Evidence Based Medicine

What is Evidence Based Medicine (EBM)?

ferret-46650_1280It is an applied aspect of clinical epidemiology…??? What that means is that the practice of medicine should be based on valid, clinically relevant research data whenever possible.

The way I like to think of EBM, and why I think it is relevant to my veterinary practice, is that it is a tool to improve my medicine.  There is a variety of information “out there” and we need to rank its usefulness.  Basically, as Dr. McKenzie described it, EMB creates a pyramid of data with super-duper extensive reviews of all the data on the planet at the top…and what is affectionately known as “In My Experience” at the bottom.

Great!  That Makes Everything Easier Right?

Nope!

Human medicine has oodles of data and studies and reviews of studies and compilations of reviews of studies available to sort through.  Veterinary medicine has not so much.
Exotic veterinary medicine has way less.

Well, How Does EBM Help Then?sneaker

Data has to come from somewhere.  It may well start with an “In My Experience” which turns into a case report or a case series.  Then someone tries to get more information through a study (double blinded is the best!).
Eventually we’ll have enough studies to be able to summarize the data in a great big review.

But until then, EMB reminds us to critically evaluate where our information comes from, not to discard the lower levels but understand they are incomplete.

For more information, check out the Evidence Based Veterinary Medical Association.

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Learning More and Giving Back

Looking Back…

I wrote this post a few weeks ago but I wasn’t able to find the time to finish and get it online.  It’s still relevant, especially as I am planning on going to another conference in just a few weeks.  This time I’ll be learning instead of teaching.Calendar

From October 1st:
Supporting the Veterinary Community

I’m a little nervous because this weekend I’m going to speak to a whole bunch of undergraduate students – it’s a pre-health conference at UC Davis. I haven’t ever done this type of talk before.  UC Davis is hosting a very large group of speakers to talk about the various health careers.  Check out the exotics speakers they have at their blog: http://ucdprehealthvet.weebly.com/avianexotic

But I’m going there because I feel it’s important to give back.LEcture Hall

Giving back, in this instance, is trying to help undergraduates make the right decision about their future.  I hope that I can share what it is really like to be a veterinarian who works with these fun and difficult creatures…the exotics. More commonly I, and my associate, like to provide support by hosting veterinary students.  It’s really important to provide real world experience and to give them a chance to get a good idea of what private practice is all about.  Providing personal mentorship, even for just a few weeks, is an invaluable opportunity for these proto-vets.

It’s also very important to support our support staff – veterinary technicians.  Many students have had rotations at our hospital that have hopefully taught them skills not available in school.

Other ways that vets help each other out is by lecturing at conferences and small meetings or by teaching classes to tech students or vet students.  I found it both fun and nerve wracking to get up in front of peers and colleagues every time I have done it.  I am amazed at veterinarians in private practice who are able to do research or publish papers – how do they find the time!

Learning More

The flip side is being the individual on the receiving end.  I am immensely grateful to my professors and private clinicians who took me under their wings.  They gave me insight into things that aren’t taught in school such as how to talk to clients or discussing difficult cases.

Of course we go to conferences.  Besides the fact that continuing education is a requirement, conferences are how we all try to stay on top of changing information.  New treatments, new tests and sometimes results that tell us “whoops, that doesn’t work”.  In the exotics field we have to work to stay on top of what’s out there.  Networking with colleagues is a great way to talk with veterinarians who think differently.

I’m looking forward to an upcoming conference for specialists – the ABVP (or American Board of Veterinary Practitioners).  Of course I’ll be spending most of my time in talks about birds, rabbits, rodents and reptiles but outside of those talks I’ll be rubbing elbows with all sorts of specialists.  The ABVP covers species specialists including cats, dogs, horses, pigs, cows…they have 11 different categories.Meeting

I don’t really know how much I’ll learn by talking to a dairy specialist at lunch – who knows?  It is always worthwhile to spend time with the veterinarians who have worked hard to gain as much expertise as they can in their field. Here’s an older post on what all those veterinary degrees mean.

I can’t wait to bring some nugget back to Bay Area Bird Hospital and use it!

Veterinary Credentials – What Do All Those Letters Mean Anyway?

The Basics

Most Veterinarians in the USA have completed an undergraduate degree at a University or College before entering veterinary school.  Veterinary school itself is a 4-year program that includes 9-12 months of clinical rotations (or spending time with doctors and patients).  Upon graduation, a veterinarian receives either a DVM or a VMD.
VetCadducus

DVM = Doctor of Veterinary Medicine (most veterinarians in the US are DVMs)

VMD = Veterinary Medical Doctorate (this is the same degree as a DVM but it means the veterinarian in question graduated from the University of Pennsylvania)

More Letters…

Veterinarians don’t need any more letters to practice medicine.  More letters means more degrees and more study.   Some veterinarians choose to do scientific research and may be granted an MS (Master of Science) or PhD (doctorate).  Or they may be certified by a specialty board and become a “Diplomate” of that board.

Veterinary Technicians

VetTech1
Even our assistants can get in on the action – Registered Veterinary Technicians (RVT) or Certified Veterinary Technicians (CVT) have completed extra schooling and passed their own examinations.  In California, only individuals with letters after their names can be called techs or technicians.

The ABVP

The American Board of Veterinary Practitioners certifies veterinarians in species specialties such as Avian (birds), Exotic Companion Mammal (rabbits, ferrets, guinea pigs…) or Reptile/Amphibian (snakes, turtles, lizards…).  As of January 2013 there are 739 diplomates of the ABVP.  Of those, 114 certified in Avian medicine.  In the state of California there are only 22 Avian diplomates (as of February 2014).

American Board of Veterinary Practitioners
Other ways to say “Diplomate of the American Board of Veterinary Practitioners, Avian Practice” include: Dip ABVP, Avian Practice and DABVP (Avian).

How Does One Become Certified with the ABVP?

Before your veterinarian can apply, he or she has to have been in practice for a minimum of 6 years or have completed a 2 to 3 year residency. They have to have graduated from an AVMA-accredited veterinary college, have a minimum of 90 hours continuing education in the previous 5 years, see enough of the species (such as birds) each week to have gained experience, obtain 3 letters of recommendation from other boarded specialists and write 2 case reports.

Case reports are not simple write ups of some event.  They are in depth investigations into the current understanding of the disease in question, the methods of diagnosis, the available treatments and the likely outcome.  If the papers are deemed acceptable by the ABVP, the veterinarian in question must then study in order to pass a difficult 2 day written and practical examination.  It doesn’t end there – diplomates must maintain their certification and renew it every 10 years!

Other Specialists

There are many other specialists, aside from species specific ones, including anesthesiologists, dentists, cardiologists, behaviorists, zoo veterinarians and more.  In veterinary medicine only veterinarians who have been certified by a board or college may call themselves specialists!

For more information, take a look at the AVMA’s website.