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Journey to a VTS in Anesthesia and Analgesia with Vivienne Montony CVT and Melissa Vehouc-Clark CVT, VTS A&A - Ep. 8
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If you’re a veterinary technician who loves practicing anesthesia as much as we love talking about it on this show, then maybe you have thought about becoming a veterinary technician specialist (VTS) in Anesthesia and Analgesia. If you haven’t heard that term before, an individual with a VTS in Anesthesia and Analgesia is a certified or licensed veterinary technician who has undergone a rigorous application and testing process that demonstrates their superior knowledge when it comes to the care and management of anesthetized patients. The organizational body that oversees this rigorous process is the Academy of Veterinary Technicians in Anesthesia and Analgesia (AVTAA). In this episode, host Dr. Bonnie Gatson dives deep into the application process in a round table discussion with a technician who is just beginning her VTS application journey and a technician who just recently obtained her VTS in Anesthesia. Together, the panel discusses the possible career benefits of obtaining a VTS in Anesthesia, what type of work environment will set you up for the best possible experience during the prequalification phase, and we will provide tips on how to maximize your efforts and avoid pitfalls during the later application and examination phases.
We would like to thank our guest panel: Vivienne Montony, CVT, veterinary anesthesia technician at the University of Wisconsin, and Melissa Vehouc-Clark, CVT, VTS (Anesthesia and Analgesia), lead veterinary anesthesia and surgery technician at Community Care Veterinary Specialists in Gainesville, FL.
If you would like to learn more about the application process, please visit the AVTAA website
If you like what you hear, we have a couple of favors to ask of you:
- Subscribe to the North American Veterinary Anesthesia Society (NAVAS) for access to more anesthesia and analgesia educational and RACE-approved CE content.
- Spread the word. Share our FB or IG post, re-tweet, post something on a network or a discussion forum, or tell a friend over lunch. That would really help us achieve our mission: Reduce mortality and morbidity in veterinary patients undergoing sedation, anesthesia, and analgesia through high quality and peer-reviewed education.
Thank you to our sponsor, Dechra - learn more about the pharmaceutical products Dechra has to offer veterinary professionals, such as Zenalpha.
If you have questions about this episode or if you want to suggest topics for future episodes, please reach out to the producers of this podcast at education@mynavas.org.
An AVTAA representative for NAVAS was consulted for this episode. However, all opinions and thoughts stated by the host and their guests are theirs alone and do not represent the thoughts or opinions of any corporation, non-profit, university, or other business or governmental entity.
Special thanks to Chris Webster, Saul Jimenez, and Maria Bridges for making this podcast a reality.
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Transcript
Introduction to Veterinary Anesthesia
00:00:07
Speaker
Hello and welcome to the official podcast of the North American Veterinary Anesthesia Society. I am your host, Dr. Bonnie Gatson, board-certified veterinary anesthesiologist and proud gas passer. I'm so glad you decided to spend your time with me today as we go through our anesthesia journey together. So I'm assuming that if you are listening to this podcast, then you are a person with a unique interest in veterinary anesthesia.
00:00:35
Speaker
And although I might be making another assumption here, you may even be a person with dreams about the future, especially in regards to the future of your career. Perhaps you are even wondering how to incorporate your passion for veterinary anesthesia into these future career goals.
Becoming a VTS in Anesthesia and Analgesia
00:00:54
Speaker
If this is something that speaks to you or perhaps you work alongside a skilled and ambitious technician who wants to push their career to the next level, then this episode is for you because we will be discussing how to successfully set yourself up on the path towards becoming a veterinary technician specialist in anesthesia and analgesia.
00:01:19
Speaker
or VTS for short. If you haven't heard that term before, an individual with a VTS and anesthesia is a certified or licensed veterinary technician who has undergone a rigorous application and testing process that demonstrates their superior knowledge when it comes to the care and management of anesthetized patients.
Meet the Experts: Vivian Montany and Melissa Clark
00:01:41
Speaker
The organizational body that oversees this rigorous process is the Academy of Veterinary Technicians in Anesthesia and Analgesia, or AVTAA for short. In this episode, we are going to dive deep into the application process in a roundtable discussion.
00:02:01
Speaker
with a technician who is just beginning her VTS journey and a technician who just recently obtained her VTS and anesthesia. We are going to discuss the possible career benefits of obtaining a VTS and anesthesia, what type of work environment will set you up,
00:02:19
Speaker
for the best possible experience during the pre-qualification phase, and we will provide tips on how to maximize your efforts and avoid pitfalls during the later application and examination phases. Our goal with this discussion is to somewhat demystify the process and provide a clear and stepwise guide on what to expect at each phase of the process.
00:02:44
Speaker
So without further ado, I hope you enjoyed this conversation I had with these two inspirational veterinary caregivers and professional gas passers, Vivian Montany and Melissa Clark.
00:03:01
Speaker
Hi, everybody. Welcome back to the podcast. So why don't you guys go ahead and introduce yourselves? We'll start with you, Melissa. Hi, my name is Melissa Vahutz-Clark, and I am an anesthesia technician who just achieved her veterinary technician specialist last year in anesthesia and analgesia. Currently the lead anesthesia and surgery technician for the Veterinary Surgeon Center in Gainesville, Florida.
00:03:28
Speaker
soon to expand into the community care veterinary specialists to hospital locations in Gainesville, just expanding what we can offer in surgery to the public.
00:03:41
Speaker
That's awesome. Just to get everybody a little bit more familiar, I actually met Melissa. We worked together for many years at the University of Florida. So Vivian, why don't you go ahead and introduce yourself?
Passion for Anesthesia: Personal Journeys
00:03:54
Speaker
Hi, I'm Vivian. I graduated from Globe University in 2015 and obtained my CVT license by passing the VTME.
00:04:04
Speaker
And I've been practicing ever since. I only recently broke into the specialty area for the last couple of years where I met Dr. Ganson. Since then, I've been just really interested in obtaining my specialty in anesthesia and analgesia because I've always
00:04:21
Speaker
ran towards anesthesia. Yeah. So let's talk a little bit more about that. We can start with you, Viv. What interests you about anesthesia and why do you even want to pursue getting a VTS in anesthesia? So I love anesthesia because I don't know how you guys feel about it, but I just feel like from beginning to end, it's all very fascinating.
00:04:42
Speaker
about how we're taking control of these pathways that the body would make different decisions if it were just able to go off on its own. And I just love that we're taking control of that and we can make things better. Yeah, that's awesome. So is it just that you are interested and fascinated by anesthesia in general that's making you want to pursue a VTS or is there some other type of goal that you have in mind? Yeah, this is like
00:05:08
Speaker
a five-part answer for me, I'm really sorry. We love detailed answers. Okay, great. In no particular order, because they're all very important aspects of it to me, just like any surgeon would go and get their boards or anything, I want to learn everything that I can about this area and then master everything and continue to master it.
00:05:32
Speaker
And so just proving that knowledge would make me, I feel like go very far with the knowledge that I've already obtained and just in my title. And then I would like to also explore
00:05:49
Speaker
the working abroad aspect of it as well. So there's a really interesting article by VTS in ECC that she just blogs about how she travels to different countries with her specialty and is able to work abroad and experience different species. And that was really interesting to me as well.
00:06:13
Speaker
Yeah. I never even thought of that as an avenue for utilizing your VTS is just traveling abroad and experiencing, I don't know, different cultures and different ways of practicing. So that's really cool. Yeah. Yeah. That's a huge focus of mine as well. Melissa, why don't we jump to you really quick? So two part question. Why do you love anesthesia and what motivated you to go through the process of obtaining your VTS in anesthesia? I absolutely love that I can make an animal.
00:06:43
Speaker
as comfortable as possible, using different pain management techniques, low stress techniques, and get them into such a comfortable state that they can have what they need done to them to make them feel better and then make them feel better after the procedure is over. So just knowing that I'm making an animal feel more comfortable and pain free just means the world to me.
00:07:07
Speaker
And what made you want to get your VTS? Well, I am the type of person that loves to know why I'm doing something. I loved being a veterinary technician and doing surgery with my doctor, but she would tell me to do something and I would want to know why. What's going to change? What's going to happen to the animal if I don't do it? What happens if I do this with something else? I wanted the why.
00:07:34
Speaker
So I got further and further into anesthesia to find out what's going on inside the animal. What differences am I making in the animal?
00:07:46
Speaker
And it's just fascinating to me all the body parts and how they work together and how we can help them throughout the process. Wonderful. So Melissa, since you've gotten your BTS, which I mean, you've only had it for a short period of time, but I'm just curious, what opportunities have you had since obtaining your anesthesia BTS that maybe you didn't have beforehand? Well, I definitely have seen a difference in
00:08:12
Speaker
The interactions between both the technicians that I work with and the doctors that I work with, I can provide them the opportunity of being a great trainer on a detailed subject. So opening up a training opportunities, providing continuing education presentations, either locally or nationally at like a conference, being able to be a part of comfort for the doctor that they can get the job done without worrying so much.
00:08:39
Speaker
So just being there as a partner with them is wonderful. I have also had the opportunity just recently, I just finished my chapter of injectable anesthetics for an upcoming textbook for future technicians.
Navigating the VTS Application Process
00:08:54
Speaker
So that was exciting for me. It's awesome. Congratulations. Yeah, absolutely. And as far as travel, I haven't had the chance to travel abroad, which sounds fantastic, but I have been traveling
00:09:07
Speaker
to and from different parts of Florida, both as in an assistant role to try and train other technicians a little further, kind of like a consult person, as well as helping with the hurricane aftermath and being a lead in the anesthesia and pain management with the doctors post-disaster. So that was exciting as well.
00:09:30
Speaker
That's awesome. So I think that's really important because I wanted to point out, at least for our listeners, that when you obtain a VTS and anesthesia, it's not just a pay raise. It actually can open up the door to obtaining new achievements in your career, which can be fulfilling in some way.
00:09:49
Speaker
So we're going to dive in now into the application process. And for this one, I think probably Melissa is going to take the lead on this because she has gone through the application process very recently. But for you, Viv, I just want you to jump in. If you have any specific questions outside of the questions that I ask, or if you are finding some problems while you're applying and you want to just point them out.
00:10:15
Speaker
please interject and do so. The other thing I want to just mention really quickly is that Viv and Melissa have never met each other before, so this is the first time that they're really interacting with one another. So I'm hoping that this interaction maybe will help you guys to find, at least for you, Viv, someone to chat with if you have any questions in the future.
00:10:33
Speaker
And then second, none of us are experts in the application process. So even though we're here to give you some tips and tricks and guidelines, I would still definitely encourage you guys to make sure that if you have any further questions or if you need any further clarification, please jump on the website for the Academy of Veterinary Technicians in Anesthesia and Analgesia.
00:11:00
Speaker
Their website is www.avtaa-vts.org. So please visit that website if you need more detailed explanation of the application process. So Melissa, my understanding is that the application process for the VTS takes place in three phases, is that correct?
00:11:24
Speaker
Yes. Okay. So the first phase is the pre-qualification phase. So for the pre-qualification phase, I think one of the questions that I get asked a lot is what type of work environment is best for this type of phase? Meaning like, should you be working in a specialty clinic? Is it okay if you're working in like a GP practice?
00:11:48
Speaker
Is it okay to work in just like a very specific specialty like dentistry, for example? What do you think is the best environment that is the most helpful towards obtaining some of these pre-qualifications? Well, one of the things that we are doing, becoming a specialist is learning about more advanced techniques. So having the opportunity to experience those different techniques is important.
00:12:15
Speaker
One would usually say that, oh, a university setting is the best because you get all these more difficult cases, the more complicated cases with the heart problems and the underlying diseases or just the more complicated surgeries themselves. But that doesn't necessarily mean that you have to start at a university. You definitely need a lot of hours in anesthesia showing that you're learning in anesthesia.
00:12:41
Speaker
But that can start at the general spays and neuters, just gaining the basic knowledge. But I think you really need to show an improvement in the types of cases, the variety of cases, the types of patients, variety of patients, showing that you are continually learning. And you can do that at a general practice. It's a little bit more challenging because they don't do the difficult cases, but there's always that case that comes through.
00:13:09
Speaker
that is just something that you can learn, like the GDV that comes in on emergency with, it's a doberman and it's got coagulopathy and oh my goodness, but learn from each and every case throughout that process, building up every time on your knowledge. I think you can have it at any place you are at. I personally enjoyed the university setting because it enabled me to work with a wide variety of doctors, anesthesiologists,
00:13:38
Speaker
and different types of cases, but I don't believe that you necessarily have to have that extreme. I think it can be done in all different types of practices.
00:13:47
Speaker
Yeah, I guess I'm going to reflect this question back to Viv because you have worked both in a specialty private practice and also for at least for a short period of time, you've been working in an academic institution. In your opinion, is there a difference between working in those two environments as far as getting your knowledge base up to snuff for the application process? Yeah, so a perspective I can offer here is that in private specialty, it's really fast paced.
00:14:16
Speaker
And you kind of already have protocols set.
00:14:19
Speaker
So you're not really getting the variation unless you are working side by side with an anesthesiologist who takes a different route as far as procedure goes. However, I've noticed in the academic setting, it is way more about the why we're using things. So I would almost say that in the short amount of time I've been in the academic setting, I have learned more about the why.
00:14:46
Speaker
That's great. So, Melissa, at least in this pre-qualification phase, and I guess by pre-qualification, we should also mention that this is before you submit the application, which includes like your case log and your skill list. Is that right? Correct. The prerequisites are one, you need to be a credentialed veterinary technician and that's different for international and different states. And all those details can be found on the website and you can ask about your specific case.
00:15:14
Speaker
but you do need to be credentialed for one and you have to be credentialed for a minimum amount of time before you can apply. You can't just graduate this year and apply next year. And that changes too. And all the details are on their website because they do change things after analyzing them year by year. So once you are credentialed, you'll have to work a specific number of hours in the industry. And then a part of those hours need to be in anesthesia only.
00:15:41
Speaker
So if you're working in a general practice where you only do two surgeries a week, that might be something you want to take a look at because you won't gather those anesthesia hours. And it is a lot of hours. When I first applied, it was only 6,000 hours. And right at the year I was going to apply, they changed it to 8,000 and I had to wait another year. So keep your eyes on the website because it does change on a yearly basis based on what they are requiring.
00:16:11
Speaker
So pre-application, make sure you're credentialed, make sure you're getting anesthesia hours as well as work-related hours and keep an eye on
Crafting Case Logs and Reports for VTS
00:16:21
Speaker
that website.
00:16:21
Speaker
So eventually once you are accepted through the pre-qualification, you'll need to acquire certain skills. And personally, one of the pitfalls that I'm sometimes seeing is that people go through the pre-application process without observing the skill list that you need to get signed off for. And then they realize kind of in hindsight that they don't have access to some of the equipment that they would need to go through the skill list.
00:16:48
Speaker
Did you ever have any issues with that, Melissa, or do you know of anybody who's had those types of issues before? I haven't known anyone that found it to be too challenging. Of course, there are specific things on the list that even I didn't have access to some of the equipment working at a university, but having a knowledge of what they are looking for is definitely something that you want to look into before you apply to make sure that you are able to get those things.
00:17:16
Speaker
And it doesn't have to be at one place. You're allowed to do two different places. So if you want to pick up some of the skills in a specialty hospital, but you really love GP, you can maybe do a few days at the specialty hospital knowing that they can provide that equipment and learn those skills. It doesn't all have to be in one practice, but the knowledge of what you're going to need to know ahead of time before you even apply is a great idea.
00:17:44
Speaker
And they do have all of those forms on their website. So you can take a look at the skills list and see, you know, have I used invasive blood pressure? Can I do that where I work? Where's another place I could work a few days a week or a few days a month so I can learn that skill and have that person sign off on it. So it could be detrimental if you do the process and then get there. I don't know anybody personally who has gotten there and said, that's it. I can't do it.
00:18:12
Speaker
But even looking at it now and knowing what to look forward to is a good idea. So I'm going to turn this question to Viv because I was very impressed when you, this was a while ago, but you presented to me with your pre-application and was very impressed with how organized you were. So do you want to just very quickly go through what your organization phase was like when you were prepping, even for the pre-application phase?
00:18:37
Speaker
So I was pretty much living on the website, just going through all of the pre-qualifications of what the website just mentioned and downloading all of the forms. I even printed out a bunch of case log examples.
00:18:53
Speaker
And then I kind of just went with the binder system. And as I was looking through the skills, I just kept in mind that it was 90% mastery. So kind of highlighting the ones that I thought that I might run into problems with.
00:19:10
Speaker
And ignoring the ones I knew I would have no problem with. That's kind of how I began things. And then I knew the first couple of things you have to pull the trigger on. So that's what I put like in the front of my binder. And so those are just like small things that I did to try to keep myself organized right away. Great. Melissa, do you have any input on how to stay organized through this application process?
00:19:37
Speaker
I agree with Viv, a binder, a very big binder with lots of tabs and keeping something at the front of my binder with a list of where I wanted my focus. And I did it week by week. And I said, this is my focus for the week. Cause then you can take that huge chunk and just get it into smaller pieces and you get the sense of accomplishment. You don't get overwhelmed by everything you need to do. You're just like, yup, got that done. I'm moving on to the next.
00:20:06
Speaker
Details are key. Everything that you write down, write a date, write a patient name next to it so that when you go back to look at it and you're like, oh my gosh, I forgot when I used this medication, everything's right there. So we're detail oriented in the first place in anesthesia. We have to be very precise. Don't let it slack during this process. You have to put all the details down so it's easy to go back and see what you did.
00:20:34
Speaker
So do you guys feel that when you are going through the application phase, that it's better to work with a diplomat in anesthesia or VTS? Because it really does give you the option of either or. And what do you guys think is better or is it nice to work with like both a VTS and a diplomat? You know, what are kind of the advantages and disadvantages of that?
00:21:00
Speaker
I was, of course, very, very grateful that I had six anesthesiologists that I've worked with as well as two VTS. And I think a well-rounded mentor learning situation is very important because everyone is going to view the patient just a little bit differently, meaning that you won't get into that streamlined, this is the protocol for this cardiac patient.
00:21:28
Speaker
you get to learn a variety. And I think doing that with both an anesthesiologist and a VTS gives you different ways of thinking about them as to how they would handle it. And they'll teach you differently as to why they think that way as well. So I like having one of each, more of each, if you can have them so that you can learn more different ways to do it. What about you, Viv?
00:21:50
Speaker
I don't think I could say it any better because it's a vast difference between both the tech side and the doctor side. It's just everybody does something so differently and having one of each gives you the well-rounded perspective that you need.
00:22:06
Speaker
Okay. So let's move on. So let's say your pre-application was approved and you're ready to start with the application phase. So I'm going to start with the case log because I feel like that is where a lot of people get bogged down by the case log. Listen, do you want to go through like what?
00:22:25
Speaker
exactly are the details that are needed in the case log, and maybe also we can start jumping into some pitfalls that you have found people have gotten into when they've started their case logs, and that way they can avoid those mistakes. Well, the first and foremost thing is to just always keep on that website. Currently, there are case logs and case reports, so two different things. The case logs are to represent your skills.
00:22:53
Speaker
So each case log is going to be representative of one or more of the skills on your skill list. So it's a document that demonstrates your advanced knowledge of that skill. So you're not going to just say, Hey, you know, I used isoflurane and they went to sleep. You can't say that you're going to say this happened and these were the vitals I'm seeing, which is what I'm used to.
00:23:19
Speaker
seeing with this because it is this type of effect on the heart and the respiratory systems. I don't want to give you answers because you got to do this yourself. But it's that. It's explaining that this patient needed this because and this is what happened. So you have to show that critical thinking process and the how, the why, the when, and the what happened after. So our case logs are very detailed.
00:23:46
Speaker
They're very short, precise, and to the point. What are some pitfalls you've found from other people maybe you've spoken to or maybe you experience these yourselves when filling out the case logs and the skill list? The pitfalls are that what you think in your brain may not be what the person is reading. It is trying to explain to somebody what your thoughts and processes are as if they don't know anything, if that makes any sense.
00:24:13
Speaker
Yeah, that makes sense. You're trying to explain it. You have to pretend that the person you're communicating to doesn't know anything about anesthesia. Is that right? Exactly. So you can't forget the small details. You have to put them in there. I like to look at it as if I was training somebody on that specific skill. I don't want to skip a thing. So that was important to just not jay, oh, isoflorine made them sleep. It's not going to pass.
00:24:42
Speaker
Right. Another pitfall that I found was trying to put too much in a case log. Because of the number of case logs and the number of skills, you might need to combine two things. Because it was an interesting part of the case itself doesn't necessarily mean it needs to go in the case log. Remember that you are only showing skills, not that it was a cute dog with this cute, cool little tattoo on its eye or something like that. It has to be very streamlined.
00:25:09
Speaker
Right. Well, like another example I can think of Melissa would be like, let's say the scale you're trying to demonstrate, it was a pheochromocytoma case. It was an adrenalectomy and you place arterial blood pressure because you want to monitor very closely blood pressure throughout that procedure, given that it's a tumor that could potentially cause alterations in blood pressure very quickly.
00:25:32
Speaker
So that would be the example of the skill. And then let's just say, for argument's sake, that the dog got hypoxemic during the procedure additionally. In that case log, you're not going to focus necessarily on the hypoxemia, even though it was a very exciting thing that happened to this dog and such. You're going to focus on why you placed the arterial blood pressure. Is that kind of what you're saying? Correct. You're never going to have enough room to do two. If you're going to combine two, I might do the arterial line and the temperature probe.
00:26:02
Speaker
I can talk about temperature in five words or less probably. So if you're going to combine skills, try and think of not too advanced skills, do the basic skill with an advanced skill. If you want to combine stuff, that might help, but yeah, hypoxemia and arterial lines too much for one little case slug.
00:26:21
Speaker
Gotcha. So then maybe if you're lacking on a case where you're dealing with hypoxemia, maybe instead you would shift gears and talk about oxygen monitoring for that patient, then pick a different patient for arterial blood pressure. Absolutely. And you don't know what's going to come. So you may think this is the great one for hypoxemia, and then you get another case that was even more interesting. You're like, oh, this is a better case.
00:26:48
Speaker
And that's why I say keep the patient numbers and IDs next to your checklist because then you're like, I'm going to do this one for hypoxemia. What else can I use from that patient for a different skill? And that would be the art line. Gotcha. Let's talk about large animal versus small animal because this is a question that I oftentimes get asked a lot when people are asking me about this process.
00:27:11
Speaker
Many people I know, at least just because of the nature of my job, they work in like a small animal private practice or specialty area. And they're very nervous about getting large animal experience. So, I mean, you guys both work in academia where you see both, but how much, at least when you're writing down your skill lists and things like that, how much needs to be small versus large? Is there tracking? Do you have to get certain large animal skills? Why don't you, Melissa, just touch base on that really quick.
00:27:40
Speaker
The skills list is available online, so this is nothing that's new, but there are two separate skills lists. There's the small animal skills list and the large animal skills list. And I'll be honest with you, I never even opened the large animal skills list because that was not my route. You can choose small or large animal and you have those specific skills in that segment.
00:28:04
Speaker
But on the small animal side, you'll see that there are the core skills and then supplemental skills. The supplemental skills list, there are several options of working with different species, whether it be exotic or large animal. It's not a required skill, it's supplemental. So if you don't touch exotics, if you don't touch large animal, those are just three or four skills that you're not going to check off and you can choose to do something else instead.
00:28:33
Speaker
So it's not necessary for small animal VTS to even touch a large animal or an exotic, but it will check off some of your supplemental skills if you do have the opportunity to work with them. And then another pitfall I have seen has to do with kind of making sure you get a good variety of different ASA statuses. So do you want to touch base on that really quick, Melissa? Absolutely. The requirements for most of the case logs are ASA 3 and higher, and that shows that we are
00:29:03
Speaker
dealing with complicated cases. So if you're in a practice that only has ASA 1s and 2s, you may want to reconsider taking on that extra position or even changing workplaces because you do definitely need more complicated cases to represent a more advanced skill in anesthesia. So you do need to have the majority of your cases at a higher ASA grading.
00:29:29
Speaker
Babe, do you have any additional questions about the application process? Where I get lost is after you're accepted and then choosing a mentor. In your opinion, was it more sought after to have a mentor that you didn't work with versus a mentor that you would work with? There are different ways that you can approach the mentorship and that's going to be your personal preference. I was very fortunate to have a wide variety of anesthesiologists to choose from.
00:29:58
Speaker
And I had the opportunity to choose the specific ones that I felt I'd learned best from. So that was important to me because I'm the type of person that likes that one-on-one relationship where I can be as open as I can be without them being offended. So that was important for me to have a mentor that I had already known. But they do offer, if you don't have someone like that or you are the type of person that wants to learn from someone else through the process,
00:30:25
Speaker
Then you can actually get a mentor from the AVTAA as well. They'll, they'll pair you up with someone. For me, that didn't work out and it was just a personal preference. Cause there's another part of the application phase, unless they got rid of it is the case reports. Oh yeah. Let's talk about the case reports. Again, I'm not sure if they'll be changing it or not, but when I went through it, we had to have case reports as well.
00:30:52
Speaker
So the case logs were short and to the point, and they represented one specific skill. The case logs were you thinking about the entire process from pre, peri, and post anesthetic viewpoints, knowing what the patient presented with, how you assessed it, how you developed your protocol, how you handled the procedure with the anesthesia, and what your plans were to take care of them post. And those are pretty lengthy.
00:31:19
Speaker
And those were the most time consuming for me to make sure that they were as accurate as possible, detailing what was in my head. Again, talking to them as if they were new to the game or they didn't know much about anesthesia, being able to say, this type of drug did this because it works on these receptors. That was so important to that patient. You can't do that in the case logs. The case report is that ability to present something on a larger scale.
00:31:48
Speaker
extremely detailed how the different systems are working with each other, what's affecting what, how you're correcting it. So the case reports, if they're still part of the application process, which I think they are, are very important as well. So you'll have those four crazy cases. They challenged you mentally. They made you think on your feet about 10 different things. And this is how you got through
Preparing for the VTS Examination
00:32:14
Speaker
it. And then you're going to look at those cases
00:32:17
Speaker
and say, this is what I learned. This is what I didn't know. And then I went to learn. This is where I needed to ask for help. So you're not saying in these reports that you're the anesthesia goddess. You're saying this was an intense case and this is my critical thinking around it. Yeah. So how many case reports do you need? There were four when I went for my application. I'm not sure what they need now. So what were some examples of some cases that made you feel like this is the type of case that I need to include in my case report?
00:32:46
Speaker
You want to come at it from different angles. You don't want all of them to be laparoscopic procedures, because that's not showing a wide variety. I had an extra hepatic portosystemic shunt that had two vena cavas. So a bifurcated vena cava going into the liver. So that was interesting. And that one had a lot of problems with blood pressure, obviously. And he also had some coagulopathies that happened.
00:33:13
Speaker
The other one I had was a tracheal stent that was just problematic upon placement. And we used a wide variety of ventilation techniques on him. So we used high flow oxygen. We used flow by, we did Tiva, of course. And if you're not familiar with those terms, get into anesthesia and you'll find out. So, you know, that was just totally different. So as I went to the respiratory aspect and I showed all of my
00:33:42
Speaker
respiratory skills and he did become hypoxemic. And we did actually push emergency drugs very close to CPR. So it got that involved into it. So I focused on two different things. There were two more and they're not coming to mind right now. I would be able to have to look him up to be able to talk about him. But those are the two that stood out in my mind.
00:34:01
Speaker
And I was like, this is a case where I could go on and on for days. I like the idea of picking a different system focus. I mean, obviously you can have multiple systems, but I do like the idea of having like a respiratory case or challenging respiratory case. Obviously other things might be going on. And then thinking of like a challenging cardiovascular case.
00:34:20
Speaker
whether that's an actual cardiac procedure or just a challenging blood pressure management case, like a septic case, something like that. So I do like that idea, just keeping those in mind. Where I think of a population of individuals that might be kind of at a disadvantage is actually, I work with a lot of dentistry specialty clinics.
00:34:41
Speaker
And dentistry goes hand in hand with anesthesia. And so I know a lot of people who work in dentistry clinics that are extremely interested in getting specialized anesthesia because it's literally what they do day in and day out. And so I don't know, Melissa, if you have any advice for people who maybe aren't seeing that kind of like array of cases, meaning like they're doing mostly dental work, but they might be seeing animals with a wide variety of different underlying diseases that they have to manage under anesthesia.
00:35:11
Speaker
So I don't know if you think those population people can still kind of write good case reports or if you would still encourage them to kind of seek alternative education maybe somewhere else. I think they can still have the variety as long as their physicians are letting them do those cases. I know a few people that work in dentistry only positions and if they get a cardiac patient they say no way I'm not doing it. I'm going to send it to the university or a specialty place.
00:35:40
Speaker
instead of maybe having someone like yourself, an anesthesiologist come in and work with them through that difficult case. So I think it depends on the practice and what you're allowed to do. And people that want to get away from that streamlined protocol, where every patient gets Torb, Mendaz, and propofol, you have to have a doctor that's willing to say, we're going to use this drug so that you can have that opportunity to have the differences.
00:36:07
Speaker
be okay with taking on those challenging cases. So you can talk about those cardio respiratory compromised cases. So I think it all depends on where you work. Yeah. I also just had a thought. Let's say you're in like the pre-application phase and you see like a really cool case and that's like before you even get approved to send in the application. Can you use cases from before you were in your application phase, if they're like interesting in some way?
00:36:35
Speaker
Unfortunately, no, they will give you a timeline when those cases can occur. Okay. Do you have any questions, Viv, about specifically case logs or case reports or anything like that? The only question I thought of was for your case reports, is this you choosing four case logs or do they overlap at all or that you are? Okay. Yeah. The four case reports were case logs that I used for skills and then I just expanded upon them. Great. Thank you.
00:37:05
Speaker
Okay, so now let's jump to the examination phase. So let's say you were approved through your application process, your case reports, your case skills, your case logs all got approved and you're ready to sit for the examination. Melissa, what are some of the best resources you found for studying for the examination? One was a partner. I found a partner who was actually in England and we hooked up just
00:37:33
Speaker
because we saw each other on the Facebook chat group and we started just sending each other questions. But that's my personality. So I like to have one person that I can just go back and forth with asking questions, kind of like a study partner, but they do give you a reading list. The reading list is going to be overwhelming and extensive because we do have to look at a lot of different aspects.
00:37:59
Speaker
The ones that I found most helpful to me were the ones that did the question and answer format, and that's how I learned. I can't just read a chapter and retain everything. I want the what and the why. So there are several on the reading list that I really enjoyed. The one that I found most helpful, and this was on their recommended reading list, was Questions and Answers in Small Animal Anesthesia by Leslie Smith.
00:38:26
Speaker
And again, it's because I like question and answer format. It's just my style. What else I found helpful was some of the other things on the reading list. I actually made my own question and answer format for when I train people. Look at that. So when I train people, I like to ask them questions and I have a lot of people that like the question and answer format. So I found it helpful when I was reading a chapter to write questions and answers. It's a large chunk of information.
00:38:56
Speaker
You have about six months. You should be studying as you go, of course, but there's a six month period ish between when you find out you get to take the exam and when you take the exam. That's a lot of information. So I took a few exams, mock exams that were provided to me by my mentor and found out where my struggles were. And I focused on those. I didn't find it necessary to study what I already felt comfortable in.
00:39:24
Speaker
And I broke it down week by week. This is what I'm going to study this week.
00:39:29
Speaker
And that helped. I would totally echo what Melissa said. There's a lot of overlap when I was like studying for boards for my diplomat status, as opposed to like what Melissa is talking about. There's a ton of overlap. And I think the two biggest things that helped me the most was one, I made a study group and we met once a week, we would go through a list of questions. One of us was responsible for providing everybody and we would go through the questions and we'd answer them together as a group.
00:39:58
Speaker
And that was super duper helpful and also helped me to stay on track with my studying because for me, the second most important thing was to have a study schedule that was broken down by week. And I would write down even what chapters of which books I was going to be reading that week. And I would stick to it.
00:40:18
Speaker
Even if I didn't get through all of the reading for that week, I would just move on to whatever I needed the next week and just started reading there. And that's how I got through it. And I don't know if that's what you did, Melissa. Yeah, I had to because it's so easy to go down a rabbit hole and then you're like, Oh, I wasted an hour trying to figure this out. And that's not what I need to do.
00:40:39
Speaker
Yeah, the rabbit hole is a big one. You can very easily like read something and then be like, oh, I'm just curious. I need to know more information about that. I would just jump to different books.
00:40:51
Speaker
And I would get lost in rabbit holes. So having a very detailed schedule that you stick to. And my last one is like, you're not intended to be a master of everything. You need to have a general knowledge of many things. So sitting there becoming an expert with studying is, I guess because I'm a perfectionist and probably many of us are detailed oriented perfectionists. And so you want to be like,
00:41:21
Speaker
the most knowledgeable individual about ketamine, for example. But that is impossible. That is a goal you cannot get to in the timeframe you have. So, like, stick to your study schedule. Would you agree with that, Melissa? Absolutely. Do you have any questions, Viv, about the examination process at all? No, I guess I'm just ignoring the examination process until I get through the application process.
00:41:48
Speaker
Let's say you are like on a small animal track. Do you take like a small animal exam or are there some large animal questions thrown in there? It's different every year. When I took it, there were a few things that I just needed to know generalized for like some exotics and stuff. I don't particularly remember a large animal, but it was an intense day of examination. So I'm sure I probably blocked a little bit from my memory, but they weren't the majority.
00:42:16
Speaker
So if you knew that question, great. If you didn't know large animal, it wasn't going to have you fail your test, but it might be that bonus question that you got because you knew that information. But honestly, I don't remember the details. Yeah. And I should have probably asked this question ahead of time, but what does the examination actually look like? Is it a single day of examining? Is it like three days? What does it look like? The exam process when I took it was a morning of.
00:42:45
Speaker
testing based on clinical competency. Then we got a lunch break and then I had the multiple choice questions afterwards. So you have two different styles of testing. So if you feel like you're better at explaining things in like an essay or a short answer format, kudos. But if you feel like you're good at multiple choice, they also have that for you, but you do have to take both. So it's one big full day.
00:43:13
Speaker
And I was under the impression they're like, Oh yeah, you can take up to four hours to take this and then take a lunch and up to four hours. And I'm like, Oh, I'll be out of there in an hour. Nope. I definitely took every single minute they offered and I made sure I was as detailed as possible, putting down as much information as possible. Cause I didn't want to just shortchange myself. So the clinical competency is an, is an essay exam essentially.
00:43:39
Speaker
or short answer, whatever you want to call it. It's not necessarily writing 2000 words on one subject, but you do have to explain yourself in a written way. Again, as you're talking to somebody who doesn't do it on a regular. So it's kind of a repeat of those case blogs and case reports that are training you for those clinical answers. Is it done on a computer or do you have to handwrite it? Oh no. Oh gosh, I would have failed if it was handwritten. It is done on a computer. Traditionally,
00:44:09
Speaker
It was that you traveled to the IVEX conference and took it there. Last year, fortunately, was the first year that you could be proctored. So I actually took my exam at the University of Florida with a proctor, and then I didn't have the stress of, is my flight going to make it on time? Do I have to get a hotel? Can I sleep in the hotel because I'm traveling?
00:44:31
Speaker
So they did offer that last year and I thought that was much easier for me to focus on the test and not have to worry about traveling on top of it. Yeah. When I took, this might be aging me, but when I took my board's exam, it was all handwritten. It was awful. I had to write for four hours straight.
Conclusion and Resources
00:44:51
Speaker
That was terrible. Oh my gosh, that's terrible.
00:44:54
Speaker
Thank you guys so much for coming on and having this discussion today about your personal journeys to obtaining your VTS in anesthesia for you, Melissa. If anybody is interested in asking you any additional questions or anything like that, is there a way people can find you? Absolutely. I am more than happy to have anyone email me with any questions.
00:45:21
Speaker
My email is missy, M-I-S-S-I-E, V is in Victor, C is in Charlie, 13, the number 13, at gmail.com. So missyvc13 at gmail.com. Thank you so much, again, to you, Viv, and to you, Melissa, for this roundtable discussion. Thank you. Thanks so much.
00:45:52
Speaker
For the purpose of this episode, we reached out to the ABTAA representative for NAVAS, who wanted us to clarify one point. On the question of when you can start collecting cases for your case log and case reports, cases are used from January 1st of the year you apply. So even if an applicant is still waiting to hear on the status or acceptance of their pre-application,
00:46:17
Speaker
they can still use cases from January 1st to December 31st of the application year.
00:46:25
Speaker
One more point that I still need to clarify is on the topic of applicants shadowing at practices outside their primary place of employment to obtain cases for either their case log or case reports. According to a representative from the ABTAA, for cases and skills to be used in the application, the applicant must be employed by the overseeing party providing service.
00:46:52
Speaker
Hours have to be verified by an employer, and cases must be associated with places of employment, not through volunteer or observational activities.
00:47:06
Speaker
If you like what you heard today, I encourage you to check out NavAss and consider becoming a member. As a member of the North American Veterinary Anesthesia Society, you get tons of benefits, including access to CE events, focusing on anesthesia and pain management, blog posts, fireside chats with boarded anesthesiologists, as well as specialty technicians, and just so much more.
00:47:29
Speaker
visit www.mynavas.org to advance your anesthesia journey today. If you have any questions about this week's episode or the Navas Podcast in general, or if you want to suggest topics you would like for us to discuss in future episodes, please reach out to us at education at mynavas.org.
00:47:53
Speaker
We would love to hear from all of you. Also a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. Visit their website, www.decra-us.com to learn more about their line of veterinary anesthesia products.
00:48:11
Speaker
As we alluded to in this episode, if you want to learn more about obtaining a BTS in anesthesia, I strongly encourage you to visit the website of the Academy of Veterinary Technicians in Anesthesia and Analgesia at www.avta-vts.org, which provides tons of resources to prospective applicants.
00:48:38
Speaker
I want to again thank our two guests, Vivian Montany and Melissa Clark, for their insightful discussion into the VTS application process. And a huge thank you to all the GAS pastors out there who choose to spend their time with me today on the NavS podcast. Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future. Until next time, I'm your host, Dr. Bonnie Gatson, and thank you for listening.