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Department of Veterinary Medicine and Surgery College of Veterinary Medicine

University of Missouri Course Syllabus

Course Name: Small Animal Neurology and Neurosurgery Course Number: VMS 6436 Course Director: Dr. Joan R. Coates Instructors Joan R. Coates, DVM, MS, Diplomate ACVIM (Neurology); Coatesj@missouri.edu; cell: 823-9892 Fred A. Wininger, VMD, MS, Diplomate ACVIM (Neurology); WiningerF@missouri.edu; cell: 823-9364 Dennis P. O’Brien, DVM, PhD, Diplomate ACVIM (Neurology); OBrienD@missouri.edu; cell: 823-9382 Assigned Residents and Interns Contacting Instructors The optimal time to contact instructors is during the clinic working hours. The clinical faculty member on-duty is available 24 hours a day by email, cell phone or home phone. Likewise are the neurology/ neurosurgery residents. I. Rotation Description

The neurology/neurosurgery rotation is designed to give students hands-on experience with clinical service, and medical and surgical neurology cases. During this rotation, the student will practice client communication skills, history taking, physical and neurologic examinations, and establish competence in the care, diagnosis and treatment of dogs and cats with neurologic diseases.

II. Rotation Objectives

Specific Learning Goals for the Neurology Rotation

Be able to take an accurate history pertaining to a neurologic case

Be able to perform the neurologic examination

Be able to provide a neuroanatomic localization

Be able to assimilate the history, patient signalment and neurologic examination findings for establishing a list of appropriate differentials

Be able to establish a neurodiagnostic plan in order of importance

Understand basic neurodiagnostic procedures

Understand basic neurosurgical procedures Overall Rotation Goals for Competency By the end of the clinical rotation, the student will be competent in the following areas as it relates to medical and surgical neurologic diseases: clinical service, physical and neurologic examinations, basic treatment techniques and be knowledgeable in neurologic diseases for the North American Veterinary Licensing Examination. Comprehensive Knowledge in Subject Area (Anatomy, physiology, pathophysiology of specific diseases)

• Precisely uses terminology to clearly explain process and principles of anatomy, physiology and pathophysiology

• Recognizes appropriate differential diagnosis

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• Integrates pathophysiology to specific disease processes • Recommends diagnostic testing appropriate for that patient • Shows eagerness to learn.

Comprehensive treatment planning, including patient referral when indicated, and record management

• Conducts accurate history taking and physical examination • Recommends and implements treatment plan accurately and in a timely manner for

each case • Accurately interprets laboratory data • Maintains well-written and accurate medical records in a timely manner • Writes discharge instructions that are thorough, clear and concise

Patient welfare, including pain management

• Provides timely and appropriate care to patients • Establishes pain and suffering assessment for each case, and provides analgesic therapy

when indicated • Recognizes and communicates changes in patient condition and needs

Basic medicine skills, experience, and case management

• Proactive in acceptance and management of cases throughout the rotation • Demonstrates knowledge base of neurologic disorders appropriate for stage of education • Demonstrates efforts to study and improve knowledge base through the rotation • Demonstrates technical competency for rotation-relevant procedures (blood and urine

collection, physical therapy, restraint, and neurologic examination)

Emergency and intensive care case management • Participates in weekday and weekend emergency duty with eagerness and enthusiasm

to fully participate in case management with the supervising clinician

Health promotion, disease prevention/biosecurity, zoonosis, and food safety • Demonstrates attention to appropriate sanitation and prevention of disease with small

animal patients • Recognizes possible zoonotic conditions to discuss with clinician, technical staff, and

owner

Client communications and ethical conduct • Maintains appropriate, timely, ethical client communication • Consistently demonstrates respect and compassion for pet and pet owner • Demonstrates collegial behavior toward classmates, clinicians, staff, and referring

veterinarians

Strong appreciation for the role of research in furthering the practice of veterinary medicine • Practices an evidence-based approach to case management through identifying

literature sources appropriate to case management • Able to present a case or topic of interest as a formal presentation

General Expectations for Student Citizenship on the Service

Before rounds: case care/treatments

Participate in rounds (4:00-5:00 p.m.)

Receive cases-assist with work up

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Assist in surgery with cases

Treat daytime cases

Complete SOAPs and TPR and weigh patients by 8:00 a.m.

Perform and enter clinical competencies

Complete rough draft of discharge summaries

Complete rough draft of surgery reports (within 24 hours of surgery)

Assist with emergency work up and surgery

Assist with after-hours treatments

Help other students

Observe other cases

Act professionally

III. Course Materials

Course materials include the opportunity to receive and manage cases with neurologic diseases. Students are encouraged to seek additional information about their cases from other text books.

• Lorenz MD, Coates JR, Kent M. Handbook of Veterinary Neurology 5th edition • De Lahunta A, Glass E. Veterinary Neuroanatomy and Clinical Neurology 3rd edition • Dewey CW. A Practical Guide to Canine and Feline Neurology 2nd edition • Sharp NJH, Wheeler SJ. Small Animal Spinal Disorders: Diagnosis and Surgery 2nd

edition IV. Sequence of topics by week or class session

This section is not applicable. See section VII, the Outline of Clinic Rotation - Duty Schedules and General Operating Procedures

V. Course Policies

A. Absences

A maximum of 1 working day can be missed on the neurology/neurosurgery rotation for job interviews or personal business. The attending faculty clinician in charge and the instructional leader (Dr. Coates) both must give permission. Permission will not be granted for frivolous reasons. Unexcused absences or failure to report for assigned duties will result in a one letter grade reduction per occurrence. Upon request of the errant student and upon approval of the instructional leader, make-up work may be assigned for one unpremeditated unexcused absence to overturn the drop in letter grade. Excused absences (including on Saturdays, Sundays, and holidays) require third-party documentation of hardship and completion of the official absence form (AStudent Absence Request From Clinics or Class Assignment@) from the departmental office (A384 Clydesdale). Failure to report for an after-hours assignment (examples: emergency duty, ward treatment duty, and weekend rounds) could result in a failing grade.

B. Submitting late work

Completion of medical records in a timely fashion is of utmost importance. Medical records personnel will alert you and the primary clinician of deficiencies in the medical

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record. These should be completed as quickly as possible. All records must be completed by the 5:00 p.m. on the Friday of block change week. If deficiencies in portions of the record for which you are responsible are still present after this time, a failing grade will be submitted.

C. Academic dishonesty statement

Academic integrity is fundamental to the activities and principles of a university. All members of the academic community must be confident that each person's work has been responsibly and honorably acquired, developed, and presented. Any effort to gain an advantage not given to all students is dishonest whether or not the effort is successful. The academic community regards breaches of the academic integrity rules as extremely serious matters. Sanctions for such a breach may include academic sanctions from the instructor, including failing the course for any violation, to disciplinary sanctions ranging from probation to expulsion. When in doubt about plagiarism, paraphrasing, quoting, collaboration, or any other form of cheating, consult the course instructor.

VI. Grading Policy

Grading in the VMS 6436 clinical block is performed by faculty, residents, interns, and veterinary technicians using a rubric system (see rubric tables at end of syllabus). The rubric is arranged as two tables: (1) Clinical Knowledge and Skills and (2) Interpersonal Relationships. The Clinical Knowledge and Skills section has 7 categories; the Interpersonal Relationships section has 3 categories. Each category has specific descriptors by which a grade is assigned. To calculate the percentage and determine a letter grade the following percentages are assigned: A = 95, B = 85, C = 75, D = 65, F = 55. The weight for Clinical Knowledge and Skills is 2/3 of the final grade and Interpersonal Relationships is 1/3 of the final grade assigned by each rotation. The percentage scores for Clinical Knowledge and Skills are averaged and multiplied by 2/3; the percentage scores for Interpersonal Relationships are averaged and multiplied by 1/3. These two scores are totaled together to arrive at the grade for the rotation. Grading scale: A = 90.00 to 100.00 B = 80.00 to 89.99 C = 70.00 to 79.99 D = 60.00 to 69.99

F = less than 60.00

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VII. Outline of Clinic Rotation - Duty Schedules and General Operating Procedures Students will report to the neurology area (A253) in the small animal clinic by 7:30 a.m. for orientation and case transfers. In-hospital cases are re-assigned to new students on switch days.

SERVICE ORGANIZATION, MEDICAL RECORDS, PATIENT CARE All VMS 6436 and elective students must be in the hospital by 7:30 a.m. (at the latest) on Monday through Friday. You should arrive early enough to examine and treat all of your patients before 8:00 a.m. Evaluations of patients scheduled for surgery at 8:00 a.m. should be completed and recorded by 7:15 a.m., and these patients should be moved to anesthesia no later than 7:30 a.m.. Orders for cases in ICU should be written and ready for clinician signature by 8:00 a.m.. NOTE: When topic rounds are scheduled for 7:15 a.m. (usually Tuesdays and Thursdays) patients must be evaluated, treated, and have ICU orders written BEFORE 7:15 a.m.. On weekends and holidays case examinations should be completed by 8:00 a.m. and ICU orders completed by 8:00 a.m. If you need to leave the building during clinic hours, you must receive permission from your clinician and exercise the common courtesy of checking in and out at the Small Animal Reception desk. Receiving. The neurology service students receive neurology cases on Mondays and Wednesdays from 10:00 a.m. to 1:00 and see rechecks on Fridays from 10:00 a.m. to 11:30 a.m. Please sign up for cases on the neurology case board and at the front desk. Neurologic emergency cases can be received during regular clinic hours and an available student will volunteer to receive the case. If a student/clinician is not available, the case will be seen through the Emergency Critical Care Service and then transferred to the Neurology Service later in the day. Case work-ups occur on Tuesday, Thursday and Friday. Case Admissions. A clinician must see all cases before they are admitted to the hospital. The admitting student will do a thorough physical examination on each animal before admission into the hospital. After completing the history/physical examination, the student will inform the pet owner that the animal will be taken to the neurology working are for performing the neurologic examination. This process will take about 45 minutes to 1 hour. The pet owner is welcome to wait in the waiting area. If the client should decide to leave the building, please make sure you take their cell phone number.

• Do not risk being bitten by an animal. If you are concerned about being bitten, muzzle the animal. If a muzzle cannot be placed on the animal, consult your clinician. All bites must be reported to the office of the Veterinary Hospital Administrator.

• All clients must sign a cost estimate / treatment release (consent) form before the animal is

hospitalized. An estimate of the costs plus the procedures to be performed must be written on the form, and the client MUST leave a deposit of at least 1/2 the upper end of the estimate before the animal is admitted! The receiving clinician should handle this, but double check to make sure it is done.

• If anesthesia is to be administered the day of admission, be sure to confirm that the patient has

been fasted. In addition, get written permission (on the estimate/consent form) for all anticipated procedures including sedation and/or general anesthesia. Always make sure that the code status is clearly indicated on the estimate/consent form.

• Remove collars and leashes and give them to the owner before the patient is taken to the

Wards. Put an identification collar on the patient. Inform clients who want to leave blankets, bedding, toys, etc. that we cannot be responsible if they are lost.

• Verify the owners contact information: cell phone and home phone

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• Record your patient’s vaccination status in UVIS regardless of whether or not they were

vaccinated at the VMTH. Note “per owner” where indicated. In-hospital Case Transfers. Cases are transferred from clinician to clinician. Students assigned to patients transferred from other services should perform a physical examination on the patient and also review the medical record and results of diagnostic tests. Never assume that everything has been done!! Lesions or problems are occasionally missed; multiple examinations decrease the possibility of oversights. The student assigned to the case prior to transfer should be consulted regarding any specific tests or additional procedures desired. Next Day Emergency Case Transfers. The students will need to sign up for case transfers by the afternoon before in preparation to receive cases from the previous night emergency cases. There will also need to be a back up student. Emergency Duty Coverage. The Neurology Technician will assign the students emergence coverage. This schedule will be posted in the neurology working area and ICU.

• Students will be responsible to handle neuromedical and neurosurgical emergencies as needed, under the direction of the primary emergency duty clinician. (The emergency surgery student is called in at the discretion of the primary emergency duty clinician if there is an emergent surgery case, or if the primary emergency student is inundated with cases. The case does not necessarily have to go to surgery for the emergency surgery student to be called in.)

• Check with the primary emergency duty clinician before leaving the VMTH. • The emergency student must be available by telephone at all times while not in the VMTH.

Rounds. Neurology rounds are held between 4:00 and 5:00 p.m. each weekday in Room A253. Each case presentation should demonstrate that the student is knowledgeable and proactively managing the case. Come prepared to discuss your cases in detail and demonstrate that you are Ain control@. Also, each student should be familiar with basic knowledge and pathophysiology of other students’ cases on the rotation. DO NOT schedule client visits/discharges between 3:30 and 5:00. Client communications are extremely important.

Verify the owner's phone numbers before hospitalizing a patient. Always get as many alternate phone numbers (work, cell phone, etc.) as possible. Make sure we have a number we can call in case of emergency or if something unexpected is found during surgery. Arrange a convenient contact time for both you and the client and call daily. All clients should leave with an understanding of when they will hear further about their pet. Remember (and inform clients) that calls to the VMTH are diverted to the emergency service after 7:00 p.m. and on weekends, and that the emergency service will likely know nothing about the case. Furthermore, the emergency doctor is often inundated with emergency phone calls and handling emergencies. Therefore, your clients cannot get information about their hospitalized pets unless you call them regularly.

Call owners on a daily basis and after completion of procedures/surgery.

Do not sit in the reception area and consult with clients. Always take the client to an examination room. Your communication with the client is privileged information! Information about patients should only be given to the owner or authorized agent.

Keep owners updated on current charges. If the estimate is likely to be exceeded ask the clinician for an approximate range. If the owner has any questions about fees, please ask the attending clinician to talk to the owner. Record all updated fee estimates in the medical record (as a Aclient communication@).

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If you don=t know the answer to a client=s questions, tell them you will find out and call them back or have the attending clinician call them.

Record every client communication in the medical record, even if you get a busy signal, voice mail, or no answer.

Patient Care. These are your most important responsibilities on the neurology rotation and should take precedence. PATIENT CARE IS OUR PRIMARY CONCERN!! Everything we do should insure that our patients get the best care possible.

• All patients should be examined and TPRed before 8:00 a.m.. Cases scheduled for 8:00 a.m. surgery should be TPRed (and recorded) and walked by 7:15 a.m., and in the anesthesia pre-med/recovery room no later than 7:30 a.m.. Anesthesia personnel will not pre-med patients if the TPR has not been done.

• Animals can be taken outside for walks if owner permission is obtained. Animals may be taken outside in the fenced area by the small animal emergency entrance, but should not cross East Campus Drive. Clean up after your patient. If your patient urinates or defecates in the building, please clean it up immediately or promptly ask someone else to clean it up. Outdoor eliminations should also be promptly cleaned up. Make sure you have a secure leash and collar on the animal. If there is any concern about the animal getting away from you, do not take it outside. Do not prop doors to the VMTH open if you go outside. Be sure to carry your ID card with you after hours so you can get back inside. Keep the doors to the wards closed at all times.

• You are responsible for making sure that all medications are administered and all treatments are

performed for each of your patients. All b.i.d. (or less frequent) treatments are to be done by the student assigned to the case. After-hours treatments will be done by the student assigned to the case or the student listed on the rotating after-hours treatment schedule for surgery block students. Treatments are to be signed up on the treatment clipboard located in the surgery treatment area. These treatments are to be performed at 10:00 p.m. and each should take no longer than 5 minutes. If the treatment would take more than one person to perform, then the surgery student assigned to the patient must also come to help. Clear instructions must be left on the treatment board, including name and case number of the patient, location of patient, treatment to be done, medications to be given, student’s name, and telephone number. The actual medications to be given must be taped to the treatment schedule. If the treatment form is not filled out properly, then the treatment cannot be performed. You should check each morning to make sure the treatments were administered and then make appropriate notation in the medical record.

• All daily ward treatments are to be documented on TREATMENT SHEETS located on the individual kennels/cage; make sure instructions on treatment sheet matches those in the Plan of your SOAP

• Cases in ICU will be treated by ICU personnel as per ICU protocol, but you are still responsible for making sure they are performed, and you are responsible for performing all 8:00 a.m. treatments.

• You are responsible for feeding all of your patients. Record the amount fed and eaten and the

patient’s weight in the record. Weigh each patient at least once daily before feeding.

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Documenting in the medical record that this care has been delivered is equally important. Medical records are kept using the POMR format. Please be diligent in making sure all information is recorded in the medical record. All records, including student surgery reports and fee charges, must be kept up to date. All abnormalities on history and physical/neurologic examinations should be fully described including location and size of any lesions. Sizes should be recorded using metric measurements. All neurologic examinations must be documented on the Neurologic Examination Form and placed in the medical record folder.

SOAPS

Concise but thorough (i.e., include all pertinent new information about the patient including any recommendations from consultations with other services)

Should be able to write a case summary by looking at the daily SOAPs

Intern or resident will review these daily and give feedback as needed

In by 8am or 7:15 on topics rounds morning

Client communications

Remember to log all communications!

Surgery Reports. The student assistant on the case is responsible for writing the surgery report. Surgery reports must be finished within 24 hours of the surgical procedure. Please ask the clinician to review and verify the report before the patient is discharged. Delays in writing the report invariably result in inaccuracies. The surgery report should include: • The approach (Standard approaches can be described as such [e.g. a ventral midline

approach to the neck], but the location and length should be listed.) • All significant findings e.g. consistence of the extruded disc material removed. • Details of the actual procedure(s) including sizes and number implants used, suture

materials and sizes, any measurements taken (e.g. portal pressure), and any tissue removed

• Closure including suture pattern, suture materials and sizes • Fossum, Slatter, or Wheeler and Sharp excellent textbooks for guidance

Discharge instructions - should include the following

Reason for visit Findings (examination and diagnostic testing, even if negative results) Homecare: (include as appropriate)

Incision

E-COLLAR

Bandage care

Activity level

Medications (last given when?, possible side effects)

Diet/feeding instructions

Bodily functions (e.g. may not have a bowel movement due to opioids; no worries if not straining; may have diarrhea due to resection of cecum, etc)

Bathing

Pending lab results

Recheck appointments/follow up

It is a timesaver to use pre-fabricated instructions, but don’t just assume all points apply every time

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Case Summary

Complete within 24 hours of patient discharge

If there is an rDVM, begin letter with “Dear Dr. Smith:”

Include the following in this order Signalment: Fluffy, a 6 year old spayed female Labrador retriever was presented to

the VMTH Soft Tissue Surgery Service for ________. Pertinent history On presentation Fluffy was _______________ (BAR, QAR, in hypovolemic shock,

laterally recumbent, etc) Physical examination revealed___________________ (list abnormalities or “was

within normal limits) Neurological examination revealed _______________ Orthopedic examination revealed ________________ Diagnostics performed and findings Course of treatment, surgical procedure(s) Outcome and date of discharge to owner Follow up treatment plan Thank you for your referral and other appropriate remarks

** If you hit the RDVM=CLIENT button, anything written in the RDVM section will be erased! Hit the button before typing your case summary or simply copy and paste the client discharge instructions into the RDVM communication.

Patient Dismissal. Students will dismiss animals and communicate with the client under the supervision of their clinician. Do not dismiss a patient without giving your clinician the opportunity to talk to the owner. Please plan in advance and develop your dismissal instructions before the client arrives. All dismissal instructions MUST be reviewed by the clinician before the patient is dismissed. All bills must be paid or payment arranged before the animal is taken up front or dismissed. All charges should be reviewed by the fee clerk and the clinician in charge before dismissal.

• Check on your patients within 3 days after the animal has gone home and at weekly intervals. One-week recheck for routines and several rechecks for majors over the entire block are recommended. Owners really appreciate these follow-up calls and sometimes we identify patients that are having complications that the owners don=t recognize as such.

• If possible, have the client make appointments for re-examination at the time of dismissal. Only

the receptionists schedule appointments.

Summary of Patient discharge protocol • Complete instructions one day before patient goes home • Set a specific time with the owner to discharge • Get the file to the cashier as early as possible so they can look over the record (must

contain at least a preliminary copy of discharges) • Organize all medications and other items to be sent home with the owners (rDVM

radiographs, medications, leashes and collars, bedding, etc) • Place owners in the exam room and go over discharge instructions and medications;

show the owners any imaging performed • When finished, call your clinician to say hello and answer questions if needed • The very last step should be to bring the patient to the owner (ideal time for owner to

pay bill while you go get the patient) • Help the owner and patient out to the car

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SCHEDULING CASES FOR DIAGNOSTIC AND SURGICAL PROCEDURES. Blood samples and urinalyses should be collected and submitted to the Clinical Pathology Laboratory. Samples for the next day=s surgery must reach the Clinical Pathology Laboratory by 4:00 p.m.. Requests for other procedures (e.g. radiographs, endoscopy, etc.) should be submitted as soon as possible. If you need help obtaining specimens, ask a surgery or neurology technician, intern, resident, or faculty member to help you. Guidelines for Work-ups for General Anesthesia. Work-up required is dictated by ASA classification. The following ASA table can be used as guidelines, but consult the anesthesiologist on duty if you have any questions. For procedures requiring sedation or special anesthetic procedures, consult with the anesthesiologist on duty. ASA Physical status Category Minimum Laboratory Data

I (normal, healthy, < 4 years of age) PCV, TP, II ( mild systemic disease) PCV, TP, urine specific gravity III (severe systemic disease CBC, mini/maxi profile, UA

but not life-threatening) IV (life-threatening disease) CBC, maxi profile, UA V (moribund) CBC, maxi profile, UA *Heartworm test is only required on patients not on preventative or tested within last year

If you have an animal that should not be clipped (i.e. show dog) for catheter placement, etc. be sure to tell the anesthesia personnel. Neurology patients 5 years of age and older or have health issue need to have thoracic and abdominal radiographs and abdominal ultrasound to check for evidence of metastatic disease Signing up cases. Diagnostic and Surgical procedures requiring anesthesia to be done the next day should be entered on the anesthesia clipboard as they are admitted to the clinic. All planned procedures surgeries IN ORDER should be on the anesthesia clipboard by 3:30 p.m. the day before the diagnostic procedure or surgery. All radiology procedures must be submitted in UVIS by 3:30 p.m. the day before the procedure. Do not take medical charts to rounds and have ALL NECESSARY INFORMATION IN THE PAPER RECORD OR RECORDED IN UVIS, including client consent/code information. Anesthesia personnel cannot work up your case without access to this information. Have your patient in the anesthesia/prep room BY 7:30 a.m. THE DAY OF SURGERY after morning walk and TPR. Place identification bands on all patients and corresponding cage cards on all cages. Be available to prep your patient BEFORE it is anesthetized. This saves time and your client’s money. Make every effort to accommodate the anesthesia service. Remember, THEY WORK FOR YOU.

• All adult surgery patients, except for emergencies, should be fasted for at least 12 hours before being anesthetized. Check with your clinician for exceptions (e.g. puppies, kittens). Make sure a ANo Food@ sign is placed on the cage before 6:00 p.m. the day before surgery. Water should not be withheld unless you are specifically told to do so by the attending clinician.

• After your patient has been pre-medicated, check to see if it can be clipped prior to induction.

Ask the anesthesia student to page you after the pre-meds have been administered. This will reduce the delay between time of induction and start of surgery (and help control anesthesia fees). If you are not sure how much to clip, ASK. One of the technicians should be available to supervise clipping. Avoid clipper burns.

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Surgery protocol. Be sure to read about the surgical procedure and review the surgical anatomy before surgery. Come prepared! Be a Aconscious@ assistant, anticipate and get involved. You can also learn a lot about surgical technique by watching someone else operate. Take advantage of this opportunity.

• Aseptic technique will be enforced during surgery. No rings or jewelry are allowed to be worn. If a break occurs or is seen, speak up! We will stop and make adjustments so aseptic surgery can continue. Scrub suits, caps, masks and clean shoe covers must be worn any time you enter the surgery area (surgery rooms, scrub area, and aseptic corridor). Scrub shirts should be tucked into your scrub pants. All hair must be sufficiently covered. A clean lab coat must be worn over the top of your scrubs any time you are out of the aseptic surgery area. Do not wear your scrub clothes to the hospital. No street clothes should be showing from under scrubs. V-necks and tank-top T-shirts are permissible under scrubs, but turtlenecks are not allowed.

• Students should arrive in the operating room with the patient and know how to position the

animal on the surgery table (i.e., dorsal recumbence, ventral recumbence, left or right lateral recumbence, perineal position, head at the end of the table, etc.). Radiographs and other imaging should be displayed on the operating room computer monitors; non-digital radiographs must accompany the patient into and out of the operating room. All biopsy and culture samples must exit the operating room with the patient.

• Before the patient leaves the operating room the student must make sure all sharps are off of

the instrument table and placed in a sharps container (located in the instrument room). The student should place all cloth drapes and gowns in the laundry bin at the end of the sterile corridor. Dirty instruments should be put in the fluid bowl that was used during the surgery. If the anesthesia personnel have not transported the animal out of the operating room once the above tasks are completed, the student should continue to help clean the operating room until the patient leaves.

• Students assisting after-hours surgery are responsible for cleaning up the surgical area and

equipment. If a surgery is still going on after 4:30 p.m., it is the student=s responsibility to clean the instruments and place them on the counter in the instrument room. The same policy applies to instruments used on emergency surgeries performed on the weekend. Put all dirty drapes and gowns in containers in the surgery hall. In most instances the After Hours Clinic Crew (AHCC) member should clean up while the student assisting with the case follows it to recovery; however, please check to see that the AHCC member has done a complete job.

• All tissues removed should be submitted for histopathology unless otherwise indicated by the

surgeon. (This does not include normal genital tracts from routine OHEs and castrations). The surgical margins of all suspected tumors should be marked with India ink prior to being placed in formalin. Be sure to enter the histopathology request completely, including the size and location of all lesions, previous histologic and/or cytologic diagnoses, and pertinent history.

• After surgery the student assistant will accompany the patient to recovery or radiology if

postoperative radiographs are needed. Be sure to submit requests for postoperative radiographs prior to surgery. Postoperative care instructions should be written for any patient placed in ICU.

Histopathology Submissions. Please take care to be thorough with the COMPLETE history of a submission to the Veterinary Medical Diagnostic Laboratory. Be sure to include previous excision/diagnosis, previous treatments, size and location of a mass, gross impression, etc... UVIS requests can be confusing. To help clarify, please note the following:

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• FRESH/FIXED means you are submitting a CULTURE AND A BIOPSY SAMPLE. You may submit

multiple culture/histopathology samples under ONE REQUEST. Simply number your samples and give DETAILED DESCRIPTIONS OF EACH under the description section.

• BIOPSY means you are submitting tissue for histopathology only. You may submit multiple samples under ONE REQUEST. Simply number your samples and give DETAILED DESCRIPTIONS OF EACH under the description section.

• Be sure you have the correct clinician listed on your VMDL submissions. Further, check with your clinician to see is s/he wishes to sign off on your submission before it is officially submitted.

Late Anesthesia Recoveries Patients (“Pink Sheets”). Patients who are anesthetized late in the day may not be recovered enough to go to the wards by the time the anesthesia technicians are done for the day. Therefore, there is nobody to monitor recovery. When a patient is not recovered before the end of the anesthesia technician’s shift, anesthesia personnel fill out an anesthesia recovery form (“pink sheet”) and give that form to ICU personnel. The ICU personnel then periodically check the recovering animal(s) in the anesthesia recovery room and take the animal(s) to the wards upon full recovery. There is no additional charge for this service. However, if a patient is not fully recovered by 10:00 p.m. it is placed in ICU, an ICU record is maintained, and the patient is charged for the overnight stay in ICU. It is rare for a routine anesthesia case to require monitoring beyond 10:00 p.m.; any case that is not recovered by 10:00 p.m. is probably serious enough to warrant ICU care. Students must check the anesthesia recovery room and ICU prior to 4:00 p.m. rounds and immediately after to see if they have patients with “pink sheets”. Any student with a “pink sheet” patient must make sure all pertinent information is on the “pink sheet” (including the student and clinician names and contact information) and must make sure that his/her patient is returned to the wards upon recovery. Any student with a “pink sheet” patient must return his/her patient to the wards before leaving the VMTH for the day. Alternately, the student may leave the VMTH and come back later (before 10:00 p.m.) to return the patient to the wards. [Of course, if the delayed recovery warrants ICU care, the student and clinician may admit the patient to ICU.] STUDENT PRESENTATIONS

• Student presentations will be given on the last Friday of the block • Presentations are to be 10 to 15 minutes long • The presentations need to be focused discussions e.g. FCE but not spinal cord diseases

of dogs.

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GENERAL HOUSEKEEPING Please consult the MU VMTH Clinical Procedures Manual located on the VMTH Website (https://cvmsecure.missouri.edu/vmth/clin_proc/ClinicalProceduresManualSept2010.pdf). You are expected to follow the Standard Student Dress Code. Equipment Requirements are as follows: 1 thermometer, 1 stethoscope, 1 bandage scissors, 1 lead rope, 1 suture scissors, plexor, 1 pen light, and 1 hemostat. Name tags must be worn at all times. This includes any time you are in contact with the public. Do not wear scrub suits to receiving. If possible, have 2 lab coats, one to wear for receiving/dismissing patients and one to wear for general work. Have a loose leaf pocket notebook to keep a record of every case you have during the surgery block and to take notes during rounds.

• Hallway lockers will be assigned by office of the Veterinary Hospital Administrator. Select one of the half length lockers in the surgery locker room. Empty your surgery lockers on the last day of block. (Anything left behind will be discarded at noon on Wednesday of the new block).

• Do not leave backpacks, coats or other miscellaneous possessions in the neurology working area

room, seminar rooms, or surgery area. You have two lockers that should be used to store these items. If you bring items such as records or books into these areas, put them away before starting other tasks. Please help us keep the rounds rooms neat and orderly.

• We ALL need to take pride in the appearance of the Veterinary Medical Teaching Hospital by

helping to keep it clean. We often have unannounced tours and visitors through the clinic. Poor appearance reflects badly on us all. Areas of particular concern include the following: • Exam rooms. ALWAYS check that the room is clean before bringing a client back from the

waiting area. • Treatment Room. Treatment tables are to be kept clean at all times. Be sure to discard used

materials appropriately as soon as you are finished with them. There is a mop in the closet if the floor is dirty.

• Runs and Cages. If a patient soils the run or cage, clean it before the patient also gets soiled. We all need to help out if we want to provide the best care possible for our patients.

• Splint room. The area is of particular concern because of infection control. Put all used bandages in the trash can immediately. Disinfect all used surfaces. Take used instrument packs to the instrument room. Treat patients with infected wounds at the wound treatment station in the bathing area.

• Rounds rooms. Keep these rooms in order and the tables clear of clutter. Unattended items on table tops may be discarded.

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VIII. ADA Statement If you need accommodations because of a disability, if you have emergency medical information to share with me, or if you need special arrangements in case the building must be evacuated, please inform me immediately. Please see me privately after class, or at my office. Office location: __A-303_____________ Office hours: __anytime____________ To request academic accommodations (for example, a notetaker or extended time on exams), students must also register with the Office of Disability Services, (http://disabilityservices.missouri.edu), S5 Memorial Union, 882-4696. It is the campus office responsible for reviewing documentation provided by students requesting academic accommodations, and for accommodations planning in cooperation with students and instructors, as needed and consistent with course requirements. For other MU resources for students with disabilities, click on "Disability Resources" on the MU homepage.

IX. Prerequisite or co-requisite course(s) required or recommended

The student must have completed and passed the preclinical curriculum during. X. Departmental policy for student participation in clinical rotations

One of the missions of the Veterinary Medical Teaching Hospital is to provide high quality clinical training for our students. The VMTH also serves to provide excellent service to its clients and care to its animal patients. With this in mind, the responsibilities given to a student on a clinical rotation may be tailored by the clinician based on the clinical situation and the assessed competence and behavior of the student. Students will be given guidance and feedback to help them improve their performance during the course of a rotation. However, a student’s participation in a clinical rotation may be significantly restricted when a student does not make sufficient progress during a rotation, and especially when the student’s actions (or inactions) compromise his/her personal safety or the safety of personnel during the course of the rotation, or put an animal into an inhumane or life-threatening situation.

Should a student’s participation in a clinical rotation be significantly restricted, it is likely that clinical activity will be supplemented with academic projects related to the subject of the clinical rotation. Moreover, when activity is restricted, the student should understand that it will most likely be associated with assignment of an unsatisfactory grade.

XI. Statement for Academic Dishonesty

Academic integrity is fundamental to the activities and principles of a university. All members of the academic community must be confident that each person's work has been responsibly and honorably acquired, developed, and presented. Any effort to gain an advantage not given to all students is dishonest whether or not the effort is successful. The academic community regards breaches of the academic integrity rules as extremely serious matters. Sanctions for such a breach may include academic sanctions from the instructor, including failing the course for any violation, to disciplinary sanctions ranging from probation to expulsion. When in doubt about plagiarism, paraphrasing, quoting, collaboration, or any other form of cheating, consult the course instructor.

XII. Dishonesty (defined as willful and malicious deception that puts patients and/or co-workers at risk for physical or emotional injury, or in any other way exemplifies behavior unbecoming of a veterinarian) will result in a failing grade for the block.

XIII. Statement for Intellectual Pluralism

The University community welcomes intellectual diversity and respects student rights. Students who have questions or concerns regarding the atmosphere in this class (including respect for

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diverse opinions) may contact the Departmental Chair or Divisional Director; the Director of the Office of Students Rights and Responsibilities (http://osrr.missouri.edu/); or the MU Equity Office (http://equity.missouri.edu/), or by email at equity@missouri.edu. All students will have the opportunity to submit an anonymous evaluation of the instructor(s) at the end of the course.

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Grade Assignment F D C B A

Clinical Knowledge and Skills

Clearly Inadequate Below Standards Average Competent Excellent

Knowledge in Subject Area: anatomy, physiology, pathophysiology of specific diseases

Generally does not use appropriate terminology and cannot explain processes and principles of anatomy, physiology, and pathophysiology.

Frequently misuses terminology and makes mistakes describing processes and principles of anatomy, physiology, and pathophysiology.

Generally uses appropriate terminology to explain most fundamental processes and principles of anatomy, physiology, and pathophysiology but gaps exist or performance is inconsistent.

Accurately uses appropriate terminology to explain processes and principles of anatomy, physiology and pathophysiology.

Precisely uses terminology to clearly explain processes and principles of anatomy, physiology and pathophysiology.

Problem Solving Skills (Comprehensive Patient Diagnosis): Identifying and prioritizing problems; integrating and applying pathophysiology; systematic with assimilating case materials

Rarely identifies and prioritizes even major problems; does not apply or integrate pathophysiology to specific disease processes; uses confused approach for assimilation of case materials; regularly errs explaining causal factors. Fails to show efforts to learn

Irregularly identifies and prioritizes even major problems; ineffectively applies and integrates pathophysiology to specific disease processes; uses disorganized approach for assimilation of case materials; frequently errs explaining causal factors. Shows minimal efforts to learn.

Usually identifies and prioritizes major problems; adequately applies and integrates pathophysiology to specific disease processes; uses deliberate approach for assimilation of case materials; explains causal factors in most cases but often needs prompting to come to conclusions in ambiguous cases. Shows some efforts to learn.

Regularly identifies and prioritizes problems; applies and integrates pathophysiology to specific disease processes; uses systematic approach for assimilation of case materials; and explains causal factors. Shows eagerness to learn.

Consistently identifies and prioritizes major and minor problems; adeptly applies and integrates pathophysiology to specific disease processes; uses a highly systematic approach for assimilation of case materials; and explains causal factors in challenging and ambiguous cases. Consistently shows eagerness to learn.

Data Gathering Skills: Taking histories, conducting physical examinations, ordering appropriate clinical laboratory tests and other diagnostic modalities, and interpreting laboratory findings

Generally does not take adequate histories or conduct competent physical examinations; frequently errs interpreting laboratory data and recognizing even major abnormalities on PE.

Often takes inadequate histories; conducts unsystematic or incomplete physical examinations; errs and struggles interpreting laboratory data; fails to recognize subtle abnormalities and occasionally major abnormalities on PE.

Generally takes adequate histories; conducts organized physical examinations; interprets laboratory data acceptably; consistently obtains valid findings for major and minor problems

Accurately, reliably, and completely takes histories; conducts thorough and organized physical examinations; interprets laboratory data accurately and reliably; usually obtains even subtle findings.

Precisely, efficiently and thoroughly takes histories; conducts highly systematic and adept physical examinations; interprets laboratory data accurately and reliably without difficulty; consistently obtains even subtle findings.

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Medical Records Skills: Producing medical records: SOAPs; Discharge instructions; Surgery reports; overall record management

Generally fails to maintain medical records, regularly omits essential details of case and uses inaccurate medical terminology; produces delayed surgery reports; writes discharge instructions that are incorrect and unclear.

Maintains inconsistent and often incomplete medical records, omitting important details of case and inaccurate medical terminology; produces delayed surgery reports; writes discharge instructions that are often incomplete and unclear.

Maintains adequate and timely medical records, providing important details of case and using acceptable medical terminology; produces sufficient and timely surgery reports; writes discharge instructions that are adequate but often need clarifying modifications.

Maintains proficient and timely medical records, providing full details of case and using accurate medical terminology; produces complete and timely surgery reports; writes discharge instructions that are usually complete and need little modification.

Maintains excellent and prompt medical records, providing full details of case and using precise medical terminology; produces complete and prompt surgery reports; writes discharge instructions that are thorough, clear and concise and rarely need significant modification.

Procedural Skills: Performing clinical diagnostic and surgical procedures: basic surgical skills, experience, and case management

Regularly fails to demonstrate adequate proficiency in handling animals and with diagnostic and surgical procedures and techniques; unaware of self-limitations; commonly puts animals at unnecessary risk or inflicts unnecessary pain.

Does not demonstrate adequate proficiency in handling animals and with diagnostic and surgical procedures and techniques; inadequately aware of self-limitations; sometimes puts animals at unnecessary risk or inflicts unnecessary pain.

Generally demonstrates adequate proficiency in handling animals and with diagnostic and surgical procedures; typically recognizes level of self-proficiency; minimizes risk and pain to patient; demonstrates adequate clinical technique.

Demonstrates competence in handling animals and with diagnostic and surgical procedures; accurately recognizes level of self-proficiency; minimizes risk and pain to patient; demonstrates competent clinical technique.

Demonstrates high level of competence in handling animals and with all diagnostic and surgical procedures; perceptively recognizes level of self-proficiency and consistently seeks help when appropriate; minimizes risk and pain to patient; demonstrates accomplished clinical technique.

Rounds Presentations: Case presentation and responses to questions

Generally fails to prepare adequately or demonstrate knowledge of content in preparation of case materials; produces disjointed and rambling presentations Fails to answer questions

Demonstrates inadequate knowledge of content in preparation of case materials; produces disjointed and lengthy presentations Fails to answer most questions.

Usually demonstrates adequate knowledge of content in preparation of case materials; usually organizes presentations adequately but often lacks continuity and concision; struggles answering some questions.

Demonstrates firm grasp of content in preparation of case materials; organizes presentations clearly and concisely; answers most questions clearly and completely.

Demonstrates sophisticated grasp of content in preparation of case materials; organizes presentations clearly and concisely; answers questions clearly and exemplifies increased breadth of knowledge.

Comprehensive treatment planning, including pain management and knowing when to refer

Generally fails to develop an adequate treatment plan; generally fails to include an adequate pain management strategy; generally fails to recognize case complexity and level of expertise required.

Often incomplete in treatment plan; often inadequate in pain management plan; often unsure of the complexity of cases and level of expertise required.

Usually develops an adequate treatment plan; usually includes an adequate pain management strategy; frequently recognizes case complexity and level of expertise required.

Develops complete treatment plans; includes good plans for pain management; usually recognizes case complexity and level of expertise required.

Develops timely and comprehensive treatment plans; includes excellent pain management strategies; demonstrates excellent grasp of case complexity and level of expertise required.

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Grade Assignment F D C B A

Interpersonal Relationships

Clearly Inadequate Below Standards Average Competent Excellent

Communication Skills: Client communications, and communications with colleagues/clinicians: tone of voice, eye contact, and body language during communications

Generally fails to communicate necessary information to pet owner and colleagues; makes inadequate presentations.

Often fails to communicate necessary information to pet owner and colleagues; generally makes inadequate presentations.

Usually communicates necessary information to pet owner and colleagues; makes some modifications to communication style to fit audience; makes adequate presentations in most cases.

Regularly communicates necessary information to pet owner and colleagues; modifies communication style to fit audience; makes well-organized presentations.

Consistently communicates very effectively to pet owner and colleagues; perceptively modifies communication style to fit audience; makes clear, concise, well-organized, and sophisticated presentations.

Relationship with Patients/Pet Owner: Courtesy, empathy, and compassion to pet owners and pets; concern for and attention to patient welfare

Generally fails to demonstrate respect for pet and pet owner; repeatedly fails to contact pet owner.

Often fails to demonstrate respect for pet and pet owner; often must be reminded to call pet owner.

Usually demonstrates respect and compassion for pet and pet owner; contacts pet owner regularly.

Demonstrates respect and compassion for pet and pet owner and seeks to understand their perspectives. Reliably contacts pet owner.

Consistently and perceptively demonstrates respect and compassion for pet and pet owner and seeks to understand their perspectives. Reliably contacts pet owner.

Professional Relationships and Ethical Conduct - Collaborating with others in clinics; courteous and cooperative;

willingness to undertake and complete responsibilities for patient care; prompt and prepared

Generally unwilling to collaborate with faculty or staff. May be insubordinate or disrespectful of staff and has difficulty establishing relationships. Leaves activities uncompleted and is unprepared for scheduled activities

Often fails to collaborate effectively; occasionally demonstrates disrespect for colleagues or staff; often late or unprepared for scheduled activities

Usually collaborates well with others, is civil and respectful, undertakes and completes responsibilities for patient care, is prompt and prepared for scheduled activities.

Regularly collaborates well with others establishing effective relationships; is civil and respectful; involves all members of different services in patient care; undertakes and completes responsibilities for patient care; is prompt and prepared for scheduled activities.

Consistently collaborates exceptionally well; seeks out opportunities to assist staff and classmates; demonstrates respectful leadership.