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Advice to graduates on taking specialist career path

Written by: Emily Dutton
Published on: 9 Apr 2024

Emily Dutton

Emily Dutton

Q. Can you tell us a little about the start of your own career journey? When did you decide you wanted to specialise and why cardiology?
A.
Since being a vet student, I’ve always had a special interest in cardiology. I was very lucky to have been at The University of Edinburgh at the same time as many eminent and inspiring lecturers in cardiology during the late 1990s. These included Virginia Luis Fuentes, Anne French, Jo Dukes McEwan, Brendan Corcoran and Karen Blissitt. They all inspired me and, as a result, I chose my elective in cardiology, which I thoroughly enjoyed.

Part of that elective was to phone or write (there were no emails in those days) to owners of dogs that had been operated on by Peter Darke, who carried out patent ductus arteriosus (PDA) ligation. After receiving many responses from owners in the form of letters and photos of their beloved pets, unbeknown to me, this was the start of a landmark manuscript published by Nicole Van Israel.

The 2003 Journal of Small Animal Practice paper, entitled “Long-term follow-up of dogs with patent ductus arteriosus”, showed a survival benefit after PDA closure versus those dogs with PDAs that were not surgically closed.

Q. How did you go about specialising?
A.
During my time in general practice, I went on to study for the old-style RCVS Certificate in Veterinary Cardiology in 2003, followed by the RCVS Diploma in Veterinary Cardiology. In those days, certificate candidates had to have a mentor, and I was very lucky that Simon Swift agreed to be mine.

As I progressed through my certificate studies, I realised that I was only going to progress so far in general practice. I was rather naive and thought that obtaining a diploma would be a simple next step. However, the reality was that applying for and carrying out a residency would have meant moving house and moving my (by now young) family with me.

That wasn’t going to happen, as it would have meant losing affordable childcare (moving away from helpful grandparents) and moving my husband’s business to another geographical location, which was not possible. I was extremely lucky at this point because the old-style RCVS Diploma in Veterinary Cardiology (DVC) was still accessible.

Sarah Smith very kindly agreed to be my supervisor (thank you, Sarah), which meant that I was able to carry out the “alternative pathway” to the diploma. Sarah was the first person to obtain the DVC via the alternative route and is a true inspiration.

Cardiologists at the University of Liverpool, the RVC and The University of Edinburgh all helped my learning journey. I had to spend 200 (unpaid) days with diplomates at these various institutions, while working part-time (paid) at two different referral hospitals in north-west England, including Northwest Surgeons (as it was called in those days) with Dr Swift.

Since I passed the DVC exams in 2014, there have since been a good number of excellent specialists in veterinary cardiology who followed suit with the DVC obtained by the alternative route. They have contributed greatly, both clinically and via research to the veterinary cardiology world. It saddens me, therefore, that this alternative route is no longer available to others. It has further limited the route to specialisation and is almost certainly contributing to the current shortage of specialists in the UK.

The European Board of Veterinary Specialisation (EBVS) has introduced the option of a credit-based modular route to specialisation. However, it is up to each individual speciality college to decide whether there is an appropriate way for a specific speciality. At the time of writing this article, only 2 of the 27 European specialist colleges, including the European College of Porcine Health Management and the European College of Veterinary Clinical Pathology, offer the modular pathway on individual request.

There is no question that the standards for becoming a specialist need to be high, but this should not be a barrier to a flexible pathway. Increasing flexibility while maintaining the same competency standards as a training end goal benefits the whole profession.

I suspect this limited access to further education has motivated me to teach cardiology to many vets in general practice, both via external CPD companies, but also internally by offering cardiology internship positions at our new premises. After becoming a diplomate in 2014, I started my own peripatetic cardiology referral business travelling around the north-west. However, I soon wanted to get my teeth into another project.

Missing the interventional procedures and becoming aware of the increasing number of practices being bought out by corporates (including the referral hospitals), plus wanting to offer the best cardiology care at a reasonable price, it seemed the natural thing to do to open an independent cardiology referral clinic. I spent around five years looking for the ideal building in the ideal location.

The Old School House

The Old School House, Cheshire.

We opened the new clinic, which is in Castle, near Northwich, Cheshire, in March 2023. The Old School House, our new practice, is close to the M6 and M56 motorways, as well as being close to the Welsh Road, the A556. I have been fortunate to be joined by Paula Hancock as head nurse, and we have a rapidly growing team, including four other vets (three cardiology interns and one certificate candidate), two registered vet nurses, one student nurse and Mike, our practice administrator.

At The Old School House, we strongly believe in teaching and educating others. The building is simply splendid and even has a viewing gallery on the first floor into theatre from which the visiting vets, interns and vet students can watch the surgical procedures.

Mike, having worked in the television industry, has also linked up a television screen with the fluoroscopy machine and our ultrasound machine (with a 4D transoesophageal probe). This enables visitors to remotely watch the angiography being performed “live” and the congenital defects, on which we operate, being imaged (with 4D ultrasound).

Our goals, as well as teaching others, are to provide the very best cardiology care at a reasonable price while providing a fulfilling and enjoyable place to work for all the members of our close-knit team.

SpecialisingLooking around our geographical area, over the past year, there has been an enormous number of independent first opinion and second opinion practices opening, as well as a pushback from the Competition and Markets Authority against ongoing corporate expansion. It is wonderful to see a strong and growing independent sector once again. Service and price are highly valued by our clients, and I feel independent practices are in a strong position to compete on both fronts.

Q. How early should someone be considering specialising? What is your practice’s approach to hiring graduates or relatively new vets, and what opportunities do you offer?
A.
To specialise now, I’d recommend applying for a rotating internship after spending one or two years in general practice. This will help you to see and understand the various specialisms, as well as get a good knowledge base and understand the high-pressure referral environment.

Exploring everything and finding where your passion lies is imperative. Due to increased competition for subject-specific residencies, it is almost the “norm” now to carry out a subject-specific internship (for example, in cardiology, as we offer at our clinic) after a rotating internship. We have recently employed our fifth cardiology intern, and our first intern, Ewelina, is in her second year of a cardiology residency.

The 12-month internship with us is a good way of seeing whether you would enjoy a cardiology residency (there is a lot of report writing in cardiology). By the end of the year, you should be able to confidently echo dogs and cats with acquired heart disease.

We ask our interns to write articles, as well as present data at meetings. This, alongside watching the surgical procedures and caring for the in-patients, is an invaluable experience.

Q. What would CPD be like in a practice such as yours, and what support do you offer to staff through their journey?
A.
We carry out CPD daily at our practice. I teach the veterinary interns and our interns teach the nurses, student nurses and vet students. This may be in the form of book club, journal club, formal presentations or during daily tasks such as analysis of electrocardiographic or echocardiographic studies.

We have renovated our large school hall to a high spec and will be starting regular CPD activities there this year, including some practical echocardiography courses. We also have capacity upstairs on the large mezzanine floor for CPD sessions.

Overall, collaborating and working with us is an enriching educational experience, and a learning journey.