My Don Low/CVMA Practitioner Fellowship Experience
By Joseph Tumang, DVM
I have always been interested in applying for a Don Low Practitioner Fellowship and was ecstatic when I was accepted into the internal medicine program. It has been a long road for me as a foreign graduate and I was glad for this opportunity to extend my knowledge.
As a sole practitioner, I depend on consultants from reference laboratories. I have developed good relationships with Drs. Rhett Nichols and Deena Sadek, who I consult with on my more challenging cases.
They inspired me to be a better clinician and the Don Low Practitioner Fellowship was a way to achieve that goal. My advisor, Dr. Lynelle Johnson also helped me accomplish it.
My first day of the Medicine A rotation was quite intimidating. The day started with introductions and answering a fun fact question. I introduced myself as a Don Low fellow and Dr. Stan Marks interjected by describing the program as a symbiotic relationship between academia and private practitioners, not only in internal medicine but in other disciplines of veterinary medicine as well. This immediately placed me at ease in my new professional environment. On my first day, Dr. Jonathan Dear asked me to join him and watch a swallow study on one of his patients. For the rest of my given assignments, I had the opportunity to be with Drs. Brian Hardy, Sean Hulsebosch, Lynelle Johnson, Lucy Kopecny, Stan Marks, and Jodi Westropp. I was invited to watch bronchoscopies, rhinoscopies, cystoscopies, GI endoscopies, and ultrasounds. I viewed CT scans with internists as they discussed cases and developed treatment plans. I have seen a variety of referral cases, from a simple case of asymptomatic bacteriuria in a dog treated with chronic antibiotic therapy to a complex case of a dog presented to surgery for lameness then referred to the small animal medicine department. Ultimately, that dog was diagnosed with coccidioidomycosis.
The program provides a total of 20 days in the William R. Pritchard Teaching Hospital in a year, and I decided to break it down to Mondays and Tuesdays each month. There are two small animal internal medicine groups, Medicine A and 13, each comprised of two faculty, two to three residents, and six to eight senior veterinary students. Mondays are always busy with internal medicine picking up cases from the emergency department and morning rounds were focused on hospitalized cases. After morning rounds on Mondays, I joined residents for an hour lecture on physiology before they started seeing appointments. Afternoon rounds were used for discussion of referral cases and progress notes on in-patients.
Tuesday morning rounds with students started with updates on hospitalized patients, and discussion of cases picked up from evening emergencies. This was followed by resident rounds. During this time, residents presented challenging cases for discussion and faculty veterinarians gave recommendations on diagnostic and treatment plans. Tuesday of involved joint rounds for senior students, when groups A and B convened for a topic discussion.
The fellowship program gave me a better understanding of how to handle the broad spectrum of illnesses that affect dogs and cats, both acute and chronic medical problems, and cases not limited to one organ but affecting multiple organs. I learned how to handle cases properly prior to referral and how to facilitate the client’s understanding of the referral process. I also learned how to better handle cases when owners have financial concerns or decline an internal medicine consult. I was able to witness how internists handle all aspects of their cases, from obtaining a comprehensive medical history, performing a physical exam, and coming up with a problem list, differential diagnoses, diagnostic tests, and treatment plan. Overall, this program met my goals of improving my clinical skills and becoming more efficient in working up complex cases, managing chronic illnesses, and diagnosing and treating young and adult diseases. It gave me the opportunity to work with students in the early stages of their clinical career and discuss the challenges and rewards available in a private practice setting.