hospitalized in ICU will be collected by student in charge.

6. Completed Salmonella Surveillance forms and fecal samples will be placed in the

Salmonella Surveillance refrigerator located in the inpatient treatment room

(please refer to biosecurity protocol).

M. Doors to the ICU should be kept closed at all times except when entering or exiting

the facility.

1. Patients should enter/exit from the south door (breezeway) and the DLAM

personnel and people transporting supplies to the ICU storage room should

enter from the north door (hallway by Alvaro’s lab).

2. Please use the “people” door from the south (breezeway) when not leading a horse

in or out of ICU. This minimize escape of air-conditioning and heat.

N. All personnel must have rubber shoes/plastic boots that are scrubbed with

disinfectant prior to entry.

O. Exam gloves must be worn if coming in contact with patients.

P. All personnel entering the stalls must wash their hands or use the hand

disinfectant when entering/exiting the stalls.

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Q. Completed, signed APR is required prior to ANY supplies from the ICU storage

room / omnicell being dispensed for the patient.

R. ICU stalls will be cleaned by the DLAM personnel in accordance with current

standard operating and biosecurity protocols.

S. The ICU technician will be responsible for:

1. Remote monitoring of horses in isolation stalls and mares with impending

parturition hospitalized in mare stalls (#57-59) via the video monitors located

in the ICU.

2. Treatment/monitoring of any patient in these areas that are receiving ICU

level 2 care or above.

3. Monitoring and appropriate TID/QID treatments for horses in isolation

during the night.

4. Providing care to neonatal foals under the direction/supervision of the faculty

medicine / Emergency after-hours clinician.

a. The faculty member will decide whether the foal team or additional

technical support (on-call technician or student worker) will be called

in to assist.

T. Feeding instructions and administration of ICU patients will be responsibility of the

service in charge.

1. Overnight feeding will be done by the ICU technician with instructions from

the service.

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VII. Visitation by owner/agents

A. Visits by owners/agents of hospitalized patients must be pre-arranged and

approved in advance by attending clinicians.

B. Visits are limited to the owner and immediate family member or trainer.

C. Visits must be arranged between 8:00 am-5:00 pm on weekdays and are limited in

length to no more than 1 hour and must not extend beyond 9:00pm.

1. During regular hours, visitors must check in at the Large Animal Office

prior to going to see their horse.

2. Only under special circumstances, can visitation outside these times can be

arranged, but this must be specifically arranged with the clinician in charge of

the horse’s care.

a. These visitations outside the regular hours must be arranged so that

the student assigned to the case, or the house officer or clinician

involved with the horse are here to accompany the owners to the stall.

3. When visiting occurs outside of normal business hours, the visitor must

check in at the security officer’s desk at the main entrance to the School

of Veterinary Medicine and await an escort back to the Equine Clinic.

a. The officer on duty must be contacted in advance, by the clinician

or student in-charge of the case in anticipation of the visit.

b. No client should be allowed in the large animal hospital if the security

officer on duty was not informed of the appointment.

D. It is not appropriate to schedule any visitation during or after hours or weekend

without prior approval or knowledge from your respective house officer and clinician

and do not to expect the evening technicians or on-duty students to take care of these

visitations…most times, they are too busy with treatments and admittance of

emergencies to deal with visitations.

E. Horses that are in isolation cannot be visited.

1. Persons not essential to the care of the patient cannot go into the isolation

area.

2. This is to protect our other hospitalized patients, and the visitors from

contracting the disease or carrying it home to other people or animals.

F. If there are problems with clients adhering to this policy, please inform the clinician

in charge of the case, the block coordinator, and if necessary the equine service chief,

hospital director and/or the SVM security personnel.

G. Self-guided client tours through the hospital are absolutely prohibited! If you

see a client in the hospital stall area direct them Conference room located across

from the front desk or snack bar during business hours.

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VIII. Discharge of a Patient:

A. Prior to discharge, you should meet with your supervising clinician/house officer as

to the written instructions and what, if any, medications need to be sent home with

the patient.

B. All discharges must be approved by the attending clinician.

C. Discharge instructions are to be completed in advance of the arrival of the client

in conjunction with the attending clinician. The discharge instructions must be

signed by the supervising clinician before submitting it to the cashier.

1. The equine online discharge forms (www.vetlsu.net) are to be used for

generating all discharges.

a. A preliminary discharge should be generated for the clinician to

review before finalizing.

b. Discharges should include the following: a summary of the case (not a day

to day log of what occurred), list of procedures performed, diagnosis, and at

home instructions for the client (this should include but is not limited to:

exercise, diet, bandaging, monitoring, suture removal, recheck appointments).

D. Horses should look better leaving then they did arriving (i.e they should be

thoroughly groomed (including removing tape from shoes, blood from skin etc.). Prior to

bathing any horse please speak to HO or clinican to make sure it is ok – no case with

surgical incisions should ever be bathed.

1. In the event a fractious animal, always ask for help to complete these tasks.

E. Make sure to return any un-used medication to pharmacy well in advance to credit

the clients bill before they leave.

F. Have any medications and patient’s belongings available at time of discharge.

1. If possible take to the cashier with the discharge instructions printed and

signed in an LSU envelope.

G. After discharge, remove the stall card, record the date and time of discharge on the

red stall card and throw the white stall card in the stall floor to signal the hospital

cleaning crew to strip and clean the stall. Also, return items from the cart to its

appropriate location, clean the cart and return to the technicians in ICU.

1. If an AM discharge is planned, place the blue index card to the front of the

card holder on the stall labeled “TO BE DISCHARGED THIS MORNING”.

IX. Student Bullet Points: Biosecurity Protocol for the LSU Large Animal Hospital

1. General Protocol for Minimizing Spread of Infectious Diseases:

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1.1 ‘RESTRICTED ZONE’: Designated Area within the Large Animal Hospital in which

strict biosecurity measures must be followed and will be enforced (Figure 1).

1.1.1 Only SVM personnel essential for patient care and instruction, hospital

cleaning, and maintenance are allowed entry into the large animal hospital

designated as ‘RESTRICTED ZONE’.

1.1.2 Signage: Signs will be posted at each entry of ‘RESTRICTED ZONE’ area

to designate the area and instruct the use and disinfection of proper foot wear.

1.2 Rubber Footwear: All personnel (faculty, house officers, technicians, students and

DLAM workers) must wear rubber shoes/boots while in the large animal hospital that

can be scrubbed, rinsed and completely submerged (to the top of the foot) in a

detergent/disinfectant foot wash/bath (rubber must cover the complete bottom, and

complete sides of the foot).

1.3 Plastic boot covers - Any person that enters the large animal hospital designated as

‘RESTRICTED ZONE’ (ie. those coming in for a short visit) that do not have rubber

foot wear alternatively must wear approved plastic disposable boots stored in cabinets

located near entrances to the restricted zone.

1.3.1 Plastic boot covers are to be removed prior to leaving the Large Animal

Hospital and disposed of before moving into other parts areas of the SVM.

1.3.2 The plastic boot covers must be disposed of in a biohazard container (red

bag).

1.3.3 Hands must be washed/disinfected after removing disposable boots.

1.4 Footwear Disinfection: Any and all persons entering the large animal hospital

designated as ‘RESTRICTED ZONE’ must scrub and disinfect their boots at the

designated disinfecting scrub stations.

1.4.1 Footwear must be thoroughly disinfected by:

Figure 1.

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1.4.1.1 Rinsing with detergent/disinfectant

1.4.1.2 Scrubbed with boot brush.

1.4.1.3 Rinsed again with detergent/disinfectant.

1.4.2 Manure, shavings, mud, other debris must be thoroughly removed/rinsed

from boots.

1.5 Foam hand disinfectants:

1.5.1 Must be used to disinfect hands after handling a patient.

1.5.2 Must be used between patients.

1.5.3 Dispenser will be available at each stall, entries/exits into ICU and isolation,

exam rooms, standing surgery, and at each boot wash station.

1.6 Pant cuffs (bottoms) must not drag the ground and be at least one inch from the floor.

1.7 No eating or drinking is permitted in the restricted areas of the large animal hospital

(including LA Isolations), except those areas specifically designated.

1.7.1 Acceptable locations for eating/drinking include:

1.7.1.1 Student Rounds Room

1.7.1.2 Breezeway when NOT working with an animal, or any biological

samples

1.7.1.3 Outside of the LA VTH proper

1.7.2 Personnel stationed to work in ICU or ICU-designated stalls in main hospital

may have a closed drink container with a lid and incorporated straw – these

drinks will be kept in a designated cubby when not being used.

1.8 Movement to and from Necropsy :

1.8.1 Persons entering the necropsy area must not re-enter the large animal hospital

without first scrubbing and disinfecting their rubber foot ware at the

appropriate disinfectant dispensing station located on the necropsy dock.

1.8.1.1 Refer to pathology biosecurity protocol regarding entering

necropsy area.

1.8.2 Thorough hand-washing and disinfecting must be performed before returning

to the LA Hospital.

1.8.3 All equipment (carts, forklift, etc.) must be cleaned and disinfected prior to

re-entering the large animal hospital at the designated disinfectant dispensing

station located on the necropsy dock.

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2. Protocol for Movement Into & Out of Isolation (LA-IU)

2.1 Isolation Layout:

2.2 The clinician in charge of a case (including emergencies) is

responsible for the examination of the patient being admitted into the large animal

hospital as soon as possible, in order to screen patients for the possibility of infectious

disease (fever, nasal exudate, cough, neurologic signs, diarrhea, etc.). Patients

suspected of having infectious disease should be examined in one of the Large Animal

Isolation Unit Examination room (LA-ISO-U Exam room #1 or LA-ISO-U #2)

2.3 LA ISO entrance/exit patients and personnel 2.3.1 Personnel entrance

2.3.1.1 There is one personnel entrance into each stall of the large animal

isolation unit via an anteroom (stalls 1-7) and ante area (stall 8/Swing

gate room).

2.3.1.2 The ante room is also the change room and is divided into clean

(outer) and dirty (inner) areas (the recessed floor area with the drain is

considered to be the dirty area).

2.3.1.3 The protocol for movement into the isolation stalls is as follows:

Prior to entering the anteroom or in the clean area, remove lab

coat or coveralls and other pieces of outer clothing, cell phones,

and place these items on the hooks provided.

Remove all items of jewelry that may come in-contact with

patients (Medical-alert bracelets are exempt)

Put on a disposable coverall, and gloves as per PPE instructions.

Place plastic boot covers over your clinic shoes

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2.3.1.4 All patient belongings (halter, specific meds, grooming kits, etc.)

will be maintained in the rolling cabinet within each anteroom (this

cabinet will remain adjacent to the personnel door opening for each stall

2.3.1.5 When designated tasks have been completed in the isolation stalls, the

following protocol is required for exit from the facility:

Doff PPE in the recessed floor area in front of the steel door,

including plastic boot covers

Scrub clinic footwear using the scrub station hose with

disinfectant

Wash and disinfect hands and other skin areas in contact with the

animals at the sink area in the ante room

Dress and exit the ante room

Use hand disinfectant at wall posts prior to leaving the ISO

building.

Scrub footwear prior to re-entering the LA hospital at designated

entry into the LA HOSP

3.3.3 Movement of patients

3.3.3.1 Patients will be moved into the LA-ISO-U stall area via the north or

vestibule entrance. The doors will remain closed at all times except for daily

cleaning, and feeding hay. Patients may move back and forth between the LA

ISO treatment area (treatment area must be cleaned immediately after use). If

horses/livestock are moved between the isolation stall to the examination

room, any feces produced in transit must be collected immediately and placed

in the manure/bedding waste area and the path disinfected

4.3.3.2 Patients are only to leave the isolation facility on discharge or

following euthanasia/death (except in exceptional circumstances).

4.3.3.3 In exceptional cases patients who are confirmed to not have aerosol

transmitted diseases and at least 3 Salmonella NEG fecal samples, may move

back and forth for isolation grazing area as long as the path is disinfected if

manure is spread or tracked.

4.3.5 Feeding

4.3.5.1 Grain will be fed by the veterinary student assigned to the case and

will be carried into the stall via the anteroom personnel door. Hay

will be fed from the animal entrance door and placed in the hay rack

twice daily in each stall by the student. Designated isolation hay

storage area will be kept in a covered hay bin and maintained in the

breezeway area of the LA ISO. Hay containers will be used to

transport hay to prevent spillage. DLAM personnel will maintain

fresh hay (alfalfa & grass hay) in the covered containers as needed

for patients housed in LA-ISO-U. Students or other care-takers will

sweep up any spilled hay immediately.

4.4 Appropriate personal protective equipment (PPE) must be worn.

4.4.5.1 Any person (faculty, house officers, technicians, students, staff,

DLAM personnel and contract personnel) entering isolation or main

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hospital stalls marked ‘ENTERIC PRECAUTIONS’, MUST wear

proper attire at ALL times including:

4.4.6 Boots and disposable foot covers,

4.4.7 Full zippered-suits (with specific specifications)

4.4.8 Latex exam gloves – double gloved

4.4.9 DLAM personnel will hang a complete PPE at each isolation stall to be cleaned

at the beginning of the day and full PPE will be changed between each stall

cleaning. Doffing and changing into clean/new PPE will occur in the vestibule

area of each stall. Once the last stall is cleaned, DLAM personnel may wear

rubber boots designated for isolation when hosing the breezeway and main

areas of isolation including the cart-wash area.

4.5 Foot scrubbers are located at both entrances of each stall of the isolation unit.

4.5.5 Individuals moving into and out of these stalls must scrub boots, or change

boot covers at each stall (ie. feet must be disinfected between stalls).

4.5.6 Disinfectant buckets should be refilled as often as necessary with fresh

disinfectant/detergent.

4.5.6.1 The technicians will be responsible for replacing disinfectant in the

buckets.

4.6 Doffing PPE - Removing foot covers, isolation suits, and gloves:

4.6.5 Care must be taken not to contaminate ‘general hospital attire’ when removing

isolation attire.

4.6.6 Outer pair of gloves is removed first.

4.6.7 Any face protection is removed.

4.6.8 Isolation suit is removed next, by pulling the arms inside out.

4.6.8.1 The process in continued by rolling the suit down the torso and leg.

4.6.9 The suit is pulled over the disposable booties and removed in unison.

4.6.10 Inner exam gloves are then removed.

4.6.11 Shoe covers, isolation suits, and exam gloves are immediately disposed of into

a biohazard (red) bag.

4.7 Rubber footwear worn in the clinic will be washed/disinfected with disinfectant from

dispensers located in anterooms and then prior to coming back into the LA hospital (at

entrances to the restricted zones).

4.8 Hands are to be immediately washed with a disinfectant detergent hand cleaner after

dressing out (doffing).

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X. GENERAL HOSPITAL PROTOCOL:

A. It takes the effort of EVERYBODY to keep the hospital clean. It is important for the

welfare of the patients and image of the hospital.

B. Any area in which an equine patient has been must be cleaned after use. It is your

responsibility to help clean up after the patients on your service!

1. This includes treatment rooms, ICU, aisle/breeze way, alternate isolation, and

isolation.

2. Manure is to be picked up, floors swept and washed down, counters wiped off,

equipment cleaned and returned to its proper place, stocks cleaned/washing off,

and trash discarded.

C. Always wash your hands between treatments or examinations of patients. D. Isolation protocol absolutely must be followed. This protocol will be explained during

orientation on Day 1.

E. If a stall is suspected of being contaminated with an infectious agent, inform an

equine technician ASAP.

F. Do NOT TIE horses ANYWHERE unattended except a slip halter tie in a properly

secured stocks. (after back and front gate are shut and latched). Before tying any

horse, make sure the horse knows how to tie – ask owner/trainer and HO/Clinician

before tying any patients.

G. Don’t TIE horses ANYWHERE with a chain shank over or under the nose.

H. Do NOT LEAVE a horse in the stocks unattended, even for a minute.

I. Use the hay cart to deliver hay to stall.

J. Inspect the front and back gate of stall to assure they are securely latched.

K. Do not use brushes assigned to one patient on any other patient.

L. Notify the respective technician of low supplies.

M. Please help clean after the patient exam is over.

N. In accordance to LSU SVM policy, students and staff are not allowed to operate the

forklift who have not been certified.

O. Complete APR’s for any supplies used from the treatment rooms, ICU, or isolation.

1. All APR’s (including for after-hours retrieval of medications and supplies)

must be signed by a clinician or house officer.

2. All APR’s must include client’s name, patient’s name, & clinic case number,

by stamping it with the patient’s red card. P. NO food or drink in ICU, isolation, or hospital refrigerators.

Q. Please do not leave personal belongings in ICU or treatment rooms.

1. Place your belongings in the cubbies in student rounds room.

XI. Proper Disposal of Waste

A. STATE LAW requires that all biohazard trash be separated from non-hazardous trash.

B. There are 3 different waste receptacles in the hospital:

1. Regular waste: This includes paper products, wrappers, manure, bandages, and

non-hazardous materials. Dispose of these items in the gray lined trash receptacle.

2. Sharps and other Biohazard materials: This includes needles, scalpel blades,

gloves, broken glass bottles or vials and blood soaked items. Dispose of these items

into the red lined receptacles.

3. Non-hazardous Pharmaceutical Wastes: This includes unused medications.

a. Dispose of these items into the receptacles labeled NPW.

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XII. Tools you are required to have while on this rotation:

-stethoscope -hoof pick and knife -bandage scissors

-suture scissors -hemostat -thermometer -pen light.

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CLINICIAN BLOCK COORDINATOR ASSIGNED ORIENTATION:

I. Student Assignments:

A. Students will rotate among 2 surgery services and 1 medicine service of the senior faculty assigned to

the block respectively. Assignment to the services will be made on Day 1.

II. Rounds:

A. Hospital Rounds: Will start 1:00 pm on Day 1 and on student rotation to different service.

The purpose of the rounds are:

1. To view and discuss each equine patient in the hospital.

2. To reassign patients to a different student.

B. Clinical Case Rounds: Will be held at 8:00 a.m. on Tuesdays and Thursdays. Each student

will be expected to present at least one case in depth including:

1. Present the facts! - A brief signalment, presenting complaint, significant findings,

assessment, therapy, plan, prognosis.

2. It is highly recommended to show radiographs, ultrasonograms, endoscopy images,

etc. If you need help accessing these images, ask the HO / clinician the day prior to rounds

to help you down load them.

3. In the essence of time please do not ramble on regarding:

a. The temperament of the patient.

b. How many times you brushed your patient.

c. How many times the patient tried to bite you.

4. Format for presenting a Hospital Rounds Case:

a. Presenting problem:

Presented on ____________(date) for _______(problem).

b. Pertinent History (including duration of signs)_________________.

c. Diagnostic Plan &/or results:

1)_______2)_______3)_______4)_______5)_______6)_______

d. Problem list (if pertinent):_________________________________

e. Treatment Plan:__________________________________________

f. Prognosis (for return to original use)_________________________

g. Other important information:

Use generic drug names

Use proper medical terminology

Do not use jargon

Avoid statements such as “We did a CBC and it showed a high white count…”

Instead, use “A leukocytosis was present.”

Avoid statements such as “We took the horse to surgery” or “We took the

horse to radiology”. Instead, “Radiographs of the ________(location) were

taken”, or “A ventral celiotomy was performed,” or “A condylar fracture was

evident in the left McIII radiographically”.

If you use radiographs or other visual aids, orient the audience to the film

when you start by telling them which limb or location is visualized on the

exposure, and point out the pertinent structures, then point out the pathology.

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MAKE NOTES in advance of your discussion.

C. Topic Rounds: Will be held at 8:00 a.m. on Wednesdays and Fridays.

1. The following topics will be covered by the faculty on block:

a. “Evaluation & Management of Colic Patients”

b. “Lameness Evaluation”

c. “Herd Health”

d. “Emergency and Critical Care Procedures”

e. “Wound Management”

f. “Student Conference”

III. Emergency Duty Rotation:

A. Emergency duty is part of the educational program.

B. All students will participate in taking emergency duty during the block.

C. Students will participate in management of emergency duty cases on a rotating schedule.

1. Assigned emergency duty must be performed personally by the student assigned and

every student must be willing to share the responsibility equally.

D. This system includes a primary and secondary student, trained veterinary technician, house

officer, and clinician to perform most after hours and emergency duties.

E. The students will develop a primary and secondary duty schedule for the block by the

afternoon on Day 1 in which all duty is divided as equally as possible.

1. If the students do not complete this task on time, the duty schedule will be assigned at

random by the clinicians.

2. A student shall not schedule two consecutive primary duties.

F. The primary and secondary duty students must be available to be called in from 5:00 p.m. to

8:00 a.m. on Monday through Friday, and all times on Saturday, Sunday, and holidays for

emergency in-hospital and ambulatory cases or if the after-hour technicians needs

assistance.

G. A house officer is the primary emergency duty clinician and is responsible for admitting

emergency in-hospital cases and ambulatory emergencies.

1. It will be the responsibility of the house officer to notify the on-call students and

ancillary services such as anesthesiology of incoming emergencies, or to delegate that

task to the on-call students.

2. Primary duty student will accept new cases under the direction of the house officer

on duty, and assist in the treatment of hospitalized patients if necessary. 3. Secondary student may be called in to assist with treatments or for additional

emergencies.

H. The primary and secondary duty students are required to be readily accessible by telephone at all

times.

I. A technician will be assigned to ICU and treatment of hospitalized patients on Saturday and

Sunday and holidays.

1. However the primary on-call student must check with the ICU tech at 8:00 am each of

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these days to assist with care and treatment of the patients.

2. Once treatments are completed the ICU tech will dismiss the primary on-call student, at

which time can leave.

J. If both primary and secondary students are occupied with emergency cases, the student(s)

with in-hospital case(s) may be called in to perform treatments on their patients. 1. Additional assistance is available from the SCAAEP colic and foal team at the request of

the house officer on duty.

K. Emergency duty rotation times for weekends and holidays:

Monday - Friday: 05:00 pm – 08:00 am

Saturday (or holiday): 08:00 am - 04:00 pm; 04:00 pm-12:00 am

Sunday (or holiday): 12:00 am -08:00 am; 8:00 am – 4:00 pm; 4:00 pm-12:00am

Monday: 12:00 am – 08:00 am

IV. Medical Records:

Medical records are legal documents. They must be handled like legal documents:

A. You must write legibly or type entries.

B. Progress Notes (SOAP’s) for each patient must be completed before rounds each day (See

Figure 1).

1. All Progress notes are completed on-line at the equine clinical web site. C. Sign your name (not just initials) to each entry/page, including your daily Progress Notes.

D. If you need to make a change or correct a mistake, draw a line through the mistake, initial/date the

mark, and make your corrections.

E. Medical records are not to leave the clinic. F. Keep the record in the appropriate folder in the record rack in either student rounds room or in ICU.

G. Fill out all requests completely.

H. DO NOT record anything on the white ‘PROBLEM LIST SHEET’ (this is for clinicians to

complete after discharge.)

I. Any communication with a person associated with your patient that is not affiliated with the Equine

Medicine/Surgery Services, must be recorded on a Client Communication Sheet and placed in the

patient’s record.

J. Do not write any profanity in a patient’s record.

V. Professionalism:

A. You are LSU in the eyes of our clients. You are not just representing yourself. Conduct yourself

professionally at all times.

B. Professional discussion and questions are welcomed. The work up and treatment of a case

referred by another veterinarian (RDVM) may be discussed. Criticism as to the manner in which a

case was handled by a RDVM is inappropriate. We do not know the circumstances surrounding the

case at the time of examination or treatment by the RDVM. Disparaging remarks about referring

veterinarians, clients or agents or others are always inappropriate.

VI. Dress Code:

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A. The students will be required adhere to the following dress during all equine clinical rotations and

this will be when you are in the clinic for daytime and after hours (evenings, nights, weekend and

holidays) shifts.

B. All clothing MUST be clean and tidy.

C. Khaki pants — these must be worn with a belt, not be low-rise, not extend below your shoes and

NOT TO drag on the ground (because they get wet when disinfecting your footwear, appears

unprofessional, and is not compatible with our biosecurity protocol).

D. Green scrub tops — these can be obtained from the SCAVMA book store.

1. They can either be the traditional type of scrub with a pocket over the left chest area, and

must be tucked into your pants.

2. The scrub tops should fit appropriately, and if necessary to make sure they are not overly

revealing.

a. A t-shirt or other type of clothing should be worn under the scrub top.

3. Alternatively, scrub tops that have two larger pockets (one on each side) are acceptable and

these do not have to be tucked into the pants.

E. Rubber footwear — the students must wear appropriate footwear, which includes having rubber

soles and top (dorsal) part of the footwear so that the shoes can easily be fully submerged in the

disinfectant footbaths.

F. Name badge – each student must also wear your name badge and have it in plain sight.

VII. Client/Patient Confidentiality:

A. NO information is to be discussed regarding a patient with any person not directly associated with a

case or the medicine/surgery service.

B. If you are asked about the case, inform the person that client-veterinarian relationship restricts it and

they will need to talk with the clinician in charge.

C. Maintain client confidentiality.

1. Do not discuss cases with friends or associates not affiliated with the SVM.

D. No information including video or photographs are to be posted on electronic media such as

facebook, e-mail etc.

VIII. Block Evaluations:

A. Evaluation forms of the course and each participating instructor must to be completed by each

student, on the last Friday of the block. These are important for our continued assessment of the

education process.

IX. Proficiency evaluation sheets

A. Proficiency evaluation sheets will be distributed at the start of the block by the faculty block

coordinator. These are to be completed, signed, and returned to Dr. Burba at the end of the block.

X. Clinical Competencies Assessments:

Outcomes of the DVM program must be measured, analyzed, and considered to improve the program.

New graduates must have the basic scientific knowledge, skills, and values to provide entry-level health

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care, independently, at the time of graduation. The LSU-SVM is developing the clinical competencies

assessment to measure and provide evidence that graduating students have attained certain

competencies. The equine section has adopted the following competencies to assess. These are

described below for you to understand what it takes to achieve a level of competency.

Assessment Scale:

Exemplary performance

Expected performance

Acceptable performance

Below expectation – generates a flag that student has not met acceptable performance

A. Competency one: comprehensive patient diagnosis (problem solving skills), appropriate use of

clinical laboratory testing, and record management 1. History/Physical Examination

a. Exemplary performance

i. Demonstrates superior efficiency, thoroughness and accuracy in performing a

history.

ii. Always asks questions that are systematic, relevant, precise, objective, non -

leading and interactive.

iii. Always asks questions of clarification and corrects inconsistencies.

iv. Excellent at organizing history information accurately in the medical record and

presents information in an orderly, clear and concise manner.

v. Always performs accurate, thorough and complete examinations in a timely

manner.

vi. Superior in ability to elaborate key physical examination findings and associated

subtleties.

b. Expected performance

i. Demonstrates good efficiency, thoroughness and accuracy in performing a

history.

ii. Frequently asks questions that are systematic, relevant, precise, objective, non -


iii. Consistently asks questions of clarification and corrects inconsistencies.

iv. Good at organizing history information accurately in the medical record and

presents information in an orderly, clear and concise manner.

v. Performs accurate, thorough and complete examinations in a timely manner.

vi. Good ability to elaborate key physical examination findings and associated

subtleties.

vii. Almost always identifies and characterizes historical information accurately.

viii. Ability to recognize and address physical examination subtleties is good but can

be improved.

c. Acceptable performance

i. Demonstrates adequate efficiency, thoroughness and accuracy in performing a

history.

ii. Occasionally asks questions that are systematic, relevant, precise, objective, non -


iii. Occasionally asks questions of clarification and corrects inconsistencies.

iv. Satisfactory at organizing history information accurately in the medical record

and presenting information in an orderly, clear and concise manner.

v. Fair in performing accurate, thorough and complete examinations in a timely

manner.

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vi. History and physical exam have occasional omissions or inaccuracies.

d. Below expectation

i. Unable to perform accurate and complete histories without frequent omissions.

ii. Poor at asking relevant, precise, objective, non leading and interactive questions.

iii. Cannot appreciate, clarify or correct inconsistencies. Examinations incomplete or

inaccurate or findings misinterpreted.

2. Patient Assessment/Clinical Thinking Skills


i. Accurately identifies all patient problems.

ii. Appropriate diagnostic and therapeutic plans are always suggested.

iii. Diagnostic test results are promptly obtained and correctly assessed independently

of instructor.

iv. Displays outstanding ability to integrate relevant information to make sound

clinical judgments.

v. Always formulates a complete problem list, accurately prioritizes problems and

develops a complete an accurate differential diagnosis list.


i. Correctly identifies and assesses most of patient’s problems.

ii. Appropriate diagnostic and therapeutic plans are usually presented.

iii. Obtains and assesses most diagnostic test results independently of instructor.

iv. Displays good ability to integrate relevant information to make sound clinical

judgments.

v. Consistently formulates a complete problem lists, accurately prioritizes problems

and develops a fundamentally sound but not always a complete differential

diagnosis list.


i. Problem identification, patient assessments, and/or diagnostic / therapeutic plans

are only occasionally inaccurate or require assistance.

ii. Occasionally fails to obtain and properly interpret test results.

iii. Displays satisfactory ability to integrate relevant information to make sound

clinical judgments.

iv. Only occasional difficulties are noted in the formulation of problem lists,

prioritization of the listed problems and development of differential diagnoses.


i. Problem identification, patient assessments, and/or diagnostic / therapeutic plans

are usually inaccurate or incomplete.

ii. Consistently fails to obtain and properly interpret test results.

iii. Displays unsatisfactory ability to integrate relevant information to make sound

clinical judgments.

iv. Often formulates an incomplete problem list, inaccurate prioritization of problems

and inappropriate differential diagnoses.

3. Knowledge Base/Basic Pathophysiology


i. Displays superior knowledge (pathophysiology, therapeutics, medicine, surgery,

etc) on own cases, as well as cases of others.

ii. Excels at demonstrating technical knowledge specific to the rotation and the

application of clinical skills.

iii. Has a strong understanding of what he/she knows and does not know.

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iv. Shows exceptional logic and knowledge in interpretation of histories, case reports,

discussion with faculty and always links observations from assessments to

plans/discharge summaries.


i. Displays good knowledge and understanding of a variety of common primary,

secondary and tertiary medical and/or surgical problems.

ii. Good at demonstrating technical knowledge specific to the rotation and the


iii. Has an accurate understanding of what he/she knows and does not know.

iv. Shows appropriate logic and knowledge in interpretation of histories, case reports,

discussion with faculty and links observations from assessments to

plans/discharge summaries.


i. Satisfactory knowledge base in most subject areas.

ii. Demonstration of adequate technical knowledge specific to the rotation and the


iii. Has a satisfactory understanding of what he/she knows and does not know.

iv. In most cases shows fair logic and knowledge in interpretation of histories, case

reports, discussion with faculty and usually links observations from assessments

to plans/discharge summaries.


i. Knowledge base is poor and inconsistent.

ii. Demonstration of inadequate technical knowledge specific to the rotation and the


iii. Has a poor understanding of what he/she knows and does not know.

iv. In most cases, does not show adequate logic and knowledge in interpretation of

histories, case reports, discussion with faculty and incapable of correlating

observations from assessments to plans/discharge summaries.

B. Competency two: comprehensive treatment planning including patient referral when indicated.

1. Treatment planning

a. Exemplary Performance

i. Student devises comprehensive treatment plan accurately utilizing the complete

problem list without input from instructors.

ii. Provides superior explanation and rationale for the treatment plan and explains

the treatment plan in the context of a specific patient.

iii. Has thorough understanding of available treatment options and alternatives to the

proposed plan.

iv. Is aware of all common potential complications arising from institution of this

plan and how these complications might be addressed.

b. Expected Performance

i. Student devises a reasonable treatment plan accurately utilizing the complete

problem list with minimal input from instructors.

ii. Provides reasonable explanation and rationale for the proposed treatment plan and

explains the treatment plan in the context of a specific patient.

iii. Has a good understanding of available treatment options and alternatives to the

proposed plan.

iv. Is aware of critical potential complications arising from proposed treatment plan

and how these complications might be addressed.

c. Acceptable Performance

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i. Student devises a reasonable treatment plan most often with input from

instructors.

ii. Occasionally proposes treatments that may not be appropriate for the individual

patient.

iii. Provides explanation for the proposed treatment plan but understanding of

rationale behind plan is frequently incomplete.

iv. There may exist an occasional inability to prioritize or delineate all aspects of the

underlying condition and treatment plan instituted from conditions or treatments

that are not directly applicable to that particular patient or situation.

v. Has an acceptable understanding of available treatment options and alternatives to

the proposed plan but is occasionally unaware of all options.

vi. Is aware of critical potential complications arising from proposed treatment plan

but may not always be aware of how these complications are addressed.

d. Below Expectations

i. Student is frequently unable to devise a reasonable treatment plan even with input

from instructors.

ii. Frequently proposes treatments which are inappropriate for the individual patient.

iii. Has difficulty providing explanation for the proposed treatment plan and rationale

is often inaccurate, faulty or incomplete.

iv. Treatment plans are most often based on a very superficial and general knowledge

of a condition and not necessarily directly applicable to the particular patient.

v. Does not have an acceptable understanding of treatment options and alternatives

to the proposed plan.

vi. Is not aware of potential complications arising from proposed treatment plan or

how the complications are addressed.

2. Understanding Therapeutic Modalities and Availability (would include knowledge of referral

services available)


i. Student has a thorough understanding of the treatment options available for a

particular case.

ii. Recognizes the scope of options and the need for advanced treatment modalities

when appropriate.

iii. Always recognizes that treatment options are not available in all locations

(primary care facilities) and discusses the need for referral to a secondary or

tertiary care facility when appropriate.


i. Student recognizes and has a good general knowledge of most treatment options

available for a particular case without assistance from instructors.

ii. Recognizes most advanced treatment options and that all options are not available

in primary care facilities.

iii. Usually recognizes the need for referral if the case were presented to a primary

care facility.


i. Student recognizes most treatment options available for a particular case with

assistance from instructors.

ii. Inconsistently recognizes advanced treatment options and the need for referral

from a primary care facility.


i. Student does not recognize significant treatment options available for a particular

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case nor can critically assess the reasoning used in prior treatment selection.

ii. Current treatment plans do not meet an acceptable standard of care. The need for

referral when appropriate is not recognized.

C. Competency four: basic surgery skills, experience, and case management

1. Case Management Comes up with own ideas, identifies and reports problems, problem list and

differentials


i. Has a superior knowledge of the surgical disease, procedure and likely

complications.

ii. Consistently and methodically identifies and reports current and prior medical

issues and shows attention to detail.

iii. Excels at creating a problem list with prioritized differential diagnoses while

demonstrating a logical and complete progression throughout the body systems.

iv. Is able to formulate a plan for treatment without clinician input.

v. Clinicians would feel extremely comfortable letting this person see cases by

themselves.

vi. Internship potential.


i. Has a good knowledge of the surgical disease, procedure and likely

complications.

ii. Regularly identifies current and past medical issues but could improve on

identification of subtleties.

iii. Creates an appropriate differential list including common disease processes; needs

some help with identification of uncommon differentials.

iv. Demonstrates a logical progression through body systems with few errors.

v. Therapeutic plan is well put together with occasional lack of thought to individual

patient needs.

vi. Clinicians feel that this person is qualified to see patients requiring minimal

(indirect) supervision.


i. Has an acceptable knowledge of the surgical disease, procedure, and likely

complications.

ii. Identifies current and past medical issues in most cases with occasional

inaccuracies or omissions noted. In most instances, recognizes common

differentials with more help needed to realize uncommon disease processes.

iii. Progression through body systems is sometimes random and unorganized.

iv. Knows the most common therapy for a given process with help needed

recognizing alternatives and individualization of a plan.

v. Can see patients themselves with direct supervision needed but on track to

requiring less supervision.


i. Demonstrates a poor knowledge of the surgical disease, procedure and likely

complications.

ii. Lacks the ability to consistently identify current and past medical issues.

iii. Significant deficiencies developing a differential list with no thought given to

body systems.

iv. Extreme difficulty choosing appropriate diagnostics and lack of understanding of

their utility.

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v. Therapies recommended are often inappropriate.

vi. Not ready to practice.

vii. Significant improvement required.

D. Competency five: basic medicine skills, experience and case management 1. Basic medical skills/ Case Management


i. Consistently identifies current and past medical issues pertinent to patient

care/visit through obtaining history and performance of physical examination.

ii. Excels at creating and prioritizing a differential list including common and

uncommon disease processes based upon information available as well as

demonstrating a logical and complete progression through body systems.

iii. Excellent ability to choose and interpret diagnostic tests methodically with

concurrent comprehension of the utility of each test.

iv. Therapeutic plan is always accurate, well thought out, and formulated with

attention given to individual patient/client needs.

v. The individual would be considered extremely capable of independently seeing

most cases admitted to the LSU-VTH with no to minimal guidance.

E. Competency seven: health promotion, disease prevention/biosecurity, zoonosis, and food safety 1. Health Maintenance/promotion


i. Displays an excellent understanding of the importance of routine health visits and

is able to recommend to the client appropriate preventative medications and

vaccines without clinician input.

ii. Superior understanding of the diagnostic tests involved in health maintenance

visits and the strengths and weaknesses of each.

iii. Always stresses the importance of routine health maintenance visits to the client

in an effective manner


i. Displays a good understanding of the importance of routine health visits and is

able to recommend to the client appropriate preventative medications and

vaccines with little clinician input needed.

ii. Accurate understanding of the diagnostic tests involved in health maintenance

visits and the strengths and weaknesses of each.

iii. Consistently stresses the importance of routine health maintenance visits to the

client in an effective manner


i. Displays a fair understanding of the importance of routine health visits and is able

to recommend to the client appropriate preventative medications and vaccines

with some clinician input needed.

ii. Fair understanding of the diagnostic tests involved in health maintenance visits

and the strengths and weaknesses of each.

iii. Usually stresses the importance of routine health maintenance visits to the client

in an effective manner


i. Does not understand or believe in the importance of routine health visits and is

unable to recommend to the client appropriate preventative medications and

vaccines without significant clinician input.

ii. Does not understand the diagnostic tests involved in health maintenance visits nor

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the strengths and weaknesses of each.

iii. Does not promote and is not interested in promoting the importance of routine

health maintenance visits to the client.

2. Biosecurity


i. Demonstrates superior knowledge of management practices designed to minimize

or prevent the introduction of infectious agents to include testing and screening

for diseases, isolation or quarantine of infected animals, immunization, selective

introduction of animals, and monitoring and group evaluation of animal health

status.

ii. Demonstrates superior knowledge in the safe use of hazardous materials to

include chemotherapeutic agents, radioisotopes, biological products, sharps and

sharps containers.

iii. Is always conscientious of disease prevention and practices good hygiene in the

clinical setting.


i. Demonstrates good knowledge of management practices designed to minimize or

prevent the introduction of infectious agents to include testing and screening for

diseases, isolation or quarantine of infected animals, immunization, selective


status.

ii. Demonstrates good knowledge in the safe use of hazardous materials to include

chemotherapeutic agents, radioisotopes, biological products, sharps and sharps

containers.

iii. Is consistently conscientious of disease prevention and practices good hygiene in

the clinical setting.


i. Demonstrates fair knowledge of management practices designed to minimize or




status.

ii. Demonstrates fair knowledge in the safe use of hazardous materials to include


containers.

iii. Is usually conscientious of disease prevention and practices good hygiene in the

clinical setting.


i. Demonstrates poor knowledge of management practices designed to minimize or




status.

ii. Demonstrates lack of knowledge in the safe use of hazardous materials to include


containers. Is not conscientious of disease prevention and does not practice good

hygiene in the clinical setting.

F. Competency eight: client communications and ethical conduct 1. Client Communication/Client Education/Discharge Summary

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i. Communicates and articulates exceptionally well, orally and in writing.

ii. Follow-up on cases is exceptional, and always appropriately documented.

iii. Puts great effort into clearly communicating and documenting discharge

information.

iv. Consistently writes in a constructive and professional manner, adapts writing

depending on the target audience.

v. Is able to capture subtle nuances and differences for individual cases.

vi. Discharge instructions require very few if any modifications.


i. Communicates and articulates well, orally and in writing.

ii. Follow-up on cases is good, and is appropriately documented.

iii. Puts appropriate effort into clearly communicating and documenting discharge

information.

iv. Consistently writes in a constructive and professional manner, adapts writing

depending on the target audience with minimal prompting.

v. Is able to capture and understand most differences for individual cases.

vi. Discharge instructions require few modifications.


i. Fair in oral and written communication.

ii. Follow-up on cases is fair, and most often documented. Puts an average amount

of effort into communicating and documenting discharge information.

iii. With prompting, writes in a constructive and professional manner, and with

prompting can adapt writing depending on the target audience.

iv. Is sometimes confused in ability to capture and understand subtle differences for

individual cases.

v. Discharge instructions require modifications.


i. Difficulties in orally and written communication.

ii. Follow-up on cases is poor and seldom documented.

iii. Puts little effort into communicating and documenting discharge information.

iv. Neither writes in a professional manner nor adapts writing to the target audience.

v. Is often confused in understanding subtle differences for individual cases even

after explanation.

vi. Discharge instructions require extensive modifications and client communication

only occurs with prompting.

2. Working with Health Care Team


i. Demonstrates excellent teamwork skills and works cooperatively with faculty

staff and other students.

ii. Conveys an exceptional "can-do" spirit, a sense of optimism, ownership,

commitment and dedication.

iii. Is always willing and quick to volunteer to help with any task even when not

specifically involved.


i. Demonstrates good teamwork skills and works cooperatively with faculty staff

and other students.

ii. Conveys a good "can-do" spirit, a sense of optimism, ownership, commitment and

dedication.

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iii. Will volunteer to help with any task even when not specifically involved.


i. Demonstrates adequate teamwork skills and works cooperatively with faculty

staff and other students.

ii. Conveys an appropriate "can-do" spirit, a sense of optimism, ownership,


iii. Will help with a task when asked.


i. Consistently demonstrates poor teamwork skills and does not work cooperatively

with faculty, staff or other students.

ii. Demonstrates a consistent sense of pessimism and/ or lack of ownership,


iii. Is not available to help with a task or cannot be located to be asked to help.

3. Ethical Conduct


i. Is always honest, fair, courteous, considerate, and compassionate. Is always

respectful and transparent in dealing with others, displays knowledge and respect

of the rules, laws and standards in place.

ii. Does not discuss prior case management or case outcome in a derogatory manner.

iii. Protects the personal privacy of clients and patients.

iv. Recognizes impairment in self or in others and acts quickly to report or rectify the

problem.


i. Is honest, fair, courteous, considerate, and compassionate. Is respectful and

transparent in dealing with others, displays knowledge and respect of the rules,

laws and standards in place and seldom needs to be reminded.

ii. Does not discuss prior case management or case outcome in a derogatory manner.

iii. Protects the personal privacy of clients and patients.

iv. Recognizes impairment in self or in others and acts appropriately to report or

rectify the problem.


i. Strives to be honest, fair, courteous, considerate, and compassionate.

ii. Is respectful and transparent in dealing with others, displays knowledge and

respect of the rules, laws and standards in place but needs to be reminded

periodically of the appropriate conduct.

iii. Does not discuss prior case management case outcome in a derogatory manner.

iv. Protects the personal privacy of clients and patients.

v. Recognizes impairment in self or in others and acts appropriately to report or

rectify the problem.


i. Is not honest, fair, courteous, considerate, and compassionate.

ii. Often has to be reminded to be respectful and transparent in dealing with others

and displays little knowledge and respect of the rules, laws and standards in place.

iii. Discusses prior case management and or case outcome in a derogatory manner.

iv. Does not protect the personal privacy of clients and patients.

v. Disregards situations of impairment in self or in others and does not attempt to

report or rectify the problem.

4. Attitude/Reliability/Thoroughness/Punctuality/Appearance


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i. Outstanding work ethic.

ii. Willingly takes ownership of actions and responsibility for the consequences.

iii. Is highly motivated and exceeds commitment made to others.

iv. Behavior, and interpersonal skills are consistently outstanding.

v. Always dresses professionally.

vi. Is always on time and meets deadlines. Overtly demonstrates maturity, honesty,

and respect in interactions with peers, staff and faculty.

vii. Is a role model.


i. Enthusiastically performs responsibilities without prompting.

ii. Takes ownership of actions and responsibility for the consequences.

iii. Follows through with commitment made to others.

iv. Behavior, interactions and dress are always appropriate.

v. Good interpersonal skills.

vi. Is on time and meets deadlines.

vii. Consistently mature, honest and respectful.


i. Generally has a positive attitude.

ii. Takes ownership of actions and responsibility for the consequences but

sometimes needing prompting.

iii. Only occasionally fails to follow through with commitment made to others.

iv. Performs clinical duties without significant redirection or prompting.

v. Is seldom late and seldom misses deadlines.

vi. Demonstrates tact, appropriate interpersonal behavior and language.

vii. Usually dressed appropriately.


i. Often demonstrates a lack of interest.

ii. Frequently commits to things without follow through, causing trust to be

questioned.

iii. Frequently exhibits unprofessional behavior or uses inappropriate language.

iv. Is usually late and misses deadlines.

v. Interpersonal skills need improvement.

vi. Dress is often inappropriate.

vii. May have hygiene issues.

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XI. Grades:

A. A major portion (80%) will be based on subjective evaluation of your knowledge, participation during

rounds, medical & surgical skills, problem solving, patient management, and responsibility (See

Figure 5).

B. The remaining 20% of your grade will be derived from an exam given on the last day of the block.

Questions will be prepared by the clinicians pertaining to the seminar topics and rounds discussion.

1. 65% of the questions will come from the Topic Rounds:

2. 35% of the questions will come from the Clinical Case Rounds.

3. The final exam will be 100 points:

a. 1. Surgery Section 1 = 30 points

b. 2. Surgery Section 2 = 30 points

c. 3. Medicine Section = 30 points

d. 4. EM clinician = 10 points (Emergency & Critical Care)

C. The following formulas are used to calculate a block grade score:

Clinical grade: Score from each clinician x 0.80 = Clinical grade

# of scoring clinicians

Block exam grade: Score from each clinician (100 pts total) x 0.20 = Block exam grade

# of scoring clinicians

Block grade: Clinical grade + Block exam grade = Block grade

D. The standard SVM grading scale applies to the total score:

GRADE HOURS CARRIED QUALITY POINTS Veterinary Medicine Grading

Scale

A+ 1 4.3 97-100

A 1 4.0 93-96

A- 1 3.7 90-92

B+ 1 3.3 87-89

B 1 3.0 83-86

B- 1 2.7 80-82

C+ 1 2.3 77-79

C 1 2.0 73-76

C- 1 1.7 70-72

D+ 1 1.3 67-69

D 1 1.0 63-66

D- 1 0.7 60-62

F 1 0 <60

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Figure 4

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Figure 5

vmed 5458 & vmed 5463 equine medicine and surgery …...vmed 5458 & vmed 5463 equine...

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