I have been focusing this column on the culture of making mistakes and how we deal with them. One of the biggest problems with making “mistakes” is recognising when one has been made, and, unfortunately, this sometimes comes about due to over-reliance of old thought processes and outdated knowledge.
For this reason (and many others), The RCVS has set a minimum expectation of 105 hours of CPD over each three-year period of your career. For some, this may seem like a lot, but what I wanted to discuss in this article was why, and how, CPD can be crucial in maintaining motivation.
The abundance of dopamine
It is nothing new to say, as vets, we have very high expectations of ourselves. The route into and through veterinary school is tough and arduous requiring an ability to jump hurdle after hurdle. This continuous challenge and reward cycle becomes an integral part of our daily life for a long period of time. My most recent audiobook adventure has been Leaders Eat Last by Simon Sinek. The book focuses around the natural hormonal responses to daily challenges in our life. Sinek focuses on four major hormones:
- endorphins
- dopamine
- serotonin
- oxytocin
He touches on the importance of balancing these hormones, and how often it appears the millennial generation has developed an over-reliance on dopamine and its challenge-reward feedback system in the body, based on the over-praising upbringing a lot of us have had. Hopefully, you can see where I am going with this. I believe vets are overtly dopamine driven and dependent. Our emotion is highly linked to our clinical competence. We find cases frustrating when we don’t get an answer and relish in the cases where we do get the chance to make a patient better.
Dopamine isn’t a bad hormone and I think it gets a bad rep. Yes, we are often addicted to dopamine because of how it makes us feel, but surely worse things to be addicted to exist than challenging yourself (yes, I know, I’m sure that’s what an addict would say). In some instances, that drive to challenge yourself and learn new information can lead to improved patient care. This is where I think one of the major benefits of CPD comes in.
Often, CPD will allow you to push out of your comfort zone, into your learning zone and keeps you in a safe environment, away from the panic zone. As an example, let’s focus on one of the most commonly disliked areas of small animal general practice and how using CPD can optimise your body’s homeostatic response systems.
Dentistry: not always a toothache
We’ve all been there – it’s late in the day, you’ve been doing a cat dental for what seems like a lifetime – and you’ve got loads more teeth to come out. In your frustration, you apply just that little extra pressure and you feel that awful sensation of snapping a root – enough to make anyone (especially me) cry.
I’m not saying if you go on a dental CPD course, suddenly it will all become butterflies and rainbows, and you’ll never have a difficult dental again. What I am saying, however, is if you take this area of discomfort and spend some time trying to learn more about it, you will probably find life gets that little bit easier.
“But dentistry is all practical” you say. Well, it’s not. I’m not here to say it isn’t an incredibly practical sector of veterinary medicine, but you can still improve on your bitch spays without doing bitch spays, so why would dentistry be any different?
So, how do you go about getting better? All practical CPD courses are expensive, and rightly so. Specialists in their field will give you their time and resources to help guide you in a small group environment. However, many other ways to get better exist, which won’t break the bank as much. As an example, the BSAVA has released an updated dentistry manual (BSAVA Manual of Canine and Feline Dentistry and Oral Surgery; 4th edn), which is a fantastic resource for independent learning.
I will happily admit my biggest improvement in dentistry technique has come with repeated practice, but learning about and applying dental radiography to my patients has been incredible in reducing stress. I cannot imagine doing a cat dental without dental radiography – it just makes no sense why anyone would do that to themselves.
Plenty of resources can be found online and in the BSAVA manual about dental radiography acquisition and interpretation, and all it takes is some time to read through. Time is precious, but a little investment now will pay dividends when you’re not crying every day in a sea of resorbing teeth roots.
For those of you who are poor responders to visual and reading methods of learning, other options are available. Remember pre-clinical veterinary school? Remember the amount of teaching via dissections? Why would now be any different.
One of the most helpful ways of improving your dentistry would be to source a cadaver (many local shelters will let you do this if you pay for disposal/cremation) and to spend an afternoon working your way around every tooth in the mouth. Never done an open extraction before? No problem, the cadaver will be a great model for you. Ever been unsure how much bone you can burr away before the mandible fractures? No problem, the cadaver will be a great model for you.
I’m not suggesting in any way this replaces structured CPD with a specialist, but it is a fairly decent halfway house, and I am sure you will get a nice shot of dopamine when you’ve finished. Even better, share that knowledge and experience with your colleagues and help them feel better about dentals, too.
Oh, oh oxytocin
Oxytocin is released in a whole variety of situations, some of which are, somewhat, out of the scope of this article…
However, small-group CPD is a fantastic way of reinforcing learning because you are surrounded by like-minded people. Bonding over the challenges faced during CPD can help release the feel-good chemical oxytocin and it can help draw us away from an over-dependence on dopamine.
No one goes to CPD to show off what they know, they have gone because, like you, they want to improve. Sharing experiences and learning from each other is great, and helps shift some of the balance away from dopamine and the challenge-reward cycle. Again, I’m not trying to say dopamine is all bad, but getting some of the other hormones to do their job may help in the more long-term job satisfaction.
I mentioned earlier in this series I had started my CertAVP with the University of Liverpool. I can confidently say one of the highlights of the past two modules has been the focus on group discussion. Certificates provide an environment full of like-minded people who want to improve themselves and purely by being surrounded by those people, your drive to improve will, y’know, improve. The same could be said for a lot of the online CPD I have done – not only does online CPD have the benefit of being a “pick-up-and-play” model where you can press pause, but it can stimulate discussion. I can’t emphasise enough the importance of discussion. Why?
No one knows everything. When you first graduate, you know a little about a lot. As a small animal practitioner, I quickly, almost entirely, forgot my knowledge of farm and equine medicine, but what I replaced that with was more knowledge about small animals – I knew a bit more about a bit less.
As a result, there will always be areas where other people can add something to the table of discussion. Group learning provides this environment, and even if you don’t agree with something someone has said, the act of discussion will help you form stronger neurological connections and you are more likely to remember the points you are discussing.
As I mentioned in a previous article (VT49.18), my practice has just started doing ward rounds. One of the most important parts of ward rounds is discussing anaesthesia. Hands up who knows anaesthesia better than the nurses in their practice? I am guessing not many people could honestly say they do in general practice. We should celebrate the knowledge other people have to offer, encourage sharing of expertise and thrive in an environment that supports continued learning.
Again, practice makes perfect, so having one of our nurses re-explain capnography traces, and how they use it each time they do an anaesthetic, was a great learning experience for all. It prompted discussion, created points for action and I am more likely to remember the information in future. Remember, clinical discussion meetings can be classified as CPD on your professional development record.
Keeping motivated
Everyone knows setting and achieving goals can be incredibly motivating. I believe relying on the dopamine-driven challenge-reward cycle, as well as oxytocin and establishing a supportive group environment, can help keep us motivated through our daily challenges as vets. I do appreciate not everyone wants their work to be as all-encompassing as I am suggesting and that is absolutely okay. I also appreciate some people thrive on being challenged and that is why I am suggesting you use your CPD to challenge yourself and keep motivated.
I have probably slaughtered the key points raised in Sinek’s book, and may have misinterpreted some basic endocrinology (who actually understands endocrinology?), so I would encourage you to read it for yourself. That being said, if I could summarise this entire article in two points it would be the following:
- Dopamine is a powerful driver to embrace challenges. Use it to push yourself, but appreciate we can become over-reliant on the feel-good chemical.
- Oxytocin can also help keep us motivated and is released when we are in a supportive group environment. Independent learning has its place, but try to focus your CPD on sharing experiences and learning from each other – you will feel better for it.
That’s all folks
If at any point you have a question, or want to discuss a topic from Practice Makes Perfect, please feel free to drop me an email at dbeeston2@rvc.ac.uk and I will try get back to you ASAP. Until next time, take care.