Oct. 31, 2023

#105: Work hard, play hard, be kind. (And think twice before you prescribe antibiotics!) With Dr Jane Heller.

#105: Work hard, play hard, be kind. (And think twice before you prescribe antibiotics!) With Dr Jane Heller.
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Season 1

Dr Jane Heller is the epitome of a mutlti-faceted vet career: she’s a Veterinary Epidemiologist with an interest is in infectious disease epidemiology, with particular reference to antimicrobial resistance and the potential for zoonotic transfer of pathogens between animals and humans. Her career has included a stint in private practice and at the University of Sydney, specialist training in Veterinary Epidemiology and Public Health through a PhD and a residency at the University of Glasgow, and a faculty position at Charles Sturt University as an Associate Professor in Veterinary Epidemiology and Public Health. In addition to her teaching, writing and research Jane also implemented a wellness program for the undergraduate veterinary students and has a deep interest in supporting student and veterinary mental health. Outside of her role at the university she is also the founder and director of Heller Consulting - her private consulting business where she gets to utilise her wide range of skills for the benefit of animals and humans. 

 

In this conversation we cover what a career as an epidemiologist could look like (not as boring as you might think!), and Jane tells us about the work of the AMR Vet Collective - a non-for profit that informs and educates around responsible antibiotic usage, including sharing resources to help you achieve better antimicrobial stewardship without making your work life harder or compromising outcomes for your patients. We discuss how to affect behaviour change, whether its around how vets use antibiotics, or getting vet students and veterinary teams to care about their wellbeing. Jane also shares openly about how her work in the student wellness space challenged her personally, and what she learned from those challenges. (Oh, and we unpack the deeper lessons from Ted Lasso, which we could do an entire podcast series on!)

 

Topic List:

10:00 Epidemiology is essential in healthcare.

14:50 Communication is always key.

21:34 Importance of antibiotic stewardship.

32:41 Awareness of responsible antibiotic use.

35:37 Change is difficult but necessary.

39:10 Changing antibiotic prescribing.

44:21 Behaviour change requires tailored messaging.

52:43 Supporting student wellness is crucial.

60:00 Facilitating and empowering employee engagement.

63:00 Prioritise work-life balance and fun.

70:09 Importance of promoting kindness in education.

74:24 Empathy fosters understanding and support.

79:30 Importance of setting boundaries.

84:30 Normalise seeking counselling and support.

 

Jane's resources:

Nagkoski twins burnout book

Antimicrobial sterwardship CPD

 

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Before we introduce our guest for today, I want to tell you about some of the content of this week's Red Vault 321 newsletter.If you haven't heard about this, it's a weekly newsletter where I share 3 clinical light bulb moments that I've learned from making the clinical podcast.Two other non vetty things that resonated with me that week.
And then one thing to think about, which is like a mini blog post about something that I'm mulling over could be vet related.But mostly it's just about life.We've just moved the newsletter to a new platform that allows you to go and read it without signing up for anything like A blog, including browsing the archives of all the posts.
Or you can sign up for free like a traditional newsletter, and you'll get each week's post in your e-mail inbox.So the thing I want to highlight from this week's 3 Clinical Pearls is from a yet to Be Released episode with Critical Care specialist Doctor Karen Boyd about new data that shows that Academy in Bolus can help control those intractable seizure cases where you throw all of the drugs at the patient without much luck.
You know the ones.Now I have to underline that using ketamine early on during a seizure can actually make things worse, but later on in the process, it can be the magical ingredient that you've been looking for.There's quite a bit to this, so if you want the doses and the exact when and how to use it, go and check out this week's newsletter.
That's the 27th of October 2023 or better yet subscribe to our clinical podcast so you can listen to the full discussion which is a total master class on the step by step process of stabilizing the status epilepticus.Patient subscription will also give you access to the full show notes so you can use it as a reference later on when you do get that seizure case and you go, what did Karen say again about this?
OK, back to our episode.We have a lot to cover, and the reason we have so much to cover is because this episode is actually made-up from three separate recordings with Doctor Jane Hiller.Our first meeting And the 1st 20 odd minutes or so of this episode was recorded last year live and in person at Red Expo 2022, where Doctor Jane joined Gerardo and I on the pink couch to talk about what it's like to be a veterinary epidemiologist and to tell us more about her work in the antimicrobial resistance space.
But I knew that we were leaving some gold on the table on that day, so Jane joined me for a Part 2 earlier this year to give us an update on what's happening in the antibiotic space, and also to talk about her work at James Cook University in student well-being.Except halfway through that interview, technology LED us down and I lost half of the recording into the ether.
So we caught up again a few weeks ago.Third time Lucky and I finally managed to stitch it all together into one beautiful Frankenstein of an episode where we cover a wide range of topics.But first, let me officially introduce our guest doctor.Jane Hiller is the epitome of a multifaceted vet career.
She's a veterinary epidemiologist with an interest in infectious disease epidemiology, with particular reference to antimicrobial resistance and the potential for zoonotic transfer of pathogens between animals and humans.Jane's early career consisted of a couple of years in private practice and at the University of Sydney.
She went on to complete her training in veterinary epidemiology and public health through a PhD and a residency at the University of Glasgow, and in 2009 Jane took up a faculty position at Charles Sturt University, where she progressed to work as an associate professor in veterinary Epidemiology and public health, a position she still holds as a part time appointment.
In addition to her teaching, writing, and research, Jane also implemented a Wellness program for the undergraduate veterinary students and has a deep interest in supporting student and veterinary mental health outside of her role at the university.She's also the founder and director of Heller Consulting, her private consulting business where she gets to utilize all of her skills for the benefit of animals and humans.
In this conversation, or should I say these conversations, we cover why epidemiology doesn't suck nearly as much as you might think it does and what a career as an epidemiologist might look like.Jen tells us about the work of the AMR Vet Collective, a not-for-profit that she Co founded that informs and educates around responsible antibiotic usage.
She shares some great resources to help you achieve better antimicrobial stewardship without making your work life harder or compromising outcomes for your patients.But three is all about affecting behavior change, whether it is around how vets use antibiotics or getting vet students and veterinary teams to care about their well-being.
Jane also shares openly about how her work in the space challenged her personally and what she learned from these challenges.Now if you are not and have no interest in becoming an epidemiologist, then you could skip to about the 10 minute mark where we start talking about how we're thinking differently about antibiotic usage.
And this bit I would urge you not to skip.It's really essential listening for anyone with a license and a reason to prescribe antibiotics, which I'm assuming is you.At around the 40 minute mark, we pivot to talking about how we can influence behavior change in a group, which leads into the conversation about student well-being, which in turn is a really lovely framework for creating systems that support well-being in the real world without, and this is important, putting your own well-being at risk like in a vet business.
So if you are in a position of trying to influence positive change and you're frustrated because people are not engaging and you're not getting traction, then this one is for you.OK, Please enjoy Doctor Jane Heller.Here we are vet Expo Day 2 heading into the afternoon sessions and we have Jane.
Hello.Who's Jane?Who's Jane?Yeah.So I'm Jane Heller.I am here from Wagga Wagga, Sunny Wagga Wagga.I'm an associate professor in Veterinary Epidemiology and Public health at Charles State University for part of my time and I have a consulting business Hella Consulting for the other part of my time.
And I'm here talking about the AMR Vet Collective, which is a not-for-profit that I'm one of the Co founders.Of AMR meaning.Antimicrobial resistance.Well, that big thing.That little thing there, That little thing, that that tiny little thing that we don't care about.No, it's good.Don't mention it.
Oh yeah, So many things we can talk about.Let's talk about We've not spoken to an epidemiologist.You always couldn't even say the.Word.Yeah, I know.That's why I wanted you to introduce you.I couldn't say Canon.Canon in the ball yet before, you know.Yeah, there you go.
So epidemi.Restart epidemiology, yes.Had uni for most of it's, unless it's changed drastically, was the thing you had to get through.Yes.Because like the stumbling block to get you to the stuff that you really want to do.
So if you was like, I think we even had ours on a Friday afternoon.So it was like the worst to be honest, I actually kind of liked it a little bit.A little bit of me went just quite interesting stuff.But mostly it's just like, yeah, not interested at all.How do you go from I want to be a vet to becoming an.
EPDL so OK.How did I do that?It was an accident, I guess.So.My Full disclosure, my father is a human epidemiologist, so I didn't know what an epidemiologist was.
But I, like you, sat through the lectures at vet school thinking, yeah, let's.Let's get through them so that we can go into something clinical.And I went out into clinical practice and I really enjoyed clinical practice and I didn't think anything about epidemiology, nothing at all, less than nothing.
And then I went back and did an internship at the University of Sydney.And then?In internship and why just?Small animals practice.Small animal medicine and surgery.At the Camden campus.And then I started a masters looking at snake and venomation in dogs.
Sorry, this is the long way around me telling you how I got into epidemiology.I had to do some research.And then actually there were some two guys that came out from the University of Glasgow that are fantastic epidemiologists and researchers.And they were really fun and they were really interesting.
And I was.I really like this.So it was based pretty much on.People being fun and actually having an interest in what I was doing and and being just having a really different take on things.So that that that's the epidemiologist recruitment strategy.
Exactly, yeah.They just go around the world, basically, Yeah.Well, you, you're much cooler than I thought.If you have a I'm not gonna stop saying that.Weird.Look, I would say that's a.Compliment, but I know it's not.Like that's just like 1 little step up off.The nerd burgers down the border.Yeah, exactly.
Thank you.Thank you so much.I.Appreciate it.So what does work look like for you?What has it like, wait, let's say somebody listening.Going on.That sounds cool.I'm half interested.Yeah, but what's my working life gonna look like?One of my options.So that's an interesting question.
So I'm a little bit different in the way that I got into EPI than most people.Most people get into EPI from.Being farm from farm animal background, yeah, that's what I thought.It was, yeah.OK, And because populations with veterinary science often are seen as head populations, so head health and head medicine, things like that.
So my background is small animals.I've never treated a large animal in my life.I did once.But anyway, that's a long.That's another.Story probably not to go into.But yeah, so for me, population medicine and epidemiology, it exists in human health.
Every animal is a part of a population and so I've come from quite a different background.So my interest when I started were very companion animals based and so I was really interested in that.So my PhD was in a companion animal area, and I've done a lot of help with research in companion animal areas, but also sort of.
Branched out into other animals as well.So.For me, what my work looks like, because I'm an academic or I have been an academic and I'm still doing some academic work, it's very much based.So looking at researching different issues in populations and that can look like any sort of issue really needs an epidemiological approach at some level, yeah.
But also I really like supporting.Clinicians to use epidemiology in their everyday life as well.So every time you do a clinical test.When you interpret it, you're using EPI skills and whether you think you are or not, and some people are doing it overtly and they're thinking, oh, the sensitivity or the specificity of this test is X or Y and the predictive value is whatever.
But really all that is saying is it's putting words to what people do, what experienced vets do every day.They get a test result back and they think, am I going to believe this or how likely is this to actually be true?OK.And then?Reference ranges would even be part of.
Absolutely no idea.Absolutely.In my head, that's statistics more than it did.Me, honestly, no, because you well, I mean there is a statistical component definitely, but but no that that judgment about diagnostic tests and and the likelihood of them being correct is really important in you use it every day and diagnostic tests don't have to just be you know PCRS or.
You know.The results of blood tests, they can be looking at an animal and seeing it's got a rough haircut looking in its mouth and all of those different clinical signs, the presenting signs, historical information, all of that sort of stuff and all of that they are all, they are all diagnostic tests and they layer and you interpret them as you go along and that's part of your diagnostic process.
We can put numbers to that.We absolutely and I love to.Don't give me, don't give me the opportunity, but the.The the reality is, is that you don't need numbers.You can think about it in epidemiological terms and come out with a a probability in your head that doesn't have a number attached to it.
It's just is this as, Is this likely enough for me to call it?Yeah.OK.Yeah.So that's all epic.So I could.That's.A shimmery veterinarian epidemiologist.You could, absolutely.Add significant numbers of letters on my name.
It's gotta be at least 15 letters in that word, that.You can't pronounce.I can't pronounce.So if I wanna go down the epidemiology pathway as a career, so beyond academia and research, one of the applications when you do other stuff, now what's the sort of work that?
You're gonna do the sort of work that you do a lot of.People who work in government have EPI backgrounds thinking about disease outbreaks.How to approach them, how to prevent them, what to do.I mean, and you know, we're in a great time for epidemiologists.
I hate to say it, but you know, there is a lot of, there are a lot of diseases on our doorstep.And you know it with there's a whole lot of people who are working very hard across all all of that wonderful government agencies to try to make sure that they stay out.And if we are unlucky enough to get an incursion, to actually figure out what we need to do to try to make it as small as possible.
So is it fun?Oh, yes.Yeah, it's really kind of wish sometimes that we had a podcast like this when I was a student or a new grad, because I feel like this is a whole world of stuff that people.Do, yeah, and.I didn't.It wasn't even on my radar.Yeah, to talk about.
And a lot of it I go that actually does sound pretty cool.I had all these preconceived ideas about stuff that I just completely unfounded and, yeah, uninformed.But you're right like.You don't get exposed to these things until you're a graduate.Yeah, a lot of the time.I mean, you are because you're taught by a lot of people.
But really it's the.And like I said, the reason I went into it was because I met these guys that were really cool and were doing great.Things.And on the flip side, you have a, you have an EPI lecturer who's really drab and bored and like, oh.No like me, no CSU grads are doing EPI but.It's yeah, it's true.
It's true.Wow.All righty.MRMR Antibiotic microbial resistance.Yeah, and that all happened.Does that tie in?Did that happen because of your job?Yeah, your career.Yeah, it did.I did my PhD in antimicrobial resistance.
I was really interested in it and I did a PhD.I was over in Glasgow because I'd followed these guys that were really cool over to Glasgow and I was interested in antimicrobial resistance.I knew it was an issue.I wanted to do something about it.I did my PhD in an area in IT and just got.
Got worried about it, I guess, and so wanted to do some work in that space.So it's a tricky space to work in it.And we were speaking before and I think you said something that it's something that I think about often and it's really true.It's really like climate change.
It's a thing that we know is going to be a really big issue.It is a little bit of an issue.Well, it is an issue.It's certainly a big issue.In some areas it's only gonna get bigger, yeah.But actually that immediate threat is quite minimal to individuals and so it's really hard and.It's hard to get action on an individual basis.
It's really hard and one of the things that I really love is communication and communicating science and thinking about how to communicate.And so I think that's part of the reason that my interest was piqued in this area as well because it's an area that's, it's a big area.People aren't engaged with it.And so that's a challenge, right?
It's it's interesting and important.Yeah, yeah.But we talked about it before the the psychology of getting people to care about it is is hard because it is a distant problem.It can sound like a bit of a drive problem, like a bit of A and and it is a.Your first instance is almost all this is just gonna make my everyday life even harder because I have all these decisions that I have to make around my patients.
And is it really real?And is it really real?Is it just something is gonna have all of?This one patient that I give this drug to and so forth.Yeah, so let's.Let's give it some perspective in terms of real Jane knowing what she knows now versus Jane practicing condition back when you qualified, what would you say to her?
Would you slap her and say?Yeah.No, I would say you're doing the best that you are doing with the information that you currently have, the old Maya Angelo quote.But when you know better, do better.And I think that's probably the biggest thing is that.We don't know enough about it.As graduates, when we start in clinical practice, there's a lot to deal with, there's a lot to deal with.
And you're making decisions that are really hard decisions every day what which type of antibiotic that you pick off the shelf or whether you use an antibiotic, that's your easy decision right at the time.That seems like it's the easy decision.You're just going to do what you need to do.But the reality is, is that once you learn a little bit more about it, you can make more informed decisions that are better decisions and.
It's really important to be able to do that.It's super important to have that capacity to actually make a decision that isn't just right for that moment where you just need to get it fixed.It's right for that moment and the next moment and the future.And the reason so we had the, if anybody hasn't listened to the episode we had with Reality Scarborough on this topic and the clinical applications of it, go back and have a listen please do you.
It was resource it was that was paradigm shifting for me.Yeah.Habit formation.Because again, I've got 20 years of bad habits.Yeah, all, let's say wrong thinking and not appreciating the gravity of the situation.And now suddenly going to the shelf and reaching for the antibiotics and going.
Not grabbing a Moxy cloud.Don't go straight for the top, yeah.For that skin effect, I just just just, yeah, just.Thinking about it, but I think it came from understanding these because I I I.I said to her at the time, in my head it was a problem for large animal vets to treat the things that we're gonna eat.
I don't need my patients.Not an issue.Yeah.So.Recap for us again, Why is it important for smallest vets to care about?What's the what's the climate change type of action that's gonna happen if we do ignore it?Yeah, I mean, it's the same as in humans.
I mean, with any time we use antibiotics, we are.Applying selection pressure and you know, whether it's a companion animal or any other species, it's still potentially applying selection pressure.You're still potentially selecting for resistant bacteria.
When you've got resistant bacteria, it's not just the bacteria, it's the genes as well.And we're in close contact with animals.So we're going to get things within the animal population, within our companion animal population.We're going to get more infections, we're going to get more difficult infections to treat.
So animals are going to be sicker and sicker for longer.They're also going to have the capacity to pass on those bacteria and infections to people.That happens relatively infrequently, but it's still a potential risk and potentially to transfer genes as well to other organisms.
Super important.So if we're not interested in reducing antibiotic use in humans, which I think we'd all agree that we are, we don't want antimicrobial resistance in humans.And the same argument is there for companion species as well.I mean, they're just another population.
We want them to have the benefit of reduced resistance and not having resistant organisms circulating in their population, with the potential for transfer to other species as well.Even if we're not eating them because we are cuddling them and they're eating in our kitchen often and they're sleeping in the same bed potentially.
What's in it for me?Yeah.And, you know, OK, so let's take it down to a situation where you've got a household where you've got an immunocompromised child and you've got a companion animal who isn't sick but might be carrying a resistant bar.Now that's a risk for that child in that setting or for an elderly person or for someone who's on chemotherapy.
Yeah, you know.Well, just not even in a personal health or family health thing.The shift for me with that conversation was, wasn't it for me?As a veterinarian, because we're talking to is that it means that maybe in 10-50 twenty years time, yeah, I won't have this.I'll go to that shelf and go, yeah, I have nothing.
Yep.The way I'll see that then it was like I'm sick in hospital with something and then like in a small way, I contributed to the fact that I have something that.That, that the ducks country.Ducks Country.Yeah, that's right.And look, let's not.Let's not forget that the it's really important to to remember where we sit in the.
Grand scheme of things, we're not saying that antibiotic use in humans is not an issue.It's a major issue and it far outweighs the issue with respect to use of antibiotics in animals.Doesn't mean that we don't have an issue.Yeah, it doesn't mean that we don't have to do.Something or our contribution won't have an impact, absolutely.
Yeah.So beyond resistance.So since having that conversation now mate is a prick for more facts about antibiotics and there's more to it.And that's maybe off topic, so you can.We could say yeah it's it's a true item but we can move on from it.But there was that conversation with Jill Madison about the data about antibiotic using young animals and how it is stronger in humans and they think in animals as well that can predispose to immuno mediated disease later in life.
We go that's so now what I've got that six month old puppy with the gastro like yeah, you're not having any antibiotics for a long unless you're really sick.Yeah.You're not having and it makes sense, right?You're you're messing around with the microbiome.Yeah, well, that's it.And that was the next thing.I'm hearing more and more about the microbiome and the importance of it and everything it does and go out every time time I give that antibiotic, I'm messing with that.
Yeah, absolutely.Suddenly, personally, if my doctor says I'm going to put you on antibiotic, I want to say, Are you sure?Because I have lots of little friends and I got that.I know I like them.They keep me healthy.Wow.So, so the AMR itself explain it as an organization.
What's it there for?How to engage in it.What's in it for me?So, OK, so it's called the AMR Vet Collective.And basically the idea is that it's an independent organization and we've just made it a not-for-profit, which is fantastic because it makes it independent.The idea is that we're there for vets to help them to connect to the fantastic resources that are around.
And where there aren't resources, we sometimes try to fill the gap.There's an online learning program.That's the big ticket item because to do an online learning program that's an investment of time.There's CPD points available with it.It's free.It's an easy.
As far as online learning programs go, it's a pretty good how long is.It How much time are we talking so it's a nine module program and each of those a couple of hours each to go through.So it's you can dip in and out and it covers a whole lot of different things.
And we've just also developed a first species specific module which is a poultry module and that's not just the poultry vets, it's also for anyone in general practice who sees any sort of poultry coming in.So your backyard took all those types of things.So super super useful, but that's it's a you have to click on the button you've got.
To register for it, right?That's a big deal.But then the other thing that we have is a website that is designed to help people to connect with all sorts of other resources that are developed by all these other wonderful groups, including and the group that raising in Melbourne who have the absolutely fantastic resources.
So the idea is we're a collective.People can go there.They can get access to other material that is developed by other groups.I can also get access to the guidelines.So there's a lot of guidelines that are being developed all the time for antibiotic use.
So we've got guidelines for companion species, we've got guidelines.Well, what else we've got?We've got mental blank, we've got sheep, we've got cattle, we've got pigs, and they're all housed on different areas, but you can access them all through the AMR collective.
So the idea is that it's an easy place to get to any resource that you need about antimicrobial assistance or stewardship, OK?And we've got some downloadable resources for clinics as well.Yeah, the resource is really.Good.They're really good.So is it searchable?So I'm trying to think in terms of my day-to-day.
So now I'm aware of this.Yes, I want to be better about it.It's a Sunday shift, 11:00 on a Sunday.Get the 10 people in the waiting room.I've got to make a decision on antibiotic for this patient now.I'm like, OK, I want to make a better decision.Yeah, so how do I use?What you're going to do is you're going to go to the guidelines.
Guidelines, The guidelines, but you're going to get to the guidelines through the AMR VET collective.I mean, you might get, so I should have.The guidelines printed out on the wall, well, the guidelines, they're pages long, so you just probably need them bookmarked or I mean it's easy just to get on through the site and they are very searchable, so you can just put in whatever you can get to it.
Put in cat apps is.Yeah, to the guidelines.And as it go, no, yeah, 100% it will say no, yes.What about?So the guidelines, Are they regional specific to Australia?They are Australian guidelines, yes.And there are guidelines that are in different parts of the world as well.
There's some fantastic ones that have been published through Canada with really, really great, great content.But we always recommend that you where you can, you use regional guidelines.And so at the moment we've got Australian guidelines, so we're specific to Australia.It would be great if we had some other resources that help people to understand what was most common in their specific regions of Australia.
That's yet to come.But yeah, our guidelines are the better guidelines to go to initially.So the reason is regional specific.Is that because the resistance patterns?Yes, I determined by what's been used commonly over the decade and a really great example in Australia, particularly with our farm animal species, we haven't used any fluoroquin lines.
So we have a very different resistance profile for our bacteria that are associated with farm animal species than they might do elsewhere in the world.So salmonella for example.So better here, much better here, really much better here.We're very lucky.
The previous decisions that have been made in Australia has stood us really well.Is that my excuse for being ignorant?Because when we spoke to Jill Madison, who's Australian but living in the UK, yeah.And we did that episode on antibiotic choices, sensible antibiotic choices.And she's also a big yeah, yeah.That's right, Yeah.
And she said something about and in very, it's sort of overhand.And of course, we never use Indro.And I was like, hey, well, hang on, we never use Indro.Why?We use it all the time.Yeah.And she's like, what?Yeah.You don't know about.Is that because it's a different pattern?Yeah.Or is it Or is it?Should it be as big an issue in Australia?I think it's probably so.
So we we don't use it in farm animal species.In companion animals, we've probably been a little bit.Slack, Slack, yeah.And the UK is probably a little bit ahead of us in terms of that kind of restricted kind of use and cascade system that they use and what have you.
But that's not to say that we, I think we when I first started in clinical practice and I have not been clinical for a very long time now.And bearing in mind we've got some great clinical people who contribute.I'm not the clinical person.I'm the epidemiologist.But when I was first in practice, it was vavulox and enroflox.
Yeah, yeah.And if vavulox didn't work, then you used it.There was no, I didn't have any great think process going into it and I think that's changed a lot.We've still got a long way to go, but I do think that it's shifting.I do.Think when I qualified, but now it's cool again because when I qualified first it was sulfur's, yes.
Because Clavulox was a new drug and that was expensive, yeah.You have the cheapies first.Yeah, And only for the bad ones.We go, well, now we're gonna go for that, for the expensive ones.And then it was like, no, that's not cool.Then use those rubbish shaded behind it, because use, these are the norm now.And now it's going back to no, no, those old ones, The old ones are good if they're indicated and that's why the guidelines are really good because they'll let you know for the issue that you're looking at what is useful and then what is the lowest level of importance.
So you can make really good informed first line decision.Basically, can I just, you asked a question about when you're in practice and you're looking for resources.I just wanna point out that one of the big things that we're trying to do is make it easy for people to get hold of resources and also to see music resources that are coming through.
And we've got to that end, we've got a social media presence, so we've got Facebook and Instagram and also LinkedIn and Twitter, but I'm not very good at Twitter.So that's still emerging and we really came for people to follow us on that.So that again, that's an easy reminder that we're there and it's an easy way again, if you can't even remember where the site is, you can remember on your social media that type in antimicrobial resistance and it will probably come up if you followed.
It sort of content that you putting on there.What sort of content we remind people of what we've got.So our resources we've got at the moment, we've got a shareable, lots of shareable tiles that are aimed at clients about why we might be making changes to what we're doing with antibiotics.
Yeah, so the idea is that clinics can just click on and share that straight out on their clinic Facebook or Instagram page.You mentioned the tiles, the shareable tiles for the clients, because I think that in response to that episode, Yep, it actually generated quite a lot of conversation on some of the vet social media things.
I don't know if you're aware of it, people sharing it, saying you need to listen to this and then watching the comments in there from vets going, yeah, very interesting, but.No, as I'm I'm not going to do that.I'm not going to not give an antibiotic in this scenario because I'll get in trouble.If that goes wrong, I'll get it, which is really I I think that's a a big reason why is it one of the big stumbling blocks.
And and how do you talk to the clients about it is a is a big thing for me, but what I'm what I'm finding in trying to be better about it is that people are totally open to it.So instead of going, here's an antibiotic in case something goes wrong with this wound or that Abscess or what?
Name the disease without discussing it with their owner.I would have just given it to cover my ass.Really.Now I'll go to them and say, look, this is what's wrong with the animal.This is what's going to happen to it.Potentially, it'll probably be fine with this, this and this without antibiotics.
Two years ago I would have given you a course of antibiotics if you're going to feel much more comfortable.If I give it, I will.But these are the reasons why.And I'll say because I'm learning more and more throughout my career that it's not without consequence.It's not completely harmless for your pet and for the greater picture.
So if you're OK with it, I'm going to skip on the antibiotics for now.Yeah.If I'm wrong and that does become an issue, these are the things to look out for, then by tomorrow that's going to be red.It's going to be plasty or these and these and these things.Then I want you to come back and then we'll do an antibiotic.Are you OK with that?And I've never had somebody say no, never had a single person go.
I'd just rather give me them, which is astounding.That's a perfect description of delayed prescribing and it's absolutely what we want people to do and we're really keen to help people to do that.And we're one of our plans is to develop some scripts for people and it's exactly that what you thank you very much.
I'm just going to write that down.We'll put it on the site and people can access it.But that's exactly right.I mean, it's really hard to start to change what you do.You you as a vet you you get really good at what you do and to change it and to get a new script and to use new words in in familiar places is so, so hard.
And you know, for anyone who's listening to this, if there's things that you think that would be useful for yourself or for other veterinarians, we want to know about it because we want to be able to help people to make that change.And we've got the platform that we can develop things and put them on the platform that people can access.
That's really important to us, is that we're doing what it is that vets need.So huge call out for people to let us know if there's something that they can say that would be useful, like conversation scripts, like handouts, what they think that it might be useful to have on handouts, what they think it might be useful to have on shareable social media tiles, those types of things We're hugely open to.
That's.Awesome.Cool.That's right.Let's wrap it up there.But we'll get you back here.We'll talk about more stuff.But not today.Fantastic.All right.Alluding for joining us.Amazing other topics that we.Well, you'll have to listen to later.We gotta talk about Jane is very into student well-being, great student well-being, yes.
And that's a big topic.So we'll tackle that as a as an official episode.Lots to say about that, but.Thank you, Jane, for joining.Thank you.So Jane, Part 2, part two of our discussion of our conversation, separated by how many months.
About nine months ago we had our last chat long.Time ago sounds like much has changed for you personally.We'll get to that in a second, but let's talk about the Adam Bahatix stuff first.It's become a thing for me through the podcast and through the interviews and the people I'm meeting.
When I had that first conversation with Three about responsible antibiotic use, that was like the Road to Damascus moment almost.I was like, oh shit, yeah, I mean, lots.I need to learn about this, which has made me curious.And we've done a few more clinical episodes about changes and how we use antibiotic with people who do this, such as yourself for a living.
What's new for AMR since we spoke last time is is has anything changed?How's it going with the whole awareness?Oh, OK, so new bits and pieces all the time.In terms of the AMR Vet Collective, we still matching along, trying to get as much information out to as many people as possible.
We.I think we've probably raised saturation with people who are interested in antimicrobial resistance.But as you well know, it's the people who haven't necessarily thought about it and been engaged in it before that are our next target audience that are the really important group for us to speak to and to encourage, to take an interest and spend a little bit of time thinking about how things could change.
Yeah, it's just getting their attention.It's just literally because, as you say, if you are not, if you're not interested, if it's not on your radar of something that's important, then if you see an article or a heading or you see, oh, there's a podcast on this, you're gonna go.Not for me, I'm not interested.Skip Rock and a listen.Yeah.Scrolling by so the how, How do you catch them?
How do you engage them?I'm sure you feel it big time, but again, since I've been, since I've become interested in this, to me it's like, oh duh, this is what the smart people are saying.This is what we should be doing.And then some people in the profession for a while.And often those are the guys who are the hardest to reach who go, yeah, that's not good for me.
And I find that, you know, they're just averse to it and you want to go, but it's science.The science says this.You can't just go on your own opinion.You have to.And no, they're just like, Nah, clients will complain.Do you find that?Yeah, and I mean, there's a whole whole lot of social science in this.
And I and I think that's where the the next.Wave really is.And I think the thought about forcing people to do anything is we've given that up because it's not useful, it doesn't work and it actually is sometimes counterproductive and detrimental.And I think really what we're wanting to do with the AMR Vet Collective and one of our big aims is to come alongside people and to really help people, because often, often people aren't interested.
Because they're worried and they're vulnerable.You know it's what I've been doing wrong and yeah of course it will be what everyone does all the time is wrong and and there's no shame in that.There's nothing bad about it.I just went to a course on it on epidemiology last week and I whole lot of stuff that I've been doing for a long time is wrong.
Great.I've figured out in a new way in a different way.It's there's new stuff let's let's do it differently And and the trick is trying to help people to be open and vulnerable enough to say OK I I actually don't know how do I how do I know it now.Learn and change and how do I find the time to do that?
Because I think that's the other really big thing is how do I take out time to actually make these changes that are difficult and and not easy and not intuitive necessarily to begin with?So the main thing is the psychology and the social science around it.And I think coming alongside people is really important.
How we get alongside people is the hard thing now I think is is getting access to actually being able to access these individuals who really need some help to start thinking about change.Yeah, time.I'm trying to think of the stumbling blocks for me and other people that I see.
Time, habit.It's just a new habit that you have to learn.So even that's why I'm stuck now because I know I I cerebrally know it.But as you say on a busy clinic day it's just so easy to do the thing that you've always done and and you have to interrupt yourself and go hang on wait and then start cultivating those those new habits of doing and and a little bit of courage because some of the things it's a fear based thing.
It's a fear of change and then also fear of repercussions go out.It's worked for me for the last 20 years.What I've done, what if this doesn't work and I start having blowback and I have issues with clients or you know, treatment doesn't work with anyone, gets sicker or something like that.So that was a big thing for me and I and I find that's a big stumbling, but for a lot of people is to go, well, if I don't use antibiotics like I'm used to, then my client's going to be unhappy.
They're going to come back or they're going to go to the other vets.And the other vets going to say that guy's an idiot, he should have used antibiotics or he should have used the longer course of antibiotics or something like that.So I think that's.Probably the biggest stumbling block I've seen.If I don't give that cat Abscess antibiotics and he goes septic, I'm going to be in trouble.
Absolutely.Never mind the fact that the chances are very, very low.I think story based learning and I think one of my big things that I'm very keen to do on the AMR VET Collective when we get a little bit more funding is to collect stories and to collect case reports and case studies, not of really interesting difficult cases about antimicrobial resistant organisms about these.
Really simple cases that are done so often with using antimicrobials.Your example is a perfect one.Treatment of Abscess, catfire abscesses.Really, really beautiful example.Treatment of diarrhoea, surgical use of antimicrobials, those types of things.
I want case after case after case where they're fine, there's no antimicrobials used, or there's a change in antimicrobial usage and.We get good outcomes because I think that's what's missing.When people have been doing it a certain way for a long period of time, they've got a big backlog in their mind of successful cases and I'm gonna put successful in inverted commas.
So not successful long term because we're contributing to resistance and it's not evidence based anymore.But there's no catalogue of successful changes and and I think that that's what we can have and I've spoken to many, many vets who have made changes like you who have found it really difficult but who have been really successful with it and said you know this is this is what I do now.
I don't have a problem this is how I address it and this is what I do to mitigate any effects with with clients.And another thing that you said, I'm pretty certain you mentioned it the last time we spoke the script that you have in your head the the way that you talk to clients about this because everyone.
And you have scripts that you go through and you say the same thing or it's a similar type of thing every day or every time you say it's a similar sort of case.And and actually changing that script is really tricky.But having some actual words around it and and I think you put some words around it the last time we we spoke and having that in your mind and being able to call on that I think super valuable and really empowering.
So I think those types of things are good.I'll I'll say that script again in case this conversation was off air.I can't remember because we've chatted again.But I I find this really useful because I'm that fear of the clients being pissed off if I don't do antibiotics.I've found it completely unfounded.
People are so open to it because the non veterinarians, the the human population, they're aware of antibiotics being an issue.It's in the media, it is out there.So my script goes, so let's say the cat Abscess or the hemorrhagic diarrhoea or all of these things that are traditionally would have just gone, oh, I'm going to go.
Just just to be sure we'll come up with antibiotics, I'll say to people now, three years ago I would have given you antibiotics for this.That's that's the way I was taught, and I've done that for 20 years.But there's new information out there that says it's not actually necessary.Most cases will be absolutely fine.I'm also learning about the potential negative repercussions of antibiotics.
It's not without consequence.Can have long term effects on your pet.And people know that They go, yeah, I'm aware of it.So then I'll say to them, what I want to do is try without antibiotics.If it develops an infection, if it isn't going to be an issue.These are the things that you kind of see.The animal's going to get sicker.
You got to.Yeah.And I give them the whole spiel of what you look out for.I'll say if I'm wrong about this and he doesn't need antibiotic within a day or so, you're going to see something worse instead of better then I want.You don't even have to bring a pet back.Just come back and it's on my notes.Just pick up some antibiotics, That's straightforward.
And then you're going to start him on an antibiotic.So I'll make it easier for them.And then I end by saying, but if you're uncomfortable, if you'd rather, we'd use antibiotic because I'm not going to say no, I'm happy to do it.And I've not had a person say, Oh yes, actually, can I have the erotics yet?
I think it's been his money as well.Like antibiotics cost is 60 bucks, 80 bucks, 100 bucks.And if I say to them it's probably not even necessary, they go, yeah, I don't know, I'm going to spend extra money again.I'll even say to them, if I'm on the fence, I'll say if it's OK with you go to your rig vet or 'cause I do emergency or come back to us in 24 hours time and we'll recheck the temperature to pick up any early signs.
And that really works.That really works.And people have no resistance.And as far as I know, I haven't had any horrible experiences.I say as far as I know because as an emergency vet, my patients go back to the regular vets.But I've not yet had a rig vet call me and say if I can eat it, my patient died.Why didn't you give it a?
Pie.Yeah, and it's.There's nothing that is overriding your clinical acumen there.It's still working within your clinical acumen.There's no, we're not conversing around lack of use of antibiotics.It's.Changing with current evidence and and understanding and I think that script is absolutely brilliant because you're giving power to the client as well and you're telling them what to expect and and that delayed potentially delayed prescribing as well another absolutely brilliant and very very valuable resource to do.
And that's that's a really good option for people as well as to to really talk about that, to ensure that people know that they can't come back if they're uncomfortable and they don't actually, you know, it's not a or or nothing phenomenon.There's a little.Bit of security in there for people who are trying to make a change.
I think it's fabulous.Interesting because again I had a clinical conversation with Professor Steve Epstein from UC Davis, who is an emergency specialist is into antibiotic stuff.And he did a talk at Vicks a couple of months ago about duration of antibiotics coming from the human medicine because again that's that's the leading the charge in this whole thing.
The human medicine guys are ahead of us and they're thinking and just how short you need it for.So pneumonia, pneumonia causes in human medicine.And he's saying he's been doing the same for two years in in his patients five to seven days of antibiotics.Utis, the simple UTI.
Three days, 3 days of antibiotics.Treat until the signs go away and then stop and let the immune system take that's.Such a paradigm shift because we were literally taught the opposite of saying full course.Otherwise you're gonna get resistance and now they're saying no, no, just treat until the signs go away and then stop.
It's a big shift.It's hard to actually get your head around, but I had the experience recently where one of my kids got a really bad middle ear infection.Same approach because I I'm nervous now with my kids with antibiotics because we had another discussion with professional medicine about the potential repercussions in juveniles, animals on the immune system, on potentially predisposing them to autoimmune stuff.
So now with my kids, I'm paranoid.I'm like, no, don't put them antibiotics if you don't have to.And I'm so pleased that the GP said no middle ear infection, mostly gonna be viral.And they have found that even if it is bacterial, it resolves maybe a day earlier with antibiotics, but it resolves anyway with antibiotics.
So we're not gonna do antibiotics just to see it out there in the human world as well like that.That same approach helps me with my decision making around it.We were talking about.How?There is resistance to the message, right?People stuck in, stuck in their ways or go run relevant, relevant to me or I've done this for 20 years and I've never had a problem.
You talked about a system of thinking, about changing ways of thinking.Yeah, Yep, talking about the trans theoretical model of behavior change.Talk us through that, please.Yeah, yeah.So since we started the ANR Vet Collective, we have been.
Using and relying on the trans theoretical model of behaviour change, which is pretty well known in in social science and marketing circles.So we're we're coming to a profession that's got a really broad range of people, OK.So they're moving from not even thinking and knowing that antimicrobial resistance is an issue or or not contemplating it.
So that's a pre contemplation stage through the contemplation stage where they kind of have an understanding to being prepared to take action then.Taking action and then being in maintenance.So the same message is not going to fit all of those people.And so for us it was really important to develop both resources and messages that essentially helped people to move through each of those stages.
So essentially if we're going to send out a whole lot of information about prevalence of antimicrobial resistance in in different disease processes and different pathogens.That'll work really well for those people who are already taking action and who are already interested in antimicrobial resistance and it's on their radar, but it will probably actually switch off people who are not at all interested those that are in the pre contemplation or the contemplation.
So it's too much, it's it's overwhelming.So for us it was really important to be aware of that and to to have those different messages that actually helped people to move through from whatever step that they're currently on to the next step, if that makes sense.So you've got to cater for.
Very basic messaging about hey, there's this thing that maybe you should be aware of where to pique their interest to go.Oh wow.You know that to then saying and I imagine on this particular topic of antimicrobial resistance where a lot of people will go, OK, I hear you but I'm too busy or it's not that important or you're making a big deal of nothing and then as you say it's kind of switch off almost going right.
I don't that I feel like it's almost the hardest group to.Go right.Now I've informed you about it, but I but I see that you don't really believe me or you don't.You're not taking it seriously.Or again, it's almost almost like the climate change thing.Sometimes you just go, oh geez, it's another thing to worry about.
I'm actually going to actively disengage from this because it causes me worry and I feel overwhelmed and powerless.Yeah, look, I think that analogy is absolutely perfect.And that's the way that I tend to think about it.And and the climate change thing is just it's perfect because.With antimicrobial resistance, it's the same thing what you do today.
You can't see a tangible outcome necessarily right at this point in time and and sometimes you'll even see potentially a a a negative in inverted commas effect in so far as you get pushed back from the client or it's not just a set and forget the real outcome is long term and it's less tangible.
So it's much harder to actually make those changes when you're not immediately seeing a a a tangible positive.Effect.And so I think that's a really good analogy.It's it's really hard.It can be really super hard and it's not just necessarily what we're saying, it's also how we're saying it as well.
It's it's the type of messaging that we're giving that that is really important to be varied for those different steps.And again, as you can imagine with climate change it it's a completely different message for those people who are willing and prepared to take action versus those that are still, no, this is really an issue and do we really need to?
Do I really need to spend time and effort and energy on it And and particularly like you said and in an environment where you've got I mean people that that's a smashed.We know that they're they're hugely busy.There's a lot of competing interests in terms of what they spend their time and effort on.And we are absolutely aware that even with the best of intentions, antimicrobial resistance and antimicrobial stewardship by its very nature is is a little bit down the list.
So we're just trying to help people to to make it easier to bring that up the list and to make it something that people are are happy.And easily able to engage with.So to make that practical, how are you doing that?Let's talk about that group of people.
Is it just repeated messaging through social media or e-mail?Like what?What's the what's the plan?And the reason I'm digging into this is I feel like this conversation about changing ways of thinking.Against be so useful for a practice owner or for anybody who's trying to change any behavior in a clinic out of or when we start talking about the Wellness stuff as well, it's same thing.
You've got to change mindset.Yeah, look, there's with.We've tried a few different things.Number one is getting the message to the right people.That's the the 1st and most simple aspect of it.And again the reality is we have a fabulous social media site which has a whole lot of things that go that that we put out on that it's links to our resources, examples of what's being done elsewhere.
But the fact of the matter is if you're in the pre contemplation or even the contemplation stage, it's unlikely that you're going to link with that.You're not going to be following us because why?Why would you so access?Is the first issue and the first really important point.And it's actually where we've hit quite a bit of a stumbling block because it's quite hard to access people around this where people are not looking for IT, people are not necessarily engaging in it even if they do see it.
And and what we need to do is to actually go through sites and areas where people are not necessarily expecting antimicrobial resistance and stewardship.And then we have to get the messaging right when we do go through those pathways to actually get people.To sit up and think that it's something that might be of interest and of of use to them and not necessarily banging on our drum, but actually just implementing it within the message that that people might be interested in something else.
So people are often interested in in how to treat certain disease processes.Of course, that's something that is tangibly useful to them And if we can get a small amount of messaging through that that is helpful to people who are treating their patients, then then that's hopefully going to be a win for.
For everybody.Competition for people's attention.It's not an easy race these days, right?To get in front of people and to maintain attention, yeah.Yeah, OK.I was just gonna add the other thing that we have is we have an online learning program which is numerous.
CPD points are available all for free, very easy win for people who are looking to do CPD and no matter what your interest is, it's useful, it's done in a way that is engaging and we're hopeful that again if people come across it.
That that will be something that is obvious.I can easily get a couple of CPD points for a couple of hours of online free online matching through something that is actually going to be useful when I'm considering cases in the future.Where do we find that?
It comes It can be accessed through the AMR VET Collective website or it can be accessed directly through its own website, which is www.vetams.org.So two different ways of getting to the same thing.
OK.I'll put a link to that in the show description list and the show notes as well.All right.So the topic that I alluded to before again talking about changing minds, it's in that and we discussed when we chatted to at VET Expo last year, ages ago.
Here we go about your your work when you're still involved with the students at or was it at World Cup?That you had a role in.That you're involved with the the student Wellness support mentorship and not just clinical teaching as well.Is that right when you just describe the position that you held there or or or how it integrated with?
Your look, when I first started at Charles Sturt, which was a long time ago, now, 14 years ago, after a couple of years I I, I started getting a little bit disillusioned because we were seeing these Absolutely Fabulous, vibrant, vivacious kids.
Turn up in first year they like we all were at one point in time absolutely busting to be a vet, so excited, could not think of anything better.And then I'd see them as they go through and I'd see them turn up in fifth year and they didn't look the same.They didn't have that level of excitement and and not just about vet, it was about the world they were.
It's like they were a bit beaten.And I thought, oh, surely we can do better than this.Surely we can support these guys to thrive a little bit more throughout their degree.Because we all know that finishing the vet degree, it seems at the time like a an end point, but really it's the beginning point of the rest of your career and if you're crawling across that line, it's no good.
You you really need to be leaping across it and and sort of ready to take on the world and and be in a really good space.And what you learn at vet school really sets you up in terms of Wellness for the rest of your career because if you can't manage your Wellness within vet school, really it's out of the firing pen and into the fire.
You're really at A at a disadvantage moving into the career, so.I thought long and hard about it, and I was very lucky enough to work with a fabulous colleague who at the time was working as a research assistant and still does work as a research assistant.
But she has fabulous psychology background and I did an undergraduate degree in in Bachelor of Science majoring in psychology before I did veterinary science as well.So I had an interest and and I'm not qualified as a psychologist, that's for certain, but I had an interest in human behavior.
When we got together and thought, look, it would be fabulous if we could set up some sort of program that actually supported the Wellness of these fabulous students a little bit better.And I had some conversations with colleagues at different universities and was introduced to a program that was at Vanderbilt University in the US and actually aimed at medical students over there that was looking at trying to support their medical students better with all of the reasons that I've just discussed.
So we developed what we called the Odyssey program, which was basically a program that talked essentially to students around Wellness and encouraged them to do 3 simple things, work hard, play hard and be kind.And it's as simple as that.
We just tried to set up some structures around it and we.Essentially the year that we started, we got very excited, put this program in place and then realized really quickly that what we were doing was putting a program in that was excellent for middle-aged women, which is what myself and my colleague Lynn were, and pretty useless for anyone who's not a middle-aged woman.
We were like, oh, this is going to be awesome.Anyway, the students very quickly kind of were like, yeah, we're not, we're not loving this, we're not loving that.And we very quickly realized that what we needed was the students to to run it and to have full buy in.And so we pivoted.
I have to, I have to interject here and say this reminds me of what we just said with the AMR of because they don't see the immediate.Absolutely, yeah.They're disinterested in it.But the reality is various.Before they know it, they will be middle-aged women and men.
Yeah, yeah.Absolutely.Poor now, but you just wait.It's coming.Yeah, exactly.It's nothing you can do to stop it.So yeah no that's exactly right.And and it was just that it that way where you just and and also you think it's just a no brainer to think that that we were a bit.
A little bit simplistic thinking that we we were going to be able to do anything that's obvious no matter what you want to change you know the the buying of the people who you're trying to help and and to give strength to.So anyway we ended up having this fabulous group of individuals that represented a number of different years that came on board and we were ended up being the facilitators and they were the ones who said look it's this time of year this is where we're getting issues.
I think we should be thinking about supporting our students in this or that way.And and.Few of the things we did, we it ranged from holding simply holding BBQ breakfasts on the week before exams.We had a cake.
Auction where people made cakes in all disgustingly beautiful forms of veterinary science.And we had Kitty little cakes, we had brain cakes, we had all, you name it, we had a dog food cake.So it's Absolutely Fabulous.And then we'd auction them off and and everyone had ate cake basically and have a fabulous time.
We had groups that were intended to cross years, so year and 3rd year groups where people got to know each other really well in these small group environments.And the idea was that whatever you're going through, whatever pressures you've got in whatever year you're in, so let's say first year when they started.
The other people within your cohort have got those same pressures.But if you're engaged with people who are in a year above and they've gone through those pressures that come out the other end, they can give you a little bit of insight into it.Then that's going to be supportive and and helpful and that can give you some strategies.So, yeah, holistically.
We saw a massive change in the way that the students approach things and and just the way that the the the feeling within the vet school over the five or so years that it that it ran really well.There is obviously varied responses to it and you know when you start university you don't want to be told that you need support, you don't want to be told that you're going into a profession that.
You need to really think about Wellness in and so there's always, there's always pushback but but holistically and in general it was we we saw some fabulous results from it.It's so tricky.What you mentioned there is, is that balance of you don't want to be a negative nearly and if they're excited and they they want to get out in the workforce and that's great because we want that enthusiasm because what we what I'm tired of is.
A bunch of middle-aged wingers who talk about how much it sucks to be.Absolutely, yeah.So we want that enthusiasm, but we also need to be realistic.I I had this challenge literally a week or so ago.I was at a small Wellness based event at UQ for the students there and the job was to go give a motivational talk and I thought, yeah, don't.
I can do that and I can definitely.And when you sit down and and finally the week that I started to write down some ideas I wanted to talk about, I had two scenarios with veterinarians, 120 years out and one 2-3 years out having a conversation about how they're struggling.
The 2020 out one was just talking about burnout.And these are enthusiasts.These are vets I respect.They're not whinges.They are really.And the other one was just saying I.It's it's really hard.It's a she's a senior, she had a job before studying Red for 15 years and she said that was just so much easier, which made me think.
How do you approach these?Students, because that is the reality.It is it's kind of be freaking hard but but yet I know lots of people who thrive.Lots of people who are happy despite the hard.And did you find ways that worked to you said the word buy in or to engage people?
In in.And and this goes for I'm asking about student but but the same way happens in practice.You you wanna create especially the bigger businesses, you wanna create programs if you have a a caring boss and they want to create a Wellness program or something like that.But I don't know.
People don't wanna engage in it.Look, the thing the the best thing that we did was just to act as facilitators just to open the doors and say anyone who has an idea you're welcome to come to us and we had fabulous ideas and and it it hit the spot and then it would hit the spot for different groups at different points in time.
So as an example we had some people come to us saying we really want to talk about LGBTQI, we want to talk about it, we want to have a have a talk.And so we set up actually a it was a sort of a lunchtime seminar session and we started off with the LGBTQI chat.
And that was fabulous and was just so good for staff and students to come and to listen to issues and to just get a little bit more understanding about what issues were still present.And issues that I had no clue were present in a regional environment that aren't necessarily present in a non regional environment.
So that was absolutely mind blowing.And then we had people who had families who wanted to organize to develop a group with other families and so we just facilitated it.And then these there were these little offshoots where people connected with each other and then they went on and did their own thing.
And we weren't, we weren't micromanaging it.We were just giving people a voice and giving people the capacity to actually connect with others and to raise their hand and say OK, I I actually, I'm struggling here and and I need others to to talk to about this.So it's all these different kind of areas that came out of the woodwork just because we gave a platform essentially for people to do that.
And I think that can be done in practice as well.And the more that people are able to connect, the more protected they are, is the bottom line.I like what you're saying there.There's a couple of takeaways and the the one that you say there is when it comes top down with the best of intentions, right with we want to we're trying to fix this for you because we really care and we want to make it better.
But if we I think immediately of me and my kids.If I come with an idea, I get eye rolls.Yeah, boring.And maybe it is a bit like that with students or in a practice or something like that is to say, well, as soon as it's management or the leadership team that comes and says, hey, here's what we're going to do to fix you or to make things better, then people are like, oh, I'm interested, but I like that idea of saying we want to help you, but we're not going to tell you what to do.
Here's time and here's money.Do what you want to do.And then the second thing that you said there that actually jumps out to me is that you had very different things for different people.Because that's the other thing.We want to find the solution for the team, for the whole 50 clinics of our corporate group.
And that's not the reality because my struggles are not your struggles.And also maybe that's an expectation thing from people rolling out programs like this is you want it to be a massive success and a massive success is all 200 employees were into it and they're probably not going to happen.This is a shift for me to go.
If five people show up and get value from that session, good.The next session absolutely tick tick the box for the other ten people.That's fine, absolutely, with an with an overarching goal.I think as long as people are aware again of that overarching goal.And for us, we tried to make it super simple, work hard, play hard, be kind.
That was it.And we figured if people managed to adhere to those three things and they had that in the back of their mind and then did all of these other little things that were seen as as positive for whatever groups, then then we thought that was a win.Yeah, I wanna dig into those three.So work hard's easy in our profession.
That's that's a given as a student.And once you start working, what does Play Hard look like in this context?Great question.We had specific ideas about what it looked like, and it was that it was scheduled, scheduled play that it wasn't.
Negotiable.It was if you work hard, you also must play hard.And play looks different to everybody.But we challenged people where we could to connect through play.So we would say things like if you like running, can you join a running group?
If you like knitting, can you join a knitting group?If you're religious, make sure you go to church and connect.What does play look like to you.And when you figure out what you like, then make sure you do it and independently.
As someone who my door was always open to students, I can't think of a time where a student turned up into my office in tears and there were a lot of times where they did that.I didn't suggest that they work less and play more.Most of the time it was, well, what are you doing for yourself and how much are you playing?
And, and, and I don't mean, you know, I would often say, well, you need to watch more Netflix, but don't watch more Netflix in a mindless way.Schedule it in.If you love watching Netflix, don't go your whole time studying, going, oh, I wish I had, you know, clicking through different things.
Schedule a time and make sure that you do it.You do your two hours study.You do your two hours Netflix or one hour Netflix or whatever it is that you decide you're going to do.Schedule it in, make sure you do it and feel good about it.I don't feel guilty about it.It's it's actually I'm.About to say the benefit that's that's because often off very often and I still find it I've got a lot of work to do and then when I do my fun thing I have this little you should actually be I'm I'm using the fun whatever the fun is whether it's TV or surfing or something as an escape.
But as you say, it's a it's a guilty escape, So it doesn't actually do me any good versus no way.Next week this time I'm doing this and screw everything else.I'm disconnecting and having fun.Purposefully, Mindfully having fun.It's that mindfulness, isn't it.
It's just doing it mindfully.And then beyond just getting the message out there that you need to remember to have fun, and it's interesting, I listened to as a quick little sidetrack to a podcast recently.I forget who it was, but a guy who does happiness research and that was one of the things pleasure was.
One of the three key pillars of happiness is that you have to do something pleasurable.It's pleasure, pleasure and.Achievement basically get a job well done and then purpose.But the the interesting thing he said about pleasure is it really helps also to stop it from becoming a negative thing like an addiction, like a, you know, Netflix addiction is to say when you have pleasure, try and do it with somebody always.
And you said it there before community say well schedule pleasure and ideally don't do it alone because then it can become a vice.Versus an uplifting thing.So when you when you do your thing, do it in community.I was gonna ask you, though, so beyond just getting the message out there that you should do that, did you guys track it at all?
Was it AI?Don't know.Do you have an outline or a framework where you say, OK, well show me your hours of fun in the last month?No, not at all.Just get the message.No.OK, yeah, it was just really trying to get the message out and and the difficult thing.
I'll tell you the most difficult thing was making sure that there were role models that the staff we're in a university environment.The most difficult thing was actually getting staff on board and making sure that the staff were practicing what we were, what we were preaching because it wasn't necessarily what they were preaching.
And sometimes it was in direct contrast to what some of the staff were preaching.And there used to be some feedback that some staff members were like, well, if you've if you've got stuff outside of uni then you need to get rid of it because you won't be able to pass this degree without putting absolutely everything into it.
So you're you're working against that kind of traditional view of things And that was really hard.It was really hard to and particularly because I'm preclinical epidemiology which is my area, I'm not in a set of overalls.I'm not at the at the fun sexy end of things.
So you whatever you tell students before they get into those clinical years is often replaced and that goes for antimicrobial stewardship as well, I must say.But certainly, certainly those two things, Wellness and antimicrobial stewardship, no matter what you say in the preclinical years what it's what people do in clinical practice that really, really has the impact.
I I just pulled up a.Quote here that I wrote down the other day from a book that says the immediate influence of behaviour is always more effective than that of words.So again, instead of saying that no, no, show me, show me how to have a balanced life and that we are so bad at that in the OR.
Certainly if I think back to my university days or in work days, but at university our course was all about they talk about the hidden.Was it the hidden curriculum?The hidden curriculum was, yeah.Yeah, sacrifice is the key thing that you have to do.Sacrifice your family and your alone time and everything.
That's the only way to be great at this job.Absolutely.That was what I was taught.Yep, It's still still there.It's still there.It's still there.And it's so damaging and it's very hard, Very hard to change it.Very hard.And then you wonder why we keep having the same freaking conversations, right, about what's why, What's wrong with the red profession, Why we say the right things.
But then we don't do it.Yeah.And.And the reality is, it is very hard to do.It really is.And it's hard for numerous reasons.In the university system, it's hard because finances don't support it.It's hard because people have made a life for themselves around it.
And then who are you if you're not that person who is sacrificing all the time?You actually have to redefine yourself on a personal, individual level.That's really hard and really confronting and I think probably it's why our profession will thrive once the new generation comes through and gets to actually be in those positions of of influence.
For a second I.Thought you were going to say once all of the old God is all dead.No, I would never say that.So play hard and then be kind.What does that look like?How did you how did you talk about that?Look, we didn't labour it because I don't think it needs labouring because it's it's simple in its simplicity, it's in, in its words, it's it's it's simple and it should be obvious.
And we again, just we just modeled them.We asked students to think about it when they were giving their feedback.Every student has the opportunity at the end of every concession to feedback on their classes, to their lecturers.
Now it's an extraordinary privilege to be able to do that.And certainly I didn't when I was an undergraduate.That was not, it was not a thing.And the privilege is that there's no feedback that they get.So it's it's one way feedback, it's anonymized or anonymous and they can say whatever they like.
And so as staff members, I've seen some pretty awful feedback and I don't think that the students I think probably now they are, but certainly when it all started, I don't think they were aware of the effect and the circular effect that that had on their education because it was, it was, it was pretty extreme.
So there were discussions about that and discussions around around how their feedback effects and what it might look like and how to create positive positive change through through that feedback process.So that was all all around kindness, but that that was a specific example.
But we had, we we run a problem based learning program within two years of our curriculum and we historically had a lot of group based issues.Group work, you say group work, anyone who has ever done group work even sort of break out in a cold sweat when group work is mentioned.
So this wasn't specifically a part of the Odyssey program, but it was certainly from the same people who were doing the Odyssey program.We developed a strategy where there was group feedback and discussions around group work.
And those discussions were very in intentional discussions around why people might not be contributing in the group setting.And and historically people would mark each other on how well they were contributing and there would be loafers and people who were that that the the the wording around people who weren't contributing was always really negative.
So we changed that and we would have this feedback.We would have feedback where people wrote things and submitted them.Then we would have a group conversation and then when we would have secondary set of feedback.
And the way that we framed it was what's going on for that individual who might not be contributing.Everyone knows that you know you there's someone who is not doing the work and it was always, what do you think is going on for that individual?How can we support them?What is it that we can do to actually figure out why they're not contributing, and what can we do to help them?
And every single time, every single time there was a really simple explanation and a really simple solution.For example, you've got a group where everyone's had some form of experience with horses, except one member of the group.
So you have an equine case.That member is always already disadvantaged and they already feel like they can't contribute.And therefore they get they have a shame response or some sort of response that makes them not only not contribute, but be really quite negative around it.
Simple, right?You figure out what's going on and then they can get support from the other people.They just they are able to be vulnerable there.And then say, actually I haven't had any experience with horses up.And then you can address it.And then all of a sudden this person is able to contribute, but they're able to contribute in a modified way or a supported way or they are able to identify what work they need to do to bring themselves up to speed.
It worked every single time.And we actually had groups that were absolutely humming by the end of that process because they had just learned how to support each other.So instead of criticizing someone for not contributing, they were asking the question of why might that be and what can we do to support it?
What a extremely valuable lesson.Like you, you're teaching cognitive empathy, and I heard the phrase the other day.Empathic.Imagining, I like that.I might not feel what you feel, but I'm going to try and imagine what are you feeling, What's making you behave and what what a great lesson for vets because that's one of my soapboxes, is the.
Clients suck.Clients are terrible, stupid people with the stupid animals, which is so damaging to you as a practicing clinician.Never mind absolutely relationship, but teaching that approach, if we go well, what's going on for this person?Why is he being such a nob?Or why are they not giving the medication?
It's such a useful skill.Yeah, yeah, really good.I'm interested, you mentioned earlier that there was some when when you guys got the students to structure their own program and bring the issues that they want to address to you.You said there are a few issues that.Completely surprised you.Can you think of any?
Can you remember any that you thought?I didn't even consider this as a problem.I've mentioned it before.The one that really stood out was the LBDHLLBGTQI or it's just Q now, I think.But that blew my mind because when they came to you, yeah, sure, absolutely.
But honestly, I didn't.I was so ignorant that I thought I don't isn't everyone's accepting these days.I mean we're in the 2000 it was 2010 this yeah it's just fine.
The information that I heard in that completely, completely changing my view on it.So that was one which seems again my ignorance is on full display there because I I was just living me in a fantasy land where I thought that everyone was open and commutative and I was wrong And that was very, very, very informative for me.
And then the other thing that I can remember is that one of our students came to us and said I had a shocker.When I started first year I had no idea what I was doing.I'd really like to put together a little book that is a little book of how to do things for new students.And so she and we said fabulous.
We'll support that.That sounds that sounds great.You know, how hard is it to be in first year and to start university sort of thing?Knowing obviously that there are some quite considerable challenges.She went away and she got contributions from a number of people in each different year.
Made this gorgeous little book, which was, I think she titled Dear Vet Student, Love Vet Student.And it was just gold about all these different things that you wouldn't think about.Don't put a saucepan in a microwave.Who knew?I mean really, really basic things that all of these different and is extended from there into a whole lot of different things, but just Nuggets of gold from students in different years.
Just stuff that you just completely forget about or don't even consider that actually they really knock you off your feet when you turn up out of home into a university environment for the first time.And that was just beautiful.I mean, there was so many, so many fabulous examples in that.
Is that book publicly available?I would love to see that.I feel like it should be a a resource.Yeah, I might.I'll dig it up.I will dig it up because we we actually printed it out for our students, but I'm sure we've we've got it online as well.The when we spoke, whether this was off air or on, but you did say that because it sounds like this role of yours was really fulfilling.
But am I right in remembering that you said you also found it personally quite training?Like it actually took it out of you?To the point where you had to step away from it because you became the default counselor and it started.Yeah.Can can you tell me about that experience?So I learnt a huge amount from it and I'm still learning from it in retrospect, thinking about how I engaged with it.
And I think the first thing to say is that I was never, I never offered counseling and I because I'm not qualified, I was a conduit.So I saw myself as someone who could facilitate people getting the help that they needed and making the decisions that they needed.And my advice was often do you need to take time out?
Do you need to actually take time out from that school?But I obviously I as I said my door was always open and so I had a lot of people come to me who were struggling and in crisis situations and subsequent to me being in the role we actually ended up getting someone who had a dedicated portion of their of their employment as someone who could take on that role and and do it far better than I ever did.
But anyway that I'll I'll come back to that.So I had a lot of students who were turning up in in these really difficult, having really difficult situations, and I was trying to help them to navigate through it by finding the support that they need, which we all know there's not enough support out there for people who are in crisis situations situations.
And I didn't have enough boundaries in place.I think I can say that now.And I wasn't aware of what I was taking on at the time.And I had a family in a situation where I had a teenage daughter, which is always challenging.
Anyone who's ever had a teenage daughter will know that it's challenging, but it's also confronting insofar as very important that issues aren't brought into the home that you can't manage.And for me, there were some really severe issues that our poor students were dealing with, with some really horrendously poor outcomes, unfortunately.
And I found it very difficult to keep that out of my home environment and I found it very difficult to engage in it.Without getting too involved, like I said, that's my it was my this is these one, my issues and my boundaries that I wasn't.
I hadn't put in place well enough.I had varied support from from the university.But universities are that they struggle and they struggle to understand.And I'm not talking about the school until the university in general start struggle to understand the extent of issues that veterinarians and veterinary students face.
And so I didn't really have the support that I needed and I didn't feel like I could advocate for that support, which again, that's an issue with me.I I should have been able to do that.I should have felt like I was able to do that.And I ended up actually burning out completely.So I dropped back.
I actually put my resignation in.But to the credit of my head of school at the time, he said, well, let's walk through this, what can we do?So I ended up going down to two days a week and I started a a business for the other three days a week, which I'm.It was a fabulous outcome in the end, but it took me, it took me about two years to recover from that.
It was a really, really bad time for me and I felt extremely guilty for burning out and for leaving because I felt like I was really letting down a huge number of people in many different ways.
And again, that's probably perception potentially rather than the reality that I can see now.But you know, again, I'm really good example of what you said before about that sacrifice and that that mentality that we often have as veterinarians where it is about self sacrifice, which it absolutely should never be.
And so I think I learnt a lot, I know I learnt a lot from that, about me, about how I engage with things and also about the profession because once you're a vet, you're always a vet.And even though I wasn't working in a clinical role, I still had that very that mindset that that that you described really well, but I think really is very hard to get out of in some situations.
And then I applied it to to this different scenario and and really kind of sunk myself with it.The positive thing about it is as I stepped out, we did manage to get some funding.We'd always struggled with funding for, for a dedicated individual who's there then one day a week to essentially triage students who were struggling and to understand how to help them.
And that was Absolutely Fabulous.We lost that funding, which was a really negative thing.But we've just applied for it again and we've got some really great support and we're hoping to get it all back on online again.So from a personal perspective, it was a really, it was a really hard time, but immense time of growth and learning for myself.
And certainly if I was to go back and do it again, I'd do it in a very different way.And I feel like I've gained some real, real perspective on what we can offer and what we should be offering our students and our graduates in this space without thinking ourselves in the process.Yeah, so do it.
You would have.Done it differently.How?Like, let's say somebody is in a mentor position or something where they are confronted with these situations and it's sometimes as as simple as just a senior student or somebody empathetic.Yeah, but you have these people who draw people, right?People come and offload on them.
How would you do it differently?Yeah, I I would be intentional about my boundaries.I would sit down and think about it and I would identify what I needed.I would identify how I was going to get it and I would identify support and that support for me would look very different to just being going home and talking about it or finding a friend and talking about it or talking about it to a colleague.
It would be actual proper support.It would be scheduling in times to speak to someone and whether that's through the our IEP program, I think that's what it's called the the external counseling program that we have through the university or whether it's through a different mechanism.
It would be an intentional situation where I could actually speak to someone who has training and background in debriefing and communicating around this because it's impossible to hold, you cannot hold it and you should never have to hold it.And this is the other thing that I've tried to do.
Don't know if it's with great effect, but I think really demystifying that communication around counselling and support, it's essential.It's absolutely essential.Doing the work on yourself and having someone to talk to who can reflect difficult things in your life back to you is absolutely essential.
And particularly if you're in a supportive role of of someone else or if you're in a role that whether you've chosen to or not.If you're in a role where where other people are coming to you and that you are not necessarily providing them with counseling, but you are just within their orbit and needing to engage.
That's so beautiful.I'm fascinated by the sentence you said earlier.I felt so guilty about burning out, which which is almost funny.It's so sad, Yeah, yeah, isn't it?Oh, I'm on fire.I'm so sorry that I'm on fire.Yeah, I hope I don't spit an ember onto you.
Sorry.Yeah, I don't know if it's time to even dig into the psychology of that.But yeah, like the the the whole burnout talk, that could be a whole separate podcast episode.But.I've never heard anybody say that.I felt I felt guilty about burning out but I I can see that because you you're feeling like a a failure in it.
Right.Complete failure and and no idea why and no idea what you need to do about it and it it's it's extraordinary actually and I think I think normalizing conversations around that as well are really important and understand and and I can say I I don't know what would have happened to me if I didn't step out and I I I I'm so grateful for having done that and I just hope that other people I mean it felt like such a such a failing at the time but it's just not and we need to re we need to we need to pivot so that we don't see it as a failing.
And and I've been talking about well before I burnt out I've been talking to students about it for years and years and years saying you need to step out have a year off and come back you need to thrive.This is what you need to do.But when it's you or or when it's in a slightly different setting or scenario.
You know we just need to normalize it.It's not failure.It's it's essential and it can take a long time to recover.And I will say it's I said two years and I I think easily two years for me to to feel like I had some semblance of of recovery.
And that's a really long time.And I think people need to know that's it.It does.When you get to that level, when you're that, when you're that low, which there'd be plenty of people out in our profession who are, it's OK to take the time.It's just trying to figure out how to do it and to get support to do it.
Remember we and we, I think it was with Rhonda Andrews.We talked about burnout and when she described the difference between just being fatigued, I'm just tired and a bit run down and burned out.I used the example of a car running out of fuel, which is that, well, I need to just get some fuel, stop, take a pause, fill up and off I go again versus the engine's burnt down.
You're gonna have to tow it in.It's gonna be at the shop for a long time, complete rebuild before you can hit the road again.And the other thing is, when you're in it, you don't know if you're ever gonna be able to be rebuilt.That's the thing that's really scary.That's what I found really scary.
You don't know.You don't know whether that's it, whether you're done.Well, rebuilding the exact same engine and then taking it back and doing the exact same stuff with that same engine again is folly, right?It's just something's got 100% because that.Why why?Why did it happen in the first place?
Yeah.And I and I think getting support for that and understanding about that is essential.And there's so many fabulous things in in the public domain now.The Nagoski twins have that fabulous resource and book around burnout and have spoken about it just so, so well.If anyone's experiencing it, I I would highly recommend that they engage with that as a start.
They just explain it in a way that is just so tangible and so easy to grab onto and and to to fail.I think.I think, yeah, dig into it.Don't shy away from it because you can't outrun it.That's for sure.That's not possible.Last time we talked about Ted Lasso, I love Ted.
I usually ask people about their favorite podcast that they listen to, but you and me have talked about Ted Lasso in the past.Can we talk about Ted Lasso?Is there anything for anybody, anybody who hasn't watched it yet, which I don't know.If there's anybody out there, What is it and why did you love it?
And what did you take from it?Ted Righto, do you know, I haven't watched it the last time we spoke.It must have been the last.Episode at.The at the last episode.I haven't watched the last episode.And you had.Yeah yeah.And I was.I was loving it anyway.
I haven't actually.I I'm going to have to go back and start, start again from the beginning.That's a good reminder.I'm I'm going to watch it again.But Ted Lasso, so it's about a a British football team who gets a coach, a new coach from the US who has had no experience of football, of British football, but has experience of American football, of soccer.
That's right.He hasn't had any any soccer experience.So he just has this beautiful view on life and this beautiful way of engaging with the team and the individuals within the team and the management of that team.And it's just how do I, how do I, how do you explain it?
It's just life affirming.It makes you think.It makes you reflect.It makes you open your heart to all of the issues that that they're going through and it just is all about teamwork and support and digging into the tricky bits of life, I think probably how would you explain it?
It's interesting when listening to you trying to explain it.I think the reason it resonates with you is it's because it is about work hard, play hard, be kind.That's the that's what the series is about.Yeah, you're right.It's funny you said about rewatching it and when I I traveled recently and they had a couple of episodes, the first couple of episodes was on the In Flight Entertainment, I was like, well, let me watch it again.
The first series is a master class in leadership.So it's a cool story and it's funny and it's it's all these things, but it's and I actually started writing on the plane and now we're going to have to finish it.I started writing an essay about leadership lessons from series one.I said lesser.And then I think Series 2 is about personal development.
Because then he goes through a rough time.Ted kind of burns out, doesn't he?So yeah, yeah, just a leadership, teamwork and a lesson in workout, play out and be kind, nice.And.And Rebecca.Rebecca.Oh, yeah, Rebecca.
I'd like to be like Rebecca.I'm just.In fact, I'm not.Quite so mean.She's mean at times.I don't like that about her, but yes, she's fabulous.Who wouldn't?Female role models there.Absolutely.All right, Jane, let's wrap it up with the well.Is there anything else that I've missed out on?
We've had so many discussions.I forget that's what we haven't, haven't covered.Is there anything on your heart that you'd like to get out there?No, I don't think so.I don't.Think about antibiotics.Just prescribe antibiotics.Fools.Yes.Take home message.
Think about your antimicrobial stewardship.That's right.OK, so you're one lesson to all the veteran new grads of 2023.A little bit of advice for their for their life around their vet degree.Yeah, OK, I've got a head start in this because I do.
I usually am the person who's standing up the front of the dinner for our vet students when they finish their their final year.So I have had the opportunity to think about this before.Two things.Number one, fail.Make sure you fail.Make sure you can fail.Make sure you are able to deal with failure in a really positive way.
Know that you will fail.Understand that it's a part of life and if you haven't managed to fail yet, make sure you do manage to fail and figure out what it takes for you to fail well and to learn from it.That's super important.And #2 define what you want your life to be like.
Sit down and think about it, the non negotiables and the negotiables and then anything that's non negotiable, make sure you don't lose that.So whether it be friends, family, support, sport, whatever it looks like to you, whatever life looks like to you, as is important.
Make sure that that is something that you can manage in whatever job that you have.And if you have a job that you can't manage it in, then you need to reassess.That would be my 2 main things that I'll impart.I like that.That last one I I feel like.And people often ask me, because I've often said on the podcast I didn't enjoy my vet career for at least the 1st 10 years.
And I think probably that was the the thing that changed was exactly that.The 1st 10 years was just I'm in this current and being dragged along and I don't like it, but I had no idea of well what else then.So if it if not this, then what?What should it look like?
And it was only when I started thinking, well what do I want?I know what I don't want, but what do I want?And then how do you make it happen?It's such a critical lesson.Yeah, it's.And I think there would be so many people like that.I feel exactly the same way you, you know, unless you're challenged to stop and think about it, you just don't.
And then regular review, right, to say, well, well, I said I wanted.This.And I started moving towards it.And now it's another five years.And hey, hang on, I'm not doing that thing that I said I want to do.Yep.Move it again.Change it again.Yeah, get someone to hold you to account yearly.Jane, thank you so much for making the time again for around 3:00.
I can't wait to get this out here.Finally out to the world.And good luck with the antibiotic microbial stuff.I think when the previous episodes, I'll put all the links to all of them.If there's any new sites or new resources, please send those to me and I'll make sure that they in the show description, the show notes, make sure we get that message out in front of people.
But thank you for for everything that you do both with antibiotics and and the life skills.Thanks.It's been great chatting to you.

Dr Jane Heller