EXPECTATIONS FOR INTERNSHIP POSITION

The goal of this internship is to provide the intern with a quality experience which balances in-hospital, ambulatory and academic veterinary medicine.
The intern will have the experience and knowledge to begin a residency program or a career in private equine ambulatory practice upon successful
completion of the program. The internship is an intensive training program that will provide the intern with and equivalent of approximately 5 years of
private practice experience.

Our slogan and motto: ‘Partners for life’, and ‘Expect Excellence’
We expect every staff member at the clinic to uphold these statements.

The following information is intended to help you become familiar with the hospital’s procedures prior to your first day, as well as guide you throughout
your internship and specify our expectations of you in your day-to-day duties. Please take the time to carefully read over these pages prior to your first
day.

 ROTATIONS – We have four, 1-2 week rotations set up with four interns. The rotations are Surgery 1, Surgery 2, Internal Medicine and
Ancillary. Ancillary Includes Surgery 3, Anesthesia, Overnights, Ambulatory, and/or Nursing.
o Daytime duties- Interns will start their days by getting the overnight update on patients and preparing for rounds. They will assess
their patients on their rotations and help each other with tasks to complete before rounds begin. They will complete SOAPs on
patients and present their cases based on primary clinician during rounds. They will then spend the day doing procedures and caring
for patients on their respective services. At times, a surgery intern or the IMed intern will need to assist with another clinician’s tasks
on a given day. Try to anticipate these needs by reviewing the schedule prior to rounds or at the end of rounds. This can be
discussed among the group of surgeons present for work that day. Please understand that we are all a big team, and need to be
flexible. Therefore, some days you may be assigned to a different primary clinician than the prior day based on caseload. You will be
expected to help intern mates with their tasks based on the hospital’s needs.
 Daytime hours are 6am-6pm.
 On the day off of your primary clinician, you may be assigned to run anesthesia or request to go out in the field if there
isn’t as much going on in house that day.
o Nighttime duties- For interns on an overnight rotation or those covering call for that night. Night interns will start their shift at 6pm by
rounding with the day interns and getting a rundown of all that happened with the patients on that day. They will be responsible for
taking in any overnight emergencies that come in during their shift. They will coordinate care for the inpatients at the hospital as
needed with nighttime technical staff and communicate with the primary clinicians on their cases as necessary. While technical
support will often be available, it is the night intern’s responsibility to triage phone calls for all hospitalized patients and address any
concerns (Catheter or fluid line care, refluxing or passing nasogastric tubes, evaluation of colic, etc.) for all hospitalized patients. This
allows the interns that are not on night duty to rest.. When four interns are present, a backup intern is assigned each weekday to run
anesthesia if a surgical case comes in. This intern can also be called to help with patient care if deemed necessary.
 Nighttime hours are 6pm-6am
 An overnight rotation may be instituted based on hospital needs.
 During this time, the overnight intern will be on call for anesthesia during the weekend days (6am-6pm) and will
be primary on call from 6pm-6am and in doing treatments overnight.
 The overnight intern gets Mon-Tues off
 The overnight intern is on call for daytime anesthesia on Sat and Sun on the weekends of their rotation. The day
intern on primary call on a given weekend is on call for nighttime anesthesia on Sat and Sun.
 Night interns assume care for all of the patients in the hospital. If the load is too great for them to handle, the clinicians
will help devise a plan to get them help with patient care via externs or technicians.
 When a backup intern is called in, the overnight intern will either scrub into surgery with the surgeon or continue to do
treatments. Once the tasks are completed by the backup intern that they were called in for, they should be sent home as
quickly as possible to allow them to rest for their daytime duties. They should not be kept longer than necessary to
continue to help.

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 IN-HOSPITAL DUTIES - Make sure you are proficient with any of the tasks that the technicians are asked to perform. Become proficient with
these tasks before delegating (setting up equipment, bloodwork, IV catheters, etc). It is your responsibility to know about all the patients in-
house (even if they are not your cases). You should read all radiographs, lab work, orders, etc… Also remember, that with increasing
competency comes increased responsibility. You will be evaluated on your openness to instruction and constructive criticism, ability to make
timely and thoughtful, clinical decisions, ability to organize yourself and timely/accurate completion of medical records . Medical records include
daily SOAPs, notes in HVMS and discharge paperwork.

o Patient care - You are responsible for the medical care and husbandry of all hospitalized cases. Ask questions if you are unsure. Do
not depend on the technical staff to tell you about the changes in your patients. You are expected to regularly observe your patients
for changes in their condition, and report any significant changes to the clinician in charge. We understand that this is one of the
most difficult parts of your internship- the ability to provide excellent patient care while performing your day-to-day duties. However,
this will teach you the most about case continuity and give you experience that few other equine veterinarians have in managing
difficult cases. Husbandry is very important, and patients should be groomed daily, a task that can be delegated to an extern if they
are able to do this safely. This is a good practice to uphold as owners will often visit unannounced.
 EVERY hospitalized case needs a primary intern in charge. This is the intern assigned to that rotation. If you have a day
off, or absence for any reason, it is your responsibility to transfer the care of your patients to another intern to ensure
continuity of care. Assuming someone will take care of it is unacceptable. You must round the intern that is covering for
you on your patients. This includes case transfers for nights and weekends.

o Treatments - Adequate assessment including physical exam, review of chart and blood work needs to be completed by 8:00am on all
cases. Ensure all blood work is available for presentation and evaluation at rounds. Interns are required to assess all patients every
morning prior to rounds. Do a thorough exam, concentrating on the problems of that horse. Be ready to answer questions regarding
each patient at rounds. Be sure that you have reviewed any imaging studies, bloodwork, etc. It will be apparent to the clinician if you
have not performed an adequate exam or if you do not understand that case. You are required to arrive at the clinic by 7:00 am or
earlier to do a thorough physical exam and catch up on any information from the night (food consumed, fluid rate (L/hr)…) on all your
hospitalized cases. Formulate an assessment and plan for all cases. This may mean arriving at the hospital at 6am or earlier during
busy times. A thorough examination/pain score of all your cases, and computerized SOAP must be performed by 8am (7am on
Journal Club/Topic Rounds days). The pain score is to be performed by the intern on the case. It will be apparent in rounds if you
have not assessed or researched your cases well.
 A pain score is required on each patient by the attending intern every morning. There are pain score sheets in
the nurses’ station to help guide you. The pain score is to be recorded in HVMS and reported during rounds.
 Gather together technicians and meet in the barn for rounds at 8:00am. It is your responsibility to make sure
rounds begin on time, that all appropriate bloodwork is complete, and everyone is present.
o TREATMENT SHEET GUIDELINES
 On every horse treatment sheet: TID-QID stall check (can skip 12am cleaning), groom SID
 ICU Check or TPR on every hospitalized horse upon admission and at least SID
 When writing medications, include name, strength (mg/g), volume (ml/tabs/scoops), route, frequency (Q __ h)
 Example: Gentamicin 3g (30cc) IV Q24h
 Example: Equisul 10.8g (27ml) PO Q12h
 HVMS provides the drug name and strength. Some drugs come in multiple concentrations, so attention to detail
is critical. HVMS also prompts to charge each time a medication is administered. In addition to this, you must
write the prescription under “special instruction”
o If there is a discrepancy in the prescription and the charge, then an error has been made on the
treatment sheet and the doctor on the case should be notified, then the error corrected. This
redundancy helps prevent medical errors.
 Be sure you understand how to calculate drug doses. Be able to accurately calculate dose (mg) from dosage (formulary)
and volume/# of tabs from dose.
 Be sure you understand how to calculate a CRI (mg/kg/min to drops per second). The common CRIs used here are
located inside the doors to the medicine cabinets in the nurse’s station.
 Make sure the correct clinician’s name is on the treatment plan- the intern responsible for that case should also be listed
as caretaker and on the stall placard, as you are the primary contact when a technician notes a problem.
 The senior clinician’s name should be the one noted on the top of the HVMS treatment sheet, not the intern
 Specialists alternate weekends and cases are transferred to the specialist(s) on-call that weekend (Friday night
until Monday morning) as deemed appropriate by the clinician in charge. This means that the electronic
treatment sheets need to be updated with the correct clinician’s name each weekend as long as the clinicians

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 have communicated a case transfer. Ensure that you know who will be in charge of the case before the
weekend.
 Monitor your patients as needed day/night (as directed by primary clinician)
o You will be the first doctor to be notified if there is a problem or a question about a case. If you do not
know the answer to a question or if you need to authorize a change in the treatment plan, call the
attending clinician. Always try to come up with a plan yourself, and then talk to the clinician .
o ALWAYS call the attending clinician if you need to administer a medication not outlined on the
treatment sheet during morning rounds (i.e.: pain meds for colic). The attending clinician can make an
exception to this rule.
o You are responsible for supervising and receiving calls on your patients.You may transfer your cases
to your intern-mate on your weekend off- Friday night starting at 6pm through Monday morning at 6am.
o *Night monitoring of patients can be transferred to the intern on nights or primary intern on call unless
other arrangements have been made. You are responsible for catching up on your case, performing a
thorough physical exam, performing a pain score and writing the morning SOAP on Monday morning
before rounds. Continuity of care is critical-this means that if you are transferring a case to your intern-
mate, ensure they know all the small details about the case so that they can speak intelligently to the
clinician in charge and the owner if needed.
o Interns and night technician staff need to communicate about overnight progress on patients before
morning rounds. A group text message or email works great. Ensure that this is pre-arranged so that a
timely transfer of information can be made before the person working the overnight shift goes to bed.
o Externs will be expected to share treatment duties with you and the technicians ONLY if they are senior
students and have been deemed competent enough to perform the tasks required. Only the clinician
on call can authorize treatments by the externs.
 Externs/technicians are not to perform procedures such as passing NG tubes, placing IV
catheters, rectal exams… without direct supervision.
 When an extern performs a procedure under direct supervision, there should be extra time
available and the client should not be present.
 Externs are not allowed to draw up drugs UNSUPERVISED. This means that if they are
helping with midnight treatments, all medications to be administered at midnight need to be
drawn up, labeled, and clearly set aside for the appropriate patient. If an extern is asked to
draw up a medication, they must bring the bottle and syringe and needle over to the intern or
attending clinician in charge and show them the substance before drawing up the appropriate
volume.
 Externs are not to perform any communication with clients or rDVMs.

Record Keeping
SOAPS
 Your SOAPs are to be entered in the computer daily by 8am (7am on Journal Club/Topic Rounds days). Initial intake
SOAPs should be written immediately after admission and at a minimum prior to rounds the following morning.
 You do not need to recreate information that is already elsewhere in the record (copying TPR, for example). Your
efficiency will be improved if you keep your SOAP concise.
 You do need to mention the things that are being monitored as part of the horse’s primary presenting complaint
 For example, horses that have had arthroscopy must include the bandage, effusion, and lameness. A horse that
is being treated for sand colic could include if sand has been passed in the manure.
 Don’t forget to include IV catheter sites and jugular veins. Jugular veins should be monitored both if there is an IVC
present AND if there has previously been an IVC present.
 If you need to add anything during the day just write ‘add’ (for addendum) and write your observations. For example, you
may write an addendum for diagnostics performed or bandage changes. A note should be written for every diagnostic,
procedure, or bandage change within 24 hours.
 If you do not write the note for the diagnostic at the time it is completed (preferred), include it in the following morning’s
SOAP.
Treatment Sheets
 Treatment sheets should be updated prior to morning rounds. Any changes discussed during rounds should be made
immediately following rounds. There will be times that clinicians may update the treatment sheets without directly
speaking to you if you are not immediately available, although we make every effort to communicate changes with you.

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  Ensure all treatments, procedures, and lab work are recorded on the treatment sheets (bills are generated from the
treatment sheets).
 Ensure you have scheduled enough repetitions in treatments so that they carry on to subsequent days. This is especially
important during weekends when your cases will be transferred to another intern for care. Treatments should be
scheduled according to the expected clinical course for the patient through the entire weekend, to the best of your ability.
 Check the treatment sheets for accuracy twice daily. This will ensure that changes have been made
appropriately and errors in scheduling or the HVMS program will not impede patient care.
 Always check with the clinician responsible before making any changes in the treatment plan. This includes walking the
patient out, adding medications or changing physical exam or medication doses or frequency.
o You must learn how to download radiographs, ultrasound images, arthroscopy pictures, and endoscopy pictures correctly into E-Film
(the hospital’s computerized image management system).
o You must learn how to email images from VetRocket.

Client Communication - The clinician in charge will delegate client communication to you if they elect. You are not required to discuss
the finances of the case with the owner. If you are concerned that the bill may go over the estimate, evaluate the cost per day for
care of your patient, bring the potential problem to the attending clinician and we will determine an appropriate plan. If you speak to
clients or referring veterinarians, record a brief note in the computer (Client Communication) with the information you discussed with
the client. This must be performed in a timely manner to get back out to the clinic for other tasks.
 You may also be asked by the clinician to update a client through the day.
 If the client asks for a phone call after hours with an update, first clear this with the clinician in charge, then write
it on the treatment sheet for the technician to call you with an update at the pre-arranged time.
 Call backs on discharged patients are your responsibility. Call back all discharged patients 1-2 days after
discharge.
 In general, the clinician in charge will update the referring veterinarian.
 Externs are not to perform any client communication.

Patient Restraint - We must maintain the utmost level of professionalism at all times. When we are tired it is very easy to become
frustrated, especially with an unruly or fractious horse, but frustration must never be taken out on a patient.
 Always use the lowest level of restraint that allows a procedure to be performed safely. The best restraint
methods usually combine a form of physical restraint (nose twitch, ear twitch, shoulder roll, etc) with chemical
restraint (xylazine, detomidine, butorphanol, etc). Human safety should always come first!
 The restraint method that is chosen should always be based upon each individual situation, taking into
consideration the horse’s temperament and the procedure to be performed. Remember, the owner will most
likely be present for most of the procedures performed.
 Understand that client perception of a situation is very important. At times, an effort should be made to include
them in restraint decisions. For example, a horse is getting tubed and is acting up, and sedation has already
been administered, it would be appropriate to ask the client “is your horse okay with a nose twitch?” This involves
the client in the decision and they often say I don’t know or they’ve never twitched the horse before, but are
usually more willing to allow you to restrain their horse that way when involved in the decision-making process.

Cleanliness – Please ensure your area is cleaned after use. This means that when on overnight rotation, if the exam room is soiled,
please clean and organize the counter before you leave or designate this task to an extern that is assisting. If you cannot get to it,
please ensure that the cleaning staff knows it needs to be done when they arrive in the morning. During the day the technician
assisting will ensure there is a plan for cleaning the area(s) used. It is our responsibility to be sure that the hospital stays clean and
tidy. Cleaning up the areas after use is the most efficient way to accomplish this.
 Clean clippers immediately after use. They must be free from hair and blood, preferably before the blood dries. Clipper
cleaning supplies are located in each exam room/clipper station and in central. This may be delegated to a technician, but
it is ultimately the responsibility of the person who used the clippers to make sure they are cleaned and returned in a timely
manner.
 Ultrasound probes should be wiped with a wet paper towel or alcohol swab after every use. The ultrasound should be
powered down completely and returned to its storage location to keep it out of the dust. The ultrasound should not be left in
the barn overnight.
 Nasogastric tubes and reflux buckets may be kept for patients if they might need them again. If they are kept, they should
be dumped and rinsed after every use.

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 NEW PATIENTS UPON ARRIVAL - Every case should be assigned to an intern prior to arrival. This corresponds to the clinician on your
assigned service.. You are responsible to looking up the history, imaging, bloodwork, etc. prior to patient arrival. Additional time may need to
be spent researching your cases and formulating a diagnostic/treatment plan.
o Ensure the owner has filled out the inpatient consent paperwork: Permission to treat form/fee estimate sheet and a new patient form
(if needed). Make sure they fill out the diet section and the section stating what equipment they are leaving in the hospital (we prefer
no equipment is left with the horse if possible). If diet information is not obtained- a phone call to the owner will be needed.
 It is important that an emergency phone number is written on the permission to treat form. Check its accuracy before
allowing the owner/trainer to leave. Ensure you ask the owner/trainer, “what is the best number where we can reach you
at all times?” and “Are there any other numbers you’d like us to have in case we cannot get ahold of you?” and “Be sure
you leave your phone on and by your bed overnight in case we need to reach out.”
 Ensure that any new phone numbers are promptly uploaded to the client file and that the primary contact is listed
first.
 Make sure you get signatures on the permission to treat/estimate form. Consult with the clinician for the estimate and
deposit required.
 During business hours, the front desk usually has the client sign the permission to treat form and collects the deposit.
 The deposit will generally be ½ of the high end of the estimate. A horse is not to enter the induction stall without a
deposit and a signed consent form.
o Medical colic estimate: basic medical colic with about 24-72h of hospitalization, emergency workup,
fluids and monitoring, $2000-2500. If more complex, then estimate will vary.
o Colic surgery estimate: $8000-10,000 for an uncomplicated large colon or small intestinal problem (with
a deposit of $5000), $10,000-12,000 for a more involved abdominal surgery with resection (with a
deposit of $6000) without complications. With complications, we quote them $10,000-12,000+.
 We accept Visa, MasterCard, American Express, or Discover.
 Care Credit and Scratch Pay are available for clients who need to make payments or who do not have the funds
for treatment. They must apply and be approved for the amount needed. Care Credit is our payment plan. There
are Care Credit forms at the front desk. Be sure to familiarize yourself with the approval process.
 Patients that arrive with proof of insurance will be asked to leave the deductible as the deposit (usually $500). If they do
not have proof of insurance either the clinician on the case and/or the hospital administrator will make the decision on
the deposit amount.
o Upon admitting the horse, set up a record, making a treatment plan and assigning the patient to a stall, assigning clinician and
caretaker to each horse. Be sure that the most accurate phone number for the owner is listed at the top of the list of numbers in the
client file and therefore, shows up at the top of the treatment plan.
 Write the patient’s name, primary clinician’s name and intern responsible name on the stall card. Put only the horse’s
name- no owner name. Patient confidentiality is strictly enforced.
 Place horse in selected stall, check that there is fresh water, and place an appropriately sized halter on the stall.
 Ensure that there is a CVMC halter and lead-rope on the stall door. If any equipment belonging to the patient is left, label
it securely with a piece of tape or label with the patient’s name. We discourage equipment being left in the hospital, but if
it is necessary, they must sign the area on the second page of the consent form stating what equipment they will be
leaving. If they leave feed, please place it in the feed room with a label and mark the treatment sheet such that it states
that the owner has provided the horse’s feed.
 BIOSECURITY
 Levels:
o 1: elective surgeries, low probability of shedding infectious agents. Place in elective aisle(GREY
EQUIPMENT).
o 2: use caution, gloves, foot bath. May shed infectious agents- medical colic, surgical colic without
diarrhea/fever/leukopenia. These horses should be placed in the ICU aisle (YELLOW EQUIPMENT).
o 3: gloves, footbath, +/- gown, +/- hairnet (clinician’s directive). Horses with 2 or more of the following
conditions: evidence of diarrhea (internal or external), leukopenia, fever, or horses with a known
infection (i.e. Strep equi). The isolation units are reserved for such cases (RED EQUIPMENT). At times
we will house neonates with diarrhea in the hospital-this is clinician’s decision and will be discussed
accordingly (YELLOW EQUIPMENT).
 Horses that present for GI disease (colic) that are in the general ICU (not isolation) will not be allowed to exit their
stall for movement to another stall for the first 72 hours post-operatively to allow close monitoring of their

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 condition and to decrease the risk of disease spread. After 72 hours, if their CBC is normal, they have had no
post-operative fevers, loose manure or other concerns, then they can be moved to a new location (i.e.. An
outdoor pen) for the remainder of their stay.
 Horses admitted into isolation will stay in isolation for the duration of their stay unless deemed appropriate to
move them out of isolation by the biosecurity officer (usually the internal medicine specialist). They should not be
walked around the property and should remain in their designated area with individual equipment for cleaning
and care.
o Any horse that presents with fever, diarrhea, leukopenia (or 2 of those three), neurological signs,
respiratory signs or other signs of potentially contagious disease will be isolated as deemed
appropriate by the internal medicine service.
 Make sure you check in your patient in HVMS and assign them a stall #. This will put them in the Facility section
and make them easy to find in the computer.

VISITING HOURS/PICK UP TIMES - Our normal in-patient visiting hours are from 9am to 4pm on weekdays and 9am to 2pm on Saturdays .
We try to avoid allowing visiting hours on Sundays. Sunday and off-time visiting hours are allowed only at the discretion of the attending
clinician as well as your schedule, as a doctor is to be present when a client visits their horse . Visits should be limited to 30 minutes unless a
clinician exception is made. We need to remember that we are a service-oriented business, and without the client we have no job. If it is easy
for the client to come visit, they will be a return client. If we do not make them feel special or show concern for their needs, they will find other
facilities which will.
o After-hours visits and pick-up times will need to be scheduled with the client to ensure that a doctor and/or staff member will be here
to greet the client, let them into the building, go over discharge instructions and answer any questions they may have, as well as
ensure that the bill is settled.

DISCHARGING PATIENTS - Ensure horses are brushed, feet picked, fluid braids removed and IV catheters removed . If they are being
discharged with a bandage in place, be sure it is clean and tidy. Our goal is ensuring that the horse looks better when they leave than when
they arrived.
o Make sure on your last contact with the client prior to discharge, you ensure that their bill has been paid. If it has not, connect them
with the hospital administrator or the front desk if it is during normal business hours. If it is going to be an after-hours or third-party
pick-up (hauler, trainer, friend, etc.), inform the client to contact the front desk to arrange for payment of their balance (through the
end of the horse’s anticipated stay). Also remember to remind the client to bring their halter and lead rope.
o Inform the client that pick-up times are between 10am and 4pm M-F and 9am-2pm on Saturday. Exceptions only with permission of
clinician. Arrange for pick-up times that work with your day. For example, do not arrange for a discharge during a surgery on one of
your cases.
 We try not to discharge patients outside of these hours, so try to work this out with the client. If an out of hours discharge
is unavoidable, prior arrangements for payment of the bill are required.
o Type up discharge instructions in MS word and save in Clinical Files. We recommend starting discharge paperwork just after patient
arrival, after the intake SOAP is composed. This will make it easier to remember the pertinent findings from admission when
finalizing the discharge on the day they leave. Discharges are your responsibility so pay close attention in rounds and write down
instructions if you need to remember them. They need to be completed no later than 24 hours prior to discharge. Prior to printing the
discharge instructions on letterhead, have the clinician review them (either provide a printed copy to the clinician or have them make
any necessary changes in the computer), then print them out (2 copies - one for the client to take home and one for them to sign to
upload to the record). There are templates for the most common problems in Clinical Files and there are old discharges if you have
questions on commonly used instructions.
 Our files in progress and shared files are maintained in a shared folder on our server, called “Clinical Files”. There is a
shortcut to these files on each computer workstation. A discharges folder is there and contains old discharges and
current discharges.
 Written Instructions
 Tips for writing discharges
o Omit unnecessary verbiage so clients don’t have to read a novel to figure out how to care for their
horse
o The discharge should be updated as you go; especially important for horses hospitalized a long time
o Update the discharge any time a case is transferred so it is complete up until the time of transfer
o Omit the horse’s name and he/she unless necessary to limit mistakes in templates

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  Be careful to customize the template so it is appropriate for your patient- i.e., change ‘he’ to ‘she’, make sure the
date is accurate, and make sure the patient’s name is accurate.
 Anticipate any possible questions, and answer them in the discharges before they are asked, i.e., ideal stall size,
bandage layers, etc.
 Be sure to have very specific medication instructions- include how many days on a medication.
 Outline your feeding or exercise regimens as follows:
o Week 1: 10 minutes hand walking daily, 4-5 days a week
o Week 2: 15 minutes hand walking daily, 4-5 days a week
 Once the clinician reviews your discharge instructions, make the changes they specify, and learn from these changes.
We will expect you not to make the same mistakes twice.
 Ensure all medications are ready to go home with clear instructions on the labels. Make sure all dispensed medications
are billed, and make sure that they have enough medication for the entire treatment regimen that is listed in the
discharge instructions unless otherwise specified that there will be follow-up with the rDVM.
 When the owner comes to pick-up the horse, greet the client and make sure that they have already checked out at the
front desk. Check with the front desk yourself to confirm that the bill is paid in full. Do not get involved if there is an issue
with payment- pass the client to the hospital administrator or the front desk for resolution. Go over the discharge
instructions with them. Answer any questions they might have. If you are unsure of how to answer a specific question,
tell them that you will ask the attending clinician and then get back to them. Be careful about answering prognosis type
questions unless we have discussed this previously.
 Generally, the doctor in charge of the case will fax or email the discharge instructions to the rDVM after discharge of that
patient. If asked, the intern helping with the case may need to send this information to the rDVM. Make sure that the
discharge instructions are on CVMC letterhead.
 Please document in HVMS that you have emailed the discharges to the rDVM so the clinician in charge of the
case can ensure that it is done. You may email directly from the program if you’d like.
 After completing the record for that patient, copy and paste the text of the discharge into “History” in HVMS, ensure the
discharge is moved to the appropriate “Discharged” folder in Clinical Files
by year. This allows everyone to know that the documents were properly moved into the record.
 Ensure you save the file as “Last name.Horse name-diagnosis.” So, a medical colic would be “Smith.Rosie-
medical colic.” After this step, move the discharge from the main discharges folder to the “discharged 2022 (or
current year)” folder.
 The only discharges in the general discharges folder should be the currently hospitalized patients.

 OUTPATIENT RESPONSPONSIBILITIES
o You will take any case that is being seen by the primary clinician on your service.
o Learn how to set up and operate the diagnostic/therapeutic equipment- ultrasound, radiology- both CR and DR, endoscopy,
shockwave, laser, CBC, chemistry, lactate, SAA, fibrinogen. You should be able to set up and run this equipment proficiently by
yourself.
o Assist with the physical exam, lameness exam and any procedures performed.
o Remain with the case you started with. Observe any diagnostic procedures and listen to the clinician talk to the client about
prognosis and treatment. You will have to do this on your own soon and this is the best way to learn.
o If you are ready for a procedure (have the proper equipment out, have reviewed the landmarks for the injection) the clinician is much
more likely to have you perform that procedure. If you are not ready, and do not know your landmarks, you will most likely be
watching the procedure.
o Try to find time to work with the technicians to learn how to set up equipment (arthroscopy, radiology, ultrasound, endoscopes, etc.)
They will be a good resource for preparing the proper equipment required for a procedure.
o When preparing for a surgery, you need to read the surgical procedure and plan as if you will be the one doing the surgery. This
means thinking through the equipment that will be needed as well as what recumbency the horse will need to be placed in.
o You are expected to write a SOAP for every patient you are involved with, including outpatients. Write your SOAP and inform the
attending clinician when it is completed for their review. This must be performed on the same day of examination. If there were
portions of the exam for which you were not present, ask the attending clinician what you missed. This is the best way to gain
complete understanding of the case.
o Discharges should be completed by the intern efficiently so they can be disseminated to the client before the client leaves.
Otherwise, the discharges will be emailed.

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 EMERGENCIES
An SOP (standard operating procedures) manual is available for use to help with setup checklists for various procedures/problems
o On nights and weekends, the intern on call will carry a cell phone dedicated to emergency calls (the “bat phone”). This will be the
phone that clients will call and leave messages on about their sick horse. It is also the line veterinarians will call that are referring
patients for care. The intern is responsible for having this phone on them and ensuring it is charged and functional. A test page will
be sent on nights and weekends to ensure it is working before switching the phone lines to the “bat phone.” You will need to learn
how to access these messages through the phone system (Hospital Administrator can teach you this). If you do not retrieve a
message and return the call in a timely fashion, the message will be passed up the line to the management person on call.
o On the nights you are on call, you must check general surgery and ensure that both anesthesia and surgery are completely set up for
a possible colic surgery prior to leaving that day.
o Most emergencies will be colic cases
o Prepare for arrival
 IV catheter supplies (MILA catheter, nonabsorbable suture on a straight needle, T-port, 2 12ml heparinized saline
flushes, sterile and non-sterile gloves, scalpel blade, scrub and alcohol, working clippers), abdominocentesis supplies
(sterile teat cannula and bitch catheter, a purple and white top tube, 15 blade, working clippers, scrub and alcohol),
rectal exam (rectal sleeve and lubricant pump bottle), blood draw supplies (6ml syringe with fresh needle, purple and
green top tubes), ultrasound (plug in, turn on and enter patient information if possible), nasogastric intubation supplies
(two metal buckets, one with ~8L warm water, NG tube of choice, pump, 3ml empty syringe case, towel and white tape)
 Check commonly used drugs in emergency situations for easy access as well as 3ml syringes with 20g needles
(xylazine, buscopan, detomidine, flunixin)
 Paperwork - partially filled out if possible, including consent form with client phone numbers, colic intake form.
 Ensure an ICU stall is ready and bedded with at least one empty bucket and a muzzle on the door (if colic).
 Clean CVMC halter and lead rope at stall
o Gather history from the client while performing the following:
 Upon arrival pull blood for purple top and green top. For any colic, start by running a PCV/TP and lactate. You should be
prepared to run a CBC, chemistry (equine 15), fibrinogen, and electrolytes (lyte 4 clip if requested) test if requested by
the clinician in charge.
 Assign a technician (if available) to prepare for/place an IV catheter and prep for an abdominocentesis
 Perform PE
 Place an IV catheter
 Pass an NG tube if a colic
 Obtain abdominal fluid- run TP, lactate (from purple top), and make a slide of spun cells if indicated.
 Perform a rectal exam if asked to do so by the attending clinician- usually this will be done by the attending clinician
unless you are asked to do so by your attending clinician .
 Write your findings on colic intake and treatment sheets in the record. It is best to write them in the computer record also
so they can be used later for a referral report. Be sure to also write any medications and times administered on the
bottom of the intake sheet - this is very important and will help us keep track of frequency of medication administration-
i.e., frequent administration of pain medications to a colic.
 Formulate your diagnosis or differential list and treatment plan and present this to the attending clinician.
o It is required that the time from the decision for surgery and having the horse on the table is no longer than 30 minutes.
 Once the decision for surgery has been made, on call team members must be called promptly. While waiting for their
arrival, prepare the patient for surgery.
 Weigh the patient
 Check anesthesia set up and draw up induction drugs
 Draw up pre-operative medications (pre-operative antibiotics, NSAIDs and tetanus toxoid). Ask the clinician in charge
what medications should be given.
 Wash the patient’s mouth and groom to remove dirt, sweat, shavings. Pick all four feet. Ensure there are two sets of
working clippers in the OR and clip the surgical site.
 Wrap any shoes with elastikon and wrap all four distal limbs with polo wraps covering the distal limbs and heel bulbs.
 Perform the surgical safety checklist
o Interns are expected to develop appropriate skills in emergency patient care which will require less supervision as the program
progresses.

 ROUNDS

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 o You are required to be at rounds every morning, which will start at 8:00 am. You should have all paperwork, computer work, 6am
treatments, and treatment sheets for the day completed by the time rounds start. We expect that you evaluate all of your patients
each morning, perform your own physical exam and medical assessment prior to rounds. DO NOT rely on the evaluation by the night
person.
o You will present your cases in a complete but concise manner. Be organized in your presentation! This is practice for you for your
future so that you can properly communicate your case and findings to other veterinarians. This skill is very important for your future
success as a referring or referral veterinarian.
 A complete and concise case presentation includes;
 Signalment, presenting complaint, and brief history (more in depth on the first presentation of that patient)
 Treatment elected (ex. “the patient was started on IV fluids and a lidocaine CRI” or “Due to intractable pain,
abdominal surgery was elected”)
o If surgery was elected, explain relevant findings (ex. “In surgery, a 360-degree large colon volvulus was
corrected and pelvic flexure enterotomy was performed”)
 Clinical progress in the last 24 hours including overnight
 Physical exam findings from that morning and water intake, manure output or other pertinent details
 The case presentation should include
o Laboratory findings
o List of problems: hemoconcentration, colic pain, anorexia…
o List of treatments: report med, dose in mg/g, route, frequency
o Response to treatments
 Short term plans
 Long term plans
o Please have any bloodwork or other test results available for rounds.
o Have total fluid rate/reflux rate per hour over the last 12 hours available for rounds. For example, if a colic came in the night before
around 8pm and was given a 5L bolus of Plasmalyte followed by crystalloids supplemented with calcium at a rate of 1L per hour
overnight, by 8 am you can say: “Rosie was started on IV fluid therapy with Plasmalyte supplemented with calcium at a rate of 1L per
hour after a 5L bolus. She has received a total of 16L of fluids since admission.” That way if the fluid rate accidentally was bumped
up or down or if the catheter is positional, you can recognize that the rate isn’t appropriate based upon your rate and how long the
patient was on fluids. This is very important as patients can fall behind on fluids or be flooded, which can be detrimental to their
overall condition and/or their bill.
 When looking over the treatment plan in the morning, be sure you record your patient’s “ins and outs” for that day. For
example: If your patient is getting fluids at 2L/hour and they’ve been on fluids for 10 hours, then your patient should have
already been charged for and had four, 5L bags hung. If they are still getting fluids at a rate of 2L/hour, at this point, a 5 th
bag should be hung (25L total hung) with 5L remaining in the stall. If instead, your patient is still receiving its 3 rd bag of
fluids that means their rate is inaccurate.
 Checking fluid rates in this manner is critical both when helping with treatments and when checking daily
treatment sheets. If fluids are not running on time, the rate should be adjusted accordingly and the clinician
should be notified.
 Fluid ins also include their water intake-so please take note of this and be prepared to present this information in rounds.
 Although we cannot accurately quantify volume of diarrhea or urine on most patients, we like to quantify volumes of
reflux obtained in the same manner as fluid “ins.” Record the volumes of reflux obtained per day and per check so that
we can track how the patient is progressing.
o You will be expected to be the ‘expert’ on the patients in the hospital. This means that you will need to read up on the conditions in
texts, journals or internet.
o You will be asked specific medical questions during rounds. These questions may be about the condition or a medication the horse is
receiving. Be prepared. It will be obvious if you have not done your homework. It is inexcusable to have a case in your care and not
understand the condition, complications, or medications.
o Ensure all changes to treatment protocols discussed in rounds are promptly changed on the treatment sheets. It is best to make any
changes at the time they are discussed. You may make changes on the computer during rounds or immediately following rounds
when that is not possible. Do not wait until after post-rounds chores when you may forget.

 SURGERY DUTIES –
o You will be responsible for ensuring patients are prepared appropriately for surgery.

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  Horse has been fasted for 6-12 hours pre-op. Water is ok. No feed as of midnight for AM surgery. No feed as of 6am for
afternoon surgery. This needs to be a part of the horse’s orders to ensure that whomever is completing treatments does
not feed your patient before surgery.
 Physical exam within normal limits. ALL PRE-OP PATIENTS NEED TO HAVE THEIR HEART AND LUNGS
AUSCULTED BY THE INTERN ON THAT CASE, PRIOR TO INDUCTION.
 Heart and lungs should be auscultated by the intern on the surgery rotation AND by the person performing
anesthesia. When you are on a surgery rotation, your responsibility is to make sure the patient is a suitable
surgical and anesthetic candidate.
 If an irregular rhythm is noted, even if it is suspected to be second degree AV block, Please hook up the ECG
and print an ECG strip for the anesthesia record prior to induction.
 Appropriate lab work completed and reported to the attending clinician.
 CBC, PCV/TP for all horses undergoing inhalant anesthesia
 PCV/TP for horses undergoing total IV anesthesia; check with clinician if additional bloodwork is necessary.
 Intravenous catheter placed on the appropriate side (consider recumbency in surgery and in recovery). Default to the left
side if in dorsal as long as the horse can recover in right lateral recumbency.
 Pre-op medications drawn up and ready to be given when horse is in the drop stall.
 Always check with the clinicians before administering pre-op meds.
 For CM, do not administer prior to entering drop stall, to keep medication administration close to incision time.
 Surgical area clipped/cleaned if possible (day of)
 Halter fitted
 Mouth washed
 Feet cleaned.
 Wraps placed on all 4 distal limbs
 Wash prepuce ahead of time if possible for anything that may require a urinary catheter. It will be cleaned again at the
time of urinary catheter placement.
o Intern is responsible for reviewing and authorizing induction medications prior to every anesthesia. Keep in mind prior sedation when
considering initial Xylazine dose.
o Help the technician ensure surgery suite is ready- table appropriate, instruments/drapes out and ready
 Ensure all equipment needed is available and in working order (the anesthetist is responsible for the anesthesia end of
things)
 If doing an arthroscopy, make sure the electronic equipment is on and working and that the media capture is attached
and working.
 Ask surgeon if any special equipment is necessary, and ensure that equipment is out and ready.
o On the day before surgery or the morning of surgery, make sure you know the surgical team and who is running the anesthesia. If
somebody has not yet been assigned to run the anesthesia, work with your intern mates and the technician coordinator to assign
someone. Gather the surgical team. Agree on an induction time and make sure that everyone knows the time and is prepared to
fulfill their role during surgery and anesthesia.
 Surgical team- anesthetist (tech or intern), technician, surgeon and assistant surgeon (intern or extern).
 The intern assigned to the case must be present for induction. No horse will be induced without a doctor and a
stethoscope present.
o You will be expected to either scrub in or assist with technician duties on all surgeries when not performing anesthesia
o You will be expected to understand the procedure and understand the anatomy involved prior to induction!! Good resources are
“Equine Surgery” by Auer & Stick, and “Techniques in Large Animal Surgery” by Turner & McIlwraith.
o You may be expected to write the surgery report. There are templates for some procedures in the word processing portion of the
computer record. Be careful to customize it to your patient. It is required that this report is completed within 24 hours of surgery.
 If you do not write the detailed surgery report, you will be expected to write the abbreviates surgery note in the patient
record. This is what may be copied into the patient’s discharge paperwork.
o In the discharge, the surgery note must be present. This is a brief summary of the procedure and approach performed. Only include
the details relevant to the owner and referring veterinarian. Be sure to include how the skin was closed and if/when sutures or staples
need to be removed.

 ANESTHESIA - Part of your internship training is to perform general anesthesia- Inhalant and injectable. You will be trained by our staff on how
to do this, but coming to the internship with prior anesthesia experience/knowledge will help you tremendously.
o Prepare your pre-op sedatives and induction agents. Check with the attending clinician to ensure your selections are appropriate.
o Prepare and check the anesthesia machine for leaks

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 o Prepare and check your endotracheal tube for leaks
o Prepare and check the EKG/BP machine
o Prepare the blood gas machine
o Perform your own PE on the patient prior to surgery and print an ECG strip prior to induction. You MUST auscult heart and lungs
prior to sedating and anesthetizing the animal.
o Perform and maintain anesthesia
 During anesthesia, you are required to check in with the clinician on the case to update them on your patient’s condition
at least every 30 minutes or when asked. Be prepared to inform them of the condition of the patient, their pulse,
respirations, blood pressure, most recent blood gas parameters (oxygenation and CO2 levels), tidal volume, in a concise
and organized manner. If you have concerns about your patient along the way, speak up! Do not be afraid to ask
questions. This is the best way to ensure a safe procedure and good recovery.
 Notify the surgeon of any abnormalities in your patient’s condition. This is included, but not limited to, blood pressure,
depth, oxygenation, ventilation, or problems with your machine. The surgeon will ask what you are doing to correct the
abnormality to check if additional measures are needed.
 If you have any uncertainty about your patient’s condition, interpreting blood gas, or general questions, please ask. The
clinicians will help you troubleshoot and provide additional resources if necessary.
o Understand thoroughly…
 The pharmacology of the agents you are using: pre-op, induction, maintenance
 Their impact on BP, RR, CO…
 The anesthesia machine and how it works
 How to troubleshoot the anesthesia machine
 Blood gas results and how to respond to them
 Blood pressure problems and how to correct them
o Prepare the recovery room and assist with recovery
o Clean and prepare the anesthesia machine/monitors for the next surgery (leave it as you would like to find it at 3am). It is best if all
parts of the anesthesia machine are opened and dried between surgeries if possible.
o Assist with recovery. Never leave your patient until they are breathing normally, standing, and stable.
o A doctor must be present for every recovery, even if a technician runs the anesthesia on the case.
o Assist in cleaning surgery room/recovery once horse is in stall and settled.
 For after-hours surgeries, the on-call technicians may complete their work prior to the horse being ready to leave the
recovery stall. It is then the intern’s primary responsibility to make sure the recovery stall is cleaned prior to the
beginning of the next morning. This can be done by the anesthesia and surgery intern. If the barn caseload is slow, the
night tech or intern can complete this between treatments.
o Enter your anesthetic items into the invoice in HVMS and log all controlled substances immediately.. It is also critical that your
anesthetic record be complete. This includes the top of the anesthesia sheet being accurately and completely filled out and the
bottom of the sheet being completed with totals of medications and the anesthetist’s signature. This includes but is not limited to:
surgery start and end time, enter recovery time, time standing.
o There is an anesthesia log in the OR. IT IS IMPERATIVE that your anesthesia logs be completed after each procedure you run.
o It is required that the time from the decision for emergency surgery and having the horse on the table is NO LONGER THAN 30
MINUTES.

 TOPIC ROUNDS/JOURNAL CLUB

o Every Tuesday morning at 7:00 am we will have Journal Club/Topic Rounds in the conference room or via Zoom. Please do not be
late - we do not want to hunt for you in the barn.
o Remember that you must evaluate your inpatients and prepare for barn rounds prior to journal club starting.
o JOUNRAL CLUB
 Either an article/topic will be assigned to you or you will choose an article/topic that interests you.
 Article presentations should be a maximum of 12 minutes (aim for 10!), with 3 minutes allocated for group discussion
and questions.
 Refrain from reading from the article as much as possible and stick to presenting the most relevant portions. It is most
difficult to give a short, concise presentation. Keep in mind that the group has already read the article so the journal club
meeting should focus on the discussion.
o TOPIC ROUNDS

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  You will be asked to present 2-4topic rounds presentations over the course of your internship. You may choose a topic
that interests you and the topic must be approved by any of the clinicians. PLAN AHEAD for these presentations, as we
expect you to research the topics in depth and provide cited literature that supports the presentation. Ask clinicians for
help if you do not have access to papers you want to read to prepare.
 The interns should make a schedule requesting topic rounds presentation dates. This way you can choose a date that
works for you with regards to your call and rotation schedule.
 Your topic should be chosen a minimum of 4 weeks ahead of your presentation date to allow ample time to prepare.
Submit your topic to Intern Coordinator.
 Topic rounds presentations should be about 30 minutes long.
 You should create a powerpoint (or similar program) slideshow to go along with your presentation. Cite literature on the
slide where it is presented.
 This format should help prepare you for future presentations to horse owners or colleagues at continuing
education meetings.
 Send a handout or article to the group prior to your presentation. The group will read this in advance and use it for a
productive discussion of the topic.
 Do not ask to reschedule your topic rounds date due to your lack of preparation in advance. Choose a date that you are
not on call the night before. If you are working the weekend, remember that you may not have time to work on your
presentation while you are working so preparation should not be left to the last minute.

 PERSONNEL MANAGEMENT
o You are expected to be a leader in the clinic. Learn and practice effective personnel management. Always treat everyone with
respect. If you have issues, we expect you will go to the hospital administrator or clinical supervisor to resolve them.
o You will be evaluated on your ability to maintain professional conduct, including the ability to interact amicably with clinicians, staff,
and clients. It is expected that you will communicate with the specialists, hospital administrator, and technicians regarding your
schedule throughout the day. Please let everyone know if you need to leave to get lunch, run an errand, or go out on an ambulatory
call.
o Resist the urge to get too deeply involved in the day-to-day management of the technicians. This is the hospital administrator’s job,
and you will have enough work to do just taking care of yourself and your daily tasks.
o You will be asked to teach technicians and externs to share your knowledge. Keep in mind the staff looks up to you as a doctor and
you will interact with them very closely. Please maintain professionalism and speak to and about others with respect.
o Remember, interns are viewed as role models by the staff and our visiting externs.

 DRESS CODE
o Clean khakis (can be colors other than tan-green, brown, black, dark blue, grey all fine) or scrubs and collared shirt or scrub top 
o Name tag (at least for the first week at the hospital) 
o Closed toed shoes 
o Bring a hair tie if you have long hair. Hair should be tied when aseptically preparing any site (performing surgery, scrubbing joints,
scrubbing catheter site, placing IV catheter)
o Stethoscope, thermometer, bandage scissors-all well labeled (with your name) 
o Pen and sharpie marker
o Lunch and water bottle. You will not have time to leave or go home for lunch every day.

 AMBULATORY DUTIES
o Licensed interns, once deemed competent to be independent in the field, will be responsible for covering a night of ambulatory call
per week and one weekend of coverage per month. Generally, this occurs after about 2-3 months of internship. You will be provided
with a stocked vehicle to use for this. During very busy times in the hospital, ambulatory coverage duties may be reduced as deemed
appropriate by the intern coordinator and hospital administrator.
 The truck being used will be shared between the interns and senior clinicians. Technicians maintain these trucks and
keep close monitoring on cleanliness, organization and stock of materials needed. Please be mindful of what you use
and what needs to be cleaned/replaced after an ambulatory shift. Keep an organized list of what needs to be done to
restock after your time on call using the truck. Communicate with your intern-mates or a technician for help if you fall
behind on stocking or cleaning so that this can be addressed before the truck is taken for a daytime call.

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  It is your responsibility to make sure a shared truck is clean and restocked promptly after use. You will lose the privilege
of using a shared truck if this is not done.
o You may be asked to assist with some ambulatory calls during normal business hours. This will happen more often during the day
when in-hospital cases are light.
o Interns are expected to develop appropriate skills in emergency patient care which will require less supervision as the program
progresses.
o As you enter the last few months of your internship, we will likely send you out independently in a truck to treat emergencies as
needed.

 COVERAGE
o **It is the intern’s responsibility to make sure that there is at least one intern on call every night and every day, 7 days a week. Your
finalized schedule is to be submitted to the intern supervisor/hospital administrator on the 15 th of the month prior. It is the intern’s
responsibility to make sure that there is at least 1 intern in the clinic daily on weekdays. You must work this out between yourselves
when it comes to vacation, sick days, or CE time. Coming to the clinician with scheduling problems is highly discouraged.
o Interns are responsible for coordinating hospitalized patient care 24 hours a day, 7 days a week. Interns are expected to equally
share coverage among one another.
o Emergency time off must be covered by your intern mate(s). Be prepared to cover for your intern mate(s) if they have an emergency.
o When you need to take a day off, you must fill out a request online through ADP and submit it to the hospital administrator. He will
keep track of your days off.
o Vacation is a part of your contract, as is paid sick leave. You also get some time for CE opportunities to fulfill your CE requirements.
When scheduling time off, notify the service you are on to arrange coverage for your duties before you finalize your schedule. Time
off during the last two weeks of your internship is not allowed (unless emergent) as this time is dedicated to new intern training. We
recommend you schedule your time off outside of the spring months if possible. Any time off requests, after approved by the intern
coordinator (who will check with your service clinician) need to be officially requested through ADP for the hospital administrator to
approve.
o Be careful with your days off. Consider unforeseen needs near the end of your internship such as job interviews.
o If you are sick, please contact the intern coordinator and hospital administrator first before coming in if you need a day off. We
encourage you to take care of yourselves and speak up if you are not feeling well or need rest.
o You will be responsible for two types of call: and primary call and back up. When on primary call, you will be the first intern the
clinician on call will contact about any emergency coming to the hospital. You are required to be close and have everything ready for
the incoming emergency per clinician instructions. When on back up call, you will be called in to run general anesthesia or if
absolutely needed as back up for a critical case. You will need to be within the required range of the hospital and be available.
o If you see either ‘Dunning’ or ‘Collection’ in the notes section of the record the client is either a slow pay or no pay. If you need to see
one of these clients you need to inform them that they must pay at the time of service- credit card or cash only.
o Hospital Hours: 7:30-5:30 M-F, 8-2 Sat.
o If a referring veterinarian calls you while you are on emergency duty- you may speak to them about the case if you feel comfortable
or have a specialist contact them directly. Please let them know who the primary clinician is on duty and that we will give them an
update once we have worked up the patient.
o You are required to be within 15 minutes of clinic always when you are on call.
o The consumption of alcohol (or any other behavior altering drug or controlled substance) while on emergency duty is inappropriate,
and may jeopardize the life and safety of the patient, client, clinician or staff members. It is also inappropriate and unacceptable to
diagnose, treat, or make other related veterinary medical judgments or assessments while under the influence of the above. It is an
expectation that consumption of alcohol, consuming other behavior altering drugs, and controlled substances (except as prescribed
by a physician) while on emergency duty is inappropriate and unacceptable behavior that will result in serious disciplinary action.

 EVALUATIONS
o You will be evaluated at least every 6 months. The evaluation will review the following:
o professional effort
o theoretical and applied knowledge
o clinical skills and tutorial skills
o scholarly activity.
o Hospital Service: communication skills, patient care, medical record keeping, performance of emergency duty, adherence to CVMC
protocol

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 o Personal/professional characteristics: responsibility, initiative, interaction with staff, leadership, emotional intelligence

 MISC HELPFUL HINTS

o A doctors meeting and staff meeting are held monthly at 7:00 or 7:30am. You will be expected to attend these meetings.
o Cell phone service will be provided. This will allow for lines of communication among all the doctors. You are expected to keep your
phone with you at all times. The clinician in charge must be able to reach you at any time when you are on call.
o You are required to be within 15 minutes of clinic at all times when you are on call.
o The clinicians are ultimately responsible for all the cases that are seen at the hospital. Always follow their instructions, and don’t vary
from the treatment plan without first clearing this with the clinician in charge.
o One of the hardest things to get a handle on in the beginning of your internship is finding stuff. Go through the cabinets and figure
out how things are organized.
o Save all receipts and submit them to the bookkeeper when you use the clinic credit card or when you pay for anything hospital
related. Initial and date the receipts.
o Learn how to use HVMS and how to take a payment ASAP. The hospital administrator or the receptionists can help you with this.
o If you remove the last or second/third to last item from the shelf (in pharmacy or in the nurse’s station), please notify the inventory
manager in the pharmacy. We depend on everyone to make sure we do not run out of inventory. Pay special attention to meds on
Thursday, such as plasma, polymyxin, K pen, fluids, metoclopramide, PPN, etc so they can be ordered prior to the weekend.
 If a horse is on PPN or metoclopramide, we can go through a large amount in a short period, especially getting into the
weekend. Notify the inventory manager if one of your patients is on a large amount of these medications.
o Controlled substances are tightly controlled by CVMC. If you need a controlled med, you must use it from your personal lock box
(little black box). Remember to log all controlled meds. The inventory manager in the pharmacy is responsible for controlled
medications if you have questions.
o Locked intern cabinet -The expiration dates of these meds need to be checked on the first of every month.

Upon completion of your internship program, you should be proficient with:

o Evaluation and management of equine colic
o IV catheter placement and maintenance
o Performing and interpreting an abdominocentesis
o Passing a nasogastric tube
o Ultrasound of the abdomen and thorax
o Ultrasound of major structures of the distal limb
o Interpreting clinicopathologic data from blood and other fluids
o Anesthesia techniques and triaging/treating problems
o Arterial blood collection and analysis
o Radiographic techniques and interpretation for the axial skeleton and thorax/abdomen
o Performing a basic lameness exam
o Landmarks and technical performance of:
 PDN, basisesamoid, abaxial, low 4 point, and high 4 point nerve blocks
 Coffin, pastern, fetlock, carpal, tarsal, elbow, shoulder, and stifle injection sites
 Digital sheath injection
o Dosages of intra-articular medications
o Suturing and laceration management
o Performing a castration independently
o Naming basic surgical instruments
o Anatomy of the equine…
 Skull, limbs (soft tissue and skeletal), abdomen and axial skeleton
 Dentition
o Dental problems- identification, diagnosis, treatment, & prognosis
o Equine fluid therapy
o Sick neonatal foal triage and care (emergency care included)
o Treatment of dystocia
o Foal angular and flexural limb deformity- diagnosis/treatment/prognosis

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 o Fracture prognosis based on diagnosis
o Vaccination protocols
o Support personnel management
o Time management as an equine ambulatory practitioner
o Basic practice management
o Effective client communication

Date of Review _____________________________________________________________

Signature__________________________________________________________

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