The route to specialisation: step 2 – residencies
The model of a 1-year internship and a 3-year residency to become eligible to specialise has been supported in Europe and the USA for decades. Once an internship is completed, many vets will then go on to apply for a residency, which allows them to sit exams, receive a diploma, and apply for specialist recognition from the RCVS.
What is a residency?
I completed my residency in small animal medicine at the Royal Veterinary College. A residency is a period of training lasting for at least 3 years in a particular discipline, such as internal medicine, anaesthesia, or clinical pathology. During this time, you will see cases referred by other vets with the support and supervision of specialists in the same discipline. In reality, this means that you receive a lot of help in your first few months but, after 3 years, you should be able to see complicated cases without needing much assistance. For those training in anatomical or clinical pathology, this time is spent making reports on submitted samples after completing post mortems or microscopic analysis.
"Becoming a specialist also opens doors for teaching, conducting clinical research, and delivering CPD"
Clinical work occupies the majority of a resident’s time, but they also undertake one or more research projects, which have to be completed and published in peer reviewed journals to obtain the diploma. There is also time allocated to work in other related disciplines, to visit other centres in the UK or abroad, and to study for the exams at the end.
What do you get out of it?
I found many aspects of my residency enjoyable, including achieving a good outcome in patients that seemed very ill, mastering new or difficult techniques, and gaining the confidence to treat complicated cases as part of a multidisciplinary team. In practical terms, salaries for specialists are higher and working conditions are often favourable, with many working 4-day weeks. Becoming a specialist also opens doors for teaching, conducting clinical research, and delivering continuing professional development (CPD), which may otherwise be difficult areas to enter.
What are the pros of being a resident?
I particularly enjoyed the feeling of learning new things every day, which I did not experience to the same extent while working in first opinion practice. I also found the residency a great way to develop new professional interests, such as teaching and clinical research, which I don’t think I would have had the opportunity to access at the time without doing this training. Although I had worked in teams in first opinion practice, I felt the importance of team work was more evident in this setting. I particularly remember an owner of a dog that had recovered from a road traffic accident coming back to express his gratitude for our care and being stunned by the number of people he needed to say ‘thank you’ to!
What are the cons of being a resident?
Residencies can be stressful because you wish to offer the highest standard of care to patients you see, but sometimes are not sure how to proceed with difficult or complicated cases. The job also involves long hours and time on call, and I often needed to do background reading or study in my own time at weekends and after work. As with internships, the salary for residents is less than you would earn in some first-opinion practice jobs, particularly at most universities, and the residency and exams are often associated with considerable costs that may not be covered by the institution. Finally, in human medicine, burnout has been reported at increased rates among residents, and I suspect this may be an underappreciated problem in veterinary medicine too.
Clinical work occupies the majority of a resident’s time, but they also undertake one or more research projects
What about those exams?
Like most people, I left vet school with the intention of avoiding all future exams, so hearing about the diploma exams was difficult! These are usually spread over 2-3 days and involve written papers, multiple choice questions and sometimes oral examinations. While they are clearly a source of concern for prospective residents, everybody sitting the exams has just gained several years of important practical experience and had the chance to develop detailed knowledge in a specific field.
Do specialists have to be trained like this?
The model of a 1-year internship and 3-year residency to become eligible to specialise has been supported in Europe and the USA for decades, but I think it is questionable whether this system is accessible and appropriate for all those vets who may wish to undertake specialist training. There is a need to discuss how programmes can be adapted to reflect wider trends in flexible working and greater awareness of the mental health consequences of stressful working patterns. The British College of Veterinary Specialists, whose members include both specialists and residents, will be holding a workshop on 23rd October 2019 to discuss how specialist training might be improved in future, and all veterinary surgeons are welcome to register.